Dobutamine Hydrochloride

Class: Selective beta-1-Adrenergic Agonists
VA Class: AU100
CAS Number: 49745-95-1
Brands: Dobutrex

Introduction

Dobutamine is a synthetic sympathomimetic that is structurally related to dopamine and generally is considered a relatively selective β₁-adrenergic agonist.

Uses for Dobutamine Hydrochloride

Cardiac Decompensation, Shock, and CHF

Used to increase cardiac output in the short-term treatment of cardiac decompensation caused by depressed contractility from organic heart disease, cardiac surgical procedures, cardiac arrest† (ACLS; see CPR under Uses), or acute MI† (see MI under Uses).^{103 107 110 111 a b}

May be particularly useful in the management of cardiogenic shock, including drug-induced cardiogenic shock, in patients with normal DBP and SBP >100 mm Hg, since the drug provides the best sympathomimetic support.^{104 112}

May be preferable to dopamine in the period immediately following cardiopulmonary bypass surgery.^b

Safety and efficacy in the long-term (e.g., exceeding 48 hours) treatment of CHF have not been established.^{103 107 109 a b} Patients with NYHA class IV disease appear at particular risk of adverse effects of long-term cAMP-dependent inotropic therapy.^a

May be ineffective and potentially harmful in marked mechanical obstruction (e.g., severe valvular aortic stenosis).^b

Should not be used alone in severely hypotensive patients (e.g., when SBP is <100 mm Hg).^b

Should not be used in patients with drug-induced distributive shock, since the drug may worsen hypotension by further decreasing systemic vascular resistance.¹¹²

CPR

Used as a potent inotropic agent to increase cardiac output in ACLS during CPR.^{110 b}

May be particularly useful for low cardiac output secondary to poor myocardial function, such as following cardiac arrest.¹¹⁰

Predominant β-adrenergic effects increase myocardial contractility in a dose-dependent manner and decrease left ventricular filling pressures.¹¹⁰

Arterial blood pressure may remain unchanged due to reflex peripheral vasodilation (baroreceptor mediated) in response to increased stroke volume.¹¹⁰

Useful in the management of postresuscitation shock (e.g., when combined with dobutamine).^{110 c}

MI

Although the manufacturers state that safety following MI has not been established, use in combination with dopamine in acute MI† management is recommended by the ACC and AHA for the management of heart failure and low-output syndromes associated with left ventricular dysfunction and for inotropic support following hypotension management associated with right ventricular ischemia.¹¹¹

May be useful as an adjunct (to increase cardiac output) to volume replacement in patients with right ventricular infarction, since dopamine may increase pulmonary vascular resistance.^b

Dobutamine Hydrochloride Dosage and Administration

Administration

Usually administered by IV infusion^b

Has also been administered by intraosseous infusion†.¹¹⁰

IV Infusion

Infuse IV using an infusion pump or other apparatus to control the rate of flow and avoid inadvertent administration of a bolus of drug.^{107 a b}

Commercially available premixed dobutamine hydrochloride in 5% dextrose should be administered only by IV infusion via a suitable catheter or needle.¹⁰⁷

Do not be use in series connections.¹⁰⁷

When the commercially available IV infusion solution of dobutamine hydrochloride in 5% dextrose is used, the accompanying labeling should be consulted for proper methods of administration and other associated precautions.^b

Dilution

The concentrate for injection must be diluted prior to administration; alternatively, commercially available diluted injections for IV infusion may be used.^{103 b}

20 mL of the concentrate for injection should be diluted in at least 50 mL of diluent and 40 mL of concentrate should be diluted in at least 100 mL of diluent.^b

The concentration used is individualized according to patient dosage and fluid requirements, but should not exceed 5000 mcg (5 mg)/mL.^{103 110 a b}

Dilution of Concentrate for Injection for IV Infusion103b

Amount of Concentrate	Add (volume of concentrate)	To Compatible IV Solution (volume of solution)	To Make (final dilution concentration)
250 mg	20 mL	1 L	250 mcg (0.25 mg)/mL
250 mg	20 mL	500 mL	500 mcg (0.5 mg)/mL
250 mg	20 mL	250 mL	1000 mcg (1 mg)/mL
250 mg	20 mL	50 mL	5000 mcg (5 mg)/mL

Rate of Administration

Avoid bolus administration.^b

Rate of IV infusion varies according to individual dose requirements titrated to response.^{103 107 110 a b}

Initiate at a slow rate (e.g., 0.5–1 mcg/kg per minute) and carefully adjust at intervals of a few minutes according to response;^b usually 2–20 mcg/kg per minute is needed.^{103 107 110 a b}

Intraosseous Administration

When IV administration is not possible, dobutamine may be given by intraosseous infusion† for emergency uses such as CPR.^{110 112}

Limit intraosseous administration to personnel well trained in the technique.¹⁰⁰

Place a cannula in a noncollapsible marrow venous plexus; such access often can be achieved in 30–60 seconds.¹⁰⁰ Use a rigid needle, preferably a specially designed intraosseous or Jamshidi-type bone marrow needle; a styleted needle is preferred to prevent obstruction of the needle with cortical bone.¹⁰⁰

Insert the intraosseous needle into the anterior tibial bone marrow; alternatively, the distal femur, medial malleolus, or anterior superior iliac spine can be used.¹⁰⁰ In older children and adults, intraosseous cannulas also have been inserted successfully into the distal radius or ulna in addition to the proximal tibia.¹⁰⁰

Successful placement outside the hospital (e.g., by emergency medical services) generally is more difficult in older than in younger children.¹⁰⁰

Onset of action and systemic concentrations are comparable to those achieved with intravascular administration.^{100 112}

Dilution

Same as those for IV infusion. (See Dilution under IV Infusion.)

Rate of Administration

Intraosseous infusion rates are the same as those for IV infusion.¹⁰⁰ (See Rate of Administration under IV Infusion.)

Administration Risks

Complications are uncommon (less than 1% of patients), and include tibial fracture, lower-extremity compartment syndrome, extravasation, and osteomyelitis; careful technique can minimize the risk.¹⁰⁰ Local effects on bone marrow and bone growth appear to be minimal.¹⁰⁰ Risk of microscopic pulmonary fat and bone marrow emboli does not appear to be increased.¹⁰⁰

Dosage

Available as dobutamine hydrochloride; dosage expressed in terms of dobutamine.^{103 107 a b}

Hemodynamic end points rather than a specific dose should be used to optimize therapy.^{110 112}

Individual response to dobutamine is variable, and infusion rate should be titrated to achieve the desired clinical response.^b

Rate and duration should be carefully adjusted according to patient response as indicated by heart rate, BP, urine flow, peripheral perfusion, presence of ectopic heartbeats, and, whenever possible, by measurement of central venous or pulmonary wedge pressure and cardiac output.^{103 107 a b}

Pediatric Patients

Pharmacokinetics and clinical responses to specific doses vary widely.¹¹⁰

Usually initiate slowly (e.g., 0.5–1 mcg/kg per minute).^b

Cardiac Decompensation and Shock

IV or Intraosseous†

Usually, 2–20 mcg/kg per minute is needed to increase cardiac output.^{110 b}

CPR

IV or Intraosseous†

Usually, 2–20 mcg/kg per minute is needed to increase cardiac output.^{110 112 b}

MI

IV or Intraosseous†

Usually, 2–20 mcg/kg per minute is needed to increase cardiac output.^{110 b}

Adults

Individual response to dobutamine is variable, and infusion rate should be titrated to achieve the desired clinical response.^{103 107 110 a b}

Initiate at a slow rate (e.g., 0.5–1 mcg/kg per minute) and carefully adjust at intervals of a few minutes according to response.^b

Dobutamine has been infused for up to 72 hours without decreased effectiveness.^b

Cardiac Decompensation and Shock

IV or Intraosseous†

Usually, 2–20 mcg/kg per minute is needed to increase cardiac output.^{112 b}

CPR

IV or Intraosseous†

Usually, 2–20 mcg/kg per minute is needed to increase cardiac output.^{112 b}

MI

IV or Intraosseous†

Usually, 2–20 mcg/kg per minute is needed to increase cardiac output.^{112 b}

Prescribing Limits

Pediatric Patients

IV or Intraosseous†

Dosages >20 mcg/kg per minute may produce tachycardia and ventricular ectopy and could induce or exacerbate myocardial ischemia.^{104 112}

Adults

IV or Intraosseous†

Dosages >20 mcg/kg per minute often increase heart rate by more than 10%, and such increases potentially could induce or exacerbate myocardial ischemia.^{104 112}

Rarely, dosages as great as 40 mcg/kg per minute,^{103 107 112} but these may substantially increase adverse effects, (e.g. ,tachycardia, hypotension) and usually should be avoided.^{104 112}

Special Populations

Hepatic Impairment

No specific hepatic dosage recommendations.^a

Renal Impairment

No specific renal dosage recommendations.^a

Geriatric Patients

Initiate therapy at lower end of usual range because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.¹⁰⁸ However, geriatric patients may exhibit a substantially decreased response.^{110 112}

Cautions for Dobutamine Hydrochloride

Contraindications

• 
  

  Idiopathic hypertropic subaortic stenosis.

  
  


• 
  

  Known hypersensitivity to dobutamine hydrochloride or any ingredient in the formulation.^{103 106 107 a b}

  
  


• 
  

  Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products.^{107 a}

  
  

Warnings/Precautions

Warnings

Cardiovascular Effects

Marked increases in heart rate and BP (especially systolic pressure) can occur.^{103 a b} Heart rate of ≥30 beats per minute or an increase in systolic BP of ≥50 mm Hg reported.^b

Cardiovascular effects are usually dose related, and dosage should be reduced or the infusion temporarily discontinued if such effects occur.^b

Patients with preexisting hypertension are at increased risk of an exaggerated pressor response.^{103 a b}

Patients with atrial fibrillation should be digitalized because of the risk of developing a rapid ventricular response.^{103 a b}

Ectopic Activity

Can precipitate or exacerbate ventricular ectopic activity; rarely, causes ventricular tachycardia.¹⁰³

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity, including skin rash, fever, eosinophilia, and bronchospasm, have been reported occasionally.^{103 107}

Sulfites

Some formulations contain sulfites, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.^{102 103 106 107 a b}

Corn

Dextrose-containing solutions may be contraindicated in patients who are sensitive to corn or corn products.^{107 a}

General Precautions

Hypovolemia

Hypovolemia should be corrected with an appropriate plasma volume expander before initiating dobutamine.^{103 107 a b}

MI

Clinical experience insufficient to rule out possibility of intensified or extended myocardial ischemia; use with extreme caution following MI.^{103 107 a b} (See MI under Uses.)

Cardiac Mechanical Obstruction

No benefit may be apparent in the presence of marked mechanical obstruction (e.g., severe valvular aortic stenosis).^{103 107 a}

Monitoring Parameters

Monitor ECG, BP and, when possible, cardiac output and pulmonary wedge pressure.^{103 107 a b}

May produce slight reductions in serum potassium concentrations and hypokalemia may occur rarely; monitor serum potassium concentrations.^b

Specific Populations

Pregnancy

Category B.^{103 a}

Lactation

Not known whether dobutamine is distributed into human milk.¹⁰³ Caution if used in nursing women.¹⁰³

Pediatric Use

May increase cardiac output and systemic pressure in pediatric patients of all age groups.^{103 107} Such increases generally are seen at lower infusion rates than those associated with substantial tachycardia.^{103 107}

Premature neonates: May be less effective in increasing systemic BP without causing undue tachycardia, and dobutamine has not been shown to provide any additional benefit when administered to such infants who are already receiving optimal dopamine therapy.^{103 107}

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults; some clinical experience showed no differences.^a

Use with caution since renal, hepatic, and cardiovascular dysfunction and concomitant disease or other drug therapy are more common in this age group.^{108 a} However, geriatric patients generally have a substantially reduced response to dobutamine.^{110 112}

Common Adverse Effects

Ectopic heartbeats, increased heart rate, elevations in BP, hypotension, phlebitis, local inflammatory changes.^{103 a b}

Interactions for Dobutamine Hydrochloride

No evidence of interactions in clinical studies when used with atropine, cardiac glycosides (digoxin), furosemide, heparin, lidocaine, morphine, nitrates, potassium chloride, or spironolactone.^{103 103 a}

Specific Drugs

Drug	Interaction	Comments
β-Adrenergic blocking agents	Cardiac effects of dobutamine are antagonized, resulting in predominant α-adrenergic effects and increased peripheral resistance; dobutamine may be ineffective103 a b	Use concomitantly with cautionb
Anesthetics, general (e.g., halogenated hydrocarbons [e.g., halothane], cyclopropane)	May increase cardiac irritability, resulting in ventricular arrhythmias with usual dobutamine dosesb	Use concomitantly with cautionb
Sodium nitroprusside	Potentiated effects on cardiac output and pulmonary wedge pressurea

Dobutamine Hydrochloride Pharmacokinetics

Absorption

Onset

Onset occurs within 2 minutes after initiation of IV infusion; peaks within 10 minutes.^b

Duration

Effects cease shortly after infusion discontinuance.^b

Distribution

Extent

Not known if dobutamine crosses the placenta^b or is distributed into milk.^{103 b}

Elimination

Metabolism

Metabolized in the liver and other tissues by catechol-O-methyltransferase (COMT) to an inactive compound, 3-O-methyldobutamine, and by conjugation with glucuronic acid.^b

Elimination Route

Conjugates of dobutamine and 3-O-methyldobutamine excreted mainly in urine and to a minor extent in feces.^b

Half-life

About 2 minutes.^{a b}

Stability

Storage

Parenteral

Pink discoloration indicates slight oxidation of the drug; however, there is no important loss of potency if administered within the recommended time period.^b

Store at 15–30°C.^b

Solutions of dobutamine hydrochloride in 5% dextrose should be protected from excessive heat or freezing and stored at room temperature (25°C); however, brief exposure of the solutions to temperatures up to 40°C does not adversely affect the products.¹⁰⁷

Solutions diluted for IV infusion should be used within 24 hours; unused portions should be discarded.^b

Concentrate for Injection for IV Infusion

15–30°C.^{103 b}

Injection for IV Infusion

25°C; may be exposed briefly to temperatures up to 40°C.^a Do not freeze.^a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Incompatible with strongly alkaline solutions.^{103 a b}

Should not be used in conjunction with other drugs or diluents containing both sodium bisulfite and ethanol.^{103 b}

Parenteral

Solution Compatibility^HID

Stable for 24 hours in dextrose 5 or 10%, dextrose 5% in sodium chloride 0.45 or 0.9%, dextrose 5% in lactated Ringer’s injection, Isolyte M with 5% dextrose, lactated Ringer's, Normosol-M with 5% dextrose, Osmitrol in water, sodium chloride 0.9%, and sodium lactate (1/6) M.¹⁰³

Compatible
Dextrose 2.5% in half-strength Ringer’s injection, lactated
Dextrose 5% in Ringer’s injection, lactated
Dextrose 2.5% in sodium chloride 0.45%
Dextrose 5% in sodium chloride 0.45 or 0.9%
Dextrose 5% in water
Ringer’s injection, lactated
Sodium chloride 0.45 or 0.9%
Incompatible
Sodium bicarbonate 5%

Drug Compatibility

Additives should not be introduced into the injection containers.^{a 107}

Since dobutamine dosage must be titrated according to response, other drugs generally should not be added to the infusion fluid.^c

Admixture CompatibilityHID

Compatible
Amiodarone HCl
Atracurium besylate
Atropine sulfate
Ciprofloxacin
Dopamine HCl
Enalaprilat
Epinephrine HCl
Flumazenil
Hydralazine HCl
Isoproterenol HCl
Lidocaine HCl
Meperidine HCl
Meropenem
Metaraminol bitartrate
Morphine sulfate
Nitroglycerin
Norepinephrine bitartrate
Phentolamine mesylate
Phenylephrine HCl
Procainamide HCl
Propranolol HCl
Ranitidine HCl
Zidovudine
Incompatible
Acyclovir sodium
Alteplase
Aminophylline
Bumetanide
Calcium gluconate
Diazepam
Digoxin
Furosemide
Magnesium sulfate
Phenytoin sodium
Potassium phosphates
Sodium bicarbonate
Variable
Bretylium tosylate
Calcium chloride
Heparin sodium
Nitroglycerin with sodium nitroprusside
Potassium chloride
Verapamil HCl

Y-Site CompatibilityHID

Compatible
Alcohol 10% in dextrose 5%
Amifostine
Amiodarone HCl
Argatroban
Atracurium besylate
Aztreonam
Bivalirudin
Bretylium tosylate
Calcium chloride
Calcium gluconate
Ciprofloxacin
Cladribine
Clarithromycin
Dexmedetomidine HCl
Diazepam
Diltiazem HCl
Docetaxel
Dopamine HCl
Dopamine HCl with lidocaine HCl
Dopamine HCl with nitroglycerin
Dopamine HCl with sodium nitroprusside
Doxorubicin HCl liposome injection
Enalaprilat
Epinephrine HCl
Etoposide phosphate
Famotidine
Fenoldopam mesylate
Fentanyl citrate
Fluconazole
Gemcitabine HCl
Granisetron HCl
Haloperidol lactate
Hetastarch in lactated electrolyte injection (Hextend)
Hydromorphone HCl
Inamrinone lactate
Insulin, regular (Humulin R)
Labetalol HCl
Levofloxacin
Lidocaine HCl
Lidocaine HCl with dopamine HCl
Lidocaine HCl with nitroglycerin
Lidocaine HCl with sodium nitroprusside
Linezolid
Lorazepam
Magnesium sulfate
Meperidine HCl
Milrinone lactate
Morphine sulfate
Nicardipine HCl
Nitroglycerin
Nitroglycerin with dopamine HCl
Nitroglycerin with lidocaine HCl
Nitroglycerin with sodium nitroprusside
Norepinephrine bitartrate
Oxaliplatin
Pancuronium bromide
Potassium chloride
Propofol
Ranitidine HCl
Remifentanil HCl
Sodium nitroprusside
Sodium nitroprusside with dopamine HCl
Sodium nitroprusside with lidocaine HCl
Sodium nitroprusside with nitroglycerin
Tacrolimus
Theophylline
Thiotepa
Tirofiban HCl
Vasopressin
Vecuronium bromide
Verapamil HCl
Zidovudine
Incompatible
Acyclovir sodium
Alteplase
Aminophylline
Amphotericin B cholesteryl sulfate complex
Cefepime HCl
Foscarnet sodium
Indomethacin sodium trihydrate
Lansoprazole
Pantoprazole sodium
Pemetrexed disodium
Phytonadione
Piperacillin sodium–tazobactam sodium
Thiopental sodium
Warfarin sodium
Variable
Cefepime HCI
Ceftazidime
Furosemide
Heparin sodium
Midazolam HCl

ActionsActions

• 
  

  The main effect of therapeutic doses is cardiac stimulation.^b

  
  


• 
  

  Principally a selective, direct stimulatory effect on β₁-adrenergic receptors, but the mechanisms of action are complex.^{100 101 110}

  
  


• 
  

  In therapeutic doses, also mild β₂- and α₁-adrenergic receptor agonist effects.^b

  
  


• 
  

  β₁-Adrenergic effects exert a potent positive inotropic effect, resulting in increased myocardial contractility and cardiac output.^{110 b}

  
  

  Increased left ventricular filling pressure decreases in CHF.^{b 110}

  
  


• 
  

  Therapeutic doses cause decreased peripheral resistance; however, systolic blood pressure and pulse pressure may remain unchanged or be increased because of augmented cardiac output.^b

  
  


• 
  

  Usual doses do not substantially change heart rate.^b

  
  


• 
  

  Coronary blood flow and myocardial oxygen consumption are usually increased because of increased myocardial contractility.^b

  
  


• 
  

  May facilitate AV conduction and shorten or cause no important change in intraventricular conduction.^b

  
  


• 
  

  Pulmonary vascular resistance may decrease if it is elevated initially and mean pulmonary artery pressure may decrease or remain unchanged.^b

  
  


• 
  

  Unlike dopamine, dobutamine does not seem to affect dopaminergic receptors and causes no renal or mesenteric vasodilation; however, urine flow may increase because of increased cardiac output.

  
  

Advice to Patients

• 
  

  Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.^{a b}

  
  


• 
  

  Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^a

  
  


• 
  

  Importance of informing patients of other important precautionary information.^{a b} (See Cautions.)

  
  

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dobutamine Hydrochloride

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	For injection concentrate, for IV infusion	12.5 mg (of dobutamine) per mL*	Dobutamine Hydrochloride for Injection (with sulfites)	Bedford, Hospira, Sicor
			Dobutrex Solution (with sodium bisulfite)	Lilly

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dobutamine Hydrochloride in Dextrose

Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Parenteral	Injection, for IV infusion	0.5 mg (of dobutamine) per mL (125 or 250 mg) in 5% Dextrose*	Dobutamine in 5% Dextrose Injection (with sulfites; Lifecare [Braun, Hospira])	Various Manufacturers
		1 mg (of dobutamine) per mL (250 or 500 mg) in 5% Dextrose*	Dobutamine in 5% Dextrose Injection (with sulfites; Lifecare [Hospira, McGaw]; Viaflex [Baxter])	Various Manufacturers
		2 mg (of dobutamine) per mL (500 mg) in 5% Dextrose*	Dobutamine in 5% Dextrose Injection (with sulfites; Lifecare [Hospira]; Viaflex [Baxter])	Various Manufacturers
		4 mg (of dobutamine) per mL (1000 mg) in 5% Dextrose*	Dobutamine in 5% Dextrose Injection (with sulfites; Lifecare [Hospira, Braun, McGaw]; Viaflex [Baxter])	Various Manufacturers

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions July 2009. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Leier CV, Unverferth DV. Dobutamine. Ann Intern Med. 1983; 99:490-6. [IDIS 176707] [PubMed 6625384]

101. Ruffolo RR Jr. The mechanism of action of dobutamine. Ann Intern Med. 1984; 100:313-4. [IDIS 181321] [PubMed 6140893]

102. Food and Drug Administration. Sulfiting agents; labeling in drugs for human use; warning statement: final rule [21 CFR Part 201]. Fed Regist. 1986; 51:43900-5.

103. Eli Lilly and Company. Dobutrex (dobutamine hydrochloride) solution prescribing information. Indianapolis, IN: 1999 Feb.

104. Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. JAMA. 1992; 268:2171-2302. [PubMed 1404767]

105. Robison-Strane SR, Bubik JS. Dobutamine-induced fever. Ann Pharmacother. 1992; 26:1523-4. [IDIS 306620] [PubMed 1482808]

106. Gensia Laboratories, Inc. Dobutamine hydrochloride injection prescribing information. Irvine, CA; 1993 Apr.

107. Abbott Laboratories. Dobutamine in 5% dextrose injection prescribing information. North Chicago, IL: 1998 Aug.

108. Food and Drug Administration. Dobutamine in 5% dextrose in flexible containers [September 1, 1999; Abbott]. MedWatch drug labeling changes. Rockville, MD; September 1999. From FDA website ().

109. Food and Drug Administration. Dobutamine in 5% dextrose in plastic container [April 21, 1999; Baxter]. MedWatch drug labeling changes. Rockville, MD; April 1999. From FDA website ().

110. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2000; 102(Suppl I) I-132,I-328.

111. Ryan TJ, Antman EM, Brooks NH et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation. 1999; 100:1016-30. [IDIS 437967] [PubMed 10468535]

112. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211.

pdh. Schilling McCann JA, Publisher. Pharmacists drug handbook. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins and American Society of Health-System Pharmacists; 2003.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:545-55.

a. Baxter Healthcare Corporation. Dobutamine hydrochloride in 5% injection prescribing information. Deerfield, IL; 2002 Jul.

b. AHFS drug information 2008. McEvoy GK, ed. Dobutamine. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1334-6

c. AHFS drug information 2008. McEvoy GK, ed. Dopamine. Bethesda, MD: American Society of Health-System Pharmacists; 2008:1336-9

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