Drugs List

Therapeutic Indications

Uses

Congestive cardiac failure
Shock - cardiogenic

For the correction of haemodynamic imbalances present in acute hypotension or shock syndrome due to myocardial infarction, trauma, septicaemia, cardiac surgery and renal failure, chronic cardiac decompensation as in congestive heart failure.

It has also been used in children under 12 years to correct the haemodynamic imbalance due to acute hypotension, shock, cardiac failure, adjunct following cardiac surgery.

Administration

For intravenous infusion only. Infuse into as large a vein as possible.

Contraindications

Hyperthyroidism
Phaeochromocytoma
Tachyarrhythmia
Ventricular fibrillation

Precautions and Warnings

Children under 12 years
Breastfeeding
Diabetes mellitus
Hepatic impairment
Hypovolaemia
Peripheral vascular disease
Pregnancy
Renal impairment

Correct hypovolaemia prior to administration
Admin. during inhalation anaesthesia may cause ventricular arrhythmias
Administer using controlled infusion device
If extravasation occurs follow local policy & seek expert help immediately
If extravasation occurs, infiltrate area with phentolamine mesylate
Infusion should be withdrawn gradually to avoid unnecessary hypotension
Must be diluted before use
Monitor blood pressure
Monitor cardiac function
Monitor ECG
Monitor patients with existing or tendency towards diabetes mellitus
Monitor skin at extremities in patients with peripheral vascular disease
Monitor urine output
Decrease rate/suspend infusion if marked decrease in pulse pressure occurs

Administration of dopamine hydrochloride should always be under the direct supervision of a physician to whom facilities are available for monitoring cardiovascular and renal function, including blood volume, cardiac output, blood pressure, electrocardiography and urine flow.

Dopamine hydrochloride in glucose 5% injection should be infused into a large vein whenever possible to prevent the possibility of infiltration of peripheral tissue adjacent to the infusion site. Extravasation may cause necrosis and sloughing of the surrounding tissue. Ischaemia can be reversed by infiltration of the affected area with phentolamine mesylate. A syringe with a fine hypodermic needle should be used to liberally infiltrate the ischaemic area as soon as extravasation is observed.

Decrease rate or suspend infusion and observe patient carefully for further evidence of predominant vasoconstriction activity, if a disproportionate rise in diastolic pressure (i.e. marked decrease in pulse pressure) is observed.

Excess administration of potassium-free solutions may result in significant hypokalaemia. The intravenous administration of these solutions can cause fluid &/or solute overloading resulting in dilution of serum electrolytes, overhydration, congested states or pulmonary oedema.

The routine use of low dose dopamine hydrochloride in critically ill patients to prevent or treat acute renal failure is not recommended because this may cause adverse effects which could further compromise such patients.

Pregnancy and Lactation

Pregnancy

Use with caution, the effect of dopamine on the human foetus is unknown. Experience with dopamine during human pregnancy is limited. Since dopamine is indicated only for life-threatening situations, chronic use would not be expected.

Animal studies have shown both increases and decreases in uterine blood flow. In a study in pregnant baboons, dopamine infusion increased uterine vascular resistance and thus impaired uteroplacental perfusion. Investigators therefore concluded that dopamine should not be used in patients with severe pre-eclampsia or eclampsia. Dopamine has been used in women to prevent renal failure in oliguric or anuric eclamptic patients by re-establishing diuresis (Briggs, 2011).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution during breastfeeding. There is limited data on the use of dopamine during breastfeeding. Because of its poor oral bioavailability and short half life, any dopamine in milk is unlikely to affect the infant. Intravenous dopamine infusion may decrease milk production. Dopamine is known to reduce serum prolactin in non-nursing women, but no information is available on its effects on milk production in nursing mothers. It is not known whether or not this drug enters human breast milk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anginal pain
Azotaemia
Bradycardia
Conduction disturbances
Dyspnoea
Ectopic beats
Fatal ventricular arrhythmias
Headache
Hypertension
Hypotension
Mydriasis
Nausea
Necrosis (injection site)
Palpitations
Peripheral ischaemic gangrene
Peripheral vasoconstriction
Piloerection
Tachycardia
Vasoconstriction
Vomiting
Widened QRS complex

Presentation

Infusions of dopamine hydrochloride.

Drugs List

Therapeutic Indications

Uses

Congestive cardiac failure
Shock - cardiogenic

For the correction of haemodynamic imbalances present in acute hypotension or shock syndrome due to myocardial infarction, trauma, septicaemia, cardiac surgery and renal failure, chronic cardiac decompensation as in congestive heart failure.

It has also been used in children under 12 years to correct the haemodynamic imbalance due to acute hypotension, shock, cardiac failure, adjunct following cardiac surgery.

Dosage

Prior to administration and where appropriate, circulating blood volume must be restored with a suitable plasma expander or whole blood.

Dosage should be adjusted according to patient's response, with particular attention to diminution of established urine flow rate, increasing tachycardia or development of new arrhythmias as indications for decreasing or temporarily suspending dosage.

Reduce dose to one tenth of the usual dose in patients who have been treated with monoamine oxidase inhibitors prior to dopamine therapy.

Initiate treatment on a low dose in patients with shock due to myocardial infarction.

Adults

Children

Administration

For intravenous infusion only. Infuse into as large a vein as possible.

Contraindications

Hyperthyroidism
Phaeochromocytoma
Tachyarrhythmia
Ventricular fibrillation

Precautions and Warnings

Children under 12 years
Breastfeeding
Diabetes mellitus
Hepatic impairment
Hypovolaemia
Peripheral vascular disease
Pregnancy
Renal impairment

Correct hypovolaemia prior to administration
Admin. during inhalation anaesthesia may cause ventricular arrhythmias
Administer using controlled infusion device
If extravasation occurs follow local policy & seek expert help immediately
If extravasation occurs, infiltrate area with phentolamine mesylate
Infusion should be withdrawn gradually to avoid unnecessary hypotension
Must be diluted before use
Monitor blood pressure
Monitor cardiac function
Monitor ECG
Monitor patients with existing or tendency towards diabetes mellitus
Monitor skin at extremities in patients with peripheral vascular disease
Monitor urine output
Decrease rate/suspend infusion if marked decrease in pulse pressure occurs

Administration of dopamine hydrochloride should always be under the direct supervision of a physician to whom facilities are available for monitoring cardiovascular and renal function, including blood volume, cardiac output, blood pressure, electrocardiography and urine flow.

Dopamine hydrochloride in glucose 5% injection should be infused into a large vein whenever possible to prevent the possibility of infiltration of peripheral tissue adjacent to the infusion site. Extravasation may cause necrosis and sloughing of the surrounding tissue. Ischaemia can be reversed by infiltration of the affected area with phentolamine mesylate. A syringe with a fine hypodermic needle should be used to liberally infiltrate the ischaemic area as soon as extravasation is observed.

Decrease rate or suspend infusion and observe patient carefully for further evidence of predominant vasoconstriction activity, if a disproportionate rise in diastolic pressure (i.e. marked decrease in pulse pressure) is observed.

Excess administration of potassium-free solutions may result in significant hypokalaemia. The intravenous administration of these solutions can cause fluid &/or solute overloading resulting in dilution of serum electrolytes, overhydration, congested states or pulmonary oedema.

The routine use of low dose dopamine hydrochloride in critically ill patients to prevent or treat acute renal failure is not recommended because this may cause adverse effects which could further compromise such patients.

Pregnancy and Lactation

Pregnancy

Use with caution, the effect of dopamine on the human foetus is unknown. Experience with dopamine during human pregnancy is limited. Since dopamine is indicated only for life-threatening situations, chronic use would not be expected.

Animal studies have shown both increases and decreases in uterine blood flow. In a study in pregnant baboons, dopamine infusion increased uterine vascular resistance and thus impaired uteroplacental perfusion. Investigators therefore concluded that dopamine should not be used in patients with severe pre-eclampsia or eclampsia. Dopamine has been used in women to prevent renal failure in oliguric or anuric eclamptic patients by re-establishing diuresis (Briggs, 2011).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution during breastfeeding. There is limited data on the use of dopamine during breastfeeding. Because of its poor oral bioavailability and short half life, any dopamine in milk is unlikely to affect the infant. Intravenous dopamine infusion may decrease milk production. Dopamine is known to reduce serum prolactin in non-nursing women, but no information is available on its effects on milk production in nursing mothers. It is not known whether or not this drug enters human breast milk.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anginal pain
Azotaemia
Bradycardia
Conduction disturbances
Dyspnoea
Ectopic beats
Fatal ventricular arrhythmias
Headache
Hypertension
Hypotension
Mydriasis
Nausea
Necrosis (injection site)
Palpitations
Peripheral ischaemic gangrene
Peripheral vasoconstriction
Piloerection
Tachycardia
Vasoconstriction
Vomiting
Widened QRS complex

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: April 2013

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Dopamine 40mg/ml Sterile concentrate. Hospira UK Ltd. Revised November 2015.

Summary of Product Characteristics: Dopamine Hydrochloride 40mg/ml concentration for solution for infusion. Mercury Pharma Group. Revised November 2014.

Summary of Product Characteristics: Dopamine Hydrochloride 160mg/ml concentration for solution for infusion. Mercury Pharma Group. Revised November 2014.

The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.

US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Dopamine Last revised: January 4, 2011.
Last accessed: April 22, 2013.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 18 August 2017