| Name: |
DOPAMINE (IntropinR) |
| Classification: |
sympathomimetic
- beta receptors - increases myocardial contractility
- alpha receptors - vasoconstriction
- dopamine has not been shown to improve renal function when administered at low doses (dopaminergic doses).
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| Dose: |
- beta dose
- 5 - 10 mcg/kg/min (titrate to desired target such as HR, blood pressure or cardiac output)
- alpha dose
- > 15 mcg/kg/min (titrate to desired target; dopamine is not the first line agent when alpha dose therapy alone is desired)
|
| Administration: |
IV Infusion
400 mg/250 mL dextrose 5%, normal saline 0.9% or Ringer's Lactate
- yellow or brown discolouration indicates loss of potency; discard discoloured solutions
- hypovolemia, acidosis and hypoxemia should be corrected concurrently with therapy
- should be weaned-off
|
| Contraindictions: |
- Hypersensitivity to dopamine or components (contains a sulfite preservative) - a relative contraindication and would not usually apply to emergency situations
- Pheochromocytoma
|
| Adverse Effects: |
- Tachycardia
- Arrhythmias, wide QRS
- Increased afterload; increased myocardial O2 consumption
- Decreased peripheral perfusion
- Hyperglycemia
- Hypokalemia
- Acute kidney injury (doses > 20 ug/kg/min)
- Mesenteric ischemia
- Fixed, dilated pupils
- Anxiety, headaches
- Piloerection
- Dyspnea
- Dopamine is an irritant that can cause severe tissue injury; extravasation of drug may cause tissue necrosis (Rx with 5-15 mg phentolamine in NS - see phentolamine monograph)
Special Risk for Torsades de Pointes (TdP):
Dopamine does not prolong the QT interval, BUT has a special risk of TdP because of its other actions; which includes epinephrine-like effects. It should be avoided in patients with Congenital Prolonged QT Syndrome (CLQTS). Physicians with expertise in the treatment of these arrhythmias may prescribe dopamine to carefully selected patients with CLQTS.
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| Drug Interactions: |
- dopamine + IV phenytoin = decreased BP
- dopamine + inhalational anaesthetics = increased risk of ventricular arrhythmias
- dopamine + alpha blocking agents = blockade of inotropic effect
- dopamine + beta blocking agents = blockade of inotropic effect
- dopamine + other sympathomimetic agents = increased risk of toxicity
|
| Monitoring Therapy: |
- IV insertion site
- Continuous heart rate and ECG rhythm
- Blood pressure
- Hourly urine output
- Changes in skin colour
- Central or mixed venous oxygen
- Lactate
- Cardiac index if available
- Blood gases
- Blood glucose
- Electrolytes
- NOTE: although the use of dopamine has not been shown to improve renal function when it is administered for the sole purpose of stimulating dopaminergic receptors (low dose infusions), dopamine may indirectly improve renal function if it is administered at doses that improve cardiac output.
|
| Adult Critical Care Protocol: |
- May be administered by IV infusion by a nurse in Adult Critical Care.
- May be titrated by a nurse in Adult Critical Care.
- Must be administered via central venous access device if protocol for peripheral vasopressor administration cannot be met; in emergency situations may be temporarily infused through a peripheral vascular access device until a central venous line can be established.
- Monitor peripheral site closely and document Infiltration and Phlebitis scale Q1H. Knowledge of the treatment for infiltration of vasoconstricting drugs is required.
- Single agent dopamine or norepinephrine may be administered for up to 24 hours when short term use is anticipated; follow the Administration of Peripheral Vasopressors Policy for required orders, timelines, assessment and documentation.
- Patient requires placement of an arterial line to monitor BP and titrate drug. Single agent dopamine or norepinephrine infusions anticipated to be required for less than 24 hours may be managed with non-invasive blood pressure monitoring. Follow the Deferral of Arterial Line Placement Policy for required orders, timelines, assessment and documentation.
- Continuous infusions must be administered by infusion device and the pump library must be enabled.
- Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).
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