Dopamine v. Norepinephrine in Shock
Following pearl is contributed by:
TheAnh Nguyen, PharmD
UT-Austin
ahacorner@yahoo.com
Norepinephrine was as effective and safer than dopamine in a trial of 1,679 patients with shock. Used as first-line vasopressor therapy, the two agents produced these outcomes over the 28 days after randomization.
- There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group, P = 0.10)
- There were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P less than 0.001)
- A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1,044 patients with septic shock or the 263 with hypovolemic shock (P = 0.03 for cardiogenic shock, P = 0.19 for septic shock, and P = 0.84 for hypovolemic shock, in Kaplan-Meier analyses)
Mar. 4 issue of the New England Journal of Medicine (2010; 362) - link here
