USEFULNESS OF HYDRALAZINE TO WITHDRAW FROM DOBUTAMINE IN SEVERE CONGESTIVE-HEART-FAILURE

The positive inotropic agent dobutamine has become an essential component of the short-term therapy of the patient with severe, decompensated ventricular failure.1-4 Although most patients with congestive heart failure may be managed with oral therapy after hemodynamic stabilization with dobutamine, a significant proportion of patients do not tolerate withdrawal of this agent. Because effective oral positive inotropic agents are not available as a substitute for dobutamine, 5 these "dobutamine dependent" patients have little therapeutic option other than commitment to intravenous therapy for an indefinite period of time, generally in the in-hospital setting. Therefore, vasodilating compounds constitute the only remaining alternative form of therapy to replace intravenous dobutamine. Among these agents, hydralazine possesses properties that suggest that it may be the most suitable in assisting withdrawal from the inotropic support provided by dobutamine. 6-8 We, therefore, tested the hypothesis that oral administration of hydralazine with dose titration guided by hemodynamic monitoring will facilitate successful withdrawal of dobutamine in patients who have become dependent on this positive inotropic agent. © 1991.