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Product Name
:
DOPAMINE-ELSaad
Chemical Name
:
Dopamine HCl
Therapeutic Category
:
Cardiovascular drugs
Pharmacologic Category
:
Adrenergic Agonist Agent
Pharmaceutical Form
:
Ampoule
Composition
:
Dopamine HCl 50mg / 200mg
Monitoring Parameters
Dosing
 
Dosing: Adult
Hemodynamic support: I.V. infusion (administration requires the use of an infusion pump): 1-5 mcg/kg/minute up to 20 mcg/kg/minute; titrate to desired response (maximum: 50 mcg/kg/minute; however, doses >20 mcg/kg/minute may not have a beneficial effect on blood pressure and increase the risk of tachyarrhythmias); infusion may be increased by 1-4 mcg/kg/minute at 10- to 30-minute intervals until optimal response is obtained
Note: If dosages >20-30 mcg/kg/minute are needed, a more direct-acting vasopressor may be more beneficial (ie, epinephrine, norepinephrine).
Hemodynamic effects of dopamine are dose dependent (however, this is relative and there is overlap of clinical effects between dosing ranges):
Low-dose: 1-5 mcg/kg/minute, increased renal blood flow and urine output
Intermediate-dose: 5-15 mcg/kg/minute, increased renal blood flow, heart rate, cardiac contractility, and cardiac output
High-dose: >15 mcg/kg/minute, alpha-adrenergic effects begin to predominate, vasoconstriction, increased blood pressure

Dosing: Pediatric

Hemodynamic support: I.V. infusion:
Children: 1-20 mcg/kg/minute, maximum: 50 mcg/kg/minute continuous infusion, titrate to desired response.

Dosing: Geriatric

Refer to adult dosing.
Use
 
Adjunct in the treatment of shock (eg, MI, open heart surgery, renal failure, cardiac decompensation) which persists after adequate fluid volume replacement
Use - Unlabeled/Investigational
Symptomatic bradycardia or heart block unresponsive to atropine or pacing
Adverse Reactions
 
Frequency not defined.
Most frequent:
Cardiovascular: Ectopic beats, tachycardia, anginal pain, palpitation, hypotension, vasoconstriction
Central nervous system: Headache
Gastrointestinal: Nausea and vomiting
Respiratory: Dyspnea
Infrequent:
Cardiovascular: Aberrant conduction, bradycardia, widened QRS complex, ventricular arrhythmia (high dose), gangrene (high dose), hypertension
Central nervous system: Anxiety
Endocrine & metabolic: Piloerection, serum glucose increased (usually not above normal limits)
Local: Extravasation of dopamine can cause tissue necrosis and sloughing of surrounding tissues
Ocular: Intraocular pressure increased, dilated pupils
Renal: Azotemia, polyuria
Contraindications
 
Hypersensitivity to sulfites (commercial preparation contains sodium bisulfite); pheochromocytoma; ventricular fibrillation
Warnings / Precautions Drug
 
Boxed warnings:
• Extravasation: See “Other warnings/precautions” below.
Concerns related to adverse effects:
• Arrhythmias: May cause increases in arrhythmias.
• Tachycardia: May cause increases in heart rate.
• Tissue necrosis: Avoid infiltration - may cause severe tissue necrosis.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease, cardiac arrhythmias and/or occlusive vascular disease.
• Myocardial infarct (post): Use with caution in patients post-MI.
Concurrent drug therapy issues:
• Monoamine oxidase inhibitors (MAO-I): Use with extreme caution in patients taking MAO inhibitors; prolong hypertension may result from concurrent use.
Dosage form specific issues:
• Sodium metabisulfite: Product may contain sodium metabisulfite.
Other warnings/precautions:
• Appropriate use: Assure adequate circulatory volume to minimize need for vasoconstrictors. Avoid hypertension; monitor blood pressure closely and adjust infusion rate.
• Extravasation: Avoid extravasation; infuse into a large vein if possible. Avoid infusion into leg veins. Watch I.V. site closely. [U.S. Boxed Warning]: If extravasation occurs, infiltrate the area with diluted phentolamine (5-10 mg in 10-15 mL of saline) with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted.
Interactions
 
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
COMT Inhibitors: May decrease the metabolism of COMT Substrates. Risk C: Monitor therapy
Inhalational Anesthetics: May enhance the arrhythmogenic effect of DOPamine. Management: Avoid use of dopamine in patients receiving halogenated hydrocarbon anesthetics. If concomitant treatment cannot be avoided, monitor for arrhythmia. Dopamine induced ventricular arrhythmia may be reversible with propranolol based on animal data. Risk X: Avoid combination
Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination
Lurasidone: DOPamine may enhance the hypotensive effect of Lurasidone. Risk X: Avoid combination
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Pregnancy
 
C
Lactation
 
Excretion in breast milk unknown
Mechanism of Action
 
Stimulates both adrenergic and dopaminergic receptors, lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors
Pharmacodynamics / Kinetics
 
Children: Dopamine has exhibited nonlinear kinetics in children; with medication changes, may not achieve steady-state for ~1 hour rather than 20 minutes
Onset of action: Adults: 5 minutes
Duration: Adults: <10 minutes
Metabolism: Renal, hepatic, plasma; 75% to inactive metabolites by monoamine oxidase and 25% to norepinephrine
Half-life elimination: 2 minutes
Excretion: Urine (as metabolites)
Clearance: Neonates: Varies and appears to be age related; clearance is more prolonged with combined hepatic and renal dysfunction
 
   
 
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