Dopamine — Prescribing Reference

Formulations

• Injection: 40 mg/mL (5, 10 mL vials)
• Pre-diluted in D5W: 0.8, 1.6, 3.2 mg/mL (250, 500 mL bags)

Mechanism of Action

Dose-Dependent Effects

Indications

• Hemodynamically significant hypotension (cardiogenic shock, trauma, heart failure, renal failure) when fluid resuscitation is unsuccessful or inappropriate
• Symptomatic bradycardia unresponsive to atropine (not first-line)
• Alternative vasopressor to norepinephrine in septic shock only in highly selected patients (those with low risk of tachyarrhythmias and with bradycardia)

Note: The Surviving Sepsis Campaign no longer recommends dopamine as initial vasopressor for septic shock — norepinephrine is preferred due to lower short-term mortality and fewer tachyarrhythmias. — Tintinalli's Emergency Medicine

Administration

• Must be given via central line or large peripheral vein (extravasation causes tissue necrosis — treat with phentolamine)
• Do not administer via umbilical arterial catheter
• Wean gradually from intermediate/high doses down to 3–5 mcg/kg/min before stopping, to avoid rebound hypotension
• Monitor vital signs and blood pressure continuously
• Correct hypovolemia before starting

Contraindications

• Pheochromocytoma
• Tachyarrhythmias
• Uncorrected hypovolemia

Adverse Effects

• Tachycardia, ectopic beats, palpitations
• Hypertension (high doses) or hypotension (low doses)
• Chest pain, headache, nausea/vomiting
• Tissue ischemia/necrosis (extravasation)
• Limb and end-organ ischemia (high doses)

Drug Interactions

• Phenytoin: may exacerbate hypotension and bradycardia
• Linezolid (MAOIs): may potentiate hypertension
• MAO inhibitors: significantly increase dopamine's effects (reduce dose to 1/10th)

Special Populations

• Neonates: more sensitive to vasoconstrictive effects; high variability in clearance
• Children <2 years: clear dopamine faster
• Heart failure: poor inotrope in severe systolic dysfunction due to depleted myocardial catecholamine stores

Key Clinical Evidence

• Low-dose dopamine for renal protection: no longer recommended — multiple trials (ROSE-AHF, DAD-HF II) showed no improvement in urine output or renal function, and increased hypotension/tachycardia vs. placebo
• Dopamine vs. norepinephrine in shock: De Backer et al. showed higher arrhythmia rates and no mortality benefit with dopamine

─────────────────────────────────────────────────────
                    PRESCRIPTION
─────────────────────────────────────────────────────
Date: _______________

Patient Name: _______________________  Age: ________
Weight: _________ kg               MRN: ___________

Diagnosis: Cardiogenic Shock
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℞

  Dopamine HCl                    400 mg
  in 5% Dextrose Water (D5W)      250 mL
  ──────────────────────────────────────
  Final concentration: 1,600 mcg/mL

  Route:     IV infusion via central line
  Dose:      5–15 mcg/kg/min
  Titrate:   Start at 5 mcg/kg/min; increase by
             2–5 mcg/kg/min every 10–30 min
             to achieve target MAP ≥65 mmHg
  Max dose:  20 mcg/kg/min

─────────────────────────────────────────────────────

MONITORING PARAMETERS:
  • Continuous cardiac monitoring (ECG)
  • Blood pressure every 5–15 min (arterial line preferred)
  • Heart rate, urine output (target ≥0.5 mL/kg/hr)
  • Signs of peripheral ischemia / extravasation

PRECAUTIONS:
  • Correct hypovolemia before initiating
  • Administer through central line only
  • If extravasation occurs: infiltrate with phentolamine
  • Wean gradually — do not abruptly discontinue

CONTRAINDICATIONS (confirm absence):
  □ Pheochromocytoma     □ Tachyarrhythmia

─────────────────────────────────────────────────────
Prescriber: _______________________
Signature:  _______________________
─────────────────────────────────────────────────────

Infusion rate calculator (for 1,600 mcg/mL concentration): Rate (mL/hr) = Dose (mcg/kg/min) × Weight (kg) × 60 ÷ 1,600

Example — 70 kg patient at 10 mcg/kg/min: 10 × 70 × 60 ÷ 1,600 = 26.25 mL/hr