Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock. Its primary mechanism is direct stimulation of ?1 receptors of the sympathetic nervous system. Dobutamine was developed in the 1970s by Drs. Ronald Tuttle and Jack Mills at Eli Lilly and Company, as a structural analogue of isoprenaline.
Video Dobutamine
Clinical uses
Dobutamine is used to treat acute but potentially reversible heart failure, such as which occurs during cardiac surgery or in cases of septic or cardiogenic shock, on the basis of its positive inotropic action.
Dobutamine can be used in cases of congestive heart failure to increase cardiac output. It is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiac decompensation due to depressed contractility, which could be the result of either organic heart disease or cardiac surgical procedures. It is not useful in ischemic heart disease because it increases heart rate and thus increases myocardial oxygen demand.
The drug is also commonly used in the hospital setting as a pharmacologic stress testing agent to identify coronary artery disease.
Maps Dobutamine
Adverse effects
Primary side effects include those commonly seen for ?1 active sympathomimetics, such as hypertension, angina, arrhythmia, and tachycardia. Used with caution in atrial fibrillation as it has the effect of increasing the atrioventricular (AV) conduction.
The most dangerous side effect of dobutamine is increased risk of arrhythmia, including fatal arrhythmias.
Pharmacology
Dobutamine is a direct-acting agent whose primary activity results from stimulation of the ?1-adrenoceptors of the heart, increasing contractility and cardiac output. Since it does not act on dopamine receptors to induce the release of norepinephrine (another ?1 agonist), dobutamine is less prone to induce hypertension than is dopamine.
Dobutamine is predominantly a ?1-adrenergic agonist, with weak ?2 activity, and ?1 selective activity, although it is used clinically in cases of cardiogenic shock for its ?1 inotropic effect in increasing heart contractility and cardiac output. Dobutamine is administered as a racemic mixture consisting of both (+) and (-) isomers; the (+) isomer is a potent ?1 agonist and ?1 antagonist, while the (-) isomer is an ?1 agonist. The administration of the racemate results in the overall ?1 agonism responsible for its activity. (+)-Dobutamine also has mild ?2 agonist activity, which makes it useful as a vasodilator.
See also
- Adenosine
- Arbutamine
- Ractopamine (a dobutamine regioisomer)
References
Source of article : Wikipedia
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