Dobutamine Hcl (dobutamine HCl)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Dobutamine hydrochloride is a synthetic sympathomimetic agent and generally is considered a relatively selective beta1-adrenergic agonist.
Dobutamine hydrochloride is a direct-acting inotropic agent whose principal effect is mediated through stimulation of cardiac beta-adrenergic receptors, producing relatively modest chronotropic, hypertensive, arrhythmogenic, and vasodilatory effects. Unlike dopamine, it does not promote the release of endogenous norepinephrine.
In animal studies, dobutamine results in a smaller increase in heart rate and a lesser reduction in peripheral vascular resistance for an equivalent inotropic effect compared with isoproterenol. In patients with impaired cardiac function, both dobutamine and isoproterenol produce comparable increases in cardiac output. However, with dobutamine, this effect is typically achieved without significant elevation in heart rate (though tachycardia may occasionally occur) and is primarily associated with an increase in stroke volume.
In contrast, isoproterenol enhances cardiac index predominantly through increased heart rate, with minimal or reduced stroke volume.
Dobutamine has been shown to facilitate atrioventricular conduction in human electrophysiologic studies, including in patients with atrial fibrillation. It generally reduces systemic vascular resistance, although mild vasoconstriction has been infrequently reported. Pharmacologic studies indicate that altering synaptic catecholamine concentrations with agents such as reserpine or tricyclic antidepressants does not affect the activity of dobutamine in animal models, suggesting that its mechanism of action is independent of presynaptic catecholamine release.
Clinical use of dobutamine is most commonly short-term, typically limited to several hours. In a small number of patients studied for >=24 hours, some demonstrated sustained increases in cardiac output, whereas others experienced a return toward baseline levels.
Following IV administration, the onset of action of dobutamine occurs within 1-2 minutes; however, up to 10 minutes may be required to achieve the maximal effect at a given infusion rate. The plasma half-life of dobutamine is about 2 minutes. Dobutamine is primarily metabolized through catechol methylation and conjugation, with the major urinary excretion products being conjugated forms of dobutamine and its metabolite, 3-O-methyldobutamine.
The 3-O-methyl derivative is pharmacologically inactive.
Generic name: dobutamine HCl
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Dobutamine Hcl
Indications
The following indications are listed for Dobutamine Hcl:
- Acute Decompensated Heart Failure
- Cardiac Decompensation
- Cardiac Decompensation Post Cardiac Surgery
- Cardiogenic Shock
Also known as: Acute Heart Failure, Cardiac Decompensation Following Cardiac Surgery, Overt Cardiac Failure, Overt Chf, Overt Congestive Heart Failure, Overt Heart Failure, Uncontrolled Cardiac Failure.
Dosing
Dosage of dobutamine hydrochloride is expressed in terms of dobutamine.
Dobutamine hydrochloride is administered by IV infusion.
Dobutamine has been administered by intraosseous (IO) infusion+ in the setting of advanced cardiovascular life support (ACLS), generally when IV access is not readily available; onset of action and systemic concentrations are comparable to those achieved with venous administration.
Dobutamine hydrochloride is available as an injection concentrate containing 250 mg of dobutamine per 20 mL (12.5 mg/mL) that must be diluted prior to administration.
Dobutamine hydrochloride is also available as a premixed solution in 5% dextrose in plastic containers containing 250 mg of dobutamine per 250 mL (1 mg/mL), 500 mg of dobutamine per 250 mL (2 mg/mL), or 1000 mg of dobutamine per 250 mL (4 mg/mL).
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*Idiopathic hypertrophic subaortic stenosis.
*Known hypersensitivity to dobutamine hydrochloride or any ingredient in the formulation.
*Known allergy to corn or corn products (for certain solutions containing dextrose).
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
Common adverse effects of dobutamine include increased heart rate and blood pressure, ventricular ectopic activity, hypotension, and infusion site reactions. Stress cardiomyopathy has been reported with dobutamine in association with cardiac stress testing.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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Dobutamine increases cardiac output and systemic blood pressure in pediatric patients of all age groups. In premature neonates, however, dobutamine is less effective than dopamine in increasing systemic blood pressure without causing undue tachycardia and has not been shown to provide any additional benefit when administered to such infants who are already receiving optimal dopamine therapy.
Adequate and well-controlled studies in pregnant women have not been conducted with dobutamine. Reproduction studies in rats or rabbits have not revealed evidence of harm to the fetus. The effect of dobutamine on labor and delivery is not known.
Dobutamine should be used in pregnant women only if clearly needed and when expected benefits clearly outweigh the potential risks to the fetus.
It is not known whether dobutamine is distributed into human milk. Because many drugs are distributed into human milk, caution should be exercised when dobutamine is administered to a breast-feeding woman.
The manufacturer recommends that breastfeeding be discontinued for the duration of therapy.
When dobutamine is used in geriatric patients, the initial dosage usually should be at the low end of the dosage range and caution should be exercised since renal, hepatic, and cardiovascular dysfunction and concomitant disease or other drug therapy are more common in this age group than in younger patients.
In clinical studies of dobutamine, no overall differences in safety or effectiveness were observed between geriatric patients 65 years of age and older and younger patients. Other reported clinical experience has not identified differences in responses between geriatric and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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