Stimulates both adrenergic and dopaminergic receptors, lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta1-adrenergic stimulating and produce cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors

Hypotension or shock: Treatment of severe hypotension or shock (eg, septic shock and other vasodilatory shock states, cardiogenic shock, decompensated heart failure, post–cardiac arrest) that persists during and after adequate fluid volume replacement.

Hypersensitivity to sulfites (commercial preparation contains sodium bisulfite); pheochromocytoma; uncorrected tachyarrhythmias; ventricular fibrillation

Dosing: Adult Note: Hemodynamic effects of dopamine are dose dependent (however, this is relative and there is overlap of clinical effects between dosing ranges) (Ref ). Low dose: Augments renal dopamine receptors, which may increase renal blood flow and urine output. The use of low-dose dopamine to prevent or treat acute kidney injury is not recommended. Intermediate dose: Dopamine and beta-adrenergic effects predominate, resulting in increased renal blood flow, heart rate, cardiac contractility, and cardiac output. High dose: Alpha-adrenergic effects begin to predominate, resulting in vasoconstriction and increased blood pressure, in addition to increased heart rate, cardiac contractility, and cardiac output due to beta-adrenergic effects. Bradycardia or atrioventricular block, symptomatic Bradycardia or atrioventricular block, symptomatic (unresponsive to atropine) (off-label use): Continuous infusion: IV: Initial: 5 mcg/kg/minute; increase by 5 mcg/kg/minute every 2 minutes until desired effect; maximum dose: 20 mcg/kg/minute (Ref ). Hypotension or shock Hypotension or shock: Cardiogenic shock (alternative agent): Note: Typically, not the preferred initial agent in cardiogenic shock; consider other inotropic and/or vasopressor options; caution with the use of dopamine due to increased arrhythmias and possibly mortality in this population (Ref ). Optimal goal of therapy not well established, but typically titrate to maintain end-organ perfusion (Ref ). Continuous infusion: IV: Usual dosage range: 0.5 to 20 mcg/kg/minute; titrate based on clinical end point (eg, end-organ perfusion) (Ref ). Septic shock and other vasodilatory shock states (alternative agent): Note: Not recommended for septic shock except as an alternative to norepinephrine in patients with bradycardia who have a low risk of tachyarrhythmias (Ref ). Compared to norepinephrine, dopamine is associated with an increased risk of tachyarrhythmias and potentially worse outcomes (eg, increased mortality, kidney failure) (Ref ). In general, maintain goal mean arterial pressure (MAP) (eg, ~65 mm Hg); consider use if patient is in shock or has hypoperfusion during or after fluid resuscitation (Ref ). Continuous infusion: IV: Initial: 2 to 5 mcg/kg/minute; titrate to goal MAP up to a dose of 20 mcg/kg/minute (Ref ). Post–cardiac arrest shock (alternative agent): Note: Typically, not the preferred initial agent in post–cardiac arrest shock due to risk of tachyarrhythmias; consider other inotropic and/or vasopressor options (Ref ). Optimal goal of therapy is not well established, but typically titrate to MAP >65 mm Hg and preferably >80 mm Hg to optimize cerebral and end-organ perfusion (Ref ). Continuous infusion: IV: Usual dosage range: 5 to 20 mcg/kg/minute; titrate based on clinical end points (eg, MAP, end-organ perfusion) (Ref ). Inotropic support Inotropic support: Note: May consider in patients with severe systolic dysfunction with decreased end-organ perfusion (Ref ). Continuous infusion: IV: 5 to 15 mcg/kg/minute; doses at lower end of this range are preferred as inotropic actions predominate at lower doses and vasoconstrictive actions predominate at higher doses (Ref ).

IV: Administer as a continuous infusion via an infusion pump. Central line administration is preferred; extravasation may cause severe ischemic necrosis. If central line is not available, may administer for a short duration (<72 hours) through a peripheral IV catheter placed in a large vein at a proximal site (eg, in or proximal to antecubital fossa). Frequent monitoring of the IV catheter site is recommended to rapidly identify extravasation (Ref ). Refer to institutional policies and procedures; catheter placement/size and vasopressor concentration may vary depending on institution.

Adults

1 week to 5 months

Adults: <10 minutes.

Adverse Reactions The following adverse drug reactions are derived from product labeling unless otherwise specified. Postmarketing: Cardiovascular: Angina pectoris, atrial fibrillation, bradycardia, cardiac conduction disorder, ectopic beats, hypertension, hypotension, palpitations, tachycardia, vasoconstriction, ventricular arrhythmia, widened QRS complex on ECG Dermatologic: Peripheral gangrene (with prolonged or high dose, can occur with low doses with concomitant occlusive vascular disease), piloerection Gastrointestinal: Nausea, vomiting Genitourinary: Azotemia Nervous system: Anxiety, headache Respiratory: Dyspnea

Warnings/Precautions Concerns related to adverse effects: • Arrhythmias: May cause increases in heart rate, increasing the risk of tachycardia and other tachyarrhythmias including ventricular arrhythmias (Tisdale 1995). In heart transplant candidates, institute appropriate measures to protect patient against risks of sudden cardiac death (Young 2000). • Extravasation: Vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation; infuse into a large vein if possible. Avoid infusion into leg veins. Watch IV site closely. [US Boxed Warning]: If extravasation occurs, infiltrate the area with diluted phentolamine (5 to 10 mg in 10 to 15 mL of saline) with a fine hypodermic needle. Phentolamine should be administered as soon as possible after extravasation is noted to prevent sloughing/necrosis. Disease-related concerns: • Cardiovascular disease: Use with caution in patients with cardiovascular disease, cardiac arrhythmias and/or occlusive vascular disease. • Active myocardial ischemia/post-myocardial infarction: Use with caution in patients with active myocardial ischemia or recent myocardial infarction; may increase myocardial oxygen consumption. • Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy to minimize the risk of arrhythmias (ACC/AHA/ESC [Zipes 2006]; Tisdale 1995). • Shock: The use of dopamine in adult patients with shock (majority of patients had septic shock) demonstrated a higher incidence of adverse events (eg, tachyarrhythmias) (De Backer 2010). Higher 28-day mortality was also seen in patients with septic shock with the use of dopamine as compared to norepinephrine (De Backer 2012; Vasu 2012). Concurrent drug therapy issues: • Monoamine oxidase inhibitors (MAO-I): Use with extreme caution in patients taking MAO inhibitors; prolong hypertension may result from concurrent use. Dosage form specific issues: • Sodium metabisulfite: Product may contain sodium metabisulfite. Other warnings/precautions: • Appropriate use: Assure adequate circulatory volume to minimize need for vasoconstrictors when used in hemodynamic support. Avoid hypertension; monitor blood pressure closely and adjust infusion rate.