Low-dose dopamine and furosemide vs. high-dose furosemide in refractory congestive heart failure: Comparable efficacy and decreased toxicity

Low-dose dopamine (D) and furosemide (F) are commonly used in the treatment of refractory congestive heart failure (rCHF) yet the optimal dosage and combination are undetermined. Methods: 20 consecutive rCHF patients (Pts.) were randomized to: (1) group A (n=7) IV low-dose D (4 mcg/kg/min.) and oral F (80 mg./24 hr.). (2) group B (n=7) IV low-dose D and intermediate dose F (5 mg/kg/24 hr, given as continuous IV drip). (3) group C (n=6) high-dose F (10 mg/kg/24 hr continuous drip). Results: The 3 groups had similar diuresis and weight loss during 72 hours. Group B and C Pts. developed more hypokalemia and a significant decrease in blood pressure compared to group A. Group B and C Pts had significant deterioration in renal function: Creatinine clearance (CCT) did not change in group A compared to a decrease of 41±23% in group B and 42±23% in group C (p=0.015). A positive correlation was found between the change in blood pressure and the change in CCT(R= 0.82, p=0.00002). Two patients in group C sustained acute renal failure and one patient in group B died suddenly due to severe hypokalemia. Conclusion: In rCHF Pts. low dose IV D and oral F have similar efficacy but induce less hypokalemia and renal impairment than higher doses of IV F with or without concomitant low dose IV D.