dobutamine hydrochloride: clinical use

Prescribing considerations

• Correct hypovolaemia before administration.
• Use particular caution in severe coronary disease, myocardial ischaemia, acute heart failure, atrial fibrillation, hyperthyroidism and paediatric patients.
• Stress echocardiography requires an experienced physician, continuous echocardiographic and cardiovascular monitoring, resuscitation-trained staff and immediately available emergency equipment.
• Prolonged continuous exposure can produce tachyphylaxis.
• Consider sodium content and sodium metabisulfite, particularly in sulfite-sensitive asthma.

Contraindications and cautions

• Hypersensitivity to dobutamine or an excipient, including sulfite hypersensitivity in a patient with asthma.
• Mechanical obstruction of ventricular filling or outflow, including tamponade, constrictive pericarditis, hypertrophic obstructive cardiomyopathy or severe aortic stenosis.
• Uncorrected hypovolaemia.
• Phaeochromocytoma.
• Stress-testing contraindications additionally include recent myocardial infarction, unstable angina, significant coronary, valvular or outflow disease, severe heart failure, important arrhythmia or conduction disease, acute cardiac inflammation, aortic dissection or aneurysm, and uncontrolled hypertension.

Monitoring

• Continuous or frequent heart rate, ECG rhythm and blood-pressure assessment.
• Clinical perfusion, urine output and infusion-site checks.
• Serum potassium and other relevant electrolytes.
• Cardiac output and filling-pressure measurements where clinically available.
• Continue observation after stopping until cardiovascular status is stable.

Clinical pharmacology

A direct-acting synthetic catecholamine with predominantly cardiac beta-1 agonism and additional alpha-1, beta-2 and alpha-2 activity. It increases contractility and stroke volume. Rapid tissue and hepatic metabolism produces a very short plasma half-life.

Formulation and product differences

• The selected product is a clear, colourless or slightly yellow solution supplied in ampoules or vials.
• It contains sodium metabisulfite and sodium chloride.
• It may be administered undiluted by a suitable syringe pump or diluted using compatible infusion fluids.
• It is incompatible with alkaline solutions and several injectable medicines; check compatibility before mixing.
• A pink colour that darkens over time can result from oxidation and does not necessarily indicate clinically important loss of activity when storage requirements have been followed.

Solution for infusion

Route: Intravenous

Strengths: 5 mg/mL, 12.5 mg/mL