Document Detail


Outpatient dobutamine therapy: the rhyme and the riddle.
MedLine Citation:
PMID:  1613124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Advances in critical care medicine have increased survival for victims of myocardial infarction and other acute cardiac events so that increasingly patients are receiving long-term, labor-intensive, and costly medical care. Innovations in drug delivery systems and skyrocketing health care costs have fostered the growth of home health care which has blossomed into a $2.8 billion industry. There is evidence that outpatient dobutamine therapy produces definite physical and possibly psychological improvements of variable degree and duration. Hemodynamic improvements are generally associated with improvement in functional class, and the financial savings are recognizably substantial. However, three major problems confront therapies with beta-adrenergic agonists: tendency for tolerance, ventricular arrhythmias, and increased myocardial oxygen consumption. There is a dire need for establishment of exclusionary patient criteria and for risk stratification, as well as for development of a portable radionuclide nonimaging monitor. Given the current fund of knowledge, outpatient dobutamine therapy should be undertaken cautiously after meticulous patient selection reflecting an awareness of the tremendous complexities and inherent risks. The therapeutic implications are dependent on the nature of the underlying cardiomyopathy and the fact that beta-adrenergic receptor desensitization is unlikely to be overcome by progressive dosage increases. Therapy is initiated with the understanding that treatment will remain blindly empirical and conjectural in the absence of a continuous physiologic monitor and an expanded comprehension of the molecular pathophysiology of the failing ventricle.
Authors:
H L Sacher; M L Sacher; S W Landau; A Araghi; M Mene; F Dooley; K A Dietrich
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of clinical pharmacology     Volume:  32     ISSN:  0091-2700     ISO Abbreviation:  J Clin Pharmacol     Publication Date:  1992 Feb 
Date Detail:
Created Date:  1992-07-30     Completed Date:  1992-07-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0366372     Medline TA:  J Clin Pharmacol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  141-7     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Massapequa General Hospital, Seaford, LI, New York.
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MeSH Terms
Descriptor/Qualifier:
Ambulatory Care / economics
Arrhythmias, Cardiac / chemically induced
Cardiomyopathies / drug therapy,  metabolism
Dobutamine / adverse effects,  economics,  therapeutic use*
Drug Tolerance
Heart Failure / drug therapy*,  metabolism,  physiopathology
Hemodynamics / drug effects
Humans
Oxygen Consumption
Chemical
Reg. No./Substance:
34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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