Dopamine HCl

What is Dopamine HCl?

Dopamine HCl is used to increase blood flow or correct an imbalance in blood
flow within the bodys organs and tissues. This is the result of shock caused
by MI, trauma, endotoxic septicemia, open heart surgery, and CHF.
Dopamine HCl can also be used to treat shock related to acute renal failure,
cirrhosis, hepatorenal syndrome, and barbiturate intoxication.
Dopamine HCl is classified as an alpha and beta adrenergic agonist which
means it is a cardiac stimulant and vasopressor. This drug will cause an
increase in the cardiac output with an increase in systolic and pulse pressure.
These effects are important because they essentially reverse the state of
shock (critically low bp) within the body. By counterbalancing a dangerously
low bp, correct blood flow and perfusion can return to the tissues. Without
correct perfusion, organs and tissues cannot function and will eventually die.
These vasopressor(constricts)/chronotropic(changes HR)/inotropic(changes
muscle contractions) abilities are not only useful in treating shock but also
decreased cardiac output.

How to use Dopamine HCl?

This drug is given only by IV. Dosage varies by age and whether it is being
used to treat shock/surgery or CHF. When used for treatment of
shock/surgery the adult dosage is 2-5 mcg/kg/min and maybe increased
gradually up to 20-50 mcg/kg/min if necessary while dosage for children is 15 mcg/kg/min increased gradually up to 20 mcg/kg/min. When being used
for CHF 3-10 mcg/kg/min is the correct dosage.
Dopamine HCl must be diluted in 250 or 500 ml of D5W, D5/NS, D5/LR,
D5/0.45% NaCl., NS. The drug is then administered with a continuous
infusion rate which depends on the body weight. The rate and dosage needs
to be continuously monitored for effectiveness and safety. Too great a
fluctuation in bp in the opposite direction causing hypertension needs
immediate attention. Any changes or adjustments are done as per the
physician.

What are adverse effects of Dopamine HCl?

Dopamine HCl can cause hypotension, ectopic beats, tachycardia, anginal
pain, palpitation, vasoconstriction (disproportionate diastolic), cold

extremities, bradycardia, widening of QRS complex, elevated bp, nausea,

vomiting, headache, necrosis, tissue sloughing with extravasation, gangrene,
aberrant conduction, dyspnea, dilated pupils and piloerection.
This drug has a BLACK BOX WARNING. Dopamine HCl can cause
extravasation of the tissues surrounding it which leads to necrosis and
sloughing. This is SERIOUS and is can be life threatening. Not only does it
open the patient up to infection but depending on the severity of the
extravasation, it can cause significant tissue death.

Drug Interactions?
Dopamine HCl will interact with other cardiac drugs such as MAOI inhibitors
and Ergot alkaloids. If used with another alpha adrenergic drug, the effects
of Dopamine HCl will be magnified which can lead to hypertension and
headaches. Certain drugs such as guanethidine and phenytoin may
decrease Dopamine HCl effectiveness. Alpha and beta blockers may
antagonize the effectiveness of this drug.

Nursing Implications
*Watch for extravasation* If extravasation observed, STOP
IMMEDIATELY. Immediately infiltrate the ischemic site with 5-10 mg
phentolamine mesylate in 10-15 ml of NS, using a syringe with a fine
needle.
-Protect Dopamine HCl from light. Do not use discolored solutions.
-Correct hypovolemia with either whole blood or plasma before initiation of
dopamine therapy.
-Use a large vein
-Monitor infusion
-Monitor bp, pulse, peripheral pulses, and urine output
-Report to physician reduced urine flow rate in the presence of hypotension,
dysrhythmias, tachycardia, disproportionate rise in diastolic pressure, signs
of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of
tenderness, pain numbness or burning)
-Monitor therapeutic effectiveness (improvement of vital signs, increase in
toe temp, capillary bed refill, reversal of confusion or comatose state)

Cautious Use

Patients with history of occlusive vascular disease, coronary artery disease,

cold injury, acute MI, diabetic endarteritis, arterial embolism, pregnancy,
lactation, children younger than 2 y.o.