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Increased toxicity of high‐dose furosemide versus low‐dose dopamine in the treatment of refractory congestive heart failure
Author(s) -
Cotter Gad,
Weissgarten Jeoshua,
Metzkor Einat,
Moshkovitz Yaron,
Litinski Irena,
Tavori Uri,
Perry Chava,
Zaidenstein Ronit,
Golik Ahuva
Publication year - 1997
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1016/s0009-9236(97)90067-9
Subject(s) - furosemide , medicine , heart failure , hypokalemia , renal function , refractory (planetary science) , creatinine , urology , anesthesia , astrobiology , physics
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 μg/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. Clinical Pharmacology & Therapeutics (1997) 62 , 187–193; doi: