DOPMYN

Active material: Dopamine
When ATH: C01CA04
CCF: Dopaminomimetic and drug adrenomimeticheskoe
ICD-10 codes (testimony): I50, N17, R57, R57.0, T79.4, T81.1
When CSF: 01.07.03
Manufacturer: ORION CORPORATION (Finland)

Pharmaceutical form, composition and packaging

5 ml – ampoule (5) – contoured plastic packaging (1) – packs cardboard.

DESCRIPTION OF ACTIVE SUBSTANCES.

Pharmacological action

Cardiac and hypertensive agent. Dopamine receptor agonist, It is their endogenous ligand.

At low doses, (0.5-3 ug / kg / min) It acts primarily on dopamine receptors, causing the expansion of the renal, mesenteric, coronary and cerebral vessels. Due to the specific effect on peripheral dopamine receptors reduces renal vascular resistance, It increases the blood flow in them, and glomerular filtration, excretion of sodium and diuresis; It comes the expansion of mesenteric vessels (This action of dopamine on renal and mesenteric vessels different from that of other catecholamines).

In low and medium doses (2-10 ug / kg / min) It stimulates postsynaptic beta₁-adrenoreceptory, It is causing positive inotropic effects and increase cardiac output. Systolic blood pressure and pulse pressure may increase; while diastolic blood pressure is not changed or slightly increased. PR does not usually change. Coronary blood flow and myocardial oxygen consumption, usually, increasing.

In high doses (10 ug / kg / min or more) α stimulation prevails₁-adrenoreceptorov, causing an increase in systemic vascular resistance, Heart rate and renal vasoconstriction (The latter can reduce the previously increased renal blood flow and urine output). Due to the increase of cardiac output and peripheral vascular resistance increases as the systolic, and diastolic blood pressure.

Starting therapeutic effect – during 5 minutes on the background I / O administration and lasts for 10 m.

Pharmacokinetics

After the on / in the widely distributed in the body, partially penetrate the BBB. About 25% dose captured neurosecretory vesicles, where the hydroxylation and formed norepinephrine. It is metabolized in the liver, kidney and T_1/2 plasma – about 2 m, of body – about 9 m. Report the news: about 80% during 24 no; mainly as metabolites, a small fraction of the dose is excreted unchanged in.

Testimony

The shock of different genesis (cardiogenic, postoperative, infectious-toxic, anaphylactic, hypovolemic / only after the restoration of BCC /). Acute heart failure of various genesis, low cardiac output syndrome in cardiac surgical patients, hypotension, to enhance diuresis in case of poisoning.

Dosage regimen

Set individually, depending on the severity of the shock, BP values ​​and the patient's response to the introduction of dopamine. In order to enhance the contractility of the myocardium and increase diuresis administered / drip 100-250 mcg / min. If necessary, effects on blood pressure, increase the dose to 300-500-700 mcg / min.

Babies are administered in a dose of 4-6 ug / kg / min.

Duration of dopamine may be up to 28 days.

The maximum dose: at / in the drip adults – 1500 mcg / min.

Side effect

Cardio-vascular system: tachycardia or bradycardia, chest pain, increased or decreased blood pressure, conduction disorders, extension of the QRS complex, vasospasm, increasing end-diastolic pressure in the left ventricle; when used in high doses – ventricular or supraventricular arrhythmia.

From the digestive system: nausea, vomiting, bleeding from the gastrointestinal tract.

From the central and peripheral nervous system: more often – headache; less frequently – anxiety, restlessness, tremor of the fingers.

Metabolism: polyuria.

Allergic reactions: in patients with bronchial asthma – bronchospasm, shock

Local reactions: in contact with the skin of dopamine – skin necrosis, subcutaneous tissue.

Other: less frequently – breathlessness, azotemia, piloэrektsiya, rarely – polyuria (when administered at low doses).

Contraindications

Gipertroficheskaya obstruktivnaya cardiomyopathy, pheochromocytoma, ventricular fibrillation, increased sensitivity to dopamine.

Pregnancy and lactation

During pregnancy and lactation (breast-feeding) dopamine is used only in cases, when the intended benefits to the mother outweighs the potential risk to the fetus or child.

Cautions

C Caution should be used when hypovolemia, myocardial infarction, cardiac arrhythmias (taxiaritmii, ventricular arrhythmias, Atrial fibrillation), metabolic acidosis, giperkapnii, hypoxia, hypertension in the pulmonary circulation, thyrotoxicosis, angle-closure glaucoma, prostatic hyperplasia, occlusive vascular diseases (incl. atherosclerosis, thromboembolism, thromboangiitis obliterans, occlusive disease, diabetic endarteritis, Raynaud's disease, freezing injury), for patients with diabetes, asthma (if you have a history of hypersensitivity to disulfite), pregnancy, Lactation, in children and adolescents under the age of 18 years.

In the presence of hypovolemia should be compensated before administration of dopamine.

Introduction of dopamine should be done under the control of heart rate, FROM, ECG, the magnitude of diuresis; it is also recommended to control the stroke volume of the heart, ventricular filling pressure, central venous pressure, pulmonary artery pressure. Decrease in urine output indicates the need for dose reduction.

Against the background of the use of MAO inhibitors, dopamine dose should be reduced 10 time.

Drug Interactions

In an application with enhanced diuretic diuretic effect of dopamine.

With simultaneous use of MAO inhibitors (incl. furazolidona, procarbazine, selegiline), guanetidina may increase the intensity and duration cardio and pressor effects of dopamine.

Introduction of dopamine in patients receiving tricyclic antidepressants (including maprotilin) It leads to strengthening of its effects (may develop tachycardia, Arrhythmia, severe hypertension).

In an application with enhanced oktadin sympathomimetic effects.

There are reports about the development of severe arterial hypotension, while the use of dopamine with phenytoin.

In an application with igalyatsionnymi funds for general anesthesia, derivatives of hydrocarbons (incl. with cyclopropane, xloroformom, enfluranom, halothane, isoflurane, metoksifluranom) It increases the risk of serious heart rhythm disturbances.

Other sympathomimetic, and cocaine increase cardiotoxicity.

Derivative butirofenona, Beta-blockers reduce the effect of dopamine.

Dopamine reduces hypotensive effect guanadrel, guanethidine, methyldopa, Rauwolfia alkaloids (last prolong the effect of dopamine).

In an application with levodopa – increased risk of arrhythmias.

While the use of thyroid hormones – may increase the action as dopamine, and thyroid hormones.

Ergometrine, ergotamin, methylergometrine, Oxytocin increases the vasoconstrictor effect and the risk of ischemia and gangrene, and severe hypertension, until intracranial hemorrhage.

In an application with cardiac glycosides may increase the risk of heart rhythm disorders, additive positive inotropic effect.

Reduces antianginal effect of nitrates, which in turn may reduce the pressor effect sympathomimetic and increase the risk of hypotension.

Pharmaceutically compatible with alkaline solutions (inaktiviruyut dopamine), okislitelyami, iron salts, tiaminom (It contributes to the destruction of vitamin B₁).