How do you prepare an intravenous (IV) infusion of dopamine (hydrochloride)?

Dopamine Infusion Preparation

Prepare dopamine infusion using a standard concentration of 400 mg in 500 mL of D5W (yielding 800 mcg/mL), or use the "Rule of 6" for pediatric patients: 0.6 × body weight (kg) = number of milligrams diluted to total 100 mL of saline, where 1 mL/h delivers 0.1 mcg/kg/min. 1, 2

Standard Adult Preparation

• Mix 400 mg dopamine in 500 mL D5W to create an 800 mcg/mL concentration, which is the most commonly used preparation 1, 2
• Alternative concentrations include:
  • 1600 mcg/mL solution for patients requiring fluid restriction 2
  • 3200 mcg/mL solution for patients with severe fluid retention or when slower infusion rates are desired 2
• The less concentrated 800 mcg/mL solution is preferred when fluid expansion is not a concern 2

Pediatric "Rule of 6" Method

• Calculate: 0.6 × body weight (kg) = milligrams of dopamine 1
• Dilute this amount to a total volume of 100 mL saline 1
• Result: 1 mL/h infusion rate delivers 0.1 mcg/kg/min 1
• This simplified approach facilitates rapid dosing calculations in pediatric emergencies 1

Critical Safety Requirements Before Administration

• Inspect solution visually - do NOT administer if solution is darker than slightly yellow or discolored in any way 2
• Verify solution clarity - do NOT administer unless solution is clear and container is undamaged 2
• Protect from light - cover the bottle, burette, or syringe pump with protective foil to prevent drug breakdown 1
• Discard unused portions after preparation 2

Administration Equipment and Route

• Use only an infusion pump, preferably a volumetric pump - do NOT regulate by gravity and mechanical clamps alone 2
• Infuse into a large vein whenever possible (antecubital fossa preferred over hand or ankle veins) to prevent extravasation and tissue necrosis 2
• Avoid umbilical artery catheter administration 2
• Switch to a more suitable infusion site as soon as possible if using less optimal veins, and continuously monitor for free flow 2

Critical Incompatibilities

• Do NOT add sodium bicarbonate or other alkalinizing substances - dopamine is inactivated in alkaline solution 2
• Do NOT mix with dextrose solutions through the same line as blood products due to risk of pseudoagglutination 2
• Dopamine is physically and chemically stable when mixed with dobutamine, tolazoline, and theophylline in D5W 3

Dosing Initiation

• Start at 2-5 mcg/kg/min for patients likely to respond to modest increases in cardiac contractility and renal perfusion 1, 2
• Start at 5 mcg/kg/min for more seriously ill patients, then increase gradually using 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed 2
• Typical therapeutic range is 2-20 mcg/kg/min, titrated to maintain systolic blood pressure >90 mmHg or age-appropriate target 1

Monitoring Requirements

• Continuous hemodynamic monitoring is essential, including blood pressure, heart rate, and ECG 1
• Monitor blood pressure continuously, preferably with an arterial line 1
• Watch closely for extravasation - can cause severe skin injury and tissue necrosis 1, 2
• Assess peripheral perfusion, urine output, and lactate clearance regularly 1

Extravasation Management

• If extravasation occurs, immediately inject phentolamine 0.1-0.2 mg/kg (up to 10 mg) diluted in 10 mL of 0.9% sodium chloride intradermally at the extravasation site to counteract dermal vasoconstriction and prevent tissue death 1, 2
• Exercise extreme caution to avoid accidental flushing or bolus injection of the IV line 1

Solution Stability

• Dopamine solutions remain stable in dextrose and saline-containing solutions for at least 84 hours at ambient temperature 4
• Despite this stability, prepare fresh solutions according to institutional protocols to minimize contamination risk 4

Important Caveats

• Be aware that actual volumes in 100-mL IV bags may exceed labeled volume (mean 109-110 mL), potentially causing clinically significant overdilution of dopamine 5
• Consider using in-line burets or premixed bags to prevent unintended underdosing 5
• Plasma dopamine concentrations show 10- to 75-fold intersubject variability even with weight-based dosing, requiring careful titration to clinical effect rather than relying on standardized dosing 6