Index of drugs

Acute circulatory failure caused by impaired contractility of the myocardium, with reduction of cardiac output and increase in pulmonary pressure during myocardial infarction, cardiomyopathy, after surgical procedures, in cardiogenic and septic shock.

1 vial contains 250 mg dobutamine.

Synthetic catecholamine with agonistic activity on β receptors₁ and α₁ -Adrenergic. It exhibits positive inotropic action on the myocardium, which results in increased contractility, ejection volume of the left ventricle and cardiac output. Dobutamine acts agonistically on peripheral β receptors₂ and to a lesser extent on α₂. Both the positive inotropic effect of dobutamine and its effect on peripheral vessels are less expressed than in the case of other catecholamines. It does not affect the Dopamine receptor and does not affect the release of endogenous noradrenaline. The onset of action occurs 1-2 min after the start of the infusion. During continuous intravenous infusion, constant blood levels are reached after 10-12 min. T_0,5 is 2-3 minutes.

Hypersensitivity to the components of the preparation. Phaeochromocytoma tumor. Treatment with MAO inhibitors.

In the event of excessive cardiac acceleration, increased systolic pressure or arrhythmia, the dose of dobutamine should be reduced or temporarily discontinued. Carefully use in patients with atrial flutter or atrial fibrillation due to the risk of developing or exacerbating additional ventricular contractions (these patients should be given digitalis glycosides before starting dopamine treatment). Particular caution is necessary when using dobutamine in patients with acute myocardial infarction, because any significant acceleration of the heart rhythm or excessive increase in blood pressure may exacerbate myocardial ischemia and induce angina pectoris and ST elevation. Dobutamine does not improve hemodynamic parameters in the majority of patients with mechanical obstruction impairing ventricular filling, outflow from the ventricles or both of them. In patients with significantly reduced ventricular compliance, the inotropic response may be inadequate. This applies to cardiac tamponade, aortic valve stenosis and idiopathic hypertrophic subvalvular aortic stenosis. Occasionally, slight peripheral vasoconstriction was observed, mainly in patients who were treated with a β-blocker prior to receiving dobutamine. Dobutamine should be used with caution in patients with severe hypotension during cardiogenic shock (mean arterial pressure below 70 mmHg). Before administering dobutamine, hypovolaemia should be compensated, if necessary, with whole blood or plasma. If arterial pressure remains low or continues to decrease with dobutamine, despite normal ventricular filling pressure and cardiac output, concomitant use of peripheral vasoconstrictor drugs such as dopamine or norepinephrine may be considered. Particularly cautiously, after considering the risk, use in ischemic heart disease. In patients with heart failure with acute or chronic myocardial ischemia, a significant increase in heart rate and / or increase in blood pressure should be avoided. Dopamine is the drug of choice in the treatment of cardiogenic shock, characterized by heart failure and lowering of blood pressure, and septic shock. In patients with impaired left ventricular function, increased left ventricular filling pressure and increased peripheral resistance, dobutamine should be added to the dopamine treatment. Due to its narrow therapeutic compartment, it should be used with caution in children.

Use only in case of extreme necessity. It is recommended that breastfeeding be stopped immediately if dobutamine is necessary during this period.

Very common: heart rate increased by ≥ 30 beats per minute.Common: eosinophilia, inhibition of platelet aggregation (only for continuous, multi-day infusion), headache, increased systolic blood pressure (10 to 20 mm Hg); increase in blood pressure by ≥ 50 mm Hg (this effect may be more severe in patients with hypertension), decrease in blood pressure, ventricular arrhythmias, dose-dependent additional ventricular contractions, acceleration of ventricular stimuli in patients with atrial fibrillation, vasoconstriction , especially in patients previously treated with β-blockers, angina pains, palpitations, bronchospasm, shortness of breath, nausea, chest pain, increased need for urination, fever, inflammation of the vein at the injection site, local inflammation due to unintentional administration of the drug beyond the vein. Uncommon: ventricular tachycardia, ventricular fibrillation. Very rare: hypokalemia, bradycardia, myocardial ischemia, myocardial infarction, cardiac arrest, punctate haemorrhage, skin necrosis. In addition: reduction of pressure in the capillary lungs, restlessness, feeling of heat and anxiety. Side effects in the pediatric population include increased systolic blood pressure, systemic hypertension or hypotension, tachycardia, headache, increased pulmonary wedge pressure, leading to pulmonary congestion and edema, and related symptoms.

The optimal dose should be determined individually. Adults: usually 2.5-10 μg / kg / min, doses of up to 40 μg / kg / min have been used in selected clinical situations. Children and adolescents (from neonates up to 18 years of age): an initial dose adjustment of 5 μg / kg / min is recommended. for clinical response in the range of 2 to 20 μg / kg / min. Occasionally, the response is obtained after a low dose of 0.5 to 1.0 μg / kg / min. It has been proven that the minimum effective doses in children are higher than in adults. When using higher doses of dobutamine, special care should be taken because the maximum doses tolerated in the treatment of children are lower than those used in adults. The majority of adverse reactions (especially tachycardia) were observed after dobutamine dosing at ≥ 7.5 μg / kg / min. Rapid resolution of side effects can be achieved by reducing the rate of infusion or discontinuing it. There was a high variability in pediatric patients with respect to dobutamine plasma hemoglobin (threshold) and hemodynamic response to increased plasma concentrations, indicating that the required dose for children can not be determined in advance and this dose should be determined taking into account the probably narrower therapeutic compartment than in adults. The drug for use in the form of continuous intravenous infusion, after dilution.