dobutamine
Brand: Dobutrex
ISMP High Alert Prototype Drug
Drug Class: inotrope
Drug Family: inotrope
Subclass: synthetic catecholamine beta-1 agonist
Organ Systems: cardiovascular
Mechanism of Action
Predominantly beta-1 agonist increasing myocardial contractility and heart rate with mild vasodilation via beta-2; minimal alpha-1 vasoconstriction; net effect: increased CO with reduced afterload.
beta-1 adrenergic receptor (predominant)beta-2 receptoralpha-1 receptor (minor)
Indications
- acute decompensated heart failure (cardiogenic shock)
- stress echocardiography (diagnostic)
Contraindications
- HOCM (outflow obstruction worsens)
- idiopathic hypertrophic subaortic stenosis
- patients on MAOIs
Adverse Effects
Common
- tachycardia
- arrhythmias
- hypertension or hypotension
Serious
- severe tachyarrhythmias
- increased oxygen demand potentially worsening ischemia
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | IV |
| Metabolism | COMT peripheral |
| Excretion | renal |
| Half-life | 2 minutes |
| Onset | immediate |
| Peak | immediate |
| Duration | minutes |
| Protein Binding | <0% |
| Vd | IV only |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| beta-blockers | antagonize beta-1 effects — may require higher doses | major |
Nursing Considerations
- Initiate at 2.5-5 mcg/kg/min; titrate by HR and CO
- Short-term use in acute decompensated HF
- Tachyphylaxis develops after 48-72 hours (receptor downregulation)
- Monitor for tachycardia and arrhythmias
Clinical Pearls
- Does not increase afterload (unlike dopamine or NE) — preferred when CO is primary concern
- Stress echo: dobutamine stress test to detect ischemic wall motion abnormalities at 5-40 mcg/kg/min
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.