Dobutamine is a medication used in the treatment ofcardiogenic shock (as a result of inadequate tissue perfusion) and severeheart failure.[2][3] It may also be used in certain types ofcardiac stress tests.[2] It is given by IV only, as aninjection into a vein orintraosseous as acontinuous infusion.[2] The amount of medication needs to be adjusted to the desired effect.[2] Onset of effects is generally seen within 2 minutes.[2] It has a half-life of two minutes. This drug is generally only administered short term, although it may be used for longer periods to relieve symptoms ofheart failure in patients awaiting heart transplantation.[4]
Dobutamine is used to treat acute but potentially reversibleheart failure, such as which occurs duringcardiac surgery or in cases ofseptic or cardiogenic shock, on the basis of its positiveinotropic action.[6]
Dobutamine can be used in cases ofcongestive heart failure to increase cardiac output. It is indicated whenparenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiacdecompensation due to depressedcontractility, which could be the result of either organic heart disease or cardiac surgical procedures. Higher doses are not useful with history of recentischemic heart disease because it increases heart rate and thus increases myocardial oxygen demand.[7]
The drug is also commonly used in the hospital setting as a pharmacologic stress testing agent to identify coronary artery disease.
Primary side effects include those commonly seen for β1 active sympathomimetics, such ashypertension,angina,arrhythmia, andtachycardia. Used with caution in atrial fibrillation as it has the effect of increasing the atrioventricular (AV) conduction.[8]
The most dangerous side effect of dobutamine is increased risk of arrhythmia, including fatal arrhythmias.
Overall, dobutamine tends to produce less tachycardia and peripheral vascular effects than agents such as epinephrine and isoproterenol.
Dobutamine is a direct-acting agent whose primary activity results from stimulation of theβ1-adrenoceptors of the heart, increasing contractility and cardiac output. Since it does not act ondopamine receptors to inhibit the release ofnorepinephrine (another α1 agonist), dobutamine is less prone to induce hypertension than isdopamine.
Dobutamine is predominantly aβ1-adrenergic agonist, with weak β2 activity, andα1 selective activity, although it is used clinically in cases of cardiogenic shock for its β1inotropic effect in increasing heart contractility and cardiac output. Dobutamine is administered as aracemic mixture consisting of both (+) and (−)isomers; the (+) isomer is a potent β1 agonist and α1 antagonist, while the (−) isomer is an α1 agonist.[9] The administration of the racemate results in the overall β1 agonism responsible for its activity. (+)-Dobutamine also has mild β2 agonist activity, which makes it useful as a vasodilator.[10]
^Tibayan FA, Chesnutt AN, Folkesson HG, Eandi J, Matthay MA (August 1997). "Dobutamine increases alveolar liquid clearance in ventilated rats by beta-2 receptor stimulation".American Journal of Respiratory and Critical Care Medicine.156 (2 Pt 1):438–444.doi:10.1164/ajrccm.156.2.9609141.PMID9279221.
