Index of drugs

Acute myocardial insufficiency occurring in the course of cardiogenic shock, myocardial infarction, after cardiac surgery.

1 vial contains 250 mg dobutamine in the form of hydrochloride.

Synthetic catecholamine that stimulates β receptors₁-Adrenergic. It does not affect the release of endogenous noradrenaline. It exhibits a strong positive inotropic action, a weaker chronotropic and arrhythmogenic effect than Dopamine (it facilitates atrio-ventricular guidance). Increases myocardial contractility, increases cardiac output and cardiac index with minimal effect on heart rate, reduces afterload, reduces left ventricular filling pressure, reduces pulmonary vascular resistance - increases pulmonary flow, increases coronary flow (secondary to a decrease in flow resistance in coronary vessels ). It increases renal flow in proportion to improving cardiac output. It does not increase peripheral resistance (in some clinical situations it may be decreased). Does not show effects on dopaminergic receptors, does not dilate renal and mesenteric vessels, has weaker effects on β receptors₂- and α-adrenergic. The onset of action occurs 1-2 min after the start of the infusion, the maximum effect - after about 10 minutes. T_0,5 is about 2 minutes. Dobutamine is metabolised to inactive metabolites, mainly to 3-O-methyl-butamine. It is excreted in the form of metabolites - approx. 67% in the urine, 30-35% in the bile.

Hypersensitivity to dobutamine or auxiliary substances. Hypertrophic cardiomyopathy with narrowing of the left ventricle drain path. Hypertrophic stenosis of the aortic valve.

If the heart rate rises, increase the systolic pressure or increase the arrhythmia, reduce the dose or discontinue dobutamine for some time. Dobutamine may increase additional ventricular contractions, but ventricular tachycardia or ventricular fibrillation is rare. In patients with flutter or ventricular fibrillation, a rapid ventricular response may occur. Particular care should be taken in patients with myocardial infarction. A significant increase in heart rate or increase in blood pressure may increase myocardial ischemia and cause angina pectoris and S-T segment elevation of the electrocardiogram. Inotropic compounds, including dobutamine, do not improve hemodynamics in the majority of patients with mechanical obstruction impairing ventricular filling or (i) outflow from the ventricles. This applies to patients with cardiac tamponade, with aortic valve stenosis and spontaneous hypertrophic subvalvular aortic stenosis. In patients who received β-blockers in the period preceding dobutamine treatment, slight peripheral vasoconstriction may occur. The inotropic action of dobutamine comes from the stimulation of β receptors₁ myocardium. This effect is eliminated by β-blockers. Although dobutamine has been shown to counteract the cardiodepressive effect of β-blockers, adrenergic blockade of β-receptors on the other hand₁ and β₂ can cause tachycardia and vasodilation. The use of dobutamine as an alternative to exercise tests is not recommended in patients with unstable angina, atrio-ventricular bundle block, valvular heart disease, aortic outflow occlusion or other cardiac diseases that might be unsuitable for performing a test stress test. The decision to perform a dobutamine stress test in patients at risk of a heart rupture should be very carefully thought out. If you reduce your blood pressure while administering your medicine, reducing the dose or stopping the infusion causes a rapid increase in pressure to the baseline. However, more serious intervention may occasionally be required and the normalization of pressure is not fast. Dobutamine should be administered with caution to patients with markedly reduced cardiogenic shock (mean arterial blood pressure less than 70 mm Hg). In hypovolaemic conditions, the volume of circulating blood should be topped up before starting treatment.The persistence of low blood pressure or a steady drop in pressure when using dobutamine, despite normal right ventricular filling pressure and cardiac output, may be an indication for administration of peripheral vasoconstrictor drugs, e.g. dopamine or norepinephrine.

The preparation can be used during pregnancy only if the benefit for the mother outweighs the potential risk of fetal damage.

Cardiac disorders: cardiac acceleration, palpitations, angina pectoris, chest pain, ectopic rhythm, arrhythmia, atrial fibrillation, ventricular fibrillation, ventricular tachycardia, myocardial ischemia, coronary artery spasm, ST segment elevation of the electrocardiogram, myocardial infarction, obstructed outflow left ventricle (seen during exercise echocardiography); in very rare cases, a heart failure with death was observed during a dobutamine stress test; in patients with an implanted heart that had been treated with many medications such as dobutamine or other inotropes prior to transplantation, eosinophilic myocarditis was observed. Vascular disorders: hypertension (markedly increased systolic pressure is evidence of dobutamine overdose), hypotension. In addition, you may experience: muscle clonic convulsions in patients with severe renal insufficiency, shortness of breath, bronchospasm, asthma, decreases in potassium in the blood, skin rash, elevated body temperature, eosinophilia, bronchospasm, nonspecific chest pain, headache, nausea . At the place of intravenous administration of dobutamine, inflammatory changes, phlebitis, skin necrosis can occur very rarely. In patients who receive dobutamine in an infusion lasting more than 72 hours, tolerability may develop. In order to keep the dobutamine working at the same level, it may be necessary to gradually increase the doses.

Intravenously. Adults: 2.5-10 μg / kg / min is usually used. For some patients, a dose of 0.5 μg / kg / min is sufficient. The need for dobutamine at higher doses, sometimes up to 40 μg / kg / min. it happens very rarely. Children: after open heart surgery in children, the average dose is 2.5-5 μg / kg / min. The preparation is given by continuous intravenous infusion using devices that accurately dose the drug. The infusion rate and duration of application should be adjusted to the patient's heart rate and rhythm, including hemodynamic parameters (blood pressure, ventricular filling pressure, central venous pressure, pulmonary wedge pressure, stroke volume or cardiac output, diuresis).
Dobutamine should be discontinued gradually. It is recommended to gradually reduce the infusion rate of the drug. During the dose reduction of dobutamine, the patient's condition and hemodynamic parameters should be monitored. After preparation, the dobutamine solution should be used within 24 hours.