Vasoactive Agents

This article is a short review of vasoactive drugs which are in use in todays clinical practice. In the past century, development of vasoactive drugs went through several phases. All of these drugs are today divided into several groups, depending on their place of action, pharmacological pathways and/or effects on target organ or organ system. Hence, many different agents are today in clinical practice, we have shown comparison between them. These agents provide new directions in the treatment of cardiovascular compromise, suggesting that the primary goal of therapy is to produce a vasodilatory effect of the circulation rather than to reverse hemodynamic failure by using inotropic agents, with their inherent risks and side effects.   

vasoactive agents, inotropic agents, levosimendan, phosphodiesterase III inhibitors

1. Lehtonen AE, Antila S, Pentikainen PJ. Pharmacokinetics and pharmacodynamics of intravenous inotropic agents. Clin Pharmacokinet 2004;43:187-203.

2. Priebe HJ. Vasoactive drugs (IARS Review Course Lectures). Anesth Analg 2004;64:79-83.

3. Opie LH, Chatterjee K, Gersh BJ. Drug for heart 2nd edition. Orlando, Florida: Grune Stratonn; 1986, pp 306-309.

4. Smith VE, Katz AM. Inotropic and lusitropic abnormalities as the basis for heart failure. Heart Failure 1987;3:55-65.

5. Lehtonen LA. Levosimendan: a parenteral calcium-sensitizing drug with additional vasodilatatory properties. Expert Opin Investing Drugs 2001;10:955-970

6. Moiseyev VS, Poder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB, Kobalava ZD, Lehtonen LA, Laine T, Nieminen MS, Lie KI; RUSSLAN Study Investigators. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double blind study (RUSSLAN). Eur Heart J 2002;23:1422-32

7. Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K, Harjola VP, Mitrovic V, Abdalla M, Sandell EP, Lehtonen L; Steering Committee and Investigators of the Levosimendan Infusion versus Dobutamine (LIDO) Study. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 2002;360:196-202.

8. Barisin S, Husedzinovic I, Sonicki Z, Bradic N, Barisin A, Tonkovic D. Levosimendan in Off–Pump Coronary Artery Bypass; A Four – times Masked Controlled Study. J Cardivasc Pharmaco 2004;44:703-708.

9. Husedzinovic I, Bradic N, Barisin S. Levosimendan-hemodynamic support during off-pump coronary artery bypass graft surgery. Intensive Care Med 2005;31(suppl 1):S 97.

10. Husedžinović I, Barišin S, Bradić N, Barišin A, Sonicki Z, Milanović R. Levosimendan as a new strategy during off – pump coronary artery bypass grafting: Double – blind randomized placebo – controlled trial. Croat Med J. 2005;46:950-6.

11. Rodeheffer RJ. Measuring plasma B-type natriuretic peptide in heart failure: good to go in 2004?. J Am Coll Cardiol. 2004; 44: 740-9.

12. Kaluski E, Kobrin I, Zimlichman R, Marmor A, Krakov O, Milo O, Frey A, Kaplan S, Krakover R, Caspi A, Vered Z, Cotter G. RITZ-5: randomized intravenous Tezosentan (an endothelin-A/B antagonist) for the treatment of pulmonary edema: a prospective, multicenter, doubleblind, placebo-controlled study. J Am Coll Cardiol. 2003;41:204-10

13. Teerlink JR, McMurray JJ, Bourge RC, Cleland JG, Cotter G, Jondeau G, Krum H, Metra M, O’Connor CM, Parker JD, Torre-Amione G, Van Veldhuisen DJ, Frey A, Rainisio M, Kobrin I; VERITAS Investigators. Tezosentan in patients with acute heart failure: design of the Value of Endothelin Receptor Inhibition with Tezosentan in Acute heart failure Study (VERITAS). Am Heart J 2005;150:46-53

14. Patel BM, Chittock DR, Russell JA, Walley KR. Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology. 2002;96:576-82.

15. Stiell IG, Hebert PC, Wells GA, Vandemheen KL, Tang AS, Higginson LA, Dreyer JF, Clement C, Battram E, Watpool I, Mason S, Klassen T, Weitzman BN. Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial. Lancet 2001;358:105-9.

16. Guzman JA, Rosado AE, Kruse JA. Vasopressin vs norepinephrine in endotoxic shock: systemic, renal, and splanchnic hemodynamic and oxygen transport effects. J Appl Physiol 2003; 95: 803-9.