Generic Name:

Dopamine

Brand Name:

Intropin

Drug Classification:

Inotropic Agents

Pregnancy Category: C

Lactation: Unknown whether drug is excreted into breast milk; use caution

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not
available or neither animal nor human studies done.

Mode of Action:

Endogenous catecholamine, acting on both dopaminergic and adrenergic neurons

Low dose stimulates mainly dopaminergic receptors, producing renal and mesenteric
vasodilation; higher dose stimulates both beta1-adrenergic and dopaminergic receptors,
producing cardiac stimulation and renal vasodilation; large dose stimulates alpha-adrenergic
receptors.

OR

Dopamine is primarily a dopamine receptor agonist; however, at higher doses, dopamine

activates α- and β-adrenergic receptors, too. Dopamine is administered as a continuous
intravenous infusion. At low doses, dopamine preferentially stimulates D1 and D2 receptors in
the renal vasculature, which leads to vasodilation and promotes renal blood flow to preserve
glomerular filtration. At intermediate doses, dopamine also stimulates β1-receptors on the
heart. At high doses, dopamine stimulates α-adrenergic receptors in the vasculature, which
exacerbates HF by increasing afterload.

Suggested Dose:

Infusion solution, in D5W Injectable solution

80mg/100mL 40mg/mL

160mg/100mL 80mg/mL

320mg/100mL 160mg/mL
Dosage Considerations – Should be Given as Follows:

Hemodynamic Conditions

Adult

Treatment of hypotension, low cardiac output, poor perfusion of vital organs; used to increase
mean arterial pressure in septic shock patients who remain hypotensive after adequate volume
expansion

1-5 mcg/kg/min intravenously (IV) (low dose): May increase urine output and renal blood flow

5-15 mcg/kg/min IV (medium dose): May increase renal blood flow, cardiac output, heart rate,
and cardiac contractitlity

20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction;
may not have a beneficial effect in blood pressure; may increase risk of tachyarrhythmias

May increase infusion by 1-4 mcg/kg/min at 10-30 min intervals until optimum response
obtained

Titrate to desired response

Pediatric

Treatment of hypotension

1-5 mcg/kg/min intravenously (IV), increased to 5-20 mcg/kg/min; not to exceed 50 mcg/kg/min

Titrate to desired response

Dosing Considerations

Strong beta1-adrenergic, alpha-adrenergic, and dopaminergic effects are based on dosing rate

Beta1 effects: 2-10 mcg/kg/min

Alpha effects: greater than 10 mcg/kg/min

Dopaminergic effects: 0.5-2 mcg/kg/min

Post-MI Therapy in Left Ventricular Dysfunction

May be initiated more than 12 hours after myocardial infarction (MI)

20 mg orally every 12 hours initially, 12 hours after MI, then increased to 40 mg orally every 12
hours within 7 days

Maintenance: Titrated to 160 mg orally every 12 hours as tolerated

 OR

Usual Adult Dose of Dopamine for Nonobstructive Oliguria:

Initial dose: 1 to 5 mcg/kg/min by continuous IV infusion.

Titrate to desired response. Administration at rates greater than 50 mcg per kg per minute have
been used safely in serious situations.

Usual Adult Dose of Dopamine for Shock:

Initial dose: 1 to 5 mcg/kg/min by continuous IV infusion.

Titrate to desired response. Administration at rates greater than 50 mcg per kg per minute have
been used safely in serious situations.

Usual Pediatric Dose for Nonobstructive Oliguria:

less than 1 month: 1 to 20 mcg/kg/min by continuous IV infusion, titrated to desired response.

1 month or older: 1 to 20 mcg/kg/min by continuous IV infusion, titrated to desired response.

Maximum of 50 mcg/kg/min.

The hemodynamic effects of dopamine are dose dependent:

Low dosage: 1 to 5 mcg/kg/minute, increased renal blood flow and urine output

Intermediate dosage: 5 to 15 mcg/kg/minute, increased renal blood flow, heart rate, cardiac
contractility, cardiac output, and blood pressure

High dosage: greater than 15 mcg/kg/minute, alpha-adrenergic effects begin to predominate,

vasoconstriction, increased blood pressure

Usual Pediatric Dose for Shock:

less than 1 month: 1 to 20 mcg/kg/min by continuous IV infusion, titrated to desired response.

1 month or older: 1 to 20 mcg/kg/min by continuous IV infusion, titrated to desired response.

Maximum of 50 mcg/kg/min.

The hemodynamic effects of dopamine are dose dependent:

Low dosage: 1 to 5 mcg/kg/minute, increased renal blood flow and urine output

Intermediate dosage: 5 to 15 mcg/kg/minute, increased renal blood flow, heart rate, cardiac
contractility, cardiac output, and blood pressure

High dosage: greater than 15 mcg/kg/minute, alpha-adrenergic effects begin to predominate,

vasoconstriction, increased blood pressure
Indications:

Dopamine HCl is indicated for the correction of hemodynamic imbalances present in the shock
syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal
failure, and chronic cardiac decompensation as in congestive failure.

Patients most likely to respond adequately to dopamine HCl are those in whom physiological
parameters, such as urine flow, myocardial function, and blood pressure, have not undergone
profound deterioration. Multi clinic trials indicate that the shorter the time interval between
onset of signs and symptoms and initiation of therapy with volume correction and dopamine
HCl, the better the prognosis. Where appropriate, blood volume restoration with a suitable
plasma expander or whole blood should be accomplished or completed prior to administration
of dopamine HCl.

Contraindications:

Hypersensitivity to dopamine, pheochromocytoma, ventricular fibrillation, uncorrected

tachyarrhythmias

Side Effects:

Irregular heartbeats

Nausea

Vomiting

Anxiety

Headache

Chills

Goosebumps

Shortness of breath

Adverse Effects:

Cardiovascular: Ventricular arrhythmia, atrial fibrillation (at very high doses), ectopic beats,
tachycardia, anginal pain, palpitation, cardiac conduction abnormalities, widened QRS complex,
bradycardia, hypotension, hypertension, vasoconstriction

Respiratory: Dyspnea

Gastrointestinal: Nausea, vomiting

Metabolic/nutritional: Azotemia

Central nervous system: Headache, anxiety

Endocrine: Piloerection

Ocular: Increased intraocular pressure; dilated pupils

 Gangrene of extremities has occurred when high doses were administered for prolonged
periods or in patients with occlusive vascular disease receiving low doses of dopamine
hydrochloride

Drug Interactions:

1. Because dopamine is metabolized by monoamine oxidase (MAO), inhibition of this enzyme

prolongs and potentiates the effect of dopamine. Patients who have been treated with MAO
inhibitors within two to three weeks prior to the administration of dopamine HCl should
receive initial doses of dopamine HCl no greater than one-tenth (1/10) of the usual dose.
2. Concurrent administration of dopamine HCl and diuretic agents may produce an additive or
potentiating effect on urine flow.
3. Tricyclic antidepressants may potentiate the pressor response to adrenergic agents.
4. Cardiac effects of dopamine are antagonized by beta-adrenergic blocking agents, such as
propranolol and metroprolol. The peripheral vasoconstriction caused by high doses of
dopamine HCl is antagonized by alpha-adrenergic blocking agents. Dopamine-induced renal
and mesenteric vasodilation is not antagonized by either alpha- or beta-adrenergic blocking
agents.
5. Haloperidol appears to have strong central antidopaminergic properties. Haloperidol and
haloperidol-like drugs suppress the dopaminergic renal and mesenteric vasodilation induced
at low rates of dopamine infusion.
6. Cyclopropane or halogenated hydrocarbon anesthetics increase cardiac autonomic
irritability and may sensitize the myocardium to the action of certain intravenously
administered catecholamines, such as dopamine. The interaction appears to be related both
to pressor activity and to the beta-adrenergic stimulating properties of these
catecholamines, and may produce ventricular arrhythmias. Therefore, EXTREME CAUTION
should be exercised when administering dopamine HCl to patients receiving cyclopropane or
halogenated hydrocarbon anesthetics. It has been reported that results of studies in animals
indicated that dopamine-induced ventricular arrhythmias during anesthesia can be reversed
by propranolol.
7. The concomitant use of vasopressors, vasoconstricting agents and some oxytocic drugs may
result in severe persistent hypertension. See Labor and Delivery below.
8. Administration of phenytoin to patients receiving dopamine HCl has been reported to lead
to hypotension and bradycardia. It is suggested that in patients receiving dopamine HCl,
alternatives to phenytoin should be used if anticonvulsant therapy is needed.

Nursing Interventions:

1. Monitor blood pressure, pulse, peripheral pulses, and urinary output at intervals prescribed
by physician. Precise measurements are essential for accurate titration of dosage.
2. Report the following indicators promptly to physician for use in decreasing or temporarily
suspending dose: Reduced urine flow rate in absence of hypotension; ascending
tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in
pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints
of tenderness, pain, numbness, or burning sensation).
 3. Monitor therapeutic effectiveness. In addition to improvement in vital signs and urine flow,
other indices of adequate dosage and perfusion of vital organs include loss of pallor,
increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion
or comatose state.
4. Monitor urine output frequently throughout administration. Report decreases in urine
output promptly.
5. Palpate peripheral pulses and assess appearance of extremities routinely during dopamine
administration. Notify physician if quality of pulse deteriorates or if extremities become cold
or mottled.
6. If hypotension occurs, administration rate should be increased. If hypotension continues,
more potent vasoconstrictors (norepinephrine) may be administered.
7. If extravasation occurs, stop infusion and infiltrate site promptly with 10 to 15 ml saline
injection containing 5 to 10 mg phentolamine. Use syringe with a fine needle, and infiltrate
area liberally with phentolamine solution. In children, 0.1 to 0.2 mg/kg up to 10 mg per dose
is recommended.
8. Dosage may need adjustment to meet individual needs of patient and to achieve desired
clinical response. If dosage needed to obtain desired systolic blood pressure exceeds
optimum renal response, reduce dosage as soon as hemodynamic condition is stabilized.
9. Give drug into a large vein to prevent the possibility of extravasation. If drug must be
administered in hand or ankle veins, change injection site to larger vein as soon as possible.
Monitor continuously for free flow. Central venous access is recommended.
10. During infusion monitor ECG, blood pressure, cardiac output, central venous pressure,
pulmonary artery wedge pressure, pulse rate, urine output, and color and temperature of
limbs.

References:

https://reference.medscape.com/drug/intropin-dopamine-342435

https://www.rxlist.com/consumer_dopamine_intropin/drugs-condition.htm

https://www.drugs.com/dopamine.html