Dopamine is an inotropic agent that produces less increase in the myocardial oxygen consumption compared to isoproterenol. Its use is usually not associated with tachyarrhythmia.
Clinical studies reveal that dopamine usually increases systolic and pulse pressures with either no effect or slight increase in diastolic pressure. Total peripheral resistance at low and intermediate therapeutic doses is usually unchanged. Blood flow to peripheral vascular beds may decrease while mesenteric flow increases. An increase in urinary output produced by dopamine is usually not associated with a decrease in osmolality of the urine.
For the correction of hemodynamic imbalances present in shock syndrome due to myocardial infarctions, trauma, endotoxic septicemia, open heart surgery, renal failure and chronic cardiac decompensation as in congestive failure.
Dopamine is used only by the IV route. The 5-mL amp containing 200 mg dopamine is transferred aseptically to either a 250 or 500 mL of any of the following solutions: 0.9% or 0.45% Sodium chloride, D5 Water, D5LRS, PLRS. These dilutions will yield a final concentration for administration as follows: 250-mL dilution contains dopamine 800 mcg/mL; 500-mL dilution contains dopamine 400 mcg/mL.
Dopamine has been found to be stable for a minimum of 24 hrs after dilution in the sterile IV solutions previously listed. However, as with all IV admixtures, dilution should be made just prior to administration. Do not add dopamine injection to 5% sodium bicarbonate or other alkaline IV solutions since these solutions inactivate dopamine.
Rate of Administration: After dilution, dopamine is administered IV through a suitable IV catheter or needle. An IV drip chamber or other suitable metering device is essential for controlling the rate of flow in drops/min. Each patient must be individually titrated to the desired hemodynamic and/or renal response with dopamine.
In titrating to the desired increase in systolic pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the hemodynamic condition is stabilized. Administration of rates >50 mcg/kg/min has safely been used in advanced circulatory decompensation states. If unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution.
As with all potent IV administered drugs, care should be taken to control the rate of administration so as to avoid inadvertent administration of a bolus of drug.
In case of accidental overdosage as evidenced by excessive blood pressure elevation, reduce rate of administration or temporarily discontinue dopamine until patient's condition stabilizes. Since dopamine's duration of action is quite short, no additional remedial measures are usually necessary. If these measures fail to stabilize the patient's condition, use of the short-acting α-adrenergic-blocking agent, phentolamine should be considered.
Antidote for Peripheral Ischemia: To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible with 10-15 mL of saline solution containing 5-10 mg of phentolamine, an adrenergic-blocking agent. A syringe with a fine hypodermic needle should be used and the solution liberally infiltrated throughout the ischemic area. Sympathetic block with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hrs. Therefore, phentolamine should be given as soon as possible after the extravasation is noted.
Patients with pheochromocytoma.
Dopamine should not be administered in the presence of uncorrected tachyarrhythmias or ventricular fibrillation. Do not add dopamine to any alkaline diluent solution since the drug is inactivated in alkaline solution. Patients who have been treated with monoamine oxidase (MAO) inhibitors prior to administration of dopamine will require substantially reduced dosage. Dopamine is metabolized by MAO, and inhibition of this enzyme prolongs and potentiates the effect of dopamine. The starting dose in such patients should be reduced to at least 1/10 of the usual dose.
Myocard contains sodium metabisulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible persons.
Use in pregnancy: Animal studies reveal no evidence of teratogenic effect. Dopamine may be used in pregnant women when, in the judgment of the physician, the expected benefits outweigh the potential risk to the fetus.
Use in children: The safety and efficacy of Myocard in children has not been established. Dopamine has been used in a limited number of pediatric patients, but such use has been inadequate to fully define proper dosage and limitations in use. Further studies are ongoing.
Avoid hypovolemia. Prior to treatment with dopamine, hypovolemia should be fully corrected, if possible, with either whole blood or a suitable plasma expander.
In case of decreased pulse pressure resulting from a marked elevation of the diastolic pressure, the infusion rate of dopamine should be reduced.
Prevention of extravasation into the tissue adjacent to the infusion site can be done by infusing dopamine into a large vein. Large veins of the antecubital fossa are preferred to veins in the dorsum of the hand or ankle.
It is mandatory to monitor any changes in color or temperature of the skin in the extremities of patients with a history of occlusive vascular diseases, eg atherosclerosis, cold injury, Raynaud's disease, Buerger disease and diabetic endarteritis.
Dopamine should be used with extreme caution in patients inhaling cyclopropane or halogenated hydrocarbon anesthetics.
Store at a temperature not exceeding 30°C.
C01CA04 - dopamine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
Myocard soln for infusion 40 mg/mL
5 mL x 10 × 1's
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