Dopamine Intropin

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GENERIC NAME: DOPAMINE

BRAND NAME: Intropin 

CLASS: Sympathomimetic

Mechanism of Action:

Immediate metabolic precursor to norepinephrine

Effects are dose-dependent: 1-2 μg/kg/min 2-10 μg/kg/min 10-20 μg/kg/min > 20 μg/kg/min

Indications and Field Use:

Acts on dopaminergic receptors to stimulate cerebral, renal and mesenteric vasculature to dilate; HR and B/P are usually unchanged; may increase urine output ß1 stimulant action is primary effect (increases cardiac output and

partially antagonizes the a-adrenergic-mediated vasoconstriction. Overall effect is increased cardiac output and only modest increase

in systemic vascular resistance (SVR)

a-adrenergic effects predominate resulting in renal, mesenteric and

peripheral arterial and venous vasoconstriction with marked increase in SVR, pulmonary vascular resistance and further increased preload Produces hemodynamic effects similar to norepinephrine; may increase HR and O2 demand to undesirable limits

Symptomatic bradycardias. Second line choice after Atropine Hemodynamically significant hypotension in the absence of hypovolemia (Cardiogenic or septic shock only after fluid administration; assess breath sounds first).

Contraindications:

Hypersensitivity Hypovolemic shock
(relative) Pheochromocytoma MAO inhibitors, such as Marplan, Nardil, or Parnate Tachyarrythmias / Ventricular Fibrillation

Adverse Reactions:

CV: Cardiac arrhythmias may occur due to increased myocardial oxygen demand (usually tachydysrhythmias), hypertension, hypotension at low doses. GI: Nausea and vomiting GU: Renal shutdown (at higher doses)

Other:

Extravasation may cause tissue necrosis

NOTES ON ADMINISTRATION Incompatibilities/Drug Interactions:

Incompatible in any alkaline solution On-board MAO inhibitors will cause hypertensive crisis

Adult Dosage:

(dosage range 2-20 μg/kg/min)

Preparation: (If premixed not carried) Add 400 mg/ 250 ml NS or Dextrose = 1600 μg/ml. Bradycardia: Start at 5 μg/kg/min Shock: cardiogenic or septic (non-hypovolemic)

BP < 70 systolic: Start drip at 5 μg/kg/min BP > 70 systolic: Start drip at 2.5 μg/kg/min

Pediatric Dosage:

2-20 μg/kg/min for circulatory shock or shock unresponsive to fluid administration. To prepare infusion for small children: 6 x body wt. in kg = mg added to NS to make 100 ml. With this mixture 1 ml/hr delivers 1 μ/kg/min; titrate to effect.

Routes of Administration:

IV infusion Infusion pump required on interfacility transfers

Onset of Action:

Almost immediate, upon presentation to central circulation

Peak Effects:

5-10 minutes

Duration of Action:

Effects cease almost immediately when infusion is shut off

Dosage Forms/Packaging:

400 mg/5 ml vials 400 mg in 250 ml D5W premixed IV solution

Arizona Drug Box Supply:

PARAMEDIC: 400 mg

Special Notes:

> Always monitor drip rate, never run "wide open".

> An infusion pump is required for interfacility transports; a minimum of microdrip tubing is required for field use.

> It is important to remember that even in low dose ranges dopamine elevates pulmonary artery occlusive pressure and may induce or exacerbate pulmonary congestion despite a rise in cardiac output.

> Notify physician if infusion infiltrates for administration of antidote. 

© Matt Dillard 2012