What is the dosage and use of intravenous (IV) dopamine (intropin)?

From the Guidelines

Dopamine should be administered at a dosage of 2-20 mcg/kg/minute as a continuous intravenous infusion, titrated to the desired hemodynamic response, with careful monitoring of cardiac function and potential side effects, as recommended by the most recent and highest quality study 1.

Key Considerations for Dopamine Administration

• The dosage range for dopamine is 2-20 mcg/kg/minute, which can be adjusted based on the patient's response to treatment.
• Dopamine should be diluted in D5W or normal saline to a concentration of 400-1600 mcg/mL and administered via a central line when possible.
• Continuous cardiac monitoring is essential during administration to minimize the risk of adverse effects.
• Dopamine can cause tachycardia, arrhythmias, and tissue necrosis if extravasation occurs, and should be used cautiously in patients with tachyarrhythmias, pheochromocytoma, or those taking MAO inhibitors.

Clinical Applications of Dopamine

• Dopamine is primarily used to treat shock states, particularly cardiogenic and septic shock, by improving cardiac output and maintaining blood pressure.
• It can also be used to treat hypotension, with a starting dose of 5 mcg/kg/minute and gradual increases of 5-10 mcg/kg/minute every 5-10 minutes until the target blood pressure is achieved.
• Lower doses of dopamine (1-5 mcg/kg/minute) primarily affect dopaminergic receptors, improving renal blood flow, while intermediate doses (5-10 mcg/kg/minute) stimulate beta-adrenergic receptors, increasing cardiac output.
• Higher doses of dopamine (>10 mcg/kg/minute) activate alpha-adrenergic receptors, causing vasoconstriction, and should be used with caution due to the risk of adverse effects 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION ... Rate of Administration: ... Each patient must be individually titrated to the desired hemodynamic or renal response to dopamine. ... Suggested Regimen:

1. When appropriate, increase blood volume with whole blood or plasma until central venous pressure is 10 to 15 cm H2O or pulmonary wedge pressure is 14 to 18 mm Hg.
2. 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. ... More than 50% of adult patients have been satisfactorily maintained on doses less than 20 mcg/kg/min

The dosage of dopamine is typically started at 2 to 5 mcg/kg/min and can be increased gradually as needed, with a maximum dose of 50 mcg/kg/min. The rate of administration should be controlled using an infusion pump, and the patient's response should be constantly evaluated to adjust the dosage accordingly 2.

• Key considerations for dosage adjustment include:
  • Urine output
  • Blood pressure
  • Cardiac output
  • Peripheral perfusion
• Dose titration should be individualized to achieve the desired hemodynamic or renal response.

From the Research

Dopamine Dosage and Use

• Dopamine is used for its inotropic effect, particularly at low dosages, due to its unique benefit of increasing renal blood flow 3.
• The suggested dosage of dopamine is less than 5-10 micrograms/kg/min, and it should be combined with nitroprusside at higher dosages 3.
• In cases of tachyarrhythmias, dobutamine may be a better option than dopamine 3.
• Dopamine has fallen out of favor due to its adverse effects, and its use is now limited to specific cases, such as bradycardic patients 4, 5.

Vasopressor Therapy

• Vasopressors, including dopamine, are used to treat vasodilatory shock, but norepinephrine is the first-choice vasopressor 4, 5.
• Dopamine may be added to vasopressor therapy if there is a need for increased inotropic activity, but its use is not recommended as a first-line treatment 4, 5.
• The choice and dose of vasopressors vary widely due to patient and physician practice heterogeneity, and there is a need for evidence regarding alternative vasopressors as first-line treatments 4.

Dopamine Receptors and Hypertension

• Dopamine exerts its actions via a class of cell surface receptors belonging to the rhodopsin-like family of G-protein coupled receptors, which are classified into D1-like and D2-like subtypes 6, 7.
• Dopamine receptors play a role in regulating blood pressure by influencing the central and/or autonomic nervous system, epithelial transport, and the secretion and receptors of several humeral agents 6, 7.
• Agonists of both D1-like and D2-like receptor subtypes can lower blood pressure in experimental animals and in hypertensive patients, but the use of dopamine in the treatment of hypertension is limited due to its alpha adrenergic activity and lack of oral availability 7.