Pharmacology · Vasopressors and inotropes
Dobutamine !
An intravenous inotrope that strengthens the heartbeat in cardiogenic shock and decompensated heart failure, with little rise in blood pressure.
Updated 2026-11-01
The figure shows dobutamine bound to the turkey beta-1 adrenergic receptor in complex with a Gs protein; the human receptor has the same binding pocket for catecholamines.
Mechanism of action
Dobutamine is a synthetic catecholamine, a racemic mixture whose isomers act on beta-1, beta-2 and alpha-1 receptors. The net effect is mainly beta-1 stimulation of the heart: more cAMP and calcium entry, stronger contraction and higher cardiac output. Alpha-1 constriction and beta-2 dilation largely cancel out, so resistance changes little.
- Dobutamine stimulates cardiac beta-1 receptors
- Gs raises cAMP and calcium entry into myocytes
- Contractility and cardiac output rise
- Vascular alpha and beta-2 effects largely cancel out
Pharmacokinetics
- Metabolism
- Methylation of the catechol and conjugation
- Half-life
- About 2 minutes (label): the effect ends soon after stopping
- Onset and duration
- Within minutes of starting the infusion
Indications
- Short-term inotropic support in cardiac decompensation from depressed contractility (heart failure, cardiogenic shock) Heart failure →
- Pharmacological stress echocardiography
Adverse effects
Common
- Rise in heart rate and blood pressure
- Ventricular ectopic beats
- Palpitations, angina and chest pain
- Nausea, headache and shortness of breath
- Mild fall in serum potassium
Contraindications
- Hypertrophic obstructive cardiomyopathy (idiopathic hypertrophic subaortic stenosis)
- Prior hypersensitivity to dobutamine
Key interactions
- Beta blockers
- Dobutamine may be ineffective after recent beta blockade
- Sodium bicarbonate or other alkaline solutions
- Physical incompatibility in the same line
What is monitored
- Continuous ECG and blood pressure
- Heart rate and signs of ischaemia
- Serum potassium
- Urine output and signs of improved perfusion
Administration and safety
- Intravenous infusion only, after dilution, by pump; a central line is preferred for long infusions.
- Do not mix with sodium bicarbonate or other alkaline solutions, and avoid mixing with other drugs in the same bag.
- Dobutamine and dopamine have look-alike names: read the label twice.
- Inspect the solution for particles and discolouration before use.
Nursing care
- Before: check volume status; dobutamine does not replace correcting hypovolaemia.
- During: ECG, heart rate and blood pressure continuously; report new arrhythmias, chest pain or a sharp rise in heart rate.
- In atrial fibrillation, watch for a faster ventricular response.
- Check potassium and urine output.
Pregnancy and breastfeeding
Human data are limited; it is used when the mother's circulation needs support.
Test yourself
Think of the answer, then tap the question to see it.
What is the main haemodynamic effect of dobutamine?
A rise in contractility and cardiac output through beta-1 stimulation, with little change in vascular resistance.
Why is dobutamine avoided in hypertrophic obstructive cardiomyopathy?
A stronger contraction worsens the dynamic outflow tract obstruction and can lower cardiac output.
Which electrolyte can fall during a dobutamine infusion?
Potassium, because beta-2 stimulation shifts it into cells.
Why is a dobutamine line kept away from sodium bicarbonate?
Dobutamine is physically incompatible with alkaline solutions and can be inactivated in the line.
Related drugs
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - DOBUTAMINE injection, solution, concentrate (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Farmacología básica y clínica (Katzung), cap. 9 (McGraw Hill, 2025).
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Representative model, for educational purposes only.