多巴胺
Dopamine
3-hydroxytyramine hydrochloride
別名: Intropin · ASL-279 · dopamini hydrochloridum · 3-hydroxytyramine hydrochloride
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
這是按速率計算的持續輸注（CRI）劑量；須計算輸注速率，不能只按體重換算。
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Vasodilatory shock if fluid resuscitation and dobutamine is not successful | 2.5-10 micrograms/kg/min | IV | CRI | Titrated to effect | 🌎 NA |
| Adjunctive therapy for acute heart failure | 1-10 micrograms/kg/min | IV | CRI | Titrated to effect | 🌎 NA |
| 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 | 🌎 NA |
| 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 | 🌎 NA |
| Adjunctive therapy for oliguric renal failure | 1-3 micrograms/kg/min | IV | CRI | Until nonoliguric state achieved | 🌎 NA |
- Vasodilatory shock if fluid resuscitation and dobutamine is not successful: If not successful may try adding norepinephrine.
- Adjunctive therapy for acute heart failure: 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: Not a substitute for adequate volume replacement therapy.
- Adjunctive therapy for oliguric renal failure: Used with diuretics (furosemide). Note: Many now believe that dopamine is not indicated for treating acute renal failure.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Vasodilatory shock if fluid resuscitation and dobutamine is not successful | 2.5-10 micrograms/kg/min | IV | CRI | Titrated to effect | 🌎 NA |
| 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 | 🌎 NA |
| 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 | 🌎 NA |
- Vasodilatory shock if fluid resuscitation and dobutamine is not successful: If not successful may try adding norepinephrine.
- Treatment of severe hypotension/shock: Not a substitute for adequate volume replacement therapy.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
多巴胺是一種內源性兒茶酚胺，也是去甲腎上腺素的直接代謝前體。在獸醫重症監護中，主要在充分的液體復甦之後，作為連續靜脈輸注 (CRI) 用於控制血流動力學不穩定，特別是低血壓休克和急性心臟衰竭。
臨床重點
- 劑量依賴性效應：多巴胺的受體親和力會根據輸注速率發生顯著變化，從多巴胺能（血管擴張）進展到 β-1（正性肌力），再到 α-1（升壓）效應。
- 腎臟劑量爭議：過去常使用「低劑量」多巴胺來促進少尿型急性腎損傷的利尿。現代證據表明它並不能顯著改善腎小球濾過率 (GFR)，在犬隻中的應用被認為未經證實或存在爭議，對貓甚至可能有害。
- 嚴格的給藥規則：必須透過專用靜脈管線並使用注射幫浦或輸液幫浦給藥。藥物外滲會導致嚴重的組織壞死。
作用機制
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.
安全性與警告
禁忌症
- Pheochromocytoma
- Ventricular fibrillation
- Uncorrected tachyarrhythmias
- Uncorrected hypovolemia (must replace fluids first)
不良反應
- 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)
注意事項
Critical Warnings
- Extravasation Risk: Extravasation can cause severe ischemic tissue necrosis and sloughing. Monitor IV sites continuously. If extravasation occurs, infiltrate the ischemic area with 5-10 mg phentolamine diluted in 10-15 mL of normal saline using a fine needle with multiple subcutaneous injections.
- Hypovolemia: Dopamine is not a substitute for adequate fluid, electrolyte, or blood product replacement. Volume deficits must be corrected prior to use.
- Cardiovascular Disease: Use with extreme caution in patients with ischemic heart disease or occlusive vascular disease. Discontinue or reduce dose if arrhythmias (e.g., PVCs) occur or if signs of reduced peripheral circulation develop.
- Feline Renal Failure: Cats are unlikely to benefit from low-dose dopamine for oliguric renal failure, and it may be detrimental.
藥物相互作用
May antagonize the vasoconstrictive properties of high-dose dopamine.
May result in increased incidences of ventricular arrhythmias.
May potentiate adverse cardiovascular effects.
May antagonize the cardiac (inotropic/chronotropic) effects of dopamine.
May potentiate urine production effects of low-dose dopamine.
Can significantly prolong and enhance the effects of dopamine.
May cause severe hypertension when used concurrently.
May antagonize the renal and mesenteric vasodilatation effects of dopamine.
Concurrent use may cause severe hypertension.
監測
- 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)
藥物動力學
半衰期
吸收
Not administered orally as it is rapidly metabolized in the GI tract. After IV administration, onset of action is usually within 5 minutes.
分佈
Widely distributed in the body, but does not cross the blood-brain barrier in appreciable quantities. Placental transfer is unknown.
代謝
Metabolized in the kidney, liver, and plasma by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) to inactive compounds. Up to 25% is metabolized to norepinephrine in adrenergic nerve terminals.
排除
Rapidly cleared; effects persist for less than 10 minutes after the infusion is stopped.
過量
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.
可用產品
劑型
- Concentrated solution for injection (40 mg/mL, 80 mg/mL, 160 mg/mL)
- Premixed injection solution in Dextrose 5% (0.8 mg/mL, 1.6 mg/mL, 3.2 mg/mL)
人用標示
- Dopamine HCl for Concentrated Solution for Injection: 40 mg/mL, 80 mg/mL and 160 mg/mL in 5 mL & 10 mL vials
- Dopamine HCl in Dextrose 5% Injection Solution: 200 mg/250 mL (0.8 mg/mL); 400 mg/500 mL (0.8 mg/mL); 400 mg/250 mL (1.6 mg/mL); 800 mg/500 mL (1.6 mg/mL); & 800 mg/250 mL (3.2 mg/mL) in premixed containers
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Protect from light. Store at room temperature (15-30°C). Solutions that are pink, yellow, brown, or purple indicate decomposition and must be discarded. After dilution in compatible IV fluids (e.g., normal saline, D5W, LRS), it is stable for at least 24 hours at room temperature, though it is recommended to dilute just prior to use. Most stable at pH < 5; oxidized at alkaline pH.
飼主須知
多巴胺是一種重症監護藥物，專門在醫院環境中使用，通常是在加護病房 (ICU)。
- 用途：用於在嚴重的休克或心臟衰竭等危及生命的狀況下，支持您寵物的血壓、心臟功能和器官血流。
- 給藥方式：透過專門的幫浦進行連續靜脈 (IV) 滴注，以確保劑量精確。
- 監測：在使用此藥物期間，獸醫團隊會密切監測您的寵物，包括持續的心跳速率、心電圖和血壓檢查。
- 安全性：獸醫團隊會頻繁檢查靜脈導管，因為如果這種藥物漏出血管外，可能會造成組織損傷。
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