Pharmacology

Dobutamine

Dobutamine (Dobutrex) is a synthetic adrenergic agonist structurally similar to isoproterenol working on the same receptor profile – primarily beta 1 and beta 2 – to create the net effect of increased chronotropy (heart rate), inotropy (contractility) and vasodilation (decreased afterload). With these hemodynamic goals, dobutamine aims to increase forward blood flow. It’s also a much cheaper alternative to isoproterenol!

As an anesthesiologist, I most often use dobutamine during heart transplant cases as these patients tend to have some combination of right heart dysfunction and initially decreased compliance which makes cardiac output more dependent on the heart rate. The denervated donor heart does not receive vagal tone which modulates several aspects of cardiac function, so I need to use direct acting agents like dobutamine and epinephrine to achieve my goals.

As an intensivist, I usually stick with epinephrine for many of the aforementioned hemodynamic goals, but a handful of times have transitioned patients to dobutamine to diagnose and treat the lactic acidosis that can be generated from epinephrine infusions. That being said, there’s no evidence supporting dobutamine as a first line agent over alternative vasoactives in any clinical situation I’m aware of.

Drop me a comment below with questions! 🙂

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Rishi

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