Indications & Uses
D-Dopamine is indicated for:
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Dosage Adult dose: Where appropriate, circulating blood volume should be restored with a suitable plasma expander or whole blood before dopamine is given. Infusion of dopamine hydrochloride solution should be started at a dosage of 2 to 5 micrograms/kg/min in patients likely to respond to a modest increase in heart force and renal perfusion. In more seriously ill patients, infusion should be started at a dosage of 5 micrograms/kg/min and increased gradually, using increments of 5 to 10 micrograms/kg/min, up to 20 to 50 micrograms/kg/min as needed. If dosages above 50 micrograms/kg/min are required, urine output should be checked frequently. In patients who do not respond to these doses, further increments of dopamine may be given in an effort to achieve adequate blood pressure, urine flow and perfusion. For patients with severe, refractory, chronic congestive heart failure, doses should be started at 0.5 to 2 micrograms/kg/min and increased by 1 to 3 micrograms/kg/min as urinary output increases. ECG, blood pressure and urine output should be monitored, and cardiac output and pulmonary wedge pressure should be monitored if possible. Children less than 12 years old: The safety and efficacy of dopamine in children under 12 years have not been established. Geriatric patients: No variation in dosage is suggested for geriatric patients, although close monitoring is required for blood pressure, urine flow and peripheral tissue perfusion.
Side Effects
Dopamine hydrochloride can cause a number of side effects. The most commonly reported are ectopic beats, nausea, vomiting, a fast heartbeat (tachycardia), chest pain (anginal pain), palpitations, breathlessness (dyspnoea), headache, low blood pressure (hypotension), high blood pressure (hypertension) and constriction of blood vessels (vasoconstriction). Less commonly, it may cause abnormal ventricular conduction, a slow heartbeat (bradycardia), goosebumps (piloerection), widened pupils (mydriasis), a widened QRS complex on ECG, raised blood urea (azotaemia) and elevated blood pressure. In patients with pre-existing vascular disease, it can lead to peripheral ischaemic gangrene. On rare occasions, fatal ventricular arrhythmias have been reported.
Cautions & Contraindications
Warnings & Precautions
Dopamine should not be given to patients with uncorrected tachyarrhythmia or ventricular fibrillation. It is broken down in the tissues and blood by the enzymes monoamine oxidase (MAO) and catechol O methyltransferase (COMT), and dopamine and its breakdown products are almost entirely removed from the body through the urine. Patients who have recently been treated with monoamine oxidase inhibitors (MAOIs) will need much smaller doses of dopamine, and the starting dose in such patients should be cut to at least one tenth (1/10) of the usual amount. Giving too much of a potassium free solution can lead to marked hypokalemia, and infusing these solutions intravenously can also overload the body with fluid or dissolved solutes, diluting serum electrolyte levels and causing overhydration, congestion, or pulmonary oedema. Patients with impaired kidney or liver function should be watched closely. Any hypovolaemia should be corrected before starting dopamine treatment. If the diastolic blood pressure rises out of proportion to the systolic pressure, shown by a marked narrowing of the pulse pressure, the infusion rate should be lowered and the patient watched closely for further signs of excessive vasoconstriction, unless this effect is actually intended. The infusion should be tapered off gradually rather than stopped abruptly, to avoid sudden hypotension. Patients with a history of peripheral vascular disease, including atherosclerosis, arterial embolism, Raynaud's disease, cold injury, diabetic endarteritis, and Buerger's disease, should be monitored closely for any change in the color or temperature of the skin on their arms and legs. If ischaemia develops and appears to be caused by vasoconstriction, the value of continuing the dopamine infusion must be weighed against the risk of tissue death, and these changes can often be reversed by slowing or stopping the infusion. Dopamine mixed in 5% dextrose solution should be infused into a large vein wherever possible, to avoid leakage into the tissue surrounding the injection site, since such leakage can cause tissue death and sloughing. If ischaemia does occur, it can often be reversed by infiltrating the affected area with 10 to 15 ml of saline containing 5 to 10 mg of phentolamine mesylate. Dopamine should be used with great caution in patients who are inhaling cyclopropane or halogenated hydrocarbon anaesthetics, because of the increased risk of arrhythmia. Because the solution contains dextrose, it should also be used cautiously in patients with known or borderline diabetes mellitus.
Contraindications
Dopamine hydrochloride should not be given to patients who are hypersensitive to it or to any of its ingredients. It is also unsuitable for those with phaeochromocytoma, uncorrected tachyarrhythmias, or ventricular fibrillation. Dextrose solution without electrolytes should never be infused through the same line as blood, since this can cause red cells to clump together (pseudoagglutination).