Dobutamine Hydrochloride

Approved Indications:

• Acute heart failure: Short-term treatment of cardiac decompensation due to depressed contractility from organic heart disease or cardiac surgery.
• Cardiogenic shock: To improve cardiac output and tissue perfusion.
• Cardiac stress testing: Used as a pharmacologic agent for stress echocardiography in patients unable to exercise adequately.
• Post-cardiac surgery support: To augment cardiac output when myocardial contractility is impaired.

Off-label / Clinically Accepted Uses:

• Treatment of low cardiac output states in septic shock (as an adjunct)
• Support in cardiac transplantation or ventricular assist device management

Route: Intravenous infusion only.

Adults:

• Initial dose: 2.5 to 5 mcg/kg/min
• Titration: Increase by 2.5 to 10 mcg/kg/min every 10 to 30 minutes based on clinical response
• Usual dose range: 2.5 to 20 mcg/kg/min
• Maximum dose: Up to 40 mcg/kg/min in some cases under close monitoring
• Duration: Usually short-term (hours to days) until hemodynamic stabilization

Pediatrics:

• Dosing individualized; typically 2 to 20 mcg/kg/min
• Monitor hemodynamics closely

Elderly:

• No specific dose adjustment; start at lower doses and titrate carefully due to increased sensitivity

Renal/Hepatic Impairment:

• No dose adjustment needed, but monitor clinical response

Administration Notes:

• Administer via controlled IV infusion pump
• Dilution: Dobutamine hydrochloride is diluted in compatible solutions (e.g., 5% dextrose or normal saline)
• Continuous monitoring of blood pressure, heart rate, and ECG is essential

Dobutamine is a synthetic catecholamine and a selective β1-adrenergic receptor agonist with mild β2 and α1 adrenergic receptor activity. Activation of β1 receptors on cardiac myocytes increases cyclic AMP, enhancing calcium influx and myocardial contractility (positive inotropy) and stroke volume without significantly increasing heart rate. Mild β2 agonism causes peripheral vasodilation, reducing afterload, and α1 agonism contributes modest vasoconstriction. The net effect is improved cardiac output and tissue perfusion with minimal heart rate increase.

• Absorption: Administered intravenously; onset within 1–2 minutes
• Distribution: Rapid distribution phase; volume of distribution ~2.5 L/kg
• Metabolism: Extensively metabolized by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO) enzymes in liver and other tissues
• Half-life: Approximately 2 minutes
• Elimination: Metabolites excreted primarily via urine

• Pregnancy: FDA category B
• Animal studies have shown no teratogenic effects at clinically relevant doses
• Use only if clearly needed with close monitoring
• Lactation:
• Unknown if excreted in human milk
• Use with caution; weigh benefits against potential risks

• Primary Class: Inotropic agent
• Subclass: Beta-1 adrenergic agonist (sympathomimetic)

• Known hypersensitivity to dobutamine or any component
• Idiopathic hypertrophic subaortic stenosis
• Severe hypotension where vasopressor support is needed without inotropes
• Uncorrected hypovolemia prior to treatment
• Patients with pheochromocytoma (relative contraindication)

• Use with caution in patients with arrhythmias due to increased risk of ventricular ectopy and tachyarrhythmias
• Monitor for hypotension especially in patients with hypovolemia or vasodilated states
• Excessive doses may lead to tachycardia and increased myocardial oxygen consumption causing ischemia
• Continuous cardiac monitoring is required during administration
• Use cautiously in patients with aortic stenosis or ischemic heart disease

Common:

• Tachycardia, palpitations
• Increased blood pressure or hypotension
• Headache
• Nausea

Less Common:

• Arrhythmias (ventricular and supraventricular)
• Angina or myocardial ischemia
• Dyspnea
• Injection site reactions

Rare / Serious:

• Hypertensive crisis
• Severe arrhythmias leading to hemodynamic compromise
• Hypersensitivity reactions including anaphylaxis

Onset: Side effects usually occur rapidly during infusion and are dose-dependent.

• Beta-blockers: May antagonize dobutamine effects; may require dosage adjustments
• Monoamine oxidase inhibitors (MAOIs): Potential for exaggerated hypertensive response
• Tricyclic antidepressants: Increased risk of arrhythmias and hypertension
• General anesthetics: May potentiate arrhythmogenic effects
• Digoxin: Combined use may increase risk of arrhythmias

• Recent critical care guidelines emphasize cautious titration to avoid excessive tachycardia and myocardial ischemia.
• Dobutamine remains recommended as a first-line inotropic agent in acute decompensated heart failure with low cardiac output.
• Use in cardiogenic shock is endorsed, but combination with vasopressors is often required.

• Store at 20°C to 25°C (68°F to 77°F)
• Protect from light and freezing
• Diluted solutions should be used within 24 hours if stored at room temperature or 7 days if refrigerated
• Use clear solutions only; discard if discoloration or particulate matter present