INTROPIN
Clinical safety rating
cautionComprehensive clinical and safety monograph for INTROPIN (INTROPIN).
Dopamine is a direct agonist at dopamine (D1 and D2) and beta-1 adrenergic receptors, and at higher doses, alpha-1 adrenergic receptors. It also causes release of norepinephrine from sympathetic nerve terminals.
| Metabolism | Metabolized in the liver, kidney, and plasma by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) to inactive metabolites. |
| Excretion | Primarily renal: 80% as unchanged drug and 20% as inactive metabolites (normetanephrine, homovanillic acid). Biliary/fecal excretion is negligible (<2%). |
| Half-life | Approximately 2 minutes. Short half-life allows rapid titration by intravenous infusion; effects cease within 5-10 minutes of discontinuation. |
| Protein binding | 25%, primarily to albumin. |
| Volume of Distribution | 0.2 L/kg (0.16-0.24 L/kg). Small Vd indicates limited extravascular distribution; compatible with rapid onset and offset. |
| Bioavailability | Oral: less than 5% due to extensive first-pass metabolism (MAO and COMT). Intramuscular: variable but limited due to peripheral vasoconstriction; not recommended. |
| Onset of Action | Intravenous: 1-2 minutes. Intracardiac (emergency): immediate. Subcutaneous: 5-10 minutes. |
| Duration of Action | Intravenous: 5-10 minutes after infusion stops. Clinical effects vary with infusion rate; prolonged use may require tapering. |
| Molecular Weight | 205.25 |
2-20 mcg/kg/min continuous IV infusion, titrated to achieve desired hemodynamic response. Typical initial dose: 5 mcg/kg/min.
| Dosage form | INJECTABLE |
| Renal impairment | No specific GFR-based dose adjustment required; monitor for renal perfusion adequacy and adjust based on clinical response. |
| Liver impairment | No specific Child-Pugh-based adjustment; use with caution in severe hepatic impairment due to altered metabolism. |
| Pediatric use | 0.5-20 mcg/kg/min continuous IV infusion; typical initial dose 2-5 mcg/kg/min, titrated to effect. |
| Geriatric use | Start at lower end of dosing range (2-5 mcg/kg/min) due to increased sensitivity and comorbid conditions; titrate cautiously. |
| 1st trimester | Crosses placenta; may cause fetal bradycardia and decreased uterine blood flow. Use only if potential benefit outweighs risk. |
| 2nd trimester | Crosses placenta; monitor fetal heart rate. Use with caution due to risk of uterine vasoconstriction. |
| 3rd trimester | Can cause uterine contractions and reduce placental perfusion; avoid during labor except when needed for maternal resuscitation. |
Clinical note
Comprehensive clinical and safety monograph for INTROPIN (INTROPIN).
| Placental transfer | Crosses placenta; detected in fetal circulation; may cause fetal tachycardia or bradycardia. |
| Breastfeeding | Excreted into breast milk in trace amounts; unlikely to affect nursing infant. Use with caution in hypertensive mothers may affect milk production. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Pregnancy Category C. In first trimester, animal studies show fetal abnormalities (e.g., skeletal and visceral malformations) at high doses. Second and third trimesters: risk of reduced uteroplacental blood flow and fetal hypoxia due to vasoconstriction; may induce preterm labor. |
| Fetal Monitoring | Monitor maternal blood pressure, heart rate, ECG, urine output, and signs of extravasation. Fetal monitoring for heart rate and uterine activity if used in pregnancy. |
| Fertility Effects | No human data on fertility; animal studies show no impairment at therapeutic doses. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to dopamine or sulfitesPheochromocytomaUncorrected tachyarrhythmiasVentricular fibrillation
| Precautions | Can cause ectopic heartbeats, tachycardia, angina, palpitations, vasoconstriction, and hypertension, May increase myocardial oxygen demand, Risk of tissue necrosis with extravasation, Use with caution in patients with occlusive vascular disease, Hypovolemia should be corrected before administration |
| Food/Dietary | No significant food interactions. However, patients on INTROPIN may have underlying conditions requiring dietary modifications (e.g., low sodium for hypertension). Avoid tyramine-rich foods if also taking MAOIs, though not a direct interaction with dopamine itself. |
| Clinical Pearls | INTROPIN (dopamine) is a catecholamine with dose-dependent effects: low dose (1-5 mcg/kg/min) stimulates D1 receptors causing renal vasodilation; intermediate dose (5-10 mcg/kg/min) activates β1 receptors increasing cardiac contractility and heart rate; high dose (>10 mcg/kg/min) stimulates α1 receptors leading to vasoconstriction. Monitor for extravasation as it can cause tissue necrosis; treat with phentolamine infiltration. Taper infusion gradually to avoid hypotension. Contraindicated in pheochromocytoma and uncorrected tachyarrhythmias. |
| Patient Advice | This medication is given intravenously and requires continuous monitoring in a hospital setting. · Report any pain, burning, or swelling at the IV site immediately. · You may experience increased heart rate, chest pain, or shortness of breath; notify staff promptly. · Inform your healthcare provider if you have a history of irregular heartbeat, high blood pressure, or thyroid disease. · Do not stop or change the infusion rate; it is controlled by medical staff. |
Loading safety data…