Dopamine Infusion Dosing Guidelines
The recommended starting dose for dopamine infusion is 2-5 mcg/kg/min in patients who are likely to respond to modest increments of heart force and renal perfusion, with titration based on clinical response. 1, 2, 3
Initial Dosing and Preparation
- For initial administration in most patients, begin dopamine infusion at 2-5 mcg/kg/min, which primarily stimulates dopaminergic receptors and mild β-adrenergic effects 4, 1
- In more seriously ill patients, begin at 5 mcg/kg/min and increase gradually using 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed 2, 3
- Prepare dopamine infusion 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 1
- Alternatively, standard solutions can be prepared as 400 mg dopamine in 500 mL D5W 1
Dose-Dependent Effects
- Low doses (1-5 mcg/kg/min): Primarily dopaminergic effects with renal and mesenteric vasodilation 1, 2, 5
- Intermediate doses (5-10 mcg/kg/min): Predominantly β-adrenergic effects with increased cardiac contractility 1, 2, 5
- Higher doses (>10 mcg/kg/min): α-adrenergic effects with peripheral vasoconstriction predominate 1, 2
Titration Guidelines
- Titrate dopamine based on the desired clinical effect, with careful monitoring of hemodynamic response 2
- Increase in increments of 5-10 mcg/kg/min up to 20-50 mcg/kg/min as needed 2
- More than 50% of adult patients are satisfactorily maintained on doses less than 20 mcg/kg/min 3
- If doses exceeding 50 mcg/kg/min are required, check urine output frequently 3
Administration Considerations
- Infuse dopamine into a large vein whenever possible to prevent infiltration of perivascular tissue 3
- Use only an infusion pump, preferably a volumetric pump, for administration 3
- Continuous hemodynamic monitoring is essential during dopamine administration 1
- Monitor for extravasation, which can cause severe tissue injury; if extravasation occurs, phentolamine (0.1-0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) can be injected intradermally at the site 4, 1
Clinical Cautions
- Infusion rates >20 mcg/kg/min may result in excessive vasoconstriction 2
- Arrhythmias are more common with dopamine compared to norepinephrine (24.1% vs. 12.4%) 6
- Consider norepinephrine instead of dopamine in patients with cardiogenic shock, as dopamine has been associated with increased mortality in this population 6
- Low-dose dopamine (≤3 mcg/kg/min) for renal protection is not recommended based on current evidence 2, 7
- Despite weight-based dosing, there is significant interindividual variability in plasma dopamine concentrations (10- to 75-fold), suggesting the need for careful clinical monitoring rather than relying solely on calculated doses 8
Monitoring During Administration
- Continuously monitor vital signs including blood pressure, heart rate, and ECG 1, 2
- Assess peripheral perfusion regularly 1
- Consider arterial line placement for accurate blood pressure monitoring, especially at higher doses 1, 2
- Monitor urine output as a decrease may indicate the need for dose reduction 3