Names and pronunciation
(doe-byoo′ta-meen)
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Drug reference
(doe-byoo′ta-meen)
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Func. class.: Adrenergic direct-acting β1-agonist, cardiac stimulant
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Chem. class.: Catecholamine
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Do not confuse: DOBUTamine/DOPamine
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ACTION: Causes increased contractility, increased cardiac output without marked increase in heart rate by acting on β1- receptors in heart; minor α and β2 effects
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USES: Cardiac decompensation due to organic heart disease or cardiac surgery
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Unlabeled uses: Cardiogenic shock in children; congenital heart disease in chil- dren undergoing cardiac catheterization
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CONTRAINDICATIONS: Hyper- sensitivity, idiopathic hypertrophic sub- aortic stenosis Precautions: Pregnancy, breastfeeding, children, hypertension, CAD, MI, hypovo- lemia, dysrhythmias, sulfite hypersensi- tivity, renal failure, geriatric patients
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SIDE EFFECTS CNS: Anxiety, headache, dizziness, fatigue CV: Palpitations, tachycardia, hypo/ hypertension, PVCs, angina ENDO: Hypokalemia GI: Heartburn, nausea, vomiting MS: Muscle cramps (leg) RESP: Dyspnea
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INTERACTIONS Increase: severe hypertension— guanethidine Increase: dysrhythmias—general anes- thetics Increase: pressor effect, dysrhythmias— atomoxetine, COMT inhibitors, tricyclics, MAOIs, oxytocics Decrease: DOBUTamine action—other beta-blockers
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DOSAGE AND ROUTES • Adult and child: IV INFUSION 0.5-1 mcg/kg/min; titrate to 2-20 mcg/kg/min, may increase to 40 mcg/kg/min if needed
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Available forms: Injection 12.5 mg/mL; premixed infusion 250 mg/mL, 500 mg/500 mL, 500 mg/250 mL, 1000 mg/250 mL
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Administer: Injectable • Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solu- tion and container permit • Store reconstituted solution for 24 hr if refrigerated IV route • Must be diluted prior to administration • Infuse into a large vein Dilution • Concentrate for injection must be di- luted with ≥50 mL of a compatible IV solu- tion, dilute 500 mg (40 mL) in 210 mL D5W or NS (withdraw 40 mL from a 250- mL bag) to produce a final concentration of 2000 mcg/mL; or 1000 mg (80 mL) in 170 mL D5W or NS (withdraw 80 mL from a 250-mL bag) to produce a final concen- tration of 4000 mcg/mL; max 5000 mcg/ D mL and should be adjusted according to the patient’s fluid requirements Infusion • Continuous: Use a controlled-infusion device • Premixed bags in D5W solutions can be a pink color that increases with time • Do not give DOBUTamine simultane- ously with solutions containing sodium bicarbonate or strong alkaline solutions (incompatible) • Infusion should be started at a low rate and titrated frequently to reach the optimal dosage; titrate to B/P, urine flow, frequency of ectopic activity, heart rate, and measurements of cardiac out- put, central venous pressure, and/or pulmonary capillary wedge pressure Y-site compatibilities: Alfentanil, alprostadil, amifostine, amikacin, aminocaproic acid, amiodarone, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium, atropine, aztreonam, benztropine, bleomy- cin, bumetanide, buprenorphine, butorpha- nol, calcium chloride/gluconate, CARBOpla- tin, caspofungin, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, cladribine, clarithromycin, cloNI- Dine, codeine, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTI- Nomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOCEtaxel, DOPamine, doripenem, doxacu- rium, DOXOrubicin, DOXOrubicin liposo- mal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifi- batide, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, flucon- azole, fludarabine, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, hydrOXYzine, IDArubi- cin, ifosfamide, irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, LORazepam, LR, magnesium sulfate, man nitol, mechlorethamine, meperidine, meropenem, metaraminol, methoxamine, methyldopate, methylPREDNISolone, meto- clopramide, metoprolol, metroNIDAZOLE, miconazole, milrinone, minocycline, mito- XANtrone, morphine, multiple vitamins injec- tion, mycophenolate mofetil, nafcillin, nalbu- phine, naloxone, netilmicin, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, PACLi- taxel, palonosetron, pamidronate, pan- curonium, papaverine, pentamidine, pentaz- ocine, phenylephrine, polymyxin B, potassium chloride, procainamide, pro- chlorperazine, promethazine, propofol, pro- pranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, Ringer’s, ritodrine, riTUXimab, rocuronium, sodium acetate, succinylcholine, SUFentanil, tacrolimus, temocillin, teniposide, theophylline, thia- mine, thiotepa, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trastuzumab, trimetaphan, urokinase, vancomycin, vaso- pressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zole- dronic acid
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Assess: • Hypovolemia: if present, correct first; administer any cardiac glycoside before DOBUTamine • Oxygenation/perfusion deficit: check B/P, chest pain, dizziness, loss of consciousness • Heart failure: S3 gallop, dyspnea, neck venous distention, bibasilar crackles in patients with HF, cardiomy- opathy; palpate peripheral pulses, re- port if extremities become cold or mottled or if peripheral pulses de- crease • ECG during administration continu- ously; if B/P increases, product is de- creased; CVP or PCWP, cardiac output during infusion; report changes, may in- duce ectopic rhythms • Serum electrolytes, urine output; cor- rect before use • Sulfite sensitivity, which may be life threatening • Pregnancy/breastfeeding: no well- controlled studies; use only if benefit outweighs fetal risk; cautious use in breastfeeding, excretion is unknown
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Evaluate: • Therapeutic response: increased B/P with stabilization, increased urine output
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the reason for product adminis- tration • To report shortness of breath, chest pain, numbness of extremities, headache, IV site discomfort, exercise intolerance, inability to complete ADLs TREATMENT OF OVERDOSE: Administer a β1-adrenergic blocker; reduce IV or discontinue, ensure oxygen- ation/ventilation; for severe tachydysrhyth- mias (ventricular), give lidocaine or propranolol HIGH ALERT
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PHARMACOKINETICS IV: Onset 1-2 min, peak 10 min, half-life 2 min, metabolized in liver (inactive metabolites), excreted in urine
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• Adult and child: IV INFUSION 0.5-1 mcg/kg/min; titrate to 2-20 mcg/kg/min, may increase to 40 mcg/kg/min if needed
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