Reassessment of dobutamine, dopamine, and milrinone in the management of acute heart failure syndromes

Melike Bayram, Leonardo De Luca, M. Barry Massie, Mihai Gheorghiade*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

202 Scopus citations


The appropriate role of intravenous inodilator therapy (inotropic agents with vasodilator properties) in the management of acute heart failure syndromes (AHFS) has long been a subject of controversy, mainly because of the lack of prospective, placebo-controlled trials and a lack of alternative therapies. The use of intravenous inodilator infusions, however, remains common, but highly variable. As new options emerge for the treatment of AHFS, the available information should be reviewed to determine which approaches are supported by evidence, which are used empirically without evidence, and which should be considered inappropriate. For these purposes, we reviewed data available from randomized controlled trials on short-term, intermittent, and long-term use of intravenous inodilator agents (dobutamine, dopamine, and milrinone) in AHFS. Randomized controlled trials failed to show benefits with current medications and suggested that acute, intermittent, or continuous use of inodilator infusions may increase morbidity and mortality in patients with AHFS. Their use should be restricted to patients who are hypotensive as a result of low cardiac output despite a high left ventricular filling pressure.

Original languageEnglish (US)
Pages (from-to)47-58
Number of pages12
JournalAmerican Journal of Cardiology
Issue number6 SUPPL.
StatePublished - Sep 19 2005

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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