Dopamine

Dopamine is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure.

• Patients most likely to respond adequately to dodpamine are those in whom physiological parameters, such as urine flow, myocardial function, and blood pressure, have not undergone profound deterioration. Multi-clinic trials indicate that the shorter the time interval between onset of signs and symptoms and initiation of therapy with volume correction and dopamine, the better the prognosis. Where appropriate, blood volume restoration with a suitable plasma expander or whole blood should be accomplished or completed prior to administration of dopamine.
• Dopamine is available under the following different brand names: Intropin.

Adult and Pediatric Dosage Forms and Strengths

Infusion solution, in D5W

• 80 mg/100mL
• 160 mg/100mL
• 320 mg/100mL

Injectable solution

• 40 mg/100mL
• 80 mg/100mL
• 160 mg/100mL

Dosage Considerations – Should be Given as Follows:

Hemodynamic Conditions

Adult

• Treatment of hypotension, low cardiac output, poor perfusion of vital organs; used to increase mean arterial pressure in septic shock patients who remain hypotensive after adequate volume expansion
• 1-5 mcg/kg/min intravenously (IV) (low dose): May increase urine output and renal blood flow
• 5-15 mcg/kg/min IV (medium dose): May increase renal blood flow, cardiac output, heart rate, and cardiac contractility
• 20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction; may not have a beneficial effect on blood pressure; may increase risk of tachyarrhythmias
• May increase infusion by 1-4 mcg/kg/min at 10-30 min intervals until optimum response obtained
• Titrate to the desired response

Pediatric

• Treatment of hypotension
• 1-5 mcg/kg/min intravenously (IV), increased to 5-20 mcg/kg/min; not to exceed 50 mcg/kg/min
• Titrate to the desired response

Dosing Considerations

• Strong beta1-adrenergic, alpha-adrenergic, and dopaminergic effects are based on the dosing rate
• Beta1 effects: 2-10 mcg/kg/min
• Alpha effects: greater than 10 mcg/kg/min
• Dopaminergic effects: 0.5-2 mcg/kg/min

Post-MI Therapy in Left Ventricular Dysfunction

• May be initiated more than 12 hours after myocardial infarction (MI)
• 20 mg orally every 12 hours initially, 12 hours after MI, then increased to 40 mg orally every 12 hours within 7 days
• Maintenance: Titrated to 160 mg orally every 12 hours as tolerated

Administration

• Although food may decrease absorption (by 40%), the manufacturer states drug may be administered without regard to meals
• The drug may also be given in combination with hydrochlorothiazide (Diovan HCT) or amlodipine (Exforge)

Dose Modification

Renal Impairment

• CrCl 30 mL/min or greater: No dose adjustment necessary in adults
• CrCl less than 30 mL/min: Use with caution in adults; not studied in children

Hepatic Impairment

• Mild to moderate liver impairment: No adjustment necessary; use with caution in liver disease
• Severe liver impairment: Not studied

Dosing Considerations

• Generally, adjust dosage monthly (maximal reduction of blood pressure attained after 4 weeks); adjust more aggressively in high-risk patients and patients with comorbidities

Side effects associated with the use of Dopamine, include the following:

• Cardiovascular:
  • Ventricular arrhythmia
  • Atrial fibrillation (at very high doses)
  • Ectopic beats
  • Fast heart rate
  • Chest pain (angina)
  • Palpitation
  • Cardiac conduction abnormalities
  • Widened QRS complex
  • Slow heart rate
  • Low blood pressure (hypotension)
  • High blood pressure (hypertension)
  • Vasoconstriction
• Respiratory:
  • Shortness of breath
• Gastrointestinal:
  • Nausea
  • Vomiting
• Metabolic/nutritional:
  • Azotemia
• Central nervous system:
  • Headache
  • Anxiety
• Endocrine:
  • “Goosebumps” (piloerection)
• Ocular:
  • Increased intraocular pressure
  • Dilated pupils

Gangrene of extremities has occurred when high doses were administered for prolonged periods or in patients with occlusive vascular disease receiving low doses of dopamine hydrochloride

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Severe interactions of dopamine include:
  • isocarboxazid
  • linezolid
  • lurasidone
  • phenelzine
  • selegiline transdermal
  • tranylcypromine
• Dopamine has serious interactions with at least 59 different drugs.
• Dopamine has moderate interactions with at least 183 different drugs.
• Mild Interactions of dopamine include:
  • desmopressin
  • eucalyptus
  • sage

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

• May cause peripheral ischemia in patients with a history of occlusive vascular disease
• If ischemia occurs, prevent sloughing and necrosis in ischemic areas by infiltrating areas as soon as possible with 5-10 mg of phentolamine (adrenergic blocking agent) in 10-15 mL of saline solution
• This medication contains dopamine
• Do not take Intropin if you are allergic to dopamine or any ingredients contained in this drug
• Keep out of reach of children
• In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Hypersensitivity

Effects of Drug Abuse

• No information provided

Short-Term Effects

• See "What Are Side Effects Associated with Using Dopamine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Dopamine?"

Cautions

• Use caution in angina pectoris, extravasation, hypovolemia, occlusive vascular disease, ventricular arrhythmias, recent use of monoamine oxidase inhibitors, sensitivity to sulfites
• The drug is inactivated by alkali
• May cause increases in heart rate
• Use with caution after myocardial infarction
• Monitor blood pressure closely
• Use caution in patients taking MAO inhibitors; prolong hypertension may occur with concurrent use

Pregnancy and Lactation

• Use dopamine with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done.
• It is unknown whether dopamine is excreted into breast milk; use caution if breastfeeding