Dopamine Hcl In 5% Dextrose (dopamine HCl in dextrose 5 % in water)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Dopamine hydrochloride, an endogenous catecholamine that is the immediate precursor of norepinephrine, is a sympathomimetic agent with prominent dopaminergic and beta1-adrenergic effects at low to moderate doses and alpha-adrenergic effects at high doses.
Dopamine is a naturally-occurring catecholamine that is a precursor to norepinephrine in noradrenergic nerves and a neurotransmitter in certain areas of the CNS and certain peripheral sympathetic nerves. Dopamine exerts its pharmacologic activity by activating dopamine D1 and D2 receptors, alpha1-adrenergic receptors, and beta1-adrenergic receptors. The agonist effects of dopamine on beta-adrenergic receptors in the myocardium result in increased heart rate and contractility from indirect release of norepinephrine.
The predominant therapeutic effect of dopamine is dependent upon the dose that is administered. At low infusion rates of 0.5-2 mcg/kg per minute, the drug activates dopaminergic receptors in the renal, mesenteric, and coronary vasculature, leading to vasodilation. Vasodilation in these vascular beds is accompanied by increased glomerular filtration rate, renal blood flow, sodium excretion, and urine flow.
An increase in urine volume is not usually associated with a decrease in urine osmolarity. At intermediate infusion rates of 2-10 mcg/kg per minute, the drug also stimulates beta1-adrenergic receptors, which enhances myocardial contractility, increases the sinoatrial rate, and enhances cardiac impulse conduction. At low and intermediate doses, total peripheral resistance from alpha-adrenergic activity usually remains unchanged.
At higher therapeutic doses of 10-20 mcg/kg per minute, alpha-adrenergic receptors are stimulated, causing vasoconstriction and increased blood pressure. Vasoconstriction is first observed in skeletal muscle beds, and then in renal and mesenteric vessels at higher doses. At very high infusion rates (>20 mcg/kg per minute), stimulation of alpha-adrenergic receptors predominates and vasoconstriction can compromise limb circulation and override dopaminergic effects, which reverses renal dilation and natriuresis.
Following IV administration, the onset of action of dopamine occurs within 5 minutes, and the drug has a duration of action of less than 10 minutes. Dopamine is widely distributed in the body but does not cross the blood-brain barrier to a substantial extent. It is not known if dopamine crosses the placenta.
Dopamine has a plasma half-life of about 2 minutes. In neonates, the elimination half-life of dopamine reportedly is 5-11 minutes. About 75% of a dose of dopamine is metabolized in the liver, kidneys, and plasma by monoamine oxidase (MAO) and catechol-O-methyltransferase to the inactive compounds homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid.
In patients receiving MAO inhibitors, the duration of action of dopamine may be as long as 1 hour. About 25% of a dose of dopamine is metabolized to norepinephrine within the adrenergic nerve terminals. Dopamine is excreted in urine principally as HVA and its sulfate and glucuronide conjugates and as 3,4-dihydroxyphenylacetic acid.
A very small fraction of a dose is excreted unchanged. Following administration of radiolabeled dopamine, approximately 80% of the radioactivity reportedly is excreted in urine within 24 hours.
Generic name: dopamine HCl in dextrose 5 % in water
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
The following indications are listed for Dopamine Hcl In 5% Dextrose:
- Acute Hypotension
- Cardiogenic Shock
- Hypotension Due To Distributive Shock
Also known as: Acutely Decreased Blood Pressure.
Dosing
The rate and duration of dopamine hydrochloride infusion should be individualized and carefully adjusted to achieve the desired hemodynamic and renal response as indicated by heart rate, blood pressure, urine flow, and, whenever possible, measurement of central venous or pulmonary wedge pressure and cardiac output.
When discontinuing an infusion, it may be necessary to gradually decrease the dose of dopamine while expanding blood volume with IV fluids to prevent a recurrence of hypotension. Sudden discontinuance of dopamine can result in marked hypotension.
Dopamine hydrochloride is administered by IV infusion using an infusion pump or other apparatus to control the rate of flow, preferably in an intensive care setting. Precise control of the infusion rate is essential to avoid inadvertent administration of a bolus dose. To minimize the risk of necrosis, infusion of dopamine should be given into a large vein. Care must be taken to avoid extravasation because local necrosis may result.
Dopamine also has been administered by intraosseous infusion+ in the setting of advanced cardiovascular life support (ACLS), generally when IV access is not readily available.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*Pheochromocytoma.
*Uncorrected tachyarrhythmias or ventricular fibrillation.
*Dopamine solutions containing dextrose may be contraindicated in patients with a known allergy to corn or corn products.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
The most common adverse effect with IV dopamine is localized vasoconstriction due to extravasation.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
No enhanced messaging available.
The manufacturer states that safety and efficacy of IV dopamine infusions have not been established in children; however, the drug has been used in pediatric patients of all age groups from neonates onward. Except for vasoconstrictive effects caused by inadvertent infusion of dopamine into the umbilical artery, adverse effects unique to the pediatric population have not been identified, nor have adverse effects identified in adults been found to be more common in pediatric patients. The usual dosage in children has been similar to that in adults on a mcg/kg per minute basis. Because of potential variability in clearance in the neonate and newborn, low dosages and slow titration should be used.
Reproduction studies in rats and rabbits using IV dopamine hydrochloride dosages up to 6 mg/kg daily during organogenesis have not revealed evidence of teratogenicity or embryotoxicity; however, maternal toxicity (e.g., decreased body weight gain, death) was observed in rats. In a study in rats, dosages of 10 mg/kg daily either throughout gestation or for 5 days beginning on day 10 or 15 of gestation, resulted in decreased body weight gain, increased mortality, and slight increases in cataract formation in the offspring.
There are no human data to date using dopamine hydrochloride in pregnant women, and the drug should be used during pregnancy only when the potential benefits justify the possible risks to the fetus. Hypotension associated with distributive shock or reduced cardiac output is considered a medical emergency in pregnancy that can be fatal if left untreated and increases the risk of maternal and fetal morbidity and mortality. At least one manufacturer states that life-sustaining therapy for the pregnant woman should not be withheld due to potential concerns regarding the effects of dopamine on the fetus.
If a vasopressor (e.g., dopamine) is used during labor in conjunction with oxytocic drugs, the vasopressor effect may be potentiated and result in severe hypertension.
It is not known whether dopamine is distributed into human milk. The effects of dopamine on the breast-fed infant and the effects on milk production are not known.
The manufacturer states that if dopamine hydrochloride is used in geriatric patients, the initial dosage usually should be at the low end of the dosage range since renal, hepatic, and cardiovascular dysfunction and concomitant disease or other drug therapy are more common in this age group than in younger patients.
Clinical studies of dopamine hydrochloride did not include sufficient numbers of patients >=65 years of age to determine whether geriatric patients respond differently than younger patients. Clinical experience to date has not identified any differences in responses between geriatric and younger patients. If dopamine is used in geriatric patients, the initial dosage of the drug usually should be at the low end of the dosage range, and caution should be exercised since renal, hepatic, and cardiovascular dysfunction and concomitant disease or other drug therapy are more common in this age group than in younger patients.
ICD codes
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Last reviewed · Source: First Databank (FDB) drug data
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