What is the recommended starting dose for a dopamine (dopamine hydrochloride) drip?

Dopamine Drip Dosing

The recommended starting dose for a dopamine drip is 2-5 mcg/kg/min in patients who are likely to respond to modest increments of heart force and renal perfusion, while more seriously ill patients should start at 5 mcg/kg/min with gradual increases of 5-10 mcg/kg/min up to 20-50 mcg/kg/min as needed. 1

Initial Dosing Guidelines

• For hypotension treatment, the typical starting dose range is 5-10 mcg/kg/min, which can be titrated based on clinical response 2
• In patients who are likely to respond to modest increments of heart force and renal perfusion, begin with 2-5 mcg/kg/min 1
• For more seriously ill patients, start at 5 mcg/kg/min and increase gradually using 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed 1
• More than 50% of adult patients have been satisfactorily maintained on doses less than 20 mcg/kg/min 1

Dose-Dependent Effects

• Low doses (<5 mcg/kg/min): Primarily dopaminergic effects with renal and mesenteric vasodilation 2, 3
• Intermediate doses (5-10 mcg/kg/min): Predominantly β-adrenergic effects with increased cardiac contractility 2, 3
• Higher doses (>10 mcg/kg/min): Predominantly α-adrenergic effects with peripheral vasoconstriction 2, 3
• Doses exceeding 20 mcg/kg/min may result in vasoconstriction or arrhythmias 2

Administration Considerations

• Administer through a large vein whenever possible to prevent infiltration of perivascular tissue 1
• Large veins of the antecubital fossa are preferred over veins of the dorsum of the hand or ankle 1
• Use an infusion pump, preferably a volumetric pump, rather than gravity-regulated apparatus 1
• If doses in excess of 50 mcg/kg/min are required, check urine output frequently 1

Monitoring During Administration

• Continuous monitoring of vital signs including blood pressure, heart rate, and ECG is essential 3
• Assess for diminution of established urine flow rate, increasing tachycardia, or development of new dysrhythmias, which may indicate the need to decrease or temporarily suspend the dosage 1
• Monitor for extravasation, which can cause severe skin injury; phentolamine (0.1-0.2 mg/kg) can be injected intradermally at the extravasation site as a countermeasure 3

Clinical Considerations and Cautions

• Dopamine is associated with more arrhythmic events compared to norepinephrine (24.1% vs. 12.4%) 4
• In cardiogenic shock, dopamine has been associated with an increased rate of death compared to norepinephrine 4
• Although low-dose dopamine was historically recommended to maintain renal blood flow or improve renal function, more recent data have failed to show a beneficial effect 2
• When discontinuing the infusion, gradually decrease the dose while expanding blood volume with intravenous fluids to prevent marked hypotension 1

Preparation Protocol

• Standard solution: 400 mg dopamine in 500 mL D5W 3
• Alternative preparation using the "rule of 6": 0.6 × body weight (kg) = number of milligrams diluted to total 100 mL of saline; then 1 mL/h delivers 0.1 mcg/kg/min 3
• Do NOT administer if solution is darker than slightly yellow or discolored in any other way 1
• Do NOT add sodium bicarbonate or other alkalinizing substances, as dopamine is inactivated in alkaline solution 1

By following these dosing guidelines and monitoring parameters, dopamine can be effectively and safely administered for the treatment of hypotension, particularly when associated with symptomatic bradycardia.