Dobutamine

Dobutamine

Class:
  • Beta-adrenergic agonist
Actions:
  • Low dose (< 5 mcg/kg/min) primarily activates β1 receptors of heart increasing contractility (positive inotropic agent); slight to no chronotropic effect
  • Higher doses ( 5 – 20 mcg/kg/min) stronger activation of β1 receptors still primarily producing positive inotropic effect; β2 activation producing moderate arterial dilation reducing afterload (decreased SVR and PVR) enhancing cardiac output by reducing workload on ventricles.
Indications:
  • heart failure
  • cardiogenic shock
Pharmacokinetics:
  • Onset: 2 – 10 minutes
  • Peak: 10 – 20 minutes
  • Half-Life: 2 minutes
  • Metabolism:  liver
Adverse Effects:
  • (dose related) headache, tremors, paresthesias, mild leg cramps, nervousness
  • Increased blood pressure and heart rate, angina
  • Nausea, vomiting, nonspecific chest pain, shortness of breath
Signs of Toxicity:
  • Fatigue
  • Angina
  • Tachycardia
Contraindications:
  • Suspected drug/poison-induced shock
  • Hypersensitivity to other sympathomimetic amines
  • Ventricular tachycardia
  • Idiopathic hypertrophic subaortic stenosis
  • Safe use during pregnancy, lactation, or children not established.
Dosages & Routes:
  • IV Infusion:  2 – 20 mcg/kg/min continuous infusion by pump
Nursing Implications:
  • Drug Interactions:  1) Beta blocking agents will inhibit the cardiovascular effects of dobutamine; 2) General anesthetics may increase the risk for dysrhythmias; 3) MAO inhibitors and tricyclic antidepressants may enhance the pressor effect of dobutamine.
  • Drug Incompatibilities:  sodium bicarbonate, aminophylline, bretylium, bumetanide, calcium chloride, calcium gluconate, diazepam, doxapram, digoxin, epinephrine, furosemide, heparin, insulin, magnesium sulfate, nitroprusside, phenytoin, potassium chloride, potassium phosphate, acyclovir
  • Monitor blood pressure and cardiac rhythm continuously during therapy.
  • Hemodynamic monitoring of all parameters is recommended during dobutamine therapy.
  • Correct hypovolemia with fluid resuscitation prior to dobutamine therapy.
  • Tolerance has been noted during continuous or prolonged infusions.
  • Check IV drug calculations carefully.  Double-check calculations with another nurse or pharmacist.
  • Weigh patient daily in order to maintain accurate dose calculations.

 

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 50). Salem, MA: AHA.

Dirks, J.L. (2010) Cardiovascular therapeutic management.  In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., pp. 546-547).  St. Louis: Mosby Elsevier.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 149-161).  St. Louis: Saunders Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007).  Prentice Hall Nurse's Drug Guide 2007 (pp. 539-540).  Upper Saddle River, NJ: Pearson Prentice Hall.

 

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