DOPAMINE HYDROCHLORIDE IN DEXTROSE 5%
Clinical safety rating: safe
MAOIs can cause severe hypertension Extravasation can cause tissue necrosis and sloughing.
Dopamine hydrochloride is a natural catecholamine neurotransmitter that acts as an agonist at dopamine, beta-1 adrenergic, and alpha-1 adrenergic receptors in a dose-dependent manner. Low doses (0.5-2 mcg/kg/min) stimulate dopaminergic receptors causing vasodilation in renal, mesenteric, and coronary beds. Moderate doses (2-10 mcg/kg/min) primarily stimulate beta-1 receptors increasing cardiac contractility and heart rate. High doses (10-20 mcg/kg/min) activate alpha-1 receptors leading to vasoconstriction and increased blood pressure.
| Metabolism | Primarily metabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) in the liver, kidneys, and plasma to inactive compounds (homovanillic acid and 3,4-dihydroxyphenylacetic acid). Approximately 25% is converted to norepinephrine via dopamine beta-hydroxylase. |
| Excretion | Primarily renal, with 75-80% excreted as metabolites (homovanillic acid, 3,4-dihydroxyphenylacetic acid) and 5-10% unchanged. Biliary excretion accounts for <2%. |
| Half-life | Terminal elimination half-life is approximately 2 minutes, requiring continuous intravenous infusion for sustained clinical effect. |
| Protein binding | Approximately 25% bound to albumin. |
| Volume of Distribution | 0.89 L/kg, indicating distribution into extracellular fluid and peripheral tissues. |
| Bioavailability | Oral bioavailability is <5% due to extensive first-pass metabolism; intravenous administration yields 100% bioavailability. |
| Onset of Action | Intravenous: within 2-5 minutes. |
| Duration of Action | Duration is 5-10 minutes after discontinuation of infusion; titrated to effect due to rapid metabolism. |
Continuous IV infusion: initial 2-5 mcg/kg/min, titrate by 1-4 mcg/kg/min every 10-30 min to desired response; max 50 mcg/kg/min.
| Dosage form | INJECTABLE |
| Renal impairment | No specific GFR-based dose adjustment required; use caution in renal impairment due to renal clearance of dopamine metabolites. |
| Liver impairment | No specific Child-Pugh based modifications; no dose adjustment required in hepatic impairment. |
| Pediatric use | Continuous IV infusion: 2-20 mcg/kg/min, titrate to effect; initial 2-5 mcg/kg/min, may increase by 1-5 mcg/kg/min every 10-30 min. |
| Geriatric use | Start at lower end of dosing (2-5 mcg/kg/min) and titrate cautiously due to increased sensitivity and potential for tachycardia or arrhythmias. |
| 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 orally bioavailable due to extensive first-pass metabolism and is poorly excreted into breast milk. The M/P ratio has not been determined. Its short half-life (2 minutes) and use in acute care settings make significant infant exposure unlikely. However, dopamine is typically used in critical care, and breastfeeding may be interrupted. Consider risk vs. benefit. |
| Teratogenic Risk |
■ FDA Black Box Warning
None
| Common Effects | hypotension |
| Serious Effects |
["Hypersensitivity to dopamine or any component","Pheochromocytoma","Ventricular fibrillation or tachydysrhythmias","Uncorrected hypovolemia"]
| Precautions | ["Hypovolemia: Correct volume depletion before administration to avoid worsening shock","Extravasation: Risk of tissue necrosis; administer via central line if possible; treat extravasation with phentolamine","Cardiac arrhythmias: Can precipitate ventricular arrhythmias, especially at high doses; monitor ECG","Gangrene: Associated with high doses and prolonged use due to vasoconstriction","MAOI interaction: Concurrent use may potentiate pressor effects; reduce dopamine dose to 1/10th usual","Pheochromocytoma: Contraindicated in patients with untreated pheochromocytoma due to risk of hypertensive crisis"] |
Loading safety data…
| Dopamine is a sympathomimetic amine and endogenous catecholamine. In animal studies, high doses of dopamine have been associated with reduced fetal weight and increased fetal resorptions. Human data are limited; however, dopamine is used in critical care settings during pregnancy when indicated for maternal hemodynamic support. There is no evidence of teratogenicity from clinical use. Risk to fetus from maternal hypotension or hypoperfusion may exceed any theoretical risk from dopamine. FDA category C. |
| Fetal Monitoring | Continuous maternal heart rate, blood pressure, ECG, and oxygen saturation monitoring. Urine output and peripheral perfusion should be assessed. Fetal heart rate monitoring (if viable) is recommended due to potential placental hypoperfusion from maternal vasoconstriction or during dose titration. |
| Fertility Effects | There are no reported effects on fertility in humans. In animal studies, no adverse effects on fertility were observed. Dopamine may alter prolactin secretion, but clinical significance is uncertain. |