DRUG GUIDELINE

DOPAMINE
SCOPE (Area): FOR USE IN: Critical Care Unit, ED, Theatre
EXCLUSIONS: Paediatrics (seek Paediatrician advice) and General Wards
SCOPE (Staff): Medical, Nursing and Pharmacy

BRAND NAMES
DBL Sterile Dopamine Concentrate®.

PHARMACOLOGY AND PHARMACOKINETICS

Dopamine is a naturally occurring sympathomimetic agent acting as an agonist at alpha, beta and
dopamine receptors. At low doses beta1 (inotropic and chronotropic) and beta2 (vasodilatation)
predominate resulting in increased cardiac output. Higher doses (above 10 microgram/kg/minute)
stimulate alpha receptors (with maintained beta1 effect, but a loss of beta2 effect) leading to
vasoconstriction causing a rise in blood pressure but decreased blood flow to vital organs including
the kidneys. Dopamine has a rapid onset of action (5 minutes), with a duration of action of less than
10 minutes for single doses (except in patients taking monoamine oxidase inhibitors where it may be
as long as an hour). Dopamine is metabolised by monoamine oxidase (MAO) and catechol-o-methyl
transferase (COMT) in the liver, kidneys and tissues. Elimination is fast when the infusion ceased
due to the short half-life of two minutes. Sodium metabisulfite is present in the injection as a
preservative.

INDICATIONS
 Inotropic support in acute heart failure and cardiogenic shock due to myocardial infarction, septic
shock, acute exacerbation of heart failure.
 Hypotension due to inadequate cardiac output or resistant bradycardia.

CONTRAINDICATIONS
 Phaeochromocytoma - dopamine may release catecholamines into the circulation resulting in
acute hypertension.
 Significant atrial or ventricular tachyarrhythmias.

PRECAUTIONS
 Hypovolaemia - correct before using dopamine.
 Extravasation – can cause tissue necrosis and sloughing. Peripheral extravasation is treated by
infiltration of the area surrounding the extravasation site with the alpha blocker phentolamine (5-
10 mg diluted in 10 to 15 mL of sodium chloride 0.9% – on imprest in Theatre).
 Pulmonary hypertension – may be worsened by dopamine-induced pulmonary vasoconstriction.
 Hyperthyroidism - increased risk of cardiovascular adverse effects with dopamine.

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 Peripheral vascular disease – increased risk of peripheral ischaemia and subsequent gangrene.
Ischaemia can be reversed by decreasing the rate of infusion.
 Cardiac ischaemia – increased risk of cardiovascular adverse effects with dopamine.
 Disproportionate increase in diastolic blood pressure – may be due to excessive dosing, will
usually respond to a decrease in infusion rate.
 Acidosis, hypercapnia or hypoxia – can decrease the effectiveness of dopamine and/or increase
its adverse reactions. Correct before commencing dopamine where possible.
 Allergy – dopamine vials contain sodium metabisulfite, which can cause severe allergy in
susceptible patients (asthmatics are of greatest risk).

PREGNANCY AND BREASTFEEDING

Seek specialist advice before prescribing, information may update regularly.

DRUG INTERACTIONS
 Vasoconstrictors (e.g. ergot alkaloids) – may increase peripheral vasoconstriction and risk of
peripheral ischaemia, avoid using together.
 Monoamine oxidase inhibitors (phenelzine, tranylcypromine, selegiline, rasagiline, linezolid
or moclobemide) – the metabolism of dopamine is inhibited, and the effect of dopamine may be
prolonged and intensified. Commence with 1/10th of usual dopamine starting rate and titrate
cautiously. This refers to patients who have received phenelzine, tranylcypromine or selegiline
within the previous 2-3 weeks, linezolid within the previous 7 days or moclobemide in the previous
48 hours.
 Phenytoin - IV phenytoin may cause significant hypotension in patients receiving dopamine,
avoid IV phenytoin if possible or monitor blood pressure carefully.
 Drugs which increase blood pressure or heart rate, or cause arrhythmias or vasodilatation –
may have an additive effect with dopamine, use cautiously.
 Beta blockers – may reduce the beta effect of dopamine allowing unopposed alpha effect (e.g.
peripheral vasoconstriction and hypertension).
 Alpha blockers – may reduce the alpha effect of dopamine allowing unopposed beta effect (e.g.
tachycardia and vasodilatation).
 Entacapone – can decrease the metabolism of dopamine leading to an increased effect, monitor
carefully.
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DOSAGE AND ADMINISTRATION

Requires continuous ECG monitoring.
For administration only
 in Critical Care Unit, ED and Theatre
 by MET or Code Blue

Administer via CVC only – see Precautions re extravasation. A large bore peripheral line
or midline may be used in an emergency where central access is planned, or short term to
avoid insertion of a CVC. If administering peripherally a second peripheral line is required
to ensure continuity of the infusion, and the site requires monitoring for extravasation.
Avoid administration on lines where other infusions may be bolused.

Dopamine must be diluted prior to use.

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IV infusion (via CVC):
Use dopamine 200 mg/5 mL ampoules to prepare infusion.
Withdraw 10 mL from a 100 mL sodium chloride 0.9% minibag.
Dopamine 400 mg (10 mL from TWO ampoules) added to remaining 90 mL sodium chloride 0.9%
in the minibag.
Total Volume: 100 mL.
Final concentration: 4 mg/mL (4000 microgram/mL).
Starting rate: 2.5-5 microgram/kg/min.
Rate increase: gradually by 5-10 microgram/kg/min. Use blood pressure and cardiac output to titrate
dose where appropriate.
Usual rate range: 20-50 microgram/kg/min.
Maximum rate: 60 microgram/kg/min.
Ceasing infusion: Wean slowly with clinical assessment.

Syringe Pump IV infusion (via CVC):

**For use in ED only**
Use dopamine 200 mg/5 mL ampoules to prepare infusion.
Dopamine 200 mg (5 mL from ONE ampoule) diluted to 50 mL with sodium chloride 0.9% in a luer
lock syringe.
Total Volume: 50 mL.
Final concentration: 4 mg/mL (4000 microgram/mL).
Rate: as for IV infusion above.

Rate table for dopamine 4 mg/mL (4000 mcg/mL) IV infusion usual range:

Weight 5 microgram/kg/min 10 microgram/kg/min 20 microgram/kg/min 40 microgram/kg/min 50 microgram/kg/min

mcg/min mL/hr mcg/min mL/hr mcg/min mL/hr mcg/min mL/hr mcg/min mL/hr
50 kg 250 3. 8 500 7. 5 1000 15 2000 30 2500 37.5
60 kg 300 4. 5 600 9 1200 18 2400 36 3000 45
70 kg 350 5. 3 700 10. 5 1400 21 2800 42 3500 52. 5
80 kg 400 6 800 12 1600 24 3200 48 4000 60
90 kg 450 6. 8 900 13. 5 1800 27 3600 54 4500 67. 5
100 kg 500 7. 5 1000 15 2000 30 4000 60 5000 75

General Administration Information

 Infusion preparation:
Mix infusion thoroughly after adding dopamine to avoid inadvertently giving a more concentrated
dose.
Sodium chloride 0.9% can be substituted for different compatible IV fluid as requested by the
Medical Officer.
Infusion stable for 24 hours.
 Infusion pump: Volumetric pump
 Routes of administration:
IV injection: No
IV intermittent infusion (15-60 minutes): No
IV continuous infusion: Yes
IM injection: No
Subcut injection: No
 Compatible/incompatible IV drugs/fluids:
Consult the Australian Injectable Drugs Handbook (‘Yellow book’) in your ward area. Assume
all unlisted drugs and IV fluids are incompatible – contact Pharmacy for further advice.

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MONITORING (INCLUDING BLOOD TESTS)
 Observe the colour and temperature of the skin (especially of patients with occlusive vascular
disease) for compromised peripheral circulation.
 Monitor electrolytes (especially potassium and magnesium) at baseline and at least daily.
 Dose range and clinical goals should be documented by the Medical Officer.
 A diminished therapeutic effect may occur with prolonged dopamine infusions due to down-
regulation of receptors.

NURSING PRACTICE POINTS

 Continuous ECG monitoring during infusion.
 Baseline 12 lead ECG, and then daily.
 Document and report any dysrhythmias or haemodynamic effects.
 At the start of the infusion, monitor vital signs (including oxygen saturation) every 30 minutes for
2 hours.
 When patient is unstable or infusion rate requires adjustment, monitor heart rate, rhythm and blood
pressure every 2-5 minutes, or continuously via arterial line.
 When blood pressure stable, monitor heart rate, rhythm and blood pressure every 30-60 minutes,
or continuously via arterial line.
 Monitor arterial blood gases as intrapulmonary shunting may occur.

ADVERSE EFFECTS
 Common - ectopic beats, nausea, vomiting, tachycardia, angina, palpitations, dyspnoea, headache,
hypotension or hypertension.
 Infrequent - abnormal ventricular conduction, bradycardia, piloerection, uraemia, mydriasis,
vasoconstriction, extravasation (may cause necrosis and sloughing of surrounding tissue).
 Rare - allergic reaction (sodium metabisulfite in product).

DRUG PRESENTATIONS, LOCATION AND STORAGE

Dopamine 200 mg/5 mL ampoules.
Imprest locations (at the time of guideline development): CCU, ED, Theatre and 5N.
Store below 25°C. Protect ampoules from light.

DRG0008: Dopamine Ratification Date: February 2014

Review Date: February 2019 Version 3
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