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Positive inotrope (beta-1 agonist) Pregnancy: Use only in life-threatening maternal emergency.

Dobutamine

Brand names: Dobutamine Injection

Adult dose

Dose: 2.5–10 micrograms/kg/min IV; range 2–20 micrograms/kg/min
Route: IV infusion (central or large peripheral vein)
Frequency: Continuous infusion titrated to response
Max: 20 micrograms/kg/min (rarely 40 in extremis)
Cardiogenic shock / acute decompensated HF: start 2.5 mcg/kg/min, titrate to response. Combination with vasopressor (noradrenaline) for cardiogenic shock with hypotension. Maximum dose limited by tachyarrhythmia. Stress echocardiography: 5–40 mcg/kg/min protocol.

Paediatric dose

Dose: 5 mcg/min/kg
Route: IV
Frequency: Continuous infusion
Max: 20 micrograms/kg/min
Concentration: 1000 mcg/min/ml
Neonates and children: 2–20 mcg/kg/min. Titrate to MAP and CO targets. Neonatal use: 5–10 mcg/kg/min (start low). Weight-based syringe driver calculations essential.

Dose adjustments

Renal

No specific dose adjustment.

Hepatic

No specific dose adjustment.

Paediatric weight-based calculator

Neonates and children: 2–20 mcg/kg/min. Titrate to MAP and CO targets. Neonatal use: 5–10 mcg/kg/min (start low). Weight-based syringe driver calculations essential.

Clinical pearls

  • Primarily inotropic (increases cardiac contractility and HR) — used for low CO despite adequate filling pressures
  • Does not significantly vasoconstrict — combine with noradrenaline for hypotensive cardiogenic shock
  • Limit dose by tachycardia (>120 bpm generally requires dose reduction)
  • Short half-life (~2 min) — effects quickly titratable
  • Milrinone: alternative inotrope via PDE inhibition — also vasodilatory

Contraindications

  • Tachyarrhythmias
  • Obstructive cardiomyopathy (HOCM)
  • Phaeochromocytoma

Side effects

  • Tachycardia (dose-limiting)
  • Ventricular arrhythmias
  • Hypertension or hypotension
  • Palpitations
  • Headache and tremor

Interactions

  • Beta-blockers — antagonise inotropic effect
  • Halothane — cardiac sensitisation to catecholamines

Monitoring

  • Cardiac output/BP
  • HR (ECG)
  • Arrhythmias
  • Fluid balance

Reference: BNFc; BNF; ESC Cardiogenic Shock Guidelines; NICE NG106. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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