Fenoldopam

Q: A 64-year-old male with a past medical history of hypertension, diabetes mellitus, hyperlipidemia, and stage-3 renal insufficiency is admitted to the ICU with hypertensive crises. The intensivist picked Fenoldopam infusion. What is the added advantage of Fenoldopam in this patient?

Answer: It either maintains or increases kidney perfusion

Although Fenoldopam is not commonly used as an antihypertensive infusion in ICUs, it offers several advantages. It is a peripherally acting dopamine-1 receptor agonist that maintains or increases renal perfusion while controlling hypertension. It has shown to increase glomerular filtration rate (GFR), urine output, and sodium excretion.

Dose-wise, it is usually initiated at 0.1 mcg/kg/min and titrated at 15-minute intervals to a maximum of 1.6 mcg/kg/min. If needed can be titrated up to 2.0 mcg/kg/minute. It is very unlikely to cause any real toxicity, though it is contraindicated in glaucoma, and caution should be applied in patients with sulpha allergy, as it is premixed in a solution containing sodium metabisulfite.

# hemodynamics

#nephrology

#pharmacology

References:

1. Murphy MB, Murray C, Shorten GD. Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension. N Engl J Med 2001; 345:1548.

2. White WB, Halley SE. Comparative renal effects of intravenous administration of fenoldopam mesylate and sodium nitroprusside in patients with severe hypertension. Arch Intern Med 1989; 149:870.

3. Shusterman NH, Elliott WJ, White WB. Fenoldopam, but not nitroprusside, improves renal function in severely hypertensive patients with impaired renal function. Am J Med 1993; 95:161.