Neurohormonal and hemodynamic effects of ibopamine

Ibopamine is the prodrug of epinine or N-methyl dopamine. Ibopamine stimulates the DA1 and DA2 dopaminergic receptors, the beta 1 and beta 2 adrenoceptors, and the alpha 1 and alpha 2 adrenoceptors. Ibopamine has varying degrees of affinity for these various families, being the highest for the dopamine receptors and the lowest for the alpha adrenergic receptors. In the clinical setting, there is a dose-related hemodynamic and neurohormonal response. In patients with heart failure (HF), low doses appear to exert beneficial neurohormonal, hemodynamic, and renal effects, without increased inotropic effects. However, at higher doses (> 200 mg) ibopamine exerts effects that do not appear to be clinically useful in long-term treatment of chronic HF. Several small trials have suggested a benefit of ibopamine on exercise performance in patients with mild to moderate HF. On the basis of these studies, ibopamine is now being used in Europe to treat patients with mild to moderate congestive heart failure (CHF). At doses of 100 or 200 mg/t.i.d., there has been no evidence of significant safety problems. Ibopamine may have a role in the treatment of patients with more severe left ventricular dysfunction who remain symptomatic despite therapy with diuretics and angiotensin-converting enzyme (ACE) inhibitors. Preliminary data suggest the drug is well tolerated in this setting and can decrease sympathetic stimulation. Large placebo-controlled trials will assess the benefits of the optimal dose of the drug when added to ACE-inhibitor therapy, and the effect on survival.