What is the recommended concentration for dopamine (a catecholamine) infusion?

Dopamine Infusion Concentration

The standard recommended concentration for dopamine infusion is 400 mg in 500 mL of 5% dextrose (D5W), yielding 800 mcg/mL, though more concentrated solutions of 1600 mcg/mL or 3200 mcg/mL may be used in fluid-restricted patients. 1, 2

Standard Adult Preparation

• Prepare 400 mg dopamine in 500 mL of D5W (concentration: 800 mcg/mL) for most adult patients requiring vasopressor support for refractory hypotension 1
• This concentration is preferred when fluid expansion is not a contraindication 2
• Infuse at 2-20 mcg/kg/min, titrated to maintain systolic blood pressure >90 mm Hg 1

Alternative Concentrations for Fluid Restriction

• Use 1600 mcg/mL or 3200 mcg/mL concentrations in patients with fluid retention or when slower infusion rates are desired 2
• These more concentrated solutions allow therapeutic dosing with reduced fluid volume 2
• The FDA label explicitly states these concentrations may be preferred when fluid expansion is problematic 2

Pediatric Preparation: "Rule of 6"

For children, a weight-based preparation method simplifies dosing:

• Mix 0.6 × body weight (kg) = number of mg dopamine, diluted to total 100 mL of saline 1, 3
• With this preparation, 1 mL/hr delivers 0.1 mcg/kg/min 3
• Dose range: 2-20 mcg/kg/min, titrated to blood pressure response 1, 3

Alternatively, use the standard adult concentration (400 mg in 500 mL D5W) with individualized calculation: Infusion rate (mL/h) = [Weight (kg) × Dose (mcg/kg/min) × 60 min/h] / Concentration (mcg/mL) 1

Critical Administration Requirements

Infusion Method

• Use only an infusion pump, preferably volumetric — never rely on gravity drip with mechanical clamps alone 2
• Infuse into large veins (antecubital fossa preferred) to minimize extravasation risk 2
• Avoid dorsal hand or ankle veins unless no alternative exists 2

Solution Stability

• Do NOT administer if solution is darker than slightly yellow 2
• Solutions remain stable for ≥84 hours in D5W, D10W, or normal saline 4
• Protect from light exposure during administration 3
• Never add sodium bicarbonate or alkalinizing substances — dopamine is inactivated in alkaline solution 2

Dose-Dependent Effects

Understanding concentration-dependent pharmacology guides titration:

• 2-5 mcg/kg/min: Dopaminergic effects (renal/mesenteric vasodilation) 3, 5
• 5-10 mcg/kg/min: β-adrenergic effects (increased cardiac contractility) 3
• >10 mcg/kg/min: α-adrenergic effects (peripheral vasoconstriction) 3, 5
• Doses >50 mcg/kg/min may cause excessive vasoconstriction and should prompt consideration of alternative vasopressors 3, 2

Monitoring Requirements

• Continuous hemodynamic monitoring is essential during dopamine infusion 1, 3
• Monitor blood pressure continuously, preferably with arterial line for doses >10 mcg/kg/min 3, 5
• Watch continuously for extravasation — can cause severe tissue necrosis even at low concentrations 3, 2
• If extravasation occurs, inject phentolamine 0.1-0.2 mg/kg (up to 10 mg) diluted in 10 mL normal saline intradermally at the site 3, 5

Critical Pitfalls

Marked pharmacokinetic variability exists — plasma concentrations can vary 10- to 75-fold between patients receiving identical weight-based doses 6. This explains why some patients respond poorly despite "adequate" dosing and necessitates titration to clinical effect rather than fixed dosing.

The 800 mcg/mL concentration (400 mg in 500 mL) represents the most widely endorsed standard across guidelines 1, 2, with concentrated alternatives reserved specifically for fluid-restricted states 2.