Dopamine Солвей® 50

General characteristics. Structure:

Active agent: dopamine hydrochloride of 50 mg

Excipients: Hydrochloride L-cysteine hydrate; citric acid monohydrate; sodium hydroxide; sodium chloride; water for injections.

Pharmacological properties:

Pharmacological action - adrenomimetichesky, hypertensive.
Excites beta adrenoceptors (in small and medium doses) and alpha adrenoceptors (in high doses). Improvement of a system hemodynamics results in diuretic effect. Exerts the stimulating impact on dopamine receptors. In low doses (0,5–3 mkg/kg/min.) affects preferential dofaminergichesky receptors. Owing to specific influence on peripheral dopamine receptors, reduces resistance of renal vessels, increases in them a blood stream, glomerular filtering, removal of sodium and a diuresis. Expands mezenterialny vessels (action on renal and mezenterialny vessels of a dopamine differs in it from other catecholamines). At doses from low to averages (2–10 mkg/kg/min.) stimulates beta1-adrenoceptors that causes a positive inotropic effect from a myocardium and increase in minute volume of heart. Systolic ABP and pulse pressure can raise, at this DAD does not change or slightly increases. OPSS usually does not change. The coronary blood stream and consumption of oxygen a myocardium, increase.

At high doses (10 mkg/kg/min. or more) stimulation of alfa1-adrenoceptors prevails, OPSS raises and renal vessels are narrowed (the last can reduce earlier increased renal blood stream and a diuresis). Both the GARDEN, and DAD increases owing to increase in minute volume of heart and peripheric resistance. After the introduction termination the effect proceeds 5–10 min.

Pharmacokinetics. Later in/in introductions of T1/2 makes less than 5 min. In a liver, kidneys and plasma is exposed to metabolism with formation of inactive metabolites; during 24 h with urine 85% of the entered dose are removed.

About 25% of a dose are taken neurosecretory vesicles where there is a hydroxylation and noradrenaline is formed. Contacts proteins of plasma of 50%, also catechol-au-methyltransferase (KOMT) to inactive metabolites is quickly metabolized in a liver, kidneys and MAO plasma. T1/2 — adults: from plasma — 2 min., from fabrics — 9 min.; newborn — 6,9 min. (within 5–11 min.). It is removed by kidneys; 80% of a dose — in the form of metabolites during 24 h.

Indications to use:

Shock of various genesis (cardiogenic, postoperative, infectious and toxic, anaphylactic, hypovolemic (only after recovery of OTsK); acute heart and vascular failure at various serious morbid conditions.

Route of administration and doses:

In/in infusionally. The dose is selected individually and depends on severity of shock, and also on reaction of the patient to treatment. If it is not offered differently, then the following doses are recommended:

a) area of low doses (for intensive treatment in clinic of internal diseases) — 100–250 mkg/min. = 1,5–3,5 mkg/kg/min.,

b) area of average doses (for intensive treatment in surgical clinic) — 300–700 mkg/min. = 4–10 mkg/kg/min.,

c) area of the maximum doses (at septic shock) — 750–1500 mkg/min. = 10,5–21,5 mkg/kg/min.

Rate of administering should be selected individually for achievement of optimum reaction of the patient. At most of patients it is possible to maintain satisfactory condition at use of doses of a dopamine less than 20 mkg/kg/min.

For increase in sokratitelny activity of a myocardium (a positive inotropic effect) the recommended dose — 100–250 mkg/min.

The maximum increase in a diuresis is reached at 250 mkg/min. (at increase in rate of administering up to 1200 mkg/min. the diuresis does not change). At further increase in a dose it is necessary to consider possible decrease in a diuresis.

For the purpose of impact on the ABP increase in a dose to 500 mkg/min. and more is recommended, or at a constant dose of a dopamine Norepinephrinum (noradrenaline) in a dose of 5 mkg/min. weighing patient about 70 kg is in addition appointed. At emergence of disturbances of a cordial rhythm, irrespective of the applied doses, further increase in a dose is contraindicated.

To children — 4 mkg/kg/min., the maximum dose — 6 mkg/kg/min. Unlike adults, at children the dose should be raised gradually, i.e. since the smallest dose.

Use duration: duration of injections depends on specific features of the patient. There is a positive experience of infusion lasting up to 28 days. After stabilization of a clinical situation drug withdrawal is made gradually. Solution for infusion has to prepare every time before the use again. To use the transparent, not painted at drug addition, infusion solutions.

Solutions, ready to use, for in/in injections remain stable during usual term for injections (not less than 24 h), except for mix with Ringera-laktatom solution (as much as possible — 6 h).

The recommended solutions for cultivation: — 0,9% solution of sodium of chloride, 5,0% glucose solution, Ringera-laktata solution.

Features of use:

Treatment of patients with occlusal diseases of peripheral vessels and/or the disseminated intravascular blood coagulation (IDCS) in the anamnesis against the background of administration of drug can cause the sharp and expressed vasoconstriction leading to a necrosis of skin and gangrene. At patients with obliterating diseases of vessels it has to be carried out under fixed control: at detection of peripheral ischemia introduction of a dopamine should be stopped immediately.

The dopamine Solvey 200 is intended only for in/in infusions and can be applied only in the diluted look.

Before an initiation of treatment a dopamine at patients with a hypovolemia it is necessary to recover blood volume. Considering that the dopamine improves atrioventricular conductivity, patients with a ciliary arrhythmia and the prompt ventricular reply before purpose of a dopamine should enter cardiac glycosides.

Speed of infusion should be adjusted constantly taking into account change of a condition of the patient under control of a diuresis, cordial emission and the ABP. After stabilization of cordial function and the ABP decrease in a dose for achievement of an optimum diuresis can be required. In case of excessive increase in DAD, reduction of a diuresis or developing of arrhythmia the dose of a dopamine should be lowered. To reduce risk of an ekstravazation, the dopamine, whenever possible, should be entered into large veins. In case of an ekstravazation infiltration of an affected area phentolamine in certain cases prevents infiltration of fabrics. Considering pharmacological properties of medicine, it is necessary to pay special attention to inadmissibility of intra arterial infusions and bolyusny injections. Purpose of a dopamine has to be carried out by the patient with diseases of a liver and kidneys under fixed observation since influence of a dopamine on reduced renal or hepatic function is unknown. Patients in coma need to provide passability of respiratory tracts. Patients with raised pre-or an afterload are recommended to appoint a dopamine together with nitroglycerine or Sodium nitroprussidum for decrease in load of heart. In addition to purpose of a dopamine it is not necessary to neglect additional obligatory measures, including substitution of sufficient volume of liquid and fixed control of balance of electrolytes, etc.

Side effects:

Nausea, vomiting, headache, feeling of concern, excitement, tremor of fingers of hands, stenocardia, heartbeat, increase in the ABP are possible, myocardium ischemia is in rare instances possible. Purpose of a dopamine can cause arrhythmia (sinus tachycardia, supraventricular and ventricular arrhythmia) and undesirable increase in end diastolic pressure in a left ventricle. Disturbance of cordial conductivity, bradycardia, expansion of the QRS complex, decrease in the ABP (for elimination of these effects it is usually enough to increase infusion speed), an azotemia and a piloerektion was in certain cases observed. In certain cases during infusion the polyuria is observed (it is necessary to control a diuresis). In extremely exceptional cases introduction of a dopamine can cause a necrosis of skin or gangrene. Inadvertent paravenous introduction can lead to a necrosis of soft tissues.

Interaction with other medicines:

Because of danger of development of arrhythmia patients at whom cyclopropane or halogenated hydrocarbons are applied to inhalation general anesthesia should be careful at purpose of a dopamine. The combination of a dopamine and alkaloids of an ergot can lead to the maximum narrowing of peripheral vessels which is followed by danger of gangrene. The patients who are receiving or received monoamine oxidase inhibitors during the last 2 weeks should appoint much lower dose of a dopamine (the initial dose has to make 1/10 usual doses). At combined use with Phenytoinum or tricyclic antidepressants decrease in the ABP and development of bradycardia is possible. Co-administration of a dopamine and diuretic means can be followed by the additive and exponential effect. Beta adrenoblockers (propranolol and метопролол) are antagonists of cordial effect of a dopamine. At co-administration with guanetidiny sympathomimetic action amplifies, with Dobutaminum — more expressed increase in the ABP can be observed (however pressure in ventricles during a diastole goes down or remains the same).

Contraindications:

Hypersensitivity to drug components (including to other sympathomimetics), a hyperthyroidism, a pheochromocytoma, closed-angle glaucoma, a prostate hyperplasia with clinical manifestations, tachyarrhythmias, fibrillation of ventricles of heart.

Use at pregnancy and feeding by a breast
The data obtained for pregnant women are not enough now. In researches on animals reproductive toxicity of a dopamine was shown. The potential risk for the person is unknown. During pregnancy to apply, only, if the advantage for mother exceeds possible risk for a fruit.

Overdose:

Symptoms: excessive increase in the ABP, disturbance of a rhythm.

Treatment: to lower a dose or for some time to stop in/in introduction since the dopamine possesses short-term action. In hard cases it is necessary to consider the possibility of appointment alpha or beta adrenoblockers.

Storage conditions:

In the place protected from light, at a temperature not above 25 °C (not to freeze).
To store in the place, unavailable to children.

Issue conditions:

According to the recipe

Packaging:

In ampoules on 5 ml; in a pack of cardboard 5, 30 and 300 pieces.