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dobutamine (Dobutrex)

Tradename: Dobutrex. Dobutamine hydrochloride. Indications: 1) refractory acute heart failure, cardiogenic shock 2) dobutamine stress echocardiography Dosage: 250 mg in 250 mL D5W (1 mg/mL) @ 2-20 ug/kg/min. - max: 40 ug/kg/min - 70 kg: 21 mL/hr = 5 ug/kg/min. Titrate to: 1) hemodynamic effect 2) excessive tachycardia 3) arrhythmia Stability: 1) remix every 24 hours 2) keep acidic, incompatible with sodium bicarbonate Pharmacokinetics: 1) onset of action is < 2 min 2) metabolized primarily by the liver 3) eliminated in the urine 4) 1/2life is approximately 3 minutes Adverse effects: 1) common (> 10%) - ectopic heartbeats - increased heart rate - elevation in blood pressure 2) less common (1-10%) - premature ventricular beats, chest pain, angina, palpitations, dyspnea, headache, nausea/vomiting, paresthesias, mild leg cramps 3) may occasionally induce atrial fibrillation 4) contains sulfite (asthmatics may be sensitive) Drug interactions: 1) beta-blockers antagonize effects of dobutamine 2) tricyclic anti-depressants (TCA) may potentiate the pressor effects of dobutamine Mechanism of action: 1) stimulates beta-1 adrenergic receptors 2) mild beta-2 adrenergic agonist & alpha adrenergic agonist effects - ref [5] claims beta-1 adrenergic agonist & beta-2 adrenergic agonist effects without mention of alpha adrenergic agonist effect 3) unlike dopamine, does not cause release of stored norepinephrine 4) does not effect dopamine receptors 5) hemodynamic effects a) inotropic stimulation b) reflex arterial vasodilation c) afterload reduction d) increased cardiac output e) blood pressure generally unchanged f) heart rate may increase in response to decreased left ventricular filling pressure g) dobutamine does not significantly increase myocardial oxygen demand in the absence of tachycardia

Interactions

drug interactions drug adverse effects (more general classes)

Related

dobutamine stress echocardiography

General

beta-1 adrenergic receptor agonist inhaled beta-2 adrenergic receptor agonist inotropic agent vasoconstrictor agent or vasopressor

Properties

AGONIST-FOR: beta-1 adrenergic receptor MISC-INFO: elimination route PLASMA 1/2life 3 MINUTES pregnancy-category D safety in lactation -

Database Correlations

PUBCHEM correlations

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 123-24
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  5. Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012