How Dopamine Injection Uses in Emergency Conditions

Posted On February 24, 2023February 24, 2023

Introduction 

Everyone knows that dopamine is a happy hormone. But did you know that dopamine is also used as a lifesaving medicine? Today, we will learn about how dopamine injection uses in life-threatening situations. 

Suppose someone gets heart failure and is rushed to a hospital. You might have seen symptoms in such patients as rapid heartbeat, severe shortness of breath, sweating, chest pain, etc. 

These symptoms indicate congestive heart failure (CHF) that occurs most commonly due to ischemic heart disease. In CHF, your heart does not pump blood properly. Sometimes, it is called a Heart attack. 

Here, Dopamine injection is an inotropic agent that contracts your heart muscles effectively. 

This injection is one of the primary emergency drugs in emergency hospital areas to treat life-threatening medical conditions. 

So, the primary use of dopamine injection is to save patient life. That’s why it is also called Life Saving Drug. 

This post will describe dopamine injection uses, side effects, action, route and dose. 

Let’s get started.  

What is dopamine injection? 

Naturally, dopamine is an endogenous catecholamine neurohormone that is produced in our brains.  

It works as a chemical messenger that communicates information from the brain to various body parts by neurons. 

In 1910, Researchers found the effect of the dopamine hormone on other body parts such as the heart, kidney and blood vessels. 

Eventually, they made a synthetic version of dopamine injection. It was first introduced in the market with the brand name “Intropin.“

Dopamine belongs to a category of sympathomimetic drug or adrenergic drug. This drug contains a catechol ring, that’s why it comes in the catecholamine category. 

Dopamine is a potent agonist on dopaminergic receptors (D1 and D2 receptors). 

It also works on adrenergic receptors (Alpha 1 and Beta 1 receptors) that mimic the effect of the sympathomimetic nervous system. 

How does dopamine injection work?

If we talk about the mechanism of dopamine injection, it does not cross the blood-brain barrier (BBB), so it only works in periphery parts (which means all body parts except brain). 

Dopamine drug directly acts on dopaminergic and adrenergic receptors.

When a doctor injects dopamine into your body, it strongly binds on α1 (alpha 1) and β1 (beta 1) adrenergic receptors to release noradrenaline and adrenaline. 

Alpha 1 is mainly present in the blood vessels, and beta 1 is in our heart muscles.  

Moreover, dopamine injection also works on a dopaminergic receptor that is present on our kidneys. 

The significant therapeutic action of dopamine injection is – 

• Vasoconstrictor means to increase the blood flow due to stimulation of alpha 1 adrenergic receptor
• Cardiac stimulant means to increase the heart pumping due to stimulation of beta 1 adrenergic receptor
• Nephroprotective means increasing the renal blood flow due to stimulation of the D1 receptor

When is dopamine injection used?

Dopamine injection is a drug of choice in congestive heart failure, septic shock and cardiogenic shock with renal failure. 

Let’s understand in detail – 

Dopamine injection uses for congestive heart failure

Congestive heart failure (CHF) is a medical emergency that usually happens without warning. 

If your heart stops beating or cannot pump properly, this condition is called congestive heart failure. 

In this condition, dopamine is a drug of choice because it is a potent inotropic agent that contracts your heart muscles more forcefully by stimulating the beta 1 receptor. 

Due to its inotropic action, it increases stroke volume and cardiac perfusion.

Dopamine injection also acts as a chronotropic agent. This means it helps to increase your heart rate by SA node. As result, the heart starts to beat again. 

This increased heart rate and stroke volume parameters, eventually increasing cardiac output. 

CO = HR x SV

The other alternative option for CHF is dobutamine injection. Dobutamine is also a cardiac selective drug that only works on β1 receptor. 

Dopamine injection uses for septic shock

When your blood pressure dangerously drops due to exposure to bacterial infection. This condition is called Septic shock.

Septic shock is a lethal medical condition that causes very low blood pressure. It may also cause multiple organ failure and death. 

In this septic shock condition, dopamine is again a drug of choice because it also acts as a pressor agent. 

Pressor agents are those agents that increase your blood pressure. 

Here, dopamine works on the alpha-1 receptor in our blood vessels. After administering dopamine injection, it contracts your blood vessels and increases blood pressure effectively. 

Dopamine injection uses for cardiogenic shocks with renal failure

Cardiogenic shock is basically a clinical feature of CHF. 

Suppose someone has heart failure with kidney dysfunction. In this condition, a person may have decreased cardiac output with reduced urine output. 

Here, dopamine injection is also a drug of choice and preferable if someone has cardiogenic with oliguria (decreased urine output).

As we discussed, dopamine works on adrenergic and dopaminergic receptors. So, it also works on your kidney, where D1 and β1 receptors are present. 

When a doctor injects dopamine into your body, it increases the renal blood flow and GFR (glomerular filtration rate), which increases urine output. On the heart side, it increases cardiac output. 

So, dopamine has a cardioprotective and nephroprotective properties. 

How does dopamine move through the body? 

It is always interesting to know the journey of a drug in the human body.

Let’s learn the important pharmacokinetic parameter of dopamine injection.

As we discussed earlier, Dopamine drug comes in the sympathomimetic catecholamine category. You can’t take catecholamine orally because these medicines get destroyed by digestive enzymes. 

Dopamine injection may be given to you only intravenous (i.v.) administration in an emergency.  

After i.v administration of dopamine, it starts working within 5 mins (onset of action). 

The health care provider needs to give a continuous infusion of dopamine injection because its half-life is very short around 1 to 5 minutes.

The 80% dopamine drug excretes from the urine within 24 hours. 

How is dopamine injection given?

Dopamine injection is always injected into a vein through an intravenous (i.v.) route of administration.  This injection must be diluted in a sterile parenteral preparation such as 5% dextrose, normal saline etc.  

The dopamine injection is available in the market in different strengths, such as dopamine hydrochloride injection 40 mg/ml, 80 mg/ml and 160 mg/ml. 

The starting infusion rate of dopamine injection is 2-5 mcg/kg/min. It means dopamine hydrochloride delivers 2 to 5 mcg in your blood every minute. 

The infusion rate of dopamine can be gradually increased in more serious patients. It can be given 5 to 10 mcg/kg/min and go up to a rate of 20 to 50 mcg/kg/min as needed. 

Health care provider needs to be cautious while handling dopamine injection.

Dopamine injection should not be added with sodium bicarbonate or alkalinizing substance because dopamine gets inactivated in an alkaline solution. 

What is the action of dopamine based on doses?

The dose of dopamine is always a concern while you are receiving dopamine injections.

Because the effect of dopamine injection is changed at different doses. 

Let me explain in a nutshell. 

Dopamine at a low dose 

If you receive dopamine injections at a low dose (2-5 mcg/kg/min), it will give you a better effect on the kidney and a mild effect on your heart.

Of course, it would be better if someone has an oliguria and struggling with cardiogenic shock.

Dopamine at a moderate dose 

The effect of dopamine will be changed if it slightly increases in dopamine dose. 

So, a moderate dose of dopamine (5 to 10 mcg/kg/min) may have a positive inotropic effect on your heart by directly acting on the Beta 1 adrenergic effect. 

It will be an appropriate dose if someone has acute congestive heart failure.  

Dopamine at a high dose

The high dose of dopamine injection (more than 10 mcg/kg/min) may give a vasoconstrictive effect by directly acting on alpha 1 adrenergic effect.  

This high dose of dopamine is beneficial if you get a septic shock. 

What are the possible side effects of dopamine injection?

If you receive dopamine injections, your vital organs will be closely monitored, such as your breathing, heart rate, blood pressure, blood sugar level, oxygen levels, kidney function, etc. 

Dopamine injection has the potential to cause unwanted effects or side effects. 

The following general side effects can be noticed after receiving this medication such as – 

• Restlessness
• Anxiety 
• Dizziness 
• Headache 
• Palpitation 

This medicine also has the potential to cause some severe side effects, such as –

• Hypertension and hypertensive crisis
• Cardiac arrhythmias – ventricular arrhythmias, tachyarrhythmia 
• Stroke 
• Hyperglycaemia (Increased blood glucose)
• Tissue necrosis and sloughing (if a dopamine injection given IV leaks into the surrounding tissue).

Tell your doctor immediately if you experience any of these severe symptoms. 

You may also be given a phentolamine injection to prevent local tissue necrosis from dopamine injection.  

What other drugs will affect dopamine?

Dopamine injection can interact with other drugs.

There are two critical situations where a doctor needs to give more attention while giving dopamine injections to a patient. 

Situation 1 – dopamine injection with phentolamine

Suppose a doctor gives you a phentolamine injection to counter dopamine’s tissue necrosis side effects.

In this condition, you may have a hypotension problem because phentolamine is an antiadrenergic alpha-blocker that decreases rising blood pressure. 

Situation 2 – dopamine injection with MAO inhibitors 

Dopamine drug also has an important concern with MAO inhibitors drugs (such as selegiline, phenelzine, and tranylcypromine) or other antidepressant drugs. 

Generally, dopamine is metabolized by MAO (Monoamine oxidase) enzyme.

If someone is already taking MAO inhibitors medicines and receiving dopamine injections. In that case, there is a chance of dopamine toxicity. 

The person will be experienced severe tachycardia and hypertension. 

Who should avoid dopamine injections? 

Dopamine injection is contraindicated in certain medical conditions. So, you must tell your doctor about your medical history before receiving a dopamine injection. 

1. Avoid dopamine injection in diabetic condition

Suppose someone has a diabetic history and that person receives a dopamine injection. In that case, a doctor needs to increase the insulin or other antidiabetic drugs dose because dopamine injection increases blood sugar levels. 

2. Avoid dopamine injection in pheochromocytoma condition

Pheochromocytoma is a tumour where chromaffin cells of the adrenal gland make a cluster. 

This cluster of chromaffin cells releases a massive amount of noradrenaline and adrenaline that produce severe hypertension. 

If you receive dopamine injection in this condition, it will increase immense blood pressure, which may be fatal.  

3. Avoid dopamine injection in tachyarrhythmia condition

Dopamine drug is a cardiac stimulant that increases heart rate. So, you should tell your doctor if you already have a rapid heart rate problem before receiving a dopamine injection. 

Conclusion 

We have seen how dopamine injection uses in critical conditions. 

Dopamine injection is only prescribed by an expert doctor. You may have been given dopamine injections in emergencies such as congestive heart failure, septic shock, and cardiogenic shock with oliguria. 

It is generally used in different units of hospitals, such as the emergency department, ICU, critical care unit, cardiac unit, etc. It can also be found in an ambulance. 

This is only an informative article. 

Being a pharmacist, I have mentioned all the important points about dopamine injection. 

For more information, you must consult your doctor. 

If you found this post informative, please share it on social media.

FAQ

Q 1. What type of drug is dopamine?

Dopamine is a prescription medicine that is used in emergencies such as heart attack, very low blood pressure, etc. 

Q 2. Does dopamine increase BP?

Yes. Since dopamine injection has a vasoconstrictive effect by binding on alpha 1 adrenergic receptor. So, it effectively increases your blood pressure. 

 Q 3. Can I use dopamine injection during pregnancy?

In animal studies of dopamine injection, no teratogenic risk was found. While there is a lack of safety data on dopamine injection in human beings. Therefore, dopamine injection can be used in pregnancy if the benefit outweighs the risk. 

Q 4. Can I consume alcohol if I have used dopamine injection?

Although alcohol itself increases the dopamine level in our brain. There is no data about alcohol and dopamine injection interaction. Since dopamine injection is used in an emergency, you must have had a life-threatening condition. It is better to ask your doctor if you have a habit of regular drinking. 

References – 

1. KD Tripathi. Essentials of Medical Pharmacology, 7^th Jaypee Brothers Medical Publishers (P) Ltd; 2013. Drugs acting on autonomic nervous system (Section 2): Adrenergic System and Drugs, Chapter-9; Page – 124 to 139.

2. Lippincott Williams & Wilkins. Nursing Pharmacology: Made incredibly easy, 3^rd Wolters kluwer health; 2013. Autonomic nervous system drugs, chapter – 2; Page – 40 to 46.

3. Dopamine hydrochloride and 5% dextrose injection USP. FDA; Hospira 2004, Reference ID: 3506755.

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