Dobutamine | (2024)

Dobutamine

Class:	Beta-adrenergic agonist
Actions:	Low dose (< 5 mcg/kg/min) primarily activates β₁ receptors of heart increasing contractility (*positive inotropic agent); slight to no chronotropic effect Higher doses ( 5 – 20 mcg/kg/min) stronger activation of β₁ receptors still primarily producing positive inotropic effect; β₂ activation producing moderate arterial dilation reducing afterload* (decreased SVR and PVR) enhancing cardiac output by reducing workload on ventricles.
Indications:	heart failure cardiogenic shock
*Pharmacokinetics:**	Onset: 2 – 10 minutes Peak: 10 – 20 minutes Half-Life: 2 minutes Metabolism: liver
Adverse Effects:	(dose related) headache, tremors, paresthesias, mild leg cramps, nervousness Increased blood pressure and heart rate, angina Nausea, vomiting, nonspecific chest pain, shortness of breath
Signs of Toxicity:	Fatigue Angina Tachycardia
Contraindications:	Suspected drug/poison-induced shock Hypersensitivity to other sympathomimetic amines Ventricular tachycardia Idiopathic hypertrophic subaortic stenosis Safe use during pregnancy, lactation, or children not established.
Dosages & Routes:	IV Infusion: 2 – 20 mcg/kg/min continuous infusion by pump
Nursing Implications:	*Drug Interactions:* 1) Beta blocking agents will inhibit the cardiovascular effects of dobutamine; 2) General anesthetics may increase the risk for dysrhythmias; 3) MAO inhibitors and tricyclic antidepressants may enhance the pressor effect of dobutamine. Drug Incompatibilities: sodium bicarbonate, aminophylline, bretylium, bumetanide, calcium chloride, calcium gluconate, diazepam, doxapram, digoxin, epinephrine, furosemide, heparin, insulin, magnesium sulfate, nitroprusside, phenytoin, potassium chloride, potassium phosphate, acyclovir Monitor blood pressure and cardiac rhythm continuously during therapy. Hemodynamic monitoring of all parameters is recommended during dobutamine therapy. Correct hypovolemia with fluid resuscitation prior to dobutamine therapy. Tolerance has been noted during continuous or prolonged infusions. Check IV drug calculations carefully. Double-check calculations with another nurse or pharmacist. Weigh patient daily in order to maintain accurate dose calculations.

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 50). Salem, MA: AHA.

Dirks, J.L. (2010) Cardiovascular therapeutic management. In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., pp. 546-547). St. Louis: Mosby Elsevier.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 149-161). St. Louis: Saunders Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007). Prentice Hall Nurse's Drug Guide 2007 (pp. 539-540). Upper Saddle River, NJ: Pearson Prentice Hall.

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