SUMMARY
DOPamine HYDROCHLORIDE
in 5% Dextrose Injection, USP
Dopamine Hydrochloride and 5% Dextrose Injection, USP is a sterile, nonpyrogenic solution of Dopamine Hydrochloride, USP and Dextrose, USP in Water for Injection.
Dopamine hydrochloride is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarctions, trauma, endotoxic septicemia, open heart surgery, renal failure and chronic cardiac decompensation as in congestive failure.
Where appropriate, restoration of blood volume with a suitable plasma expander or whole blood should be instituted or completed prior to administration of dopamine hydrochloride.
Patients most likely to respond adequately to dopamine hydrochloride are those in whom physiological parameters, such as urine flow, myocardial function and blood pressure have not undergone profound deterioration. Reports indicate that the shorter the time interval between onset of signs and symptoms and initiation of therapy with volume correction and dopamine hydrochloride, the better the prognosis.
Poor Perfusion of Vital Organs
Urine flow appears to be one of the better diagnostic signs by which adequacy of vital organ perfusion can be monitored. Nevertheless, the physician should also observe the patient for signs of reversal of confusion or comatose condition. Loss of pallor, increase in toe temperature and/or adequacy of nail bed capillary filling may also be used as indices of adequate dosage. Reported studies indicate that when dopamine hydrochloride is administered before urine flow has diminished to levels of approximately 0.3 mL/minute, prognosis is more favorable. Nevertheless, in a number of oliguric or anuric patients, administration of dopamine hydrochloride has resulted in an increase in urine flow which in some cases reached normal levels. Dopamine hydrochloride may also increase urine flow in patients whose output is within normal limits and thus may be of value in reducing the degree of preexisting fluid accumulation. It should be noted that at doses above those optimal for the individual patient, urine flow may decrease, necessitating reduction of dosage. Concurrent administration of dopamine hydrochloride and diuretic agents may produce an additive or potentiating effect.
Low Cardiac Output
Increased cardiac output is related to dopamine hydrochloride’s direct inotropic effect on the myocardium. Increased cardiac output at low or moderate doses appears to be related to a favorable prognosis. Increase in cardiac output has been associated with either static or decreased systemic vascular resistance (SVR). Static or decreased SVR associated with low or moderate increments in cardiac output is believed to be a reflection of differential effects on specific vascular beds with increased resistance in peripheral beds (e.g., femoral) and concomitant decreases in mesenteric and renal vascular beds. Redistribution of blood flow parallels these changes so that an increase in cardiac output is accompanied by an increase in mesenteric and renal blood flow. In many instances the renal fraction of the total cardiac output has been found to increase. Increase in cardiac output produced by dopamine hydrochloride is not associated with substantial decreases in systemic vascular resistance as may occur with isoproterenol.
Hypotension
Hypotension due to inadequate cardiac output can be managed by administration of low to moderate doses of dopamine hydrochloride, which have little effect on SVR. At high therapeutic doses, dopamine hydrochloride’s alpha-adrenergic activity becomes more prominent and thus may correct hypotension due to diminished SVR. As in the case of other circulatory decompensation states, prognosis is better in patients whose blood pressure and urine flow have not undergone profound deterioration. Therefore, it is suggested that the physician administer dopamine hydrochloride as soon as a definite trend toward decreased systolic and diastolic pressure becomes evident.
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NEWS HIGHLIGHTS
Published Studies Related to Dopamine Injection
Monthly administration of long-acting injectable risperidone and striatal dopamine D2 receptor occupancy for the management of schizophrenia. [2008.08]
CONCLUSION: As with plasma levels, there was considerable variability in D(2) occupancy levels for individuals receiving long-acting risperidone. This work suggests a possibility that sustained D(2) occupancy at or above the accepted threshold with acute clinical response may not be necessary to maintain response, a hypothesis with important clinical implications as we consider antipsychotic dosing and future antipsychotic development. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00236353.
Induction of tolerance of dopaminergic responses in man. [2008.08]
Schizophrenia may reflect a sensitization of dopaminergic (DA) function...
Brain dopamine response in human opioid addiction. [2008.07]
CONCLUSIONS: The absence of a dopamine response to opioid agonists contrasts with that found with stimulant drugs and suggests dopamine may not play the same role in addiction to opioids. This questions the role of dopamine in the subjective experience of heroin in opioid addicts.
Effects of intravenous glucose on dopaminergic function in the human brain in vivo. [2007.09]
Dopamine is known to regulate food intake by modulating food reward via the mesolimbic circuitry of the brain. The objective of this study was to compare the effects of high energy input (i.v... Although gender differences were not among the a priori hypotheses of the present study and, therefore, they must be considered to be preliminary findings, we postulate that this observation is a reflection of an interaction between glucose, sex steroids (estrogen), leptin, and dopamine.
Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. [2007.08]
CONTEXT: Ovarian hyperstimulation syndrome (OHSS) results from increased vascular permeability (VP) caused by ovarian hypersecretion of vascular endothelial growth factor (VEGF), which activates its receptor-2. In animals, the dopamine receptor 2 agonist cabergoline (Cb2) inactivates VEGF receptor-2 and prevents increased VP. OBJECTIVE: Our objective was to test whether Cb2 reduces VP and prevents OHSS in humans... CONCLUSIONS: Given that Cb2 is a well-established and safe medication, this study provides proof of concept for the use of dopamine agonists in the prevention of OHSS in women undergoing assisted reproduction.
Clinical Trials Related to Dopamine Injection
PET Imaging of Dopamine in Healthy Study Participants [Completed]
The purpose of this study is to measure molecules on or in cells that interact with a
chemical in the nervous system, called dopamine. Investigators will obtain two kinds of
images of the brain-a position emission tomography (PET) scan and a magnetic resonance
imaging (MRI) scan.
Thirty-eight participants aged 18 to 45 will be enrolled in this study. They must have no
history of medical or psychiatric illness, including substance abuse. Participants will have
four appointments at NIH. On the first visit, they will undergo a physical exam, a medical
history, and lab tests. The second and third visits will involve PET scans and the fourth
visit will involve an MRI scan.
Participants will be compensated up to $430 for their involvement in this study.
Relationship of Dopamine to Cognitive Function in Parkinson's Disease [Completed]
This study will examine how the brain chemical dopamine affects memory, reasoning, and other
thought processes in people with Parkinson's disease with and without dementia and in healthy
control subjects.
Healthy normal volunteers and people with Parkinson's disease who are between 40 and 85 years
of age may be eligible for this study. Pregnant women with Parkinson's disease and
breastfeeding normal volunteers are excluded. Candidates are screened with a physical and
neurological examination, blood tests, a brief mental test called the Mini Mental Status
Examination, and other tests designed to assess memory, learning, reasoning, and other
thought processes. Patients with Parkinson's disease also undergo a more thorough mental
evaluation called the Mattis Dementia Rating Scale. The study requires about 15 hours over 4
or 5 outpatient visits to NIH.
Participants undergo two positron emission tomography (PET) scans on two separate days and a
magnetic resonance imaging (MRI) scan, as follows:
PET Scans
The two PET procedures are done the same way, except one uses a radioactive tracer called
[(18)F]DOPA and one uses a tracer called [(11)C]NNC-112. A catheter (small plastic tube) is
placed in a vein in the subject's arm for injection of the tracer. The subject lies on the
scanner bed and a special mask is fitted to his or her head to hold it in place during the
procedure. Just before injecting the tracer, a 10-minute "transmission scan" is done of the
head using a tracer called (68)Ge. Then, a series of scans using one of the two study tracers
([(18)F]DOPA or [(11)C]NNC-112 are done for about 90 minutes. About 1 hour before injection
of the [(18)F]DOPA tracer, subjects take 200 mg of the drug carbidopa by mouth to help the
tracer work properly. Blood pressure, breathing and heart are monitored before and after
injection of the [(11)C]NNC-112 tracer.
Patients with Parkinson's disease are taken off all Parkinson's medications the night before
the [(18)F]DOPA scan and their motor function is tested the following morning before the
scans are done, using the Unified Parkinson's Disease Rating Scale. Patients can resume all
medications except L-DOPA (including Sinemet) after the movement test, and they can resume
L-DOPA after the PET scan is finished.
MRI Scan
MRI uses a strong magnetic field and radio waves to obtain images of the brain. The subject
lies still on a table that slides inside the scanner, a metal cylinder. They wear ear plugs
to muffle loud knocking sounds that occur during the scanning and can communicate with the
MRI staff at any time through an intercom.
Study of the Effects of Dopaminergic Medications on Dopamine Transporter Density in Subjects With Parkinson's Disease [Completed]
This study investigates whether there is a change in 123iodine-2ß-
carbomethoxy-3ß-(4-iodophenyl) tropane ([123I]ß-CIT) uptake after short-term treatment with
levodopa compared to either dopamine agonist or placebo.
Embryonic Dopamine Cell Implants for Parkinson's Disease: A Double-Blind Study [Active, not recruiting]
The purpose of this trial is to determine if patients who received embryonic dopamine cell
implant surgery showed significantly greater improvement in their Parkinson's disease than a
control group undergoing the placebo treatment, and to determine if the cell implant surgery
was more effective in younger or older patients.
Benefits of Optimizing Antipsychotic Doses and Their Relationship to Dopamine D2 Receptor Occupancy in Older Persons With Schizophrenia [Recruiting]
Since side effects of antipsychotics, dopamine D2 receptor blockers, frequently occur in
older patients with schizophrenia and the risk is dose dependent, clinical guidelines
universally advocate the use of lower doses. However, there is no report to test this dosing
guideline with measurements of D2 receptor blockade caused by antipsychotics. In this study,
dopamine D2 receptor occupancy will be measured, using Positron Emission Tomography (PET),
in 12 patients aged 50 and older with schizophrenia-spectrum disorders before and after a
gradual 40 % dose reduction of antipsychotics that was safely achieved in the past study
while setting a target dose still above the lower limit of the dose range recommended in
clinical guidelines, i. e. 1. 25 mg/day, for older patients. Our goal is to relate changes in
clinical outcome, including subjective and objective clinical ratings, to dopamine D2
receptor occupancy, and compare these results with the data for younger patients in the
literature.
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Page last updated: 2008-11-03
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