Dopamine Hydrochloride and Arrhythmias

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

  Intropin

Used as adjunctive therapy to correct hemodynamic imbalances (e.g., increase cardiac output and BP) in the treatment of shock.

Pressor therapy is not a substitute for replacement of blood, plasma, fluids, and/or electrolytes. Correct blood volume depletion as fully as possible before administration.

The Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock recommend norepinephrine as the vasopressor of choice in adults with septic shock; although dopamine was used widely in the past, more recent evidence indicates that the drug is associated with a greater risk of adverse effects (e.g., arrhythmias) and possibly also an increased risk of death compared with norepinephrine. In these guidelines, dopamine is considered an alternative to norepinephrine only in highly selected patients with septic shock (e.g., those with low risk of tachyarrhythmias and bradycardia).

Also used to provide vasopressor support in other types of shock (e.g., cardiogenic, hemorrhagic), generally as a temporary measure until underlying cause can be treated.

Some evidence suggests that dopamine may be associated with increased risk of mortality compared with norepinephrine in patients with cardiogenic shock. Early revascularization is standard of care in patients with cardiogenic shock; individualize use of vasopressors in this setting.

Some experts state dopamine may be considered for treatment of drug-induced hypovolemic shock when patient is unresponsive to fluid volume expansion and inotropic and/or vasopressor support is required.

May increase cardiac output, BP, and urine flow in shock; however, exact effects are dose related and based on patient's clinical status at time of administration. In low or intermediate doses, usually does not produce sufficient peripheral vasoconstriction to increase BP. If hypotension persists, a more potent vasoconstrictor such as norepinephrine may be required.

Appears to be most effective when therapy is begun shortly after the signs and symptoms of shock appear and before physiologic parameters such as BP and myocardial function undergo severe deterioration and before urine flow has decreased to <0.3 mL/minute.

Used in ACLS for treatment of symptomatic bradycardia in adults, particularly if associated with hypotension; although not a first-line drug, may be considered in patients who are unresponsive to atropine, or as a temporizing measure while awaiting a pacemaker.

Also used during resuscitation for management of patients in cardiac arrest. Principal goal of pharmacologic therapy during cardiac arrest is to facilitate the return of spontaneous circulation (ROSC), and epinephrine is the drug of choice for this use. Vasoactive drugs such as dopamine may be used for hemodynamic support following resuscitation.

Low-dose (“renal dose,” e.g., <5 mcg/kg per minute) therapy does not appear to prevent or ameliorate acute (e.g., oliguric) renal failure in critically ill patients despite some evidence of increased renal and mesenteric perfusion from selective dopaminergic effects. Currently available data do not support any benefit from such therapy, and routine use of low-dose (“renal dose”) dopamine therapy for prevention or amelioration of acute renal failure in critically ill patients not recommended.

In addition, low-dose dopamine infusions are not without risk and may be associated with adverse effects (e.g., suppression of respiratory drive, increased cardiac output and myocardial oxygen consumption, arrhythmias, hypokalemia, hypophosphatemia, gut ischemia, disruption of metabolic and immunologic homeostasis).

May be used for inotropic support in patients with refractory heart failure. Because parenteral inotropes 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.

Low-dose dopamine infusion has been used in combination with loop diuretics to augment diuresis and improve renal blood flow in patients with acute decompensated heart failure; however, current evidence does not support routine use of dopamine for this purpose.