Summary
To evaluate the long-term effects of orally administered levodopa, 11 patients with chronic congestive heart failure (NYHA III–IV) were studied during maintenance therapy (30±1 days) and after withdrawal from levodopa. The daily levodopa dose was 4 g in six patients; because of side effects the levodopa dose was reduced to 2–3 g in the remaining patients. After withdrawal of levodopa, mean pulmonary capillary wedge pressure and mean right atrial pressure increased significantly (from 19±2 to 24±3 and from 7±2 to 9±2 mmHg, respectively). Effective renal plasma flow was 329±57 during levodopa therapy and decreased significantly to 252±27 ml/min after withdrawal of levodopa. The number of ventricular premature contractions and couplets increased during levodopa therapy and decreased again significantly after withdrawal of levodopa. No significant differences between on and off levodopa were observed in resting heart rate, arterial blood pressure, cardiac index, stroke work index, systemic vascular resistance, sodium and water excretion, or creatinine clearance. Seven patients improved on levodopa therapy by one NYHA class; four of these seven patients deteriorated again by one NYHA class after withdrawal of levodopa. Regarding both clinical and hemodynamic changes after withdrawal of levodopa, three patients were classified as responders to long-term levodopa therapy. All three responders received 4 g levodopa per day. Average dopamine plasma level was 5.3±0.8 ng/ml in the responder group and 2.0±0.5 ng/ml in the nonresponder group.
Long-term administration of oral levodopa is associated with beneficial clinical and hemodynamic response in only a minority of patients with chronic congestive heart failure.
Similar content being viewed by others
References
Barnardo DE, Baldus WP, Maher FT (1970) Effects of dopamine on renal function in patients with cirrhosis. Gastroenterology 58:524–531
Beregovich J, Bianchi C, Rubler S, Lomnitz E, Cagin N, Levitt B (1974) Dose-related hemodynamic and renal effects of dopamine in congestive heart failure. Am Heart J 87:550–557
Braunwald E, Colucci WS (1984) Evaluating the efficacy of new inotropic agents. J Am Coll Cardiol 3:1570–1574
Brogden RN, Speight TM, Avery GS (1971) Levodopa: a review of its pharmacological properties and therapeutic uses with particular reference to Parkinsonism. Drugs 2:262–400
Cotzias GC, Papavasiliou PS, Gellene R (1969) Modification of Parkinsonism — chronic treatment withl-dopa. N Engl J Med 287:337–345
Da Prada M, Zuercher G (1976) Simultaneous radioenzymatic determination of plasma and tissue adrenaline, noradrenaline and dopamine within the fentomole range. Life Sci 19:1161–1174
Felder RA, Blecher M, Calcagno PL, Jose PA (1984) Dopamine receptors in the proximal tubule of the rabbit. Am J Physiol 247:F499-F505
Finlay GD, Whitsett TL, Cucinell E, Goldberg LI (1971) Augmentation of sodium and potassium excretion, glomerular filtration rate and renal plasma flow by levodopa. N Engl J Med 284:865–870
Goldberg LI (1972) Cardiovascular and renal actions of dopamine: potential clinical applications. Pharmacol Rev 24:1–29
Goldberg LI, Rajfer SI (1985) Dopamine receptors: applications in clinical cardiology. Circulation 72:245–248
Henderson IS, Beattie TJ, Kennedy AC (1980) Dopamine hydrochloride in oliguric states. Lancet II:827–828
Holzer J, Karliner JS, O'Rouke RA, Ross J (1973) Effectiveness of dopamine in patients with cardiogenic shock. Am J Cardiol 32:79–84
Leon AS, Solomon HM, Ross I, Golden RH, Abrams WB (1970) Cardiovascular activity ofl-dopa. Clin Res 18:340
McDonald RH, Goldberg LI, McNay JL, Tuttle EP (1964) Effects of dopamine in man: augmentation of sodium excretion, glomerular filtration rate, and renal plasma flow. J Clin Invest 43:1116–1124
Mutschler E (1986) Vorkommen, Funktion und klinische Bedeutung von Dopamin-Rezeptoren. In: Schölmerich P, Holtmeier HJ (eds) Kardiovaskuläre Rezeptoren. Stuttgart, New York: Thieme, pp 121–127
Pixberg HU, Just G (1971) Die Bestimmung des effektiven Nierenplasmastroms mit der J-Hippursäure-Ganzkörperclearance. Dtsch Med Wochenschr 96:156–161
Rajfer SI, Anton AH, Rossen JD, Goldberg LI (1984) Beneficial hemodynamic effects of oral levodopa in heart failure. Relation to the generation of dopamine. N Engl J Med 310:1357–1362
Shah PK, Amin DK, Horn E (1985) Adverse clinical and hemodynamic effects of oral levodopa in chronic congestive heart failure. Am Heart J 110:488–489
Talley RC, Forland M, Beller B (1970) Reversal of acute renal failure with a combination of intravenous dopamine and diuretics. Clin Res 18:518
Whitsett TL, Goldberg LI (1972) Effects of levodopa on systolic preejection period, blood pressure, and heart rate during acute and chronic treatment of Parkinson's disease. Circulation 45:97–106
Wirtzfeld A, Klein G, Delius W, Himmler C, Vogler E, Davidson J (1978) Dopamin und Dobutamin in der Behandlung der schweren Herzinsuffizienz. Dtsch Med Wochenschr 103:1915–1921
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hasenfuss, G., Kasper, W., Meinertz, T. et al. Evaluation of long-term oral levodopa therapy in chronic congestive heart failure. Klin Wochenschr 65, 1087–1094 (1987). https://doi.org/10.1007/BF01736115
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01736115