Dobutamine Hydrochloride and Asthmatics

• Generic Name: dobutamine
• Dosage Forms: n.a.
• Other Brand Names: Dobutrex

Used for inotropic support in the short-term management of cardiac decompensation caused by depressed contractility from organic heart disease or cardiac surgery.

Safety and efficacy in the long-term (e.g., >48 hours) treatment of congestive heart failure not established.

Because positive inotropes have not demonstrated improved outcomes and can be potentially harmful (e.g., increased risk of arrhythmias) in patients with heart failure, some experts recommend that such use be reserved for patients with severe systolic dysfunction who have low cardiac index and evidence of systemic hypoperfusion and/or congestion, or for palliative therapy in those with end-stage heart failure. To minimize risk of adverse effects, use lowest possible dosage and evaluate regularly for need for continued inotropic therapy.

Used in the treatment of septic or cardiogenic shock to improve myocardial contractility and maintain systemic perfusion. Current expert guidelines recommend a trial of dobutamine (alone or in addition to a vasopressor) in patients with septic shock if myocardial dysfunction is present, or if there is ongoing hypoperfusion despite adequate intravascular volume and mean arterial pressure. Early revascularization is standard of care in patients with cardiogenic shock; individualize use of inotropes in this setting.

Has been used for postresuscitation stabilization in patients who require additional cardiac output and blood pressure support following cardiac arrest.

Has been used as a pharmacologic stress test agent during echocardiography in patients unable to exercise.

Also has been used as an alternative to exercise stress testing in patients undergoing myocardial perfusion imaging. However, coronary vasodilating agents (e.g., adenosine, dipyridamole, regadenoson) are drugs of choice for this use; dobutamine generally recommended only as an alternative in patients who have contraindications (e.g., bronchospastic airway disease).