Pharmacologic Category

Adrenergic Agonist Agent; Inotrope

Dosing: Adult

Hemodynamic support: IV infusion:

Dosage range: 2 to 20 mcg/kg/minute; titrate to desired response (maximum: 50 mcg/kg/minute; however, doses >20 mcg/kg/minute may not have a beneficial effect on blood pressure and may increase the risk of tachyarrhythmias); infusion may be gradually increased by 5 to 10 mcg/kg/minute increments until optimal response is obtained

Cardiogenic shock (off-label dose): IV: 0.5 to 20 mcg/kg/minute (AHA [van Diepen 2017])

Inotropic support in advanced heart failure: IV infusion: 5 to 15 mcg/kg/minute; lower doses are preferred (ACCF/AHA [Yancy 2013]).

ACLS guideline recommendations (to treat hypotension especially if associated with symptomatic bradycardia in the immediate post-cardiac arrest care setting) (off-label use): Initial: 5 to 10 mcg/kg/minute; titrate to effect (AHA [Peberdy 2010])

Note: If dosages >20 to 30 mcg/kg/minute are needed, a more direct-acting vasopressor may be more beneficial (ie, epinephrine, norepinephrine).

Hemodynamic effects of dopamine are dose dependent (however, this is relative and there is overlap of clinical effects between dosing ranges):

Low-dose: 1 to 5 mcg/kg/minute, results in increased renal blood flow and urine output. Note: The use of low-dose dopamine to prevent or treat acute kidney injury is not recommended (KDIGO 2012).

Intermediate-dose: 5 to 10 mcg/kg/minute, results in increased renal blood flow, heart rate, cardiac contractility, and cardiac output

High-dose: >10 mcg/kg/minute, alpha-adrenergic effects begin to predominate, resulting in vasoconstriction, increased blood pressure, in addition to increased heart rate, cardiac contractility, and cardiac output due to beta-adrenergic effects.

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Hemodynamic support: Infants, Children, and Adolescents: Continuous IV or intraosseous infusion: 2 to 20 mcg/kg/minute, titrate gradually by 5- to 10-mcg/kg/minute increments until optimal response is obtained (PALS [Kleinman 2010])

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: >15 mcg/kg/minute, alpha-adrenergic effects begin to predominate, vasoconstriction, increased blood pressure

Calculations

• Dopamine

Use: Labeled Indications

Hemodynamic support: Adjunct in the treatment of shock (eg, MI, open heart surgery, renal failure, cardiac decompensation) that persists after adequate fluid volume replacement when indicated

Guideline recommendations:

Cardiogenic shock: To maintain systemic perfusion and preserve end-organ performance in patients with cardiogenic shock. Vasopressor therapy is indicated in patients with hemodynamic instability (eg, systolic blood pressure <90 mm Hg or evidence of end organ hypoperfusion) or the following etiologies of cardiogenic shock: Right ventricular failure, aortic regurgitation, mitral regurgitation, ventricular septal defect after MI, or bradycardia. Note: Norepinephrine is preferred over dopamine for most of these etiologies of cardiogenic shock due to lower likelihood for causing arrhythmias. However, in the case of shock due to bradycardia or aortic regurgitation, then dopamine is preferred (ACCF/AHA [Yancy 2013], AHA [van Diepen 2017]).

Inotropic support in advanced heart failure: Bridge therapy in stage D HF unresponsive to guideline-directed medical therapy and device therapy in patients awaiting heart transplant or mechanical circulatory support; short-term management of hospitalized patients with severe systolic dysfunction presenting with low blood pressure and significantly depressed cardiac output; long-term management (palliative therapy) in select patients with stage D heart failure unresponsive to guideline-directed medical therapy and device therapy who are not candidates for heart transplant or mechanical circulatory support (ACCF/AHA [Yancy 2013]).

Sepsis and septic shock: Suggested for use as an alternative vasopressor to norepinephrine only in highly selected patients (eg, patients with low risk of tachyarrhythmias and absolute or relative bradycardia) (SCCM [Rhodes 2017]).

* See Uses in AHFS Essentials for additional information.

Use: Off-Label: Adult

Heart block unresponsive to atropine or pacing; Symptomatic bradycardia

Use: Unsupported: Adult

‘Low-dose’ dopamine for renal protection:

Data from a relatively large trial and meta-analysis has shown that low-dose dopamine (≤5 mcg/kg/minute) has no effect on renal function, need for renal replacement therapy, ICU or hospital length stay or mortality in patients with or at risk for acute renal failure. (Bellomo 2000; Friedrich 2005). KDIGO Clinical Practice Guideline for Acute Kidney Injury does not recommend low-dose dopamine (1 to 3 mcg/kg/minute) to prevent or treat acute kidney failure (KDIGO 2012). In patients with severe sepsis and septic shock, the Surviving Sepsis Campaign International Guidelines for the Management of Severe Sepsis and Septic Shock recommends against the use of low-dose dopamine for renal protection (Rhodes 2017). In the heart failure population, data demonstrates that low-dose dopamine does not improve renal function or congestive symptoms when used in combination with diuretic therapy (Chen 2013; Triposkiadis 2014).There is also limited evidence to show that low-dose dopamine may be associated with certain risks, such as new-onset atrial fibrillation (Argalious 2005).

Clinical Practice Guidelines

Advanced Cardiac Life Support (ACLS)/Emergency Cardiovascular Care (ECC):

AHA, “Contemporary Management of Cardiogenic Shock,” September 2017

AHA, “2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” October 2015.

AHA, "2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,” November 2010.

Bradycardia:

ACC/AHA/HRS, “Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay,” November 2018

Coronavirus Disease 2019 (COVID-19):

“Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19),” March 2020

Heart Failure:

ACCF/AHA, “2013 ACCF/AHA Guideline for the Management of Heart Failure,” June 2013

Sepsis:

ACCM/SCCM, “Practice Parameters for Hemodynamic Support of Sepsis in Adult Patients,” September 2004

“Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016,” March 2017

Usual Infusion Concentrations: Pediatric

Note: Premixed solutions available.

IV infusion: 1600 mcg/mL or 3200 mcg/mL

Usual Infusion Concentrations: Adult

Note: Premixed solutions available.

IV infusion: 400 mg in 250 mL (concentration: 1600 mcg/mL) or 800 mg in 250 mL (concentration: 3200 mcg/mL) of D5W or NS

Administration: IV

Administer as a continuous infusion with the use of an infusion pump. Administer into large vein to prevent the possibility of extravasation (central line administration); monitor continuously for free flow; use infusion device to control rate of flow; when discontinuing the infusion, gradually decrease the dose of dopamine (sudden discontinuation may cause hypotension). Vials (concentrated solution) must be diluted prior to use.

Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.

Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate phentolamine (or alternative) antidote. Apply dry warm compresses (Hurst 2004; Reynolds 2014).

Phentolamine: Dilute 5 to 10 mg in 10 to 20 mL NS and administer into extravasation site as soon as possible after extravasation; may readminister if patient remains symptomatic (Reynolds 2014)

Alternatives to phentolamine:

Nitroglycerin topical 2% ointment (based on limited data): Apply a 1-inch strip to the site of ischemia; may repeat every 8 hours as necessary (Reynolds 2014).

Terbutaline (based on limited case reports): Infiltrate extravasation area using a solution of terbutaline 1 mg diluted in 10 mL NS (large extravasation site; administration volume varied from 3 to 10 mL) or 1 mg diluted in 1 mL NS (small/distal extravasation site; administration volume varied from 0.5 to 1 mL) (Reynolds 2014; Stier 1999)

Administration: Injectable Detail

pH: 2.5 to 5 (undiluted vials); 2.5 to 4.5 (premixed solution in D5W)

Administration: Pediatric

Parenteral: Administer as a continuous IV infusion with the use of an infusion pump or an intraosseous infusion until IV access can be obtained in pediatric patients (PALS [Kleinman 2010]). Administer into large vein to prevent the possibility of extravasation (central-line administration); administration into an umbilical arterial catheter is not recommended. Some experts recommend that low-dose dopamine infusion may be administered peripherally while trying to establish central access; once central access is available, begin central line infusion and wait for pharmacologic effect prior to stopping peripheral administration (Brierley 2009; Dellinger 2013). Monitor continuously for free flow; use infusion device to control rate of flow; when discontinuing the infusion, gradually decrease the dose of dopamine (sudden discontinuation may cause hypotension).

Rate of infusion (mL/hour) = dose (mcg/kg/minute) x weight (kg) x 60 minutes/hour divided by concentration (mcg/mL)

Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate phentolamine (or alternative) antidote (see Management of Drug Extravasations for more details). Apply dry warm compresses (Hurst 2004).

Vesicant/Extravasation Risk

Vesicant

Storage/Stability

Protect from light. Solutions that are darker than slightly yellow should not be used.

Preparation for Administration: Pediatric

Parenteral: Vials (concentrated solution) must be diluted prior to administration; maximum concentration: 3,200 mcg/mL (3.2 mg/mL); concentrations as high as 6,000 mcg/mL (6 mg/mL) have been infused into large veins, safely and with efficacy, in cases of extreme fluid restriction (Murray 2014). ISMP and Vermont Oxford Network recommend a standard concentration of 1,600 mcg/mL (1.6 mg/mL) for neonates (ISMP 2011).

Compatibility

See Trissel’s IV Compatibility Database

Open Trissel's IV Compatibility

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to treat heart failure (weak heart).

• It is used to treat low blood pressure.

• It may be given to you for other reasons. Talk with the doctor.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Nausea

• Vomiting

• Goose bumps

• Anxiety

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, fast heartbeat, increased thirst, seizures, loss of strength and energy, lack of appetite, unable to pass urine or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting.

• Shortness of breath

• Chest pain

• Slow heartbeat

• Fast heartbeat

• Abnormal heartbeat

• Severe dizziness

• Passing out

• Severe headache

• Vision changes

• Cool extremities

• Pale extremities

• Skin discoloration

• Unable to pass urine

• Change in amount of urine passed

• Severe injection site redness, burning, pain, swelling, or irritation

• Signs of an allergic reaction, like 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; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Medication Safety Issues

​Sound-alike/look-alike issues:

​High alert medication:

Contraindications

Hypersensitivity to sulfites (commercial preparation contains sodium bisulfite); pheochromocytoma; uncorrected tachyarrhythmias; ventricular fibrillation

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmias: May cause increases in heart rate, increasing the risk of tachycardia and other tachyarrhythmias including ventricular arrhythmias (Tisdale 1995). In heart transplant candidates, institute appropriate measures to protect patient against risks of sudden cardiac death (Young 2000).

• Extravasation: Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation; infuse into a large vein if possible. Avoid infusion into leg veins. Watch IV site closely. [US Boxed Warning]: If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in 10 to 15 mL of saline) with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent sloughing/necrosis.

Disease-related concerns:

• Cardiovascular disease: Use with caution in patients with cardiovascular disease, cardiac arrhythmias and/or occlusive vascular disease.

• Active myocardial ischemia/post-myocardial infarction: Use with caution in patients with active myocardial ischemia or recent myocardial infarction; may increase myocardial oxygen consumption.

• Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy to minimize the risk of arrhythmias (ACC/AHA/ESC [Zipes 2006]; Tisdale 1995).

• Shock: The use of dopamine in adult patients with shock (majority of patients had septic shock) demonstrated a higher incidence of adverse events (eg, tachyarrhythmias) (De Backer 2010). Higher 28-day mortality was also seen in patients with septic shock with the use of dopamine as compared to norepinephrine (De Backer 2012; Vasu 2012).

Concurrent drug therapy issues:

• Monoamine oxidase inhibitors (MAO-I): Use with extreme caution in patients taking MAO inhibitors; prolong hypertension may result from concurrent use.

Dosage form specific issues:

• Sodium metabisulfite: Product may contain sodium metabisulfite.

Other warnings/precautions:

• Appropriate use: Assure adequate circulatory volume to minimize need for vasoconstrictors when used in hemodynamic support. Avoid hypertension; monitor blood pressure closely and adjust infusion rate.

• Long-term therapy: According to the ACCF/AHA 2013 heart failure guidelines, long-term use of intravenous inotropic therapy without a specific indication or for reasons other than palliation is potentially harmful (ACCF/AHA [Yancy 2013]).

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Has not been specifically studied in the elderly; monitor closely, especially due to increase in cardiovascular disease with age.

Pregnancy Considerations

It is not known if dopamine crosses the placenta. Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant woman. Appropriate medications should not be withheld due to concerns of fetal teratogenicity. Dopamine use during the post-resuscitation phase may be considered; however, the effects of vasoactive medications on the fetus should also be considered. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines (Jeejeebhoy [AHA] 2015).

Breast-Feeding Considerations

It is not known if dopamine is present in breast milk. The manufacturer recommends that caution be exercised when administering dopamine to breastfeeding women.

Briggs' Drugs in Pregnancy & Lactation

• Dopamine

Adverse Reactions

Frequency not defined.

Cardiovascular: Angina pectoris, atrial fibrillation, bradycardia, ectopic beats, hypertension, hypotension, palpitations, tachycardia, vasoconstriction, ventricular arrhythmia, ventricular conduction, widened QRS complex on ECG

Central nervous system: Anxiety, headache

Dermatologic: Gangrene (high dose), piloerection

Endocrine & metabolic: Increased serum glucose (usually not above normal limits)

Gastrointestinal: Nausea, vomiting

Genitourinary: Azotemia

Ophthalmic: Increased intraocular pressure, mydriasis

Renal: Polyuria

Respiratory: Dyspnea

Miscellaneous: Tissue necrosis

* See Cautions in AHFS Essentials for additional information.

Metabolism/Transport Effects

Substrate of COMT, OCT2

Drug Interactions Open Interactions

Alpha1-Blockers: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Similarly, Alpha-/Beta-Agonists may antagonize Alpha1-Blocker vasodilation. Risk C: Monitor therapy

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Benzylpenicilloyl Polylysine: Alpha-/Beta-Agonists may diminish the diagnostic effect of Benzylpenicilloyl Polylysine. Management: Consider use of a histamine skin test as a positive control to assess a patient's ability to mount a wheal and flare response. Risk D: Consider therapy modification

Bretylium: May enhance the therapeutic effect of Alpha-/Beta-Agonists (Direct-Acting). Risk C: Monitor therapy

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Risk C: Monitor therapy

Chloroprocaine: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

CloZAPine: May diminish the therapeutic effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification

COMT Inhibitors: May increase the serum concentration of COMT Substrates. Risk C: Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Erdafitinib: May increase the serum concentration of OCT2 Substrates. Risk C: Monitor therapy

Ergot Derivatives: May enhance the hypertensive effect of Alpha-/Beta-Agonists. Ergot Derivatives may enhance the vasoconstricting effect of Alpha-/Beta-Agonists. Exceptions: Ergoloid Mesylates; Nicergoline. Risk X: Avoid combination

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Hyaluronidase: May enhance the adverse/toxic effect of DOPamine. Management: Avoid the use of hyaluronidase to enhance dispersion or absorption of dopamine. Use of hyaluronidase for other purposes in patients receiving dopamine may be considered as clinically indicated. Risk D: Consider therapy modification

Inhalational Anesthetics: May enhance the arrhythmogenic effect of DOPamine. Management: Avoid use of dopamine in patients receiving halogenated hydrocarbon anesthetics. If concomitant treatment cannot be avoided, monitor for arrhythmia. Dopamine induced ventricular arrhythmia may be reversible with propranolol based on animal data. Risk X: Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Risk D: Consider therapy modification

Lurasidone: DOPamine may enhance the hypotensive effect of Lurasidone. Risk X: Avoid combination

Monoamine Oxidase Inhibitors: May enhance the hypertensive effect of DOPamine. Management: Initiate dopamine at no greater than one-tenth (1/10) of the usual dose in patients who are taking (or have taken within the last 2 to 3 weeks) monoamine oxidase inhibitors. Monitor for an exaggerated hypertensive response to dopamine. Risk D: Consider therapy modification

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. If combined, monitor patients closely for the development of hypertension, including hypertensive crises. Risk D: Consider therapy modification

Procarbazine: May enhance the adverse/toxic effect of Sympathomimetics. Management: Consider alternatives to this combination when possible. Procarbazine prescribing information states that this combination should be avoided. Risk D: Consider therapy modification

Serotonin/Norepinephrine Reuptake Inhibitors: May enhance the tachycardic effect of Alpha-/Beta-Agonists. Serotonin/Norepinephrine Reuptake Inhibitors may enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: If possible, avoid coadministration of direct-acting alpha-/beta-agonists and serotonin/norepinephrine reuptake inhibitors. If coadministered, monitor for increased sympathomimetic effects (eg, increased blood pressure, chest pain, headache). Risk D: Consider therapy modification

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Spironolactone: May diminish the vasoconstricting effect of Alpha-/Beta-Agonists. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tafenoquine: May increase the serum concentration of OCT2 Substrates. Management: Avoid use of OCT2 substrates with tafenoquine, and if the combination cannot be avoided, monitor closely for evidence of toxicity of the OCT2 substrate and consider a reduced dose of the OCT2 substrate according to that substrate's labeling. Risk D: Consider therapy modification

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the vasopressor effect of Alpha-/Beta-Agonists. Management: Avoid, if possible, the use of alpha-/beta-agonists in patients receiving tricyclic antidepressants. If combined, monitor for evidence of increased pressor effects and consider reductions in initial dosages of the alpha-/beta-agonist. Risk D: Consider therapy modification

Monitoring Parameters

Blood pressure, ECG, heart rate, CVP, RAP, MAP; serum glucose, renal function; urine output; if pulmonary artery catheter is in place, monitor CI, PCWP, SVR, and PVR

Consult individual institutional policies and procedures.

Advanced Practitioners Physical Assessment/Monitoring

Obtain serum electrolytes prior to and during administration of drug, especially serum glucose, potassium, and magnesium; correct electrolyte disturbances as indicated. Obtain renal function tests and urine output. Obtain blood pressure, ECG, heart rate, CVP, RAP, and MAP; continuous cardiac and hemodynamic monitoring is required for inpatient therapy. Infusion pump and frequent assessment of IV site is required for inpatient therapy; consider placement of central line for therapy. If pulmonary artery catheter is in place, monitor CI, PCWP, SVR, and PVR. If patient is pregnant, consider drug effect on fetus.

Nursing Physical Assessment/Monitoring

Check ordered labs and report abnormalities. Check vital signs as ordered; report abnormalities. Infusion pump and continuous cardiac and hemodynamic monitoring are required for inpatient therapy. Monitor I & O and check blood sugars. Closely monitor infusion site for extravasation to prevent adverse effects. Educate patient on side effects; instruct to immediately report signs of fluid and electrolyte imbalances. Monitor for peripheral ischemia.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous, as hydrochloride:

Generic: 0.8 mg/mL (250 mL, 500 mL); 1.6 mg/mL (250 mL, 500 mL); 3.2 mg/mL (250 mL); 40 mg/mL (5 mL, 10 mL); 80 mg/mL (5 mL [DSC]); 160 mg/mL (5 mL [DSC])

Solution, Intravenous, as hydrochloride [preservative free]:

Generic: 40 mg/mL (5 mL, 10 mL)

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as hydrochloride:

Generic: 0.8 mg/mL (250 mL); 1.6 mg/mL (250 mL, 500 mL); 3.2 mg/mL (250 mL, 500 mL)

Anatomic Therapeutic Chemical (ATC) Classification

• C01CA04

Generic Available (US)

Yes

Pricing: US

Solution (DOPamine HCl Intravenous)

40 mg/mL (per mL): $0.70

Solution (DOPamine in D5W Intravenous)

0.8 mg/mL 5% (per mL): $0.05

1.6 mg/mL 5% (per mL): $0.06

3.2 mg/mL 5% (per mL): $0.08 - $0.09

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Stimulates both adrenergic and dopaminergic receptors, lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors

Pharmacodynamics/Kinetics

Note: Children: Dopamine has exhibited nonlinear kinetics in children; with dose changes, may not achieve steady-state for ~1 hour rather than 20 minutes

Onset of action: Adults: Within 5 minutes

Duration: Adults: <10 minutes

Metabolism: Renal, hepatic, plasma; 75% to inactive metabolites by monoamine oxidase and 25% to norepinephrine (active)

Half-life elimination: ~2 minutes

Excretion: Urine (as metabolites)

Clearance: Neonates: Varies and appears to be age related; clearance is more prolonged with combined hepatic and renal dysfunction

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

No significant effects or complications reported

Effects on Bleeding

No information available to require special precautions

Related Information

• Adult ACLS Algorithms
• Management of Drug Extravasations
• Vasoactive Agents, Intravenous

Pharmacotherapy Pearls

Dopamine is most frequently used for treatment of hypotension because of its peripheral vasoconstrictor action. In this regard, dopamine is often used together with dobutamine and minimizes hypotension secondary to dobutamine-induced vasodilation. Thus, pressure is maintained by increased cardiac output (from dobutamine) and vasoconstriction (by dopamine). It is critical neither dopamine nor dobutamine be used in patients in the absence of correcting any hypovolemia as a cause of hypotension.

Low-dose dopamine is often used in the intensive care setting for presumed beneficial effects on renal function. However, there is no clear evidence that low-dose dopamine confers any renal or other benefit. Indeed, dopamine may act on dopamine receptors in the carotid bodies causing chemoreflex suppression. In patients with heart failure, dopamine may inhibit breathing and cause pulmonary shunting. Both these mechanisms would act to decrease minute ventilation and oxygen saturation. This could potentially be deleterious in patients with respiratory compromise and patients being weaned from ventilators.

Index Terms

Dopamine HCl; Dopamine HCl/D5W; Dopamine Hydrochloride; Intropin

FDA Approval Date

February 25, 1974

References

Argalious M, Motta P, Khandwala F, et al. "Renal dose" dopamine is associated with the risk of new-onset atrial fibrillation after cardiac surgery [published corrction appears in: Crit Care Med. 2005;33(7):1678.]. Crit Care Med. 2005;33(6):1327-1332.[PubMed 15942351]

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Bellomo R, Chapman M, Finfer S, et al, “Low-dose Dopamine in Patients With Early Renal Dysfunction: A Placebo-Controlled Randomised Trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group,” Lancet, 2000, 356(9248):2139-43.[PubMed 11191541]

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Chen HH, Anstrom KJ, Givertz MM, et al. Low-dose dopamine or low-dose nesiritide in acute heart failure with renal dysfunction: the ROSE acute heart failure randomized trial. JAMA. 2013;310(23):2533-2543.[PubMed 24247300]

De Backer D, Aldecoa C, Njimi H, et al, “Dopamine versus Norepinephrine in the Treatment of Septic Shock: A Meta-Analysis,” Crit Care Med, 2012, 40(3):725-30.[PubMed 22036860]

De Backer D, Biston P, Devriendt J, et al, “Comparison of Dopamine and Norepinephrine in the Treatment of Shock,” N Engl J Med, 2010, 362(9):779-89.[PubMed 20200382]

Denkler KA and Cohen BE, “Reversal of Dopamine Extravasation Injury With Topical Nitroglycerin Ointment,” Plast Reconstr Surg, 1989, 84(5):811-3.[PubMed 2510208]

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Dopamine Hydrochloride Injection (Fliptop, Pintop, LifeShield Fliptop Vials) [prescribing information]. Lake Forest, IL: Hospira; February 2019.

Dopamine Hydrochloride in 5% Dextrose Injection [prescribing information]. Irvine, CA: B. Braun: November 2004.

Dopamine Hydrochloride in 5% Dextrose Injection [prescribing information]. Lake Forest, IL: Hospira; April 2007.

Dopamine hydrochloride in 5% dextrose injection [prescribing information]. Lake Forest, IL: Hospira; May 2014.

Elkayam U, Ng TM, Hatamizadeh P, Janmohamed M, Mehra A. Renal Vasodilatory Action of Dopamine in Patients With Heart Failure: Magnitude of Effect and Site of Action. Circulation. 2008;117(2):200-205. J Card Fail. 2010;16(12):922-930.[PubMed 18172028]

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Brand Names: International

A Si Ke Ding (CN); Admeda (HU); Bagotropin (UY); Cardiofast (PH); Cardopa (BD); Catabon (JP); Cetadop (ID); Cordodopa Forte (PT); Domin (IN); Dopacard (IN); Dopacin (TZ); Dopacris (BR); Dopamax (PH); Dopamex (TH); Dopamin (BG, CH, DE, NO); Dopamin AWD (HN); Dopamin Giulini (HU, LU); Dopamina (ES); Dopamine (FR); Dopamine Pierre Fabre (LU); Dopaminex (BD); Dopaminum (PL); Dopamix (KR); Dopar (IN, TW); Dopasin (KR); Dopasol (LK); Dopasunny (EG); Dopatropin (AR); Dopavate (TW); Dopazef (PH); Dopina (VE); Dopinga (IN); Dopmin (DK, EE, FI, MY, RU, TR, TW); Dopnax (PH); Dopress (IN); Dopuramin (KR); Drinalken (MX); Dynatra (LU); Emodopan (PE); Giludop (AT, GR, SE, TR); Glomin (ID); Inopan (VN); Inopin (TH); Inotropisa (CO); Inovan (JP); Intropin (IE, PK); Intropin IV (MY); Limdopa (VN); Medopa (MT, PT); Megadose (AR, UY); Myocard (PH); Myotil (HK, LB); Pamin (BD); Pre Dopa (JP); Proinfark (ID); Revivan (IT); Tensamin (CZ, SK); Tropin (KR, PK, SG); Udopa (KR); Uramin (TW); Zetarina (MX)

Last Updated 8/28/20