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Generic Name: dopamine
Brand Names: Intropin (discontinued)
Drug Class: Inotropic Agents
What is dopamine, and what is it used for?
Dopamine is a medication administered intravenously to correct imbalances in the blood circulation dynamics (hemodynamics) due to shock, including low blood pressure (hypotension), low cardiac output, and poor perfusion of vital organs. Hemodynamic imbalance can be caused by conditions such as heart attack (myocardial infarction), cardiac arrest, open-heart surgery, trauma, septic shock, kidney failure, and decompensated heart failure.
Dopamine is both a hormone (catecholamine) and a chemical messenger (neurotransmitter), produced in the brain and adrenal gland, and has multiple functions. Dopamine is most known for its central nervous system role as a neurotransmitter in the regulation of movement, learning, memory, cognition, and emotion. Peripherally, dopamine has many functions some of which include:
- Mediating changes in blood flow
- Dilating blood vessels in kidneys and the intestinal area
- Increasing glomerular filtration rate (GFR)
- Increasing sodium and water excretion in the kidneys
- Stimulating contraction of the cardiac muscles (myocardium)
Dopamine manufactured in the lab works like natural dopamine. In the treatment of hemodynamic imbalance, dopamine stimulates cardiac muscle contraction and increases the heart rate, which results in improved cardiac output. Its vasodilatory effects improve blood flow to vital organs such as the kidneys, enhancing their function.
Low dose of dopamine increases blood flow to the kidneys and urine output. Intermediate dose increases renal blood flow, heart rate, cardiac contractility, and cardiac output. High dose results in constriction of blood vessels and increase in blood pressure in addition to the cardiac effects.
Apart from the use in hemodynamic conditions, dopamine is also being investigated for use in prevention of intraventricular hemorrhage in premature newborns (orphan designation).
Warnings
- Do not administer dopamine under the following circumstances:
- Hypersensitivity to dopamine
- Hypersensitivity to sulfites; commercial preparations contain sodium bisulfite
- Pheochromocytoma, a kind of tumor in the adrenal gland
- Abnormal ventricular rhythm (ventricular fibrillation)
- Uncorrected irregular and rapid heart rhythms (tachyarrhythmias)
- Increases heart rate and risk for tachyarrhythmia; use with extreme caution and institute appropriate measures to protect against sudden cardiac death in heart transplant patients
- Leakage of dopamine from the vein (extravasation) can cause tissue damage and death (necrosis); administer with care; 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
- Use with caution in patients with low blood volume (hypovolemia) chest pain related to coronary heart disease (angina pectoris), cardiovascular disease, cardiac arrhythmias and/or occlusive vascular diseases such as atherosclerosis or arterial embolism
- Use with caution during and after a heart attack (myocardial infarction); may increase myocardial oxygen consumption
- Use with caution in patients treated with monoamine oxidase inhibitor (MAOI); concurrent use may cause prolonged high blood pressure (hypertension)
- Closely monitor blood pressure and urine flow throughout
- Do not add any alkalinizing substance; dopamine is inactivated in alkaline solution
- Correct low oxygen levels (hypoxia), high carbon dioxide levels (hypercapnia) and low pH levels (acidosis) prior to or concurrently with dopamine therapy
- Correct electrolyte imbalances prior to and during dopamine therapy
- Discontinue dopamine infusion gradually while increasing blood volume with intravenous fluids; sudden withdrawal may cause marked low blood pressure (hypotension)
QUESTION
In the U.S., 1 in every 4 deaths is caused by heart disease.
See Answer
What are the side effects of dopamine?
Side effects of dopamine include:
- Cardiovascular effects including:
- Chest pain (angina pectoris)
- High or low blood pressure (hypertension/hypotension)
- Constriction of blood vessels (vasoconstriction)
- Abnormality in the heart conduction system
- Abnormal ECG readings
- Palpitations
- Irregular and rapid contraction of atria (atrial fibrillation)
- Irregular ventricular rhythm (ventricular arrhythmia)
- Slow heartbeat (bradycardia)
- Rapid heartbeat (tachycardia)
- Extra or skipped beats (ectopic beats)
- Nausea
- Vomiting
- Excessive urination
- Elevation of creatinine, blood urea nitrogen (BUN) and other waste products in blood
- Increase in blood glucose levels
- Anxiety
- Headache
- Shortness of breath (dyspnea)
- Increase in intraocular pressure
- Dilation of pupils (mydriasis)
- Goosebumps (piloerection)
- Tissue death (necrosis) at infusion site due to extravasation
- Gangrene with high dose
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.
Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of dopamine?
Infusion solution, in D5W
- 80 mg/100mL
- 160 mg/100mL
- 320 mg/100mL
Injectable solution
- 40 mg/100mL
- 80 mg/100mL
- 160 mg/100mL
Adult
Hemodynamic conditions
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 contractility
- 20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction; may not have a beneficial effect on 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 the desired response
Dosing Considerations
- Strong beta1-adrenergic, alpha-adrenergic, and dopaminergic effects are based on the 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
Pediatric
Hemodynamic conditions
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 the desired response
Overdose
- In case of accidental overdose, which can increase blood pressure, reduce the rate of infusion, or temporarily discontinue dopamine administration until the patient’s condition stabilizes.
- Patients stabilize with these measures usually, because dopamine’s duration of action is quite short.
- If required, use of phentolamine, the short-acting alpha adrenergic blocking agent, should be considered.
What drugs interact with dopamine?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Severe interactions of dopamine include:
- isocarboxazid
- linezolid
- lurasidone
- phenelzine
- selegiline transdermal
- tranylcypromine
- Dopamine has serious interactions with at least 59 different drugs.
- Dopamine has moderate interactions with at least 183 different drugs.
- Mild Interactions of dopamine include:
- desmopressin
- eucalyptus
- isavuconazonium sulfate
- sage
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information.
Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- Animal studies show no evidence of fetal harm, however, there are no adequate well-controlled studies of dopamine use in pregnant women; use if potential benefits outweigh potential risks to the fetus.
- It is not known if dopamine is excreted in breast milk; use with caution in nursing mothers because many drugs are excreted in milk