Response to dopamine vs norepinephrine in tricyclic antidepressant- induced hypotension

T. Paul Tran, Edward A Panacek, Kenneth J. Rhee, Garrett E. Foulke

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: To compare the efficacy of dopamine (DA) with that of norepinephrine (NE) in the treatment of refractory hypotension caused by tricyclic antidepressants (TCAs). Methods: A retrospective analysis was used to compare blood pressure responses in concurrent case series of patients treated with vasopressors for TCA-associated hypotension. The patients were adults (aged ≤16 years) treated at 2 urban teaching hospitals from 1983 to 1994. All patients were diagnosed as having TCA ingestion (positive serum toxicologic assay), were hypotensive [systolic blood pressures (SBPs) ≤90 mm Hg], and required vasopressor therapy. The patients were grouped by initial vasopressor treatment (i.e., NE vs DA). Results: There were 26 hypotensive adult patients who met study criteria. All 26 patients remained hypotensive after initial treatment of their TCA-associated hypotension with crystalloid infusion and alkalinization. The NE and DA groups were similar in age, sex, and proportion of patients with single and co-drug ingestion. The NE group, however, had a significantly lower average SBP at study entry (56 vs 74 mm Hg, p = 0.04). Nine of 15 (60%) patients responded to DA (5-10 μg/kg/min) and 11/11 (100%) patients responded to NE (5-53 μg/min). The difference in response rates was statistically significant (p = 0.02). Six patients in whom DA (max rate 10-50 μg/min/kg) failed to raise the SBP subsequently responded to NE (max rate 5-74 μg/ min) when this drug was later used. One patient receiving NE (12 μg/min) developed ventricular ectopy, successfully treated with lidocaine. There were no ischemic complications from either NE or DA. Patients who failed DA therapy tended to be older (39 vs 30 years, p = 0.08), to be more hypotensive at study entry (64 vs 81 mm Hg, p = 0.008), and to remain hypotensive even at higher doses of DA (24 vs 7 μg/min/kg, p = 0.002). Conclusion: While this was not a prospective randomized study, NE appears advantageous over DA as the first-line vasopressor agent for those patients who require vasopressor support in the setting of TCA-induced hypotension that is refractory to IV fluid and serum alkalinization.

Original languageEnglish (US)
Pages (from-to)864-868
Number of pages5
JournalAcademic Emergency Medicine
Volume4
Issue number9
StatePublished - Sep 1997

Fingerprint

Controlled Hypotension
Tricyclic Antidepressive Agents
Dopamine
Norepinephrine
Blood Pressure
Hypotension
Eating
Therapeutics
Urban Hospitals
Vasoconstrictor Agents
Lidocaine
Serum
Teaching Hospitals

Keywords

  • Cyclic antidepressant
  • Hypotension
  • Overdose
  • TCA
  • Treatment
  • Tricyclic andepressant
  • Vasopressor

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Response to dopamine vs norepinephrine in tricyclic antidepressant- induced hypotension. / Tran, T. Paul; Panacek, Edward A; Rhee, Kenneth J.; Foulke, Garrett E.

In: Academic Emergency Medicine, Vol. 4, No. 9, 09.1997, p. 864-868.

Research output: Contribution to journalArticle

Tran, T. Paul ; Panacek, Edward A ; Rhee, Kenneth J. ; Foulke, Garrett E. / Response to dopamine vs norepinephrine in tricyclic antidepressant- induced hypotension. In: Academic Emergency Medicine. 1997 ; Vol. 4, No. 9. pp. 864-868.
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abstract = "Objective: To compare the efficacy of dopamine (DA) with that of norepinephrine (NE) in the treatment of refractory hypotension caused by tricyclic antidepressants (TCAs). Methods: A retrospective analysis was used to compare blood pressure responses in concurrent case series of patients treated with vasopressors for TCA-associated hypotension. The patients were adults (aged ≤16 years) treated at 2 urban teaching hospitals from 1983 to 1994. All patients were diagnosed as having TCA ingestion (positive serum toxicologic assay), were hypotensive [systolic blood pressures (SBPs) ≤90 mm Hg], and required vasopressor therapy. The patients were grouped by initial vasopressor treatment (i.e., NE vs DA). Results: There were 26 hypotensive adult patients who met study criteria. All 26 patients remained hypotensive after initial treatment of their TCA-associated hypotension with crystalloid infusion and alkalinization. The NE and DA groups were similar in age, sex, and proportion of patients with single and co-drug ingestion. The NE group, however, had a significantly lower average SBP at study entry (56 vs 74 mm Hg, p = 0.04). Nine of 15 (60{\%}) patients responded to DA (5-10 μg/kg/min) and 11/11 (100{\%}) patients responded to NE (5-53 μg/min). The difference in response rates was statistically significant (p = 0.02). Six patients in whom DA (max rate 10-50 μg/min/kg) failed to raise the SBP subsequently responded to NE (max rate 5-74 μg/ min) when this drug was later used. One patient receiving NE (12 μg/min) developed ventricular ectopy, successfully treated with lidocaine. There were no ischemic complications from either NE or DA. Patients who failed DA therapy tended to be older (39 vs 30 years, p = 0.08), to be more hypotensive at study entry (64 vs 81 mm Hg, p = 0.008), and to remain hypotensive even at higher doses of DA (24 vs 7 μg/min/kg, p = 0.002). Conclusion: While this was not a prospective randomized study, NE appears advantageous over DA as the first-line vasopressor agent for those patients who require vasopressor support in the setting of TCA-induced hypotension that is refractory to IV fluid and serum alkalinization.",
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AU - Panacek, Edward A

AU - Rhee, Kenneth J.

AU - Foulke, Garrett E.

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N2 - Objective: To compare the efficacy of dopamine (DA) with that of norepinephrine (NE) in the treatment of refractory hypotension caused by tricyclic antidepressants (TCAs). Methods: A retrospective analysis was used to compare blood pressure responses in concurrent case series of patients treated with vasopressors for TCA-associated hypotension. The patients were adults (aged ≤16 years) treated at 2 urban teaching hospitals from 1983 to 1994. All patients were diagnosed as having TCA ingestion (positive serum toxicologic assay), were hypotensive [systolic blood pressures (SBPs) ≤90 mm Hg], and required vasopressor therapy. The patients were grouped by initial vasopressor treatment (i.e., NE vs DA). Results: There were 26 hypotensive adult patients who met study criteria. All 26 patients remained hypotensive after initial treatment of their TCA-associated hypotension with crystalloid infusion and alkalinization. The NE and DA groups were similar in age, sex, and proportion of patients with single and co-drug ingestion. The NE group, however, had a significantly lower average SBP at study entry (56 vs 74 mm Hg, p = 0.04). Nine of 15 (60%) patients responded to DA (5-10 μg/kg/min) and 11/11 (100%) patients responded to NE (5-53 μg/min). The difference in response rates was statistically significant (p = 0.02). Six patients in whom DA (max rate 10-50 μg/min/kg) failed to raise the SBP subsequently responded to NE (max rate 5-74 μg/ min) when this drug was later used. One patient receiving NE (12 μg/min) developed ventricular ectopy, successfully treated with lidocaine. There were no ischemic complications from either NE or DA. Patients who failed DA therapy tended to be older (39 vs 30 years, p = 0.08), to be more hypotensive at study entry (64 vs 81 mm Hg, p = 0.008), and to remain hypotensive even at higher doses of DA (24 vs 7 μg/min/kg, p = 0.002). Conclusion: While this was not a prospective randomized study, NE appears advantageous over DA as the first-line vasopressor agent for those patients who require vasopressor support in the setting of TCA-induced hypotension that is refractory to IV fluid and serum alkalinization.

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