What is the use of Dobutamine (Dobutamine hydrochloride)?

From the Guidelines

Dobutamine should be used at a dosage of 2–3 mg/kg/min infusion rate without a loading dose, with progressive modification according to symptoms, diuretic response, or clinical status, as recommended by the European Society of Cardiology 1.

Key Points

• Dobutamine is a synthetic catecholamine medication used for short-term treatment of heart failure and cardiogenic shock, stimulating beta-1 adrenergic receptors to increase cardiac contractility and output 1.
• The typical dosage ranges from 2.5 to 20 mcg/kg/minute administered as a continuous intravenous infusion, titrated based on clinical response 1.
• Dobutamine is not suitable for long-term therapy and is generally limited to hospital settings where continuous cardiac monitoring is available 1.
• Side effects may include tachycardia, arrhythmias, headache, and increased myocardial oxygen demand, with caution warranted in patients with hypertrophic cardiomyopathy, atrial fibrillation, or recent myocardial infarction 1.
• Dobutamine stress echocardiography is also used diagnostically to assess cardiac function and detect coronary artery disease by evaluating wall motion abnormalities under pharmacological stress 1.

Dosage and Administration

• The infusion rate may be progressively modified according to symptoms, diuretic response, or clinical status, with a maximum dose of 15 mg/kg/min 1.
• In patients receiving beta-blocker therapy, dobutamine doses may have to be increased to as high as 20 mg/kg/min to restore its inotropic effect 1.
• Care should be exercised in weaning patients from dobutamine infusion, with gradual tapering and simultaneous optimization of oral therapy essential 1.

From the FDA Drug Label

INDICATIONS AND USAGE Dobutamine Injection, USP is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures Experience with intravenous dobutamine in controlled trials does not extend beyond 48 hours of repeated boluses and/or continuous infusions Whether given orally, continuously intravenously, or intermittently intravenously, neither dobutamine nor any other cyclic-AMP-dependent inotrope has been shown in controlled trials to be safe or effective in the long-term treatment of congestive heart failure

The primary use of dobutamine is for short-term inotropic support in patients with cardiac decompensation due to depressed contractility.

• Key indications include:
  • Organic heart disease
  • Cardiac surgical procedures
• Important limitations:
  • Not safe or effective for long-term treatment of congestive heart failure 2
  • Limited experience beyond 48 hours of repeated boluses and/or continuous infusions 2

From the Research

Dobutamine Overview

• Dobutamine is a cardiac inotrope used in the treatment of congestive heart failure and cardiogenic shock 3, 4, 5, 6, 7
• It improves cardiac output, decreases pulmonary wedge pressure, and decreases total systemic vascular resistance with little effect on heart rate or systemic arterial pressure 7

Comparison with Milrinone

• Studies have compared the efficacy of dobutamine with milrinone in patients with cardiogenic shock and acute decompensated heart failure 3, 4, 5, 6
• Some studies found no significant difference between the two in terms of primary composite outcome or important secondary outcomes 3, 6
• Others found that milrinone was associated with a lower risk of mortality in patients with acute decompensated heart failure 5
• Dobutamine may be associated with a shorter hospital length of stay, but also a potential for increased all-cause mortality 4

Adverse Events

• Arrhythmias were more common in patients treated with dobutamine than milrinone 6
• Hypotension occurred to a similar extent in both groups, but milrinone was more commonly discontinued due to hypotension 6
• Dobutamine was more commonly discontinued due to arrhythmia 6

Chronic Intermittent Infusions

• Chronic intermittent infusions of dobutamine have been shown to provide sustained clinical and hemodynamic improvement in patients with congestive heart failure 7
• The mechanism by which dobutamine creates this effect is not entirely known, but it may exert a physical conditioning effect similar to exercise 7