title: Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of low-dose dopamine, high-dose furosemide, and their combination in the treatment of refractory congestive heart failure.
  
  
  METHODS
  Twenty consecutive patients with refractory congestive heart failure were randomized to receive intravenous low-dose (4 micrograms/kg/min) dopamine combined with low-dose (80 mg/day) oral furosemide (group A; n = 7), intravenous low-dose dopamine with medium-dose furosemide (5 mg/kg/day through continuous intravenous administration; group B; n = 7), or high-dose furosemide (10 mg/kg/day through continuous intravenous administration; group C; n = 6).
  
  
  RESULTS
  The three groups showed similar improvement in signs and symptoms of congestive heart failure, urinary output (2506 +/- 671 ml/24 hr, mean +/- SD) and weight loss (3.3 +/- 2.3 kg) after 72 hours of therapy. Mean arterial blood pressure (MAP) decreased by 14% +/- 8% and 15% +/- 6% in groups B and C, respectively, but increased by 4% +/- 15% in group A (p = 0.017). Renal function deteriorated significantly in groups B and C: creatinine clearance decreased by 41% +/- 23% and 42% +/- 23%, respectively, but increased by 14% +/- 35% in group A (p = 0.0074). MAP decrease was positively correlated with the decrease in creatinine clearance (r = 0.7; p = 0.0007). Patients in group B and C had more hypokalemia than group A. Two patients in group C sustained acute oliguric renal failure and one patient in group B died suddenly while sustaining severe hypokalemia.
  
  
  CONCLUSIONS
  Combined low-dose intravenous dopamine and oral furosemide have similar efficacy but induce less renal impairment and hypokalemia than higher doses of intravenous furosemide taken either alone or with low-dose dopamine. The renal impairment induced by intravenous furosemide is probably related to its hypotensive effect in patients with refractory congestive heart failure.
authors.affiliation: Department of Internal Medicine, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Cotter
authors.forename: J
authors.initials: J
authors.lastname: Weissgarten
authors.forename: E
authors.initials: E
authors.lastname: Metzkor
authors.forename: Y
authors.initials: Y
authors.lastname: Moshkovitz
authors.forename: I
authors.initials: I
authors.lastname: Litinski
authors.forename: U
authors.initials: U
authors.lastname: Tavori
authors.forename: C
authors.initials: C
authors.lastname: Perry
authors.forename: R
authors.initials: R
authors.lastname: Zaidenstein
authors.forename: A
authors.initials: A
authors.lastname: Golik
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000503:physiopathology; D000284:Administration, Oral; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004298:Dopamine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D012449:Safety; D015431:Weight Loss / Q000187:drug effects
chemical_list: D004232:Diuretics; D005665:Furosemide; D004298:Dopamine