Dopamine

• What it does: Catecholamine inotrope/vasopressor with dose-dependent dopaminergic, β1, and α1 effects
• Administration: Continuous IV infusion only; very short half-life (~2 minutes) and onset ~5 minutes, so titrate every 5–10 minutes to effect
• Typical Adult Dose: Start 2–5 mcg/kg/min; usual maintenance range 5–20 mcg/kg/min (rarely up to 50 mcg/kg/min in select patients)
• ACLS Symptomatic Bradycardia: 5–20 mcg/kg/min IV infusion, titrated to blood pressure and perfusion
• Key Warning: Not first-line vasopressor in shock due to higher arrhythmia burden and worse outcomes compared with norepinephrine; reserve for selected patients or when other agents are unavailable
• Special Precautions: Avoid in pheochromocytoma and uncorrected tachyarrhythmias; extravasation risk is high—use a large-bore vein or central line and monitor the site closely

• Generic Name: Dopamine
• Brand Names: Intropin (various generics; institution-specific availability)

Catecholamine inotrope / vasopressor

Mechanism of Action:

• Endogenous catecholamine and precursor of norepinephrine; stimulates multiple receptors with different effects depending on dose
• Low dose (≈0.5–2 mcg/kg/min): Predominately D1 and D2 receptor agonism in renal, mesenteric, coronary, and cerebral vasculature, producing vasodilation and increased renal blood flow/diuresis, but without proven renal-protective benefit
• Intermediate dose (≈2–10 mcg/kg/min): β1-adrenergic agonism → increased myocardial contractility, stroke volume, and heart rate, increasing cardiac output
• High dose (>10 mcg/kg/min, especially >20 mcg/kg/min): α1-adrenergic agonism → systemic vasoconstriction, increased systemic vascular resistance and blood pressure, with higher risk of tachyarrhythmias and limb/gut ischemia
• Also indirectly increases norepinephrine release from sympathetic nerve terminals, augmenting inotropy and vasoconstriction

Pharmacokinetics (IV infusion):

• Route: IV infusion only; inactivated in alkaline solutions—do not mix with sodium bicarbonate or other alkaline diluents
• Onset: Approximately 5 minutes after starting infusion; hemodynamic effects change quickly with rate adjustments
• Duration: Less than 10 minutes after stopping the infusion under usual conditions (longer if monoamine oxidase inhibitors are present)
• Half-life: About 2 minutes in adults
• Distribution: Widely distributed in peripheral tissues but does not significantly cross the blood–brain barrier
• Metabolism: Mainly by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) in liver, kidney, and plasma to inactive metabolites such as homovanillic acid and 3,4-dihydroxyphenylacetic acid; a minority is converted to norepinephrine
• Excretion: Roughly 80% excreted in urine as metabolites within 24 hours

• Hemodynamic support in distributive or low-output shock after adequate volume resuscitation, when first-line vasopressors (e.g., norepinephrine) are unavailable, limited, or contraindicated
• Temporary support of cardiac output and blood pressure in decompensated heart failure or cardiogenic shock where additional chronotropy/inotropy is desired and other inotropes are not an option per local protocol
• Symptomatic bradycardia with hypotension refractory to atropine and pacing, as a continuous IV infusion in ACLS algorithms
• Hemodynamic support in post–cardiac surgery or post–myocardial infarction low-output states according to institutional protocols

Diseases & Conditions Treated:

• Distributive/septic shock (not as first-line vasopressor)
• Cardiogenic shock and mixed shock states
• Acute decompensated heart failure with low cardiac output
• Post–cardiac surgery low-output syndrome
• Symptomatic bradycardia with hypotension (ACLS context)

Available Forms:

• Concentrated IV solution vials: 40 mg/mL, 80 mg/mL, 160 mg/mL dopamine hydrochloride (specific strengths may vary by manufacturer)
• Premixed D5W infusion bags (common): 80 mg/100 mL (800 mcg/mL), 160 mg/100 mL (1600 mcg/mL), 320 mg/100 mL (3200 mcg/mL), or institution-specific standard concentrations
• Frequently prepared standard concentration: 400 mg in 250 mL (1600 mcg/mL); always verify local concentrations, order sets, and pump libraries

Dosing (IV Infusion – Always Follow Local Protocols):

Administration Guidelines:

• Titrate by small increments (about 1–4 mcg/kg/min) every 10–30 minutes based on blood pressure, perfusion, heart rate/rhythm, and urine output
• Correct hypovolemia, hypoxia, and acidosis before or during dopamine therapy; pressors are not a substitute for volume resuscitation
• Avoid abrupt discontinuation when the patient is catecholamine-dependent; taper as other agents are added or hemodynamics improve
• Use an infusion pump and a standard concentration whenever possible to reduce medication error risk

Absolute Contraindications:

• Known hypersensitivity to dopamine or any component of the formulation (including sulfites in some products)
• Pheochromocytoma
• Uncorrected tachyarrhythmias or ventricular fibrillation

Major Precautions:

• Hypovolemia: Dopamine is less effective and more dangerous if volume is not adequately restored; volume resuscitation should be prioritized
• Severe peripheral vascular disease, Raynaud's phenomenon, or known limb ischemia: Higher risk of digital or limb necrosis at moderate-to-high doses
• Ischemic heart disease: Increased myocardial oxygen demand and risk of ischemia or infarction
• Recent or current MAO inhibitor therapy: Risk of exaggerated pressor response; if used at all, doses should be greatly reduced and the patient closely monitored
• Concurrent ergot alkaloid therapy (e.g., ergotamine): Increased risk of severe vasospasm and ischemia
• Pregnancy and lactation: Limited data; use only if potential benefit justifies potential risk

Common:

• Sinus tachycardia, palpitations
• Nausea and vomiting
• Headache, anxiety, or restlessness
• Benign ventricular or supraventricular ectopy
• Local infusion-site irritation

Serious:

• Sustained supraventricular tachycardia (SVT), atrial fibrillation, or atrial flutter
• Ventricular tachycardia or ventricular fibrillation
• Severe hypertension with risk of intracranial hemorrhage in susceptible patients
• Myocardial ischemia or infarction due to increased oxygen demand and vasoconstriction
• Digital ischemia, limb ischemia, or gangrene—especially in patients with peripheral vascular disease or when high doses are used
• Mesenteric or splanchnic ischemia at high doses
• Severe tissue necrosis and sloughing at extravasation site

Renal Impairment:

• No specific dose adjustment required for renal impairment
• Monitor hemodynamics closely as with all patients

Hepatic Impairment:

• No specific dose adjustment required
• Use with caution in severe hepatic dysfunction

Pregnancy & Lactation:

• Pregnancy: Limited data; use only if potential benefit justifies potential risk to fetus
• Lactation: Unknown if excreted in breast milk; use with caution

Pediatric Considerations:

• Dosing: Initial 1–5 mcg/kg/min; usual range 5–20 mcg/kg/min; maximum up to 50 mcg/kg/min
• Use same monitoring parameters as adults
• Follow institutional pediatric shock protocols

Geriatric Considerations:

• Higher risk of peripheral vascular disease and ischemic complications
• May be more sensitive to arrhythmogenic effects
• Start at lower end of dosing range and titrate carefully

Clinical Monitoring:

• Continuous ECG and heart rate monitoring for tachyarrhythmias and conduction abnormalities
• Frequent blood pressure measurement (preferably via arterial line in critically ill patients)
• Urine output (hourly when possible) as a marker of perfusion; target ≥0.5 mL/kg/hr in most adults unless otherwise specified
• Peripheral perfusion: capillary refill, skin temperature, mottling, and limb color—especially in extremities with prior vascular disease
• Mental status, lactate trends, and other markers of global perfusion as available
• IV site monitoring for signs of extravasation

Hemodynamic Monitoring (if available):

• Central venous pressure or other hemodynamic monitoring to guide volume status and inotrope/vasopressor titration
• Arterial blood pressure monitoring in critically ill patients

• 1. American Heart Association. (2025). Adult bradycardia with a pulse algorithm. In ACLS guidelines update. https://cpr.heart.org
• 2. Drugs.com. (2024, June 10). DOPamine: Drug monograph for professionals. Drugs.com. https://www.drugs.com/monograph/dopamine.html
• 3. DrugBank Online. (n.d.). Dopamine (DB00988). DrugBank. https://go.drugbank.com/drugs/DB00988
• 4. Medscape. (2024). Intropin (dopamine) dosing, indications, interactions, adverse effects, and more. Medscape Reference. https://reference.medscape.com/drug/intropin-dopamine-342435
• 5. Pfizer. (2021). Dopamine hydrochloride injection, USP: Clinical pharmacology and prescribing information. DailyMed. https://dailymed.nlm.nih.gov
• 6. Sonne, J., & colleagues. (2023). Dopamine. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535451/
• 7. U.S. Food and Drug Administration. (2023). Dopamine hydrochloride in dextrose injection: Prescribing information. FDA Drug Label. https://www.accessdata.fda.gov
• 8. Weiss, J., & others. (2003). Renal-dose dopamine: Myth or ally in the treatment of acute renal failure? Medscape. https://www.medscape.com/viewarticle/462075
• 9. Weingart, S. (2020). Vasopressors. EMCrit Project, Internet Book of Critical Care. https://emcrit.org/ibcc/pressors/