Included in the formulation
Included in the list (Order of the Government of the Russian Federation No. 2782-r of 30.12.2014):VED
АТХ:C.01.C.A.07 Dobutamine
Pharmacodynamics:The drug has beta-adrenomimetic, cardiotonic action.
Stimulates beta1-adrenoceptors of the myocardium and causes a positive inotropic effect. Slightly affects beta2- and alpha1-adrenoceptors. Moderately increases the heart rate, stroke and minute volume of the heart, reduces the overall peripheral vascular resistance and vascular resistance in the small circle of the circulation. The systemic arterial pressure does not decrease significantly. Increases coronary blood flow, improves the supply of oxygen to the myocardium, reduces the pressure of filling the ventricles of the heart. Children have less pronounced decrease in total peripheral vascular resistance and ventricular filling pressure, with more pronounced increase in heart rate and increased blood pressure. The effect develops in 1-2 minutes and reaches a maximum after 10 minutes.
Pharmacokinetics:Rapidly metabolized in the liver with the formation of inactive metabolites, the main of which is 3-O-methyldobutamine. Half-life is 2-3 minutes. It is excreted mainly by the kidneys.
Indications:Acute heart failure, acute myocardial infarction, cardiogenic shock, the consequences of surgical intervention on the heart, the use of drugs with a negative inotropic effect (for example, beta-blockers); exacerbation (acute decompensation) of chronic heart failure, chronic heart failure (as a temporary adjuvant on the background of basic therapy); acute cardiac insufficiency of non-cardiogenic genesis (including toxic and traumatic shock), some forms of heart failure against hypovolemia (when the mean arterial pressure is above 70 mmHg and intracapillary pressure in the small circulation system is from 18 mmHg and above, with an inadequate reaction to replenishment of the circulating blood volume and an increase in ventricular filling pressure); low cardiac output (as an adverse event with artificial lung ventilation with positive residual pressure on exhalation); Diagnosis of coronary heart disease (pharmacological test as a substitute for exercise).
IX.I20-I25.I21.9 Acute myocardial infarction, unspecified
IX.I20-I25.I21 Acute myocardial infarction
IX.I30-I52.I50.0 Congestive heart failure
IX.I30-I52.I50.1 Left ventricular failure
XVIII.R50-R69.R57.0 Cardiogenic shock
Contraindications:Hypersensitivity, idiopathic hypertrophic subaortal stenosis, cardiac tamponade, aortic stenosis, pheochromocytoma, ventricular arrhythmias (including ventricular fibrillation).
Carefully:Metabolic acidosis, hypercapnia, hypoxia, tachyarrhythmia, atrial fibrillation, pulmonary hypertension, hypovolemia, occlusive vascular diseases (arterial thromboembolism, atherosclerosis, thromboangiitis obliterans (Buerger's disease), cold trauma, including frostbite, diabetic endarteritis, Raynaud's disease), angle-closure glaucoma, simultaneous administration of inhibitors monoamine oxidase, pregnancy, breast-feeding, age to 18 years.Before the introduction, correction of hypovolemia by transfusion of whole blood or plasma-replacing fluids is necessary.During treatment, constant monitoring of blood pressure, ventricular filling pressure, central venous pressure, pulmonary artery pressure, heart rate, ECG, stroke volume, body temperature and diuresis is mandatory. It is desirable to monitor the potassium level in the blood serum. When treating patients with diabetes mellitus, it is necessary to monitor the level of glucose in the blood.
Pregnancy and lactation:The use of the drug in pregnancy is possible if the expected effect of therapy exceeds the potential risk to the fetus.
The action category for fetus by FDA is B.
For the duration of treatment, breastfeeding should be discontinued (it is not known whether
dobutamine in breast milk).
Intravenously, drip (preferably using an infusion pump), adults usually 2.5-10 (if necessary - 20-40) mkg / kg / min. The dose is set individually.
The necessary dose for children should be calculated taking into account the latitude of the therapeutic effect that is smaller than in adults.
Side effects:From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): tachycardia (including ventricular), atrial fibrillation, pain in the heart and chest, palpitations, dyspnea, increased blood pressure / hypotension, hypokalemia, inhibition of platelet aggregation (with prolonged use), petechial bleeding.
Allergic reactions: skin rash, fever, bronchospasm, eosinophilia, etc.
Other: headache, nausea, polyuria (with the introduction of high doses); phlebitis, in some cases - necrosis of the skin (at the injection site).
Overdose:Symptoms: anorexia, nausea, vomiting, tremor, anxiety, palpitation, headache, dyspnea, angina pectoris or cardialgia, tachyarrhythmia, excessive blood pressure rise, myocardial ischemia.
Treatment: a decrease in the rate or discontinuation of the administration of the drug, ventilation of the lungs and oxygenation of the blood, with ventricular tachyarrhythmias are used
propranolol or
lidocaine.
Interaction:Beta-blockers reduce the positive inotropic effect. There is a more pronounced decrease in total peripheral vascular resistance and an increase in cardiac output when combined with sodium nitroprusside or nitrates than with a separate prescription.When used simultaneously with inhibitors monoamine oxidase possible hypertensive crisis, collapse, violation of the heart rhythm. Halogen containing narcotic drugs (halothane and others) increase the risk of ventricular arrhythmia. Pharmaceutically incompatible with alkaline solutions, including 5% sodium bicarbonate solution, with solutions containing ethanol, sodium bisulfite. Because of possible pharmaceutical incompatibility it is not recommended to mix dobutamine with other solutions in one syringe.
Special instructions:With the continuous use of the drug for more than 72 hours, the development of tolerance is possible (a dose increase is necessary). In the presence of mechanical obstacles to filling the ventricles (vices, cardiac tamponade, pericarditis) and / or outflow of blood from them, infusion does not cause improvement in hemodynamics. With cardiac tamponade, valvular aortic stenosis, subaortic stenosis, it is possible to develop a paradoxical reaction (decrease in cardiac output).