Dobutel Special Precautions

During treatment with Dobutel, ECG and blood pressure should be monitored continuously. In addition, cardiac filling pressure and output should be monitored whenever possible. Hypovolemia should always be corrected before instituting Dobutamine therapy. Dobutamine, like any catecholamine, may provoke chest pain in patients with coronary heart disease. Therefore, the dosage should be carefully considered. Care should also be taken after acute myocardial infarction, excessive inotropism and tachycardia should be avoided as these may increase myocardial oxygen consumption and consequently, infarct size.
Dobutamine usually causes a slight increase in systolic blood pressure (10-20 mmHg) and heart rate (5-10 beats/min). Unusually high blood pressure increases have been reported especially in patients with arterial hypertension. Sometimes, excessive tachycardia may occur. Discontinuation of infusion or reduction of infusion rate usually normalizes the situation rapidly.
Dobutamine increases atrioventricular conduction. Therefore, care should be taken when determining the dosage for patients with atrial fibrillation. These patients should preferably be digitalized before dobutamine therapy is instituted. Dobutamine may provoke ventricular ectopic activity.
Hypersensitivity: Reactions suggestive of hypersensitivity associated with administration of Dobutel injection, including skin rash, fever, eosinophilia and bronchospasm, have been reported occasionally.
Dobutel injection contains sodium bisulfite, a sulfite that may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes, in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown and probably low. Sulfite sensitivity is seen more frequently in asthmatic than in non-asthmatic people.
Use in Pregnancy: As dobutamine injection has not been administered to pregnant women, the physician should, in each case, weigh the benefits against the potential risks.
Use in Lactation: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when dobutamine is administered to a nursing woman. If the mother requires dobutamine treatment, breastfeeding should be discontinued for the duration of the treatment.
Use in Children: Special attention should be paid to the monitoring of immediate haemodynamic effects, as these may differ both in quality and strength from those occurring in adults. Heart rate and blood pressure may increase more commonly and strongly in children. In contrast to adults, an increase in pulmonary wedge pressure may occur especially in infants under 1 year of age.