Dobutamine (Acute HF / Stress Echo)

Source: eMC SPC for Dobutamine 12.5 mg/mL concentrate for solution for infusion, §4.2. DOBUTAMINE STRESS ECHOCARDIOGRAPHY (ADULT POPULATION ONLY): administration is by gradually increasing infusion; the most frequently applied scheme starts at 5 micrograms/kg/min, increased every 3 minutes to 10, 20, 30, then 40 micrograms/kg/min until a diagnostic endpoint is reached. If no endpoint is reached, atropine sulfate may be given at 0.5 to 2 mg in divided doses of 0.25–0.5 mg at 1-minute intervals to increase the heart rate; alternatively the dobutamine infusion rate may be increased to 50 micrograms/kg/min. Stress echocardiography may only be performed by a physician with sufficient personal experience of dobutamine for this indication, with continuous echocardiographic and ECG monitoring, blood pressure control, resuscitation-trained staff and emergency drugs/defibrillator available; fatal cardiac rupture has been reported very rarely. Infusion solutions should be prepared immediately before use. Reduce the dose gradually when discontinuing therapy. Duration depends on clinical requirement and should be as short as possible; if administered continuously for more than 72 hours, tolerance (tachyphylaxis) may occur, requiring a dose increase. Monitor heart rate, heart rhythm, blood pressure, diuresis and infusion rate closely; monitor cardiac output, CVP and pulmonary capillary pressure if possible. Correct hypovolaemia before administering dobutamine, and monitor serum potassium. Dobutamine is incompatible with bicarbonate and other strong alkaline solutions, and may interfere with HPLC determination of chloramphenicol. Worked infusion-rate tables for 50/70/90 kg patients at 2.5, 5 and 10 micrograms/kg/min are given in the SPC for both infusion-delivery systems (250 mg in 500 mL, final concentration 0.5 mg/mL) and syringe pumps (250 mg in 50 mL, final concentration 5 mg/mL) — for double concentration the infusion rates must be halved. No eMC §4.5 interaction text and no renal dosing statement were captured in the fetched source; verify both against the full SPC.

eMC §4.2 verbatim: '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 in children is believed to be higher, and the maximum tolerated dosage lower, than in adults; the required dose cannot be determined a priori and must be titrated. Reducing or stopping the infusion rapidly reverses undesirable effects. Dilution for continuous infusion by pump: 0.5 to 1 mg/mL (maximum 5 mg/mL if fluid restricted) with glucose 5% or sodium chloride 0.9% — infuse higher-concentration solutions through a central venous catheter only. 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. Dobutamine stress echocardiography is for the ADULT population only; paediatric experience is limited to patients requiring positive inotropic support. Verify all under-18 dosing against a children's formulary before prescribing.