This information is a reference and it is not enough that the drug was prescribed by a doctor. .
PHARMACHOLOGIC EFFECT
Beta 1- adrenomimetic. Has a positive inotropic effect, which is associated with an increase in the transmembrane calcium current within the cardiomyocytes with an increase in the content of cAMP in them as a result of beta-adrenergic stimulation and activation of the G-protein adenylate cyclase. Moderately increases heart rate, increases stroke and minute volume, reduces the final diastolic pressure in the left ventricle, reduces OPSS and vascular resistance of the small circulation. Systemic BP does not change significantly, The increase in the shock volume is offset by a decrease in the OPSS.
Reduces the filling pressure of the ventricles of the heart, increases coronary blood flow and improves oxygen supply to the myocardium. An increase in cardiac output may cause an increase in renal perfusion and an increase in excretion of sodium and water.
In children, an increase in stroke volume, which is observed under the influence of dobutamine, is accompanied by a less pronounced decrease in OPSS and ventricular filling pressure; with a more pronounced increase in heart rate and an increase in blood pressure.
PHARMACOKINETICS
After intravenous administration, it is metabolized in the liver to inactive compounds. T 1/2 is about 2 minutes. It is excreted by the kidneys in the form of metabolites.
INDICATIONS
Acute heart failure (including acute myocardial infarction, cardiogenic shock, the consequences of surgical intervention on the heart, the use of drugs with negative inotropic effect), chronic heart failure (decompensation).
As an adjuvant: temporary maintenance treatment of patients with chronic heart failure receiving standard therapy; acute cardiac insufficiency of non-cardiogenic genesis (including toxic and traumatic shock), some forms of heart failure against hypovolemia (when the average blood pressure is above 70 mmHg and intracapillary pressure in the small circulation system is 18 mm Hg. st and above, with inadequate response to the replenishment of bcc and increased filling pressure of the ventricles); low minute volume of blood on the background of mechanical ventilation with positive residual pressure on exhalation; Diagnosis of IHD (pharmacological test as a substitute for physical exercises).
DOSING MODE
Individual. Enter in / in the drip with a speed of 2.5-10 Ојg / kg / min. If necessary, the rate of administration can be increased to 20-40 Ојg / kg / min.
SIDE EFFECT
From the cardiovascular system: tachycardia, ventricular extrasystole, atrial fibrillation (tachysystolic form), chest pain, shortness of breath, increase or decrease in blood pressure.
From the digestive system: nausea, vomiting.
From the nervous system: headache, irritability, motor anxiety.
From the side of metabolism: hypokalemia.
Local reactions: phlebitis.
Other: nonspecific chest pain.
CONTRAINDICATIONS
Hypertrophic obstructive cardiomyopathy, cardiac tamponade, pheochromocytoma, ventricular arrhythmias (including ventricular fibrillation), hypersensitivity to dobutamine.
PREGNANCY AND LACTATION
The use of dobutamine during pregnancy and lactation (breastfeeding) is possible in cases where the intended benefit to the mother exceeds the potential risk to the fetus or child.
APPLICATION FOR CHILDREN
Caution should be used in children and adolescents under the age of 18 years.
SPECIAL INSTRUCTIONS
It should be used with caution in metabolic acidosis, hypercapnia, hypoxia, tachyarrhythmia, atrial fibrillation, myocardial infarction (high doses of dobutamine may increase heart rate and myocardial contractility and, increasing myocardial oxygen demand, enhance ischemia), pulmonary hypertension, hypovolemia, occlusive vascular diseases arterial thromboembolism, atherosclerosis, thromboangiitis obliterans, diabetic endarteritis, Raynaud's disease), cold trauma (including frostbite), angle-closure glaucoma, in children and grown up Cove at the age of 18 years.
In the presence of hypovolemia, it should be compensated before the introduction of dobutamine.
In the presence of an obstacle to filling the ventricles and / or outflow of blood from the ventricles, the administration of dobutamine does not cause improvement in hemodynamics.
In cases of significantly reduced diastolic relaxation of the ventricles (with cardiac tamponade, valve aortic stenosis and idiopathic hypertrophic subaortic stenosis), the reaction of the cardiac muscle to dobutamine administration may be inadequate.
If, despite adequate values ​​of ventricular filling pressure and cardiac output, BP remains low or progressively decreases during the administration of dobutamine, consideration should be given to the simultaneous use of vasoconstrictors.
The administration of dobutamine should be performed under the control of heart rate, blood pressure, ECG, diuresis; it is also recommended to monitor the stroke volume of the heart, ventricular filling pressure, central venous pressure, and pulmonary artery pressure. It is necessary to observe the temperature of the body and the mental state of the patient.
Continuous infusion of 72 hours or more may result in the development of tolerance, so higher doses may be needed to maintain the initial effect.
DRUG INTERACTION
With the simultaneous use of beta-blockers and dobutamine in small doses, the narrowing of the arterial vessels is possible, due to the alpha-adrenomimetic activity of dobutamine. With the simultaneous use of beta-adrenoblocker and dobutamine in high doses, antagonistic interaction at the level of ОІ-adrenoreceptors is possible.
With simultaneous use with cardiac glycosides, inotropic action is mutually reinforced, the risk of arrhythmia increases.
With simultaneous use with dipyridamole, there is a risk of severe arterial hypotension.
With simultaneous use with dopamine, systemic blood pressure rises, kidney blood flow increases, sodium excretion and diuresis, while the ventricular filling pressure does not increase (which is possible only with dopamine administration).
With simultaneous use with nitroglycerin, sodium nitroprusside (especially in patients with IHD), the minute volume of the heart increases, the OPSS and the ventricular filling pressure decrease.
With simultaneous application with theophylline, there is a risk of developing tachycardia.
Tolkapon inhibits the activity of COMT, so it is theoretically possible to increase the concentration of dobutamine in the blood plasma and to increase its side effects.
With simultaneous use with ACE inhibitors, there are pains in the heart, arrhythmias.
When used simultaneously with MAO inhibitors (including furozolidone, procarbazine, selegiline), there is a risk of developing life-threatening conditions (hypertensive crisis, hemorrhagic stroke, arrhythmias).
Inhalational anesthetics - derivatives of hydrocarbons (including chloroform, enflurane, halothane, isoflurane, methoxyflurane) increase the risk of severe atrial or ventricular arrhythmias with dobutamine (increase myocardial sensitivity to sympathomimetics).
Tricyclic antidepressants, maprotiline, cocaine, doxapram, guanadrel, guanethidine, enhance the pressor effect and the risk of cardiotoxic side effects.
With simultaneous use with dobutamine, ergometrine, ergotamine, methylergometrine, oxytocin increase the vasoconstrictor effect and the risk of occurrence of ischemia and gangrene, as well as severe arterial hypertension, up to intracranial hemorrhage.
Levodopa increases the risk of arrhythmias (a reduction in the dose of sympathomimetic is required).
With simultaneous use with thyroid hormones, mutual enhancement occurs, which increases the risk of coronary insufficiency (especially in coronary atherosclerosis).
Dobutamine is pharmaceutically incompatible with a 5% sodium bicarbonate solution or any other alkaline solution, as well as with solutions containing sodium bisulfate or ethanol.
The information is provided for your information, do not self-medicate, it is dangerous for your health.
