DOPAMINE HYDROCHLORIDE

Posology Adults:

Where appropriate, the circulating blood volume must be restored with a suitable plasma expander or whole blood, prior to administration of dopamine hydrochloride. 5 microgram/kg/min in patients who are likely to respond to modest increments of heart force and renal perfusion.

In more severe cases, administration may be initiated at a rate of 5 microgram/kg/min and increased gradually in 5- to 10 microgram/kg/min increments up to 20 to 50 microgram/kg/min as needed. If doses in excess of 50 microgram/kg/min are required, it is advisable to check urine output frequently.

Should urinary flow begin to decrease in the absence of hypotension, reduction of dopamine dosage should be considered. It has been found that more than 50% of patients have been satisfactorily maintained on doses less than 20 microgram/kg/min.

In patients who do not respond to these doses, additional increments of dopamine may be given in an effort to achieve adequate blood pressure, urine flow and perfusion generally. Treatment of all patients requires constant evaluation of therapy in terms of blood volume, augmentation of cardiac contractility, and distribution of peripheral perfusion and urinary output.

Dosage of dopamine should be adjusted according to the patient's response, with particular attention to diminution of established urine flow rate, increasing tachycardia or development of new dysrhythmias as indications for decreasing or temporarily suspending the dosage.

Paediatric population The safety and efficacy of dopamine in paediatric patients has not been established. Elderly population No variation in dosage is suggested for geriatric patients. However, close monitoring is suggested for blood pressure, urine flow and peripheral tissue perfusion.

Method of administration To be administered by intravenous infusion only after dilution with the appropriate diluents. 6. A suitable metering device is required in the infusion system to control the rate of flow, and this should be adjusted to the optimum patient response and monitored constantly in the light of the individual patient's response.

Adverse reactions to dopamine are related to its pharmacological action. Frequencies are defined as: very common (>1/10), common (>1/100 to <1/10), uncommon (>1/1,000 to <1/100), rare (>1/10,000 to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).

System Organ Class Frequency Adverse reactions Infections and infestations Uncommon Gangrene1 Common HeadacheNervous system disorders Eye disorders Uncommon Mydriasis Common Ectopic heart beats, tachycardia, anginal pain, palpitation.

Cardiac disorders Uncommon Aberrant conduction, bradycardia, widened QRS complex, fatal ventricular arrhythmias have been reported on rare occasions. Not known Atrial fibrillation Common Hypotension, vasoconstrictionVascular disorders Uncommon Hypertension Respiratory, thoracic and mediastinal disorders Common Dyspnoea Gastrointestinal disorders Common Nausea, vomiting Skin and subcutaneous tissue disorders Uncommon Piloerection Renal and urinary disorders Uncommon Azotaemia 1 Serious or Life-threatening Reactions: Gangrene of the feet has occurred following doses of 10-14 microgram/kg/min and higher in a few patients with pre-existing vascular disease.

Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Dopamine should not be used in the presence of uncorrected tachyarrhythmias or ventricular fibrillation. Nor should it be used in patients with phaeochromocytoma or hyperthyroidism. Cyclopropane and halogenated hydrocarbon anaesthetics must be avoided.

Monoamine oxidase (MAO) inhibitors Patients who have been treated with MAO inhibitors prior to dopamine should be given reduced doses; the starting dose should be one tenth (1/10th) of the usual dose. Potassium-free solutions Excess administration of potassium-free solutions may result in significant hypokalaemia.

The intravenous administration of these solutions can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary oedema. Hypovolaemia Hypovolaemia should be corrected where necessary prior to dopamine infusion.

Low doses should be used in shock due to acute myocardial infarction. e. a marked decrease in pulse pressure) is observed, the infusion rate should be decreased and the patients observed carefully for further evidence of predominant vasoconstriction activity, unless such an effect is desired.

Occlusive vascular disease Patients with a history of peripheral vascular disease should be closely monitored for any changes in colour or temperature of the skin of the extremities. If change of skin colour or temperature occurs and is thought to be the result of compromised circulation to the extremities, the benefits of continued dopamine infusion should be weighed against the risk of possible necrosis.

These changes may be reversed by decreasing the rate or discontinuing the infusion. IV administration of phentolamine mesylate 5-10 mg may reverse the ischaemia. Extravasation Dopamine hydrochloride in 5% dextrose injection should be infused into a large vein whenever possible to prevent the possibility of infiltration of perivascular tissue adjacent to the infusion site.

Extravasation may cause necrosis and sloughing of the surrounding tissue. Ischaemia can be reversed by infiltration of the affected area with 10-15 ml of saline containing 5 to 10 mg phentolamine mesylate. A syringe with a fine hypodermic needle should be used to liberally infiltrate the ischaemic area as soon as extravasation is noted.

Diabetes Dextrose solutions should be used with caution in patients with known subclinical or overt diabetes mellitus. Laboratory test interferences Infusion of dopamine suppresses pituitary secretion of thyroid stimulating hormone, and prolactin.

2). Paediatric use The safety and efficacy of dopamine in paediatric patients has not been established. Renal and hepatic impairment As the effect of dopamine on impaired renal and hepatic function is not known, close monitoring is advised.

Hypotension Dopamine infusion should be withdrawn gradually, to avoid unnecessary hypotension. e. it is essentially ‘sodium-free’. This medicine contains potassium metabisulfite (E224); in rare cases, it may cause allergic-type reactions and bronchospasm.

, essentially ‘potassium-free’.

1. • Phaeochromocytoma or hyperthyroidism • Uncorrected atrial or ventricular tachyarrhythmias or ventricular fibrillation. • Cyclopropane and halogenated hydrocarbon anaesthetics.