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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Dopexamine hydrochloride is a novel compound with properties of DA1-dopaminergic and beta 2-adrenergic receptor agonism and neuronal noradrenaline uptake inhibition. It has been shown to produce beneficial renal and haemodynamic effects in patients with severe heart failure. We compared the haemodynamic effects of dopexamine (0.5 to 6 micrograms/kg/min) with those of dobutamine (5 to 25 micrograms/kg/min) in 9 patients with severe congestive heart failure. The two drugs were similar in their effects at peak infusion rates: heart rate increased (dopexamine 87 +/- 17 to 100 +/- 14; dobutamine 91 +/- 18 to 103 +/- 17 min-1), cardiac index increased (dopexamine 1.7 +/- 0.5 to 2.8 +/- 1.1; dobutamine 1.8 +/- 0.5 to 3.0 +/- 1.1 l.min-1.m-2) and systemic vascular resistance decreased (dopexamine 1553 +/- 221 to 1117 +/- 432; dobutamine 1721 +/- 347 to 1280 +/- 433 dyne.s.cm-5). Neither drug affected pulmonary artery wedge pressure (dopexamine 24 +/- 6 to 22 +/- 6; dobutamine 25 +/- 9 to 24 +/- 10 mm Hg). Dopexamine had significantly lower peak effects on left ventricular stroke work index (dopexamine 20 +/- 9, dobutamine 27 +/- 15 g.m.m-2, P less than 0.05) and cardiac power output (dopexamine 0.71 +/- 0.36, dobutamine 0.93 +/- 0.46 W, P less than 0.05). These haemodynamic effects, due largely to vasodilatation but with some contributory positive inotropy, indicate that dopexamine will be useful in the acute treatment of congestive heart failure.
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PMID:Comparison of the haemodynamic effects of dopexamine and dobutamine in patients with severe congestive heart failure. 201 Feb 43

A clinical development program was initiated to identify the hemodynamic profile of activity of dopexamine hydrochloride. Studies in healthy subjects confirmed the cardiovascular activity of dopexamine hydrochloride and demonstrated its potency. Doses of 0.5 to 8 micrograms/kg/min doubled cardiac output without change in mean blood pressure, although pulse pressure did widen. In patients with stable chronic cardiac failure (mainly New York Heart Association class III), dopexamine hydrochloride (4 micrograms/kg/min) increased stroke volume 47 +/- 9%, cardiac index 64 +/- 10% and heart rate 11.7 +/- 3%. Systemic vascular resistance decreased by 42 +/- 5%. At higher doses, cardiac index increased further, but chronotropic effects became more prominent. Subsequent studies in patients recovering from cardiac surgery and studies of longer duration in patients with chronic congestive heart failure have demonstrated a similar hemodynamic profile that is sustained throughout the infusion. The renal vasodilator effects have been confirmed in both healthy subjects and patients. With all catecholamines the balance of chronotropic to inotropic or vasodilator effect is critical. Dopexamine hydrochloride (1 to 4 micrograms/kg/min) increases cardiac index by over 40% at clinically insignificant (10%) increases of heart rate.
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PMID:Clinical development of dopexamine hydrochloride (Dopacard) and an overview of its hemodynamic effects. 304 60

Dopexamine hydrochloride (Dopacard) is a new synthetic catecholamine compound, which possesses potent beta 2-adrenergic and DA1-dopaminergic agonistic properties. It is free of alpha-adrenergic activity, has no beta 1-adrenergic activity and is less potent at DA2-dopaminergic receptors than dopamine. In the present study the acute haemodynamic effects of dopexamine hydrochloride were compared to those of dobutamine and nitroprusside in 12 patients with idiopathic congestive cardiomyopathy in an open crossover study. With dopexamine hydrochloride, there were dose-dependent increases from control in cardiac output and stroke volume, decreases in blood pressure, right and left atrial pressure, systemic vascular resistance and pulmonary vascular resistance and little change in heart rate. Similar effects were seen with nitroprusside, apart from a marked increase in heart rate, and with dobutamine, except that systolic aortic blood pressure increased and there was no change in diastolic or mean pressure or pulmonary artery systolic pressure. In general, dopexamine hydrochloride produced effects between those produced by the other two treatments. This suggests that dopexamine with its combined vasodilator and inotropic action has a desirable cardiovascular profile with advantages over the beta 1-receptor agonist dobutamine and the pure vasodilator sodium nitroprusside.
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PMID:Comparison of acute haemodynamic effects of dopexamine hydrochloride, dobutamine and sodium nitroprusside in chronic heart failure. 340 66

Dopexamine hydrochloride is a new intravenous, short-acting agent with agonist activity at beta 2-adrenergic and DA1-dopaminergic receptors. The effects of dopexamine hydrochloride infusion on systemic and coronary hemodynamics, myocardial metabolism and the neuroendocrine system were evaluated in 10 patients with chronic severe congestive heart failure at baseline, at rates of 1, 2, 4 and 6 micrograms/kg/min at 15-minute intervals, and after a 1-hour infusion of the "optimal" dose. Right atrial pressure was reduced by 25% (p less than 0.01), pulmonary capillary wedge pressure by 26% (p less than 0.05), systemic vascular resistance by 44% (p less than 0.001) and pulmonary vascular resistance by 34% (p less than 0.01) after the optimal dose. Heart rate increased by 17% (p less than 0.01), rate-pressure product by 17% (p less than 0.01) and stroke volume index by 31% (p less than 0.001). There was no change in mean arterial pressure, myocardial oxygen consumption, coronary sinus blood flow, myocardial oxygen extraction or norepinephrine balance. None of the patients demonstrated net myocardial lactate production. These findings suggest that dopexamine hydrochloride improves systemic hemodynamics and cardiac performance without adversely affecting myocardial energetics or norepinephrine balance. Thus, dopexamine hydrochloride may be a useful agent for the short-term treatment of congestive heart failure.
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PMID:Dopexamine hydrochloride in chronic congestive heart failure with improved cardiac performance without increased metabolic cost. 340 96

Dopexamine hydrochloride is a novel beta 2- and dopaminergic-receptor agonist proposed for intravenous therapy in patients with congestive heart failure. To gain a clearer knowledge of its efficacy relative to other agents, intravenous infusions of dopexamine hydrochloride (4 micrograms/kg/min) and dobutamine (10 micrograms/kg/min) were administered to 10 patients with congestive heart failure (ejection fraction less than 0.4). Both agents increased stroke volume and cardiac indexes to a similar degree, and both decreased systemic vascular resistance, with a trend toward a greater decrease with dopexamine hydrochloride. Although dobutamine had no significant effect on left ventricular systolic pressure, dopexamine hydrochloride caused a decrease from 121 +/- 8 to 110 +/- 7 mm Hg (p less than 0.01). Both dobutamine and dopexamine hydrochloride increased peak rate of left ventricular pressure development (dP/dt), and there was a trend to a greater increase with dobutamine (control 1,043 +/- 102 mm Hg/s; dobutamine 1,340 +/- 142 mm Hg/s; dopexamine hydrochloride 1,213 +/- 120 mm Hg/s, p = 0.067 vs dobutamine). Plasma norepinephrine levels increased only with dopexamine hydrochloride (+49%, p less than 0.05). Plasma renin activity increased with both agents (dobutamine +38%, p less than 0.06; dopexamine hydrochloride +41%, p less than 0.05). Dobutamine and dopexamine hydrochloride, therefore, improve cardiac function by way of both vasodilator and inotropic mechanisms. At the doses administered, dopexamine hydrochloride relies on a greater systemic vasodilator effect than dobutamine to achieve and increase in left ventricular performance. Increased levels of endogenous catecholamines may contribute to the increased inotropic state with dopexamine hydrochloride.
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PMID:Inotropic, vascular and neuroendocrine effects of dopexamine hydrochloride and comparison with dobutamine. 340 97

The short- and long-term hemodynamic effects of intravenous dopexamine hydrochloride (Dopacard) were studied in 12 patients with low cardiac output left ventricular heart failure. In the short-term study, a dose of 4 micrograms/kg/min produced a 60% increase in cardiac output (p less than 0.001), a 30% increase in stroke volume (p less than 0.01), a 23% increase in heart rate (p less than 0.01) and a 39% decrease in systemic vascular resistance (p less than 0.001). In the long-term study, there was a sustained hemodynamic benefit after 8 hours of dopexamine hydrochloride infusion (mean dose 3.5 micrograms/kg/min). There was a 32% increase in cardiac output (p less than 0.001), an 18% increase in stroke volume (p less than 0.05), a 12% increase in heart rate (p less than 0.001) and a 30% decrease in systemic vascular resistance (p less than 0.01). After 48 hours of dopexamine hydrochloride infusion (mean dose 3.8 micrograms/kg/min), the hemodynamic effect was significant only for cardiac output (+20%, p less than 0.05) and for systemic vascular resistance (-26%, p less than 0.01). Thus, dopexamine hydrochloride has beneficial short-term hemodynamic effects in patients with low-output left ventricular heart failure and the benefit appears to diminish with long-term infusion.
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PMID:Use of dopexamine hydrochloride in intensive care patients with low-output left ventricular heart failure. 340 98

Dopexamine hydrochloride, a new dopaminergic derivative with potent beta 2-agonist activity, was administered to 10 patients with severe congestive heart failure. Initially, the drug was infused at increasing dosage to achieve a maximal tolerated dose and then titrated to maintain acceptable clinical parameters over the next 48 to 72 hours. Cardiac index increased significantly during the initial titration and at peak effect. Tolerance over the duration of the study was noted in most patients, although further increases in cardiac index could usually be achieved by modest increases in the infusion rate. The peak hemodynamic effect was noted at an average infusion rate of 4.8 micrograms/kg/min. Both stroke volume and stroke work indexes increased during dopexamine hydrochloride infusion in association with decreases in mean arterial, right atrial, mean pulmonary artery and pulmonary capillary wedge pressures, systemic vascular resistance and pulmonary arteriolar resistance. Cardiac output increased by 60% during the infusion and this was out of proportion to the 12% increase in heart rate at peak effect. Most of the increase in cardiac index appeared to be due to the strong vasodilatory profile of the medication producing afterload reduction, with direct inotropic and chronotropic effects contributing to a lesser degree. Drug-related side effects occurred in 4 patients and were easily controlled by down-titration. Dopexamine hydrochloride is an effective and well-tolerated sympathomimetic agent that increases cardiac index while promoting vasodilatation.
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PMID:Hemodynamic effects of dopexamine hydrochloride infusions of 48 to 72 hours' duration for severe congestive heart failure. 340 99

Dopexamine hydrochloride is a new synthetic catecholamine for intravenous use in low cardiac output states with co-existing raised systemic or pulmonary vascular resistance. Dopamine has been commonly used since several years in these situations. The drawbacks of dopamine include a vasoconstrictive effect with high infusion rates, and a marked tendency for ventricular ectopy due to the potent beta-1 adrenergic stimulation. Dopexamine hydrochloride has interesting vasodilator properties, with marked intrinsic agonist activity at beta-2 adrenoreceptors and a lesser agonist activity at dopaminergic receptors (DA1 and DA2). Its mild inotropic activity arises primarily from baroreceptor reflex stimulation with a possible contribution from direct stimulation of myocardial beta 2-adrenoreceptors. Dopexamine hydrochloride is responsible for an inhibition of neuronal re-uptake of catecholamines (uptake-1), producing an indirect stimulation of cardiac beta 1-receptors. This catecholamine has no effect at alpha 1 and alpha 2-adrenoreceptors, and only very weak and clinically insignificant beta 1-adrenoreceptor agonist activity. Dopexamine hydrochloride improves cardiac performance by a marked vasodilation and a mild inotropic activity. The specific activity at dopaminergic receptors increases cerebral, myocardial, splanchnic and renal blood flows. These haemodynamic effects are associated with an increase in diuresis and natriuresis. These benefits are achieved without side effects such as an increased myocardial oxygen consumption, although induced tachycardia may be responsible for chest pain/anginae pain in patients with ischaemic heart disease. In clinical practice, dopexamine hydrochloride is easy to use; the short plasma half-life (6 minutes in healthy volunteers and 11 minutes in patients with low cardiac output) allows a rapid return to pretreatment status at discontinuation of the infusion. Preliminary studies have shown that dopexamine hydrochloride can produce beneficial effects in patients with acute heart failure or with compromised left ventricular function following cardiac surgery. The drug has also been assessed in patients with septic shock, most often in association with dopamine or norepinephrine. In these patients, dopexamine produces a dose-related increase in cardiac index, stroke volume, heart rate and a decrease in systemic vascular resistance. Its use in this indication must be cautious, particularly in patients with hypotension or decreased venous return. Comparative therapeutic trials are clearly required to establish the efficiency and tolerance of dopexamine hydrochloride in comparison with dopamine and dobutamine, before its place in therapy can fully be defined.
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PMID:[Dopexamine: a new dopaminergic agonist]. 790 85

Dopexamine hydrochloride, a synthetic dopamine analog with predominantly beta and delta agonist properties, has been shown to improve cardiac performance and renal function in adults with heart failure. This study was designed to investigate the haemodynamic and renal effects of dopexamine in children after cardiac surgery. Seven children were selected in whom a need for postoperative vasodilation after cardiac surgery was anticipated. Haemodynamics and renal function were determined under baseline conditions and during a continuous infusion of dopexamine at 2 and 6 micrograms.kg-1.min-1 for 90 minutes, the sequence being randomized for the initial dose. Cardiac output was measured by thermodilution and glomerular filtration rate (GFR) and renal plasma flow (RPF) by the clearances of inulin and para-aminohippurate respectively. Dopexamine induced a dose-related increase in cardiac index (CI) expressed as mean (SD) from 3.5 (0.7) to 3.9 (0.76) and 4.5 (0.8) l.min.-1m-2 (both P < 0.05), and in heart rate (HR) from 107 (17) to 122 (17) and 136 (17) beats.min-1 (P < 0.05). Stroke volume index (SVI) and mean systemic pressure were unchanged, but pulmonary wedge pressure decreased from 14 (3) to 11 (4) and 12 (3) mmHg (both P < 0.05). Systemic vascular resistances (SVR) decreased from 24 (7) to 20 (5) mmHg.l-1.min-1.m-2 (P < 0.05), with dopexamine 6 micrograms.kg-1.min-1. Renal blood flow (RBF) increased from 319 (113) to 441 (230) and 410 (138) ml.min-1.m-2 (both P < 0.05), GFR from 115 (32) to 142 (34) and 146 (29) ml.min-1.1.73m-2 (both P < 0.05), urine output and fractional excretion of sodium respectively from 3.12 (2) to 7.16 (8) and 7.21 (6) ml.kg-1 (both P < 0.05) and from 2.24 (1) to 4.25 (3.4) (P < 0.05) and 3.15 (3.1)% (n.s.). The fraction of CI delivered to the kidneys, the fraction of RBF filtered in the kidneys, plasma renin activity and aldosterone levels remained unchanged. In children after cardiac surgery, dopexamine increases CI at the expense of a concomitant increase in heart rate and demonstrates few selective vascular systemic or intrinsic renal actions.
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PMID:Haemodynamic and renal effects of dopexamine after cardiac surgery in children. 886 39