When is dopamine administration recommended in medicine?

From the Guidelines

Dopamine administration is recommended in medicine primarily for treating shock, particularly cardiogenic, septic, or hypovolemic shock that is refractory to fluids, and should be used with caution and at specific doses. The use of dopamine in shock treatment is guided by its effects on the body, which vary depending on the dose administered.

• At low doses (2-5 μg/kg/min), dopamine has an inotropic effect, increasing cardiac contractility, and is often used in cardiogenic shock.
• At moderate doses (5-10 μg/kg/min), it improves renal perfusion.
• At higher doses (>10 μg/kg/min), dopamine has a vasopressor effect, increasing peripheral vasoconstriction, which can be beneficial in certain cases of shock but also carries risks such as increased afterload and potential for worsening cardiac function or inducing arrhythmias 1. The administration of dopamine should be tailored to the individual patient's response, with careful monitoring of vital signs, diuresis, and hemodynamic parameters to avoid adverse effects such as excessive vasoconstriction or tachyarrhythmias 1. It is also important to note that dopamine should not be used for renal protection at low doses, as evidence suggests it does not provide benefit in this context 1. In cases of distributive shock, norepinephrine is generally recommended as the first-line vasoactive agent, with dopamine considered in specific situations such as bradycardia or low risk for tachycardia 1. Overall, the decision to use dopamine and the dose at which it is administered should be based on a thorough assessment of the patient's condition, including the type of shock, hemodynamic status, and potential risks and benefits of therapy.

From the FDA Drug Label

When indicated, restoration of circulatory volume should be instituted or completed with a suitable plasma expander or whole blood, prior to administration of dopamine hydrochloride. Patients most likely to respond to dopamine are those whose physiological parameters (such as urine flow, myocardial function and blood pressure) have not undergone extreme deterioration Reports indicate that the shorter the time between onset of signs and symptoms and initiation of therapy with volume restoration and dopamine, the better the prognosis As in other circulatory decompensation states, prognosis is better in patients whose blood pressure and urine flow have not undergone extreme deterioration Therefore, it is suggested the physician administer dopamine as soon as a definite trend toward decreased systolic and diastolic pressure becomes apparent.

Dopamine administration is recommended in medicine for patients with:

• Poor perfusion of vital organs
• Low cardiac output
• Hypotension due to inadequate cardiac output or diminished systemic vascular resistance The best prognosis is seen when dopamine is administered:
• Before extreme deterioration of physiological parameters such as urine flow, myocardial function, and blood pressure
• As soon as a definite trend toward decreased systolic and diastolic pressure becomes apparent 2

From the Research

Dopamine Administration in Medicine

Dopamine administration is recommended in various medical situations, including:

• Shock following acute myocardial infarction, where dopamine can increase mean arterial pressure and urine output 3
• Severe cardiogenic shock complicating acute myocardial infarction, where low doses of dopamine may be preferred to correct hypotension 4
• Severe pump failure and hypotension complicating acute myocardial infarction, where combined dopamine and nitroprusside therapy may be beneficial 5
• Visceral hypoperfusion states such as shock and refractory heart failure, where dopamine can directly dilate mesenteric, renal, and cerebral vessels and redirect blood flow to essential viscera 6
• Treatment of shock, where dopamine is recommended as a first-line vasopressor agent, although it may be associated with more adverse events than norepinephrine 7

Key Considerations

When administering dopamine, the following considerations are important:

• Dose titration: Dopamine doses should be titrated to achieve the desired effect, with low doses (100-700 mug/min) having a dopaminergic effect and higher doses (700-1400 mug/min) having a beta-adrenergic, inotropic effect 6
• Monitoring: Patients receiving dopamine should be closely monitored for adverse events, such as arrhythmic events, and for changes in hemodynamic status 3, 4, 7
• Combination therapy: Dopamine may be used in combination with other agents, such as nitroprusside, to achieve optimal hemodynamic effects 5

Specific Indications

Dopamine administration may be specifically indicated in the following situations:

• Cardiogenic shock: Dopamine may be associated with an increased rate of death at 28 days in patients with cardiogenic shock, and norepinephrine may be a preferred agent in this subgroup 7
• Septic shock: Dopamine may be used as a first-line vasopressor agent in septic shock, with no significant difference in mortality compared to norepinephrine 7
• Hypovolemic shock: Dopamine may be used to treat hypovolemic shock, although the evidence is limited 7