Vasopressors and inotropes
Dobutamine (Dobutrex) drip
Dobutrex
Dosing
| Start | 2–5 mcg/kg/min (label starts 0.5–1) |
|---|---|
| Titrate | By response every 10–30 minutes |
| Maximum | 20 mcg/kg/min (rarely 40) |
| Common bags | 250 mg in 250 mL (1 mg/mL); 500 mg in 250 mL (2 mg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- Tachycardia and ectopy
- Hypotension (inodilator): MAP first, then dobutamine
Dobutamine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Dobutamine: β1 > β2: ↑ / ↑↑ / ↓
- Right Heart Failure and Pulmonary HypertensionManagement priorities: Contractility: dobutamine or milrinone, usually with a pressor.
- Sepsis and Septic Shock BundleVasopressors and MAP: Cardiac dysfunction: Add dobutamine, or epi alone: Low output despite fluids and pressors
- Endocarditis and Valve EmergenciesValve emergencies: LVOT obstruction: SAM; worse on dobutamine; systolic murmur: Stop inotropes; fluid, esmolol, phenylephrine
- Heart FailureDecompensated HF and shock: Cardiogenic shock: SBP <90 mm Hg for >30 min or pressors needed, plus hypoperfusion (urine <30 mL/h, lactate >2 mmol/L); typically CI <2.2 and PCWP >15. Revascularize if MI. Norepinephrine for hypotension, plus an inotrope (dobutamine or milrinone) for low output. Temporary MCS (e.g., Impella, VA-ECMO) if drugs fail; routine IABP or ECMO is not advised
- ACS and STEMIMechanical complications, RV infarction and shock: RV infarction accompanies up to 40% of inferior STEMIs (LITFL). V4R elevation marked 31% vs 6% in-hospital mortality (Zehender 1993) and fades within 10 h in half of patients. Expect hypotension, clear lungs and raised JVP, with RAP ≥10 mm Hg close to the wedge (RAP:PCWP ≥0.8). Reperfuse; no nitrates or diuretics; fluid in 250–500 mL steps while o
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.