Catecholamine (Dose-Dependent Vasopressor/Inotrope)
Pregnancy: Use with caution — used in obstetric circulatory collapse when other agents fail
Dopamine (ICU — Vasopressor/Inotrope)
Brand names: Intropin
Adult dose
Dose: Low: 1–5 mcg/kg/min; Intermediate: 5–10 mcg/kg/min; High: 10–20 mcg/kg/min
Route: IV infusion (central line)
Frequency: Continuous
Max: 20–50 mcg/kg/min
Dose-dependent receptor activity: low dose (D1/D2 — renal/mesenteric vasodilation — 'renal-protective dose' concept is DISCREDITED); intermediate (beta-1 — inotropy); high dose (alpha-1 — vasoconstriction). Largely superseded by noradrenaline + dobutamine in current sepsis guidelines.
Paediatric dose
Dose: 2–20 mcg/min/kg
Route: IV infusion
Frequency: Continuous
Max: 20 mcg/kg/min
Neonatal/paediatric haemodynamic support under specialist guidance.
Dose adjustments
Renal
No dose adjustment — titrate to haemodynamic response.
Hepatic
No dose adjustment required.
Paediatric weight-based calculator
Neonatal/paediatric haemodynamic support under specialist guidance.
Clinical pearls
- SOAP II trial (De Backer 2010, NEJM): dopamine vs. noradrenaline in shock — dopamine associated with higher rate of arrhythmias and higher 28-day mortality in cardiogenic shock subgroup. Noradrenaline now preferred first-line.
- 'Renal-dose dopamine' is NOT evidence-based — ANZICS low-dose dopamine trial showed no renoprotective benefit
- Antidote for extravasation: phentolamine 5–10 mg in 10 mL NS, intradermal
Contraindications
- Tachyarrhythmias
- Phaeochromocytoma
- Uncorrected hypovolaemia
Side effects
- Tachyarrhythmias (higher rate than noradrenaline)
- Extravasation necrosis
- Nausea/vomiting
- Immunosuppression (inhibits prolactin/TSH)
Interactions
- MAOIs (hypertensive crisis)
- Phenytoin (hypotension — avoid concurrent IV infusion)
Monitoring
- Continuous ECG (arrhythmia)
- Arterial line BP
- Urine output
- Peripheral perfusion
Reference: BNFc; BNF 90; SOAP II Trial (NEJM 2010); Surviving Sepsis Campaign 2021; BNFc. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators