Intravenous Dobutamine
Dobutamine is a cardiac stimulant (positive inotrope) which acts on beta 1
receptors in cardiac muscle, and increases contractility and cardiac output
with little effect on rate.
Pharmacokinetics
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Onset of action is 1-2 minutes after start of infusion.
Half-life of 2-3 minutes. The effects of the drug cease shortly after
discontinuing an infusion.
Steady state plasma levels achieved after 10-12 minutes of continuous
infusion.
Titrate dose upwards/downwards to desired effect - plasma level increases
dose-dependently linearly to the infusion rate.
Avoid abrupt withdrawal instead gradually reduce dose. (Unless there are
signs of toxicity where the infusion should be temporarily discontinued until
the patient’s condition stabilises.)
Plasma clearance not dependant on cardiac output.
Partial tolerance develops after administration >72 hours.
Dobutamine is metabolised by the liver, use with caution if hepatic
impairment.
Uses
Used for positive inotropic support in cardiac decompensation due to low
output cardiac failure e.g. myocardial infarction, cardiogenic shock, heart
failure.
Adverse effects and warnings
Adverse effects are dose related and less frequent with doses
<10micrograms/kg/min. Higher doses can be used but are rarely needed.
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Tachycardia, ectopic heart beats and arrhythmias may occur
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Inhibition of platelet aggregation (develops after a number of days
treatment).
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Particular care is required when administering dobutamine to patients with
acute myocardial infarction, as any significant increase in heart rate or
excessive increases in arterial pressure that occur may intensify ischaemia
and cause anginal pain and ST segment elevation.
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Symptoms of toxicity include anorexia, nausea, vomiting, tremor, anxiety,
palpitations, headache, shortness of breath and non-specific cardiac pain.
The positive inotropic and chronotropic effects may cause hypertension,
Written by Alison Warren, Consultant Pharmacist Cardiology Approved March 2018,
Updated by Sarah Connop, Lead Cardiology Pharmacist June 2020
Checked by Lorrie Glover July 2020
tachyarrhythmias, myocardial ischaemia and ventricular
Hypotension can occur due to peripheral vasodilation.
fibrillation.
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Hypovolaemia should be corrected prior to administration
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The inotropic effect of dobutamine stems from stimulation of cardiac beta 1
receptors, this effect is reversed by concomitant administration of betablockers.
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Caution and careful monitoring should occur with the following
medications, beta blockers, theophylline, clonidine, vancomycin or
linezolid or monoamine oxidase inhibitors (MAOIs). Any patients these
may experience a reduced or enhanced effect from dobutamine infusion.
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Phlebitis has been reported occasionally (care with
administration). Resite cannula at first signs of inflammation.
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Do not add dobutamine to any strong alkaline solutions E.g. sodium
bicarbonate.
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Expiry time of infusion once started is 24 hours.
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For information regarding Y site compatibility please check the most up to
date information on Medusa.
peripheral
Administration and monitoring – use the ready diluted 250mg/50ml
preparation.
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Given by continuous IV infusion via a rate controlled infusion pump. With
ECG, BP and heart rate monitoring.
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Central administration preferred due to low pH, but may also be given via
a large peripheral vein (use more dilute solution if possible, for example
250mg/250ml). Concentrations greater than 1mg/ml via central line only.
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The rate of administration and the duration of therapy should be adjusted
according to the patient's response as determined by heart rate, blood
pressure, urine flow, and if possible, measurement of cardiac output.
Dose calculation
Mg required/hour = Dose (micrograms/kg/minute) x weight (kg) x 60 (minutes)
1000
Infusion rate = mg required/hour x infusion total volume of solution prepared
number of mg in prepared solution
Written by Alison Warren, Consultant Pharmacist Cardiology Approved March 2018,
Updated by Sarah Connop, Lead Cardiology Pharmacist June 2020
Checked by Lorrie Glover July 2020
Example
Infusion rate for 250mg/50ml solution to 80kg patient at rate 5
micrograms/kg/minute
Mg/hour = 5 mcg/kg/min x 80 kg x 60 minutes
1000
Infusion rate =
24 mg/hour x 50 ml
250mg
= 24 mg/ hour
= 4.8 ml/hour
Weight (kg)
DOSING TABLE FOR DOBUTAMINE 250mg/50ml  INFUSION RATE IN
ml/hour
Infusion rate calculated from Dose (microgram/kg/min) which provides m/l hour
infusion rate
2.5 microgram 5.0 microgram 7.5 microgram 10 microgram
50
1.5ml/hr
3.0 ml/hr
4.5 ml/hr
6.0 ml/hr
55
1.65 ml/hr
3.3 ml/hr
4.95 ml/hr
6.6 ml/hr
60
1.8 ml/hr
3.6 ml/hr
5.4 ml/hr
7.2 ml/hr
65
1.95 ml/hr
3.9 ml/hr
5.85 ml/hr
7.8 ml/hr
70
2.1 ml/hr
4.2 ml/hr
6.3 ml/hr
8.4 ml/hr
75
2.25 ml/hr
4.5 ml/hr
6.75 ml/hr
9.0 ml/hr
80
2.4 ml/hr
4.8 ml/hr
7.2 ml/hr
9.6 ml/hr
85
2.55 ml/hr
5.1 ml/hr
7.65 ml/hr
10.2 ml/hr
90
2.7 ml/hr
5.4 ml/hr
8.1 ml/hr
10.8 ml/hr
95
2.85 ml/hr
5.7 ml/hr
8.55 ml/hr
11.4 ml/hr
100 3.0 ml/hr
6.0 ml/hr
9.0 ml/hr
12.0 ml/hr
References
For full prescribing details see www.medcines.org.uk :dobutamine
Medusa via pharmacy intranet page
Medicines complete, Stockely’s Drug interactions and Martindale via
https://about.medicinescomplete.com/
www.micromedexsolutions.com
Written by Alison Warren, Consultant Pharmacist Cardiology Approved March 2018,
Updated by Sarah Connop, Lead Cardiology Pharmacist June 2020
Checked by Lorrie Glover July 2020