関: dobutamine、dobutamine hydrochloride、dobutamine lactobionate、dobutamine tartrate

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/09/26 23:06:55」(JST)

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Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock. Its primary mechanism is direct stimulation of β₁ receptors of the sympathetic nervous system. Dobutamine was developed in the 1970s by Drs. Ronald Tuttle and Jack Mills at Eli Lilly and Company, as a structural analogue of isoprenaline.^[1]

Clinical uses

Dobutamine is used to treat acute but potentially reversible heart failure, such as which occurs during cardiac surgery or in cases of septic or cardiogenic shock, on the basis of its positive inotropic action.^[2]

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 myocardial oxygen demand.^{[citation needed]}

The drug is also commonly used in the hospital setting as a pharmacologic stress testing agent to identify coronary artery disease.

Adverse effects

Primary side effects include those commonly seen for β₁ active sympathomimetics, such as hypertension, angina, arrhythmia, and tachycardia. Used with caution in atrial fibrillation as it has the effect of increasing the atrioventricular (AV) conduction.^[3]

The most dangerous side effect of dobutamine is increased risk of arrhythmia, including fatal arrhythmias.

Pharmacology

Dobutamine 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.

Dobutamine is predominantly a β₁-adrenergic agonist, with weak β₂ activity, and 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 administered as a racemic mixture consisting of both (+) and (−) isomers; the (+) isomer is a potent β₁ agonist and α₁ antagonist, while the (−) isomer is an α₁ agonist.^[4] The administration of the racemate results in the overall β₁ agonism responsible for its activity. (+)-Dobutamine also has mild β₂ agonist activity, which makes it useful as a vasodilator.^[5]

References

^ Tuttle RR, Mills J (January 1975). "Dobutamine: development of a new catecholamine to selectively increase cardiac contractility". Circ Res. 36 (1): 185–96. PMID 234805. doi:10.1161/01.RES.36.1.185.
^ Rang HP, Dale MM, Ritter JM, Flower RJ. Rang and Dale's Pharmacology.
^ Shen, Howard (2008). Illustrated Pharmacology Memory Cards: PharMnemonics. Minireview. p. 6. ISBN 1-59541-101-1.
^ Parker K, Brunton L, Goodman LS, Blumenthal D, Buxton I (2008). Goodman & Gilman's manual of pharmacology and therapeutics. McGraw-Hill Medical. p. 159. ISBN 0-07-144343-6.
^ Tibayan FA, Chesnutt AN, Folkesson HG, Eandi J, Matthay MA (1997). "Dobutamine increases alveolar liquid clearance in ventilated rats by beta-2 receptor stimulation". Am. J. Respir. Crit. Care Med. 156 (2 Pt 1): 438–44. PMID 9279221. doi:10.1164/ajrccm.156.2.9609141.

UpToDate Contents

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1. 冬眠心筋の評価におけるドブタミン負荷心エコー検査 dobutamine stress echocardiography in the evaluation of hibernating myocardium
2. 成人における確定診断を得られていない低血圧やショックの評価および初期アプローチ evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock
3. 負荷心エコーの概要 overview of stress echocardiography
4. 周産期心筋症：治療および予後 peripartum cardiomyopathy treatment and prognosis
5. Management and prognosis of stress (takotsubo) cardiomyopathy

English Journal

Noninvasive assessment of myocardial bridging by coronary flow velocity reserve with transthoracic Doppler echocardiography: vasodilator vs. inotropic stimulation.

Aleksandric S1, Djordjevic-Dikic A2, Beleslin B2, Parapid B2, Teofilovski-Parapid G3, Stepanovic J2, Simic D2, Nedeljkovic I2, Petrovic M2, Dobric M2, Tomasevic M4, Banovic M2, Nedeljkovic M2, Ostojic M5.
International journal of cardiology.Int J Cardiol.2016 Dec 15;225:37-45. doi: 10.1016/j.ijcard.2016.09.101. Epub 2016 Sep 28.
BACKGROUND: To consider hemodynamic assessment of myocardial bridging (MB) adequate, it is believed that inotropic stimulation with dobutamine should be estimated because its dynamic nature depends on the degree of extravascular coronary compression. This study evaluated comparative assessment of he
PMID 27710800

Ventricular-vascular dynamics in pediatric patients with heart failure and preserved ejection fraction.

Masutani S1, Kuwata S1, Kurishima C1, Iwamoto Y1, Saiki H1, Sugimoto M1, Ishido H1, Senzaki H2.
International journal of cardiology.Int J Cardiol.2016 Dec 15;225:306-312. doi: 10.1016/j.ijcard.2016.09.118. Epub 2016 Sep 30.
OBJECTIVE: The details of the ventricular-vascular dynamics of heart failure with preserved ejection fraction (HFpEF) in children remain poorly understood. We tested the hypothesis that pediatric HFpEF patients have ventricular systolic, diastolic, and arterial stiffening at rest as well as impaired
PMID 27744267

Similar hemodynamic decongestion with vasodilators and inotropes: systematic review, meta-analysis, and meta-regression of 35 studies on acute heart failure.

Ishihara S1,2, Gayat E2,3,4, Sato N1, Arrigo M2,4,5, Laribi S2,3,6, Legrand M2,3,4, Placido R2,7, Manivet P2,8,9, Cohen-Solal A2,3,10, Abraham WT11, Jessup M12, Mebazaa A13,14,15.
Clinical research in cardiology : official journal of the German Cardiac Society.Clin Res Cardiol.2016 Dec;105(12):971-980. Epub 2016 Jun 17.
BACKGROUND: Acute heart failure (AHF) with reduced left-ventricular ejection fraction (LVEF) is often a biventricular congested state. The comparative effect of vasodilators and inotropes on the right- and/or left-sided congestion is unknown.METHODS AND RESULTS: A systematic review, meta-analysis, a
PMID 27314418

Japanese Journal

Clinical efficacy and safety of dobutamine hydrochloride: Patients' profiles.

松原義弘,林和敏,佐藤尚志,坂本亜州紀,後藤昌司,佐久間昭
臨床薬理 21(4), 703-712, 1990
… It this paper, we evaluated the clinical efficacy and safety of dobutamine hydrochloride (Dobutrex), based on the data collected as a part of postmarketing surveilance of the drug. …
NAID 130002046166

ドプラム注射薬の配合変化試験に関する研究

村瀬勢津子,落合かおり,青木路恵,朝長文弥
病院薬学 13(4), 244-260, 1987-08-20
… Mixing with following injections should be made with caution: Potacol-R Aml-U, Transamin, Digosin, Dobutrex, Bisolvon, Ketalar 10, Flavitan, Kaytwo, Ribomin-S, Neolamin 3B, Esquinon, Gripenin and Minomycin. …
NAID 110001798481

アクトシン注の配合変化

木村和哲,渡辺由美子,黒川幹夫,小野武
病院薬学 11(4), 355-358, 1985-08-20
… Preparations with unsatisfactory compatibility: Dobutrex, Neophylline Inj, Soldactone, Uronase, FOY. …
NAID 110001798093

Related Pictures

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★リンクテーブル★

リンク元	「ドブタミン」「dobutamine hydrochloride」「dobutamine lactobionate」「dobutamine tartrate」

「ドブタミン」

Dobutamine
Clinical data
Trade names	Dobutrex
Synonyms	Dobutrex, Inotrex
AHFS/Drugs.com	Monograph
MedlinePlus	a682861
Pregnancy; category	B;
Routes of; administration	Intravenous
ATC code	C01CA07 (WHO);
Legal status
Legal status	In general: ℞ (Prescription only);
Pharmacokinetic data
Biological half-life	2 minutes
Identifiers
	IUPAC name (RS)-4-(2-{[4-(4-hydroxyphenyl)butan-2-yl]amino}ethyl)benzene-1,2-diol;
CAS Number	34368-04-2 ;
PubChem CID	36811;
IUPHAR/BPS	535;
DrugBank	DB00841 ;
ChemSpider	33786 ;
UNII	0WR771DJXV;
KEGG	D03879 ;
ChEBI	CHEBI:4670 ;
ChEMBL	CHEMBL926 ;
Chemical and physical data
Formula	C18H23NO3
Molar mass	301.38 g/mol
3D model (JSmol)	Interactive image;
Chirality	Racemic mixture
	SMILES Oc1ccc(cc1O)CCNC(C)CCc2ccc(O)cc2 ;
	InChI InChI=1S/C18H23NO3/c1-13(2-3-14-4-7-16(20)8-5-14)19-11-10-15-6-9-17(21)18(22)12-15/h4-9,12-13,19-22H,2-3,10-11H2,1H3 ; Key:JRWZLRBJNMZMFE-UHFFFAOYSA-N ;
(verify)

　　[★]

英: dobutamine DOB
化: 塩酸ドブタミンドブタミン塩酸塩 dobutamine hydrochloride
商: ドブトレックス Dobutrex、ドブックス、ドブポン、ドプミン、レタメックス
関: アドレナリン受容体、強心剤

概念

比較的選択的なβ₁受容体アゴニスト
心拍出量↑、利尿作用なし

(-)isomer→α1受容体アゴニスト→昇圧

(+)isomer→α1拮抗薬

β受容体刺激作用は(+)の方が(-)より10倍高い

ラセミ体として使用することで、昇圧が軽度

作用機序

強いβ1刺激作用→陽性変力作用、陽性変時作用。弱いβ2受容体刺激作用→末梢血管拡張。総じて、一回拍出量増加。心充満圧低:ICU.258

下。動脈圧は変化しない。心仕事量と心筋酸素消費量の増加を伴う。

薬理作用

心拍出量増加。末梢血管抵抗低下。

動態

適応

左室拡張終期圧上昇時
虚血性心疾患

ICU.258

収縮期機能不全による非代償性心不全　＋　血圧正常
好ましくない：不全心筋(新仕事量やエネルギー必要量が既に高い)。非代償性心不全の急性期(→血管拡張薬の方がよい)

注意

禁忌

ICU.258

肥大型心筋症
悪性の心室性頻脈性不整脈

副作用

ICU.258

頻脈
心室性不整脈：良性のことが多い？

カテコールアミンの体循環に対する作用の比較

	α1,α2	β1	β2
	末梢血管収縮	心筋収縮増強	骨格筋・内臓末梢血管拡張	腎血管拡張
ドブタミン	+	+++	++	-
ドパミン	+++	+++	++	++(低濃度)
ノルエピネフリン	+++	+++	-	-

「dobutamine hydrochloride」

　　[★]

塩酸ドブタミン、ドブタミン塩酸塩

関: dobutamine、dobutamine lactobionate、dobutamine tartrate、Dobutrex

「dobutamine lactobionate」

　　[★]

ラクトビオン酸ドブタミン

関: dobutamine、dobutamine hydrochloride、dobutamine tartrate、Dobutrex

「dobutamine tartrate」

　　[★]

酒石酸ドブタミン

関: dobutamine、dobutamine hydrochloride、dobutamine lactobionate、Dobutrex

[1] Tuttle RR, Mills J (January 1975). "Dobutamine: development of a new catecholamine to selectively increase cardiac contractility". Circ Res. 36 (1): 185–96. PMID 234805. doi:10.1161/01.RES.36.1.185.

[rang-2] Rang HP, Dale MM, Ritter JM, Flower RJ. Rang and Dale's Pharmacology.

[pharmnemonics-3] Shen, Howard (2008). Illustrated Pharmacology Memory Cards: PharMnemonics. Minireview. p. 6. ISBN 1-59541-101-1.

[4] Parker K, Brunton L, Goodman LS, Blumenthal D, Buxton I (2008). Goodman & Gilman's manual of pharmacology and therapeutics. McGraw-Hill Medical. p. 159. ISBN 0-07-144343-6.

[5] Tibayan FA, Chesnutt AN, Folkesson HG, Eandi J, Matthay MA (1997). "Dobutamine increases alveolar liquid clearance in ventilated rats by beta-2 receptor stimulation". Am. J. Respir. Crit. Care Med. 156 (2 Pt 1): 438–44. PMID 9279221. doi:10.1164/ajrccm.156.2.9609141.

v t e Adrenergic receptor modulators
α₁	Agonists: 6-FNE Amidephrine Anisodine Buspirone Cirazoline Corbadrine Desglymidodrine Dexisometheptene Dipivefrine Dopamine Droxidopa (L-DOPS) Ephedrine Epinephrine Etilefrine Etilevodopa Ethylnorepinephrine Indanidine Isometheptene L-DOPA (levodopa) L-Phenylalanine L-Tyrosine Melevodopa Metaraminol Methoxamine Methyldopa Midodrine Naphazoline Norepinephrine Octopamine (drug) Oxymetazoline Phenylephrine Phenylpropanolamine Pseudoephedrine Synephrine Tetryzoline Tiamenidine XP21279 Xylometazoline Antagonists: Abanoquil Adimolol Ajmalicine Alfuzosin Amosulalol Anisodamine Arotinolol Atiprosin Atypical antipsychotics (e.g., brexpiprazole, clozapine, olanzapine, quetiapine, risperidone) Benoxathian Buflomedil Bunazosin Carvedilol Corynanthine Dapiprazole Domesticine Doxazosin Ergolines (e.g., ergotamine, dihydroergotamine, lisuride, terguride) Etoperidone Eugenodilol Fenspiride Hydroxyzine Indoramin Ketanserin L-765,314 Labetalol mCPP Mepiprazole Metazosin Monatepil Moxisylyte Naftopidil Nantenine Neldazosin Niaprazine Nicergoline Niguldipine Pardoprunox Pelanserin Phendioxan Phenoxybenzamine Phentolamine Phenylpiperazine antidepressants (e.g., hydroxynefazodone, nefazodone, trazodone, triazoledione) Piperoxan Prazosin Quinazosin Ritanserin Silodosin Spiperone Talipexole Tamsulosin Terazosin Tiodazosin Tolazoline Tetracyclic antidepressants (e.g., amoxapine, maprotiline, mianserin) Tricyclic antidepressants (e.g., amitriptyline, clomipramine, doxepin, imipramine, trimipramine) Trimazosin Typical antipsychotics (e.g., chlorpromazine, fluphenazine, loxapine, thioridazine) Urapidil WB-4101 Zolertine
α₂	Agonists: (R)-3-Nitrobiphenyline 4-NEMD 6-FNE Amitraz Apraclonidine Brimonidine Cannabivarin Clonidine Corbadrine Detomidine Dexmedetomidine Dihydroergotamine Dipivefrine Dopamine Droxidopa (L-DOPS) Etilevodopa Ephedrine Ergotamine Epinephrine Etilefrine Ethylnorepinephrine Guanabenz Guanfacine Guanoxabenz L-DOPA (levodopa) L-Phenylalanine L-Tyrosine Lofexidine Medetomidine Melevodopa Methyldopa Mivazerol Naphazoline Norepinephrine Oxymetazoline Phenylpropanolamine Piperoxan Pseudoephedrine Rezatomidine Rilmenidine Romifidine Talipexole Tasipimidine Tetrahydrozoline Tiamenidine Tizanidine Tolonidine Urapidil Vatinoxan XP21279 Xylazine Xylometazoline Antagonists: 1-PP Adimolol Amesergide Aptazapine Atipamezole Atypical antipsychotics (e.g., asenapine, brexpiprazole, clozapine, lurasidone, paliperidone, quetiapine, risperidone, zotepine) Azapirones (e.g., buspirone, gepirone, ipsapirone, tandospirone) BRL-44408 Buflomedil Cirazoline Efaroxan Esmirtazapine Fenmetozole Fluparoxan Idazoxan mCPP Mianserin Mirtazapine NAN-190 Olanzapine Pardoprunox Phentolamine Phenoxybenzamine Piperoxan Piribedil Rauwolscine Rotigotine SB-269970 Setiptiline Spiroxatrine Sunepitron Tolazoline Typical antipsychotics (e.g., chlorpromazine, fluphenazine, loxapine, thioridazine) Yohimbine
β	Agonists: Abediterol Alifedrine Amibegron Arbutamine Arformoterol Arotinolol BAAM Bambuterol Befunolol Bitolterol Broxaterol Buphenine Carbuterol Carmoterol Cimaterol Clenbuterol Colterol Corbadrine Denopamine Dipivefrine Dobutamine Dopamine Dopexamine Droxidopa (L-DOPS) Ephedrine Epinephrine Etafedrine Etilefrine Etilevodopa Ethylnorepinephrine Fenoterol Formoterol Hexoprenaline Higenamine Indacaterol Isoetarine Isoprenaline Isoxsuprine L-DOPA (levodopa) L-Phenylalanine L-Tyrosine Levosalbutamol Mabuterol Melevodopa Methoxyphenamine Methyldopa Mirabegron Norepinephrine Orciprenaline Oxyfedrine PF-610355 Phenylpropanolamine Pirbuterol Prenalterol Ractopamine Procaterol Pseudoephedrine Reproterol Rimiterol Ritodrine Salbutamol Salmeterol Solabegron Terbutaline Tretoquinol Tulobuterol Vilanterol Xamoterol XP21279 Zilpaterol Zinterol Antagonists: Acebutolol Adaprolol Adimolol Afurolol Alprenolol Alprenoxime Amosulalol Ancarolol Arnolol Arotinolol Atenolol Befunolol Betaxolol Bevantolol Bisoprolol Bopindolol Bornaprolol Brefonalol Bucindolol Bucumolol Bufetolol Bufuralol Bunitrolol Bunolol Bupranolol Butaxamine Butidrine Butofilolol Capsinolol Carazolol Carpindolol Carteolol Carvedilol Celiprolol Cetamolol Cicloprolol Cinamolol Cloranolol Cyanopindolol Dalbraminol Dexpropranolol Diacetolol Dichloroisoprenaline Dihydroalprenolol Dilevalol Diprafenone Draquinolol Ecastolol Epanolol Ericolol Ersentilide Esatenolol Esprolol Eugenodilol Exaprolol Falintolol Flestolol Flusoxolol Hydroxycarteolol Hydroxytertatolol ICI-118,551 Idropranolol Indenolol Indopanolol Iodocyanopindolol Iprocrolol Isoxaprolol Isamoltane Labetalol Landiolol Levobetaxolol Levobunolol Levomoprolol Medroxalol Mepindolol Metipranolol Metoprolol Moprolol Nadolol Nadoxolol Nebivolol Nifenalol Nipradilol Oxprenolol Pacrinolol Pafenolol Pamatolol Pargolol Penbutolol Pindolol Practolol Primidolol Procinolol Pronethalol Propafenone Propranolol Ridazolol Ronactolol Soquinolol Sotalol Spirendolol SR 59230A Sulfinalol Talinolol Tazolol Tertatolol Tienoxolol Tilisolol Timolol Tiprenolol Tolamolol Toliprolol Xibenolol Xipranolol
See also: Receptor/signaling modulators Dopaminergics Serotonergics Monoamine reuptake inhibitors Monoamine releasing agents Monoamine metabolism modulators Monoamine neurotoxins

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案内

案内

Dobutrex

Wikipedia preview

wiki en

Contents

Clinical uses

Adverse effects

Pharmacology

See also

References

UpToDate Contents

English Journal

Japanese Journal

Related Links

Related Pictures

★リンクテーブル★

「ドブタミン」

概念

作用機序

薬理作用

動態

適応

注意

禁忌

副作用

カテコールアミンの体循環に対する作用の比較

「dobutamine hydrochloride」

「dobutamine lactobionate」

「dobutamine tartrate」