Side Effects of Dobutamine Injection

Dobutamine is a synthetic catecholamine used to help increase cardiac output in a failing heart due to heart disease or cardiac surgery. 

It is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of adults with cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures. 

Common side effects of dobutamine include

• increased heart rate,
• increased blood pressure,
• irregular ventricular beats,
• chest pain,
• fever,
• headache,
• nausea, and
• shortness of breath.

Serious side effects of dobutamine include

• abnormal heartbeats,
• low blood pressure,
• chest pain,
• fainting, and
• eosinophilic myocarditis.

Drug interactions of dobutamine include other agents that increase heart rate or blood pressure (sympathomimetics), such as

• atomoxetine,
• dopamine, and
• epinephrine.

Use lower doses of dobutamine initially if the patient is also on linezolid as there is a risk of a significant increase in blood pressure. Calcium salts may decrease the effect of dobutamine, so monitor closely. 

Available evidence suggests dobutamine may be safely used in pregnancy. Dobutamine should be used cautiously by breastfeeding mothers as it is unknown whether it is excreted in breast milk. 

The most frequent adverse reactions include

• increased heart rate,
• increased blood pressure,
• irregular ventricular beats, and
• chest pain.

Other important side effects include

• fever,
• headache,
• nausea, and
• shortness of breath.

Serious side effects of dobutamine include

• abnormal heart beats,
• increased heart rate,
• low blood pressure,
• chest pain,
• fainting , and
• eosinophilic myocarditis.

Increased Heart Rate, Blood Pressure, And Ventricular Ectopic Activity

• A 10- to 20-mm increase in systolic blood pressure and an increase in heart rate of 5 to 15 beats/minute have been noted in most patients.
• Approximately 5% of patients have had increased premature ventricular beats during infusions. These effects are dose related.

Hypotension

• Precipitous decreases in blood pressure have occasionally been described in association with dobutamine therapy.
• Decreasing the dose or discontinuing the infusion typically results in rapid return of blood pressure to baseline values.
• In rare cases, however, intervention may be required and reversibility may not be immediate.

Reactions At Sites Of Intravenous Infusion

• Phlebitis has occasionally been reported. Local inflammatory changes have been described following inadvertent infiltration.
• Isolated cases of cutaneous necrosis (destruction of skin tissue) have been reported.

Miscellaneous Uncommon Effects

The following adverse effects have been reported in 1% to 3% of patients:

• nausea,
• headache,
• anginal pain,
• nonspecific chest pain,
• palpitations, and
• shortness of breath.

Isolated cases of thrombocytopenia have been reported.

Administration of dobutamine, like other catecholamines, can produce a mild reduction in serum potassium concentration, rarely to hypokalemic levels.

Longer-Term Safety

Infusions of up to 72 hours have revealed no adverse effects other than those seen with shorter infusions.

Animal studies indicate that dobutamine may be ineffective if the patient has recently received a beta-blocking drug. In such a case, the peripheral vascular resistance may increase.

Preliminary studies indicate that the concomitant use of dobutamine and nitroprusside results in a higher cardiac output and, usually, a lower pulmonary wedge pressure than when either drug is used alone.

There was no evidence of drug interactions in clinical studies in which dobutamine was administered concurrently with other drugs, including

• digitalis preparations,
• furosemide,
• spironolactone,
• lidocaine,
• nitroglycerin,
• isosorbide dinitrate,
• morphine,
• atropine,
• heparin,
• protamine,
• potassium chloride,
• folic acid, and
• acetaminophen.