What is the typical starting dose of dopamine for a patient?

Dopamine Starting Dose

The typical starting dose of dopamine is 5-10 mcg/kg/min for most patients requiring vasopressor support, with lower doses of 2-5 mcg/kg/min appropriate for patients who may respond to modest increases in cardiac contractility and renal perfusion. 1, 2, 3

Initial Dosing Strategy

For adults and pediatric patients:

• Start at 2-5 mcg/kg/min if the patient is likely to respond to modest increments in heart force and renal perfusion 3
• Start at 5-10 mcg/kg/min for more seriously ill patients or those with symptomatic bradycardia and hypotension 1, 2, 3
• In pediatric patients specifically, the dosing range is 2-20 mcg/kg/min, titrated to maintain adequate blood pressure 4, 2

Titration Protocol

After initiating therapy, increase gradually using 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed based on hemodynamic response 1, 3. The maximum recommended dose is 20 mcg/kg/min, as doses exceeding this may cause excessive vasoconstriction 5. If the target mean arterial pressure cannot be achieved at 20 mcg/kg/min, switch to norepinephrine or add a second-line agent rather than escalating dopamine further 5.

Dose-Dependent Effects

Understanding dopamine's pharmacology guides appropriate starting doses:

• <3 mcg/kg/min: Predominantly dopaminergic effects with renal vasodilation 1, 5
• 3-5 mcg/kg/min: Inotropic (β-adrenergic) effects predominate 1, 5
• >5-10 mcg/kg/min: Combined inotropic and vasopressor (α-adrenergic) effects with increasing vasoconstriction 1, 5

Critical Administration Requirements

Before starting dopamine:

• Ensure adequate fluid resuscitation (central venous pressure 10-15 cm H₂O or pulmonary wedge pressure 14-18 mm Hg) 3
• Use only an infusion pump, preferably volumetric—never rely on gravity drips 3
• Establish continuous hemodynamic monitoring including blood pressure, heart rate, and ECG 1, 2
• Place an arterial line as soon as practical for accurate blood pressure monitoring 2
• Infuse into a large vein (antecubital fossa preferred) to prevent extravasation and tissue necrosis 3

When Dopamine Is NOT the Right Choice

Do not use dopamine as first-line therapy for:

• Septic shock: Norepinephrine is the first-choice vasopressor with strong evidence (Grade 1B recommendation) 2, 5, 6, 7
• Cardiogenic shock: Norepinephrine is associated with lower mortality compared to dopamine 1, 6
• Renal protection: Low-dose dopamine (≤3 mcg/kg/min) for renal protection is strongly discouraged and provides no benefit (Grade 1A recommendation) 1, 5, 8

Dopamine is specifically indicated for:

• Hypotension with symptomatic bradycardia 1, 2
• Highly selected patients with low risk of tachyarrhythmias 2
• Post-cardiac arrest hypotension when bradycardia coexists 2

Common Pitfalls to Avoid

• Arrhythmia risk: Dopamine causes significantly more arrhythmic events (24.1%) compared to norepinephrine (12.4%) 6. Use caution in patients with heart rate >100 bpm 5
• Extravasation: Can cause severe tissue necrosis even at low doses. If extravasation occurs, immediately infiltrate the site with phentolamine 5-10 mg diluted in 10-15 mL saline 2, 3
• Alkaline incompatibility: Never add sodium bicarbonate or other alkalinizing substances, as dopamine is inactivated in alkaline solution 3
• Fluid overload: More than 50% of patients are satisfactorily maintained on doses <20 mcg/kg/min. If higher doses are needed, consider switching agents rather than continuing escalation 3

Monitoring During Therapy

Watch for signs requiring dose reduction or discontinuation:

• Diminishing urine output despite adequate blood pressure 3
• Increasing tachycardia or new dysrhythmias 3
• Disproportionate rise in diastolic pressure (marked decrease in pulse pressure) indicating excessive vasoconstriction 3