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Intravenous Dilution Guidelines

Dopamine hydrochloride

The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]

Primary (Ready-to-use IV Bags)
400 mg/ 250 ml [Titrate]
800 mg/ 250 ml [Titrate]
800 mg/ 500 ml [Titrate]

(200 to 800 mg/ 250 to 500 ml)

Stability / Miscellaneous

EXP: 1 DAY (RT). The ICU's prefer 400 to 800mg/250 ml.

Calculation of drip rate (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375.

Refractory CHF: initial dose: 0.5 to 2 mcg/kg/min.

Renal: 1 to 5 mcg/kg/min.

Severely ill patient: initially 5 mcg/kg/min, increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min.


Effects:
[0.5 to 2 mcg/kg/min] - dopa;
[2-10 mcg/kg/min] - dopa/beta;
[>10 mcg/kg/min] - primarily alpha.

Used to support BP, CO and renal perfusion in shock.

IMPORTANT - Antidote for Peripheral Ischemia - To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible with 10 to 15 mL of saline solution containing 5 to 10 mg of Regitine®(brand of phentolamine), an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore, phentolamine should be given as soon as possible after the extravasation is noted.


Central line required.
*Central line required for administration of doses above 240 mcg/min; in cases of emergency or profound hypotension, dopamine may be given peripherally using the 200 mg / D5W 250 ml concentration while preparation for central line is underway.
Source: http://www.mgh.harvard.edu/pharmacy/ICU%20Guidelines/dopamine.htm

EXTRAVASATION- May result in sloughing and tissue necrosis. Use central line or large veins e.g. cephalic or basilic, to decrease risk. Treatment: Stop infusion. Restart at new IV site and notify physician. Physician to infiltrate area of extravasation with phentolamine: 5 - 10 mg diluted in 10 mL NS (adults); 0.1 - 0.2 mg/kg up to 10 mg diluted in 10 mL NS (pediatrics). Use a fine needle. To be effective, use within 12 hours.

DOSAGE AND ADMINISTRATION
WARNING: This is a potent drug: It must be diluted before administration to patient.


Suggested Dilution: Transfer contents of one or more ampuls or vials by aseptic technique to either 250 mL or 500 mL of one of the following sterile intravenous solutions:

1. Sodium Chloride Injection, USP
2. Dextrose (5%) Injection, USP
3. Dextrose (5%) and Sodium Chloride (0.9%) Injection, USP
4. 5% Dextrose in 0.45% Sodium Chloride Solution
5. Dextrose (5%) in Lactated Ringer's Solution
6. Sodium Lactate (1/6 Molar) Injection, USP
7. Lactated Ringer's Injection, USP

DOPAMINE has been found to be stable for a minimum of 24 hours after dilution in the sterile intravenous solutions listed above. However, as with all intravenous admixtures, dilution should be made just prior to administration.

Do NOT add DOPAMINE Injection to Sodium Bicarbonate or other alkaline intravenous solutions, since the drug is inactivated in alkaline solution.

Mixing of dopamine with alteplase in the same container should be avoided as visible particulate matter has been observed.

It is recommended that dopamine not be added to amphotericin B solutions because amphotericin B is physically unstable in dopamine-containing solutions.


Rate of Administration:
DOPAMINE, after dilution, is administered intravenously through a suitable intravenous catheter or needle. An i.v. drip chamber or other suitable metering device is essential for controlling the rate of flow in drops/minute. Each patient must be individually titrated to the desired hemodynamic and/or renal response with DOPAMINE. In titrating to the desired increase in systolic blood pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the hemodynamic condition is stabilized.

Administration rates greater than 50 mcg/kg/minute have safely been used in advanced circulatory decompensation states. If unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution.

Suggested Regimen:
When appropriate, increase blood volume with whole blood or plasma until central venous pressure is 10 to 15 cm H2O or pulmonary wedge pressure is 14-18 mm Hg.

Begin administration of diluted solution at doses of 2-5 mcg/kg/minute DOPAMINE in patients who are likely to respond to modest increments of heart force and renal perfusion.

In more seriously ill patients, begin administration of diluted solution at doses of 5 mcg/kg/minute DOPAMINE and increase gradually, using 5 to 10 mcg/kg/minute increments, up to 20 to 50 mcg/kg/minute as needed. If doses of DOPAMINE in excess of 50 mcg/kg/minute are required, it is suggested that urine output be checked frequently. Should the urine flow begin to decrease in the absence of hypotension, reduction of DOPAMINE dosage should be considered. Multiclinic trials have shown that more than 50% of the patients were satisfactorily maintained on doses of DOPAMINE less than 20 mcg/kg/minute. In patients who do not respond to these doses with adequate arterial pressures or urine flow, additional increments of DOPAMINE may be employed in an effort to produce an appropriate arterial pressure and central perfusion.

Treatment of all patients requires constant evaluation of therapy in terms of the blood volume, augmentation of myocardial contractility, and distribution of peripheral perfusion. Dosage of DOPAMINE should be adjusted according to the patient's response, with particular attention to diminution of established urine flow rate, increasing tachycardia or development of new dysrhythmias as indices for decreasing or temporarily suspending the dosage.

As with all potent intravenously administered drugs, care should be taken to control the rate of administration so as to avoid inadvertent administration of a bolus of drug.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.


HOW SUPPLIED
Dopamine HCl Injection, USP is available as follows:

Dopamine HCl
Product No. Mg per volume fill How Packaged
NDC 0517-1805-25 200 mg/5 mL Vial
(40 mg/mL)
Packages of 25 vials
(color-coded WHITE)
NDC 0517-1905-25 400 mg/5 mL Vial
(80 mg/mL)
Packages of 25 vials
(color-coded GREEN)
NDC 0517-1305-25 800 mg/5 mL Vial
(160 mg/mL)
Packages of 25 vials
(color-coded YELLOW)

Store at controlled room temperature 15°-30°C (59°-86°F) (See USP).

Avoid contact with alkalis (including sodium bicarbonate), oxidizing agents or iron salts.

NOTE - Do not use the injection if it is darker than slightly yellow or discolored in any other way.

WARNING: NOT FOR DIRECT INTRAVENOUS INJECTION, MUST BE DILUTED BEFORE USE.

IV INFUSION ONLY.

IN1805
Rev. 4/01
MG #8090

AMERICAN
REGENT
LABORATORIES, INC.
SHIRLEY, NY 11967

Disclaimer
The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.  PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.
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