GL/PTC/08.

R1-2014

CHANGI GENERAL HOSPITAL

GUIDELINES ON USE OF
DOBUTAMINE
These guidelines are approved for use with effect from 8 JAN 2014, by the Pharmacy and Therapeutics
Committee on and supersedes the previous version (GL/PTC/08.R0-2005)

Drug Class
Cardiac stimulant, adrenergic agent

Drug Status
General, unrestricted use in areas where continuous blood pressure and heart rate monitoring can be
carried out.

Mechanism of Action
Stimulates 1-adrenergic receptors, causing increased heart rate and contractility.
Has little effect on - and 2-adrenergic receptors.

Therapeutic indications
Inotropic support in the short term treatment of conditions characterised by low output cardiac
failure, e.g. myocardial infarction, open heart surgery, cardiomyopathies, septic shock and
cardiogenic shock.
Increase or maintain cardiac output during positive end expiratory pressure (PEEP) ventilation.

Contraindications
1. Hypersensitivity to dobutamine.
2. Idiopathic hypertrophic aortic stenosis.
3. Hypersensitivity to sulfites (commercial preparations usually contain sodium metabisulfite).

Precautions
1. Patients with atrial fibrillation may experience an increase in cardiac response.
2. Ineffective in the presence of mechanical obstruction, e.g., severe aortic stenosis.
3. May precipitate angina pain in ischaemic heart disease, particularly post-myocardial infarction.
4. Metabolic acidosis, hypercapnia, hypoxaemia, hypovolaemia or electrolyte imbalances should be
corrected before and during treatment.
5. Elderly patients start at lower end of dosage range.
6. Avoid extravasation in the event of extravasation, infiltrate area of extravasation with IV
phentolamine 5-10 mg in 10-15 mL of sodium chloride 0.9%.

Drug Interactions
1. Effects of dobutamine may be prolonged and intensified by:
a. -adrenergic blockers (nonselective)
b. -blockers (e.g. phenoxybenzamine)
c. Cocaine
d. Cyclopropane, halothane and other halogenated anaesthetics
e. Methyldopa
f. Phenytoin
g. Monoamine oxidase inhibitors
h. Tricyclic antidepressants
i. Linezolid
j. Cimetidine
k. Ergot alkaloids

2. A decreased effect of dobutamine may be caused by -adrenergic blockers

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Pregnancy Risk Factor

Category B
i.e., animal studies have not demonstrated foetal risk; no controlled studies in women

Lactation
Extent of excretion into breast milk unknown

Adverse Drug Effects

(Incidences not always defined)

Cardiovascular : Tachycardia, hypertension, increased ventricular ectopic activity,

paradoxical hypotension, premature ventricular beats (5%, dose-
related), anginal pain (1-3%), non-specific chest pain (1-3%),
palpitations (1-3%)
Central nervous system : Fever (1-3%), headache (1-3%), paraesthesia
Endocrine & metabolic : Slight rise in serum potassium
Gastrointestinal : Nausea (1-3%)
Haematologic : Thrombocytopaenia (isolated cases)
Local : Phlebitis, local inflammation and pain, cutaneous necrosis (isolated
cases)
Neuromuscular & skeletal : Mild leg cramps
Respiratory : Dyspnoea (1-3%)

Initiating Dosing
1. Obtain an accurate body weight.
2. If an accurate body weight cannot be obtained, estimate the patients body weight (to the nearest
5 kg).
3. Do not utilise ideal body weight or adjusted body weight in calculating infusion rate.

Recommended Dosing (Adults)

1-5 mcg/kg/min initially. Dose may be increased by 1-2 mcg/kg/min at 10- to 30-minute intervals
until optimal response is obtained.
(N.B. When IV dobutamine is prescribed, it is advisable that physicians indicate in writing what
the desired clinical outcome(s) are, e.g., target blood pressure readings and/or heart rate, as well
as how they intend the dose of the drug to be titrated based on the response of the patient).
Maximum dose of dobutamine is 40 mcg/kg/min. Doses exceeding 20 mcg/kg/min require
continuous heart rate and blood pressure monitoring.

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Reconstitution and Administration

Each ampoule of dobutamine 250 mg/20 mL injection is formulated as a solution for infusion.

For patients without fluid restriction

Dilute 250 mg (i.e., 20 mL) of IV dobutamine to a final volume of 100 mL using dextrose 5% or
sodium chloride 0.9%.
The final concentration of the drug solution is 2.5 mg/mL (i.e., 2500 mcg/mL)
The drug shall be infused as a continuous IV infusion via an infusion pump.
The drug should be infused into a large central vein to prevent possibility of extravasation.
Discard solution 24 hours after dilution.
See Table 1 for infusion rates corresponding to dose ranges.
The rate of infusion (in mL/hour) for a given dose of IV dobutamine (in mcg/kg/min) may be
calculated using the following formula:

Dose (in mcg/kg/min) x body weight (kg) x 60 (mins)

Infusion rate (mL/hour) = ------------------------------------------------------------------------------
2500 (mcg/mL)

Table 1: Infusion rates for patients without fluid restriction

Infusion rate (ml/hr)
Dose
(mcg/kg/min)
40 kg 45 kg 50 kg 55 kg 60 kg 65 kg 70 kg 75 kg 80 kg

1 0.96 1.08 1.20 1.32 1.44 1.56 1.68 1.80 1.92

2 1.92 2.16 2.40 2.64 2.88 3.12 3.36 3.60 3.84

3 2.88 3.24 3.60 3.96 4.32 4.68 5.04 5.40 5.76

4 3.84 4.32 4.80 5.28 5.76 6.24 6.72 7.20 7.68

5 4.80 5.40 6.00 6.60 7.20 7.80 8.40 9.00 9.60

6 5.76 6.48 7.20 7.92 8.64 9.36 10.08 10.80 11.52

7 6.72 7.56 8.40 9.24 10.08 10.92 11.76 12.60 13.44

8 7.68 8.64 9.60 10.56 11.52 12.48 13.44 14.40 15.36

9 8.64 9.72 10.80 11.88 12.96 14.04 15.12 16.20 17.28

10 9.60 10.80 12.00 13.20 14.40 15.60 16.80 18.00 19.20

11 10.56 11.88 13.20 14.52 15.84 17.16 18.48 19.80 21.12

12 11.52 12.96 14.40 15.84 17.28 18.72 20.16 21.60 23.04

13 12.48 14.04 15.60 17.16 18.72 20.28 21.84 23.40 24.96

14 13.44 15.12 16.80 18.48 20.16 21.84 23.52 25.20 26.88

15 14.40 16.20 18.00 19.80 21.60 23.40 25.20 27.00 28.80

16 15.36 17.28 19.20 21.12 23.04 24.96 26.88 28.80 30.72

17 16.32 18.36 20.40 22.44 24.48 26.52 28.56 30.60 32.64

18 17.28 19.44 21.60 23.76 25.92 28.08 30.24 32.40 34.56

19 18.24 20.52 22.80 25.08 27.36 29.64 31.92 34.20 36.48

20 19.20 21.60 24.00 26.40 28.80 31.20 33.60 36.00 38.40

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For patients who are fluid restricted

Dilute 500 mg (i.e., 40 mL) of IV dobutamine to a final volume of 100 mL using dextrose 5% or
sodium chloride 0.9%.
The final concentration of the drug solution is 50 mg/mL (i.e., 5000 mcg/mL)
The drug shall be infused as a continuous IV infusion via an infusion pump.
The drug should be infused into a large central vein to prevent possibility of extravasation.
Discard solution 24 hours after dilution.
See Table 2 for infusion rates corresponding to dose ranges.
The rate of infusion (in mL/hour) for a given dose of IV dobutamine (in mcg/kg/min) may be
calculated using the following formula:

Dose (in mcg/kg/min) x body weight (kg) x 60 (mins)

Infusion rate (mL/hour) = ------------------------------------------------------------------------------
5000 (mcg/mL)

Table 2. Infusion rates for patients with fluid restriction

Dose Infusion rate (mL/hour)
(mcg/kg/min) 40 kg 45 kg 50 kg 55 kg 60 kg 65 kg 70 kg 75 kg 80 kg
1 0.48 0.54 0.60 0.66 0.72 0.78 0.84 0.90 0.96
2 0.96 1.08 1.20 1.32 1.44 1.56 1.68 1.80 1.92
3 1.44 1.62 1.80 1.98 2.16 2.34 2.52 2.70 2.88
4 1.92 2.16 2.40 2.64 2.88 3.12 3.36 3.60 3.84
5 2.40 2.70 3.00 3.30 3.60 3.90 4.20 4.50 4.80
6 2.88 3.24 3.60 3.96 4.32 4.68 5.04 5.40 5.76
7 3.36 3.78 4.20 4.62 5.04 5.46 5.88 6.30 6.72
8 3.84 4.32 4.80 5.28 5.76 6.24 6.72 7.20 7.68
9 4.32 4.86 5.40 5.94 6.48 7.02 7.56 8.10 8.64
10 4.80 5.40 6.00 6.60 7.20 7.80 8.40 9.00 9.60
11 5.28 5.94 6.60 7.26 7.92 8.58 9.24 9.90 10.56
12 5.76 6.48 7.20 7.92 8.64 9.36 10.08 10.80 11.52
13 6.24 7.02 7.80 8.58 9.36 10.14 10.92 11.70 12.48
14 6.72 7.56 8.40 9.24 10.08 10.92 11.76 12.60 13.44
15 7.20 8.10 9.00 9.90 10.80 11.70 12.60 13.50 14.40
16 7.68 8.64 9.60 10.56 11.52 12.48 13.44 14.40 15.36
17 8.16 9.18 10.20 11.22 12.24 13.26 14.28 15.30 16.32
18 8.64 9.72 10.80 11.88 12.96 14.04 15.12 16.20 17.28
19 9.12 10.26 11.40 12.54 13.68 14.82 15.96 17.10 18.24
20 9.60 10.80 12.00 13.20 14.40 15.60 16.80 18.00 19.20

Monitoring
1. Blood pressure (including mean arterial pressure, if possible)
2. Heart rate
3. Central venous pressure (if available)
4. Urine output
5. Serum potassium

References
st
1. Drug Information Handbook (21 Edition) 2012-2013
th
2. Pharmacotherapy. A Pathophysiologic Approach. (5 Edition).
3. Dobutamine Summary of Product Characteristics
http://www.medicines.org.uk/emc/medicine/28133/SPC/Dobutamine+12.5mg+ml+Concentrate+fo
st
r+Solution+for+Infusion/ . Last accessed 31 Dec 2013

For any clarification regarding this document, contact the pharmacist at:
In-Patient Pharmacy (Ext. 1915/1917) or Drug Information Service (Ext. 1885)
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