Fenoldopam, A Selective Dopamine-1 Receptor Agonist, Raises Intraocular Pressure in Males with Normal Intraocular Pressure

Abstract

Recent studies have suggested that intravenous infusion of fenoldopam, a selective dopamine-1 receptor agonist, elevates intraocular pressure (IOP) in man. This study evaluated the effect of intravenous fenoldopam on IOP, aqueous humor outflow facility and gonioscopy in 12 healthy human subjects. Three doses (0.2, 0.5 and 1.0 microg/kg/min) were infused for 120 minutes in a double masked, placebo controlled, four-way crossover design. IOP was measured every 20 minutes in the supine position and every 40 minutes while sitting during the drug and placebo infusions. Tonography and gonioscopy were performed at baseline and after 120 minutes of infusion. Compared to placebo, IOP increased by 3.5 mm Hg (32%) for the lowest dose, 5.8 mm Hg (46%) for the intermediate dose, and 6.9 mm Hg (55%) for the highest dose (p<0.05 for all three doses). IOP returned to baseline within 30 minutes of stopping the infusion. The outflow facility decreased from baseline by 26% after 120 minutes of infusion for all drug doses. In contrast, outflow facility increased from baseline by 11% during placebo infusion. Compared to placebo, the fenoldopam induced changes in outflow were statistically significant (p<0.05). There was no change in the gonioscopic appearance of the anterior chamber angle during the infusion. This study shows that systemic administration of a selective dopamine-1 receptor agonist causes a significant dose-dependent increase in IOP that can be explained in part by diminished outflow facility. These results support a role for the dopamine-1 receptor in the modulation of IOP in general and suggest modulation of aqueous humor outflow by dopaminergic receptors.

Fenoldopam — A Selective Peripheral Dopamine-Receptor Agonist for the Treatment of Severe Hypertension

“…75 The increase in intraocular pressure induced by fenoldopam has been attributed, at least in part, to diminished drainage of aqueous humor. 76 Fenoldopam also increases the intraocular pressure in patients with ocular hypertension, and the increase may be more marked than in patients with normal intraocular pressure. 77 Fenoldopam should therefore be given cautiously, if at all, in patients with glaucoma or high intraocular pressure.…”

Role of Dopaminergic Receptors in Glaucomatous Disease Modulation

“…Subsequently, it was confirmed that the stimulation by fenoldopam could alter the outflow of the aqueous humor increasing IOP [31]. …”

Effect of Intravenous Droperidol on Intraocular Pressure and Retrobulbar Hemodynamics

“…However, for nearly two decades evidence has accumulated that alterations of dopamine activity in the eye will alter the intraocular presure (3,5). Dopamine receptor subtypes 1 and 2 have apparently independent effects upon the IOP, D1 agonists elevating IOP by blocking aqueous outflow facility (4,6,15), while D1 antagonists decrease IOP presumably via a similar mechanism (5). The D2 receptor system provides actions converse to the D1 system: D2 agonists, like D1 antagonists, reduce IOP (3).…”