Dobutamine

Dobutamine, developed by a laboratory led by Dr. Ronald Tuttle at Eli Lilly & Company, was created to sustain patients with severe heart failure. It is is a sympathomimetic drug that is a selective β₁-adrenergic agonist with α₁ selective activity, although it is used clinically in cases of cardiogenic shock for its β₁ inotropic effect in increasing heart contractility and cardiac output. Dobutamine is used to treat acute but potentially reversible heart failure, such as cardiac surgery or cases of septic or cardiogenic shock, on the basis of its positive inotropic action.^[1] The drug is administered as a racemic mixture consisting of both (+) and (−) isomers, and the (+) isomer is a potent β₁ agonist while the (−) isomer is a α₁ agonist. Dobutamine also has mild β₂ agonist activity.^[2]

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Function

It is a direct-acting agent whose primary activity results from stimulation of the β₁-adrenoceptors of the heart, increasing contractility and cardiac output. Since it does not act on dopamine receptors to induce the release of norepinephrine (another α₁ agonist), dobutamine is less prone to induce hypertension than is dopamine. Chronotropic, arrhythmogenic, and vasodilative effects are negligible.

Uses

Dobutamine can be used in cases of congestive heart failure to increase cardiac output. It is indicated when parenteral therapy is necessary for inotropic support in the short-term treatment of patients with cardiac decompensation due to depressed contractility, which could be the result of either organic heart disease or cardiac surgical procedures. It is not useful in ischemic heart disease because it increases heart rate and thus increases the heart's demand for oxygen.

Dobutamine is also used intraoperatively in case of venous air embolus (VAE) to provide inotropic support.^{[citation needed]}