Navigation Links
Safety data favor norepinephrine over dopamine for shock
Date:3/3/2010

ATLANTA - Physicians treating patients with shock should consider norepinephrine instead of dopamine as a tool for stabilizing blood pressure, according to an editorial in the March 4, 2010, issue of the New England Journal of Medicine (NEJM).

Jerrold Levy, MD, FAHA, professor and deputy chair for research, Department of Anesthesiology, Emory University School of Medicine, and co-director of cardiothoracic anesthesiology, Emory Healthcare, authored the editorial.

The editorial accompanies a report in the same issue of NEJM on a European clinical trial evaluating dopamine and norepinephrine in shock patients. The randomized trial, led by Daniel De Backer, MD, PhD, at Erasme University Hospital in Belgium, compared 28-day mortality in 1679 patients treated for shock with dopamine or norepinephrine in Austria, Belgium and Spain between 2003 and 2007.

"Dopamine has been commonly used as a first-line therapy for shock at many hospitals for years, partially because of the widespread perception that norepinephrine is associated with adverse events," Levy says. "The current study supports the concept that shock from any cause carries a high risk of death, and raises significant concerns about the safety of dopamine."

Shock, or dangerously low blood pressure, can occur as a result of sepsis (severe inflammation resulting from bacterial infection), heart failure (cardiogenic), hemorrhage (severe blood loss) or anaphylaxis. Most of the patients (62.2 percent) in the European trial had septic shock, 16.7 percent had heart failure and 15.7 percent hemorrhage.

The authors of the clinical study reported no overall difference in death rates at 28 days. However, heart arrhythmias were almost twice as common in the dopamine group (24.1 percent vs 12.4 percent) and mortality was higher for patients with cardiogenic shock treated with dopamine.

A previous observational study showed that dopamine's use in intensive care units added to the risk of death, and rapid heart rate is known to be a frequent side effect of dopamine, Levy notes.

Norepinephrine has been used to stabilize patients' blood pressure during cardiac and non cardiac surgery, and in intensive care units after surgery. Vasopressin, although not studied in the European clinical trial, is also a viable alternative treatment for shock, Levy says.

The hormones dopamine and norepinephrine have functions in the brain, helping neurons communicate, as well as in the body to maintain vascular tone. In an emergency situation, they both can increase blood pressure by constricting blood vessels. Dopamine is the precursor to norepinephrine in the sympathetic nervous system, and thus acts indirectly.

"The data challenge consensus guidelines that recommend dopamine as the initial vasopressor for increasing arterial pressure in the case of septic shock or cardiogenic shock," Levy writes in the editorial.

"In addition, norepinephrine needs to be considered as an initial therapeutic agent for patients in circulatory shock. The results of the study by De Backer et al should also put an end to the outdated view that the use of norepinephrine increases the risk of death."


'/>"/>

Contact: Lance Skelly
lskelly@emory.edu
404-686-8538
Emory University
Source:Eurekalert

Related medicine news :

1. FDA, FSIS, CDC Collaborate on Methods to Measure Success of Food Safety Programs
2. MainStreet MD Launches Personal Safety Solutions for Children and Seniors Built On SensorLogic's Cloud Computing Platform
3. Brain Injury Association of Washington Provides National Leadership in Concussion Safety & Awareness
4. Occupational Health Expert Expands PureSafety's Growing Strategic Resources Team
5. Surgical Information Systems Introduces SIS OR View to Maximize Communication and Improve Patient Safety in the Operating Room
6. Food Safety Attorney Fred Pritzker Calls on Food Retailers to Keep Precise Beef Handling Records
7. American Stroke Association Late-Breaking Science Report: Surgery, Stenting to Open Blocked Neck Arteries Similar in Safety, Efficacy, But Show Differences in Stroke, Heart Attack and Death Rates at Certain Ages
8. Toyota Recalls Raise Awareness of Vehicle Safety Issues, Risks of Accidents from Driving Defective Automobiles
9. The Coalition for Vaccine Safety Calls for Congressional Hearings on Federal Agencies Failure to Provide Adequate Safety Research
10. Bitrex Bitter Safety Additive Exhibiting at the Safe Kids Fair 2010; Making a Bitter Face to Learn about Poisoning Prevention
11. Tests to Measure Safety of Anti-Clotting Drugs of Limited Value
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/5/2016)... ... 05, 2016 , ... The event is being held on April 7, 2016 ... Minn. Triumph Over Parkinson’s will fund nearly $100,000 for research for the care and ... Parkinson’s disease and is the architect of this informative event to raise awareness and ...
(Date:2/5/2016)... ... February 05, 2016 , ... Looking for a last-minute ... at the tips of your toes. Foot massage, whether administered by a professional masseuse ... and relaxation. The American Board of Multiple Specialties in Podiatry (ABMSP) has ...
(Date:2/5/2016)... ... 2016 , ... The Lymphoma Research Foundation (LRF) – the ... the lymphoma community through a comprehensive series of education programs, outreach initiatives and ... Event at the La Gorce Country Club in Miami Beach on March 15, ...
(Date:2/5/2016)... Grants Pass, OR (PRWEB) , ... February 05, 2016 , ... ... though, with modern technology, such water may be safer than regular municipal or well ... water advocate and radio host Sharon Kleyne, could go a long way toward increasing ...
(Date:2/5/2016)... ... February 05, 2016 , ... Boar’s Head Brand®, one ... time for this weekend’s Big Game. Take the stress out of your party preparation ... your guests happy at every stage of the game. , “The key to hosting ...
Breaking Medicine News(10 mins):
(Date:2/4/2016)... 4, 2016  Edwards Lifesciences Corporation (NYSE: EW ... heart disease and critical care monitoring, announced today that ... agreement with Morgan Stanley & Co. LLC to repurchase ... part of the Company,s previously authorized program to repurchase ... --> --> ...
(Date:2/4/2016)... Wegener Polyangiitis - Pipeline Review, H2 ... Polyangiitis - Pipeline Review, H2 2015, provides an ... This report provides comprehensive information on the therapeutic ... at various stages, therapeutics assessment by drug target, ... and molecule type, along with latest updates, and ...
(Date:2/4/2016)... Feb. 4, 2016  Omnicell, Inc. (NASDAQ: OMCL ), ... to healthcare systems, today announced results for its fiscal ... --> --> GAAP results: Revenue ... up $5.1 million or 4.1% from the third quarter ... the fourth quarter of 2014. Revenue for the year ...
Breaking Medicine Technology: