Parenteral Manual

DOBUTamine

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
DOBUTREX®
Classification: 
Sympathomimetic
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Treatment of cardiac decompensation due to depressed contractility resulting from organic heart disease or following cardiac surgical procedures in which parenteral therapy is necessary for inotropic support
Reconstitution and Stability: 
  • Dilute before use
  • Solution may have a pink discoloration due to slight oxidation of the drug.  No significant loss in potency over 48 hrs.
  • Diluted solutions stable 48 hours at room temperature and 7 days in fridge
  • Protect from light
Compatibility: 

- Solutions Compatible: dextrose up to D10W, NS, dextrose-saline combinations, ringer's lactate

- Additives/Above Cassette Compatible: nitroprusside (in NS)

-Y-site Compatible: atracurium, dopamine, epinephrine, fentanyl, KCl,  hydromorphone, lidocaine, tobramycin, TPN (amino acids/dextrose), vercuronium

- Incompatible: acyclovir, alkaline solutions, alteplase, aminophylline, calcium salts, diazepam, digoxin, furosemide, heparin, insulin, magnesium, phenytoin, piperacillin, potassium phosphate,  sodium bicarbonate, thiopental

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion NO
IV Continuous Infusion

YES, Cardiac monitoring, continuous BP monitoring

Administer into a large vein

Standard concentrations in ER/OR/PICU: 800 mcg/mL, 1600 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric/Adult

  • 2.5-15 mcg/kg/minute continuous IV infusion (Maximum: 40 mcg/kg/minute)
  • Titrate to effect.
  • The rate of infusion is adjusted to the patient's response according to heart rate, BP, ectopic activity, urine flow, pulmonary capillary wedge pressure.
Potential hazards of parenteral administration: 
  • Increase in systolic blood pressure, ectopic heartbeats, increase in heart rate, increased premature ventricular beats, cardiac awareness, transient bigeminy, tachycardia, angina, palpitations, vasoconstriction
  • These adverse effects are dose related and the dose should be reduced or the drug temporarily discontinued if they occur
  • Nausea, vomiting, bad taste
  • Headache, anxiety, fatigue, paresthesia
  • Dyspnea, thrombocytopenia, pruritis, fever, chills, sweating
  • Extravasation: extreme caution if using peripheral route (max: 5 mcg/kg/min). If extravasation occurs, click HERE for treatment guidelines.   
  • Tissue necrosis may occur with extravasation - treatment:  remove canula from site of extravasation.  Elevate and splint limb.  If this is ineffective, subcutaneous infiltration of phentolamine may be used at the discretion of the physician (see phentolamine monograph).
Notes: 
  • Before using dobutamine, correct hypovolemia with an appropriate plasma expander                    
  • Blood pressure and continuous ECG monitoring as ordered                                                            
  • Patients with pre-existing hypertension have increased risk of developing rapid ventricular response, a digitalis preparation should be used prior to dobutamine
  • Patients with atrial fibrillation are at risk of developing rapid ventricular response
  • DO NOT use in the presence of uncorrected tachycardia, ventricular fibrillation, pheochromocytoma
  • Use with caution in patients with hyperthyroidism
  • Use with caution in patients receiving anesthetic agents, or in patients taking concomitantly other sympathomimetic amines
  • Beta blockers decrease the effectiveness of dobutamine
  • Contraindicated in patients with idiopathic hypertrophic, subaortic stenosis

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