Amitriptyline
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Drug reference
Dobutamine
Beta-1 selective inotrope (synthetic catecholamine) · Cardiac stimulant
Also known as Dobutamine hydrochloride
START
IV 2.5–5 mcg/kg/min, titrate to cardiac output/BP (correct hypovolaemia first)
TYPICAL MAX
Up to ~20 mcg/kg/min (≤40 in monitored ICU/stress test)
STOP IF
Significant tachyarrhythmia, myocardial ischaemia, severe BP change
WATCH
Continuous ECG/BP, heart rate, potassium, signs of ischaemia, infusion-site
CDSCO approvedSchedule HATC C01CA07
KDIGO 2024 + manufacturer label
- ONSET
- 2min · onset (~2 min)
- PEAK
- 10min · steady state (~10 min)
- t½
- 2min · plasma t½ (~2 min)
- DURATION
- 5min · offset (<5 min)
EXCRETION
COMT metabolism; renal inactive metabolites
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Use only for serious maternal haemodynamic indication — limited data
FDA category + note
Top interactionssee all 12 →
- AmitriptylineSevereDatabaseDDInter
- AmoxapineSevereDatabaseDDInter
- ClomipramineSevereDatabaseDDInter
- DesipramineSevereDatabaseDDInter
Available in India
32 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Predominant beta-1 adrenergic agonism increasing myocardial contractility and stroke volume with relatively modest chronotropy; mild beta-2 vasodilation and alpha effects (racemate) → improved cardiac output, usually reduced systemic vascular resistance.
Indications
Acute decompensated heart failure / low-output states (short-term inotropic support)Cardiogenic shock (adjunct)Pharmacologic (dobutamine) stress echocardiography
Dosing
- Adult
- IV infusion 2.5–10 mcg/kg/min, titrate to haemodynamics (range 0.5–20; rarely up to 40 mcg/kg/min). Stress echo: 5–40 mcg/kg/min staged.
- Pediatric
- 2–20 mcg/kg/min titrated (specialist).
- Renal adjustment
- No specific adjustment.
- Hepatic adjustment
- No specific adjustment.
- Geriatric
- Titrate cautiously; arrhythmia/ischaemia risk.
- Max dose
- Up to 40 mcg/kg/min (ICU/stress test); usual ≤20 mcg/kg/min
Pharmacokinetics
Onset
1–2 min
Peak effect
~10 min (steady state)
Duration
<5 min after stopping
Half-life
~2 min
Bioavailability
IV only
Protein binding
Low
Metabolism
COMT methylation + conjugation (rapid)
Excretion
Renal (inactive metabolites)
Contraindications
- Idiopathic hypertrophic subaortic stenosis
- Hypersensitivity to dobutamine/sulfites
- Uncorrected hypovolaemia (correct first)
- Caution: tachyarrhythmia, recent MI, severe outflow obstruction
Side effects
Common
TachycardiaIncreased blood pressurePalpitations/ectopyHeadache, tremorMild hypokalaemia
Serious
- Tachyarrhythmia (AF, VT)
- Myocardial ischaemia/infarction (increased oxygen demand)
- Severe hypertension or hypotension
- Eosinophilic myocarditis (prolonged use)
- Stress-induced cardiomyopathy/arrhythmia during testing
Pregnancy & lactation
Pregnancy
Use only for serious maternal haemodynamic indication — limited data
Lactation
Acute critical-care use; minimal relevance (very short t½) — caution
Drug interactions
Amoxapine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clomipramine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Desipramine
Severe
Database
Clinical effect not specified
Source: DDInter
Beta Blockers
Severe
Database
Antagonise inotropy; unopposed alpha → severe hypertension
Avoid; if needed titrate carefully under monitoring
Source: Kimi deep-research + Cla
Doxepin
Severe
Database
Clinical effect not specified
Source: DDInter
Imipramine
Severe
Database
Clinical effect not specified
Source: DDInter
Linezolid
Severe
Database
.
Source: DDInter
Maois
Severe
Database
Potentiated pressor/arrhythmic response
Avoid; great caution
Source: Kimi deep-research + Cla
Nortriptyline
Severe
Database
Clinical effect not specified
Source: DDInter
Protriptyline
Severe
Database
Clinical effect not specified
Source: DDInter
Trimipramine
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Ask House about Dobutamine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19