Heart failure
The rate of administration and the duration of therapy should be adjusted according to the patient’s response, The indicators are: haemodynamic parameters such as heart rate and rhythm, arterial pressure, and, whenever possible, cardiac output and measurements of ventricular filling pressures and signs of pulmonary congestion. Concentrations up to 5,000 mg/L have been administered to humans. The final volume administered should be determined by the fluid requirements of the patient. Rather than abruptly discontinuing therapy with Dobutamine Hydrochloride, it is often advisable to decrease the dosage gradually.
Rates of Infusion Based on Concentration of Dobutamine Hydrochloride. The rates of fluid infusion that are required to deliver specific dosages are a function of the concentration of Dobutamine Hydrochloride in the infusate. The following table provides a guideline of infusion rates (mL/kg/min) required for 3 frequently used concentrations of Dobutamine Hydrochloride (250, 500, and 1000 mg/L).
There has been no overt indication of medicine interactions in clinical studies in which Dobutamine Hydrochloride was administered concurrently with other medicines, including digitalis preparations, furosemide, spironolactone, lidocaine, nitroglycerin, nitroprusside, isosorbide dinitrate, morphine, atropine, heparin, protamine, potassium chloride, folic acid, and paracetamol.
Hypotension: Precipitous decreases in blood pressure have occasionally been described in association with dobutamine therapy. Decreasing the dose or discontinuing the infusion typically results in rapid return of blood pressure to baseline values. In rare cases, however, intervention may be required and reversibility may not be immediate.
Reactions At Sites Of Intravenous Infusion: Phlebitis has occasionally been reported. Local inflammatory changes have been described following inadvertent infiltration. Isolated cases of cutaneous necrosis (destruction of skin tissue) have been reported.
Miscellaneous Uncommon Effects: The following adverse effects have been reported in 1% to 3% of patients: nausea, headache, anginal pain, nonspecific chest pain, palpitations, and shortness of breath. Isolated cases of thrombocytopenia have been reported.
Administration of dobutamine, like other catecholamines, can produce a mild reduction in serum potassium concentration, rarely to hypokalemic levels.
Longer-Term Safety: Infusions of up to 72 hours have revealed no adverse effects other than those seen with shorter infusions.
It is not known whether this medicine is excreted in human milk. Because many medicines are excreted in human milk, caution should be exercised when Dobutamine Hydrochloride is administered to a nursing woman. If a mother requires dobutamine treatment, breastfeeding should be discontinued for the duration of the treatment.
Treatment: To obtain up-to-date information about the treatment of overdose, a good resource is your certified Regional Poison Control Center. Telephone numbers of certified poison control centers are listed in the Physicians’ Desk Reference (PDR). In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in your patient.
The initial actions to be taken in a dobutamine hydrochloride overdose are discontinuing administration, establishing an airway, and ensuring oxygenation and ventilation. Resuscitative measures should be initiated promptly. Severe ventricular tachyarrhythmias may be successfully treated with propranolol or lidocaine. Hypertension usually responds to a reduction in dose or discontinuation of therapy.
Protect the patient’s airway and support ventilation and perfusion. If needed, meticulously monitor and maintain, within acceptable limits, the patient’s vital signs, blood gases, serum electrolytes, etc. If the product is ingested, unpredictable absorption may occur from the mouth and the gastrointestinal tract. Absorption of drugs from the gastrointestinal tract may be decreased by giving activated charcoal, which, in many cases, is more effective than emisis of lavage; consider charcoal instead of or in addition to gastric emptying. Repeated doses of charcoal over time may hasten elimination of some drugs that have been absorbed. Safeguard the patient’s airway when employing gastric emptying or charcoal.
Forced diuresis, peritoneal dialysis, hemodialysis, or charcoal hemoperfusion have not been established as beneficial for an overdose of dobutamine hydrochloride.