Dopexamine in congestive heart failure: how do the pharmacological activities translate into the clinical situation?

Dopexamine is a newly developed sympathetic catecholamine which combines dopaminergic (DA-1) and beta 2-adrenergic agonist activity with only minor beta 1-adrenergic action. Thereby, this compound exerts systemic and preferential renal vasodilation, causing afterload reduction, increases in cardiac output, and improved renal perfusion in animals and normal volunteers. Short-term administration of dopexamine in congestive heart failure established beneficial effects in central hemodynamics, that is, reduction of systemic and pulmonary vascular resistance, combined with a decrease in LV-filling pressures and increased renal blood flow. The effect on central hemodynamics are comparable to sodium nitroprusside. With higher doses, however, heart rate may increase substantially with dopexamine along with increased myocardial oxygen consumption. Experiences with prolonged administration of this drug are scarce and have, so far, yielded conflicting results. Thus, dopexamine appears to be a promising agent in the short-term management of congestive heart failure. However, its ultimate value for prolonged administration remains to be established.