Dopamine HCl

(DOE-puh-meen HIGH-droe-KLOR-ide)

Trade Name(s):

Intropin

Injection

40 mg/mL

Injection

80 mg/mL

Injection

160 mg/mL

Revimine

Indicates Canadian trade names.

Class:

Vasopressor

Action:
Stimulates beta₁ receptors in heart, causing more complete and forceful contractions (inotropy). Also acts on alpha receptors (dose dependent) and has dopaminergic effects.

Indications:
Correction of hemodynamic imbalances present in shock after MI; trauma, endotoxic septicemia, surgery and renal failure or imbalances in conditions of chronic refractory cardiac decompensation (eg, CHF).

Contraindications:
Pheochromocytoma; uncorrected tachyarrhythmias; ventricular fibrillation.

Route/Dosage:

Adults:
IV Initial dose: 2 to 5 mcg/kg/min with incremental changes of 5 to 10 mcg/kg/min at 10 to 15 min intervals until adequate response is noted. Most patients are maintained at < 20 mcg/kg/min. If dosage exceeds 50 mcg/kg/min, assess renal function frequently.

Interactions:

Furazolidone, methyldopa, rauwolfia alkaloids: Hypertension may result.

Guanethidine: Antihypertensive effects of guanethidine may be negated.

MAOIs: May greatly increase pressor response from dopamine.

Phenytoin: Severe hypotension and bradycardia may result after concomitant administration with dopamine.

Tricyclic antidepressants: May decrease pressor response from dopamine.

INCOMPATIBILITIES: Chemically incompatible with alkaline solutions (drug is inactivated).

Lab Test Interferences:
None well documented.

Adverse Reactions:

CV:: Ectopic beats; tachycardia; anginal pain; palpitation; hypotension; vasoconstriction; ventricular arrhythmias (at high doses); hypertension.
CNS:: Headache; anxiety.
EENT:: Dilated pupils (at high doses).
GI:: Nausea; vomiting.
GU:: Decreased urine output.
RESP:: Dyspnea.
OTHER:: Gangrene of extremities.

Precautions:

Pregnancy: Category C.

Lactation: Undetermined.

Children: Safety and efficacy not established.

Special risk patients: Do not give in presence of uncorrected tachyarrhythmias or ventricular fibrillation.

Extravasation: Avoid by infusing into large vein and monitoring infusion carefully.

Sulfite sensitivity: Use caution in sulfite-sensitive individuals; some commercial preparations contain sodium bisulfite.

Patient Care Considerations

Administration/Storage:

Administer by IV infusion only. Metering device is essential for controlling rate of flow.
Dopamine is potent drug. Dilute before use if not prediluted.
Dilute medication just prior to administration. Solution is stable for 24 hr after dilution.
Do not use if solution is discolored.
Store at room temperature and protect from light. Discard dissolved solution.

Assessment/Interventions:

Obtain patient history, including drug history and any known allergies.
Monitor vital signs and ECG closely throughout therapy.
Monitor I&O regularly. Notify health care provider promptly if urine output decreases.
Monitor IV rate for free flow throughout administration.
Monitor central venous pressure or pulmonary wedge pressure if possible during infusion.
Observe infusion site for extravasation. If extravasation occurs, treat by infiltrating the area with 10 to 15 mL of normal saline containing 5 to 10 mg of phentolamine.
Notify health care provider immediately if these signs occur: significant changes in vital signs, ECG changes (eg, arrhythmias, tachycardia); deterioration of peripheral pulses, and cold, mottled extremities.

OVERDOSAGE: SIGNS & SYMPTOMS
Hypertension

Patient/Family Education:

Instruct patient to inform nurse immediately if these signs occur: chest pain, dyspnea, numbness, tingling or burning of extremities, and discomfort at IV site.