What about dobutamine (dobutamine hydrochloride)?

From the Guidelines

Dobutamine is a synthetic catecholamine that primarily stimulates beta-1 adrenergic receptors in the heart, increasing cardiac contractility and output, and its use should be guided by the most recent and highest quality evidence, which recommends a dosage range of 2-20 mcg/kg/minute administered as a continuous intravenous infusion, titrated to achieve the desired hemodynamic response 1.

Key Points to Consider

• Dobutamine is typically used in acute settings for patients with decompensated heart failure, cardiogenic shock, or during stress echocardiography, as stated in the guidelines for the diagnosis and treatment of acute and chronic heart failure 1.
• The medication should be used cautiously in patients with hypertrophic cardiomyopathy, severe aortic stenosis, or recent myocardial infarction, due to the potential for adverse effects such as tachycardia, arrhythmias, and myocardial ischemia 1.
• Continuous cardiac monitoring is essential when administering dobutamine, as it can cause significant changes in heart rate and blood pressure, and the medication should be titrated to achieve the desired hemodynamic response 1.
• Dobutamine has a short half-life of about 2 minutes, allowing for quick titration and discontinuation if adverse effects occur, and it's not suitable for long-term management, but rather as a bridge to more definitive therapies or recovery 1.

Administration and Monitoring

• The usual dosage range for dobutamine is 2-20 mcg/kg/minute administered as a continuous intravenous infusion, and the infusion rate may be progressively modified according to symptoms, diuretic response, or clinical status 1.
• Blood pressure should be monitored, invasively or non-invasively, and care should be exercised in weaning patients from dobutamine infusion, with gradual tapering and simultaneous optimization of oral therapy being essential 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, and the elimination of the drug is rapid after cessation of infusion 1.

From the FDA Drug Label

ADVERSE REACTIONS Increased Heart Rate, Blood Pressure, and Ventricular Ectopic Activity − A 10 to 20 mm increase in systolic blood pressure and an increase in heart rate of 5 to 15 beats/minute have been noted in most patients (see WARNINGS regarding exaggerated chronotropic and pressor effects). Approximately 5% of patients have had increased premature ventricular beats during infusions These effects are dose related. Hypotension − Precipitous decreases in blood pressure have occasionally been described in association with dobutamine therapy. Reactions at Sites of Intravenous Infusion − Phlebitis has occasionally been reported. Miscellaneous Uncommon Effects − The following adverse effects have been reported in 1% to 3% of patients: nausea, headache, anginal pain, nonspecific chest pain, palpitations and shortness of breath. Isolated cases of thrombocytopenia have been reported Administration of dobutamine hydrochloride, like other catecholamines, can produce a mild reduction in serum potassium concentration, rarely to hypokalemic levels (see PRECAUTIONS).

Dobutamine (dobutamine hydrochloride) can cause:

• Increased heart rate and blood pressure
• Ventricular ectopic activity
• Hypotension
• Phlebitis at the site of intravenous infusion
• Miscellaneous uncommon effects such as nausea, headache, and shortness of breath
• Thrombocytopenia and hypokalemia in rare cases 2

From the Research

Dobutamine Overview

• Dobutamine is a cardiac inotrope used in the acute treatment of congestive heart failure, improving cardiac output and decreasing pulmonary wedge pressure and total systemic vascular resistance 3.
• It has been observed to have a sustained clinical benefit for weeks to months after discontinuation, but tolerance can develop with infusions lasting 72 hours or longer 3.

Clinical Applications

• Dobutamine has been used in chronic intermittent infusions to treat congestive heart failure, with studies showing sustained clinical and hemodynamic improvement in patients 3, 4.
• It is also used in patients with acute decompensated heart failure and cardiogenic shock, although a meta-analysis suggests that milrinone may have a marginal benefit over dobutamine in these patients 5.
• In septic shock patients, dobutamine's effects can be heterogenous and unpredictable, and it may behave as a chronotropic and vasodilatory drug without inotropic action 6.

Safety and Outcome Predictors

• Long-term dobutamine therapy can lessen symptoms of congestive heart failure and improve exercise tolerance and cardiac function, but it does not prolong survival in most patients 4.
• Home dobutamine intravenous infusion can be a solution for end-stage heart failure patients, with a one-year survival rate of 32% and few adverse events related to the intravenous catheter 7.
• Biological markers such as glomerular filtration rate and brain natriuretic peptide level can predict one-year survival in patients receiving home dobutamine infusion 7.