Table 3 Pharmacotherapy available to treat pulmonary hypertension or decompensation of right ventricular failure
From: Pulmonary Hypertension in an Oncologic Intensive Care Unit
Agent (receptor & MOA) | Primary goal Secondary effect | Usual dosing | Adverse effects other notes |
|---|---|---|---|
Increased inotropy | |||
Dopamine  Low to medium dose (D, β1 > α1)  High dose (α1 = β1, D) | ↑ Inotropy ↑ Renal perfusion ↑ CI ↑ SVR at higher doses | 2–10 μg/kg/min 10–50 μg/kg/min | Tachycardia Arrhythmias ↑ PVR at higher doses |
Dobutamine (β1 > β2) | ↑ Inotropy ↑ CI, ↓ PVR | 2.5–15 μg/kg/min | Tachycardia, arrhythmias Hypotension (↓ SVR) |
Epinephrine (α1 = β1 > β2) | ↑ CI ↓ PVR, ↑ SVR | 0.1–0.5 μg/kg/min | Tachycardia, arrhythmias |
Milrinone (PDE3I) | ↑ Inotropy ↑ CI, ↓ PVR | Load: 50 μg/kg 0.25–0.75 μg/kg/min | Tachycardia, arrhythmias Hypotension (↓ SVR) |
Levosimendan (Ca2+ sensitizer and PDE3I) | ↑ Inotropy ↑ CI, ↓ PVR | Load: 6–12 μg/kg 0.05–0.2 μg/kg/min | Tachycardia, arrhythmias Hypotension (↓ SVR) |
Digitalis | ↑ Inotropy ↓ HR | Rhythm control in atrial fibrillation | AV blocks Use when ↓ LVEF |
Decreased pulmonary vascular resistance | |||
Inhaled NO | ↓ PVR | 10–40 ppm | Methemoglobinemia Hypotension |
Inhaled prostanoids  Iloprost  Treprostinil | ↓ PVR | 2.5–5 μg 6–9/day 6–54 μg QID | Hypotension, headache Flushing Jaw pain |
IV/SC prostanoids  Epoprostenol (IV)  Treprostinil (IV/SC) | ↓PVR | 1–40 ng/kg/min | Hypotension, headache Flushing, jaw pain |
Sildenafil IV/SL (PDE5I) | ↓ PVR | 5–20 mg TID | Hypotension |
Increased mean arterial pressure | |||
Norepinephrine (α1 > β1) | ↑ SVR ↑ CI | 0.01–3 μ/kg/min | Tachycardia, arrhythmias PVR neutral at low doses ↑ PVR at higher doses |
Vasopressin (V1, D) | ↑ SVR | 0.01–0.03 IU/min | PVR, CI neutral Heart rate neutral |
Phenylephrine (α1) | ↑ SVR | 0.5–5 μg/kg/min | ↓ CI, ↑ PVR Reflex bradycardia |