Journal article
Beneficial Hemodynamic Effects of Oral Levodopa in Heart Failure: Relation to the Generation of Dopamine
The New England journal of medicine, Vol.310(21), pp.1357-1362
05/24/1984
DOI: 10.1056/NEJM198405243102105
PMID: 6717507
Abstract
Among the positive inotropic drugs available to improve myocardial contractility in congestive heart failure, only digitalis glycosides are suitable for oral administration. In this study, we administered oral levodopa (1.5 to 2.0 g), which is decarboxylated to form dopamine, to 10 patients with severe congestive heart failure. Peak hemodynamic responses occurred one hour after the ingestion of levodopa, with the mean (±S.E.M.) cardiac index increasing from 1.8±0.1 to 2.4 ± 0.2 liters per minute per square meter of body-surface area (P<0.01) and systemic vascular resistance declining from 1905±112 to 1513±121 dyn • sec · cm
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(P<0.01). These effects persisted for four to six hours. Left ventricular filling pressure, heart rate, and mean arterial pressure were unchanged. Plasma concentrations of dopamine rose to a peak level of 34±5 ng per milliliter one hour after drug ingestion and decreased toward base line over the ensuing five hours. A significant correlation was observed between plasma dopamine levels and changes in cardiac index (r = 0.8; P<0.02). Five patients enrolled in a trial to evaluate the effectiveness of long-term therapy with levodopa had similar hemodynamic responses to the drug after 6.8±1.7 months of treatment. Thus, oral administration of levodopa to patients with severe heart failure produced a sustained improvement in cardiac function. The hemodynamic responses observed can be attributed to the activation of beta
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-adrenergic, dopamine
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, and dopamine
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receptors by dopamine derived from levodopa. (N Engl J Med 1984; 310:1357–62.)
IMPROVEMENT of myocardial contractility through the use of positive inotropic agents is a critical component in the management of heart failure. Unfortunately, although many drugs exert cardiotonic effects in experimental studies, few of these agents have been found to be useful in the treatment of heart failure in human beings.
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At present, the only oral positive inotropic agents available for widespread clinical use are the digitalis glycosides, and these agents have a narrow therapeutic range and a relatively high incidence of toxicity.
The administration of dopamine results in substantial improvement in the performance of the failing heart, and an oral . . .
Details
- Title: Subtitle
- Beneficial Hemodynamic Effects of Oral Levodopa in Heart Failure: Relation to the Generation of Dopamine
- Creators
- Sol I RajferAaron H AntonJames D RossenLeon I Goldberg
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.310(21), pp.1357-1362
- Publisher
- Massachusetts Medical Society
- DOI
- 10.1056/NEJM198405243102105
- PMID
- 6717507
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Language
- English
- Date published
- 05/24/1984
- Academic Unit
- Neurology; Cardiovascular Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984020988302771
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