DOBUTamine

General

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

Pronunciation:
doe-byoo-ta-meen

Trade Name(s)

• Dobutrex

Ther. Class.
inotropics

Pharm. Class.
adrenergics

Indications

Short-term (<48 hr) management of heart failure caused by depressed contractility from organic heart disease or surgical procedures.

Action

Stimulates beta₁ (myocardial)-adrenergic receptors with relatively minor effect on heart rate or peripheral blood vessels.

Therapeutic Effect(s):

Increased cardiac output without significantly increased heart rate.

Pharmacokinetics

Absorption: Administered by IV infusion only, resulting in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Metabolized by the liver and other tissues.

Half-life: 2 min.

TIME/ACTION PROFILE (inotropic effects)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity to dobutamine or bisulfites;
• Idiopathic hypertrophic subaortic stenosis.

Use Cautiously in:

• History of hypertension (↑ risk of exaggerated pressor response);
• MI;
• Atrial fibrillation (pretreatment with digoxin recommended);
• History of ventricular atopic activity (may be exacerbated);
• Hypovolemia (correct before administration);
• OB:  Safety not established.

Adverse Reactions/Side Effects

CNS: headache

CV: hypertension, increased heart rate, premature ventricular contractions, angina pectoris, arrhythmias, hypotension, palpitations

GI: nausea, vomiting

Local: phlebitis

Resp: shortness of breath

Misc: hypersensitivity reactions, nonanginal chest pain

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Use with  nitroprusside ; may have a synergistic effect on ↑ cardiac output.
•  Beta blockers  may negate the effect of dobutamine.
• ↑ risk of arrhythmias or hypertension with some  anesthetics  (cyclopropane,  halothane ), MAO inhibitors, oxytocics, or  tricyclic antidepressants.

Route/Dosage

IV (Adults and Children): 2.5–15 mcg/kg/min; titrate to response (max dose = 40 mcg/kg/min).

IV Neonates: 2–15 mcg/kg/min.

Availability (generic available)

Solution for injection (requires dilution): 12.5 mg/mL

Premixed infusion: 250 mg/250 mL, 500 mg/250 mL, 1000 mg/250 mL

Assessment

• Monitor BP, heart rate, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, CVP, and urinary output continuously during the administration. Report significant changes in vital signs or arrhythmias. Consult physician for parameters for pulse, BP, or ECG changes for adjusting dose or discontinuing medication.
• Palpate peripheral pulses and assess appearance of extremities routinely during dobutamine administration. Notify health care professional if quality of pulse deteriorates or if extremities become cold or mottled.

Lab Test Considerations:

Monitor potassium concentrations during therapy; may cause hypokalemia.

• Monitor electrolytes, BUN, creatinine, and prothrombin time weekly during prolonged therapy.

Toxicity Overdose:

If overdose occurs, reduction or discontinuation of therapy is the only treatment necessary because of the short duration of dobutamine.

Potential Diagnoses

• Decreased cardiac output (Indications) 
• Ineffective tissue perfusion (Indications) 

Implementation

• High Alert: IV vasoactive medications are potentially dangerous. Have second practitioner independently check original order, dose calculations, and infusion pump settings. Do not confuse dobutamine with dopamine. If available as floor stock, store in separate areas.

• Correct hypovolemia with volume expanders before initiating dobutamine therapy.

  • Administer into a large vein and assess administration site frequently. Extravasation may cause pain and inflammation.

Patient/Family Teaching

• Explain to patient the dobutamine and the need for frequent monitoring.
• Advise patient to inform nurse immediately if chest pain; dyspnea; or numbness, tingling, or burning of extremities occurs.
• Instruct patient to notify nurse immediately of pain or discomfort at the site of administration.
• Home Care Issues:

  Instruct caregiver on proper care of IV equipment.

  • Instruct caregiver to report signs of worsening HF (shortness of breath, orthopnea, decreased exercise tolerance), abdominal pain, and nausea or vomiting to health care professional promptly.

Evaluation/Desired Outcomes

Increase in cardiac output.

• Improved hemodynamic parameters.
• Increased urine output.