HOW TO USE DOBUTAMIN

HOW TO USE DOBUTAMIN DR VO ANH MINH ESC GUIDELINE 2016 PHARMACOLOGIC EFFECTS ADMINISTRATION AND DOSING Ruffolo RR, Jr The pharmacology of dobutamine. Am J Med Sci 1987;294:244–248 Patients taking beta-blocker agent The Inotropic-hemodynamic properties of dobutamine are blunted in patients taking beta-adrenergic bloacking agents, especially the nonselective adrenergic receptor blockers (e.g., carvedilol) dobutamine, 50kg (Dobutamine 250mg, 50ml) ES: 1.2ml/h - 12ml/h 70Kg (Dobutamine 250mg, 50ml) ES: 1.7ml/h - 17ml/h 32-34 This effect can be reversed with incremental dosing of The hemodynamic response at 72 hours was 66 percent of that noted at hours; the hemodynamic response at 96 hours was 57 percent of that at hours This study demonstrated that significant hemodynamic tolerance to dobutamine develops after three days of continuous infusion We suggest that the most appropriate manner of dealing with this attenuation of effect is simply to increase the dose until the desired hemodynamic effect is attained With time and experience, it became clear that dobutamine infusions lasting longer than 72h were associated with pharmacodynamics tolerance Am J Med 1980 Aug;69(2):262-6 Dobutamine may lead to tachyarrhythmias and ventricular ectopic beats Similar to epinephrine and dopamine, the incidence of tachyarrhythmias may be worse in patients who are already experiencing atrial fibrillation or already receiving other adrenergic medications or who are receiving infusion rates greater than 20 mcg/kg per minute The primary β1-effects caused by dobutamine may also lead to an increase in cardiac work that will increase myocardial oxygen demand The mild peripheral vasodilation caused by dobutamine may potentially reduce afterload such that in patients with intravascular volume depletion, this mild peripheral vasodilation may lead to profound hypotension It is not recommended to administer dobutamine to hypotensive patients Jessup M, et al Circulation 2009;119:197722016 CONCLUSIONS Inotropic agents are not recommended unless the patients is symptomatically hypotensive or hypoperfused because of safe concern Dosing can be increased incrementally until the desired clinical and hemodynamic responses are attained Higher infusion rates administered over an extended period usually require gradual weaning over 12–72 hours It is not recommended to administer dobutamine to hypotensive patients  ... that dobutamine infusions lasting longer than 72h were associated with pharmacodynamics tolerance Am J Med 1980 Aug;69(2):262-6 Dobutamine may lead to tachyarrhythmias and ventricular ectopic... primary β1-effects caused by dobutamine may also lead to an increase in cardiac work that will increase myocardial oxygen demand The mild peripheral vasodilation caused by dobutamine may potentially... agents, especially the nonselective adrenergic receptor blockers (e.g., carvedilol) dobutamine, 50kg (Dobutamine 250mg, 50ml) ES: 1.2ml/h - 12ml/h 70Kg (Dobutamine 250mg, 50ml) ES: 1.7ml/h - 17ml/h