Dumin is a medication form of a substance that occurs naturally in the body. It works by improving the pumping strength of the heart and improves blood flow to the kidneys.
Dumin injection (Intropin) is used to treat certain conditions, such as low pressure, that occur when you are in shock, which may be caused by heart attack, trauma, surgery, heart failure, kidney failure, and other serious medical conditions.
Dumin may also be used for purposes not listed in this medication guide.
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or Dumin is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of Dumin. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Dumin Hydrochloride in 5% Dextrose Injection USP is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarctions, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation as in congestive heart failure.
Where appropriate, restoration of blood volume with a suitable plasma expander or whole blood should be instituted or completed prior to administration of Dumin.
Patients most likely to respond adequately to administration of Dumin are those in whom physiological parameters such as urine flow, myocardial function, and blood pressure, have not undergone profound deterioration. Multiclinic trials indicate that the shorter the time interval between onset of signs and symptoms and initiation of therapy with volume correction and Dumin, the better the prognosis.
Poor Perfusion of Vital Organs - Urine flow appears to be one of the diagnostic signs by which adequacy of vital organ perfusion can be monitored. Nevertheless, the physician should also observe the patient for signs of reversal of confusion or comatose condition. Loss of pallor increase in toe temperature, and/or adequacy of nail bed capillary filling may also be used as indices of adequate dosage. Clinical studies have shown that when Dumin is administered before urine flow had diminished to levels approximately 0.3 mL/minute, prognosis is more favorable.
Nevertheless, in a number of oliguric or anuric patients, administration of Dumin has resulted in an increase in urine flow which in some cases reached normal levels. Dumin may also increase urine flow in patients whose output is within normal limits and thus may be of value in reducing the degree of pre-existing fluid accumulation. It should be noted that at doses above those optimal for the individual patient, urine flow may decrease, necessitating reduction of dosage. Concurrent administration of Dumin and diuretic agents may produce an additive or potentiating effect.
Low Cardiac Output - Increased cardiac output is related to Dumin’s direct inotropic effect on the myocardium. Increased cardiac output at low or moderate doses appears to be related to a favorable prognosis. Increase in cardiac output has been associated with either static or decreased systemic vascular resistance (SVR). Static or decreased SVR associated with low or moderate increments in cardiac output is believed to be a reflection of differential effects on specific vascular beds with increased resistance in peripheral beds (e.g., femoral) and concomitant decreases in mesenteric and renal vascular beds. Redistribution of blood flow parallels these changes so that an increase in cardiac output is accompanied by an increase in mesenteric and renal blood flow. In many instances the renal fraction of the total cardiac output has been found to increase. Increase in cardiac output produced by Dumin is not associated with substantial decreases in systemic vascular resistance as may occur with isoproterenol.
Hypotension - Hypotension due to inadequate cardiac output can be managed by administration of low to moderate doses of Dumin, which have little effect on SVR. At high therapeutic doses, Dumin’s alpha adrenergic activity becomes more prominent and thus may correct hypotension due to diminished SVR. As in the case of other circulatory decompensation states, prognosis is better in patients whose blood pressure and urine flow have not undergone profound deterioration. Therefore, it is suggested that the physician administer Dumin as soon as a definite trend toward decreased systolic and diastolic pressure becomes evident.
How should I use Dumin?
Use Dumin as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Dumin is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Dumin at home, carefully follow the injection procedures taught to you by your health care provider.
If Dumin contains particles or is discolored (darker than slightly yellow), or if the vial is cracked or damaged in any way, do not use it.
Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.
If you miss a dose of Dumin, contact your doctor right away.
Ask your health care provider any questions you may have about how to use Dumin.
Uses of Dumin in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Use: Labeled Indications
Hemodynamic support: Adjunct in the treatment of shock (eg, MI, open heart surgery, renal failure, cardiac decompensation) that persists after adequate fluid volume replacement when indicated
Cardiogenic shock: To maintain systemic perfusion and preserve end-organ performance in patients with cardiogenic shock. Vasopressor therapy is indicated in patients with hemodynamic instability (eg, systolic blood pressure <90 mm Hg or evidence of end organ hypoperfusion) or the following etiologies of cardiogenic shock: Right ventricular failure, aortic regurgitation, mitral regurgitation, ventricular septal defect after MI, or bradycardia. Note: Norepinephrine is preferred over Dumin for most of these etiologies of cardiogenic shock due to lower likelihood for causing arrhythmias. However, in the case of shock due to bradycardia or aortic regurgitation, then Dumin is preferred (ACCF/AHA [Yancy 2013], AHA [van Diepen 2017]).
Inotropic support in advanced heart failure: Bridge therapy in stage D HF unresponsive to guideline-directed medical therapy and device therapy in patients awaiting heart transplant or mechanical circulatory support; short-term management of hospitalized patients with severe systolic dysfunction presenting with low blood pressure and significantly depressed cardiac output; long-term management (palliative therapy) in select patients with stage D heart failure unresponsive to guideline-directed medical therapy and device therapy who are not candidates for heart transplant or mechanical circulatory support (ACCF/AHA [Yancy 2013]).
Sepsis and septic shock: Suggested for use as an alternative vasopressor to norepinephrine only in highly selected patients (eg, patients with low risk of tachyarrhythmias and absolute or relative bradycardia) (SCCM [Rhodes 2017]).
Off Label Uses
Heart block unresponsive to atropine or pacing; Symptomatic bradycardia
Each 5 mL ampule of solution for infusion contains Dopamine HCl (equivalent to Dumin 161.5 mg) 200 mg, sodium metabisulfite 50 mg and water for injection to make 5 mL.
Dumin HCl is 4-(2-aminoethyl) benzene-1,2-diol hydrochloride.
Dumin HCl is a naturally occurring biochemical catecholamine precursor of noradrenaline and adrenaline.
It is a white, odorless powder, freely soluble in water and soluble in alcohol. It is sensitive to light, alkalis, iron salts and oxidizing agents.
Sterile Dumin concentrate is a sterile solution of Dumin HCl in water for injection, containing 1% sodium metabisulfite. The strength supplied by DBL is 200 mg/5 mL in a clear glass ampule. The pH of the solution is approximately 4.
Generic name: Dumin HYDROCHLORIDE 80mg in 100mL, DEXTROSE MONOHYDRATE 5g in 100mL
Dosage form: injection
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Dumin Hydrochloride in 5% Dextrose Injection USP is for intravenous use only.
Dosage is to be directed by a physician.
The less concentrated 400 mcg/mL or 800 mcg/mL solutions may be preferred when fluid expansion is not a concern.
Rate of Administration — Dumin Hydrochloride in 5% Dextrose Injection USP is administered intravenously through a suitable intravenous catheter or needle. An IV drip chamber or other suitable metering device is essential for controlling the rate of flow in drops/min. Each patient must be individually titrated to the desired hemodynamic and/or renal response with Dumin: In titrating to the desired increase in systolic blood pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the hemodynamic condition is stabilized.
Administration at rates greater than 50 mcg/kg/min have safely been used in advanced circulatory decompensation states. If unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution.
When appropriate, increase blood volume with whole blood or plasma until central venous pressure is 10 to 15 cm H2O or pulmonary wedge pressure is 14 to 18 mm Hg.
Begin infusion of Dumin hydrochloride solution at doses of 2.5 mcg/kg/min in patients who are likely to respond to modest increments of heart force and renal perfusion.
In more seriously ill patients, begin infusion of Dumin hydrochloride at doses of 5 mcg/kg/min and increase gradually using 5 to 10 mcg/kg/min increments up to a rate of 20 to 50 mcg/kg/min as needed. If doses in excess of 50 mcg/kg/min are required, it is suggested that the urine output be checked frequently. Should urine flow begin to decrease in the absence of hypotension, reduction of Dumin dosage should be considered. Multiclinic trials have shown that more than 50% of the patients were satisfactorily maintained on doses of Dumin hydrochloride less than 20 mcg/kg/min. In patients who do not respond to these doses with adequate arterial pressure or urine flow, additional increments of Dumin may be employed in an effort to produce an appropriate arterial pressure and central perfusion.
Treatment of all patients requires constant evaluation of therapy in terms of blood volume, augmentation of myocardial contractility, and distribution of peripheral perfusion. Dosage of Dumin should be adjusted according to the patient’s response, with particular attention to diminution of established urine flow rate, increasing tachycardia or development of new dysrhythmias as indices for decreasing or temporarily suspending the dosage.
As with all potent intravenously administered drugs, care should be taken to control the rate of infusion so as to avoid inadvertent administration of a bolus of the drug.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Because Dumin is metabolized by monoamine oxidase (MAO), inhibition of this enzyme prolongs and potentiates the effect of Dumin. Patients who have been treated with MAO inhibitors within two to three weeks prior to the administration of Dumin HCl should receive initial doses of Dumin HCl no greater than one-tenth (1/10) of the usual dose.
Concurrent administration of Dumin HCl and diuretic agents may produce an additive or potentiating effect on urine flow.
Tricyclic antidepressants may potentiate the pressor response to adrenergic agents.
Cardiac effects of Dumin are antagonized by beta-adrenergic blocking agents, such as propranolol and metroprolol. The peripheral vasoconstriction caused by high doses of Dumin HCl is antagonized by alpha-adrenergic blocking agents. Dumin-induced renal and mesenteric vasodilation is not antagonized by either alpha- or beta-adrenergic blocking agents.
Haloperidol appears to have strong central antidopaminergic properties. Haloperidol and haloperidol-like drugs suppress the dopaminergic renal and mesenteric vasodilation induced at low rates of Dumin infusion.
Cyclopropane or halogenated hydrocarbon anesthetics increase cardiac autonomic irritability and may sensitize the myocardium to the action of certain intravenously administered catecholamines, such as Dumin. The interaction appears to be related both to pressor activity and to the beta-adrenergic stimulating properties of these catecholamines, and may produce ventricular arrhythmias. Therefore, EXTREME CAUTION should be exercised when administering Dumin HCl to patients receiving cyclopropane or halogenated hydrocarbon anesthetics. It has been reported that results of studies in animals indicated that Dumin-induced ventricular arrhythmias during anesthesia can be reversed by propranolol.
The concomitant use of vasopressors, vasoconstricting agents and some oxytocic drugs may result in severe persistent hypertension. See Labor and Delivery below.
Administration of phenytoin to patients receiving Dumin HCl has been reported to lead to hypotension and bradycardia. It is suggested that in patients receiving Dumin HCl, alternatives to phenytoin should be used if anticonvulsant therapy is needed.
Common Reactions: Adverse eactions have been observed in 19% of patients during clinical evaluation; however, only half of these were attributed to Dumin. Treatment was terminated in 5% of all patients due to adverse reactions.
Less Common Reactions: Biochemical Abnormalities: Azotemia.
Cardiovascular: Aberrant ventricular conduction, bradycardia, widened QRS complex, hypertension. Gangrene of the feet has occurred in a few patients with preexisting vascular disease. A few cases of peripheral cyanosis have been reported in patients receiving Dumin.
Nervous System: Piloerection, anxiety.
Serious or Life-Threatening Reactions: Gangrene of the feet has occurred following doses of 10-14 mcg/kg/min and higher in a few patients with preexisting vascular disease.
Fatal ventricular arrhythmias have been reported on rare occasions. Extravasation of Dumin may cause necrosis and sloughing of surrounding tissue.
If possible before you receive Dumin injection, tell your caregivers if you have pheochromocytoma (tumor of the adrenal gland).
Also tell your caregivers if you have hardened arteries, circulation problems, diabetes, frostbite, Buergers disease, asthma, sulfite allergy, or a history of blood clots.
Tell your doctor about all the prescription and over-the-counter medications you use, especially if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 21 days.
In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast feeding. Make sure any doctor caring for you afterward knows that you have received this medication.
DTP/NCI. "dopamine: The NCI Development Therapeutics Program (DTP) provides services and resources to the academic and private-sector research communities worldwide to facilitate the discovery and development of new cancer therapeutic agents.". https://dtp.cancer.gov/dtpstandard/s... (accessed September 17, 2018).
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