Dobutamine
Class
- synthetic isoprenaline derivative
- adrenergic agonist
- racemic mixture
Mechanism of Action
- levo: alpha 1 agonist -> vasoconstriction + beta 2 effects -> inotropy
- dextro: beta 1 and beta 2 agonist + alpha 1 blocking effects
-> inotropy with some vasodilation
Dose
- 1-40mcg/kg/min, onset = minutes
Pharmaceutics
- 250mg/20mL (with meta-bisulfite),
- racemic mixture of levo and dextro enantiomers
Indications
- for low Q states from:
- MI
- cardiac surgery
- cardiomyopathy
- Septic shock
- cardiac stress testing
-> increases contractility
-> little effect on HR, SVR and PVR
Adverse Effects
- pulmonary artery vasodilation
- increase HR-> dysrhythmias
- headaches
- anxiety
- tremors
PK
- Absorption – IV
- Distribution – Vd small,
- Metabolism – hepatic, methylated (COMT) and conjugated
- Elimination – t1/2 = 2 min, urine and faeces
Evidence
No evidence that Dobutamine is to be used in any situation over other similar agents.
Mebazza, (2007) SURVIVE – Levosimendan vs Dobutamine in patients with acute decompensated heart failure, JAMA
- n = 1320
- -> no difference in 180 day mortality
SUMMARY
Read, M.C. (2008) – “The case for Dobutamine” Critical Care and Resuscitation, Volume 10 (3) page 179
- cheap
- titratable
- few metabolic adverse effects
- familiarity
- increases heart rate while causing vasodilation
- increases myocardial consumption but also increases coronary perfusion
- no lactic acidosis
References and Links
CCC Pharmacology Series
Respiratory: Bosentan, Delivery of B2 Agonists in Intubated Patients, Nitric Oxide, Oxygen, Prostacyclin, Sildenafil
Cardiovascular: Adenosine, Adrenaline (Epinephrine), Amiodarone, Classification of Vasoactive drugs, Clevidipine, Digoxin, Dobutamine, Dopamine, Levosimendan, Levosimendan vs Dobutamine, Milrinone, Noradrenaline, Phenylephrine, Sodium Nitroprusside (SNiP), Sotalol, Vasopressin
Neurological: Dexmedetomidine, Ketamine, Levetiracetam, Lignocaine, Lithium, Midazolam, Physostigmine, Propofol, Sodium Valproate, Sugammadex, Thiopentone
Endocrine: Desmopressin, Glucagon Therapy, Medications and Thyroid Function
Gastrointestinal: Octreotide, Omeprazole, Ranitidine, Sucralfate, Terlipressin
Genitourinary: Furosemide, Mannitol, Spironolactone
Haematological: Activated Protein C, Alteplase, Aprotinin, Aspirin, Clopidogrel, Dipyridamole, DOACs, Factor VIIa, Heparin, LMW Heparin, Protamine, Prothrombinex, Tenecteplase, Tirofiban, Tranexamic Acid (TXA), Warfarin
Antimicrobial: Antimicrobial Dosing and Kill Characteristics, Benzylpenicillin, Ceftriaxone, Ciprofloxacin, Co-trimoxazole / Bactrim, Fluconazole, Gentamicin, Imipenem, Linezolid, Meropenem, Piperacillin-Tazobactam, Rifampicin, Vancomycin
Analgesic: Alfentanil, Celecoxib, COX II Inhibitors, Ketamine, Lignocaine, Morphine, NSAIDs, Opioids, Paracetamol (Acetaminophen), Paracetamol in Critical Illness, Tramadol
Miscellaneous: Activated Charcoal, Adverse Drug Reactions, Alkali Therapies, Drug Absorption in Critical Illness, Drug Infusion Doses, Epidural Complications, Epidural vs Opioids in Rib Fractures, Magnesium, Methylene Blue, Pharmacology and Critical Illness, PK and Obesity, PK and ECMO, Sodium Bicarbonate Use, Statins in Critical Illness, Therapeutic Drug Monitoring, Weights in Pharmacology
Toxicology: Digibind, Flumazenil, Glucagon Therapy, Intralipid, N-Acetylcysteine, Naloxone, Propofol Infusion Syndrome
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
