Hypersensitivity, idiopathic hypertrophic subaortic stenosis, cardiac tamponade, pericarditis, hypertrophic obstructive cardiomyopathy, severe aortic stenosis, hypovolemia, taking MAO inhibitors.
Beta-blockers reduce the positive inotropic effect. MAO inhibitors unpredictably increase adrenomimetic activity (the risk of developing a hypertensive crisis, heart rhythm disorders). Venous vasodilators (nitrates, sodium nitroprusside), when used in combination with dobutamine, increase the minute volume of the heart, a pronounced decrease in OPSS and the filling pressure of the ventricles of the heart. Simultaneous administration of ACE inhibitors (in t.tsch. captopril) and high doses of dobutamine leads to an increase in the minute volume of the heart, increases the consumption of oxygen by the heart muscle (possibly the appearance of pain in the heart and a violation of the heart rhythm)
In combination with dopamine, dobutamine causes, depending on the dose of dopamine, a pronounced increase in blood pressure.
Tachycardia (including ventricular), atrial fibrillation, palpitations, pain in the heart and chest, shortness of breath, increased blood pressure or hypotension, headache, nausea, hypokalemia, petechial bleeding, phlebitis, allergic reactions (skin rash, fever, bronchospasm, eosinophilia, etc.), skin necrosis (at the injection site) in contact with the skin.
Heart failure (acute, exacerbation of chronic), inotropic therapy for heart failure, accompanied by low cardiac output on the background of myocardial infarction, open heart surgery, cardiomyopathy, septic shock, cardiogenic shock.
Duvig (Dobutamine)
Dobutamine
In/in. The dose is selected individually. The recommended dose for adults is 2.5-10 mcg / kg / min, in some cases-up to 40 mcg/kg / min, for children-1-15 mcg/kg / min (there is evidence that the minimum effective dose in children is higher than in adults), when using high doses, caution is necessary, because at the same time there is evidence that the maximum tolerated dose for children is lower than for adults. At doses greater than or equal to 7.5 mcg / kg / min, the greatest number of side effects (especially tachycardia) was observed.
Tables for determining intravenous dosages for different types of infusions and at different initial concentrations:
| Dosage for the infusion pump 1 ampoule containing 250 mg of dobutamine per solution volume of 50 ml | |||
| Dose range | Infusion rate, ml / h (ml / min)* at the patient's body weight | ||
| 50 kg | 70 kg | 90 kg | |
| Low — 2.5 micrograms / kg / min | 1,5 (0,025) | 2,1 (0,035) | 2,7 (0,045) |
| Average — 5 mcg/kg / min | 3,0 (0,05) | 4,2 (0,07) | 5,4 (0,09) |
| High — 10 mcg/kg / min | 6,0 (0,10) | 8,4 (0,14) | 10,8 (0,18) |
| * at twice the concentration, i.e. at 2x250 mg of dobutamine per 50 ml solution volume, the rate of administration should be 2 times slower | |||
| Dosage for an infusion dropper 1 ampoule containing 250 mg of dobutamine per 500 ml solution volume | |||
| Dose range | Infusion rate, ml / hour (drops / min)* at the patient's body weight | ||
| 50 kg | 70 kg | 90 kg | |
| Low — 2.5 micrograms / kg / min | 15 (5) | 21 (7) | 27 (9) |
| Average — 5 mcg/kg / min | 30 (10) | 42 (14) | 54 (18) |
| High — 10 mcg/ml / min | 60 (20) | 84 (28) | 108 (36) |
| * at twice the concentration, i.e. at 2x250 mg of dobutamine per 500 ml solution volume or 250 mg per 250 ml solution volume, the rate of administration should be 2 times slower | |||
Before discontinuing the drug, it is necessary to gradually reduce its dose!
Instructions for the preparation of the infusion solution: Duvig (Dobutamine) as a solution for intravenous administration in ampoules with a capacity of 50 ml is used undiluted in infusion droppers. Alternatively, the drug can be pre-diluted with 5% glucose solution, saline solution, Ringer-lactate solution.
Use only for intravenous administration.
Due to the short elimination period, the drug should be administered continuously.
During the administration of Dobutamine Solway, the heart rate, blood pressure, the volume of urine excreted, the volume of infusion and the rate of administration should be monitored. If possible, the minute volume of the heart, central venous pressure, and pulmonary capillary pressure should be monitored during the infusion.
The duration of intravenous administration depends on the clinical symptoms and is determined by the doctor.
With continuous use of the drug for more than 72 hours, tolerance may develop, which makes it necessary to increase the dosage of the drug.
In / in the form of infusions.
Duvig (Dobutamine) is intended only for intravenous infusions after pre-dilution. The rate and duration of administration of Dobutamine Hexal is set individually, taking into account the patient's reaction and the dynamics of hemodynamic parameters.
Duvig (Dobutamine), a lyophilizate for the preparation of an infusion solution, is initially diluted in 10 ml of sterile water for injection, if the drug is not completely dissolved, another 10 ml is added.
If further dilution of the dobutamine concentrate is required, a 5% glucose solution, 0.9% sodium chloride solution, Ringer's solution, or sodium lactate solution should be used.
The diluted solution can be stored for 24 hours, after which it is not subject to use.
Solutions containing dobutamine for infusions can give a pink color, the intensity of which will increase over time (due to its oxidation, but there is no significant loss of activity and no increase in toxicity). The prepared solutions are not intended for repeated selection of the drug. Due to the short half-life of dobutamine, continuous long-term infusions should be performed.
The duration of intravenous infusions depends on the results of clinical efficacy. During the administration of Dobutamine Hexal, constant monitoring of heart rate, heart rate, blood pressure, the amount of urine excreted and the rate of infusions is necessary. If possible, during treatment, you should also monitor the value of the minute volume of the heart, central venous pressure and pressure in the pulmonary capillaries.
In the absence of other prescriptions, adults are recommended to administer Duvig (Dobutamine) in doses of 2.5-10 mcg/kg / min. In some cases, the dosage is up to 40 mcg/kg / min of dobutamine.
Children are recommended to administer dobutamine in doses from 1 to 15 mcg/kg / min. When using doses higher than or equal to 7.5 mcg / kg / min, most of the side effects (especially tachycardia) begin to appear. There is evidence that the minimum effective dose in children is higher than in adults. At the same time, the maximum tolerated dose in children is lower than in adults. Achieving the required dosages in children should be done carefully due to the apparently lower therapeutic breadth in childhood!
Recommendations for infusions of Dobutamine Hexal in various initial doses
| Dosage recommendations for discontinuous infusion* | |||
| 1 fl. for injection of 250 mg of dobutamine in 50 ml of solvent | |||
| Dose areas | Data in ml / h* (ml / min) | ||
| Body weight 50 kg | Body weight 70 kg | Body weight 90 kg | |
| Low (2.5 mcg / kg / min) | 1,5 (0,025) | 2,1 (0,035) | 2,7 (0,045) |
| Medium (5 mcg / kg / min) | 3 (0,05) | 4,2 (0,07) | 5,4 (0,09) |
| High (10 mcg / kg / min) | 6 (0,1) | 8,4 (0,14) | 10,8 (0,18) |
*At twice the concentration, i.e. at 2 × 250 mg of dobutamine in 50 ml of solvent, it is necessary to reduce the recommended dosage by 2 times.
