DOPAMINE

• Management of cardiac failure after acute MI
• see Acute myocardial infarction guideline

• Dopamine hydrochloride 40 mg/mL in 5 mL ampoules (200 mg)
• Ampoules must be clear, colourless or pale yellow
• if solution is darker than slightly yellow, or discoloured, do not use

• Sodium chloride 0.9% or glucose 5%
• Dopamine is inactivated by sodium bicarbonate 5% and alkaline solutions 

• Use dopamine only in critical care and in the coronary care unit
• It is strongly advised to administer dopamine through a central line
• Give dopamine peripherally only on the advice of a consultant
• use a large vein high up in a limb, preferably the arm
• in order to reduce risk of tissue necrosis, administer the 2 mg/mL solution only
• Inspect infusion site regularly for signs of irritation or vasoconstriction
• extravasation may cause local vasoconstriction leading to tissue necrosis/sloughing

Preparing 2 mg/mL solution

• Preferable for infusion via a peripheral vein
• Take 2.5 mL (100 mg) of dopamine hydrochloride solution and make up to 50 mL with diluent (see Diluents) in a 50 mL syringe
• the diluted solution is stable for 24 hr
• Concentration = 100 mg in 50 mL = 2 mg/mL (2000 mcg/mL)

Preparing 4 mg/mL solution

• infuse via a central line only
• Take 5 mL (200 mg) of dopamine hydrochloride solution and make up to 50 mL with diluent (see Diluents) in a 50 mL syringe
• the diluted solution is stable for 24 hr
• Concentration = 200 mg in 50 mL = 4 mg/mL (4000 mcg/mL)

• An IV syringe infusion pump is essential for controlling infusion rate

Starting dose

• If patient has been treated with an MAOI (e.g. linezolid, isoniazid, phenelzine, isocarboxazid – see BNF) within the last 2 weeks, start with 0.2 mcg/kg/min
• MAOIs potentiate effects of dopamine and its duration of action
• Otherwise start with 2 mcg/kg/min by continuous IV infusion via as large a vein as possible
• if patients taking MAO-B inhibitors e.g. rasagiline, or standard doses of selegiline, do not reduce dose of dopamine

Rate change

• Monitor heart rate and rhythm, BP, cardiac output (if possible), and urine output
• if no response, seek advice of cardiology before increasing dose further
• Increase up to 10 mcg/kg/min if required
• dopamine given at rates >5 microgram/kg/min causes vasoconstriction, which can reduce renal perfusion and worsen heart failure

50mL syringe of 2 mg/mL solution

50mL syringe of 4 mg/mL solution

• Give ONLY through a central line

• Withdraw dopamine gradually, monitoring for hypotension