Dopamine (medication)

Last updated

Dopamine
Dopamine2.svg
Skeletal formula of dopamine
Dopamine-from-xtal-view-1-3D-bs-17.png
Ball-and-stick model of the zwitterionic form of dopamine found in the crystal structure [1]
Clinical data
Trade names Intropin, Dopastat, Revimine, others
Other names2-(3,4-Dihydroxyphenyl)ethylamine; 3,4-Dihydroxyphenethylamine; 3-hydroxytyramine; DA; Intropin; Revivan; Oxytyramine; Prolactin inhibiting factor; Prolactin inhibiting hormone
AHFS/Drugs.com Monograph
Routes of
administration
Intravenous injection
ATC code
Physiological data
Source tissues Substantia nigra; ventral tegmental area; many others
Target tissuesSystem-wide
Receptors D1, D2, D3, D4, D5, TAAR1 [2]
Agonists Direct: apomorphine, bromocriptine
Indirect: cocaine, substituted amphetamine, cathinone, bupropion
Antagonists Neuroleptics, metoclopramide, domperidone
Metabolism MAO, COMT, [2] ALDH, DBH, MAO-A, MAO-B, COMT
Legal status
Legal status
  • EU:Rx-only [3]
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Metabolism MAO, COMT, [2] ALDH, DBH, MAO-A, MAO-B, COMT
Excretion Kidney
Identifiers
  • 4-(2-Aminoethyl)benzene-1,2-diol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
Chemical and physical data
Formula C8H11NO2
Molar mass 153.181 g·mol−1
3D model (JSmol)
Density 1.26 g/cm3
Melting point 128 °C (262 °F)
Boiling point decomposes
  • c1cc(c(cc1CCN)O)O
  • InChI=1S/C8H11NO2/c9-4-3-6-1-2-7(10)8(11)5-6/h1-2,5,10-11H,3-4,9H2 Yes check.svgY
  • Key:VYFYYTLLBUKUHU-UHFFFAOYSA-N Yes check.svgY
   (verify)

Dopamine, sold under the brand name Intropin among others, is a medication most commonly used in the treatment of very low blood pressure, a slow heart rate that is causing symptoms, and, if epinephrine is not available, cardiac arrest. [4] In newborn babies it continues to be the preferred treatment for very low blood pressure. [5] In children epinephrine or norepinephrine is generally preferred while in adults norepinephrine is generally preferred for very low blood pressure. [6] [7] It is given intravenously or intraosseously as a continuous infusion. [4] Effects typically begin within five minutes. [4] Doses are then increased to effect. [4]

Contents

Common side effects include worsening kidney function, an irregular heartbeat, chest pain, vomiting, headache, or anxiety. [4] If it enters into the soft tissue around the vein local tissue death may occur. [4] The medication phentolamine can be given to try to decrease this risk. [4] It is unclear if dopamine is safe to use during pregnancy or breastfeeding. [4] At low doses dopamine mainly triggers dopamine receptors and β1-adrenergic receptors while at high doses it works via α-adrenergic receptors. [4]

Dopamine was first synthesized in a laboratory in 1910 by George Barger and James Ewens in England. [8] It is on the World Health Organization's List of Essential Medicines. [9] In human physiology dopamine is a neurotransmitter as well as a hormone. [10]

Medical uses

Low blood pressure

In newborn babies it continues to be the preferred treatment for very low blood pressure. [5] In children epinephrine or norepinephrine is generally preferred while in adults norepinephrine is generally preferred for very low blood pressure. [6] [7]

In those with low blood volume or septic shock, this should be corrected with intravenous fluids before dopamine is considered. [4]

Kidney function

Low-dosage dopamine has been routinely used for the treatment and prevention of acute kidney injury. However, since 1999 a number of reviews have concluded that doses at such low levels are not effective and may sometimes be harmful. [11] [12]

Administration

Since the half-life of dopamine in plasma is short—approximately one minute in adults, two minutes in newborn babies and up to five minutes in preterm babies—it is usually given as a continuous intravenous drip rather than a single injection. [13]

Other

A fluorinated form of L-DOPA known as fluorodopa is available for use in positron emission tomography to assess the function of the nigrostriatal pathway. [14]

Contraindications

Dopamine should generally not be given to people who have a pheochromocytoma or uncorrected very fast heart rate. [4]

Side effects

The LD50, or dose which is expected to prove lethal in 50% of the population, has been found to be: 59 mg/kg (mouse; administered intravenously); 950 mg/kg (mouse; administered intraperitoneally); 163 mg/kg (rat; administered intraperitoneally); 79 mg/kg (dog; administered intravenously). [15]

Extravasation

If extravasation occurs local tissue death may result. [4] The medication phentolamine can be injected at the site to try to decrease the risk of tissue death. [4]

Mechanism of action

Its effects, depending on dosage, include an increase in sodium excretion by the kidneys, an increase in urine output, an increase in heart rate, and an increase in blood pressure. [13] At low doses it acts through the sympathetic nervous system to increase heart muscle contraction force and heart rate, thereby increasing cardiac output and blood pressure. [16] Higher doses also cause vasoconstriction that further increases blood pressure. [16] [17]

While some effects result from stimulation of dopamine receptors, the prominent cardiovascular effects result from dopamine acting at α1, β1, and β2 adrenergic receptors. [18] [19]

Society and culture

In March 2024, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a pediatric use marketing authorization (PUMA) for the medicinal product Neoatricon, intended for treatment of hypotension in neonates, infants and children under 18 years of age. [3] [20] The applicant for this medicinal product is BrePco Biopharma Limited. [3]

Related Research Articles

<span class="mw-page-title-main">Sepsis</span> Life-threatening response to infection

Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.

<span class="mw-page-title-main">Septic shock</span> Dangerously low blood pressure due to damage from an organ infection

Septic shock is a potentially fatal medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defines septic shock as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by requiring a vasopressor to maintain a mean arterial pressure of 65 mm Hg or greater and having serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%.

<span class="mw-page-title-main">Clonidine</span> Pharmaceutical drug

Clonidine, sold under the brand name Catapres among others, is an α2A-adrenergic agonist medication used to treat high blood pressure, ADHD, drug withdrawal, menopausal flushing, diarrhea, spasticity, and certain pain conditions. The drug is often prescribed off-label for tics. It is used orally, by injection, or as a transdermal skin patch. Onset of action is typically within an hour with the effects on blood pressure lasting for up to eight hours.

<span class="mw-page-title-main">Sympathomimetic drug</span> Substance that mimics effects of catecholamines

Sympathomimetic drugs are stimulant compounds which mimic the effects of endogenous agonists of the sympathetic nervous system. Examples of sympathomimetic effects include increases in heart rate, force of cardiac contraction, and blood pressure. The primary endogenous agonists of the sympathetic nervous system are the catecholamines, which function as both neurotransmitters and hormones. Sympathomimetic drugs are used to treat cardiac arrest and low blood pressure, or even delay premature labor, among other things.

<span class="mw-page-title-main">Phenylephrine</span> Decongestant medication

Phenylephrine, sold under the brand names Neosynephrine and Sudafed PE among numerous others, is a medication used as a decongestant for uncomplicated nasal congestion, used to dilate the pupil, used to increase blood pressure, and used to relieve hemorrhoids. It can be taken by mouth, as a nasal spray, given by injection into a vein or muscle, applied to the skin, or as a rectal suppository.

<span class="mw-page-title-main">Synephrine</span> Chemical compound

Synephrine, or, more specifically, p-synephrine, is an alkaloid, occurring naturally in some plants and animals, and also in approved drugs products as its m-substituted analog known as neo-synephrine. p-Synephrine and m-synephrine are known for their longer acting adrenergic effects compared to epinephrine and norepinephrine. This substance is present at very low concentrations in common foodstuffs such as orange juice and other orange products, both of the "sweet" and "bitter" variety. The preparations used in traditional Chinese medicine (TCM), also known as Zhi Shi (枳实), are the immature and dried whole oranges from Citrus aurantium. Extracts of the same material or purified synephrine are also marketed in the US, sometimes in combination with caffeine, as a weight-loss-promoting dietary supplement for oral consumption. While the traditional preparations have been in use for millennia as a component of TCM-formulas, synephrine itself is not an approved over the counter drug. As a pharmaceutical, m-synephrine (phenylephrine) is still used as a sympathomimetic, mostly by injection for the treatment of emergencies such as shock, and rarely orally for the treatment of bronchial problems associated with asthma and hay-fever.

<span class="mw-page-title-main">Isoprenaline</span> Medication for slow heart rate

Isoprenaline, also known as isoproterenol and sold under the brand name Isuprel among others, is a sympathomimetic medication which is used in the treatment of acute bradycardia, heart block, and rarely for asthma, among other indications. It is used by injection into a vein, muscle, fat, or the heart, by inhalation, and in the past under the tongue or into the rectum.

<span class="mw-page-title-main">Alpha-2 adrenergic receptor</span> Protein family

The alpha-2 (α2) adrenergic receptor is a G protein-coupled receptor (GPCR) associated with the Gi heterotrimeric G-protein. It consists of three highly homologous subtypes, including α2A-, α2B-, and α2C-adrenergic. Some species other than humans express a fourth α2D-adrenergic receptor as well. Catecholamines like norepinephrine (noradrenaline) and epinephrine (adrenaline) signal through the α2-adrenergic receptor in the central and peripheral nervous systems.

<span class="mw-page-title-main">Norepinephrine</span> Catecholamine hormone and neurotransmitter

Norepinephrine (NE), also called noradrenaline (NA) or noradrenalin, is an organic chemical in the catecholamine family that functions in the brain and body as a hormone, neurotransmitter and neuromodulator. The name "noradrenaline" is more commonly used in the United Kingdom, whereas "norepinephrine" is usually preferred in the United States. "Norepinephrine" is also the international nonproprietary name given to the drug. Regardless of which name is used for the substance itself, parts of the body that produce or are affected by it are referred to as noradrenergic.

<span class="mw-page-title-main">Dopexamine</span> Chemical compound

Dopexamine is a synthetic analogue of dopamine that is administered intravenously in hospitals to reduce exacerbations of heart failure and to treat heart failure following cardiac surgery. It is not used often, as more established drugs like epinephrine, dopamine, dobutamine, norepinephrine, and levosimendan work as well. It works by stimulating beta-2 adrenergic receptors and peripheral dopamine receptor D1 and dopamine receptor D2. It also inhibits the neuronal re-uptake of norepinephrine.

<span class="mw-page-title-main">Benzoctamine</span> Sedative and anxiolytic medication

Benzoctamine is a drug that possesses sedative and anxiolytic properties. Marketed as Tacitin by Ciba-Geigy, it is different from most sedative drugs because in most clinical trials it does not produce respiratory depression, but actually stimulates the respiratory system. As a result, when compared to other sedative and anxiolytic drugs such as benzodiazepines like diazepam, it is a safer form of tranquilizing. However, when co-administered with other drugs that cause respiratory depression, like morphine, it can cause increased respiratory depression.

A cardiac stimulant is a drug which acts as a stimulant of the heart – e.g., via positive chronotropic action and/or inotropic action. They increase cardiac output.

<span class="mw-page-title-main">Atipamezole</span> Veterinary medication

Atipamezole, sold under the brand name Antisedan among others, is a synthetic α2 adrenergic receptor antagonist used for the reversal of the sedative and analgesic effects of dexmedetomidine and medetomidine in dogs. Its reversal effect works by competing with the sedative for α2-adrenergic receptors and displacing them. It is mainly used in veterinary medicine, and while it is only licensed for dogs and for intramuscular use, it has been used intravenously, as well as in cats and other animals(intravenous use in cats and dogs is not recommended due to the potential for cardiovascular collapse. This occurs due to profound hypotension caused by reversal of the alpha 1 effects while the reflex bradycardia is still in effect.). There is a low rate of side effects, largely due to atipamezole's high specificity for the α2-adrenergic receptor. Atipamezole has a very quick onset, usually waking an animal up within 5 to 10 minutes.

<span class="mw-page-title-main">Alpha blocker</span> Class of pharmacological agents

Alpha-blockers, also known as α-blockers or α-adrenoreceptor antagonists, are a class of pharmacological agents that act as antagonists on α-adrenergic receptors (α-adrenoceptors).

<span class="mw-page-title-main">Phenylethanolamine</span> Chemical compound

Phenylethanolamine, or β-hydroxyphenethylamine, is a trace amine with a structure similar to those of other trace phenethylamines as well as the catecholamine neurotransmitters dopamine, norepinephrine, and epinephrine. As an organic compound, phenylethanolamine is a β-hydroxylated phenethylamine that is also structurally related to a number of synthetic drugs in the substituted phenethylamine class. In common with these compounds, phenylethanolamine has strong cardiovascular activity and, under the name Apophedrin, has been used as a drug to produce topical vasoconstriction.

<span class="mw-page-title-main">Norepinephrine (medication)</span> Therapeutic use of norepinephrine

Norepinephrine, also known as noradrenaline and sold under the brand name Levophed among others, is a medication used to treat people with very low blood pressure. It is the typical medication used in sepsis if low blood pressure does not improve following intravenous fluids. It is the same molecule as the hormone and neurotransmitter norepinephrine. It is given by slow injection into a vein.

<span class="mw-page-title-main">Epinephrine (medication)</span> Hormone used as a medicine

Epinephrine, also known as adrenaline, is a medication and hormone. As a medication, it is used to treat several conditions, including anaphylaxis, cardiac arrest, asthma, and superficial bleeding. Inhaled epinephrine may be used to improve the symptoms of croup. It may also be used for asthma when other treatments are not effective. It is given intravenously, by injection into a muscle, by inhalation, or by injection just under the skin.

<span class="mw-page-title-main">Vasopressin (medication)</span> Chemical compound

Vasopressin infusions are in use for septic shock patients not responding to fluid resuscitation or infusions of catecholamines to increase the blood pressure while sparing the use of catecholamines. These argipressins have much shorter elimination half-life than synthetic non-arginine vasopresines with much longer elimination half-life of many hours. Further, argipressins act on V1a, V1b, and V2 receptors which consequently lead to higher eGFR and lower vascular resistance in the lungs. A number of injectable arginine vasopressins are in clinical use in the United States and the European Union. Pitressin among others, is a medication most commonly used in the treatment of frequent urination, increased thirst, and dehydration such as that resulting from diabetes insipidus, which causes increased and diluted urine. It is used to treat abdominal distension following some surgeries, and in stomach roentgenography. Vasopressin is a hormone that affects the kidneys and reduces urine flow.

<span class="mw-page-title-main">Angiotensin II (medication)</span> Medication for low blood pressure

Angiotensin II is a medication that is used to treat hypotension resulting from septic shock or other distributive shock. It is a synthetic vasoconstrictor peptide that is identical to human hormone angiotensin II and is marketed under the brand name Giapreza. The Food and Drug Administration approved the use of angiotensin II in December 2017 to treat low blood pressure resulting from septic shock.

Vasodilatory shock, vasogenic shock, or vasoplegic shock is a medical emergency belonging to shock along with cardiogenic shock, septic shock, allergen-induced shock and hypovolemic shock. When the blood vessels suddenly relax, it results in vasodilation. In vasodilatory shock, the blood vessels are too relaxed leading to extreme vasodilation and blood pressure drops and blood flow becomes very low. Without enough blood pressure, blood and oxygen will not be pushed to reach the body's organs. If vasodilatory shock lasts more than a few minutes, the lack of oxygen starts to damage the body's organs. Vasodilatory shock like other types of shock should be treated quickly, otherwise it can cause permanent organ damage or death as a result of multiple organ dysfunction.

References

  1. Cruickshank L, Kennedy AR, Shankland N (2013). "Tautomeric and ionisation forms of dopamine and tyramine in the solid state". J. Mol. Struct. 1051: 132–136. Bibcode:2013JMoSt1051..132C. doi:10.1016/j.molstruc.2013.08.002.
  2. 1 2 3 "Dopamine: Biological activity". IUPHAR/BPS guide to pharmacology. International Union of Basic and Clinical Pharmacology. Archived from the original on 5 February 2016. Retrieved 29 January 2016.
  3. 1 2 3 "Neoatricon EPAR". European Medicines Agency (EMA). 21 March 2024. Retrieved 23 March 2024. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Dopamine Hydrochloride". drugs.com. American Society of Health-System Pharmacists. 29 June 2016. Archived from the original on 14 September 2016. Retrieved 15 July 2016.
  5. 1 2 Bhayat SI, Gowda HM, Eisenhut M (May 2016). "Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence". World Journal of Clinical Pediatrics. 5 (2): 212–222. doi: 10.5409/wjcp.v5.i2.212 . PMC   4857235 . PMID   27170932.
  6. 1 2 De Backer D, Aldecoa C, Njimi H, Vincent JL (March 2012). "Dopamine versus norepinephrine in the treatment of septic shock: a meta-analysis*". Critical Care Medicine. 40 (3): 725–730. doi:10.1097/ccm.0b013e31823778ee. PMID   22036860. S2CID   24620964.
  7. 1 2 Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. (February 2013). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Critical Care Medicine. 41 (2): 580–637. doi: 10.1097/CCM.0b013e31827e83af . PMID   23353941. S2CID   34855187.
  8. Fahn S (2008). "The history of dopamine and levodopa in the treatment of Parkinson's disease". Movement Disorders. 23 (Suppl 3): S497–S508. doi:10.1002/mds.22028. PMID   18781671. S2CID   45572523. According to Hornykiewicz,6 dopamine was first synthesized by George Barger and James Ewens in 1910 at the Wellcome labs in London, England.
  9. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  10. Millar T (2002). Biochemistry explained : a practical guide to learning biochemistry. London: Routledge. p. 40. ISBN   9780415299411. Archived from the original on 15 August 2016.
  11. Karthik S, Lisbon A (2006). "Low-dose dopamine in the intensive care unit". Seminars in Dialysis. 19 (6): 465–471. doi:10.1111/j.1525-139X.2006.00208.x. PMID   17150046. S2CID   22538344.
  12. Power DA, Duggan J, Brady HR (April 1999). "Renal-dose (low-dose) dopamine for the treatment of sepsis-related and other forms of acute renal failure: ineffective and probably dangerous". Clinical and Experimental Pharmacology & Physiology. Supplement. 26: S23–S28. PMID   10386250.
  13. 1 2 Bhatt-Mehta V, Nahata MC (1989). "Dopamine and dobutamine in pediatric therapy". Pharmacotherapy. 9 (5): 303–314. doi:10.1002/j.1875-9114.1989.tb04142.x. PMID   2682552. S2CID   25614283.
  14. Deng WP, Wong KA, Kirk KL (2002). "Convenient syntheses of 2-, 5- and 6-fluoro- and 2,6-difluoro-L-DOPA". Tetrahedron: Asymmetry. 13 (11): 1135–1140. doi:10.1016/S0957-4166(02)00321-X.
  15. Lewis RJ (2004). Sax's Dangerous Properties of Industrial Materials, 11th Ed. Hoboken, NJ.: Wiley & Sons. p. 1552. ISBN   978-0-471-47662-7.
  16. 1 2 Bronwen JB, Knights KM (2009). Pharmacology for Health Professionals (2nd ed.). Elsevier Australia. p. 192. ISBN   978-0-7295-3929-6.
  17. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, et al. (March 2010). "Comparison of dopamine and norepinephrine in the treatment of shock". The New England Journal of Medicine. 362 (9): 779–789. doi: 10.1056/NEJMoa0907118 . PMID   20200382. S2CID   2208904.
  18. Moses S. "Dopamine". Family Practice Notebook. Archived from the original on 1 February 2016. Retrieved 1 February 2016. Dopamine binds to alpha-1 and beta-1 adrenergic receptors. Mediated through myocardial beta-1 adrenergic receptors, dopamine increase heart rate and force, thereby increasing cardiac output. Alpha-1 adrenergic receptor stimulation on vascular smooth muscle, leads to vasoconstriction and results in an increase in systemic vascular resistance
  19. Katritsis DG, Gersh BJ, Camm AJ (19 September 2013). Clinical Cardiology: Current Practice Guidelines. OUP Oxford. p. 314. ISBN   9780191508516. Archived from the original on 6 May 2016. Dopamine binds to beta-1, beta-2, alpha-1 and dopaminergic receptors.
  20. "Meeting highlights from the Committee for Medicinal Products for Human Use (CHMP) 18-21 March 2024". European Medicines Agency (Press release). 22 March 2024. Retrieved 13 June 2024.