IV Medicines for HF

Intravenous agents for treatment of heart failure. (Update soon)

Dose Onset Last Mechanism Indication Adverse reaction Comment

Nitroglycerine 5-200 mcg/min. Infusion.
Start at 5-10 mcg/min.
Increase 5-10 mcg q 5-10 min.
2-5 min 3-5 min Vasodilator Lower LA pressure.
Lower BP.
Coronary insuffeciency
Hypotension, headache, GI upset, develope tolerance Patient with CVA may increase intracranial pressure.

Nitroprusside 0.25-10 mcg/kg/min
Infusion. Start at lowest dose.
Immediate 1-2 min Vasodilator Lower BP. Lower afterload
Lower LA pressure.
Aortic dissection.
Hypotension, nausea, vomiting, muscle twitching, cyanide toxicity Avoid prolonged use in hepatic and renal insuffeciency to prevent cyanide toxicity
Require arterial line in hypotensive patient.

Nesiritide
(Natrecor)
2 mcg/kg. Bolus. Then 0.01 mcg/kg/min infusion. Hemodynamic effect seen in <1 hr 2-4 hr
Recombinant BNP. Vasodilator
Lower LA pressure.
Promote diuresis.
No tachyphylaxis
Hypotension, headache, nausea
May Use short term up to 7 days.
Caution in hypovolemia, AS and HOCM.
Caution in patient on ACEI.

Dobutamine Start at 2.5 mcg/kg/min then 5.0, (or up to 7.5-20) q 1/2-1 hr.
Duration 48-72(or more)hr
. .
Inotropic and chronotropic. Vasodilator.

Symptomatic improvement for heart failure class III and IV.
Increase CO and promote diurees
Tachyarrhythmias No mortality benefit and may increase
Require ECG monitor.

Dopamine 2-3 mcg/kg/min for renal perfusion.
5-20 mcg/kg/min for Increase BP.
. . Inotropic and chronotropic. Vasoconstrictor at higher dose.

At low dose, increase renal perfusion., increase CO, promote diuresis.
At high dose, cause vasoconstrictor, increase BP. increase CO.

Tachycardia.
At high dose, increase afterload.
Require ECG monitor.

Milrinone
(Primacor)
25-50 mcg/kg. Bolus over 15 min. Maintenance dose of 0.375-0.5 mcg/kg/min . . . . Hypotension
Arrhythmia No bolus if BP is low.
Prefer over Dobutamine in patient on chronic Beta blocker.
Require ECG monitor.

(Print with landscape orientation)

	Dose	Onset	Last	Mechanism	Indication	Adverse reaction	Comment
Nitroglycerine	5-200 mcg/min. Infusion. Start at 5-10 mcg/min. Increase 5-10 mcg q 5-10 min.	2-5 min	3-5 min	Vasodilator	Lower LA pressure. Lower BP. Coronary insuffeciency	Hypotension, headache, GI upset, develope tolerance	Patient with CVA may increase intracranial pressure.
Nitroprusside	0.25-10 mcg/kg/min Infusion. Start at lowest dose.	Immediate	1-2 min	Vasodilator	Lower BP. Lower afterload Lower LA pressure. Aortic dissection.	Hypotension, nausea, vomiting, muscle twitching, cyanide toxicity	Avoid prolonged use in hepatic and renal insuffeciency to prevent cyanide toxicity Require arterial line in hypotensive patient.
Nesiritide (Natrecor)	2 mcg/kg. Bolus. Then 0.01 mcg/kg/min infusion.	Hemodynamic effect seen in <1 hr	2-4 hr	Recombinant BNP. Vasodilator	Lower LA pressure. Promote diuresis. No tachyphylaxis	Hypotension, headache, nausea	May Use short term up to 7 days. Caution in hypovolemia, AS and HOCM. Caution in patient on ACEI.
Dobutamine	Start at 2.5 mcg/kg/min then 5.0, (or up to 7.5-20) q 1/2-1 hr. Duration 48-72(or more)hr	.	.	Inotropic and chronotropic. Vasodilator.	Symptomatic improvement for heart failure class III and IV. Increase CO and promote diurees	Tachyarrhythmias	No mortality benefit and may increase Require ECG monitor.
Dopamine	2-3 mcg/kg/min for renal perfusion. 5-20 mcg/kg/min for Increase BP.	.	.	Inotropic and chronotropic. Vasoconstrictor at higher dose.	At low dose, increase renal perfusion., increase CO, promote diuresis. At high dose, cause vasoconstrictor, increase BP. increase CO.	Tachycardia. At high dose, increase afterload.	Require ECG monitor.
Milrinone (Primacor)	25-50 mcg/kg. Bolus over 15 min. Maintenance dose of 0.375-0.5 mcg/kg/min	.	.	.	.	Hypotension Arrhythmia	No bolus if BP is low. Prefer over Dobutamine in patient on chronic Beta blocker. Require ECG monitor.