BB and Dobutamine

Q: Which Beta-blocker is particularly more potent in blocking the effectiveness of Dobutamine?



Answer:  Carvedilol

In patients who are on chronic beta-blocker therapy, dobutamine is usually not a preferred inotrope. Dobutamine is primarily a beta-agonist. There is weak literature to suggest that out of all beta-blockers, carvedilol is more prone to block dobutamine effectiveness. This is more crucial to know as carvedilol is the preferred beta-blockers for congestive heart failure (CHF) patients in outpatient. When these patients get admitted to ICU with CHF exacerbation, both can't be used simultaneously. In such cases, PDE-3 inhibitor is preferred if no other contra-indication, such as hypotension or vasoplegia.

Said that, data in this area of CHF management i.e., concomitant use of dobutamine and various BBs is still not very evidence-based, and usually gets guided by bedside clinician's experience and judgment.

#cardiology
#pharmacology


References:

1. Metra M, Nodari S, D'Aloia A, et al. Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. J Am Coll Cardiol 2002; 40:1248. 

2. Luiz Carlos Santana Passos; Andréa Cristina Costa Barbosa; Márcio Galvão Oliveira; Edval Gomes Santos Jr. Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure? Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. vol.100 no.2 São Paulo Feb. 2013 http://dx.doi.org/10.5935/abc.20130034