#incomplete # Indications ## Right heart failure / pulm HTN [Dobutamine for pulm HTN](bookends://sonnysoftware.com/annotation/DL/207779/1729321998/10/-37/-189): - Dobutamine is a selective b1-agonist that increases myocardial contractility, reduces PVR and systemic vascular resistance (SVR), and improves PA/RV coupling. It is the preferred inotropic medication for patients with PH - Dobutamine is superior to vasopressors (eg, norepinephrine) alone in patients with pressure-induced right heart failure. - It is important to anticipate complications, such as systemic hypotension, secondary to dobutamine’s b2-mediated systemic vasodilatory properties. If hypotension does occur, *vasopressor* therapy should be initiated rapidly **Dose:** - In *normotensive* patients with PH with RV dysfunction, a dobutamine infusion should be initiated at *2 mcg/kg/min* and titrated to a maximum of 10 mcg/kg/min. (Often ~200mcg/min) - Infusion rates greater than 10 mcg/kg/min should be avoided, as they have been shown to increase RV afterload and produce reflexive tachycardia and are associated with an increased mortality rate.