Dopamine
Class
- naturally occurring catecholamine
Mechanism of Action
- dopamine and adrenoreceptor agonist
- 1-5mcg/kg/min – D 1 & 2 receptors (inotropy
- 5-10mcg/kg/min – direct & indirect effects on beta receptors -> inotropy
- >10mcg/kg/min – alpha effects -> vasoconstriction
- immediate precursor to noradrenaline
- neurotransmitter in the nervous system
- increases aldosterone secretion
Dose
- 1-20mcg/kg/min (onset: 5min, duration: 10min)
Pharmaceutics
- ampoule 200mg/5mL + meta-bisulfite
Indications
- low Q states
Adverse Effects
- arrhythmias
- pulmonary artery vasoconstriction
- caution with MAO-I and phenytoin
- N+V
- immune dysfunction
- decreased GI oxygenation in shock states
- diuresis in patients who are hypovolaemia
- inhibits TSH and prolactin release
PK
- Absorption – IV
- Distribution
- Metabolism – hepatic and adrenergic nerve endings (MAO and COMT)
- Elimination – urinary, T1/2 = 2min
Evidence
Myles, P.S et al (1993) “’Renal dose’ dopamine on renal function following cardiac surgery” Anaes. Intens. Care 21:56
- CABG patients
- dopamine 200mcg/min vs placebo for 24 hours
- -> no improvement in CrCl
Duke G.J. et al (1994) “Renal support in critically ill patients: low-dose dopamine vs low dose dobutamine?” Critical Care Medicine, 22:(12), page 1919-25
- RCT
- placebo vs dopamine vs dobutamine
- -> increased U/O with dopamine but no change in CrCl
- -> improved CrCl while no change in U/O with dobutamine compared with placebo
- -> increased urine output is not synonymous with improved renal function
ANZICS (2000, Lancet)
- RCT – dopamine vs placebo
- no change in Cr, ICU LOS, hospital LOS, RRT
- -> don’t use low dose dopamine for renal protection
De Backer, D. et al (2010) “Comparison of dopamine and norepinephrine in the treatment of shock” N Engl J Med, 362:779-789
- MRCT
- n = 858
- 50% of patients died in both groups
- -> no difference in mortality rates (ICU, 6 months and 12 months)
- -> more arrhythmias
- -> increased risk of death @ 28 days with dopamine + cardiogenic shock
Patel, G.P. et al (2010) “Efficacy and safety of dopamine versus norepinephrine in management of septic shock” Shock 33:375-380
- SRCT
- n = 252 with septic shock in a medical ICU
- -> more arrhythmias in dopamine group
- -> no difference in 28 day mortality
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.
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