Dopamine/d5w 3.2mg/ml Inj, 250ml
Overview
What is this medicine?
How to Use This Medicine
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
If you miss a dose, contact your doctor immediately to receive guidance on what steps to take next.
Lifestyle & Tips
- This medication is given in a hospital setting under close medical supervision. No specific lifestyle modifications are required by the patient during treatment.
- Report any discomfort at the IV site immediately.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
Side Effects
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high blood pressure, including:
+ Severe headache or dizziness
+ Passing out
+ Changes in eyesight
Shortness of breath
Chest pain or pressure
Abnormal heartbeat (fast, slow, or irregular)
Cool or pale arm or leg
Changes in skin color, such as turning black or purple
Difficulty urinating or changes in urine output
If you notice any of the following symptoms at the injection site, inform your nurse immediately:
Redness
Burning
Pain
Swelling
Blisters
Skin sores
Leaking of fluid
This medication can cause tissue damage if it leaks from the vein.
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Upset stomach or vomiting
Headache
Anxiety
Goosebumps
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns, consult your doctor.
Reporting Side Effects
To report side effects, you can:
Call your doctor for medical advice
Contact the FDA at 1-800-332-1088
Visit the FDA's MedWatch website at https://www.fda.gov/medwatch
Seek Immediate Medical Attention If You Experience:
- Chest pain or discomfort
- Feeling your heart race or skip beats (palpitations)
- Shortness of breath
- Headache
- Numbness, tingling, pain, or discoloration (bluish/pale) in your fingers or toes
- Pain, swelling, or redness at the IV site
Before Using This Medicine
It is essential to inform your doctor about the following conditions to ensure safe treatment:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
If you have been diagnosed with pheochromocytoma, a type of adrenal gland tumor.
If you have a history of abnormal or rapid heartbeat.
If you have any of the following health conditions:
+ Low potassium or magnesium levels.
+ Low blood volume.
+ Acidic blood problem (acidosis).
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor. Please provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking.
Any natural products or vitamins you are using.
* All your health problems, including those not listed above.
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to ensure your safety and the effectiveness of your treatment.
Precautions & Cautions
Regular blood tests will be necessary, as directed by your doctor, to monitor your condition. Be sure to discuss any concerns or questions with your doctor.
Additionally, it is crucial to check your blood pressure as instructed by your doctor.
Be aware that stopping this medication too quickly can lead to low blood pressure, which may cause severe dizziness or fainting. If you experience any of these symptoms, contact your doctor immediately.
If you have a sulfite allergy, consult with your doctor before taking this medication, as some products may contain sulfites.
If you are pregnant, planning to become pregnant, or are breastfeeding, inform your doctor. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Excessive hypertension (very high blood pressure)
- Tachycardia (very fast heart rate)
- Arrhythmias (irregular heartbeats)
- Peripheral vasoconstriction (cold, pale extremities)
- Headache
- Nausea/vomiting
What to Do:
Dopamine has a very short half-life. Overdose symptoms are typically managed by reducing the infusion rate or temporarily discontinuing the infusion. If severe hypertension or vasoconstriction occurs, an alpha-adrenergic blocking agent (e.g., phentolamine) may be administered. Call 1-800-222-1222 (Poison Control) for further guidance if needed, though this is typically managed by the medical team.
Drug Interactions
Contraindicated Interactions
- Patients with pheochromocytoma (risk of severe hypertension)
- Patients with uncorrected tachyarrhythmias or ventricular fibrillation
Major Interactions
- Monoamine Oxidase Inhibitors (MAOIs): Potentiates the pressor effect of dopamine, leading to severe, prolonged hypertension and possible arrhythmias. Concomitant use is contraindicated or requires extreme caution with significantly reduced dopamine doses.
- Ergot Alkaloids (e.g., Ergotamine, Dihydroergotamine): Increased peripheral vasoconstriction, leading to severe ischemia and gangrene.
- Beta-blockers (non-selective): May antagonize the cardiac effects of dopamine, leading to reduced inotropic response.
- Alpha-blockers (e.g., Phenoxybenzamine, Phentolamine): May antagonize the peripheral vasoconstrictor effects of dopamine, leading to hypotension.
- Tricyclic Antidepressants (TCAs): May potentiate the cardiovascular effects of dopamine, leading to hypertension and arrhythmias.
- General Anesthetics (e.g., Halothane, Cyclopropane): May sensitize the myocardium to the effects of catecholamines, increasing the risk of arrhythmias.
Moderate Interactions
- Diuretics: May enhance the diuretic effect of dopamine, requiring careful fluid and electrolyte monitoring.
- Phenytoin: May cause hypotension and bradycardia when administered concurrently with dopamine.
- Oxytocin: May enhance the pressor effect of dopamine, leading to severe hypertension.
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Rationale: To establish baseline and guide titration for target perfusion pressure.
Timing: Prior to initiation and continuously during infusion.
Rationale: To assess cardiac rhythm and detect arrhythmias, especially tachycardia.
Timing: Prior to initiation and continuously during infusion.
Rationale: To assess renal perfusion and response to dopamine's renal vasodilatory effects.
Timing: Prior to initiation and hourly during infusion.
Rationale: To assess adequacy of tissue perfusion and detect signs of vasoconstriction.
Timing: Prior to initiation and frequently during infusion.
Rationale: To assess volume status and cardiac preload, guiding fluid management.
Timing: Prior to initiation and periodically during infusion (if invasive monitoring is in place).
Rationale: To assess tissue hypoperfusion and response to therapy.
Timing: Prior to initiation and periodically as indicated.
Routine Monitoring
Frequency: Continuous
Target: MAP >65 mmHg (or as clinically indicated)
Action Threshold: MAP below target: Increase infusion rate; MAP significantly above target or signs of excessive vasoconstriction: Decrease infusion rate.
Frequency: Continuous
Target: Maintain within physiological limits, avoid significant tachycardia or arrhythmias.
Action Threshold: HR >120 bpm or new onset arrhythmias: Consider decreasing rate or alternative agent.
Frequency: Hourly
Target: >0.5 mL/kg/hr
Action Threshold: <0.5 mL/kg/hr: Assess fluid status, consider increasing dopamine (if renal dose desired) or other interventions.
Frequency: Every 1-4 hours or as needed
Target: Warm, dry skin, brisk capillary refill
Action Threshold: Cool, mottled extremities, delayed capillary refill: Assess for extravasation or excessive vasoconstriction.
Frequency: Every 4-8 hours or as needed
Target: CI >2.2 L/min/m2
Action Threshold: CI below target: Increase dopamine or consider other inotropes.
Frequency: Daily or as needed
Target: Within normal limits
Action Threshold: Abnormalities: Correct to minimize arrhythmia risk.
Symptom Monitoring
- Chest pain (angina)
- Palpitations
- Shortness of breath
- Headache
- Nausea/vomiting
- Extremity pain or discoloration (signs of ischemia/extravasation)
Special Patient Groups
Pregnancy
Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Use only if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
Lactation
L3 (Moderately Safe). It is not known whether dopamine is excreted in human milk. Due to its short half-life and poor oral bioavailability, systemic exposure to the infant is likely to be minimal. However, caution should be exercised when dopamine is administered to a nursing mother. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for dopamine and any potential adverse effects on the breastfed infant from dopamine or from the underlying maternal condition.
Pediatric Use
Dopamine is used in pediatric patients for similar indications as adults, with dosing adjusted by weight (mcg/kg/min). Close monitoring of hemodynamic parameters, urine output, and peripheral perfusion is crucial. Neonates and infants may be more sensitive to its effects.
Geriatric Use
No specific dose adjustment is generally required for elderly patients, but they may be more sensitive to the effects of dopamine, particularly the pressor and arrhythmogenic effects. Start with lower doses and titrate carefully, monitoring closely for adverse effects and hemodynamic response. Age-related decline in renal or hepatic function may indirectly affect drug clearance, though dopamine's rapid metabolism limits this impact.
Clinical Information
Clinical Pearls
- Dopamine's effects are highly dose-dependent: low doses for renal vasodilation, moderate for inotropy, high for vasoconstriction. Titrate carefully based on desired effect.
- Always administer via a central venous catheter if possible due to the risk of extravasation and tissue necrosis. If extravasation occurs, infiltrate the area with phentolamine.
- Correct hypovolemia before initiating dopamine, as it is not a substitute for fluid replacement.
- Monitor for arrhythmias, especially tachycardia, which is a common side effect.
- Dopamine is often considered a second-line vasopressor after norepinephrine in septic shock due to potential for increased arrhythmias and mortality in some studies, but remains a viable option in specific scenarios (e.g., bradycardia, low cardiac output with renal dysfunction).
Alternative Therapies
- Norepinephrine (Levophed) - primary vasopressor for septic shock
- Epinephrine (Adrenalin) - vasopressor, inotrope, chronotrope
- Phenylephrine (Neo-Synephrine) - pure alpha-1 agonist, vasopressor
- Vasopressin (Pitressin) - vasopressor (V1 receptor agonist)
- Dobutamine (Dobutrex) - primarily inotrope (beta-1 agonist)
- Milrinone (Primacor) - inotrope/vasodilator (phosphodiesterase inhibitor)