Dobutamine is a medicine that makes the heart beat harder. It is used in hospital for patients with severe heart failure or cardiogenic shock, when the heart cannot pump enough.
Also known as: Dobutrex
β1 blockade directly antagonises the inotropic effect of dobutamine, with a risk of haemodynamic deterioration in patients dependent on the inotrope.
The inotropic effect of dobutamine derives from cardiac β1 receptor stimulation and is reversed by concomitant beta-blocker administration; with β1 blocked, alpha-agonist effects become dominant and may cause peripheral vasoconstriction and a rise in blood pressure.
Invasive blood pressure, cardiac index, continuous ECG, lactate, urine output and peripheral perfusion.
Refractory hypotension, arrhythmias, oliguria, lactic acidosis, cold extremities.
Titrate the dose under haemodynamic monitoring; in patients on chronic beta-blockade expect a reduced inotropic response and consider non-adrenergic alternatives (phosphodiesterase III inhibitors or calcium sensitisers) or, in beta-blocker poisoning, treat the antagonism first.
Dobutamine label (Pfizer labeling) — "The inotropic effect of dobutamine stems from stimulation of cardiac beta1 receptors, this effect is reversed by concomitant administration of beta-blockers": https://labeling.pfizer.com/ShowLabeling.aspx?id=16395; EMC-UK — Dobutamine 5 mg/ml solution for infusion, SmPC 4.5 (unopposed alpha effects with vasoconstriction and hypertension): https://www.medicines.org.uk/emc/product/6462/smpc
Propranolol blocks both β1 and β2 and antagonises the inotropic effect of dobutamine more markedly, with a risk of loss of inotropic support, peripheral vasoconstriction and paradoxical hypertension.
Besides reversing the β1 (inotropic) effect, β2 blockade removes beta-2-mediated vasodilation, leaving dobutamine alpha effects unopposed — the result is peripheral vasoconstriction with increased vascular resistance and blood pressure (propranolol label: interaction with sympathomimetic amines).
Invasive blood pressure, cardiac index and vascular resistance, continuous ECG, lactate, peripheral perfusion.
Hypotension with cold extremities, paradoxical hypertension, oliguria, arrhythmias.
Avoid the combination in patients dependent on the inotrope; if the beta-blocker is indispensable, use the least negative chronotropic/inotropic option and monitor invasively; consider an inodilator as an alternative.
Dobutamine label (Pfizer labeling): https://labeling.pfizer.com/ShowLabeling.aspx?id=16395; EMC-UK — Dobutamine 5 mg/ml solution for infusion, SmPC 4.5: https://www.medicines.org.uk/emc/product/6462/smpc; INFARMED Prontuário Terapêutico (11th ed., 2012), Cardiotonics 3.1 (sympathomimetic amines require monitoring).
No documented food or drink interactions.
Dobutamine (inotrope) in fixed severe aortic stenosis can cause collapse (cannot increase flow through the stenosed valve).
Avoid/test only in echocardiography setting with support.
Site monograph (dobutamine — continuous cardiac monitoring in shock).
Dobutamine is a beta-agonist — severe arrhythmias in phaeochromocytoma.
Contraindicated.
Site monograph (dobutamine — caution in rapid atrial fibrillation).
No specific Annex 1 entry; dobutamine is used in maternal cardiogenic shock with intensive monitoring. Pregnancy data are limited to case reports — maternal and fetal tachycardia is the best-documented effect. Use only if maternal benefit justifies.
Emergency use (ICU); lowest effective dose; monitor maternal and fetal heart rate.
Compatible as an emergency drug (minutes half-life).
EMC-UK (MHRA) — Dobutamine hydrochloride SmPC (section 4.6).
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
↑ cardiac contractility with mild heart rate rise; reduced systemic vascular resistance (β2).
Predominantly β1 agonist (racemic: (-)-isomer α1 agonist, (+)-isomer β1/β2 agonist) — net inotropic effect with mild vasodilation.
IV exclusive; onset in 1–2 min; peak at 10 min.
Metabolised by COMT and hepatic conjugation; short plasma half-life → continuous infusion.
~ 2 min (IV).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
