Dopamine

Dose & administration
2-20 mcg/kg/min administered via continuous intravenous infusion, and titrated to desired blood pressure effect. Different doses lead to different patterns of stimulation effects on dopaminergic, beta-1, and alpha receptors (see Pharmacological aspects)

• Administration of dopamine via large vein is preferred to prevent extravasation
• Can be administered through intravenous or intraosseous route
• Avoid bolus administration
• Dilute vials prior to administration per your local protocols

Indications
Hypotension: there is no standard definition for hypotension in term or preterm infants, and variations should take into consideration gestational age and postnatal age.

Severe sepsis and septic shock: dopamine is indicated in full-term neonates that are non-responsive to fluid resuscitation

Contraindications and special considerations (incl incompatibilities)

Special considerations: use of a small vein may lead to extravasation, which should be treated with phentolamine (Phentolamine 0.5mg/ml; inject 1-5 mL into affected area)

Stability: Once diluted, solution is stable for 24 hours (compatible in 5% dextrose in water, 5% dextrose in sodium chloride, 10% dextrose in water, lactated ringers, and 0.9% sodium chloride)

Incompatibilities, injection site: acyclovir, alteplase, amphotericin B, ampicillin, cefepime, furosemide, indomethacin, insulin, penicillin G, sodium bicarbonate

Adverse effects
Tachycardia, arrhythmias, increased pulmonary artery pressure, suppression of prolactin secretion (reversible), potential for local necrosis or infiltration.

Pharmacological aspects
Mechanism of action: catecholamine that increases blood pressure by increasing systemic vascular resistance through α-adrenergic effects

Dose-dependent effects:

• 0.5-2.0 mcg/kg/min: dopaminergic stimulation (vasodilation, increased renal blood flow, GFR, urinary output)
• 2-10 mcg/kg/min: beta-1 receptor stimulation (improved contractility, cardiac output, and impulse conduction)
• 10-20 mcg/kg/min: alpha-receptor stimulation (vasoconstriction and increased blood pressure)
• >20 mcg/kg/min: alpha-receptor stimulation overrides dopaminergic effects (reversal of renal vasodilation and natriuresis)

Selective renal vasodilation with increased urine output in preterm neonates when dosed at 2-5 mcg/kg/minute

Half-life: 2-5 minutes with varying clearance

Monitoring: heart rate, blood pressure, urine output, peripheral perfusion, signs of infiltration

Document version history
Created 2017-08-23 / Amanda Teachey

References

• Kleinman ME, Chameides L, Schexnayder SM et al. 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 14: pediatric advanced life support. Circulation Nov02, 2010; 122(18 Suppl.3): S876-S908. PMID 20956258
• Seri I. Cardiovascular, renal, and endocrine actions of dopamine in neonates and children. J Pediatr 1995;126:333. PMID 7869189
• Lynch SK, Lemley KV, Polak MJ. The effect of dopamine on glomerular filtration rate in normotensive, oliguric premature neonates. Pediatr Nephrol 2003;18:649-652. PMID 12750981
• Product Information: dopamine hydrochloride injection, dopamine hydrochloride injection. American Regent Laboratories Inc, Shirley, NY, 04/00/2001. URL
• Institute for Safe Medication Practices (ISMP) and Vermont Oxford Network (VON). Standard concentrations of neonatal drug infusions. Institute for Safe Medication Practices (ISMP), Horsham, PA, May24, 2011. Available at: http://ismp.org/Tools/PediatricConcentrations.pdf
• Subhedar NV, Shaw NJ. Dopamine versus dobutamine for hypotensive preterm infants. Cochrane Database Syst Rev. 2003;(3):CD001242. PMID: 12917901
• Bhatt-Mehta V, Nahata MC, McClead RE, et al. Dopamine pharmacokinetics in critically ill newborn infants. Eur J Clin Pharmacol (1991) 40:593. PMID 1884740
• Bellomo R, Cole L, & Ronco C: Hemodynamic support and the role of dopamine. Kidney Int 1998; 53:S71-S74. PMID 9573578
• Goldberg LI: Cardiovascular and renal actions of dopamine: potential clinical applications. Pharmacol Rev 1972; 24:1. PMID: 4554480