Dopamine

Registered South African indications:

• Shock  
• Haemodynamic imbalance
• Congestive heart failure, refractory

Contraindications 

• Hypersensitivity to the active ingredients or any of its excipients
• Pheochromocytoma
• Hyperthyroidism
• Uncorrected atrial tachyarrhythmias
• Uncorrected ventricular tachyarrhythmias
• Ventricular fibrillation
• Co-administration of cyclopropane and halogenated hydrocarbon anaesthetic agents

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Cardiovascular disease
• Occlusive vascular disease  
• History of peripheral vascular disease
• Abrupt discontinuation may result in vascular collapse  
• Hypovolaemia
• Excess administration of potassium-free solutions
• Subclinical or overt diabetes mellitus (when diluted with glucose solution)
• History of asthma
• Atopy
• Sulphite-sensitivity
• Treatment with monoamine oxidase inhibitors prior to dopamine administration

Forms avail. in SA and covered in this monograph: inj

Haemodynamic support

• IV: Initial: 2-5μg/kg/min infusion; Increase gradually by 5-10μg/kg/min; Dose range: 2-20μg/kg/min; Max dose: 50μg/kg/min  

Must be diluted before admin.  

Do not add dopamine hydrochloride to 5% sodium bicarbonate or any alkaline I.V solutions (alkalinity will inactivate dopamine hydrochloride)

Dopamine should be admin. through an IV catheter or needle in as large a vein as possible

Use IV drop chamber or infusion pump

Not established for use in South Africa for children

Pregnancy

• Caution
• Animal studies have shown no evidence of teratogenic effects with dopamine. However, the effect of dopamine on human foetus is unknown. Therefore, the drug should be used in pregnant women only when the expected benefits outweigh the possible risks to the foetus

Breastfeeding

• Caution
• It is not known if dopamine is excreted in breast milk, nor is the effect on the infant known. Because many agents are expected in human milk, caution should be exercised when dopamine hydrochloride is administered to a nursing woman

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; dose adjustment recommended
  Initiate at lower doses: 2-5μg/kg/min; Up titrate as needed; Max: 20μg/kg/min

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Headaches

Cardiovascular Disorders

• Ectopic beats
• Tachycardia
• Anginal pain
• Palpitations
• Hypotension
• Vasoconstriction
• Aberrant conduction bradycardia
• Widened QRS complex
• Hypertension
• Fatal ventricular arrhythmias

Respiratory Disorders

• Dyspnoea

Gastrointestinal Disorders

• Nausea and vomiting v

Genitourinary Disorders

• Azotaemia v

Skin and Subcutaneous Tissue Disorders

• Piloerection
• Extravasation at the site of infusion can cause local vasoconstriction
• Gangrene

Sensory Disorders

• Mydriasis

• Monoamine oxidase inhibitors
• Beta blockers
• Propranolol
• Metoprolol
• Alpha blockers
• Cyclopropane anaesthetics
• Halogenated hydrocarbon anaesthetics
• Phenytoin
• Ergot alkaloids
• Tricyclic antidepressants
• Guanethidine
• Dopaminergic agents
• Digitalis glycosides

• Urine flow
• Cardiac output
• Blood pressure
• ECG
• Renal function
• Serum glucose

Extravasation 

• Dopamine hydrochloride in 5% Glucose injection should be infused into a large vein whenever possible to prevent the possibility of infiltration of perivascular tissue adjacent to the infusion site
• Extravasation of dopamine hydrochloride during infusion may cause ischaemic necrosis and sloughing of surrounding tissue
• Ischaemia can be reversed by infiltration of the affected area with 10-15ml of saline containing 5-10mg phentolamine mesylate
• A syringe with a fine hypodermic needle should be used to liberally infiltrate the ischaemic area as soon as extravasation is noted

Dopamine (3,4-dihydroxyphenylethylamine) is the third naturally occurring catecholamine and is a metabolic precursor of noradrenaline and adrenaline. Dopamine exerts positive inotropic and chronotropic effects on the myocardium, acting as an agonist at beta-adrenergic receptors. In addition to its direct action on beta-adrenergic receptors, dopamine acts indirectly by releasing noradrenaline from sympathetic storage sites. Depending on the vascular bed being studied and the dose administered, Dopamine can cause relaxation or contraction of vascular smooth muscle.

Injection (per 5ml) 200mg

• Dopamine HCI-Fresenius (Fresenius)
• Pharma-Q Dopamine (Pharma-Q Holdings)

Injection 50mg

• Micro-Dopamine (Micro Healthcare)