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Dobutamine: Drug information

Dobutamine: Drug information
(For additional information see "Dobutamine: Patient drug information" and see "Dobutamine: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Pharmacologic Category
  • Adrenergic Agonist Agent;
  • Inotrope
Dosing: Adult
Acute decompensated heart failure

Acute decompensated heart failure: Note: May consider for short-term use in patients with low cardiac index and hypotension or end-organ hypoperfusion (Ref).

Continuous infusion: IV: Initial: 2 to 5 mcg/kg/minute; titrate based on clinical end point (eg, systemic perfusion or end-organ perfusion); usual dosage range: 2 to 10 mcg/kg/minute; maximum dose: 20 mcg/kg/minute (Ref).

Inotropic support

Inotropic support (off-label use): Note: In patients with shock (eg, sepsis) who fail to meet hemodynamic goals with vasopressor therapy (eg, norepinephrine), dobutamine may be added to vasopressor therapy if there is continued hypoperfusion despite volume resuscitation (Ref).

Continuous infusion: IV: Initial: 2 to 5 mcg/kg/minute; titrate based on clinical end point (eg, BP, end-organ perfusion); usual dosage range: 2 to 10 mcg/kg/minute; however, doses as low as 0.5 mcg/kg/min have been used in less severe cardiac decompensation; maximum dose: 20 mcg/kg/minute (Ref).

Stress echocardiography, routine

Stress echocardiography, routine (diagnostic agent) (off-label use): Continuous infusion: IV: Initial: 5 mcg/kg/minute; increase at 3-minute intervals to 10 mcg/kg/minute, then 20 mcg/kg/minute, then 30 mcg/kg/minute, and then 40 mcg/kg/minute. May coadminister atropine in patients who do not achieve target heart rate (Ref).

Stress echocardiography, viability assessment

Stress echocardiography, viability assessment (diagnostic agent) (off-label use): Continuous infusion: IV: Initial: 2.5 mcg/kg/minute; increase at 5-minute intervals in 2.5 mcg/kg/minute increments until contractile response is noted, up to a maximum dose of 10 mcg/kg/minute (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Obesity: Adult

The recommendations for dosing in patients with obesity are based upon the best available evidence and clinical expertise. Senior Editorial Team: Jeffrey F. Barletta, PharmD, FCCM; Manjunath P. Pai, PharmD, FCP; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC.

Class 1, 2, and 3 obesity (BMI ≥30 kg/m2):

Continuous infusion: IV: Use ideal body weight for initial weight-based dosing, then titrate to hemodynamic effect and clinical response (Ref). During therapy, clinicians should not change dosing weight from one weight metric to another (ie, actual body weight to/from ideal body weight) (Ref). Refer to "Dosing: Adult" for indication-specific doses.

Note: For dobutamine stress test dosing, use actual body weight for all BMI categories (Ref).

Rationale for recommendations:

There is a paucity of studies evaluating the influence of obesity on dobutamine dosing or pharmacokinetics. One observational study of patients undergoing dobutamine stress testing using a weight-based protocol (and use of atropine) supports the protocolized use of actual body weight for all classes of obesity in this setting; however, this may not be applicable to the general population receiving dobutamine as a continuous infusion for inotropic support (Ref). Dobutamine has a small volume of distribution with a short half-life enabling rapid titration to the desired effect. Due to the short onset of action and small volume of distribution, rapid titration to clinical effect after initial dosing is possible (Ref).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Dobutamine: Pediatric drug information")

Hemodynamic support

Hemodynamic support: Infants, Children, and Adolescents: Continuous IV or intraosseous infusion: Initial: 0.5 to 1 mcg/kg/minute; titrate gradually every few minutes until desired response achieved; usual range: 2 to 20 mcg/kg/minute (Ref).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Cardiovascular: Increased heart rate (10%), increased systolic blood pressure (8%), ventricular premature contractions (5%), angina pectoris (1% to 3%), chest pain (1% to 3%), palpitations (1% to 3%)

Central nervous system: Headache (1% to 3%)

Gastrointestinal: Nausea (1% to 3%)

Respiratory: Dyspnea (1% to 3%)

Frequency not defined:

Cardiovascular: Hypotension, ventricular ectopy

Endocrine & metabolic: Decreased serum potassium

<1%, postmarketing, and/or case reports: Cardiomyopathy (stress), eosinophilia, hypersensitivity reaction, localized phlebitis

Contraindications

Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate), or any component of the formulation; hypertrophic cardiomyopathy with outflow tract obstruction (formerly known as idiopathic hypertrophic subaortic stenosis).

Canadian labeling: Additional contraindications (not in the US labeling): Pheochromocytoma.

Note: When utilized for stress testing, additional contraindications according to the American Society of Nuclear Cardiology include patients with recent (<2 to 4 days) myocardial infarction, unstable angina, severe aortic stenosis, atrial tachyarrhythmias with uncontrolled ventricular response, prior history of ventricular tachycardia, uncontrolled hypertension (>200/110 mm Hg), and aortic dissection or large aortic aneurysm (ASNC [Henzlova 2016]).

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmias: Ventricular arrhythmias, including nonsustained ventricular tachycardia and supraventricular arrhythmias, have been reported (Tisdale 1995). Observe closely for arrhythmias in patients with decompensated heart failure; sudden cardiac death has been observed (O’Connor 1999; Pickworth 1992; Young 2000). Ensure that ventricular rate is controlled in atrial fibrillation/flutter before initiating; may increase ventricular response rate.

• BP effects: An increase in BP is more common due to augmented cardiac output, but hypotension secondarily to vasodilation may occur at higher doses.

• Heart failure complications: An increased risk of hospitalization and death has been observed with prolonged use in New York Heart Association Class III/IV heart failure patients (O’Connor 1999).

• Tachycardia: May cause dose-related increases in heart rate.

• Ventricular ectopy: May exacerbate ventricular ectopy (dose related).

Disease-related concerns:

• Aortic stenosis: Ineffective therapeutically in the presence of mechanical obstruction such as severe aortic stenosis.

• Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy to minimize the risk of arrhythmias (ACC/AHA/ESC [Zipes 2006]; Tisdale 1995).

• Hypovolemia: If needed, correct hypovolemia first to optimize hemodynamics.

• Active myocardial ischemia/myocardial infarction (post): Use with caution in patients with active myocardial ischemia or recent myocardial infarction; can increase myocardial oxygen demand.

Concurrent drug therapy issues:

• Monoamine oxidase inhibitors: Use with extreme caution in patients taking monoamine oxidase inhibitors; prolong hypertension may result from concurrent use.

Dosage form specific issues:

• Sodium sulfite: Product may contain sodium sulfite.

Special populations:

• Older adults: Use with caution in older adults; start at lower end of the dosage range.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as hydrochloride:

Generic: 1 mg/mL (250 mL); 2 mg/mL (250 mL); 4 mg/mL (250 mL); 250 mg/20 mL (20 mL)

Solution, Intravenous, as hydrochloride [preservative free]:

Generic: 12.5 mg/mL (20 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (DOBUTamine HCl Intravenous)

12.5 mg/mL (per mL): $0.39 - $0.46

Solution (DOBUTamine in D5W Intravenous)

2 mg/mL (per mL): $0.07 - $0.19

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as hydrochloride:

Generic: 12.5 mg/mL (20 mL)

Administration: Adult

IV: Always administer via infusion device; administer into large vein.

May be a vesicant; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately; leave cannula/needle in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry, warm compresses; initiate phentolamine antidote in severe cases (eg, when local tissue concentration is high) in addition to supportive management (Ref).

Phentolamine: SUBQ: Dilute 5 to 10 mg in 10 mL NS and administer into extravasation site as soon as possible after extravasation; if IV catheter remains in place, administer initial dose intravenously through the infiltrated catheter; may repeat in 60 minutes if patient remains symptomatic (Ref).

Alternatives to phentolamine:

Nitroglycerin topical 2% ointment: Apply a 1-inch strip to the site of ischemia to cover affected area; may repeat every 8 hours as necessary (Ref).

Terbutaline: SUBQ: Infiltrate extravasation area with terbutaline 1 mg using a solution of terbutaline 1 mg diluted in 10 mL NS. May repeat dose after 15 minutes (Ref).

Administration: Pediatric

Parenteral: Continuous IV infusion: Vials (concentrated solution) must be diluted prior to administration; premixed IV solutions (1,000 mcg/mL, 2,000 mcg/mL, 4,000 mcg/mL) are available. Administer as a continuous IV infusion via an infusion device. Central line administration is preferred; if central line not available, may administer for a short duration through a peripheral IV catheter placed in a large vein or via intraosseous access (Ref). Administration into an umbilical arterial catheter is not recommended (Ref). Frequent monitoring of the IV catheter site is recommended to rapidly identify extravasation (Ref). Refer to institutional policies and procedures; catheter placement/size and vasopressor concentration may vary depending on institution.

Rate of infusion (mL/hour) = dose (mcg/kg/minute) × weight (kg) × 60 minutes/hour divided by the concentration (mcg/mL)

Usual Infusion Concentrations: Adult

Note: Premixed solutions available.

IV infusion: 250 mg in 500 mL (concentration: 500 mcg/mL), 500 mg in 250 mL (concentration: 2,000 mcg/mL), or 1,000 mg in 250 mL (concentration: 4000 mcg/mL) of D5W or NS

Usual Infusion Concentrations: Pediatric

Note: Premixed solutions available.

IV infusion: 1,000 mcg/mL, 2,000 mcg/mL, or 4,000 mcg/mL

Use: Labeled Indications

Acute decompensated heart failure: Short-term management of patients with cardiac decompensation.

Use: Off-Label: Adult

Inotropic support; Stress echocardiography (diagnostic agent)

Medication Safety Issues
Sound-alike/look-alike issues:

DOBUTamine may be confused with DOPamine

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Metabolism/Transport Effects

Substrate of COMT

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Beta-Blockers: May diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy

Calcium Salts: May diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification

COMT Inhibitors: May increase the serum concentration of COMT Substrates. Risk C: Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination

Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Pregnancy Considerations

Dobutamine should not be used as a diagnostic agent for stress testing during pregnancy; use should be avoided when other options are available (ESC [Regitz-Zagrosek 2018]). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant female. Appropriate medications should not be withheld due to concerns of fetal teratogenicity. Dobutamine use during the post-resuscitation phase may be considered; however, the effects of inotropic support on the fetus should also be considered. Doses and indications should follow current Advanced Cardiovascular Life Support (ACLS) guidelines (AHA [Jeejeebhoy 2015 ]).

Breastfeeding Considerations

It is not known if dobutamine is present in breast milk.

Monitoring Parameters

BP, heart rate, ECG, hemodynamic parameters as appropriate (eg, CVP, RAP, MAP, CI, PCWP, SVR, ScvO2 or SvO2); intravascular volume status; kidney function; urine output.

Consult individual institutional policies and procedures.

Mechanism of Action

Dobutamine, a racemic mixture, stimulates myocardial beta1-adrenergic receptors primarily by the (+) enantiomer and some alpha1 receptor agonism by the (-) enantiomer, resulting in increased contractility and heart rate, and stimulates both beta2- and alpha1-receptors in the vasculature. Although beta2 and alpha1 adrenergic receptors are also activated, the effects of beta2 receptor activation may equally offset or be slightly greater than the effects of alpha1 stimulation, resulting in some vasodilation in addition to the inotropic and chronotropic actions (Leier 1988; Majerus 1989; Ruffolo 1987). Lowers central venous pressure and wedge pressure, but has little effect on pulmonary vascular resistance (Leier 1977; Leier 1978).

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: IV: 1 to 10 minutes

Peak effect: 10 to 20 minutes

Metabolism: In tissues and hepatically to inactive metabolites

Half-life elimination: 2 minutes

Excretion: Urine (as metabolites)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Dobutamine hameln | Dobutrex;
  • (AR) Argentina: Dobucard | Dobutamina | Dobutamina bioquim | Dobutamina fabra | Dobutamina gray | Dobutamina Norgreen | Dobutrex | E.m.c. dobutamina;
  • (AT) Austria: Dobutamin | Dobutamin hameln | Inotop;
  • (AU) Australia: Dobutamine | Dobutamine claris | Dobutamine HCL | Dobutamine-bc | Dobutrex;
  • (BD) Bangladesh: Dobumin | Dobutamine-abbott | Dobutin;
  • (BE) Belgium: Dobutamine Baxter | Dobutamine eg | Dobutamine mayne pharma (ben) | Dobutrex;
  • (BG) Bulgaria: Dobutamin | Dobutrex;
  • (BR) Brazil: Cloridrato de dobutamina | Dobutal | Dobutamol | Dobutanil | Dobutrex;
  • (CH) Switzerland: Dobutamin | Dobutamin fresenius | Dobutrex;
  • (CN) China: Dobutamine | Dobutrex;
  • (CO) Colombia: Autobod | Dobutamina | Dobutrex | Docarip | Dotropina | Duvig;
  • (CZ) Czech Republic: Dobuject | Dobutamin | Dobutamin admeda;
  • (DE) Germany: Dobutamin | Dobutamin carinopharm | Dobutamin hexal | Dobutamin-hameln;
  • (DO) Dominican Republic: Dobutrex | Dotropina | Inoject;
  • (EC) Ecuador: Dobutamina | Dobutamina sanderson;
  • (EE) Estonia: Dobcard | Dobuject | Dobutamine claris | Dobutamine hameln | Dobutamine HCL | Dobutamine merck | Dobutamine mylan | Dobuthaver | Dobutrex | Mekard;
  • (EG) Egypt: Dobutamine | Dobutrex | Dubuject;
  • (ES) Spain: Dobucor | Dobutamina abbott | Dobutamina inibsa | Dobutamina rovi | Dobutrex;
  • (FI) Finland: Dobuject | Dobutamin abbott | Dobutrex;
  • (FR) France: Dobutamine Aguettant | Dobutamine Baxter | Dobutamine dakota | Dobutamine merck | Dobutamine Panpharma | Dobutamine Qualimed | Dobutamine winthrop | Dobutrex;
  • (GB) United Kingdom: Dobutamine | Dobutrex | Posiject;
  • (GR) Greece: Dobutamine HCL | Dobutan;
  • (HK) Hong Kong: Dobutamine;
  • (HU) Hungary: Dobuject | Dobutamin admeda | Dobutrex;
  • (ID) Indonesia: Cardiject | Dobuca | Dobuject | Doburan | Dobutamin | Dobutamine | Dobutel | Dobutrex | Domine | Dominic | Inodex | Inotrop;
  • (IE) Ireland: Dobutamine | Posiject;
  • (IN) India: Cardiforce | Dobicard | Dobier s | Dobunex pf | Dobusol | Dobustat | Inoject;
  • (IT) Italy: Dobutamina abbott | Dobutamina bioindustria | Dobutrex | Miozac;
  • (JP) Japan: Bubucin | Doburack | Dobutamine | Dobutrex | Dobux | Dobux nichiiko | Dopmin | Doputamin | Doputamin Fuji | Doputamin h hexal | Hercarenone d | Retamex;
  • (KR) Korea, Republic of: Aukomine | Dobamine | Dobuject | Doburan | Dobutamine | Dobutamine hcl and dextrose | Dobutamine hcl injection huons | Dobutrex | Toburex;
  • (KW) Kuwait: Dobuject | Dobutrex;
  • (LB) Lebanon: Dobutamin | Dobutrex;
  • (LT) Lithuania: Dobuject | Dobutamin | Dobutamina panpharma | Dobutamine claris | Dobutamine hameln | Dobutrex;
  • (LV) Latvia: Dobuject | Dobutamin | Dobutamine claris | Dobutamine mylan | Dobutrex;
  • (MA) Morocco: Dobutrex;
  • (MX) Mexico: Adregotec | Corbusin | Cryobutol | Dobuject | Dobutamina | Dobutamina gi tecn;
  • (MY) Malaysia: Dobutamine | Mobitil;
  • (NL) Netherlands: Dobutamine | Dobutamine CF | Dobutamine claris;
  • (NO) Norway: Dobutamin | Dobutrex;
  • (NZ) New Zealand: Dobutamine | Dobutamine claris | Dobutamine hameln;
  • (PE) Peru: Dobutamina | Dobutrex;
  • (PH) Philippines: Abbott dobutamine hydrochloride | Cardease | Cardiotrex | Cardob | Dobine | Dobucard | Dobucore | Dobuject | Dobulex | Dobumarc | Dobumean | Doburan | Dobutamine | Dobutamine Baxter | Dobutrex | Dobutrim | Dobuzef | Inocard | Pusogard;
  • (PK) Pakistan: Dobamin | Dobutine | Dobutrex;
  • (PL) Poland: Dobuject | Dobutrex;
  • (PR) Puerto Rico: Dobutamine HCL | Dobutrex;
  • (PT) Portugal: Dasomin | Dobucor | Dobutamina | Dobutamina Aps | Dobutamina Claris | Dobutamina Generis | Dobutamina genthon | Dobutamina Hikma | Dobutina | Inotrex;
  • (PY) Paraguay: Dobuject | Dobutamina sanderson | E.m.c.;
  • (RO) Romania: Dobutamin admeda | Dobutamina panpharma;
  • (RU) Russian Federation: Dobutamin admeda | Dobutamine | Dobutel | Dobutrex;
  • (SA) Saudi Arabia: Dobuject | Dobutamin | Dobutamine;
  • (SE) Sweden: Dobutamin hameln | Dobutrex;
  • (SG) Singapore: Dobutamine | Dobutrex;
  • (SI) Slovenia: Dobutamin hameln | Inotop;
  • (SK) Slovakia: Dobutrex;
  • (TH) Thailand: Cardiject | Dobucin | Dobutamine | Dobutamine abbott | Dobutamine hcl DBL | Dobutel | Dobutrex;
  • (TN) Tunisia: Dobutamine mylan | Dobutamine Panpharma;
  • (TR) Turkey: Dobcard | Dobutamin | Dobutasel | Dobuthaver | Mekard;
  • (TW) Taiwan: Butamine | Dobuha | Dobuject | Dobutamine | Dobutamine HCL | Dobutrex | Easydobu | Gendobu | Utamine;
  • (UA) Ukraine: Cardiject | Dobutamin admeda | Dobutamin ebewe | Dobutel;
  • (UY) Uruguay: Dobutam | Dobutamina | Dobutamina blaufarma | Dobutamina fu | Duvig;
  • (VE) Venezuela, Bolivarian Republic of: Doburan | Dobutamina | Dobutrex | Dobuxin;
  • (ZA) South Africa: Dobutamine
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