For intravenous use only. 5 to 10 micrograms/kg/minute, which should be adjusted according to the patient’s heart rate, blood pressure, cardiac output and urine output. 5 micrograms/kg/min and the dose may be increased in intervals of 10-30 minutes until desired hemodynamic response is achieved or until side effects, such as excessive tachycardia, arrhythmia, headache or tremor limit a further increase in dosage.
The dose should be adjusted individually according to heart rate and rhythm, blood pressure and urinary flow. 5 micrograms/kg/minute will produce a response. Up to 40 micrograms/kg/minute may be required. During prolonged continuous infusion (48-72 hours), a decrease in haemodynamic response may occur, which makes an increase in dose necessary.
Dosage for cardiac stress testing:
The use of dobutamine in cardiac stress testing should only be undertaken in units which already perform exercise stress testing and all normal care and precautions required for such testing are also required when using dobutamine for this purpose including the availability of a defibrillator and personnel specially trained in resuscitation are present.
The recommended dosage is an incremental increase in infusion rates from 5 micrograms/kg/minute to 10, 20, 30 and a maximum of 40 micrograms/kg/minute, each dose being infused for 3 minutes. In addition, atropine can be added during further infusion of the peak dose.
1 mV (1 mm) in patients without history of myocardial infarction, or any significant cardiac arrhythmias. The infusion of dobutamine should be terminated if the heart rate reaches 85% of the age- predicted maximum, systolic blood pressure rises above 220 mmHg or a symptomatic decrease in systolic blood pressure > 40 mmHg from baseline, new cardiac wall motion abnormalities, severe chest pain or any non-tolerable adverse effect occurs.
Elderly:
No variation in dosage is suggested. Close monitoring is required for blood pressure, urine flow and peripheral tissue perfusion. Cardiac stress testing: when used as an alternative to exercise for cardiac stress testing the recommended dose should start at 5 micrograms/kg/minute, and the dose should be increased incrementally by 5 micrograms/kg/minute every 8 minutes to a maximum rate of 20 micrograms/kg/minute.
Continuous ECG monitoring is essential and the infusion terminated in the event of > 3 mm ST segment depression or any ventricular arrhythmia. The infusion should also be terminated if heart rate reaches the age/sex maximum, systolic blood pressure rises above 220 mm Hg or any side effects occur.
Paediatric population For all paediatric age groups (neonates to 18 years) an initial dose of 5 micrograms/kg/minute, adjusted according to clinical response to 2 – 20 micrograms/kg/minute is recommended. 0 micrograms/kg/minute will produce a response.
There is reason to believe that the minimum effective dosage for children is higher than for adults. Caution should be taken in applying high doses, because there is also reason to believe that the maximum tolerated dosage for children is lower than the one for adults.
5 micrograms/kg/minute, but reducing or termination of the rate of dobutamine infusion is all that is required for rapid reversal of undesirable effects. A great variability has been noted between paediatric patients in regard to both the plasma concentration necessary to initiate a hemodynamic response (threshold) and the rate of hemodynamic response to increasing plasma concentrations, which demonstrates that the required dose for children cannot be determined a priori and should be titrated in order to allow for the supposedly smaller “therapeutic width” in children.
Method of administration Dobutamine should be diluted before use and administered by IV infusion only. The concentration of the dobutamine administered depends upon the dosage and fluid requirements of the individual patient. The final concentrations generally used for perfusion are 250 micrograms/ml, 500 micrograms/ml or 1000 micrograms/ml.
4. High concentrations of dobutamine should only be given with an infusion pump or other suitable apparatus to ensure accurate dosage. Due to its short half-life dobutamine should be administered as a continuous intravenous infusion.
Dobutamine should be administered intravenously through an intravenous needle or catheter. 9% Sodium Chloride Injection and Sodium Lactate Injection. 6). e. 500 mg Dobutamine added to 500 ml, or 250 mg added to 250 ml solution, […]