Dobutamine

Drug classes:
● Beta1-selective adrenergic agonist
● Sympathomimetic

Therapeutic actions:
Positive inotropic effects are mediated by beta1- adrenergic receptors in the heart; increases
the force of myocardial contraction with relatively minor effects on heart rate, arrhythmogenesis; has
minor effects on blood vessels.

Indications:
● For inotropic support in the short-term treatment of cardiac decompensation due to depressed
contractility, resulting from either organic heart disease or from cardiac surgical procedures
● Unlabeled uses: In children with congenital heart disease undergoing diagnostic cardiac catheterization,
to augment CV function

Contraindications and cautions:

● Contraindicated with IHSS; hypovolemia
(dobutamine is not a substitute for blood, plasma, fluids, electrolytes, which should be restored promptly
when loss has occurred and in any case before treatment with dobutamine); acute MI (may increase the
size of an infarct by intensifying ischemia); general anesthesia with halogenated hydrocarbons or
cyclopropane, which sensitize the myocardium to catecholamines; pregnancy.
● Use cautiously with diabetes mellitus, lactation; allergy to sulfites, more common in
asthmatic patients.

Available forms:
● Injection—12.5 mg/mL; injection in 5% dextrose injection—1 mg/mL, 2 mg/mL, 4 mg/mL

Dosages:
● Administer only by IV infusion using an infusion pump or other device to control the rate
of flow. Titrate on the basis of the patient’s hemodynamic and renal responses. Close monitoring is
necessary.
● Adults:
2–20 mcg/kg/min IV is usual rate to increase cardiac output; rarely, rates up to 40 mcg/kg/min are
needed.
● Pediatric patients:
Initially, 0.5–1 mcg/kg/min as continuous IV infusion. Maintenance dose, 2–20 mcg/kg/min;
on rare occasions up to 40 mcg/kg/min may be needed.

Adverse effects:
● CNS: Headache
● CV: Increase in HR, increase in systolic
BP, increase in ventricular ectopic beats
(PVCs), anginal pain, palpitations, shortness of breath
● GI: Nausea
Nursing Management:

Interventions:
● Arrange to digitalize patients who have atrial fibrillation with a rapid ventricular rate
before giving dobutamine—dobutamine facilitates AV conduction.
● Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, and BP closely during infusion;
adjust dose and rate accordingly.