Quickest Dopamine Drip Formulation
Use the "Rule of 6" method: multiply 0.6 × patient's weight in kg = number of milligrams of dopamine, then dilute to a total of 100 mL of saline; at this concentration, 1 mL/h delivers 0.1 mcg/kg/min. 1
Rapid Preparation Methods
Rule of 6 Method (Preferred for Pediatrics)
- Calculation: 0.6 × body weight (kg) = mg of dopamine to add 2, 1
- Dilute calculated dose to total 100 mL of saline 2, 1
- Infusion rate: 1 mL/h = 0.1 mcg/kg/min 1
- Example: For a 20 kg child: 0.6 × 20 = 12 mg dopamine in 100 mL saline 1
Standard Adult Concentration (Alternative)
- Preparation: 400 mg dopamine in 500 mL of 5% dextrose 2
- This creates a standard concentration for adult dosing 2
- Requires individual calculation: Infusion rate (mL/h) = (Weight [kg] × Dose [mcg/kg/min] × 60 min/h) / Concentration (mcg/mL) 2
Dosing Guidelines
Initial Dosing
- Start at 2-5 mcg/kg/min for most patients 1
- Titrate to maintain systolic BP >90 mmHg (or age-appropriate target) 1
- Therapeutic range: 2-20 mcg/kg/min 2, 1
Dose-Dependent Effects
- 2-3 mcg/kg/min: Dopaminergic effects (renal/mesenteric vasodilation) 2, 1
- 3-5 mcg/kg/min: β-adrenergic effects (increased cardiac contractility) 2, 1
- >5-10 mcg/kg/min: α-adrenergic effects (peripheral vasoconstriction) 2, 1
Critical Safety Measures
Administration Requirements
- Use large vein (antecubital fossa preferred over hand/ankle) to prevent extravasation 3
- Continuous BP monitoring required, preferably with arterial line at higher doses 2, 1
- Cover infusion container with protective foil to prevent light degradation 1
Extravasation Management
- If extravasation occurs, inject phentolamine 0.1-0.2 mg/kg (up to 10 mg) diluted in 10 mL of 0.9% saline intradermally at the site 1
- Monitor extremities for color/temperature changes indicating compromised circulation 3
When to Switch Agents
- If doses approach >20 mcg/kg/min without adequate response, consider switching to norepinephrine 1
- If tachycardia >100 bpm develops, consider alternative vasopressors 2, 1
- Dopamine should be avoided in patients with tachyarrhythmias 4
Important Caveats
Drug Interactions
- MAO inhibitor use: Reduce initial dopamine dose to 1/10 of usual dose if patient received MAO inhibitors within 2-3 weeks 3
- Halogenated anesthetics: Use extreme caution due to risk of ventricular arrhythmias 3
- β-blockers may require higher dopamine doses (up to 20 mcg/kg/min) to achieve effect 2
Pre-Administration Requirements
- Correct hypovolemia first: Administer 1-2 L normal saline to adults (5-10 mL/kg in first 5 minutes) or up to 30 mL/kg in first hour for children 2
- Correct hypoxia, hypercapnia, and acidosis before or during dopamine administration 3
Weaning Protocol
- Gradually decrease by steps when discontinuing 2
- Expand blood volume with IV fluids while tapering to prevent marked hypotension 3
Note on "Levodopamine": The evidence provided addresses dopamine (the vasopressor) exclusively. If the question refers to levodopa (the Parkinson's medication), this is contraindicated for hypotension as levodopa causes hypotension through negative inotropic effects 5, 6. Levodopa should never be used as a vasopressor.