도부타민

비경구용 베타 아드레날린성 강심제

**도부타민(Dobutamine)**은 합성 카테콜아민이며 속효성 주사용 양성 변력성 약물(강심제)입니다. 주요 임상적 특징은 다음과 같습니다: - **주요 용도:** 급성 심부전(예: 확장성 심근병증) 및 심인성 쇼크의 단기 치료. - **혈역학적 지원:** 수액 요법만으로 적절한 동맥 혈압, 심박출량 또는 조직 관류를 회복하지 못할 때 사용됩니다. - **임상 요점:** 반감기가 매우 짧기 때문에 면밀히 모니터링되는 중환자실(ICU) 환경에서 지속적 정맥 주입(CRI)으로 투여해야 합니다. 도파민과 달리 내인성 노르에피네프린의 방출에 의존하지 않으므로 카테콜아민이 고갈된 심부전 환자에게 더 신뢰할 수 있습니다.

작용 기전: Dobutamine acts primarily as a direct **beta1-adrenergic agonist** with mild **beta2-** and **alpha1-adrenergic** effects. **Mechanism Pathway:** **Dobutamine** binds to **beta-1 receptors** on the myocardium → activates **G-stimulatory (Gs) proteins** → stimulates **adenylyl cyclase** → increases intracellular **cyclic AMP (cAMP)** → activates **Protein Kinase A (PKA)** → increases intracellular calcium influx → enhances myocardial contractility (positive inotropy). Unlike dopamine, it does not cause the release of endogenous norepinephrine and lacks dopaminergic receptor activity. It increases cardiac output and stroke volume while decreasing left ventricular filling pressures (wedge pressures), with minimal direct effect on systemic vasculature. Higher doses can induce tachycardia.

동물 종별 용량

Cats

Short-term treatment of acute heart failure · 5-15 micrograms/kg/minute IV · IV · CRI · Short-term
Unspecified cardiac support · 1-3 micrograms/kg/minute IV · IV · CRI
Unspecified cardiac support · 1-5 micrograms/kg/minute IV · IV · CRI · Start at 1 microgram/kg/minute and titrate until clinical effect.
Short-term inotropic support (heart failure, shock, anesthesia hypotension) · 1-5 µg/kg/min (start low and titrate up) · IV · CRI · Up to 48 hours · Adverse effects are more commonly seen at doses >2.5 µg/kg/min. Doses over 5 µg/kg/min may cause seizures.

Horses

Unspecified cardiac support · 1-10 micrograms/kg/minute as an IV infusion · IV · CRI · ARCI UCGFS Class 2 Drug
Hemodynamic support in foals (after volume repletion) · 2-20 micrograms/kg minute CRI · IV · CRI · Another section of this reference states the dose is 3-40 micrograms/kg/minute. Follow the rule of '6': 6 times the weight of foal (in kg) = the number of mg to add to 100 mL of saline (1 mL/hr = 1 microgram/kg/minute).

Dogs

Short-term treatment of acute heart failure · 5-40 micrograms/kg/minute IV · IV · CRI · Short-term · Doses of 5-20 micrograms/kg/minute are generally adequate. Infusions >20 micrograms/kg/minute may cause tachycardia.
Shock where fluid therapy alone not adequate · 5-15 micrograms/kg/minute constant rate IV infusion · IV · CRI

투여 경로

금기

Known hypersensitivity to dobutamine or the preservative sodium bisulfite
Idiopathic hypertrophic subaortic stenosis (IHSS)
Uncorrected hypovolemic states
Cardiac outflow obstruction (e.g., aortic stenosis)

이상반응

Tachycardia
Facial twitching (especially in dogs)
Seizures
Tachyphylaxis (increasing dosages required over time)
CNS effects such as tremors or seizures (especially in cats at >5 mcg/kg/min)
Ectopic beats
Increased blood pressure
Chest pain and palpitations (reported in humans)
Proarrhythmia (ventricular arrhythmias)
Hypertension
Hypokalaemia (with prolonged use)
Nausea
Vomiting
Seizures (particularly in cats at higher doses)

약물 상호작용

Halogenated hydrocarbon anesthetics (e.g., halothane, cyclopropane) · May result in increased incidences of ventricular arrhythmias
Beta-blockers (e.g., metoprolol, propranolol) · May antagonize the cardiac effects of dobutamine, resulting in a preponderance of alpha-adrenergic effects and increased total peripheral resistance
Nitroprusside · Synergistic effects (increased cardiac output and reduced wedge pressure) can result
Oxytocic drugs · May induce severe hypertension when used with dobutamine in obstetric patients
Insulin · Increased insulin requirements in diabetic patients · moderate
Propranolol · Increased systemic vascular resistance · major
Doxapram · Increased systemic vascular resistance · moderate
Selegiline · Increased systemic vascular resistance (MAOI interaction) · major
Halothane · Increased incidence of arrhythmias · major
Digoxin · Recommended prior/concurrently in cases of atrial fibrillation to prevent increased ventricular rate · minor

모니터링

Heart rate and rhythm (ECG)
Blood pressure
Mucous membrane color and capillary refill time
Urine flow/output
Central venous or pulmonary wedge pressures (ideally)
Cardiac output
Continuous ECG
Arterial blood pressure (direct preferred)
Serum potassium levels
Heart rate and rhythm

과용량

Clinical signs reported with excessive dosage include **tachycardias**, **increased blood pressure**, **nervousness**, and **fatigue**. Because of the drug's extremely short duration of action, temporarily halting the intravenous infusion is usually all that is required to reverse these adverse effects.

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