What are the recommended doses of Dopamine (a catecholamine neurotransmitter)?

From the Guidelines

Dopamine should be dosed at 5-10 mcg/kg/min for hypotension, especially if associated with symptomatic bradycardia, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.

Dopamine Dosing

The dose of dopamine can vary based on the desired hemodynamic effect.

• For renal perfusion and mild hypotension, a dose of 2-5 mcg/kg/min may be used, although recent data have failed to show a beneficial effect on renal function 1.
• For cardiac support with moderate inotropic effects, a dose of 5-10 mcg/kg/min is recommended 1.
• For vasopressor effects in severe hypotension, a dose of 10-20 mcg/kg/min may be used, but higher doses should be avoided due to the risk of excessive vasoconstriction and tissue ischemia 1.

Administration and Monitoring

Dopamine should be administered via central venous access using an infusion pump, titrating to the desired hemodynamic response while monitoring blood pressure, heart rate, urine output, and peripheral perfusion.

Mechanism of Action and Adverse Effects

Dopamine works by stimulating different receptors at various doses: dopaminergic receptors at low doses, beta-adrenergic receptors at moderate doses, and alpha-adrenergic receptors at high doses.

• Potential adverse effects include tachyarrhythmias, tissue ischemia, and decreased splanchnic perfusion, especially at higher doses.

Alternative Therapy

Consider norepinephrine as an alternative if the patient remains hypotensive despite dopamine at 20 mcg/kg/min. It is essential to note that the use of dopamine should be individualized and guided by the patient's hemodynamic response, and that the benefits and risks of dopamine therapy should be carefully weighed in each case 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION ... Begin infusion of dopamine hydrochloride solution at doses of 2 to 5 mcg/kg/min in adult or pediatric patients who are likely to respond to modest increments of heart force and renal perfusion In more seriously ill patients, begin infusion of dopamine hydrochloride at doses of 5 mcg/kg/min and increase gradually, using 5 to 10 mcg/kg/min increments, up to a rate of 20 to 50 mcg/kg/min as needed. Administration rates greater than 50 mcg/kg/min have safely been used in adults in advanced circulatory decompensation states More than 50% of adult patients have been satisfactorily maintained on doses less than 20 mcg/kg/min

The recommended dopamine doses are:

• Initial dose: 2 to 5 mcg/kg/min
• Incremental dose: 5 to 10 mcg/kg/min
• Maximum dose: up to 50 mcg/kg/min, with administration rates greater than 50 mcg/kg/min used in advanced circulatory decompensation states 2

From the Research

Dopamine Doses

• The use of dopamine as a vasopressor is recommended only in bradycardic patients 3
• Low doses of dopamine may be used for inotropic support, but high doses carry an excessive risk of adverse events when used for vasopressor support and should be avoided 4
• Dopamine is not recommended as a first-line vasopressor due to its adverse effects, and its use has fallen to almost no-use recommendation 5
• In elderly patients with sepsis and pre-existing heart failure, dopamine alone reduces ICU and hospital length of stay but increases the new-onset arrhythmias 6
• Dopamine was found to be an independent risk factor in reducing ICU and hospital length of stay, and an independent risk factor for new-onset arrhythmias 7, 6

Comparison with Other Vasopressors

• Norepinephrine is the first-choice vasopressor in septic and vasodilatory shock, and is recommended over dopamine due to its lower risk of adverse events 4, 3, 5
• Vasopressin may be added to norepinephrine in patients who are not responsive to norepinephrine alone, and has been shown to decrease 28-day mortality in some studies 3, 5
• Epinephrine may also be added to norepinephrine in patients who are not responsive to norepinephrine alone, and has been shown to be effective in increasing cardiac output 4, 5

Clinical Use

• The choice and dose of vasopressors, including dopamine, vary widely due to patient and physician practice heterogeneity 3, 5
• Vasopressors should be administered simultaneously with fluid replacement to prevent and decrease duration of hypotension in shock with vasodilation 5
• The use of vasopressors, including dopamine, should be guided by the patient's individual needs and response to treatment, and should be monitored closely for adverse effects 4, 3, 5