Renal effects of L-DOPA in heart failure.
We examined whether low-dose L-DOPA treatment induces natriuresis and diuresis in patients with congestive heart failure who have cardiac decompensation despite treatment with digoxin, a diuretic, and an angiotensin-converting enzyme inhibitor and who respond acutely to intravenously infused dopamine. In a randomized, double-blind, placebo-controlled crossover study, 11 patients with severe congestive heart failure received L-DOPA (0.10 g, p.o., t.i.d., for 1 day and then 0.25 g, p.o., t.i.d., for 2 days after a washout period of > or = 1 day), with assessments of plasma and urinary levels of catechols, urinary volume, and sodium content, and clinical and laboratory measures of improvement of congestive heart failure. L-DOPA elicited short-term, dose-related increases in urinary volume and sodium excretion. At the 0.10-g dose, L-DOPA increased plasma L-DOPA levels and urinary L-DOPA excretion by about fivefold, whereas at the 0.25-g dose, L-DOPA increased plasma and urinary L-DOPA by >50-fold. Twenty-four-hour urinary dopamine excretion increased by about fivefold after the low dose of L-DOPA and approximately 50-fold after the high dose. The results demonstrate that oral L-DOPA treatment can produce beneficial natriuretic and diuretic effects in selected patients with congestive heart failure. The bioavailability of oral L-DOPA appears to vary with the dose. These results support findings from previous studies about beneficial cardiac functional effects of L-DOPA in patients with refractory heart failure.
Grossman
E
E
Department of Internal Medicine D, The Chaim Sheba Medical Center, Tel-Hashomer, Israel. gross-e@ultinet.co.il
Shenkar
A
A
Peleg
E
E
Thaler
M
M
Goldstein
D S
DS
D000284:Administration, Oral; D000368:Aged; D001682:Biological Availability; D002395:Catecholamines / Q000097:blood / Q000494:pharmacology; D018592:Cross-Over Studies; D004231:Diuresis / Q000187:drug effects; D004298:Dopamine / Q000096:biosynthesis*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D007980:Levodopa / Q000493:pharmacokinetics / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects*
D002395:Catecholamines; D007980:Levodopa; D004298:Dopamine