Dopamine Dosing in Shock

Introduction to Dopamine Use

The American College of Critical Care Medicine recommends that dopamine should not be used as a first-line vasopressor in shock, with norepinephrine being the preferred choice, and dopamine reserved for highly selected patients with absolute or relative bradycardia and low risk of tachyarrhythmias 1, 2, 3

The Society of Critical Care Medicine suggests starting dopamine at 2-5 mcg/kg/min for patients likely to respond to modest increments of heart force and renal perfusion, with dose-dependent effects including dopaminergic effects at <5 mcg/kg/min, β-adrenergic effects at 5-10 mcg/kg/min, and α-adrenergic effects at >10 mcg/kg/min 2, 4
The European Society of Intensive Care Medicine recommends targeting a mean arterial pressure (MAP) of 65 mmHg when using dopamine, with increments of 5-10 mcg/kg/min every 15-30 minutes based on hemodynamic response 1, 2

The American Heart Association advises against using dopamine as first-line therapy in septic shock, with norepinephrine being superior with fewer adverse events, and against using low-dose dopamine (<5 mcg/kg/min) for "renal protection" due to lack of benefit 1, 2, 3
The Society of Critical Care Medicine recommends gradual decrease of dopamine dose when stopping, while expanding blood volume with IV fluids, and avoiding abrupt cessation to prevent marked hypotension 2