• Clinical Info

Uses

Shock

Used to increase cardiac output, BP, and urine flow as an adjunct in the treatment of shock that persists after adequate fluid volume replacement and when systemic vascular resistance is decreased. Individual hemodynamic abnormalities must be identified and monitored so that therapy can be adjusted as necessary.

It has not been established whether dopamine decreases mortality due to shock in spite of drug-induced increases in cardiac output, BP, and urine flow.

Has been used to support cardiac output and maintain arterial pressure during intra-aortic balloon counterpulsation therapy (e.g., in patients with hypotensive cardiogenic shock following AMI).

May be considered for the treatment of drug-induced hypovolemic shock, when patient is unresponsive to fluid volume expansion and inotropic and/or vasopressor support is required.

Use in low cardiac output syndrome following open heart surgery can increase long-term survival. However, because of pharmacologic and pharmacodynamic differences, dobutamine may be preferable in the period immediately following cardiopulmonary bypass surgery.

May increase cardiac output, BP, and urine flow in shock that is refractory to other agents.

Appears to be most effective when therapy is begun shortly after the signs and symptoms of shock appear and before physiologic parameters such as BP and myocardial function undergo severe deterioration and before urine flow has decreased to <0.3 mL/minute.

CPR

Used to increase cardiac output and BP in ACLS during CPR.

Treatment of symptomatic bradycardia unresponsive to atropine, as a temporizing measure while awaiting availability of a pacemaker, or if pacing ineffective.

Often used for the management of hypotension, particularly if associated with symptomatic bradycardia or after return of spontaneous circulation.

Useful in the management of postresuscitation hypotension when combined with other agents such as dobutamine.

If hypotension persists after filling pressure (i.e., intravascular volume) is optimized, drugs with combined inotropic and vasopressor actions (e.g., epinephrine, norepinephrine) may be used.

Acute Renal Failure

Low-dose (“renal dose,” e.g., <5 mcg/kg per minute) therapy does not appear to prevent or ameliorate acute (e.g., oliguric) renal failure in critically ill patients despite some evidence of increased renal and mesenteric perfusion from selective dopaminergic effects. Although diuresis may occur, GFR does not improve, and such therapy no longer is recommended.

In addition, low-dose dopamine infusions are not without risk and may be associated with adverse effects (e.g., suppression of respiratory drive, increased cardiac output and myocardial oxygen consumption, arrhythmias, hypokalemia, hypophosphatemia, gut ischemia, disruption of metabolic and immunologic homeostasis).

CHF

May improve cardiac output and stroke volume and is considered useful in the short-term management of severe CHF that is refractory to cardiac glycosides (digoxin) and diuretics.

Relative value and role of dopamine versus dobutamine in patients with CHF remain to be clearly established, although dobutamine may be preferred because of pharmacologic and pharmacodynamic differences in chronic CHF.

Hepatorenal Syndrome

Has been used as part of a regimen for treatment of hepatorenal syndrome†; however, long-term beneficial effects have not been demonstrated.

Cirrhosis

Has been used as part of a regimen for treatment of cirrhosis†; however, long-term beneficial effects have not been demonstrated.