Dobutamine Hexal, lyophilizate, 250 mg

Indications

Acute heart failure, exacerbation (acute decompensation) of chronic heart failure, chronic heart failure (as a temporary adjunct to main therapy), low heart volume (as a side effect of artificial lung ventilation with positive residual pressure on exhalation).

Active ingredient

Composition

1 vial contains dobutamine hydrochloride 250 mg.

How to take, the dosage

Powder of Dobutamine GEXAL is dissolved in 10 ml of water for injection and then diluted with 5% glucose or other solvents to 50 ml (intermittent infusion) or 500 ml (continuous).

Dobutamine HEXAL infusion solution: If further dilution is necessary, the same solutions are used as for the powder. The dose is set individually. Typically 2.5-10 (up to 40) mcg/kg/min in adults and 1-15 mcg/kg/min in children.

Interaction

In concomitant administration of beta-adrenoblockers, due to competitive inhibition of receptors, the catecholaminergic effects of dobutamine may be attenuated. Prevailing alpha-adrenergic effects contribute to peripheral vasoconstriction with subsequent increase in BP.

In simultaneous blockade of α-adrenoreceptors, the prevailing beta-adrenergic-stimulatory effects may cause tachycardia and peripheral vasodilation.

Simultaneous use of nitroglycerin or sodium nitroprusside, especially in CHD, increases cardiac output and reduces systemic vascular resistance and ventricular filling pressure. HR and BP are slightly increased or unchanged.

The use of dobutamine in diabetic patients may cause a higher insulin requirement. Therefore, diabetic patients should monitor their glucose levels.

The simultaneous use of ACE inhibitors and dobutamine in high doses may lead to an increase in the minute volume of the heart caused by increased myocardial oxygen demand. This may lead to heart pain and arrhythmias.

In combination with dopamine, there is usually no additional increase in cardiac output that is possible with dobutamine alone. However, such a combination increases systemic BP, increases renal blood flow, sodium excretion and diuresis, and prevents an increase in ventricular filling pressure.

The concomitant use of MAO inhibitors is contraindicated, as life-threatening side effects (hypertensive crisis, collapse, cardiac arrhythmias, and intracranial bleeding) may develop.

The tricyclic antidepressants, maprotiline, cocaine, doxapram, guanadrel, guanethidine, increase pressor effect and risk of cardiotoxic side effects.

Ergometrine, ergotamine, methylergometrine, and oxytocin increase the vasoconstrictor effect and risk of ischemia and gangrene and severe arterial hypertension, up to and including intracranial hemorrhage.

Levodopa increases the risk of arrhythmias (requires reduction of the sympathomimetic dose).

The thyroid hormones increase (reciprocally) the effect and associated risk of coronary artery disease (especially in coronary atherosclerosis).

There are no clear indications of interaction of dobutamine with digitalis preparations, furosemide, spironolactone, lidocaine, isosorbide dinitrate, morphine, atropine, heparin, protamine sulfate, potassium chloride, folic acid and paracetamol.

Pharmaceutical incompatibility

Inhaled anesthetics hydrocarbon derivatives (including chloroform, enflurane, halothane, isoflurane, methoxyflurane) increase the risk of severe atrial or ventricular arrhythmias (increasing myocardial sensitivity to sympathomimetics).

. Do not mix dobutamine solution with alkaline solutions (e.g., 5% sodium bicarbonate solution), solutions containing both sodium bisulfate and ethanol, with acyclovir, aminophylline, bretylium, calcium chloride, calcium gluconate, cefamandole formate sodium salt of cephalothin, sodium salt of cefazolin, diazepam, digoxin, etacrynic acid (sodium salt), furosemide, sodium heparin, hydrocortisone sodium succinate, insulin, potassium chloride, magnesium sulfate, penicillin, phenytoin, streptokinase, verapamil.

Special Instructions

Tolerance phenomenon may occur with continuous administration of Dobutamine GEXAL (more than 72 hours) (dosage must be increased).

Contraindications

Hypersensitivity, idiopathic hypertrophic subaortic stenosis, pericardial tamponade, aortic stenosis, hypovolemia, concomitant use of MAO inhibitors, breastfeeding.

Side effects

Nervous system and sensory organs: headache.

Cardiovascular system and blood (hematopoiesis, hemostasis): tachycardia (including ventricular). ventricular), atrial fibrillation, heart and chest pain, palpitations, shortness of breath, increased BP, hypotension, hypokalemia (very rare), transient inhibition of platelet aggregation (with long-term use), petechial hemorrhages, phlebitis.

Gastrointestinal system disorders: nausea.

Skin disorders: skin necrosis (at the site of injection).

Allergic reactions: rarely – skin rash, fever, bronchospasm, eosinophilia, etc.), polyuria (in high doses).

Overdose

Symptoms: nausea, vomiting, loss of appetite, tremor, anxiety, palpitations, tachycardia, tachyarrhythmia, ventricular fibrillation, excessive BP, myocardial ischemia, cardialgia, headache, shortness of breath, angina or non-specific chest pain.

Treatment: discontinuation of the drug, tracheal intubation to ensure ventilation of the lungs and blood oxygenation. In case of excessive rise in BP – intravenous injection of short-acting alpha-adrenoblockers, in ventricular tachyarrhythmia – propranolol or lidocaine. For accidental ingestion, activated charcoal (more effective than gastric lavage and induction of vomiting). Hemo- and peritoneal dialysis, forced diuresis, hemosorption with activated charcoal are ineffective.