Vasopressor · Inotrope · Catecholamine
Dopamine
Indications
- Symptomatic bradycardia when atropine fails, as a bridge to pacing (AHA; off-label)
- Distributive or cardiogenic shock (label), now second line: norepinephrine is preferred (SOAP II)
- Septic shock only when norepinephrine is unavailable or in selected bradycardic patients with low arrhythmia risk
- Pediatric septic shock when epinephrine and norepinephrine are unavailable (PALS 2025)
Dosing
Dopamine drip card and mL/h converterStart: 2–5 mcg/kg/min; symptomatic bradycardia 5–20
| Where | Dose |
|---|---|
| Rhythm control | Dopamine infusion: 5–20 mcg/kg/min |
On the quick cards
Mechanism of action
Dopamine is the endogenous precursor of norepinephrine and acts on D1, β1 and α1 receptors in a dose-dependent order. D1 receptors couple to Gs and dilate renal, mesenteric and coronary arterioles; β1 receptors (Gs, cAMP) raise contractility and rate; α1 receptors (Gq, IP3, calcium) constrict vessels. Part of the effect is indirect: dopamine enters sympathetic nerve terminals and releases stored norepinephrine, and about a quarter of a dose is converted to norepinephrine.
Pharmacology
- Cardiovascular, under 5 mcg/kg/min: D1 renal and splanchnic vasodilation
- Cardiovascular, 5–10 mcg/kg/min: β1 raises contractility, heart rate and output; above 10, α1 vasoconstriction raises SVR; the bands overlap widely between patients
- Cardiovascular: more tachyarrhythmias than norepinephrine, especially AF (SOAP II: 24% vs 12%)
- Renal: D1 natriuresis and more urine, but no kidney protection (ANZICS 2000)
- Respiratory: blunts the carotid body response to hypoxemia (D2)
- GI: nausea and vomiting (the chemoreceptor trigger zone lies outside the blood–brain barrier)
- Other: pituitary D2 action suppresses prolactin, TSH and growth hormone, which can confuse thyroid tests
Pharmacokinetics
| Onset | Within 5 min IV (label) |
|---|---|
| Duration | Under about 10 min after stopping (label) |
| Half-life | Under 2 min in adults; 5–11 min in neonates (label) |
| Distribution | Hydrophilic; does not cross the blood–brain barrier |
| Metabolism | 75% by MAO and COMT to inactive DOPAC and HVA; 25% converted to norepinephrine in nerve terminals (label) |
| Elimination | Urine, about 80% within 24 h as metabolites (label) |
Chemistry
- 3,4-dihydroxyphenethylamine: a catechol ring and primary amine but no β-hydroxyl, so it has no chiral center and no isomers
- Natural catecholamine made from L-DOPA; dopamine β-hydroxylase adds the β-hydroxyl that makes norepinephrine
- Amine pKa about 8.9 (PubChem): ionized at pH 7.4, so it stays out of the brain (levodopa crosses by carrier transport)
- Premixed 1,600 or 3,200 mcg/mL in D5W with sodium metabisulfite, pH 2.5–4.5 (label)
- Inactivated in alkaline solutions such as sodium bicarbonate (label); discard if darker than slightly yellow
Adverse effects and cautions
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Dopamine: DA <5, β1 5–10, α1 >10 mcg/kg/min: ↑ / ↑ / ↑ at high dose
- Shock Types at a GlanceCardiogenic shock: LV, RV, SCAI and MCS escalation: Norepinephrine first (SOAP II); avoid dopamine and use epinephrine cautiously (OptimaCC: refractory shock 37% vs 7% with norepinephrine).
- Temporary PacingTranscutaneous pacing (TCP): Dopamine: 5 to 20 mcg/kg/min
- Toxins, Stings and Anaphylaxis in the FieldHidden or delayed drug toxicity: Disulfiram plus alcohol: Flushing, headache, vomiting, shock: Fluids, then norepinephrine (dopamine may fail)
- ACLS Algorithms in BriefBradycardia with a pulse: If atropine fails: transcutaneous pacing and/or dopamine 5–20 mcg/kg/min or epinephrine 2–10 mcg/min
- Pediatric Assessment and EmergenciesShock, fluids and sepsis (Phoenix 2024): For fluid-refractory septic shock start epinephrine or norepinephrine (PALS 2025, 2a), peripherally until central access is in (SSC); dopamine only if neither is available. Stress-dose hydrocortisone may be considered once vasoactives are needed (2b) and is given early for known adrenal insufficiency. Check glucose and ionized calcium.
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Sources
- FDA label: dopamine in dextrose (2025)
- SOAP II (De Backer, NEJM 2010)
- ANZICS (Bellomo, Lancet 2000)
- PubChem: dopamine
For education and exam preparation only. Follow your institution’s protocols. Typical adult values for study. Follow your local protocols and medical direction.