Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes.
The appropriate role of intravenous inodilator therapy (inotropic agents with vasodilator properties) in the management of acute heart failure syndromes (AHFS) has long been a subject of controversy, mainly because of the lack of prospective, placebo-controlled trials and a lack of alternative therapies. The use of intravenous inodilator infusions, however, remains common, but highly variable. As new options emerge for the treatment of AHFS, the available information should be reviewed to determine which approaches are supported by evidence, which are used empirically without evidence, and which should be considered inappropriate. For these purposes, we reviewed data available from randomized controlled trials on short-term, intermittent, and long-term use of intravenous inodilator agents (dobutamine, dopamine, and milrinone) in AHFS. Randomized controlled trials failed to show benefits with current medications and suggested that acute, intermittent, or continuous use of inodilator infusions may increase morbidity and mortality in patients with AHFS. Their use should be restricted to patients who are hypotensive as a result of low cardiac output despite a high left ventricular filling pressure.
Bayram
Melike
M
Department of Medicine Residency Training Program, University of Michigan, Ann Arbor, Michigan, USA.
De Luca
Leonardo
L
Massie
M Barry
MB
Gheorghiade
Mihai
M
D000208:Acute Disease; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D020105:Milrinone / Q000627:therapeutic use; D013577:Syndrome
D002316:Cardiotonic Agents; D004280:Dobutamine; D020105:Milrinone; D004298:Dopamine