GL/PTC/07.

R1-2013

CHANGI GENERAL HOSPITAL

GUIDELINES ON USE OF
DOPAMINE
These guidelines were approved for use with effect from _4 Sep 2013_ by the Pharmacy and Therapeutics
Committee and supercedes the previous version (GL/PTC/07.R1.2005) dated _20 May 2005_

Drug Class
Adrenergic agonist; cardiac inotrope

Drug Status
General, unrestricted

Mechanism of Action
Stimulates both adrenergic and dopaminergic receptors.
Lower doses (<5 mcg/kg/min) are mainly dopaminergic stimulating and produce renal and
mesenteric vasodilation, resulting in an increase in glomerular filtration rate, renal blood flow and
sodium excretion.
At higher doses (5-10 mcg/kg/min), 1-adrenergic stimulation predominates and produces cardiac
stimulation (increased cardiac contractility and heart rate) and renal vasodilation
At large doses (>10 mcg/kg/min), -adrenergic stimulation predominates, leading to arterial
vasoconstriction and an increase in blood pressure.
Much overlap in these effects can occur, especially in critically ill patients.

Indications
Adjunct in the treatment of shock which persists after adequate fluid volume replacement.

Contraindications
1. Phaeochromocytoma.
2. Malignant ventricular arrhythmias.
3. Hypersensitivity to sulfites (commercial preparations usually contain sodium bisulfite).

Precautions
1. Post-myocardial infarct patients, uncontrolled cardiac arrhythmias or occlusive vascular disease.
2. Hypovolaemia or electrolyte imbalances must be corrected.
3. Extravasation at drip site.

Drug Interactions
1. Effects of dopamine may be prolonged and intensified by:
a. - and -adrenergic blockers
b. Cocaine
c. General anaesthetics
d. Methyldopa
e. Phenytoin
f. Monoamine oxidase inhibitors (e.g., moclobemide)

2. Dopamine may cause a decreased effect of tricyclic antidepressants (e.g., amitriptyline,

imipramine) when co-administered

Pregnancy Risk Factor

Category C
i.e., animal studies have revealed adverse effects on the foetus (teratogenic or embryocidal or others)
+ no controlled studies in women,
or
studies in women and animals are not available

1
 GL/PTC/07.R1-2013

Lactation
Extent of excretion into breast milk unknown

Adverse Drug Effects

Most frequent (all frequencies undefined)
Cardiovascular : Ectopic beats, tachycardia, angina, hypotension (paradoxical)
Central nervous system : Headache
Gastrointestinal : Nausea, vomiting
Respiratory : Dyspnoea

Infrequent (all frequencies undefined)

Cardiovascular : Bradycardia (paradoxical), widened QRS complex, ventricular
arryhthmias (high doses), gangrene (high doses), hypertension
Central nervous system : Anxiety
Endocrine/metabolic : Mild increases in serum glucose levels
Local effects : Sloughing/tissue necrosis (if extravasation occurs)
Ocular : Raised intra-ocular pressure, dilated pupils
Renal : Azotaemia, dilated pupils

Initiating Dosing
1. Obtain an accurate body weight.
2. If an accurate body weight cannot be obtained, estimate the patients body weight (to the nearest
5 kg).
3. Do not utilise ideal body weight or adjusted body weight in calculating infusion rate.

Recommended Dosing (Adults)

3-5 mcg/kg/min initially, titrated to a maximum of 20 mcg/kg/min.
Dose may be increased by 1-3 mcg/kg/min at 10- to 30-minute intervals until optimal response is
obtained.
(N.B. When IV dopamine is prescribed, it is advisable that physicians specify what the desired
clinical outcome(s) are, e.g., target blood pressure readings and/or heart rate, as well as how
they intend the dose of the drug to be titrated based on the response of the patient).

Reconstitution and Administration

Each ampoule of dopamine 200 mg/5 mL injection is pre-reconstituted.
Suitable diluents include sodium chloride 0.9% injection or dextrose 5% injection.

Usual concentrations for patients not admitted to intensive care units or operating theatres
Non-fluid restricted : 2 mg/mL (200 mg in 100 mL)
Fluid restricted : Up to 4 mg/mL (400 mg in 100 mL)

Usual concentrations for patients admitted to intensive care or operating theatres

Non-fluid restricted : 4 mg/mL (400 mg in 100 mL)
Fluid restricted : Up to 8 mg/mL (800 mg in 100 mL, or 400 mg in 50 mL)

General administration requirements

The drug shall be infused as a continuous IV infusion via an infusion pump.
The drug should be infused into a large central vein to prevent possibility of extravasation. Where
this is not possible, administration into a peripheral vein is allowed but should be carried out with
caution.
Discard solution 24 hours after dilution.
See Tables 1 (2 mg/mL), 2 (4 mg/mL) and 3 (8 mg/mL) for infusion rates corresponding to dose
ranges. Note that the concentration of the drug solution may be modified at the discretion of the
physician.
The rate of infusion (in mL/hour) for a given dose of IV dopamine (in mcg/kg/min) may be
calculated using the following formula:

2
 GL/PTC/07.R1-2013

At concentration of 2 mg/mL

Dose (in mcg/kg/min) x body weight (kg) x 60 (mins)

Infusion rate (mL/hour) = ------------------------------------------------------------------------------
2000 (mcg/mL)

Table 1. Infusion rates for patients who are not fluid restricted (concentration 2 mg/mL)
Dose Infusion rate (mL/hour)
(mcg/kg/min) 40 kg 45 kg 50 kg 55 kg 60 kg 65 kg 70 kg 75 kg 80 kg
3 3.6 4.1 4.5 5.0 5.4 5.9 6.3 6.8 7.2
4 4.8 5.4 6.0 6.6 7.2 7.8 8.4 9.0 9.6
5 6.0 6.8 7.5 8.3 9.0 9.8 10.5 11.3 12.0
6 7.2 8.1 9.0 9.9 10.8 11.7 12.6 13.5 14.4
7 8.4 9.5 10.5 11.6 12.6 13.7 14.7 15.8 16.8
8 9.6 10.8 12.0 13.2 14.4 15.6 16.8 18.0 19.2
9 10.8 12.2 13.5 14.9 16.2 17.6 18.9 20.3 21.6
10 12.0 13.5 15.0 16.5 18.0 19.5 21.0 22.5 24.0
11 13.2 14.9 16.5 18.2 19.8 21.5 23.1 24.8 26.4
12 14.4 16.2 18.0 19.8 21.6 23.4 25.2 27.0 28.8
13 15.6 17.6 19.5 21.5 23.4 25.4 27.3 29.3 31.2
14 16.8 18.9 21.0 23.1 25.2 27.3 29.4 31.5 33.6
15 18.0 20.3 22.5 24.8 27.0 29.3 31.5 33.8 36.0
16 19.2 21.6 24.0 26.4 28.8 31.2 33.6 36.0 38.4
17 20.4 23.0 25.5 28.1 30.6 33.2 35.7 38.3 40.8
18 21.6 24.3 27.0 29.7 32.4 35.1 37.8 40.5 43.2
19 22.8 25.7 28.5 31.4 34.2 37.1 39.9 42.8 45.6
20 24.0 27.0 30.0 33.0 36.0 39.0 42.0 45.0 48.0

3
 GL/PTC/07.R1-2013

At concentration of 4 mg/mL

Dose (in mcg/kg/min) x body weight (kg) x 60 (mins)

Infusion rate (mL/hour) = ------------------------------------------------------------------------------
4000 (mcg/mL)

Table 2. Infusion rates for patients who are not fluid restricted (concentration 4 mg/mL)
Dose Infusion rate (mL/hour)
(mcg/kg/min) 40 kg 45 kg 50 kg 55 kg 60 kg 65 kg 70 kg 75 kg 80 kg
3 1.8 2.0 2.3 2.5 2.7 2.9 3.2 3.4 3.6
4 2.4 2.7 3.0 3.3 3.6 3.9 4.2 4.5 4.8
5 3.0 3.4 3.8 4.1 4.5 4.9 5.3 5.6 6.0
6 3.6 4.1 4.5 5.0 5.4 5.9 6.3 6.8 7.2
7 4.2 4.7 5.3 5.8 6.3 6.9 7.4 7.9 8.4
8 4.8 5.4 6.0 6.6 7.2 7.8 8.4 9.0 9.6
9 5.4 6.1 6.8 7.4 8.1 8.9 9.5 10.1 10.8
10 6.0 6.8 7.5 8.3 9.0 9.8 10.5 11.3 12.0
11 6.6 7.4 8.3 9.1 9.9 10.7 11.6 12.4 13.2
12 7.2 8.1 9.0 9.9 10.8 11.7 12.6 13.5 14.4
13 7.8 8.8 9.8 10.7 11.7 12.7 13.7 14.6 15.6
14 8.4 9.5 10.5 11.6 12.6 13.7 14.7 15.8 16.8
15 9.0 10.1 11.3 12.4 13.5 14.6 15.8 16.9 18.0
16 9.6 10.8 12.0 13.2 14.4 15.6 16.8 18.0 19.2
17 10.2 11.5 12.8 14.0 15.3 16.6 17.9 19.1 20.4
18 10.8 12.2 13.5 14.9 16.2 17.6 18.9 20.3 21.6
19 11.4 12.8 14.3 15.7 17.1 18.5 20.0 21.4 22.8
20 12.0 13.5 15.0 16.5 18.0 19.5 21.0 22.5 24.0

4
 GL/PTC/07.R1-2013

At concentration of 8 mg/mL

Dose (in mcg/kg/min) x body weight (kg) x 60 (mins)

Infusion rate (mL/hour) = ------------------------------------------------------------------------------
8000 (mcg/mL)

Table 3. Infusion rates for patients who are considered to be fluid restricted (concentration 8 mg/mL)
Dose Infusion rate (mL/hour)
(mcg/kg/min) 40 kg 45 kg 50 kg 55 kg 60 kg 65 kg 70 kg 75 kg 80 kg
3 0.9 1.0 1.1 1.2 1.4 1.5 1.6 1.7 1.8
4 1.2 1.4 1.5 1.7 1.8 2.0 2.1 2.3 2.4
5 1.5 1.7 1.9 2.1 2.3 2.4 2.6 2.8 3.0
6 1.8 2.0 2.3 2.5 2.7 2.9 3.2 3.4 3.6
7 2.1 2.4 2.6 2.9 3.2 3.4 3.7 3.9 4.2
8 2.4 2.7 3.0 3.3 3.6 3.9 4.2 4.5 4.8
9 2.7 3.0 3.4 3.7 4.1 4.4 4.7 5.1 5.4
10 3.0 3.4 3.8 4.1 4.5 4.9 5.3 5.6 6.0
11 3.3 3.7 4.1 4.5 5.0 5.4 5.8 6.2 6.6
12 3.6 4.1 4.5 5.0 5.4 5.9 6.3 6.8 7.2
13 3.9 4.4 4.9 5.4 5.9 6.3 6.8 7.3 7.8
14 4.2 4.7 5.3 5.8 6.3 6.8 7.4 7.9 8.4
15 4.5 5.1 5.6 6.2 6.8 7.3 7.9 8.4 9.0
16 4.8 5.4 6.0 6.6 7.2 7.8 8.4 9.0 9.6
17 5.1 5.7 6.4 7.0 7.7 8.3 8.9 9.6 10.2
18 5.4 6.1 6.8 7.4 8.1 8.8 9.5 10.1 10.8
19 5.7 6.4 7.1 7.8 8.6 9.3 10.0 10.7 11.4
20 6.0 6.8 7.5 8.3 9.0 9.8 10.5 11.3 12.0

Monitoring
1. Blood pressure (including mean arterial pressure, if possible) systolic blood pressure should not
fall below 90 mmHg
2. Heart rate should not exceed 110 beats/min
3. Central venous pressure (if available)
4. Urine output

References
th
1. Drug Information Handbook (20 edition, 201-12
th
2. Pharmacotherapy. A Pathophysiologic Approach. (6 Edition).

For any clarification regarding this document, contact any pharmacist at:
Inpatient Pharmacy (Ext. 1915/1917)
Drug Information Centre (Ext. 1885)

Contributing Authors/Reviewers (May 2005):

Dr Goh Ping Ping Mr Ian Wee
Senior Consultant, Dept of Cardiology Senior Pharmacist, Pharmacy

This edition updated (July 2013) by:

Mr Ian Wee
Principal Clinical Pharmacist, Pharmacy