dobutamine
inotrope· Brands: Dobutrex, InotrexIV
Mechanism of action
Dobutamine is a synthetic catecholamine that primarily stimulates beta-1 adrenergic receptors in the heart, leading to increased intracellular cyclic AMP and enhanced calcium influx, which increases myocardial contractility (positive inotropic effect). It also has some beta-2 and alpha-1 agonist activity, producing a net increase in cardiac output and stroke volume with only modest increases in heart rate. Its effects on peripheral vascular resistance are variable, typically causing mild vasodilation due to beta-2 stimulation.
Pharmacokinetics
Dobutamine is administered intravenously, with an onset of action within 1 to 2 minutes and peak effect at about 10 minutes. It has a short half-life of approximately 2 minutes. It is rapidly metabolised in the liver and peripheral tissues by catechol-O-methyltransferase to inactive metabolites, which are excreted in the urine. Continuous infusion is required to maintain therapeutic plasma levels.
Indications & dosing
Short-term inotropic support in acute heart failure or cardiogenic shock
Titrate to haemodynamic response, using the lowest dose that achieves the desired effect.
- adult · IV: 2.5–20 mcg/kg/min continuous infusion · Titrate to haemodynamic response, using the lowest dose that achieves the desired effect.
Pharmacological stress agent for myocardial perfusion imaging or stress echocardiography
Administered by graded incremental infusion, typically in 3-minute stages, until the target heart rate is achieved.
- adult · IV: 10–40 mcg/kg/min continuous infusion · Administered by graded incremental infusion, typically in 3-minute stages, until the target heart rate is achieved.
Contraindications & precautions
- Hypersensitivity to dobutamine or sulfite preservatives · Anaphylaxis and hypersensitivity reactions reported.
- Idiopathic hypertrophic subaortic stenosis (IHSS) or hypertrophic obstructive cardiomyopathy · Inotropic stimulation may worsen outflow tract obstruction.
- Severe aortic stenosis · Dobutamine may increase myocardial oxygen demand and worsen ischemia; use only if clearly indicated, e.g., for pharmacological stress testing with appropriate precautions.
- Correct hypovolaemia before administration to avoid worsening hypotension.
- Monitor ECG and blood pressure continuously during infusion.
- Use with caution in patients with atrial fibrillation; dobutamine may increase ventricular rate.
- Use with caution in patients with acute myocardial infarction or coronary artery disease; may increase myocardial oxygen demand and worsen ischaemia.
- Ensure proper dilution and use of an infusion pump; extravasation may cause tissue necrosis, so avoid extravasation.
Adverse effects
- Tachycardia
- Arrhythmias (including premature ventricular contractions, ventricular tachycardia)serious
- Hypertension
- Hypotensionserious
- Myocardial ischemia (chest pain)serious
- Nausea
- Headache
Monitoring, pregnancy & toxicity
- Heart rate and rhythm · Continuously during infusion
- Blood pressure · Continuously during infusion
- ECG · Continuously during infusion
- Cardiac output · Periodically, if haemodynamic monitoring is used
- Serum potassium · Regularly, especially with prolonged infusion
- Infusion site · Frequently for evidence of extravasation
- Pregnancy: Use only if the potential benefit justifies the potential risk to the fetus; limited data on safety in pregnancy.
- Toxicity: Tachycardia and arrhythmias · Stop or reduce the infusion rate; administer anti-arrhythmic agents as clinically indicated; ensure adequate oxygenation and electrolyte balance.
- Toxicity: Hypertension · Stop or reduce the infusion rate; consider vasodilator therapy if necessary.
- Toxicity: Hypotension · Stop or reduce the infusion rate; administer fluids; consider vasopressor if required.
- Toxicity: Headache, nausea, and tremor · Reduce the infusion rate or discontinue; these effects are usually reversible.
Clinical notes
Dobutamine is used for short-term management of acute heart failure, cardiogenic shock, and low cardiac output states, particularly after cardiac surgery. It is given by intravenous infusion, typically at doses of 2.5 to 20 micrograms per kilogram per minute, titrated to haemodynamic response. Close monitoring of heart rate, blood pressure, ECG, and urine output is essential. Common adverse effects include tachycardia, arrhythmias, and hypotension. It is contraindicated in patients with hypertrophic obstructive cardiomyopathy and should be used with caution in those with arrhythmias, ischaemic heart disease, or hypovolaemia. Dobutamine may also be used in stress echocardiography.
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British National Formulary (BNF); local hospital formulary