도파민

아드레날린성/도파민성 강심제

도파민은 내인성 **카테콜아민**이며 노르에피네프린의 직접적인 대사 전구체입니다. 수의학 중환자 치료에서 주로 적절한 수액 소생술 *이후* 혈역학적 불안정성(특히 저혈압성 쇼크 및 급성 심부전)을 관리하기 위해 지속적 정맥 주입(CRI)으로 사용됩니다. ### 임상 요약 * **용량 의존적 효과**: 도파민의 수용체 친화력은 주입 속도에 따라 극적으로 변하며, 도파민성(혈관 확장)에서 베타-1(강심 작용), 알파-1(승압 작용) 효과로 진행됩니다. * **신장 용량 논란**: 과거에는 핍뇨성 급성 신손상에서 이뇨를 촉진하기 위해 '저용량' 도파민이 사용되었습니다. 현대의 증거에 따르면 사구체 여과율(GFR)을 유의하게 개선하지 못하며, 개에서의 사용은 입증되지 않았거나 논란의 여지가 있고 고양이에게는 해로울 수 있습니다. * **엄격한 투여 규칙**: 전용 정맥 라인과 주사기 펌프 또는 수액 펌프를 사용하여 투여해야 합니다. **혈관 외 유출**은 심각한 조직 괴사를 유발합니다.

작용 기전: Dopamine acts directly on **dopaminergic**, **β1-adrenergic**, and **α1-adrenergic** receptors, and indirectly by stimulating the release of endogenous norepinephrine from sympathetic nerve terminals. Its effects are highly dose-dependent: * **Low Dose (0.5–2 µg/kg/min)**: Primarily stimulates **D1 and D2 dopaminergic receptors** → vasodilation of renal, mesenteric, coronary, and intracerebral vascular beds. Increases renal blood flow and urine output, but does not appreciably increase GFR. * **Medium Dose (2–10 µg/kg/min)**: Stimulates **β1-adrenergic receptors** in the myocardium → increases intracellular cAMP → positive inotropic (increased contractility) and mild chronotropic (increased heart rate) effects. Improves cardiac output and organ perfusion. * **High Dose (>10–12 µg/kg/min)**: Overrides dopaminergic effects and strongly stimulates **α1-adrenergic receptors** in the vasculature → profound vasoconstriction → increases systemic vascular resistance (SVR) and blood pressure. Renal and peripheral blood flows are decreased at these rates.

동물 종별 용량

Cats

Vasodilatory shock if fluid resuscitation and dobutamine is not successful · 2.5-10 micrograms/kg/min · IV · CRI · Titrated to effect · If not successful may try adding norepinephrine.
Treatment of severe hypotension/shock · 1-3 micrograms/kg/minute CRI; higher dosages of 3-10 micrograms/kg/min CRI are indicated if greater cardiotonic and BP support are indicated · IV · CRI · Titrated to effect · Not a substitute for adequate volume replacement therapy.
Treatment of severe hypotension/shock after fluid correction and if dobutamine does not give desired effect · 1-10 micrograms/kg/min · IV · CRI · Titrated to effect

Dogs

Vasodilatory shock if fluid resuscitation and dobutamine is not successful · 2.5-10 micrograms/kg/min · IV · CRI · Titrated to effect · If not successful may try adding norepinephrine.
Adjunctive therapy for acute heart failure · 1-10 micrograms/kg/min · IV · CRI · Titrated to effect · Initially, a dose of 2 micrograms/kg/min is usually used and titrated upward to desired clinical effect. Doses higher than 10 may increase peripheral vascular resistance and heart rate.
Treatment of severe hypotension/shock · 1-3 micrograms/kg/minute CRI; higher dosages of 3-10 micrograms/kg/min CRI are indicated if greater cardiotonic and BP support are indicated · IV · CRI · Titrated to effect · Not a substitute for adequate volume replacement therapy.
Treatment of severe hypotension/shock after fluid correction and if dobutamine does not give desired effect · 1-10 micrograms/kg/min · IV · CRI · Titrated to effect

투여 경로

IV (Constant Rate Infusion only)

금기

Pheochromocytoma
Ventricular fibrillation
Uncorrected tachyarrhythmias
Uncorrected hypovolemia (must replace fluids first)

이상반응

Nausea and vomiting
Ectopic beats (arrhythmias)
Tachycardia
Palpitations
Hypotension (at low doses) or Hypertension (at high doses)
Dyspnea
Vasoconstriction (reduced peripheral circulation)
Severe tissue necrosis and sloughing (if extravasated)

약물 상호작용

Alpha-adrenergic blockers (e.g., prazosin) · May antagonize the vasoconstrictive properties of high-dose dopamine.
Halogenated hydrocarbon anesthetics (e.g., halothane) · May result in increased incidences of ventricular arrhythmias.
Tricyclic antidepressants · May potentiate adverse cardiovascular effects.
Beta-blockers (e.g., propranolol, metoprolol) · May antagonize the cardiac (inotropic/chronotropic) effects of dopamine.
Diuretics · May potentiate urine production effects of low-dose dopamine.
Monoamine oxidase inhibitors (MAOIs) · Can significantly prolong and enhance the effects of dopamine.
Oxytocic drugs · May cause severe hypertension when used concurrently.
Phenothiazines · May antagonize the renal and mesenteric vasodilatation effects of dopamine.
Vasopressors/Vasoconstrictors · Concurrent use may cause severe hypertension.

모니터링

Continuous electrocardiogram (ECG) for cardiac rate and rhythm
Direct or indirect blood pressure
Urine output/flow
IV catheter site (frequent checks for patency and signs of extravasation)

과용량

Accidental overdosage is primarily manifested by **excessive blood pressure elevation** (severe hypertension) and arrhythmias. * **Treatment**: Because dopamine's half-life is extremely short (~2 minutes), treatment usually consists only of temporarily discontinuing the IV infusion or reducing the rate until parameters normalize. * If the patient's condition fails to stabilize rapidly after discontinuation, the alpha-adrenergic antagonist **phentolamine** may be administered.

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