Levophed & dobutamine

[saraclark62]

Levophed & dobutamine -   Both provide beta 1 support. But why run these together? Wouldn't Levo's alpha 1 properties antagonize Levophed's goal to reduce afterload?

[MaxAttack, BSN, RN]

I wouldn't say the goal with either Levophed or dobutamine is to reduce afterload. Dobutamine is used as an inotrope as it increases contractility in a poorly functioning heart. The reduction in SVR is a side effect (sometimes good sometimes bad) but not the goal per se.

Agents like nicardipine or clevidipine are vasodilators and are used if you're targeting afterload reduction.

In this case, it sounds like you had issues with contractility and LOW SVR either due to the disease state and/or as a side effect of dobutamine. In that case, you would need the dobutamine to target contractility and something to tighten up your afterload - hence the vasopressor Levo. In my unit in this situation, we would use dobutamine with Levo, vasopressin, or epi.

 

So basically it depends on the context and what you're targeting. With high afterload you're correct - you wouldn't want to use Levo. With low afterload that would be the correct treatment. I'm assuming this was a cardiac patient? Did you have a Swan and do you remember the measurements?