In this episode, I’ll discuss the effect of beta-blocker therapy on dobutamine.
Dobutamine is an inotropic agent useful in the treatment of decompensated heart failure. Part of dobutamine’s action is on beta 1 and beta 2 receptors and therefore concomitant beta-blocker therapy can be expected to blunt a patient’s hemodynamic response to dobutamine.
A randomized trial attempted to quantify the effects of metoprolol or carvedilol on the hemodynamic response to dobutamine compared with a phosphodiesterase inhibitor.
The authors found that metoprolol treatment decreased the magnitude of mean pulmonary artery pressure (PAP) and pulmonary wedge pressure (PWP) decline during dobutamine infusion but had no effect on other hemodynamic parameters. The interaction was more significant with carvedilol as treatment abolished the increase in heart rate, stroke volume index, and cardiac index and caused a rise, rather than a decline, in PAP, PWP, systemic vascular resistance, and pulmonary vascular resistance during dobutamine infusion.
While beta-blocker use is not an absolute contraindication to dobutamine therapy, if inotropic effects are desired, consider whether concomitant beta-blocker therapy will render dobutamine less effective than a phosphodiesterase inhibitor such as milrinone.
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