dopamine
Brand: Intropin
ISMP High Alert Prototype Drug
Drug Class: vasopressor/inotrope
Drug Family: vasopressor
Subclass: catecholamine (endogenous)
Organ Systems: cardiovascular
Mechanism of Action
Dose-dependent effects: low (1-5 mcg/kg/min) — D1 receptors → renal/mesenteric vasodilation; medium (5-15 mcg/kg/min) — beta-1 → increased HR and contractility; high (>15 mcg/kg/min) — alpha-1 → vasoconstriction.
dopamine D1/D2 receptorsalpha-1 adrenergic receptorbeta-1 adrenergic receptor
Indications
- hemodynamic instability (shock — cardiogenic, distributive)
- symptomatic bradycardia (alternative to pacing)
Contraindications
- pheochromocytoma
- VF/VT
- sulfite allergy (preparation contains sulfites)
Adverse Effects
Common
- tachycardia
- arrhythmias
- hypertension
- nausea
Serious
- severe arrhythmias
- gangrene (high doses)
- extravasation necrosis
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | variable |
| Metabolism | MAO/COMT peripheral |
| Excretion | renal |
| Half-life | 2 minutes |
| Onset | minutes |
| Peak | minutes |
| Duration | minutes |
| Protein Binding | <0% |
| Vd | IV only |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| MAOIs | severe hypertensive crisis (prevents dopamine degradation) | major |
| tricyclic antidepressants | enhanced pressor response | major |
Nursing Considerations
- Administer via central venous catheter to prevent extravasation necrosis
- Monitor BP and HR continuously
- If extravasation occurs: phentolamine 5-10 mg in 10 mL NS injected locally
- SOAP II trial: dopamine had more arrhythmias than norepinephrine in septic shock — NE preferred
Clinical Pearls
- SOAP II: dopamine associated with more arrhythmias and higher mortality in cardiogenic shock subgroup vs norepinephrine
- 'Renal dose dopamine' (1-5 mcg/kg/min) for renoprotection is NOT supported by evidence
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.