DOBUTAMINE
Dobutamine
is a racemic mixture of two isomers with affinity for both β1
and β2
receptors, with rela-tively higher selectivity for β1
receptors. Its primary cardiovascular effect is a rise in cardiac output as a
result of increased myocardial contractility. A decline in peripheral vascular
resistance caused by β2-activation
usually prevents much of a rise in arte-rial blood pressure. Left ventricular
filling pressure decreases, whereas coronary blood flow increases.Favorable eff
ects on myocardial oxygen bal-ance are believed to make dobutamine a choicefor
patients with the combination of congestive heart failure and coronary artery
disease, particularly if peripheral vascular resistance is elevated. However,
because it has been shown to increase myocardial oxygen consumption, such as
during stress testing (rationale for its use in perfusion imaging), some
concern remains regarding its use in patients with myocardial ischemia.
Moreover, dobutamine should not be routinely used without specific indications
to facilitate separation from cardiopulmonary bypass.
Dobutamine is administered as an
infusion at a rate of 2–20 mcg/kg/min. It is supplied in 20-mL vials containing
250 mg.
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