DOPamine

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

DOPamine

Indication

  • An inotropic agent used to improve cardiac output and renal perfusion in neonates with shock or hypotension

Dosage Guidelines

  • Initial dose 5 microgram/kg/min by continuous IV infusion. Titrate to patient response every 15 to 30 minutes
  • Usual dose range is 5-20 microgram/kg/min 

Administation

  • IV continuous infusion

  • For patients 0.5 kg or less:

    Use DOPamine 800 mcg/mL

    To make 50 mL of DOPamine [800 mcg/mL]

    [40 mg/50mL]:

    Add 25 mL (40 mg) of DOPamine [1600 mcg/mL premix] to 25 mL of D5W

  • For patients over 0.5 kg:

    Use DOPamine 1600 mcg/mL

    To make 50 mL of DOPamine [1600 mcg/mL]

    [80 mg/50mL]:

    The Pyxis machines stock a premix bag of 400 mg/250 mL [1600 mcg/mL]. Draw up 50 mL of this solution

  • Administer via central line whenever possible

Adverse Effects

  • Increased heart rate, ventricular arrhythmias, tissue necrosis and vasoconstriction (at doses greater than or equal to 10 mcg/kg/min over prolonged periods)
  • High dose dopamine (greater than10 mcg/kg/min) may have an unpredictable effect on pulmonary arterial pressure and change the systemic to pulmonary arterial pressure ratio allowing right to left shunting across the patent ductus arteriosus and potentially aggravating tissue hypoxia.

Comments

  • Monitor blood pressure, urine output, ECG, heart rate, and O2 saturation 
  • Avoid veins close to forehead
  • Hypovolemia should be corrected prior to use
  • Check IV site for extravasation often
  • If extravasation occurs, consider use of phentolamine  
  • Clearance of dopamine is gestation dependent and can be markedly decreased in sick neonates.

Supplied As

  • Commercial premixed 1600mcg/mL solution as 400mg in 250mL D5W
  • Supplied by pharmacy as standard concentrations:
    • 0.5kg or less: 800mcg/mL, supplied as 40mg in 50mL D5W
    • Over 0.5kg: 1600mcg/mL, supplied as 80mg in 50mL D5W
  • At LHSC, standard concentration reference charts are available on the NICU Intranet site

References

Lexi- Sick Kids, Lexi Pediatric and Neonatal, Joynt C, Cheung PY. Treating Hypotension in Preterm Neonates with Vasoactive Medications. Front Pediatr. 2018 Apr 13; 6:86