Hemodynamic Effects of Ibopamine in Patients with Idiopathic Congestive Cardiomyopathy

Dei, Livio; Bolognesi, R; Cucchini, F; Fappani, A; Riva, S; Visioli, O

doi:10.1097/00005344-198303000-00014

Cited by 50 publications

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“…The short-term hemodynamic effects of single doses of ibopamine (100 and 150 mg) have been reported by other investigators.8 The magnitude of the responses was similar to that observed in our investigation, and the duration of action of the drug ranged from 26 to 5 hr. 8 Ren et al ,9 in a multiple-dose trial similar to ours, did note comparable hemodynamic changes at doses of 200 and 300 mg.…”

Section: Discussionsupporting

confidence: 80%

Effects of long-term therapy with oral ibopamine on resting hemodynamics and exercise capacity in patients with heart failure: relationship to the generation of N-methyldopamine and to plasma norepinephrine levels.

Rajfer¹,

Rossen²,

Douglas³

et al. 1986

Circulation

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N-Methyldopamine (epinine), one of the few modifications of the dopamine (DA) molecule that retains agonist activity at the DA, receptor, was administered orally as the diisobutyric ester, ibopamine (100, 200, and 300 mg), to 15 patients with congestive heart failure. An increase in cardiac index and decline in systemic vascular resistance was observed with each dose, and these hemodynamic effects persisted for 3 to 6 hr. Small transient increments in right atrial and pulmonary capillary wedge pressures occurred 0.5 hr after ingestion of 200 and 300 mg of ibopamine, but these pressures returned to baseline or lower levels within 30 min. Heart rate and mean arterial pressure were unchanged. Plasma concentrations of epinine peaked 0.5 hr after administration of drug and then declined to minimal levels at 3 hr. Ten patients enrolled in a trial to evaluate the efficacy of long-term therapy with ibopamine; after 8 weeks of treatment, the initial hemodynamic responses to the drug were attenuated and no significant improvement in oxygen uptake at peak exercise was observed. A decline in plasma norepinephrine concentrations, which could be attributed to activation of a2-adrenoceptors and/or DA2 receptors on sympathetic nerves, was observed after initial administration of ibopamine and persisted after long-term drug ingestion; no long-term hemodynamic benefit could be ascribed to the reduction in sympathetic activity. Circulation 73, No. 4, 740-748, 1986. THE ADMINISTRATION of dopamine to patients with congestive heart failure may effect an improvement in the performance of the impaired myocardium, and thus an oral formulation of this drug would be desirable. 2 The beneficial actions of dopamine in patients with heart failure have been attributed not only to a positive inotropic effect that is mediated by activation of the 8,1-adrenoceptor, but also to its agonist activity at the dopamine vascular (DA1) receptor.3 Activation of the DA1 receptor in the renal vascular bed appears primarily responsible for the marked natriuresis produced by this drug. N-Methyldopamine (epinine) is one of the few modifications of the dopamine molecule that retains full agonist activity at the DA1 receptor.4 Ibopamine is the diisobutyric ester of epinine, and after ingestion, it is hydrolyzed by plasma esterases to yield epinine.5 Initial studies have demonstrated beneficial short-term hemodynamic responses to ibopamine in patients with heart failure.-9 This investigation was undertaken to evaluate the hemodynamic actions and bioavailability of ibopamine after short-and long-term administration to patients with chronic congestive heart failure, and to assess the role of the sympathetic nervous system in modulating the hemodynamic responses to the drug.

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Section: Discussionsupporting

confidence: 80%

Effects of long-term therapy with oral ibopamine on resting hemodynamics and exercise capacity in patients with heart failure: relationship to the generation of N-methyldopamine and to plasma norepinephrine levels.

Rajfer¹,

Rossen²,

Douglas³

et al. 1986

Circulation

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“…The mechanism whereby Ib further reduced SVR appears to result both from its inotmpic action, with a consequent increase of CI and SVI, and from its direct stimulating action on the peripheral pz receptors. These findings, therefore, are consistent with those of previous works concerning Ib effects in patients with idiopathic cardiomyopathy , 1983. Regarding the effect on PAP, there is however, a par-…”

Section: Discussionsupporting

confidence: 93%

“…tial disagreement with what we observed in previous studies showing a 25-30% reduction of this parameter after Ib administration , 1983Guiha et al, 1974;Miller et al, 1976Miller et al, , 1978Stefoni et al, 198 I). It must be kept in mind, however, that the administration of a strong vasodilator agent such as NP, capable of inducing almost maximal pulmonary dilating effects, might have inhibited Ib from increasing its action.…”

Section: Discussioncontrasting

confidence: 83%

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Hemodynamic advantage of combined administration of oral ibopamine and nitroprusside in patients with ischemic and idiopathic congestive cardiomyopathy

Dei

Fappani

Riva

et al. 1985

Clinical Cardiology

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Summary: The hemodynamic efffects of combined administration of ibopamine (Ib) (150 mg orally) with nitroprusside (NP) (50-150 pg/min intravenously) were compared with those of NP alone in 17 patients with severe congestive heart failure due to coronary artery disease (7 patients) or idiopathic cardiomyopathy (10 patients). Hernodynamic measurements were obtained using a Swan-Ganz thermodilution catheter and a bedside thermodilution cardiac output computer. Nitroprusside alone produced a significant decrease (-12.4%) in mean arterial pressure, mean pulmonary arterial pressure (-28.3%), and systemic vascular resistance (-22.6%), and a significant increase in stroke volume index (23.1 %). The administration of combined NP and Ib produced a further significant increase of stroke volume index (20.1 %) with a concomitant and significant reduction of systemic vascular resistance (-19.4%); heart rate, mean systemic and pulmonary arterial pressures did not change significantly from the values observed with NP alone. Moreover, stroke work index, although not significantly modified with the vasodilator alone, was significantly increased over control values with NP+Ib association. Although NP alone induced similar effects in both the ischemic and idiopathic cardiomyopathies, the association of Ib gave a more favorable, though not significant, hemodynamic response in the subjects with primitive cardiomyopathy than in the ischemic ones. Thus, the association of Ib to NP therapy, in patients with congestive heart failure, further increases stroke volume index and stroke work index with a concomitant reduction of systemic vascular resistance, without any significant change in mean systemic and pulmonary arterial pressures, or hem rate. These results point out the possibility of associating Ib with other orally active vasodilators in the chronic treatment of congestive heart failure.

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“…Digoxin is not recommended [13] and even drugs which have both vasodilator and ino tropic properties may potentially worsen gas exchange in patients with severe chronic ob structive pulmonary disease, by worsening ventilation/perfusion mismatching [14], Ibopamine. an ester of dopamine, when given by mouth, has been shown to improve cardiac performance in patients with congestive heart failure secondary to ischaemic heart disease or idiopathic congestive cardiomvopathv [ 15,16].…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Effects of Ibopamine on the Pulmonary Circulation and Right Ventricular Performance in Patients with Chronic Obstructive Pulmonary Disease

1992

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We have studied the effects of ibopamine, an oral dopamine derivative, on pulmonary hemodynamics and blood gas values when given as a single oral dose (100 mg) to patients with severe hypoxic chronic obstructive pulmonary disease. A small but significant increase in mean pulmonary arterial pressure from 29 ± 8 to 32 ± 7 mm Hg (p < 0.01) was noted 30min after ibopamine was given associated with a small increase in cardiac index. No other consistent hemodynamic changes were observed, and no alteration in blood gas values or oxygen saturation occurred. These results do not indicate a role for ibopamine in the treatment of patients with hypoxic chronic obstructive pulmonary disease and pulmonary hypertension, but, in addition, do not indicate any major deleterious effects of ibopamine on pulmonary hemodynamics or blood gas values in such patients.

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Hemodynamic Effects of Ibopamine in Patients with Idiopathic Congestive Cardiomyopathy

Cited by 50 publications

References 0 publications

Effects of long-term therapy with oral ibopamine on resting hemodynamics and exercise capacity in patients with heart failure: relationship to the generation of N-methyldopamine and to plasma norepinephrine levels.

Effects of long-term therapy with oral ibopamine on resting hemodynamics and exercise capacity in patients with heart failure: relationship to the generation of N-methyldopamine and to plasma norepinephrine levels.

Hemodynamic advantage of combined administration of oral ibopamine and nitroprusside in patients with ischemic and idiopathic congestive cardiomyopathy

Hemodynamic Effects of Ibopamine on the Pulmonary Circulation and Right Ventricular Performance in Patients with Chronic Obstructive Pulmonary Disease

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