Vasopressin as an alternative to norepinephrine in the treatment of milrinone-induced hypotension.
OBJECTIVE
To determine whether vasopressin could be effective in treating the hypotension associated with phosphodiesterase III inhibition. Phosphodiesterase III inhibitors are cardiotonic agents that increase myocardial contractility and decrease vascular smooth muscle tone. The vasodilatory effect can be profound, and the resulting hypotension frequently requires the administration of catecholamine pressors.


METHODS
Retrospective analysis of existing data.


METHODS
The medical or surgical intensive care unit of Columbia-Presbyterian Medical Center.


METHODS
Three consecutive patients receiving milrinone and requiring catecholamine pressors to maintain systolic arterial pressure of > or =90 mm Hg.


METHODS
Vasopressin was administered to the three patients.


RESULTS
Vasopressin (0.03-0.07 units/min) increased systolic arterial pressure from 90+/-4.7 to 130+/-2.3 mm Hg while reducing the administration of catecholamine pressors.


CONCLUSIONS
Vasopressin at very low doses appears to be an effective vasopressor for milrinone-induced hypotension.
Gold
J A
JA
Department of Medicine, Columbia University, New York, NY, USA.
Cullinane
S
S
Chen
J
J
Oz
M C
MC
Oliver
J A
JA
Landry
D W
DW
D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D017809:Fatal Outcome; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy*; D008297:Male; D020105:Milrinone / Q000009:adverse effects*; D008943:Mitral Valve; D009638:Norepinephrine / Q000627:therapeutic use*; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects*; D011184:Postoperative Period; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D010726:Phosphodiesterase Inhibitors; D014662:Vasoconstrictor Agents; D014667:Vasopressins; D020105:Milrinone; D009638:Norepinephrine