What are the typical total daily doses of dopamine, dobutamine, and noradrenaline?

Typical Total Daily Doses of Dopamine, Dobutamine, and Noradrenaline

The typical total daily doses for these vasopressors and inotropes are determined by weight-based infusion rates multiplied by duration of administration, with dobutamine typically dosed at 2-20 μg/kg/min (2.9-28.8 mg/kg/day), dopamine at 2-10 μg/kg/min (2.9-14.4 mg/kg/day), and noradrenaline at 0.2-1.0 μg/kg/min (0.29-1.44 mg/kg/day). 1, 2

Dobutamine

Dosing Range

• Initial dose typically starts at 2-3 μg/kg/min without a loading dose 1, 2
• Can be titrated up to 15-20 μg/kg/min based on clinical response 1, 2
• In patients on beta-blockers, doses may need to be increased up to 20 μg/kg/min to restore inotropic effect 2
• Total daily dose calculation: 2-20 μg/kg/min × 60 min × 24 hours = 2.9-28.8 mg/kg/day 1, 2

Clinical Considerations

• Dose should be progressively modified according to symptoms, diuretic response, or clinical status 1
• At low doses (2-3 μg/kg/min), causes mild arterial vasodilation 2
• At 3-5 μg/kg/min, primary inotropic effects become predominant 2
• At doses >5 μg/kg/min, both inotropic effects and potential vasoconstriction may occur 2
• Prolonged infusion (>24-48 hours) is associated with tolerance and partial loss of hemodynamic effects 2

Weaning Protocol

• Gradual tapering is recommended when discontinuing (decrease by steps of 2 μg/kg/min) 1, 2
• Simultaneous optimization of oral therapy is essential during weaning 1

Dopamine

Dosing Range

• No bolus dose is recommended 1
• At 2-3 μg/kg/min: primarily renal/dopaminergic effects 1
• At 3-5 μg/kg/min: inotropic (β1) effects predominate 1
• At >5 μg/kg/min: vasopressor (α) effects become significant 1
• Total daily dose calculation: 2-10 μg/kg/min × 60 min × 24 hours = 2.9-14.4 mg/kg/day 1

Clinical Considerations

• In acute heart failure, approximately 10% of patients may require dopamine at an average of 2300 mg per day in the ICU setting 1
• Should be used with caution in patients with heart rate >100 bpm 1
• May increase risk of tachycardia, arrhythmias, and α-adrenergic stimulation with vasoconstriction at higher doses 1
• Low-dose dopamine is frequently combined with higher doses of dobutamine for synergistic effect 1

Noradrenaline (Norepinephrine)

Dosing Range

• No bolus dose is recommended 1
• Typical infusion rate: 0.2-1.0 μg/kg/min 1
• Total daily dose calculation: 0.2-1.0 μg/kg/min × 60 min × 24 hours = 0.29-1.44 mg/kg/day 1

Clinical Considerations

• In acute heart failure/ICU settings, approximately 70% of patients may require norepinephrine at an average of 250 mg per day 1
• Primary vasopressor effect with minimal inotropic activity 1
• Used when hypotension is severe (SBP <90 mmHg) despite adequate fluid resuscitation 1
• Can be combined with dobutamine for better hemodynamic profile in cardiogenic shock 3

Monitoring Requirements

• Continuous clinical monitoring and ECG telemetry is required for all three agents 1, 2
• Blood pressure monitoring (invasive or non-invasive) is essential 1, 2
• Monitor for arrhythmias, particularly at higher doses 1, 2
• In patients with atrial fibrillation, both dobutamine and dopamine may facilitate AV conduction and lead to tachycardia 1, 2

Common Pitfalls and Caveats

• Tolerance development: Prolonged infusions (>24-48 hours) may lead to tolerance, particularly with dobutamine 2
• Arrhythmia risk: Higher doses of all three agents increase risk of arrhythmias 1, 2
• Tissue damage: Extravasation can cause tissue necrosis, particularly with noradrenaline 1
• Weaning difficulties: Abrupt discontinuation can lead to hemodynamic deterioration; gradual tapering is recommended 1, 2
• Drug interactions: Effects may be diminished in patients on beta-blockers, requiring higher doses 2