Dopamine, 40 mg/ml concentrate 5 ml 5 pcs

Name: Dopamine, 40 mg/ml concentrate 5 ml 5 pcs
SKU: 484682
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EAN: 4680020180584 SKU: 484682 Categories: Cardiovascular, Medicine

Description

Cardiotonic drug of non-glycoside structure

ATX: C.01.C.A.04 Dopamine

Pharmacodynamics:

Dopamine is a catecholamine identical to the human body’s natural neurotransmitter, dopamine, and is also a precursor of noradrenaline.

It excites beta-adrenoceptors (in low and medium doses) and alpha-adrenoceptors (in high doses). Improvement of systemic hemodynamics leads to a diuretic effect. It has a specific stimulatory effect on postsynaptic dopamine receptors in vascular smooth muscle and the kidneys.

In low doses (0.5-3 µg/kg/min), it acts predominantly on dopamine receptors, causing dilation of renal, mesenteric, coronary and cerebral vessels. Renal vasodilation results in increased renal blood flow, increased glomerular filtration rate, increased diuresis, and excretion of sodium ions. The action on the renal and mesenteric vessels differs from that of other catecholamines.

In low to medium doses (2-10 µg/kg/min), it stimulates postsynaptic beta1-adrenoreceptors, which causes a positive inotropic effect and an increase in the minute volume of blood circulation. Systolic blood pressure and pulse pressure may increase; diastolic blood pressure is unchanged or slightly increased. Total peripheral vascular resistance (TPR) usually does not change. Coronary blood flow and myocardial oxygen consumption tend to increase.

In high doses (10 µg/kg/min or more), alpha1-adrenoreceptor stimulation predominates, causing increased RPS, heart rate, and renal vasoconstriction (the latter may reduce previously increased renal blood flow and diuresis). Both systolic and diastolic blood pressure increase as a consequence of the increase in the minute volume of blood circulation and RPS.

The onset of therapeutic effect is within 5 min against the background of intravenous administration and lasts for 10 min.

Strictly controlled studies of dopamine in children under 18 years of age have not been conducted.

Pharmacokinetics:

Intravenous only.

About 25% of the dose is taken up by neurosecretory vesicles, where hydroxylation occurs and norepinephrine is formed. It is widely distributed in the body and partially passes through the blood-brain barrier. The apparent volume of distribution is 0.89 l/kg. Binding with blood plasma proteins is 50%.

It is quickly metabolized in liver, kidneys and plasma by monoamine oxidase (MAO) and catechol-O-methyltransferase to inactive metabolites – homovanilic acid and 3,4-dihydroxyphenylacetate.

Half-life of dopamine: adults, from blood plasma – 2 min, from tissues – 9 min. Dopamine clearance is 4.4 l/kg/h. Excreted by the kidneys: 80% of the dose – as metabolites within 24 hours, minor amounts (less than 10%) – unchanged.

Indications

– Shock of different genesis: cardiogenic, postoperative, infectious-toxic, anaphylactic, hypovolemic (only after restoration of circulating blood volume);

– acute cardiovascular failure, “low minute circulation volume” syndrome in cardiac surgery patients;

– acute arterial hypotension.

Active ingredient

Dopamine

Composition

Active ingredient:

dopamine hydrochloride 40 mg;

Excipients:

dinate edetate 0.25 mg,

ouatria metabisulfite 10 mg,

water for injections up to 1 ml.

How to take, the dosage

It is administered by intravenous drip.

The dose is set individually, depending on the severity of shock, the value of blood pressure and patient’s response to treatment.

To obtain the inotropic effect, administer at a rate of 100-250 mcg/min (1.5-3.5 mcg/kg/min), a low-dose area.

In intensive surgical therapy, 300-700 mcg/min (4-10 mcg/kg/min) is the area of medium doses; in septic shock, 750-1500 mcg/min (10.5-21 mcg/kg/min) is the area of maximum doses.

In order to influence blood pressure, it is recommended to increase the dose to 500 mcg/min or more, or when a constant dose of Dopamine, norepinephrine (noradrenaline) is additionally administered in a dose of 5 mcg/min at a patient weight of about 70 kg.

If cardiac rhythm abnormalities occur, regardless of the doses used, further dose increases are contraindicated.

In most patients a satisfactory condition can be maintained with doses of Dopamine less than 20 mcg/kg/min.

Length of use: the duration of administration is determined individually. There is a positive experience of infusion duration up to 28 days. Once the clinical situation has stabilized, the drug should be withdrawn gradually.

Rules for solution preparation: for dilution use 0.9% sodium chloride solution, 5% dextrose (glucose) solution (including their mixtures), 5% dextrose (glucose) solution in Ringer lactate solution, sodium lactate and Ringer lactate solution.

In order to prepare a solution for intravenous infusion, 400-800 mg of Dopamine must be added to 250 ml of solvent (Dopamine concentration will be 1.6-3.2 mg/ml). The infusion solution should be prepared immediately prior to administration (the solution is stable for 24 h, except when mixed with Ringer’s lactate solution – maximum 6 h).

The Dopamine solution should be clear and colorless.

Interaction

The sympathomimetic effect is enhanced by adrenostimulants, monoamine oxidase inhibitors (including furazolidone, procarbazine, selegiline), guanethidine (increase in duration and enhancement of cardio-stimulating and pressor effects).

Dopamine may potentiate the effects of diuretics.

The cardiotonic effect of dopamine is enhanced by inhaled drugs for general anesthesia, hydrocarbon derivatives such as cyclopropane, chloroform, enflurane, halothane, isoflurane, methoxyflurane (increased risk of severe atrial or ventricular arrhythmias), tricyclic antidepressants including maprotiline (risk of heart rhythm disturbances, severe arterial hypertension or hyperpyrexia), cocaine, other sympathomimetics Weakened by butyrophenones and beta-adrenoblockers (propranololol).

Dopamine weakens the antihypertensive effect of guanadrel, guanethiline, mecanilamine, methyldopa, rauwolfia alkaloids (the latter prolong the effect of dopamine).

In concomitant use with levodopa – increased risk of arrhythmias; with thyroid hormones – possible increase in the effect of both dopamine and thyroid hormones.

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

Phenytoin may contribute to arterial hypotension and bradycardia (depending on the dose and speed of administration); ergot alkaloids to vasoconstriction and gangrene.

With cardiac glycosides there may be an increased risk of arrhythmias, additive inotropic effect (ECG monitoring required).

Decreases the antianginal effect of nitrates, which in turn may decrease the pressor effect of sympathomimetics and increase the risk of arterial hypotension (simultaneous use is permitted depending on achieving the therapeutic effect).

Pharmaceutical Incompatibilities

Incompatible with acyclovir, alteplase, amikacin, amphotericin B, ampicillin, cephalothin, dacarbazine citrate, theophylline ethylenedamide (eufylline), calcium theophylline (eufylline calcium), furosemide, gentamicin, sodium heparin, sodium nitroprusside, benzylpenicillin, tobramycin, alkaline solutions, oxidizing agents, iron salts, thiamine (promotes its destruction).

Special Instructions

Dopamine is intended for intravenous infusions only and may only be used diluted!

Dopamine improves atrial-ventricular conduction, so patients with atrial fibrillation should be given cardiac glycosides before using the drug; hypoxia, hypercapnia, and acidosis reduce the effectiveness of dopamine, increasing the chance of side effects.

Hypovolemia should be corrected by administration of plasma and other blood substitute fluids before administration in patients who are in shock.

Infusion should be performed under control of diuresis, minute blood volume; blood pressure, ECG, HR. Decreased diuresis without a concomitant decrease in blood pressure indicates the need to reduce the dopamine dose.

Moamine oxidase inhibitors, by increasing the pressor effect of sympathomimetics, may cause headache, arrhythmias, vomiting, and other manifestations of hypertensive crisis, so in patients who have received monoamine oxidase inhibitors for the last 2-3 weeks, the initial dopamine dose should not exceed 10% of the usual dose.

In order to reduce the risk of extravasation, the drug should be injected into large veins whenever possible. To prevent tissue necrosis in case of extravasal ingestion of the drug, 10-15 ml of 0.9% sodium chloride solution with 5-10 mg of phentolamine should be infiltrated immediately.

The use of the drug against a background of peripheral vascular obliterative diseases and/or a history of dyssymptomatic intravascular clotting may cause severe and pronounced vasoconstriction, leading to skin necrosis and gangrene (close monitoring should be performed and the drug administration should be stopped immediately if signs of peripheral ischemia are detected).

Influence on driving ability:

Dopamine is a drug for inpatient use with a very short half-life. After discharge from hospital, there is no possibility of the drug affecting reaction speed when driving motor vehicles or operating other mechanisms.

Contraindications

– Hypersensitivity to the components of the drug, including. to sulfites;

– hypertrophic obstructive cardiomyopathy;

– pheochromocytoma;

– thyrotoxicosis;

– tachyarrhythmia;

– ventricular fibrillation of the heart.

– closed-angle glaucoma;

– concomitant use of cyclopropane and hydrocarbon derivatives for inhalation anesthesia, ergot alkaloids.

– age under 18 years (efficacy and safety not established).

With caution:

. Hypovolemia, myocardial infarction, cardiac rhythm disorders (ventricular arrhythmias, atrial fibrillation), marked aortic stenosis, metabolic acidosis, hypercapnia, hypoxia, arterial hypotension in the “small” circuit of the circulation, Obliterating vascular diseases (including atherosclerosis, thromboembolism, obliterating thrombangitis, obliterating endarteritis, diabetic endarteritis, Raynaud’s disease, frostbite), diabetes, pregnancy, breast-feeding.

Side effects

Cardiovascular system disorders: tachycardia or bradycardia, palpitations, chest pain, angina pectoris, increased or decreased blood pressure, conduction disorders, dilated QRS complex; vasospasm, increased left ventricular end-diastolic pressure; when used in high doses – ventricular or supraventricular arrhythmias.

Gastrointestinal tract: nausea, vomiting, bleeding from the gastrointestinal tract.

Central and peripheral nervous system: headache; anxiety, motor restlessness, hand tremor.

Allergic reactions: severe hypersensitivity reactions and bronchospasm (due to the presence of sulfites in the drug), shock.

Local reactions: if dopamine gets under the skin – necrosis of the skin, subcutaneous tissue, gangrene may develop.

Others: dyspnea, azotemia, piloerection, polyuria (when administered in low doses).

Overdose

Symptoms: excessive increase in blood pressure, peripheral arterial spasm, arrhythmia, tachycardia, ventricular extrasystoles, angina pectoris, dyspnea, headache, psychomotor agitation.

Treatment: due to rapid elimination of dopamine from the body these phenomena are controlled by dose reduction or discontinuation of administration; if ineffective – short-acting alpha-adrenoblockers (for excessive increase in blood pressure) and beta-adrenoblockers (for arrhythmia).

Pregnancy use

During pregnancy, the drug Dopamine should be used only when the estimated benefit to the mother, exceeds the potential risk to the fetus (in the experiment, an adverse effect on the fetus was revealed). There are insufficient clinical data on the use of the drug in pregnant women. Preclinical studies revealed reproductive toxicity of dopamine.

Whether dopamine penetrates into breast milk is unknown. If it is necessary to use the drug Dopamine during lactation, breastfeeding should be stopped.

Similarities

Dopamine, Dopamine

Additional information

Weight	0.057 kg
Shelf life	3 years. Do not use after the expiration date.
Conditions of storage	In protected from light, at a temperature not exceeding 25 ° C. Do not freeze. Store out of the reach of children.
Manufacturer	Ozon, Russia
Medication form	concentrate for preparation of infusion solution
Brand	Ozon