Sympathomimetic (Adrenergic)
PREGNANCY RECOMMENDATION: Limited Human Data—Animal Data Suggest Low Risk
BREASTFEEDING RECOMMENDATION: No Human Data—Probably Compatible
PREGNANCY SUMMARY
Although the animal data suggest low risk, the limited human pregnancy experience prevents an assessment of the embryo–fetal risk.
FETAL RISK SUMMARY
Dobutamine, an inotropic agent, is structurally related to dopamine. Reproduction studies in rats (at doses up to the normal human dose of 10 mcg/kg/min for 24 hours for a total daily dose of 14.4 mg/kg [NHD]) and rabbits (at doses up to 2 times the NHD) did not reveal any evidence of fetal harm (1).
No reports describing the placental transfer of dobutamine or studying its effects during human pregnancy have been located (see also Dopamine). The relatively low molecular weight (about 301) suggests that exposure of the embryo and fetus probably occurs. Short-term use in one patient with a myocardial infarction at 18 weeks’ gestation was not associated with any known fetal adverse effects (2).
In a 1996 abstract, eight women with severe preeclampsia who required pulmonary artery catheter monitoring were given an IV infusion of dobutamine (3). The drug was effective in improving oxygen delivery in patients with depressed left ventricular function. No mention was made of fetal effects.
A 2009 report described a pregnant woman with dilated cardiomyopathy who was treated with dobutamine starting at 22 weeks’ (4). She underwent a cesarean section at 28 weeks’ and the 830-g infant was in stable condition.
BREASTFEEDING SUMMARY
No reports describing the use of dobutamine during human lactation have been located. The relatively low molecular weight (about 301) suggests that the drug will be excreted into breast milk. The effect of this exposure on a nursing infant is unknown.
References
1.Product information. Dobutrex. Eli Lilly and Company, 2000.
2.Stokes IM, Evans J, Stone M. Myocardial infarction and cardiac arrest in the second trimester followed by assisted vaginal delivery under epidural analgesia at 38 weeks’ gestation. Case report. Br J Obstet Gynaecol 1984;91:197–8.
3.Graves C, Wheeler T, Troiano N. The effect of dobutamine hydrochloride on ventricular function and oxygen transport in patients with severe preeclampsia (abstract). Am J Obstet Gynecol 1996;174:332.
4.Cho FN. Management of pregnant women with cardiac diseases at potential risk of thromboembolism—experience and review. Int J Cardiol 2009;136:229–32.