What is the use of dobutamine (dobutamine hydrochloride)?

From the Guidelines

Dobutamine is a positive inotropic agent that should be used to treat heart failure and cardiogenic shock by increasing cardiac output, with a recommended initial infusion rate of 2–3 mg/kg/min, which can be progressively modified according to symptoms, diuretic response, or clinical status, as stated in the most recent and highest quality study 1.

Key Points

• Dobutamine acts through stimulation of b1-receptors to produce dose-dependent positive inotropic and chronotropic effects, with its haemodynamic actions being dose-related, which can be increased to 15 mg/kg/min 1.
• The infusion rate may need to be increased to as high as 20 mg/kg/min in patients receiving b-blocker therapy 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 being essential 1.
• Dobutamine has relatively minimal effects on heart rate and peripheral vascular resistance, making it particularly useful when increased cardiac output is needed without wanting to significantly increase myocardial oxygen demand or blood pressure 1.

Administration and Monitoring

• Dobutamine is administered intravenously in hospital settings, with continuous cardiac monitoring required during administration due to potential side effects such as arrhythmias, tachycardia, and hypotension 1.
• Blood pressure should be monitored, invasively or non-invasively, during dobutamine infusion 1.

Clinical Considerations

• The improved diuresis observed during dobutamine infusion in patients with heart failure is the result of increased renal blood flow in response to improved cardiac output 1.
• Prolonged infusion of dobutamine (above 24–48 h) is associated with tolerance and partial loss of haemodynamic effects, and weaning from dobutamine may be difficult due to recurrence of hypotension, congestion, or renal insufficiency 1.

From the FDA Drug Label

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 The use of dobutamine (dobutamine hydrochloride) is for inotropic support in the short-term treatment of patients with:

• Cardiac decompensation due to depressed contractility
• Organic heart disease
• Cardiac surgical procedures 2

From the Research

Uses of Dobutamine

• Dobutamine is a cardiac inotrope useful in the acute treatment of congestive heart failure 3
• It improves cardiac output, decreases pulmonary wedge pressure, and decreases total systemic vascular resistance with little effect on heart rate or systemic arterial pressure 3
• Dobutamine is used in the treatment of patients with acute decompensated heart failure or cardiogenic shock, enhancing myocardial contractibility and leading to increased cardiac output 4
• It is also used in patients with right ventricular infarction, treated with volume expansion and dobutamine 5

Mechanism of Action

• Dobutamine acts on alpha-1, beta-1, and beta-2 adrenergic receptors, producing a relatively strong inotropic effect and a relatively weak chronotropic effect in the heart 6
• In the vasculature, alpha-1 agonist activity balances the beta-2 agonist effect, resulting in a decrease in total peripheral resistance 6
• The expected hemodynamic effects are an increase in cardiac output and a decrease in systemic vascular resistance without significant change in arterial pressure or heart rate 6

Clinical Applications

• Dobutamine is used in the management of acute heart failure and cardiogenic shock, particularly in patients with a high left ventricular filling pressure and a cardiac index < 2.2 L/min/m2 5
• It is also used in patients with congestive cardiomyopathy, improving functional status and lifestyle, although it may not affect survival rates 7
• Intermittent dobutamine infusions have been shown to be effective in improving clinical and hemodynamic parameters in patients with congestive heart failure 3, 7