od pressure appear to be more frequent and intense in children. Pulmonary wedge pressure may not decrease in children, as it does in adults, or it may actually increase, especially in infants less than one year old. The neonate cardiovascular system has been reported to be less sensitive to dobutamine and hypotensive effect seems to be more often observed in adult patients than in small children.
Accordingly the use of dobutamine in children should be monitored closely, bearing in mind these pharmacodynamic characteristics.
4.5 Interaction with other medicinal products and other forms of interaction
Alpha-blockers: Potential for hypotension and tachycardia to occur with concomitant administration of sympathomimetics and alpha-blockers such as phenoxybenzamine.
Anaesthetics: Although it is less likely than adrenaline to produce ventricular arrhythmias, dobutamine should be used with extreme caution during anaesthesia with cyclopropane, halothane and other halogenated anaesthetics.
Anti-arrhythmics: An increased risk of arrhythmias may occur if sympathomimetic agents are given to patients receiving quinidine.
Antidepressants: Hypertension and an increased risk of arrhythmias may occur if sympathomimetic agents are given to patients receiving tricyclic antidepressants. Many sympathomimetics interact with MAOIs (possibility of hypertensive crisis), and should not be given to patients receiving such treatment or within 14 days of its termination.
Antihypertensives: Special care is advisable in patients receiving antihypertensive therapy in whom dobutamine may increase blood pressure.
Beta-blockers: The inotropic effects of dobutamine on the heart are reversed by concomitant administration of beta-blockers. Dobutamine may be ineffective or may have a slight vasoconstricting effect in patients who have recently received beta-blockers. There is a possibility of severe hypertension and bradycardia occurring with concurrent use of dobutamine and beta-blockers, especially non-selective beta-blockers.
Calcium Chloride: Calcium chloride infusion may reduce the cardiotonic effects of dobutamine.
Cardiac Glycosides: An increased risk of arrhythmias may occur if sympathomimetic agents are given to patients receiving cardiac glycosides.
Cimetidine: It is possible that cimetidine may inhibit the uptake and/or the metabolism of dobutamine by the liver with a subsequent increase in the degree and duration of its action.
Doxapram: An increased risk of hypertension with concomitant use of the sympathomimetic agents and doxapram.
Entacapone: The effects of dobutamine may be enhanced by concomitant administration of entacapone.
Ergot Alkaloids: Potential for ergotism to occur with concomitant administration of sympathomimetics and ergotamine or egometrine (ergonovine) or methysergide. There is a possibility of ergotamine or egometrine (ergonovine) enhancing the pressor effect and severe hypertension occurring.
Oxytocin: There is a possibility of oxytocin enhancing the pressor effects of sympathomimetics with or without hypertension.
Rasagiline: Avoid concomitant use of sympathomimetics with rasagiline.
4.6 Pregnancy and lactation
Studies in rats and rabbits have revealed no evidence of a teratogenic effect of dobutamine. There are no adequate studies in human pregnancy and therefore dobutamine should not be used without very careful cons
