Clinical Pharmacology Of Dobutamine In Infants And Children

Dobutamine resembles dopamine structurally but possess a bulky aromatic substituent on the amino group. The pharmacological effects of dobutamine are due to direct interaction with α and β receptors. Dobutamine possess a centre of asymmetry, the (-) isomer of dobutamine is a potent α1 agonist and can cause marked pressor response. In contrast, (+) dobutamine is a potent α1 receptor antagonist which can block the effect of (-) dobutamine. Both isomers are full agonist at β receptors; the (+) isomer is a more potent β agonist than the (-) isomer by about 10-fold. Dobutamine is indicated for the short-term treatment of cardiac decompensation that may occur after cardiac surgery and dobutamine is used in the treatment of hypotension especially if related to myocardial dysfunction. Dobutamine is administered by continuous intravenous infusion and the initial dose is 5 µg/kg per min in infants and children. Some authors stated that dopamine is more effective than dobutamine in increasing blood pressure whereas other authors observed that dobutamine and dopamine produce similar pressure response. Dobutamine is methylated and is also conjugated with glucuronic acid. The elimination half-life of dobutamine is 25.6 min in infants and children but it ranges in a wide interval. The treatment of infants and children with dobutamine has been extensively studied and some authors observed that dobutamine increase the blood pressure and decreases vascular resistance. The aim of this study is to review the dobutamine dosing, effects, metabolism, pharmacokinetics, and treatment.