What is Tsurudopami?
Tsurudopami 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.
Tsurudopami injection (Tsurudopami) 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.
Tsurudopami may also be used for purposes not listed in this medication guide.
Tsurudopami indications
Tsurudopami 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 Tsurudopami.
Patients most likely to respond adequately to administration of Tsurudopami 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 Tsurudopami, 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 Tsurudopami 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 Tsurudopami has resulted in an increase in urine flow which in some cases reached normal levels. Tsurudopami 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 Tsurudopami and diuretic agents may produce an additive or potentiating effect.
Low Cardiac Output - Increased cardiac output is related to Tsurudopami’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 Tsurudopami 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 Tsurudopami, which have little effect on SVR. At high therapeutic doses, Tsurudopami’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 Tsurudopami as soon as a definite trend toward decreased systolic and diastolic pressure becomes evident.
How should I use Tsurudopami?
Use Tsurudopami as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Tsurudopami is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Tsurudopami at home, carefully follow the injection procedures taught to you by your health care provider.
- If Tsurudopami 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 Tsurudopami, contact your doctor right away.
Ask your health care provider any questions you may have about how to use Tsurudopami.
Uses of Tsurudopami in details
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
Guideline recommendations:
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 Tsurudopami 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 Tsurudopami 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
Tsurudopami description
Each 5 mL ampule of solution for infusion contains Dopamine HCl (equivalent to Tsurudopami 161.5 mg) 200 mg, sodium metabisulfite 50 mg and water for injection to make 5 mL.
Tsurudopami HCl is 4-(2-aminoethyl) benzene-1,2-diol hydrochloride.
Tsurudopami 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 Tsurudopami concentrate is a sterile solution of Tsurudopami 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.
Tsurudopami dosage
Tsurudopami Dosage
Generic name: Tsurudopami 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.
Tsurudopami 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 — Tsurudopami 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 Tsurudopami: 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.
Suggested Regimen
- 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 Tsurudopami 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 Tsurudopami 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 Tsurudopami dosage should be considered. Multiclinic trials have shown that more than 50% of the patients were satisfactorily maintained on doses of Tsurudopami 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 Tsurudopami 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 Tsurudopami 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.
More about Tsurudopami (Tsurudopami)
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Professional resources
- Tsurudopami (FDA)
- Tsurudopami Hydrochloride (AHFS Monograph)
Related treatment guides
- Shock
Tsurudopami interactions
See also:
What other drugs will affect Tsurudopami?
Because Tsurudopami is metabolized by monoamine oxidase (MAO), inhibition of this enzyme prolongs and potentiates the effect of Tsurudopami. Patients who have been treated with MAO inhibitors within two to three weeks prior to the administration of Tsurudopami HCl should receive initial doses of Tsurudopami HCl no greater than one-tenth (1/10) of the usual dose.
Concurrent administration of low-dose Tsurudopami HCl and diuretic agents may produce an additive or potentiating effect on urine flow.
Tricyclic antidepressants may potentiate the cardiovascular effects of adreneric agents.
Cardiac effects of Tsurudopami are antagonized by beta-adrenergic blocking agents, such as propranolol and metoprolol. The peripheral vasoconstriction caused by high doses of Tsurudopami HCl is antagonized by alpha-adrenergic blocking agents. Tsurudopami-induced renal and mesenteric vasodilation is not antagonized by either alpha-or beta-adrenergic blocking agents.
Butyrophenones (such as haloperidol) and phenothiazines can suppress the dopaminergic renal and mesenteric vasodilation induced with low dose Tsurudopami 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 Tsurudopami. This interaction appears to be related both to pressor activity and to beta-adrenergic stimulating properties of these catecholamines and may produce ventricular arrhythmias and hypertension. Therefore, EXTREME CAUTION should be exercised when administering Tsurudopami HCl to patients receiving cyclopropane or halogenated hydrocarbon anesthetics. It has been reported that results of studies in animals indicate that Tsurudopami-induced ventricular arrhythmias during anesthesia can be reversed by propranolol.
The concomitant use of vasopressors, vasoconstricting agents (such as ergonovine) and some oxytocic drugs may result in severe hypertension.
Administration of phenytoin to patients receiving Tsurudopami HCl has been reported to lead to hypotension and bradycardia. It is suggested that in patients receiving Tsurudopami HCl, alternatives to phenytoin should be used if anticonvulsant therapy is needed.
Tsurudopami side effects
See also:
What are the possible side effects of Tsurudopami?
Common Reactions: Adverse eactions have been observed in 19% of patients during clinical evaluation; however, only half of these were attributed to Tsurudopami. Treatment was terminated in 5% of all patients due to adverse reactions.
Cardiovascular: Ectopic beats, tachycardia, anginal pain, palpitation, hypotension, vasoconstriction.
Gastrointestinal: Nausea, vomiting.
Nervous system: Headache.
Respiratory: Dyspnea.
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 Tsurudopami.
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 Tsurudopami may cause necrosis and sloughing of surrounding tissue.
Tsurudopami contraindications
See also:
What is the most important information I should know about Tsurudopami?
If possible before you receive Tsurudopami 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.
Active ingredient matches for Tsurudopami:
Dopamine in Japan.
List of Tsurudopami substitutes (brand and generic names) | Sort by popularity |
| Unit description / dosage (Manufacturer) | Price, USD |
| Kakodin D 0.1% (Japan) | |
| Kakodin D 0.3% (Japan) | |
| Martburn (Japan) | |
| Martburnl (Japan) | |
| Megadose (Argentina) | |
| Megadose Menor (Uruguay) | |
| Miocina (Mexico) | |
| Myocard (Philippines) | |
| Myocard / amp 40 mg/1 mL x 5 mL x 10's (Korea United Pharma) | |
| Myocard inj 40 mg/mL / amp 5 mL x 10 x 1's (Korea United Pharma) | |
| Myocard-DX | |
| Myocard-DX 200 mg x 250 mL | |
| Myocard-DX 400 mg x 250 mL | |
| Myocard-DX 400 mg x 500 mL | |
| Myofast (Colombia) | |
| Myomine (Bangladesh) | |
| Myotil (Hong Kong) | |
| Myotil inj 40 mg/mL 5 mL x 25 x 1's (Claris) | |
| Obamaine | |
| Obamaine 200 mg Injection (Oboi Laboratories (Ciron Drugs & Pharmaceuticals Pvt Ltd)) | $ 0.07 |
| Osdop | |
| Osdop 50 mg Injection (Oscar Remedies Pvt. Ltd.) | $ 0.57 |
| Oxytyramine | |
| Pharma-Q Dopamine (South Africa) | |
| Predopa (Japan) | |
| Predopa 200 mL | |
| Predopam (Turkey) | |
| Proinfark (Indonesia) | |
| Proinfark 20 mg x 10 mL x 5's (Phapros) | $ 17.77 |
| Rascordin (Venezuela) | |
| Redopa (Georgia) | |
| Revimine (Canada) | |
| Revivan (Brazil, Italy) | |
| Injectable; Injection; Dopamine Hydrochloride 40 mg / ml (Astrazeneca) | |
| Injectable; Injection; Dopamine Hydrochloride 80 mg / ml (Astrazeneca) | |
| Sterile Dopamin Concentrate (New Zealand, United Kingdom) | |
| Sterile Dopamine BP (New Zealand) | |
| Sterile Dopamine Conc. (Oman) | |
| Sterile Dopamine Concentrate (United Kingdom) | |
| Sterile Dopamine Concentrate Martindale (United Kingdom) | |
| Sterile Dopamine Selectajet | |
| Injectable; Injection; Dopamine Hydrochloride 4% | |
| Tensamin (Czech Republic, Slovakia) | |
| Tropin (South Korea, Taiwan) | |
| Tropin 5 mg/1 mL x 5 mL | |
| Udopa (Indonesia, Myanmar, Vietnam) | |
| Udopa 200 mg x 10 tube | |
| Udopa / amp 40 mg/1 mL x 5 mL x 10's | $ 18.29 |
| Uramin (Taiwan) | |
| Uramin 40 mg/1 mL x 5 mL x 10's | |
| Vasomine (Brazil) | |
| Yaelista (Japan) | |
| Zetarina (Mexico) | |
See 332 substitutes for Tsurudopami | |
References
- PubChem. "dopamine". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "dopamine". http://www.drugbank.ca/drugs/DB00988 (accessed September 17, 2018).
- 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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Information checked by Dr. Sachin Kumar, MD Pharmacology
