Myocard-DX

Dopamine Hydrochloride in 5% Dextrose Injection USP is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarctions, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation as in congestive heart failure.

Where appropriate, restoration of blood volume with a suitable plasma expander or whole blood should be instituted or completed prior to administration of dopamine.

Patients most likely to respond adequately to administration of dopamine are those in whom physiological parameters such as urine flow, myocardial function, and blood pressure, have not undergone profound deterioration. Multiclinic trials indicate that the shorter the time interval between onset of signs and symptoms and initiation of therapy with volume correction and dopamine, the better the prognosis.

Poor Perfusion of Vital Organs - Urine flow appears to be one of the diagnostic signs by which adequacy of vital organ perfusion can be monitored. Nevertheless, the physician should also observe the patient for signs of reversal of confusion or comatose condition. Loss of pallor increase in toe temperature, and/or adequacy of nail bed capillary filling may also be used as indices of adequate dosage. Clinical studies have shown that when dopamine is administered before urine flow had diminished to levels approximately 0.3 mL/minute, prognosis is more favorable.

Nevertheless, in a number of oliguric or anuric patients, administration of dopamine has resulted in an increase in urine flow which in some cases reached normal levels. Dopamine may also increase urine flow in patients whose output is within normal limits and thus may be of value in reducing the degree of pre-existing fluid accumulation. It should be noted that at doses above those optimal for the individual patient, urine flow may decrease, necessitating reduction of dosage. Concurrent administration of dopamine and diuretic agents may produce an additive or potentiating effect.

Low Cardiac Output - Increased cardiac output is related to dopamine’s direct inotropic effect on the myocardium. Increased cardiac output at low or moderate doses appears to be related to a favorable prognosis. Increase in cardiac output has been associated with either static or decreased systemic vascular resistance (SVR). Static or decreased SVR associated with low or moderate increments in cardiac output is believed to be a reflection of differential effects on specific vascular beds with increased resistance in peripheral beds (e.g., femoral) and concomitant decreases in mesenteric and renal vascular beds. Redistribution of blood flow parallels these changes so that an increase in cardiac output is accompanied by an increase in mesenteric and renal blood flow. In many instances the renal fraction of the total cardiac output has been found to increase. Increase in cardiac output produced by dopamine is not associated with substantial decreases in systemic vascular resistance as may occur with isoproterenol.

Hypotension - Hypotension due to inadequate cardiac output can be managed by administration of low to moderate doses of dopamine, which have little effect on SVR. At high therapeutic doses, dopamine’s alpha adrenergic activity becomes more prominent and thus may correct hypotension due to diminished SVR. As in the case of other circulatory decompensation states, prognosis is better in patients whose blood pressure and urine flow have not undergone profound deterioration. Therefore, it is suggested that the physician administer dopamine as soon as a definite trend toward decreased systolic and diastolic pressure becomes evident.

Special Applications

1. Before use, perform the following checks:
    • Inspect each container. Read the label. Ensure solution is the one ordered and is within the expiration date.
    • Invert container and carefully inspect the solution in good light for cloudiness, haze, or particulate matter, check the bottle for cracks or other damage. In checking for cracks, do not be confused by normal surface marks and seams on the bottom and sides of the bottle. These are not flaws. Look for bright reflections that have depth and penetrate into the wall of the bottle. Reject any such bottle.
2. To remove the outer closure, lift the tear tab and pull up, over, and down until it is below the stopper (See Figure 1). Use a circular puffing motion on the tab until it breaks away.
   
3. Grasp and remove the metal disk, exercising caution not to touch the exposed sterile stopper surface.
4. If the first puncture of the stopper is the administration set spike, insert the spike fully into the target area of the rubber stopper and promptly invert the bottle (see Figure 2). Verify vacuum by observing rising air bubbles. Do not use the bottle if vacuum is not present. Refer to Directions for Use of air-inletting administration set to be used.
   
5. If set insertion is not performed immediate following removal of protective metal disk, swab stopper surface.

CAUTION: FOODS, DRUGS, DEVICES AND COSMETICS ACT prohibits dispensing without prescription.

Regitine is a trademark of Novartis Corporation.

Manufactured by:
B. BRAUN MEDICAL INC.
Irvine, CA  92614-5895  USA

Imported & Distributed by:
PHIL PHARMAWEALTH, INC.
Suite 3001, East Tower, PSE Center,
Exchange Road., Ortigas Center,
Pasig City, Philippines