Active Ingredient: Dobutamine
Dobutamine is indicated for patients who require a positive inotropic support in the treatment of cardiac decompensation due to depressed contractility.
In cardiogenic shock characterised by heart failure with severe hypotension and in case of septic shock Dobutamine may be useful if added to dopamine in case of disturbed ventricular function, raised filling pressure of the ventricles and raised systemic resistance.
For this indication, competent medicine agencies globally authorize below treatments:
Intravenous
0.5 - 20 ug per kg of body weight
From 0.5 To 20 ug per kg of body weight once every day
For all paediatric age groups (neonates to 18 years) an initial dose of 5 micrograms/kg/minute, adjusted according to clinical response to 2–20 micrograms/kg/minute is recommended. Occasionally, a dose as low as 0.5-1.0 micrograms/kg/minute will produce a response.
There is reason to believe that the minimum effective dosage for children is higher than for adults. Caution should be taken in applying high doses, because there is also reason to believe that the maximum tolerated dosage for children is lower than the one for adults. Most adverse reactions (tachycardia in particular) are observed when dosage was higher than/equal to 7.5 micrograms/kg/minute but reducing or termination of the rate of dobutamine infusion is all that is required for rapid reversal of undesirable effects.
A great variability has been noted between paediatric patients in regard to both the plasma concentration necessary to initiate a hemodynamic response (threshold) and the rate of hemodynamic response to increasing plasma concentrations, which demonstrates that the required dose for children cannot be determined a priori and should be titrated in order to allow for the supposedly smaller “therapeutic width” in children.
One ampoule or vial Dobutamine 5 mg/ml (250 mg in 50 ml) diluted to a solution volume of 500 ml (final concentration 0.5 mg/ml).
| Dosage range | Specifications in ml/h* (drops/min) | |||
|---|---|---|---|---|
| Patient’s weight | ||||
| 50 kg | 70 kg | 90 kg | ||
| Low 2.5 µg/kg/min | ml/h (drops/min) | 15 (5) | 21 (7) | 27 (9) |
| Medium 5 µg/kg/min | ml/h (drops/min) | 30 (10) | 42 (14) | 54 (18) |
| High 10 µg/kg/min | ml/h (drops/min) | 60 (20) | 84 (28) | 108 (36) |
* For double concentration, i.e. 500 mg dobutamine added to 500 ml, or 250 mg added to 250 ml solution volume, infusion rates must be halved.
One ampoule or vial Dobutamine 5 mg/ml (250 mg in 50 ml) undiluted (final concentration 5 mg/ml).
| Dosage range | Specifications in ml/h* (drops/min) | |||
|---|---|---|---|---|
| Patient’s weight | ||||
| 50 kg | 70 kg | 90 kg | ||
| Low 2.5 µg/kg/min | ml/h (ml/min) | 1.5 (0.025) | 2.1 (0.035) | 2.7 (0.045) |
| Medium 5 µg/kg/min | ml/h (ml/min) | 3.0 (0.05) | 4.2 (0.07) | 5.4 (0.09) |
| High 10 µg/kg/min | ml/h (ml/min) | 6.0 (0.10) | 8.4 (0.14) | 10.8 (0.18) |
The chosen syringe pump must be suitable for the volume and rate of administration.
For continuous intravenous infusion using an infusion pump, dilute to a concentration of 0.5 to 1 mg/mL (max 5mg/mL if fluid restricted) with Glucose 5% or Sodium Chloride 0.9%. Infuse higher concentration solutions through central venous catheter only. Dobutamine intravenous infusion is incompatible with bicarbonate and other strong alkaline solutions.
Dilute 30 mg/kg body weight to a final volume of 50 mL of infusion fluid. An intravenous infusion rate of 0.5 mL/hour provides a dose of 5 micrograms/kg/minute.
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