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Action/Kinetics:
Dopamine is the immediate precursor of epinephrine in the body. Exogenously administered, it produces direct stimulation of beta-1 receptors and variable (dose-dependent) stimulation of alpha receptors (peripheral vasoconstriction). Will cause a release of norepinephrine from its storage sites . These actions result in increased myocardial contraction, CO, and SV, as well as increased renal blood flow and sodium excretion. Exerts little effect on DBP and induces fewer arrhythmias than are seen with isoproterenol.
Onset: 5 min.
Duration: 10 min.
t
1/2: 2 min. Does not cross the blood-brain barrier. Metabolized in liver and excreted in urine.
Uses:
Cardiogenic shock due to MI, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation (as in CHF). Clients most likely to respond include those in whom urine flow, myocardial function, and BP have not deteriorated significantly. Best responses are observed when the time is short between onset of symptoms of shock and initiation of dopamine and volume correction.
Investigational: COPD, CHF, respiratory distress syndrome in infants.
Additional Contraindications:
Pheochromocytoma, uncorrected tachycardia or arrhythmias. Pediatric clients.
Special Concerns:
Use with caution during lactation. Safety and efficacy have not been established in children. Dosage may have to be adjusted in geriatric clients with occlusive vascular disease.
Additional Side Effects:
CV: Ectopic heartbeats, tachycardia, anginal pain, palpitations, vasoconstriction, hypotension, hypertension. Infrequently: aberrant conduction, bradycardia, widened QRS complex.
Other: Dyspnea, headache, mydriasis. Infrequently, piloerection, azotemia, polyuria. High doses may cause mydriasis and ventricular arrhythmia. Extravasation may result in necrosis and sloughing of surrounding tissue.
Overdose Management:
Symptoms: Extravasation.
Treatment: To prevent sloughing and necrosis, infiltrate as soon as possible with 10-15 mL of 0.9% NaCl solution containing 5-10 mg phentolamine using a syringe with a fine needle. Infiltrate liberally throughout the ischemic area.
Additional Drug Interactions:
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Diuretics / Additive or potentiating effect
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Phenytoin / Hypotension and bradycardia
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Propranolol /
Effect of dopamine
How Supplied:
Injection: 40 mg/mL, 80 mg/mL, 160 mg/mL
Dosage
?IV Infusion
Shock.
Initial: 2-5 mcg/kg/min;
then, increase in increments of 1-4 mcg/kg/min at 10-30-min intervals until desired response is obtained.
Severely ill clients.
Initial: 5 mcg/kg/min;
then, increase rate in increments of 5-10 mcg/kg/min up to 20-50 mcg/kg/min as needed.
NOTE: Dopamine is a potent drug. Be sure to dilute the drug before administration. The drug should not be given as a bolus dose.
