DOBUTREX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for DOBUTREX (DOBUTREX).
Dobutamine is a direct-acting inotropic agent primarily stimulating beta-1 adrenergic receptors, with mild beta-2 and alpha-1 effects. It increases myocardial contractility and stroke volume, resulting in increased cardiac output.
| Metabolism | Primarily metabolized by catechol-O-methyltransferase (COMT) and conjugation (glucuronidation). Major metabolite is 3-O-methyldobutamine, which is inactive. |
| Excretion | Renal: 75-80% as metabolites (3-O-methyl-dobutamine and conjugates) and unchanged drug; minor biliary/fecal elimination (<5%) |
| Half-life | Terminal elimination half-life approximately 2 minutes; clinical effects wane within minutes of infusion cessation due to rapid redistribution and metabolism |
| Protein binding | 25-30% bound to plasma proteins (primarily albumin) |
| Volume of Distribution | 0.2 L/kg (approximately 15 L in 70 kg adult), indicating limited tissue distribution |
| Bioavailability | Intravenous: 100%; not administered orally due to extensive first-pass metabolism (<5% oral bioavailability) |
| Onset of Action | Intravenous: 1-2 minutes; peak effect within 10 minutes |
| Duration of Action | Short duration, effects persist for 10-20 minutes after discontinuation of infusion; requires continuous IV administration for sustained effect |
| Action Class | Sympathomimetics agonist-Inotropes |
| Brand Substitutes | Dotamin 250mg Injection, Dobutam 250mg Injection, Cardigen Injection, Dobucef 250mg Injection, Doburan 250mg Injection |
2.5-20 mcg/kg/min continuous IV infusion; titrate to hemodynamic response.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required for renal impairment. |
| Liver impairment | No specific guidelines; use with caution in severe hepatic impairment due to altered metabolism. |
| Pediatric use | 0.5-20 mcg/kg/min continuous IV infusion; initiate at lower doses and titrate. |
| Geriatric use | Initiate at lower doses (2.5 mcg/kg/min) and titrate cautiously due to increased sensitivity and comorbidities. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for DOBUTREX (DOBUTREX).
| Breastfeeding | It is not known whether dobutamine is excreted in human milk. Many drugs are excreted, and caution is advised. No M/P ratio available. |
| Teratogenic Risk | No adequate studies in pregnant women. Animal studies have not been conducted. Dobutamine is not teratogenic in rats or rabbits at doses up to 2.5 mg/kg/day (0.3 times the human dose) and 5 mg/kg/day (0.6 times the human dose), respectively. However, the drug may cause fetal hypoxia and acidosis due to uterine vasoconstriction. Use only if potential benefit justifies potential risk. |
■ FDA Black Box Warning
Dobutamine is not approved for use in patients with atrial fibrillation or flutter with a rapid ventricular response due to the risk of increasing ventricular rate.
| Serious Effects |
Hypersensitivity to dobutamine or sulfites (some formulations contain sulfites). Idiopathic hypertrophic subaortic stenosis (IHSS).
| Precautions | May cause significant increase in heart rate, blood pressure, or ventricular ectopy; monitor ECG and hemodynamics. Use with caution in patients with hypertension, ischemic heart disease, or hypovolemia. Risk of tachyphylaxis with prolonged use. |
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| Fetal Monitoring |
| Continuous ECG monitoring, blood pressure, heart rate, cardiac output, pulmonary wedge pressure, and central venous pressure. In pregnancy, monitor fetal heart rate and uterine activity during infusion. |
| Fertility Effects | No data on human fertility effects. Animal reproduction studies have not been conducted. |