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Dopamine...soon will be part of History

Soon Dopamine will be part of history of medicine...

This is because of  two main  reasons:

First, renal sparing low dose dopamine was disproven.

Second two big studies published in 2010 pushed Dopamine  further into darkness

The SOAP II study had 1600 patients and another one printed in Shock had 250 patients.

Both studies randomised patients in shock and in need of vasopressors to either dopamine or noradrenaline. Both made the same conclusion.

There was no significant overall difference in 28-day mortality, but the dopamine group had significantly higher incidence of arrhythmia.

The dopamine sub-group with cardiogenic shock actually did show a higher mortality compared to noradrenaline. Cardiogenic shock is exactly the group where dopamine was recommended by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines.

So as you see Dopamine is suffering to survive...this may not be the end of Dopamine,but for the time being other vasopressors like noradrenaline seems like the safest vasopressor choice in shock patients. Also – or even especially – in cardiogenic shock.


N Engl J Med. 2010 Mar 4;362(9):779-89

Shock. 2010 Apr;33(4):375-80:
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Comments

  1. arunarali144February 26, 2012 at 8:53 AM

    non-catecholamine inotropes are the best bet in cardiogenic shock along with other non-pharmacologic measures to improve preload. don't blame poor dopamine for the mishaps. it's merely poor drug selection. using a combination of dobutamine and noradrenaline may be just as good. even adrenaline works well. but non-catecholamine inotropes are very important in the management of cardiogenic shock. vasopressors only play a supportive role during initial management.

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