dopamine (Inotropin®)
Sympathomimetic
The essential amino acid tyrosine is converted to L-DOPA and then to dopamine. It is then converted to norepinephrine and then to epineprhine. It acts primarily on alpha 1, beta 1 adrenergic receptors in dose-dependant fashion. At low doses ("renal doses"), dopamine has a dopaminergic effect that causes renal, mesenteric, and cerebral vascular dilation. At moderate doses ("cardiac doses"), dopamine has beta 1 adrenergic effect, causing enhanced myocardial contractility, increased cardiac output, and a rise in blood pressure. At high doses ("vasopressor doses"), dopamine has an alpha 1 adrenergic effect, producing peripheral arterial and venous constriction. Dopamine is commonly used in the treatment of hypotension associated with cardiogenic shock.
2-4 minutes
10 - 15 min after cessation of infusion
Hemodynamically significant hypotension in the absence of hypovolemia.
VF/VT
Hypovolemia
Patients with pheochromocytoma
Dose-related tachydysrhythmias
Hypertension
Increased myocardial oxygen demand
May be deactivated by alkaline solutions (sodium bicarbonate and furosemide)
MAO inhibitors and bretylium may potentiate the effect of dopamine
Sympathomimetics and phosphodiesterase inhibitors exacerbate dysrhythmia response.
200 mg/5ml, 400 mg/5 ml prefilled syringes and ampules for IV infusion
Dopaminergic response: 1-5 mcg/kg/min
Beta Adrenergic response: 5-10 mcg/kg/min
Alpha Adrenergic response: 10 – 20 mcg/kg/min
dilute 6 mg/kg in solution to a total of 100 mg; begin infusion at 10 mcg/kg/min IV/IO, titrate to effect (max 20 mcg/kg/min)
Pregnancy Safety: Not well established
Infuse through large, stable vein to avoid the possibility of extravasation injury.
Use infusion pump to ensure precise flow rates.
Monitor for signs of compromised circulation.