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Drug dosage identifier

Dobutamine Hydrochloride

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Dose and administration

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  1. 2-25 micrograms/kg/minute by continuous IV infusion.
  2. Begin at a low dose and titrate by monitoring effects.
  3. Administer via a central line (UVC, Longline, or Surgical CVL). If no central access available, use a large vein.
  4. Usual dilution 30 mg/kg (2.4 ml/kg) dobutamine to make 50 ml with NS or D5W
    1 ml/hour = 10 micrograms/kg/minute.

    Dobutamine (mg) in 50ml IV solution = 3 x weight (kg) x dose (micrograms/kg/min)
                                                                                IV rate (ml/hr)

Maximum concentration = 5 mg/mL

Indication

Blood pressure support in infants with shock and hypotension.

Contraindications and precautions

  1. Hypersensitivity to sympathomimetic amines and sodium metabisulfite.
  2. Hypovolaemia should be corrected prior to commencing the drug.
  3. Uncorrected tachyarrhythmia.
  4. Caution in infants with hypertension, LV outflow tract obstruction.

Clinical pharmacology

Dobutamine is a synthetic catecholamine with primarily beta 1 adrenergic activity. It is an inotropic vasopressor. It increases myocardial contractility, cardiac index, oxygen delivery and oxygen consumption. It decreases systemic and pulmonary vascular resistance (adults).

The drug must be administered by continuous IV infusion because of rapid metabolism of the drug. It is metabolised in the liver to an inactive compound. The onset of action is 1-2 minutes after IV administration with the peak effect occurring in 10 minutes. The half-life of its drug effect is two minutes.

Possible adverse effects

  1. Venous irritation, soft tissue injury at site of IV infusion.
  2. May cause hypotension if patient is hypovolaemic.
  3. Tachycardia at high dosage.
  4. Arrhythmias, hypertension especially systolic pressure and cutaneous vasodilatation.

Special considerations

  1. Volume loading is recommended before commencing dobutamine infusion. 
  2. Renal dysfunction: no dosage adjustment necessary.
  3. Clinical experience with dobutamine in neonates is limited. Whether dobutamine has any consistent advantages over dopamine in the treatment of a neonate with myocardial dysfunction remains to be established. 
  4. Beta blockers may antagonise dobutamine effect. 
  5. General anaesthetics: greater incidence of ventricular arrhythmias. 
  6. Dobutamine should not be used with agents containing sodium bisulfite.

Management of Dobutamine administration

Description

  1. Clear, colourless solution 250mg in 20 ml (12.5 mg/ml in 20ml vials). pH 2.5-5.5. Osmolality is 260 - 280 mOsm/Kg in glucose 5%.
  2. Contains sodium metabisulfite BP 4.4mg/20ml.

Prescription

Charted on fluid chart giving:

  • rate in ml/hour
  • dose in micrograms/kg/minute

Also charted on drug chart under continuous infusions giving:

  • amount of drug to be added
  • base fluid, type and volume
  • infusion rate and dose in micrograms/kg/minute

Administration

Continuous Infusion

Should be administered via a central line (UVC, Longline, or Surgical CVL). If no central access available, use a cannula in a large vein.

  1. Administered by a Nurse with neonatal IV drug certification.
  2. Solution can discolour (pink) but may still be used.
  3. Dilute 30 mg/kg (2.4 ml/kg) dobutamine to make 50ml with NS or D5W. Mix well.
    1 ml/hour = 10 micrograms/kg/minute.
    Solution strength should not exceed 5 mg/ml.
  4. Compatible with NS, D5W and D10W. Also compatible at Y injection site with dopamine, morphine, insulin and IVN.
  5. Incompatible with sodium bicarbonate and any strongly alkaline solution.
  6. Do NOT mix with any other drug, blood or blood products. Do NOT flush line.
  7. Administer via a syringe pump.
  8. Change fluid and tubing every 48 hours.

Nursing considerations

  1. Observe IV site closely and avoid extravasation. Dobutamine can cause inflammatory response and tissue ischaemia.
  2. Monitor for adverse reactions
  3. Continuous blood pressure monitoring
  4. Continuous cardiorespiratory monitoring
  5. Document vital signs hourly and PRN
  6. Monitor fluid balance

Storage

  • At room temperature <25° C. Protect from light.
  • Diluted solution stable for 48 hours at room temperature.

References

  1. Data sheet 2008
  2. Hey, E, editor. Neonatal formulary. 5th ed. Oxford: Blackwell Publishing; 2007
  3. Martin, J, Managing editor. BNF for children 2010-2011. London: BMJ Group, Pharmaceutical Press & RCPCH Publications Ltd; 2010.
  4. Phelps SJ, Hak EB, Crill CM, editors. Teddy bear book: Pediatric injectable drugs. 8th ed. Bethesda, MD: American Society of Heath-System Pharmacists; 2007.

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Document Control

  • Date last published: 30 November 2011
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years