see also:

• sympathomimetics
• inotropes

• The naturally occurring immediate precursor of noradrenaline;
• was once used for cardiogenic shock with renal hypoperfusion;
• was once used to counteract renal & mesenteric vasoconstriction with alpha-adrenergic doses adrenaline & noradrenaline;

• 40mg/ml 5ml; dilute by addition to saline &/or dextrose fluids;

• Infusion as short T½
• central line preferred
• Monitor: blood volume; contractility; periph.perfusion;

• Does not readily cross BBB → little effect on CNS receptors

• mainly by monoamine oxidase & COMT;

• 97% in urine as metabolites; inhib. by probenecid; T½ 2min;

• mainly acts on dopamine DA1 receptors:
  • ⇒ renal & mesenteric vasodilation
• NB. “renal dose” dopamine does not effect clinical outcomes in pts with ARF (Ann Int Med April 2005)

• dose-dep. beta (muscle vasodil.) & decr. NA release:
  • ⇒ unchanged total periph. resistance
  • ⇒ inc. CO; inc. SV; inc. contractility; inc.P initial only;
• NB. HR depends on beta1→SAnode, DA2 →decr.NA rel.; vagal & symp.tone;

• alpha effects as well (vasoconst.; inc. BP; inc. ven.press.;)

• mainly alpha → vasoconstriction mainly → resist.inc.;
  • ⇒ decr. renal & mesenteric blood flow & decr. urine output;
  • ⇒ risk of tachyarrythmias increases;

• 2.5mg/kg approx = 45µg/kg adrenaline;

• extravasation necrosis → large V; Rx with S/C local phentolamine;
• ectopics; tachycardia; anginal pain; hypotension; vasoconstriction;
• aberrant conduction; bradycardia; widened QRS; HT; gangrene;
• N/V; headache; piloerection; SOB; azotaemia;

• HT; marked decrease in pulse pressure;

• phaeochromocytoma; hyperthyroidism;
• atrial/ventricular arrythmias;
• cyclopropane/halthane anaesth;
• hypovolaemia (ensure CVP 10-15cm or PWP 14-18mmHg)
• care in peripheral vascular disease (PVD or PAD) (diabetes/Raynaud's/arteriosclerosis) or IHD;

• incompatible with alkali & ? as for adrenaline / epinephrine;
• MAOI ⇒ reduce starting dose to 1/10th;
• alpha-beta blockers, etc. may cause complex interactions;
• Probenecid ⇒ decr. excretion;
• ? butyrophenones ⇒ block renal vasodilatation;