dopamine hydrochloride: clinical use

Prescribing considerations

• Correct hypovolaemia where appropriate before infusion.
• Identify and correct hypoxia, hypercapnia and acidosis.
• Assess peripheral vascular disease carefully because vasoconstriction may cause limb ischaemia.
• Use dextrose-containing diluents cautiously in diabetes.
• Safety and efficacy in children are not established in the selected product licences; paediatric use requires specialist local governance.

Contraindications and cautions

• Hypersensitivity to dopamine or product excipients.
• Phaeochromocytoma.
• Uncorrected atrial or ventricular tachyarrhythmias or ventricular fibrillation.
• One selected product lists hyperthyroidism and cyclopropane or halogenated anaesthetics as contraindications; the other states dopamine should not be used or should be avoided in these circumstances.
• Use additional caution with narrow-angle glaucoma or benign prostatic hyperplasia with urinary retention where specified by the product.

Monitoring

• Continuous blood pressure, heart rate and ECG or rhythm assessment.
• Urine output, peripheral perfusion and cardiac output where clinically indicated.
• Infusion site and limb colour and temperature for extravasation or ischaemia.
• Fluid balance, electrolytes and acid-base status, especially during prolonged treatment.
• Reassess the response if tachyarrhythmia, ectopic beats or falling urine output develops.

Clinical pharmacology

Dopamine acts directly at beta-1 and dopaminergic receptors and indirectly releases noradrenaline. Alpha-adrenergic vasoconstriction becomes more prominent at greater exposure. It is rapidly metabolised by monoamine oxidase and catechol-O-methyltransferase and has a very short plasma half-life.

Formulation and product differences

• Both selected products are single-use intravenous concentrates requiring dilution; their listed compatible diluents are not identical.
• One selected product contains potassium metabisulfite, sodium chloride and pH-adjusting agents; the other contains sodium metabisulfite and sodium.
• Sulfite excipients may cause allergic reactions or bronchospasm in susceptible people.
• Follow product-specific storage, dilution and compatibility instructions; dopamine is incompatible with alkaline solutions such as sodium bicarbonate.

Solution for infusion

Route: Intravenous

Strengths: 40 mg/mL, 200 mg/5 mL