Dobutamine

DEVELOPMENT SITE ONLY
Please use current guidelines available on the UHNM intranet for patient treatment

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INDICATIONS

Inotropic support in low output cardiac failure associated with myocardial infarction, cardiogenic shock
Before commencing dobutamine, seek advice from cardiology team
Dobutamine hydrochloride is contraindicated in any hypotensive states due to hypovolaemia or systemic vasodilatation such as septic shock - see Sepsis Management guideline

PREPARATIONS

Dobutamine hydrochloride 250 mg in 50 mL pre-prepared vials

DILUENTS

Sodium chloride 0.9% or glucose 5%
Dobutamine hydrochloride is incompatible with sodium bicarbonate and other strongly alkaline solutions
IV solutions prepared as below are stable for 24 hr at room temperature

the solutions may turn pink and the colour may intensify with time

ADMINISTRATION

Only to be infused in areas able to provide enhanced level care and continuous ECG monitoring
- e.g. critical care unit, coronary care unit, or a high dependency unit
Administer dobutamine through a central line, if available
Give Dobutamine peripherally only on the advice of a consultant
- use a large vein high up in a limb, preferably the arm, to reduce risk of tissue necrosis
- administer the 2 mg/mL solution in a minibag only

DOSAGE

Start with continuous IV infusion 2.5-10 micrograms/kg/min, adjusted every 30 minutes according to response
Monitor heart rate and rhythm, BP, cardiac output (if possible), and urine output

if no response, seek advice of cardiology team before increasing dose further

Infusion via syringe pump

ONLY via central line
Use a 50 mL syringe to draw pre-prepared 250 mg dobutamine in 50 mL vial

250 mg in 50mL syringe=5 mg/mL

Syringe (5mg/mL) rate for selected dose

Give ONLY through a central line

Table 1: Infusion via syringe pump (flow rate mL/hr)

Dosage microgram/kg per min	Weight (kg)
Dosage microgram/kg per min	45	50	55	60	65	70	75	80	85	90	95	100	105	110
0.5	0.3	0.3	0.3	0.4	0.4	0.4	0.5	0.5	0.5	0.5	0.6	0.6	0.6	0.7
1	0.5	0.6	0.7	0.7	0.8	0.8	0.9	1.0	1.0	1.1	1.1	1.2	1.3	1.3
2	1.1	1.2	1.3	1.4	1.6	1.7	1.8	1.9	2.0	2.2	2.3	2.4	2.5	2.6
3	1.6	1.8	2.0	2.2	2.3	2.5	2.7	2.9	3.1	3.2	3.4	3.6	3.8	4.0
4	2.2	2.4	2.6	2.9	3.1	3.4	3.6	3.8	4.1	4.3	4.6	4.8	5.0	5.3
5	2.7	3.0	3.3	3.6	3.9	4.2	4.5	4.8	5.1	5.4	5.7	6.0	6.3	6.6
6	3.2	3.6	4.0	4.3	4.7	5.0	5.4	5.8	6.1	6.5	6.8	7.2	7.6	7.9
7	3.8	4.2	4.6	5.0	5.5	5.9	6.3	6.7	7.1	7.6	8.0	8.4	8.8	9.2
8	4.3	4.8	5.3	5.8	6.2	6.7	7.2	7.7	8.2	8.6	9.1	9.6	10.1	10.6
9	4.9	5.4	5.9	6.5	7.0	7.6	8.1	8.6	9.2	9.7	10.3	10.8	11.3	11.9
10	5.4	6.0	6.6	7.2	7.8	8.4	9.0	9.6	10.2	10.8	11.4	12.0	12.6	13.2
12	6.5	7.2	7.9	8.6	9.4	10.1	10.8	11.5	12.2	13.0	13.7	14.4	15.1	15.8
14	7.6	8.4	9.2	10.1	10.9	11.8	12.6	13.4	14.3	15.1	16.0	16.8	17.6	18.5
16	8.6	9.6	10.6	11.5	12.5	13.4	14.4	15.4	16.3	17.3	18.2	19.2	20.2	21.1
18	9.7	10.8	11.9	13.0	14.0	15.1	16.2	17.3	18.4	19.4	20.5	21.6	22.7	23.8
20	10.8	12.0	13.2	14.4	15.6	16.8	18.0	19.2	20.4	21.6	22.8	24.0	25.2	26.4
25	13.5	15.0	16.5	18.0	19.5	21.0	22.5	24.0	25.5	27.0	28.5	30.0	31.5	33.0
30	16.2	18.0	19.8	21.6	23.4	25.2	27.0	28.8	30.6	32.4	34.2	36.0	37.8	39.6
35	18.9	21.0	23.1	25.2	27.3	29.4	31.5	33.6	35.7	37.8	39.9	42.0	44.1	46.2
40	21.6	24.0	26.4	28.8	31.2	33.6	36.0	38.4	40.8	43.2	45.6	48.0	50.4	52.8

Minibag infusion via controlled-infusion device

Via a large peripheral vein or central line
- monitor for phlebitis and re-site cannula immediately if inflamed
Withdraw 100 mL from a 250 mL bag of diluent (see Diluents)
Add two 250 mg pre-prepared vials of dobutamine (100 mL) to the bag and mix well

500 mg in 250 mL minibag = 2 mg/mL

Minibag infusion via controlled-infusion device (flow rate mL/hr)

Dosage microgram/kg per min	Weight (kg)
Dosage microgram/kg per min	45	50	55	60	65	70	75	80	85	90	95	100	105	110
0.5	1	1	1	1	1	1	1	1	1	1	1	2	2	2
1	1	2	2	2	2	2	2	2	3	3	3	3	3	3
2	3	3	3	4	4	4	5	5	5	5	6	6	6	7
3	4	5	5	5	6	6	7	7	8	8	9	9	9	10
4	5	6	7	7	8	8	9	10	10	11	11	12	13	13
5	7	8	8	9	10	11	11	12	13	14	14	15	16	17
6	8	9	10	11	12	13	14	14	15	16	17	18	19	20
7	9	11	12	13	14	15	16	17	18	19	20	21	22	23
8	11	12	13	14	16	17	18	19	20	22	23	24	25	26
9	12	14	15	16	18	19	20	22	23	24	26	27	28	30
10	14	15	17	18	20	21	23	24	26	27	29	30	32	33
12	16	18	20	22	23	25	27	29	31	32	34	36	38	40
14	19	21	23	25	27	29	32	34	36	38	40	42	44	46
16	22	24	26	29	31	34	36	38	41	43	46	48	50	53
18	24	27	30	32	35	38	41	43	46	49	51	54	57	59
20	27	30	33	36	39	42	45	48	51	54	57	60	63	66
25	34	38	41	45	49	53	56	60	64	68	71	75	79	83
30	41	45	50	54	59	63	68	72	77	81	86	90	95	99
35	47	53	58	63	68	74	79	84	89	95	100	105	110	116
40	54	60	66	72	78	84	90	96	102	108	114	120	126	132

WITHDRAWAL

Decrease dosage gradually by 1 microgram per kg every 2 hours according to response

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Table 1: Infusion via syringe pump (flow rate mL/hr)

Dosage microgram/kg per min	Weight (kg)
Dosage microgram/kg per min	45	50	55	60	65	70	75	80	85	90	95	100	105	110
0.5	0.3	0.3	0.3	0.4	0.4	0.4	0.5	0.5	0.5	0.5	0.6	0.6	0.6	0.7
1	0.5	0.6	0.7	0.7	0.8	0.8	0.9	1.0	1.0	1.1	1.1	1.2	1.3	1.3
2	1.1	1.2	1.3	1.4	1.6	1.7	1.8	1.9	2.0	2.2	2.3	2.4	2.5	2.6
3	1.6	1.8	2.0	2.2	2.3	2.5	2.7	2.9	3.1	3.2	3.4	3.6	3.8	4.0
4	2.2	2.4	2.6	2.9	3.1	3.4	3.6	3.8	4.1	4.3	4.6	4.8	5.0	5.3
5	2.7	3.0	3.3	3.6	3.9	4.2	4.5	4.8	5.1	5.4	5.7	6.0	6.3	6.6
6	3.2	3.6	4.0	4.3	4.7	5.0	5.4	5.8	6.1	6.5	6.8	7.2	7.6	7.9
7	3.8	4.2	4.6	5.0	5.5	5.9	6.3	6.7	7.1	7.6	8.0	8.4	8.8	9.2
8	4.3	4.8	5.3	5.8	6.2	6.7	7.2	7.7	8.2	8.6	9.1	9.6	10.1	10.6
9	4.9	5.4	5.9	6.5	7.0	7.6	8.1	8.6	9.2	9.7	10.3	10.8	11.3	11.9
10	5.4	6.0	6.6	7.2	7.8	8.4	9.0	9.6	10.2	10.8	11.4	12.0	12.6	13.2
12	6.5	7.2	7.9	8.6	9.4	10.1	10.8	11.5	12.2	13.0	13.7	14.4	15.1	15.8
14	7.6	8.4	9.2	10.1	10.9	11.8	12.6	13.4	14.3	15.1	16.0	16.8	17.6	18.5
16	8.6	9.6	10.6	11.5	12.5	13.4	14.4	15.4	16.3	17.3	18.2	19.2	20.2	21.1
18	9.7	10.8	11.9	13.0	14.0	15.1	16.2	17.3	18.4	19.4	20.5	21.6	22.7	23.8
20	10.8	12.0	13.2	14.4	15.6	16.8	18.0	19.2	20.4	21.6	22.8	24.0	25.2	26.4
25	13.5	15.0	16.5	18.0	19.5	21.0	22.5	24.0	25.5	27.0	28.5	30.0	31.5	33.0
30	16.2	18.0	19.8	21.6	23.4	25.2	27.0	28.8	30.6	32.4	34.2	36.0	37.8	39.6
35	18.9	21.0	23.1	25.2	27.3	29.4	31.5	33.6	35.7	37.8	39.9	42.0	44.1	46.2
40	21.6	24.0	26.4	28.8	31.2	33.6	36.0	38.4	40.8	43.2	45.6	48.0	50.4	52.8

Minibag infusion via controlled-infusion device (flow rate mL/hr)

Dosage microgram/kg per min	Weight (kg)
Dosage microgram/kg per min	45	50	55	60	65	70	75	80	85	90	95	100	105	110
0.5	1	1	1	1	1	1	1	1	1	1	1	2	2	2
1	1	2	2	2	2	2	2	2	3	3	3	3	3	3
2	3	3	3	4	4	4	5	5	5	5	6	6	6	7
3	4	5	5	5	6	6	7	7	8	8	9	9	9	10
4	5	6	7	7	8	8	9	10	10	11	11	12	13	13
5	7	8	8	9	10	11	11	12	13	14	14	15	16	17
6	8	9	10	11	12	13	14	14	15	16	17	18	19	20
7	9	11	12	13	14	15	16	17	18	19	20	21	22	23
8	11	12	13	14	16	17	18	19	20	22	23	24	25	26
9	12	14	15	16	18	19	20	22	23	24	26	27	28	30
10	14	15	17	18	20	21	23	24	26	27	29	30	32	33
12	16	18	20	22	23	25	27	29	31	32	34	36	38	40
14	19	21	23	25	27	29	32	34	36	38	40	42	44	46
16	22	24	26	29	31	34	36	38	41	43	46	48	50	53
18	24	27	30	32	35	38	41	43	46	49	51	54	57	59
20	27	30	33	36	39	42	45	48	51	54	57	60	63	66
25	34	38	41	45	49	53	56	60	64	68	71	75	79	83
30	41	45	50	54	59	63	68	72	77	81	86	90	95	99
35	47	53	58	63	68	74	79	84	89	95	100	105	110	116
40	54	60	66	72	78	84	90	96	102	108	114	120	126	132