Dopamine - instructions for use, dose, side effects, contraindications

In therapeutic doses stimulates dopamine receptors, in large doses stimulates beta-adrenergic receptors, in high-beta and alpha-adrenergic receptors. Promotes the release of norepinephrine in adrenergic synapses. Causes a positive inotropic effect, improves peripheral circulation (especially in shock states),selectively dilates the renal arteries; slightly increases the heart rate, increases myocardial oxygen demand, overall peripheral vascular resistance and blood pressure. Stimulation of renal blood flow leads to increased filtration in the kidneys, contributes to diuresis and sodium naresis.

Pharmacokinetics:

Poorly absorbed from the gastrointestinal tract, is administered only intravenously. After parenteral administration, it is widely distributed throughout the body, but does not pass through the blood-brain barrier in significant amounts. Rapidly metabolized in the liver, kidneys and plasma monoamine oxidase and catechol-O-methyltransferase to inactive metabolites. About 25% of the dose is captured by neurosecretory vesicles (adrenergic nerve terminals), where hydroxylation occurs and the norepinephrine. Half-life from the plasma - 2 minutes. It is excreted by the kidneys: 80% of the dose - in the form of metabolites within 24 hours, in small amounts - in unchanged form. The action develops within 5 minutes, the duration of the action is less than 10 minutes after the infusion.

Indications:

Shock of various genesis, including cardiogenic, postoperative, infectious-toxic, anaphylactic, hypovolemic (only after recovery of circulating blood volume), acute cardiovascular insufficiency, low ejection syndrome in cardiosurgical patients, severe arterial hypotension. Poisoning (to enhance diuresis and accelerate the excretion of xenobiotic).

ICD-10

IX.I30-I52.I50.9 Heart failure, unspecified

IX.I30-I52.I50.0 Congestive heart failure

XIX.T80-T88.T81.1 Shock during or after the procedure, not elsewhere classified

XIX.T79.T79.4 Traumatic shock

XIX.T66-T78.T78.2 Anaphylactic shock, unspecified

XVIII.R50-R69.R57.1 Hypovolemic shock

XVIII.R50-R69.R57.0 Cardiogenic shock

XVIII.R50-R69.R57 Shock, not elsewhere classified

I.A30-A49.A48.3 Toxic shock syndrome

IX.I95-I99.I95.9 Hypotension, unspecified

XX.X40-X49.X49 Accidental poisoning and exposure to other and unspecified chemical and toxic substances

Contraindications:

Hypersensitivity, hypertrophic obstructive cardiomyopathy, pheochromocytoma, ventricular fibrillation.

Carefully:

C caution should be used for hypovolemia, myocardial infarction,disorders of the heart rhythm (tachyarrhythmias, ventricular arrhythmias, atrial fibrillation), metabolic acidosis, hypercapnia, hypoxia, hypertension in the small circulation, thyrotoxicosis, angle-closure glaucoma, prostatic hyperplasia, occlusive diseases of the blood vessels endarteritis, diabetic endarteritis, Raynaud's disease, frostbite), with diabetes mellitus, bronchial asthma (if a history of increased sensitivity to be disulfite), pregnancy, lactation, in children and adolescents under the age of 18 years.

Pregnancy and lactation:

The action category for fetus by FDA is C.

Adequate and controlled trials on humans have not been conducted. Animals had no teratogenic effect, but the drug caused increased fetal mortality. At pregnancy and thoracal feeding application is possible only in the event that the expected effect of therapy exceeds potential risk for a fetus and the child.

Dosing and Administration:

Intravenously, drip, the dose is selected individually, depending on the degree of severity of the shock and the patient's reaction to the administration.Adults are injected at a rate of 2-20 μg / kg / min, the dose is titrated under the control of heart rate and blood pressure. Children - with an initial speed of 4-6 (maximum - 10) mkg / kg / min. The maximum dose for adults with intravenous drip infusion is 1.5 mg / min.

In order to increase myocardial contractility and increase diuresis, intravenous drip is injected with 100-250 μg / min. If necessary, the effect on arterial pressure is increased to 300-500-700 μg / min.

Side effects:

From the nervous system and sensory organs: headache, anxiety, motor anxiety, tremor of fingers.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): stenocardia, tachycardia or bradycardia, palpitations, chest pain, increased or decreased blood pressure, conduction disorders, QRS complex expansion, vasospasm, increased end-diastolic pressure in the left ventricle; when used in high doses - ventricular or supraventricular arrhythmia.

On the part of the digestive system: nausea, vomiting.

Allergic reactions: in patients with bronchial asthma - bronchospasm, shock.

Other: dyspnea, azotemia, pylorarection; rarely - polyuria (when administered in low doses); local reactions: when the drug gets under the skin - necrosis of the skin, subcutaneous tissue.

Overdose:

Symptoms: excessive increase of arterial pressure, violation of the rhythm of the heart, renal vasoconstriction.

Treatment: a decrease in speed or a temporary cessation of dopamine administration.

Interaction:

Because the dopamine metabolized with the participation of MAO, inhibition of this enzyme leads to prolongation and potentiation of the effect of dopamine. Patients who receive or have received MAO inhibitors during the previous 2-3 weeks should be given a significantly lower dose of dopamine (the initial dose should be 1/10 of the usual dose).

The simultaneous administration of dopamine and diuretics can be accompanied by an additive and potentiating effect.

When used simultaneously with cyclopropane or halogenated hydrocarbons for inhalation anesthesia, the risk of arrhythmia increases (extreme caution should be observed). The introduction of dopamine against the background of tricyclic antidepressants leads to an increase in its effects (possibly developmentarrhythmia, severe arterial hypertension).

Beta-blockers (propranolol and metoprolol) are antagonists of dopamine cardiac effects. Butyrophenones (including haloperidol) and phenothiazines can reduce the effect of dopamine.

Alkaloids of ergot, oxytocin increase the vasoconstrictor effect of dopamine, which is accompanied by the danger of ischemia and gangrene, as well as severe arterial hypertension.

Joint application with phenytoin promotes the development of arterial hypotension and bradycardia.

With simultaneous administration with guanethidine, octadine, sympathomimetic action is enhanced.

Other sympathomimetics, as well as cocaine intensify cardiotoxic action.

With simultaneous use with levodopa, the risk of arrhythmias increases.

At simultaneous application with hormones of a thyroid gland probably amplification of action both dopamine, and hormones of a thyroid gland.

Ergometrine, ergotamine, methylergomethrin, oxytocin increase the vasoconstrictor effect and the risk of occurrence of ischemia and gangrene, as well as severe arterial hypertension, up to intracranial hemorrhage.

With simultaneous use with cardiac glycosides, an increased risk of cardiac arrhythmias, an additive positive inotropic effect, is possible.

Reduces the antianginal effect of nitrates, which in turn can reduce the pressor effect of sympathomimetics and increase the risk of arterial hypotension.

Pharmaceutically incompatible with alkaline solutions (inactivate dopamine), oxidants, iron salts, thiamine (promotes the destruction of vitamin B₁).

Special instructions:

In the presence of hypovolemia, it should be compensated before the introduction of dopamine.

Dopamine administration should be performed under the control of heart rate, blood pressure, ECG, diuresis; it is also recommended to monitor the stroke volume of the heart, ventricular filling pressure, central venous pressure, and pulmonary artery pressure. Reducing diuresis indicates the need to reduce the dose.

Dopamine is incompatible with alkaline solutions (do not mix in one syringe).

Instructions

Dopamine (Dopaminum)