Dobutamine Injection

GENERIC AVAILABLE: Yes

• Use caution when combining dobutamine with other agents that increase heart rate or blood pressure (sympathomimetics), such as atomoxetine (Strattera), dopamine, and epinephrine.
• Use lower doses of dobutamine initially if the patient is also on linezolid (Zyvox) as there is a risk of significant increase in blood pressure.
• Calcium salts may decrease the effect of dobutamine, so monitor closely.

Dobutamine is a direct-acting inotropic agent whose primary activity results from stimulation of the β receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects. It does not ccause the release of endogenous norepinephrine, as does dopamine. In animal studies, dobutamine produces less increase in heart rate and less decrease in peripheral vascular resistance for a given inotropic effect than does isoproterenol.

In patients with depressed cardiac function, both dobutamine and isoproterenol increase the cardiac output to a similar degree. In the case of dobutamine, this increase is usually not accompanied by marked increases in heart rate (although tachycardia is occasionally observed), and the cardiac stroke bolume is usually increased. In contrast, isoproterenol increases the cardiac index primarily by increasing the heart rate while stroke volume changes little or declines.

Facilitation of atrioventricular conduction has been observed in human electrophysiologic studies and in patients with atrial fibrillation.

Systemic vascular resistance is usually decreased with administration of dobutamine. Occasionally, minimum vasoconstriction has been observed.

Most clincical experience with dobutamine is short-term-not more than several hours in duration. In the limited number of patients who were studied for 24, 48, and 72 hours, a persistent increase in cardiac output occurred in some, whereas output returned toward baseline values in others.

The onset of action of dobutamine is within 1 to 2 minutes; however, as much as 10 minutes may be required to obtain the peak effect of a particular infusion rate.

The plasma half-life of dobutamine in humans is 2 minutes. The principal routes of metabolism are methylation of the catechol and conjugation. In human urine, the major excretion products are the conjugates of dobutamine and 3-0-methyl dobutamine. The 3-0 methyl derivative of dobutamine is inactive.

Alteration of synaptic concentrations of catecholamines with either reserpine or tricyclic antidepressants does not alter the actions of dobutamine in animals, which indicates that the actions of dobutamine are not dependent on presynaptic mechanisms.

Dobutamine Injection is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of adults with cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures.

In patients who have atrial fibrillation with rapid ventricular response, a digitalis preparation should be use prior to institution of therapy with dobutamine hydrochloride.

Dobutamine Injection, USP, 12.5 mg/mL is available as:

20 mL Single-Dose Vials containing 250 mg dobutamine (as the hydrochloride), boxes of 10 (List 2025).

40 mL Single-Dose Vials containing 500 mg dobutamine (as the hydrochloride), boxes of 10 (List 2025).

Store at 20 to 25C (68 to 77F). [See USP Controlled Room Temperature.]

Revised: January, 2005.

HOSPIRA, INC., Lake Forest, IL 60045 USA