HOW TO USE DOBUTAMIN

The pharmacology of dobutamine... The Inotropic-hemodynamic properties of dobutamine are blunted in patients taking beta-adrenergic bloacking agents, especially the nonselective adrenerg

HOW TO USE DOBUTAMIN

DR VO ANH MINH

ESC GUIDELINE 2016

PHARMACOLOGIC EFFECTS

Ruffolo RR, Jr The pharmacology of dobutamine. Am J Med Sci 1987;294:244–248.

ADMINISTRATION AND DOSING

The Inotropic-hemodynamic properties of dobutamine are blunted in patients taking beta-adrenergic bloacking agents, especially the nonselective adrenergic receptor blockers (e.g., carvedilol) 32-34 This effect can be reversed with incremental dosing of dobutamine,

50kg (Dobutamine 250mg, 50ml) ES: 1.2ml/h - 12ml/h

70Kg (Dobutamine 250mg, 50ml) ES: 1.7ml/h - 17ml/h

Patients taking beta-blocker agent

Am J Med 1980 Aug;69(2):262-6.

With time and experience, it became clear that dobutamine infusions lasting longer than 72h were associated with

pharmacodynamics tolerance

The hemodynamic response at 72 hours was 66 percent of that noted at 2 hours; the hemodynamic response at 96 hours was 57 percent of that at 2

hours This study demonstrated that significant hemodynamic tolerance to dobutamine develops after three days of continuous infusion We suggest

that the most appropriate manner of dealing with this attenuation of effect is simply to increase the dose until the desired hemodynamic effect is attained.

Dobutamine may lead to tachyarrhythmias and ventricular ectopic beats Similar to epinephrine and dopamine, the incidence of tachyarrhythmias may be worse in patients who are already experiencing atrial fibrillation or already receiving other adrenergic medications or who are receiving infusion rates greater than 20 mcg/kg per minute.

The primary β1-effects caused by dobutamine may also lead to an increase in cardiac work that will increase myocardial oxygen demand

The mild peripheral vasodilation caused by dobutamine may potentially reduce afterload such that in patients with intravascular volume depletion, this mild peripheral vasodilation may lead to profound hypotension It is not recommended

to administer dobutamine to hypotensive patients

Jessup M, et al Circulation 2009;119:197722016  

hypoperfused because of safe concern

are attained

over 12–72 hours