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Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure.
Clin Pharmacol Ther. 1997 Aug; 62(2):187-93.CP

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.

CONCLUSION

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+Show Affiliations

Department of Internal Medicine, Assaf Harofeh Medical Center, Zerifin, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9284855

Citation

Cotter, G, et al. "Increased Toxicity of High-dose Furosemide Versus Low-dose Dopamine in the Treatment of Refractory Congestive Heart Failure." Clinical Pharmacology and Therapeutics, vol. 62, no. 2, 1997, pp. 187-93.
Cotter G, Weissgarten J, Metzkor E, et al. Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure. Clin Pharmacol Ther. 1997;62(2):187-93.
Cotter, G., Weissgarten, J., Metzkor, E., Moshkovitz, Y., Litinski, I., Tavori, U., Perry, C., Zaidenstein, R., & Golik, A. (1997). Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure. Clinical Pharmacology and Therapeutics, 62(2), 187-93.
Cotter G, et al. Increased Toxicity of High-dose Furosemide Versus Low-dose Dopamine in the Treatment of Refractory Congestive Heart Failure. Clin Pharmacol Ther. 1997;62(2):187-93. PubMed PMID: 9284855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased toxicity of high-dose furosemide versus low-dose dopamine in the treatment of refractory congestive heart failure. AU - Cotter,G, AU - Weissgarten,J, AU - Metzkor,E, AU - Moshkovitz,Y, AU - Litinski,I, AU - Tavori,U, AU - Perry,C, AU - Zaidenstein,R, AU - Golik,A, PY - 1997/8/1/pubmed PY - 1997/8/1/medline PY - 1997/8/1/entrez SP - 187 EP - 93 JF - Clinical pharmacology and therapeutics JO - Clin Pharmacol Ther VL - 62 IS - 2 N2 - 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. CONCLUSION: 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. SN - 0009-9236 UR - https://www.unboundmedicine.com/medline/citation/9284855/Increased_toxicity_of_high_dose_furosemide_versus_low_dose_dopamine_in_the_treatment_of_refractory_congestive_heart_failure_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0009-9236&date=1997&volume=62&issue=2&spage=187 DB - PRIME DP - Unbound Medicine ER -