What is the dose of dobutamine (Dobutrex) for a Dobutamine Stress Echocardiogram (DSE)?

Dobutamine Dosing Protocol for Stress Echocardiography

For dobutamine stress echocardiography (DSE), dobutamine should be administered in gradually increasing doses starting at 5-10 μg/kg/min and increasing to a maximum dose of 40-50 μg/kg/min in 3-5 minute stages. 1

Standard DSE Protocol

Initial Setup and Dosing

• Start with an initial dose of 5-10 μg/kg/min 1
• Increase dose in 3-5 minute stages 1
• Standard incremental steps: 5 → 10 → 20 → 30 → 40 μg/kg/min 1
• Maximum dose: 40-50 μg/kg/min 1

Atropine Supplementation

• If target heart rate is not achieved at maximum dobutamine dose, add atropine
• Atropine dosing: 0.01 mg/kg up to 0.25 mg aliquots every 1-2 minutes
• Maximum atropine dose: 1 mg 1
• Approximately two-thirds of patients require atropine, typically administered at 40 or 50 μg/kg/min of dobutamine 1

Special Considerations

Target Endpoints

• Achievement of target heart rate (85% of age-predicted maximum) 1
• Development of new wall motion abnormalities 1
• Significant ECG changes 1
• Completion of protocol at maximum dose 1

Safety Measures

• Have esmolol readily available (10 mg/mL dilution) at a dose of 0.5 mg/kg to rapidly reverse dobutamine effects if needed 1
• Continuous ECG monitoring throughout the procedure 2
• Regular blood pressure monitoring every 5-15 minutes 2
• Echocardiographic images should be obtained throughout with ECG gating 1

Modified Protocol for Aortic Stenosis

• For patients with low-flow, low-gradient aortic stenosis:
  • Start at lower doses (2.5-5 μg/kg/min)
  • Maximum dose typically limited to 20 μg/kg/min 1
  • Longer stages (5-8 minutes per dose) 1

Preparation and Administration

• Requires peripheral intravenous line for infusion 1
• Dilute in appropriate IV solutions (5% Dextrose, 0.9% Sodium Chloride, etc.) 3
• Use appropriate infusion pumps for controlled administration 1
• Sedation is rarely needed but may be required for young patients or those with limited ability to cooperate 1

Potential Complications

• Arrhythmias (most common side effect, occurring in approximately 20% of patients) 4, 5
• Hypotension (occurs in about 8% of patients) 6
• Hypertension 4
• Nausea, headache, anxiety, tremor 5
• Chest pain (occurs in approximately 19% of patients) 5

The safety profile of DSE is generally good, with serious complications being rare. Studies involving over 1,000 patients have shown no occurrences of death, myocardial infarction, or sustained ventricular tachycardia 5. However, careful monitoring is essential throughout the procedure.