DOPAMINE HYDROCHLORIDE AND DEXTROSE 5%
Clinical safety rating: safe
MAOIs can cause severe hypertension Extravasation can cause tissue necrosis and sloughing.
Dopamine is a direct-acting sympathomimetic amine that stimulates dopaminergic (D1 and D2) and adrenergic (α1, β1, β2) receptors. At low to moderate doses, it primarily activates β1 receptors in the heart and D1/D2 receptors in the renal and mesenteric vasculature, leading to increased cardiac contractility and renal blood flow. At high doses, α1 receptor activation causes vasoconstriction and increased systemic vascular resistance.
| Metabolism | Primarily metabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) to homovanillic acid (HVA) and other inactive metabolites. Approximately 25% is converted to norepinephrine in adrenergic nerve terminals. |
| Excretion | Renal: 80% as dopamine metabolites (e.g., homovanillic acid, DOPAC); <10% unchanged; biliary/fecal: minimal. |
| Half-life | 2 minutes (short, due to rapid metabolism by MAO and COMT; clinical effects are brief and dose-dependent). |
| Protein binding | 25% (albumin). |
| Volume of Distribution | 0.89 L/kg (large, indicating extensive tissue distribution). |
| Bioavailability | Oral: <5% (extensive first-pass metabolism); intravenous: 100%. |
| Onset of Action | Intravenous: within 2-5 minutes. |
| Duration of Action | Intravenous: 10-15 minutes (short, requiring continuous infusion for sustained effect). |
Continuous IV infusion: 0.5-20 mcg/kg/min, titrated to desired hemodynamic effect. Start at 2-5 mcg/kg/min and increase by 1-4 mcg/kg/min every 10-30 minutes.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment required for renal impairment. Monitor for adequate urine output and avoid extravasation. Dose based on clinical response. |
| Liver impairment | No specific dose adjustment for hepatic impairment based on Child-Pugh score. Use with caution in severe hepatic impairment due to altered catecholamine metabolism; titrate to effect. |
| Pediatric use | Continuous IV infusion: 2-20 mcg/kg/min, titrated to desired effect. Initial dose 2-5 mcg/kg/min; increase by 1-5 mcg/kg/min every 10-30 minutes. Maximum 20 mcg/kg/min. |
| Geriatric use | Start at low end of dosing range (0.5-2 mcg/kg/min) due to increased sensitivity and higher risk of adverse effects (e.g., tachycardia, arrhythmia, ischemia). Titrate slowly with close hemodynamic monitoring. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
MAOIs can cause severe hypertension Extravasation can cause tissue necrosis and sloughing.
| FDA category | Animal |
| Breastfeeding | Dopamine is not excreted into breast milk in clinically significant amounts due to its short half-life and rapid metabolism. The M/P ratio is not established but expected to be very low. Compatible with breastfeeding; monitor infant for irritability or changes in heart rate. |
| Teratogenic Risk | Dopamine is a catecholamine that does not cross the placenta significantly. First trimester: no specific teratogenic effects identified in animal studies; human data insufficient. Second and third trimesters: potential fetal hypoxia and tachycardia due to maternal vasoconstriction and increased cardiac output; may cause uterine vasoconstriction reducing placental perfusion. Use only if clearly needed. |
■ FDA Black Box Warning
Contains sodium metabisulfite, which may cause allergic-type reactions including anaphylactic symptoms and life-threatening asthmatic episodes in susceptible individuals. Not for use in patients with pheochromocytoma, uncorrected tachyarrhythmias, or ventricular fibrillation.
| Common Effects | hypotension |
| Serious Effects |
Pheochromocytoma, uncorrected tachyarrhythmias (e.g., ventricular fibrillation), hypersensitivity to dopamine or sulfites (contains sodium metabisulfite), concurrent use with MAOIs or within 2 weeks of MAOI discontinuation.
| Precautions | Extravasation risk: may cause tissue necrosis if extravasated; administer via central line if possible. Not an adequate treatment for hypovolemia; correct volume deficits first. May increase heart rate and exacerbate myocardial ischemia. Caution in patients with occlusive vascular disease (e.g., Raynaud's). Use with monoamine oxidase inhibitors (MAOIs) may potentiate pressor effects. Taper gradually if patient developed tolerance. |
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| Fetal Monitoring | Monitor maternal heart rate, blood pressure, ECG, urine output, and peripheral perfusion continuously. Fetal heart rate monitoring during infusion to detect signs of distress. Assess uterine activity if near term. |
| Fertility Effects | Dopamine may inhibit prolactin secretion, potentially impairing ovulation and fertility in women. Transient effects; no long-term reproductive toxicity reported. |
| Food/Dietary | No significant food interactions. Maintain adequate hydration as directed. |
| Clinical Pearls | Administer via central line to prevent extravasation necrosis; extravasation requires phentolamine infiltration. Titrate to achieve target mean arterial pressure (MAP) >65 mmHg and adequate organ perfusion. Correct hypovolemia before use. Monitor ECG for arrhythmias and urine output for renal perfusion. Avoid abrupt discontinuation; wean gradually. |
| Patient Advice | This medication is given intravenously to support blood pressure and heart function. · You may experience rapid heartbeat or chest pain; report immediately. · Notify staff if you have pain, swelling, or redness at the IV site. · Do not stop this medication suddenly; it must be tapered under medical supervision. |