• 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


  • 1-40mcg/kg/min, onset = minutes


  • 250mg/20mL (with meta-bisulfite),
  • racemic mixture of levo and dextro enantiomers


  • for low Q states from:
  1. MI
  2. cardiac surgery
  3. cardiomyopathy
  4. Septic shock
  5. cardiac stress testing

-> increases contractility
-> little effect on HR, SVR and PVR

Adverse Effects

  • pulmonary artery vasodilation
  • increase HR-> dysrhythmias
  • headaches
  • anxiety
  • tremors


  • Absorption – IV
  • Distribution – Vd small,
  • Metabolism – hepatic, methylated (COMT) and conjugated
  • Elimination – t1/2 = 2 min, urine and faeces


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


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

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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