Indication
Decompensated heart failure, RV failure, post-cardiac surgery low CO.
Preparation
20 mg in 100 mL D5W (200 mcg/mL).
Dilution
20 mg / 100 mL → 200 mcg/mL
Rate
Loading 50 mcg/kg over 10 min (often omitted); maintenance 0.375–0.75 mcg/kg/min.
Monitoring
- • Continuous BP (hypotension common)
- • ECG (arrhythmia)
- • Platelets
- • Renal function
Common errors
- • Failing to renally dose in AKI/CKD
- • Concurrent β-blocker without dose review
Pearls
- • Pulmonary vasodilator — useful in RV failure
- • Loading dose causes hypotension — start maintenance only if BP marginal
