Inotrope (Beta-1 Agonist) Pregnancy: There are no adequate data on the safety of dobutamine in human pregnancy and it is not known whether dobutamine crosses the placenta; it should not be used during pregnancy unless the potential benefits outweigh the potential risks to the foetus and there are no safer therapeutic alternatives. It is not known whether dobutamine is excreted in breast milk, so caution should be exercised; if treatment is required during lactation, breast feeding should be discontinued for the duration of treatment.

Dobutamine (ICU — Inotrope)

Brand names: Dobutrex

Dobutamine is a beta-1-selective inotrope given by continuous intravenous infusion in the intensive care setting to improve cardiac output in patients with low-output states such as cardiogenic shock or decompensated heart failure.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 2.5-10 micrograms dobutamine/kg/min by continuous intravenous infusion - according to experience the majority of patients respond to this range. In individual cases doses up to 40 micrograms dobutamine/kg/min have been administered.

Route: Intravenous infusion only, after dilution with a compatible infusion solution (5% glucose, 0.9% sodium chloride, or 0.45% sodium chloride in 5% glucose). Because of its short half-life dobutamine must be given as a continuous intravenous infusion.

Frequency: Continuous intravenous infusion, individually adjusted - the required rate of infusion depends on the patient's response to therapy and the adverse reactions experienced

Max: No absolute ceiling is stated for the inotropic indication; the SPC records that doses up to 40 micrograms dobutamine/kg/min have been administered in individual cases (for stress echocardiography only, the infusion rate may alternatively be increased to 50 micrograms/kg/min)

Doses must be individually adjusted. Worked infusion rates from the SPC - infusion delivery systems, one ampoule of 12.5 mg/mL (250 mg in 20 mL) diluted to 500 mL (final concentration 0.5 mg/mL): 2.5 micrograms/kg/min = 15 mL/h (5 drops/min) at 50 kg, 21 mL/h (7) at 70 kg, 27 mL/h (9) at 90 kg; 5 micrograms/kg/min = 30 (10), 42 (14), 54 (18) mL/h; 10 micrograms/kg/min = 60 (20), 84 (28), 108 (36) mL/h. For double concentration (500 mg in 500 mL, or 250 mg in 250 mL) the infusion rates must be halved. Syringe pumps, one ampoule diluted to 50 mL (final concentration 5 mg/mL): 2.5 micrograms/kg/min = 1.5 mL/h at 50 kg, 2.1 mL/h at 70 kg, 2.7 mL/h at 90 kg; 5 micrograms/kg/min = 3.0, 4.2, 5.4 mL/h; 10 micrograms/kg/min = 6.0, 8.4, 10.8 mL/h. Infusion solutions should be prepared immediately before use. The dose should be gradually reduced when discontinuing therapy. Duration of treatment depends on clinical requirements and should be as short as possible; if dobutamine is administered continuously for more than 72 hours tolerance (tachyphylaxis) may occur, requiring a dose increase. During administration, heart rate, heart rhythm, blood pressure, diuresis and infusion rate should be closely monitored, and cardiac output, central venous pressure and pulmonary capillary pressure monitored if possible. Hypovolaemia should be corrected before administering dobutamine. Potassium levels should be monitored. Dobutamine is incompatible with bicarbonate and other strong alkaline solutions. SEPARATE INDICATION - dobutamine stress echocardiography (adult population only, and only by a physician with sufficient experience of cardiology stress testing, with continuous echocardiographic and ECG monitoring, blood pressure control, resuscitation equipment and trained staff available): the most frequently applied scheme starts at 5 micrograms/kg/min increased every 3 minutes to 10, 20, 30, 40 micrograms/kg/min until a diagnostic endpoint is reached; if no endpoint is reached, atropine sulfate 0.5 to 2 mg may be given in divided doses of 0.25-0.5 mg at 1-minute intervals to increase heart rate, or the dobutamine infusion rate may be increased to 50 micrograms/kg/min. This stress-test scheme is NOT the inotropic support regimen and must not be used as one. Source: eMC SPC for Dobutamine 12.5 mg/ml concentrate for solution for infusion.

Paediatric dose

Dose: 5 micrograms/kg

Route: Continuous intravenous infusion using an infusion pump; dilute to a concentration of 0.5 to 1 mg/mL (maximum 5 mg/mL if fluid restricted) with glucose 5% or sodium chloride 0.9%, and infuse higher concentration solutions through a central venous catheter only

Frequency: Per minute - i.e. an initial dose of 5 micrograms/kg/minute for all paediatric age groups (neonates to 18 years), then adjusted according to clinical response to 2-20 micrograms/kg/minute

Max: No absolute paediatric ceiling is stated; the SPC cautions that the maximum tolerated dosage for children is believed to be LOWER than for adults and that most adverse reactions (tachycardia in particular) were observed at doses of 7.5 micrograms/kg/minute or more

UNIT IS MICROGRAMS/KG/MINUTE - this is an infusion rate, not a per-dose milligram amount. eMC section 4.2: 'For all paediatric age groups (neonates to 18 years) an initial dose of 5 micrograms/kg/minute, adjusted according to clinical response to 2-20 micrograms/kg/minute is recommended. Occasionally, a dose as low as 0.5-1.0 micrograms/kg/minute will produce a response.' The minimum effective dosage for children is believed to be higher than for adults, and there is great variability between paediatric patients in both the threshold plasma concentration and the rate of haemodynamic response, so the required dose cannot be determined a priori and must be titrated, allowing for a supposedly smaller therapeutic width in children. Reducing or terminating the infusion rate is all that is required for rapid reversal of undesirable effects. Neonatal intensive care: dilute 30 mg/kg body weight to a final volume of 50 mL of infusion fluid - an intravenous infusion rate of 0.5 mL/hour then provides a dose of 5 micrograms/kg/minute. Verify all under-18 dosing against a children's formulary before prescribing.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

Contraindications

Hypersensitivity to dobutamine or to any of the excipients, including in patients with bronchial asthma with hypersensitivity to sulfites
Mechanical obstruction of ventricular filling and/or of outflow, such as pericardial tamponade, constrictive pericarditis, hypertrophic obstructive cardiomyopathy or severe aortic stenosis
Hypovolaemic conditions
Phaeochromocytoma
Additional contraindications apply to the stress echocardiography indication only: recent myocardial infarction (within the last 30 days), unstable angina, left main stem stenosis, haemodynamically significant left ventricular outflow obstruction or valvular defect, severe heart failure (NYHA III or IV), predisposition to or history of clinically significant or chronic arrhythmia (particularly recurrent persistent ventricular tachycardia), significant conduction disturbance, acute pericarditis/myocarditis/endocarditis, aortic dissection, aortic aneurysm, poor sonographic imaging conditions and inadequately controlled arterial hypertension

Side effects

Cardiac and vascular (very common): increase of heart rate by 30 beats/min or more, and blood pressure increase of 50 mmHg or more (greater increases in patients with arterial hypertension)
Cardiac and vascular (common): blood pressure decrease, ventricular dysrhythmia, dose-dependent ventricular extrasystoles, increased ventricular frequency in atrial fibrillation, vasoconstriction, anginal pain and palpitations; ventricular tachycardia, ventricular fibrillation and atrial fibrillation are uncommon, and bradycardia, myocardial ischaemia, myocardial infarction and cardiac arrest very rare
Hypersensitivity reactions including rash and eosinophilic myocarditis; the sodium metabisulfite excipient may cause allergic reactions including anaphylaxis and life-threatening or minor asthmatic attacks
Eosinophilia and inhibition of thrombocyte aggregation (the latter only when the infusion is continued over a number of days); hypokalaemia (very rare)
Headache (common); myoclonus has been reported in patients with severe renal failure receiving dobutamine (very rare); bronchospasm and shortness of breath, nausea and exanthema (common)
Paediatric patients: elevation of systolic blood pressure, systemic hypertension or hypotension, tachycardia, headache, and elevation of pulmonary wedge pressure leading to pulmonary congestion and oedema

Interactions

Patients with atrial fibrillation may develop an increased ventricular frequency and should be digitalised prior to dobutamine infusion (SPC section 4.8)
Beta blockers - vasoconstriction may occur, in particular in patients who have previously been treated with beta blockers (SPC section 4.8)
Sodium bicarbonate and other strong alkaline solutions - dobutamine intravenous infusion is incompatible with these (SPC section 4.2)
Dobutamine may interfere with HPLC determination of chloramphenicol (SPC section 4.4)
NOTE: SPC section 4.5 was not retrieved in this bundle - the entries above are drawn from sections 4.2, 4.4 and 4.8; verify the full interactions section

Clinical monograph

How it works

It is a synthetic catecholamine that predominantly stimulates beta-1 adrenoceptors in the myocardium, increasing the force of cardiac contraction (positive inotropy) and, to a lesser extent, heart rate, thereby raising cardiac output.

Prescribing in practice

Administer only via an infusion pump with continuous cardiac and haemodynamic monitoring, as it can provoke tachycardia, arrhythmias and myocardial ischaemia.
Correct hypovolaemia before starting, since dobutamine increases contractility but does not reliably support an inadequate circulating volume.
It can cause vasodilatation and a fall in blood pressure, particularly in volume-depleted patients.

Monitoring

Monitor ECG, heart rate, blood pressure and indices of perfusion or cardiac output continuously during the infusion.

Counselling the patient

Team: titrate to haemodynamic targets and watch for tachyarrhythmia and ischaemia.
Team: ensure adequate intravascular volume before and during infusion.

Evidence & guidelines

Dobutamine is an established first-line inotrope for low cardiac output states in critical care and is recommended in heart-failure guidance for selected patients.

Reference: Surviving Sepsis Campaign 2021; ESC Guidelines on Acute Heart Failure 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

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