Vasopressors and inotropes
Dopamine (Intropin) drip
Intropin
Dosing
| Start | 2–5 mcg/kg/min; symptomatic bradycardia 5–20 |
|---|---|
| Titrate | 1–4 mcg/kg/min every 10–30 minutes |
| Maximum | 20 mcg/kg/min usual; label up to 50 |
| Common bags | 400 mg in 250 mL (1.6 mg/mL); 800 mg in 250 mL (3.2 mg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Central line preferred; peripheral is acceptable short term in a large proximal arm vein with frequent site checks
- Extravasation: stop, aspirate, phentolamine 5–10 mg in 10–15 mL saline injected into the area
Watch for
- More arrhythmias than norepinephrine (not first line in septic shock)
- Low-dose "renal" dopamine does not protect the kidneys
Dopamine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Dopamine: DA <5, β1 5–10, α1 >10 mcg/kg/min: ↑ / ↑ / ↑ at high dose
- Acute Kidney InjuryProtect the kidney, predict progression: No low-dose dopamine (KDIGO 1A); diuretics for overload only, not to prevent or treat AKI
- Sepsis and Septic Shock BundleVasopressors and MAP: NE over dopamine (strong): dopamine causes more arrhythmias
- Mental Health: Meds and CommunicationAntipsychotics, QT and neuroleptic malignant syndrome: NMS develops over days. The 2011 international consensus (Gurrera) lists recent dopamine blockade or dopamine-agonist withdrawal, temperature above 38 °C twice, rigidity, altered mental status, CK at least 4 times the upper limit of normal, BP 25% or more above baseline or swinging by 20 mm Hg diastolic or 25 mm Hg systolic in 24 h, HR 25% and
- Shock Types at a GlanceCardiogenic shock: LV, RV, SCAI and MCS escalation: Norepinephrine first (SOAP II); avoid dopamine and use epinephrine cautiously (OptimaCC: refractory shock 37% vs 7% with norepinephrine).
- Temporary PacingTranscutaneous pacing (TCP): Dopamine: 5 to 20 mcg/kg/min
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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.