What is the recommended dopamine infusion dosage for treating bradycardia (abnormally slow heart rate)?

From the Guidelines

For bradycardia, dopamine should be administered at a dosage of 5 to 20 mcg/kg/min intravenously, starting at 5 mcg/kg/min and increasing by 5 mcg/kg/min every 2 min, as recommended by the 2018 ACC/AHA/HRS guideline 1. This guideline provides the most recent and highest quality evidence for the management of bradycardia.

Key Considerations

• The dosage of dopamine should be titrated to achieve the desired heart rate response, with careful monitoring of vital signs, including heart rate, blood pressure, ECG changes, and urine output.
• At low doses (5-10 mcg/kg/min), dopamine primarily stimulates dopaminergic receptors and beta-1 adrenergic receptors, increasing heart rate and cardiac contractility without significant vasoconstriction.
• Higher doses (10-20 mcg/kg/min) provide additional chronotropic and inotropic effects.
• Alternative treatments, such as atropine (0.5-1 mg IV) or isoproterenol, should be considered if dopamine is ineffective or contraindicated.

Monitoring and Precautions

• Continuous monitoring of the patient's heart rate, blood pressure, and ECG changes is essential to avoid excessive doses, which may cause tachyarrhythmias, hypertension, or tissue ischemia.
• The patient's urine output should also be monitored to assess renal function and adjust the dopamine dosage as needed.

Comparison with Other Guidelines

• The 2018 ACC/AHA/HRS guideline 1 provides the most recent and highest quality evidence for the management of bradycardia, and its recommendations should be followed.
• Other guidelines, such as the 2018 ACC/AHA/HRS guideline published in the Journal of the American College of Cardiology 1 and the executive summary of the 2018 ACC/AHA/HRS guideline 1, provide similar recommendations for the use of dopamine in bradycardia.

From the FDA Drug Label

DOSAGE & ADMINISTRATION ... Begin infusion of dopamine hydrochloride solution at doses of 2 to 5 mcg/kg/min in adult or pediatric patients who are likely to respond to modest increments of heart force and renal perfusion In more seriously ill patients, begin infusion of dopamine hydrochloride at doses of 5 mcg/kg/min and increase gradually, using 5 to 10 mcg/kg/min increments, up to a rate of 20 to 50 mcg/kg/min as needed.

The dopamine infusion dosage in bradycardia is 2 to 5 mcg/kg/min initially, and may be increased gradually as needed, up to a rate of 20 to 50 mcg/kg/min. 2

From the Research

Dopamine Infusion Dosage in Bradycardia

• The dosage of dopamine infusion in bradycardia is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, the study 3 mentions that unstable bradycardic patients who failed to respond to a fluid bolus and up to 3mg atropine were enrolled, and dopamine was used as an intervention.
• The study 4 compares the clinical outcomes of various management strategies for symptomatic bradycardia, including observation, non-invasive management, and permanent pacemaker implantation, but does not provide information on dopamine infusion dosage.
• The other studies 5, 6, 7 focus on different aspects of bradycardia management, such as the use of anticholinergic drugs, physiologic pacing, and evaluation and management of bradycardia, but do not provide information on dopamine infusion dosage.
• Therefore, there is no specific information available on the dopamine infusion dosage in bradycardia from the provided studies 3, 4, 5, 6, 7.