Drug Summary

Dopamine Hydrochloride (Intropin®)

Pharmacologic properties:

Dopamine is an endogenous catecholamine that exerts an inotropic effect on the myocardium resulting in increased cardiac output. It stimulates dopaminergic, beta-adrenergic and alpha- adrenergic receptors of the nervous system in a dose-dependent manner. Low to moderate doses (2-10 mcg/kg/min) have predominant beta-adrenergic receptor stimulating actions that result in increased cardiac output and heart rate with minimal vasoconstriction. At higher doses (>10 mcg/kg/min), dopamine has alpha receptor stimulating actions that result in peripheral vasoconstriction and increased blood pressure.

Indications:

  • Cardiogenic, neurogenic, septic, or anaphylactic shock
  • Bradycardia with hypotension refractory to Atropine
  • Hemodynamically significant (SBP < 90 mmHg) overdose
  • Hypotension (SBP < 90 mmHg) not secondary to hypovolemia

Contraindications:

  • Shock due to hypovolemia
  • Dopamine should not be administered in the presence of uncorrected tachyarrhythmias or ventricular fibrillation
  • Dopamine should not be used in patients with pheochromocytoma

Precautions:

  • Significant local tissue necrosis can occur with extravasation from peripheral IV
  • Dopamine is inactivated in alkaline solution, do not use any alkaline dilutent
  • Patients who have been treated with monoamine oxidase (MAO) inhibitors will require substantially reduced dosage

Adverse Reactions:

  • Headache
  • Ectopic beats
  • Tachycardia
  • Anginal pain
  • Palpitation
  • Hypotension
  • Nausea
  • Vomiting
  • Local
  • Necrosis with extravasation
  • Piloerection
  • Dyspnea

Dosage and administration:

  • Mix 400 mg of Dopamine in 250 ml NS to yield a concentration of 1600 mcg/ml
  • Hypotension/Shock:
    • 5 - 20 mcg/kg/min titrated to maintain SBP > 90 mm Hg
  • Bradycardia with hypotension, refractory to atropine
    • 2 - 10 mcg/kg/min titrated to maintain SBP > 90 mm Hg