Inotrope (Beta-1 Agonist)
Pregnancy: Use with caution — limited data; use in life-threatening cardiogenic shock
Dobutamine (ICU — Inotrope)
Brand names: Dobutrex
Adult dose
Dose: 2.5–20 mcg/kg/min IV infusion
Route: IV infusion
Frequency: Continuous
Max: 40 mcg/kg/min (rarely used)
First-line inotrope for cardiogenic shock with low cardiac output. Predominantly beta-1 agonist — increases contractility and HR. Some beta-2 (mild vasodilation). Do NOT use in hypovolaemia without volume resuscitation first. Central line preferred but can be given peripherally for short periods.
Paediatric dose
Dose: 2–20 mcg/min/kg
Route: IV infusion
Frequency: Continuous
Max: 40 mcg/kg/min
Paediatric cardiogenic shock: 2–20 mcg/kg/min titrated to cardiac output under specialist guidance.
Dose adjustments
Renal
No dose adjustment — titrate to haemodynamic response.
Hepatic
No dose adjustment required.
Paediatric weight-based calculator
Paediatric cardiogenic shock: 2–20 mcg/kg/min titrated to cardiac output under specialist guidance.
Clinical pearls
- Surviving Sepsis 2021: dobutamine added if cardiac dysfunction/low CO persists despite adequate filling and vasopressors — not recommended routinely
- Tolerance develops after 72 hours — consider milrinone or levosimendan for prolonged inotropic support
- Unlike adrenaline, dobutamine does NOT cause significant vasoconstriction — useful when MAP is adequate but CO is low
Contraindications
- HOCM (hypertrophic obstructive cardiomyopathy — outflow tract obstruction worsened)
- Uncorrected hypovolaemia
Side effects
- Tachyarrhythmias (AF, VT)
- Hypotension (beta-2 vasodilation)
- Tachycardia
- Angina/increased myocardial oxygen demand
- Tolerance with prolonged use (>72 hours)
Interactions
- Beta-blockers (antagonise inotropic effect)
- MAOIs (potentiate)
- Volatile anaesthetics (sensitise myocardium to arrhythmias)
Monitoring
- Cardiac output monitoring (PA catheter, PICCO, echocardiography)
- ECG (arrhythmia)
- BP, HR
- Lactate clearance
Reference: BNFc; BNF 90; Surviving Sepsis Campaign 2021; ESC Guidelines on Acute Heart Failure 2021. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- MAGGIC Heart Failure Risk Score · Heart Failure
- Long QT Syndrome (Schwartz Score) · Channelopathy / Sudden Cardiac Death
- C-Peptide to Glucose Ratio · Diabetes Classification
- International Staging System (ISS) for Multiple Myeloma · Multiple Myeloma
- Revised ISS (R-ISS) for Multiple Myeloma · Haematological Malignancy
- International Staging System for Multiple Myeloma (ISS) · Oncology