From the Guidelines
Dobutamine is primarily indicated for short-term treatment of patients with acute decompensated heart failure who need inotropic support, as well as for stress echocardiography to assess cardiac function and detect coronary artery disease. The medication works by stimulating beta-1 adrenergic receptors in the heart, increasing contractility and cardiac output without significantly affecting peripheral vascular resistance 1.
Indications for Dobutamine
- Short-term treatment of acute decompensated heart failure
- Stress echocardiography to assess cardiac function and detect coronary artery disease
- Situations where cardiac output is decreased and there is evidence of tissue hypoperfusion, such as cardiogenic shock, severe heart failure exacerbations, or after cardiac surgery
Dosage and Administration
- Typical dosage ranges from 2.5 to 20 mcg/kg/minute administered as a continuous intravenous infusion
- Most patients respond to doses between 5-10 mcg/kg/minute
- During stress echocardiography, dobutamine is infused intravenously at doses that increase every 3 minutes until a maximal dose is reached or an end point has been achieved 1
Safety and Monitoring
- Continuous cardiac monitoring is essential as dobutamine can cause tachycardia, arrhythmias, and increased myocardial oxygen consumption
- Complications of dobutamine infusion include nausea, headache, tremor, anxiety, angina and atypical chest pain, atrial and ventricular arrhythmias, and hypertension or hypotension 1
- Side effects or complications can be treated by intravenous injection of adrenergic β-receptor–blocking agents such as metoprolol or esmolol
Special Considerations
- Dobutamine should be used cautiously in patients with hypertrophic cardiomyopathy, severe aortic stenosis, or recent myocardial infarction
- It is not intended for long-term therapy due to potential tachyphylaxis and increased mortality risk with prolonged use 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 indications for dobutamine (Dobutrex) are:
- Inotropic support in the short-term treatment of patients with:
- Cardiac decompensation due to depressed contractility from organic heart disease
- Cardiac decompensation due to depressed contractility from cardiac surgical procedures 2
From the Research
Indications for Dobutamine
The indications for dobutamine (Dobutrex) include:
- Evaluation of coronary artery disease, including chest pain and risk assessment before noncardiac surgery 3
- Treatment of congestive heart failure, including improvement of cardiac output and decrease of pulmonary wedge pressure 4, 5
- Management of cardiogenic shock, where dobutamine is used to increase cardiac contractility and enhance peripheral vasodilation 6
- Treatment of severe heart failure, although its effect on mortality is still uncertain 7
Specific Uses
Some specific uses of dobutamine include:
- Dobutamine stress echocardiography for evaluation of known or suspected coronary artery disease 3
- Intermittent dobutamine infusion for chronic treatment of congestive heart failure 4, 5
- Management of arrhythmias in cardiogenic shock, where dobutamine is used with caution due to its potential to induce ventricular and supraventricular tachyarrhythmias 6
Patient Selection
Dobutamine may be used in patients with:
- Advanced coronary artery disease 3
- Congestive heart failure, including those in New York Heart Association functional classes III and IV 5
- Severe heart failure, although its use should be carefully considered due to potential increased mortality 7
- Cardiogenic shock, where dobutamine is used to increase cardiac contractility and enhance peripheral vasodilation 6