Dopamine and congestive heart failure: pharmacology, clinical use, and precautions.
It has been suggested that low dose dopamine (<5 micro g/kg/min) may have renal protective effects. There are, however, no randomized, double blind, placebo controlled studies to support these observations. The contribution of improvements in cardiac output (due to beta(1)-adrenergic stimulation) to increases in renal blood flow, independent of changes in renal vasodilation, are unclear. There is little evidence to support any dopamine induced clinically significant improvement in renal function in the presence of diuretics. Given the limited evidence of benefits of low dose dopamine, potential adverse effects need to be recognized, particularly in patients with heart failure. Low dose dopamine induces hypoxemia in patients with heart failure by impairing both gas exchange and ventilatory responses and thus could precipitate respiratory decompensation in patients being weaned from ventilators. Sleep disordered breathing is highly prevalent in heart failure patients-the effects of dopamine induced chemoreflex inhibition may prove deleterious in this condition. We therefore believe that current knowledge of the risk/benefit ratio of the use of "renal doses" of dopamine does not support its widespread use in patients with heart failure, particularly in those patients in whom respiratory function is compromised. (c)1999 by CHF, Inc.
Hypertension Clinic, Erasme Hospital, Brussels, Belgium.
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