Clinical pharmacology of dobutamine and dopamine in preterm neonates

Abstract

Dobutamine is a b 1 selective stimulant. b Receptor agonists are used to stimulate the rate and the force of cardiac contraction. The chronotropic effect is useful for the treatment of arrhythmias whereas the inotropic effect is useful to augment the myocardial contractility. Dobutamine is about four times as potent as dopamine in stimulating myocardial contractility in low concentrations and increases left ventricular output in the hypotensive preterm infants. Dobutamine possesses a center of asymmetry. The (2 )-isomer of dobutamine is a potent agonist of a 1 receptors and is capable of causing marked pressor responses. In contrast, (þ)-dobutamine is a potent a 1 receptor antagonist which can block the effects of (2)-dobutamine. Dobutamine is relatively cardioselective at dosages used in clinical practice with its main action being on b 1 -adrenergic receptors. Dobutamine and dopamine undergo intense metabolism in neonates where they are conjugated with sulphate and O-methylated. The clearance and the half-life of dobutamine and dopamine range over one order of magnitude in neonates. Dopamine is widely used to increase blood pressure, cardiac output, urine output and peripheral perfusion in neonates with shock and cardiac failure. Dopamine is more effective than dobutamine in the short-term treatment of systemic hypotension in preterm infants. High doses of dopamine cause vasoconstriction, increase systemic vascular resistance, and, eventually, decrease renal blood flow. Treatment with dobutamine is associated with a significantly greater increase in left ventricular output in the single study reporting that outcome. Dobutamine is indicated for the short-term treatment of cardiac decompensation.

Dobutamine Stress Echocardiography in Chronic Kidney Disease Patients Candidates for Renal Transplantation

“…The delayed response to dobutamine and need to use higher doses of atropine may be related to effect of metabolites in ESRD that may blunt the heart response to dobutamine as dobutamine is metabolized by the liver and no role of kidney in dobutamine metabolism. Although previous report in pediatrics of delayed clearance of dobutamine in infants with serum creatinine concentrations >2 mg/dl [20]. This observation alerts the alternative protocol of accelerated DSE [21] where atropine is used at dobutamine dose of 20 µ/kg/min that could decrease the procedure time and dose of dobutamine used.…”

Analysis of Characteristics of Peripheral Arterial Ischemia in Premature Babies and Effects of Nitroglycerin Patch Application

“…If whole-body circulation does not improve despite the use of drugs, it may be necessary to continue the use of vasoconstrictors and inotropic agents in large quantities. However, the continuing application of vasoconstrictors and inotropic agents in large doses may cause hypodermic tissue ischemia and peripheral vasoconstriction, and ultimately, tissue necrosis [26][27][28].…”

Recent Advances in Marine-Based Nutraceuticals and Their Health Benefits

“…[ 215 , 216 , 217 , 218 , 219 ]. Besides these functions of DA on brain functions, Pacifici [ 220 ] reported that DA could be used to increase blood pressure and urine output as well as for pediatric treatments [ 221 ]. The sourcing of DA is potentially important to the drug industry.…”