Vasopressin as an alternative to norepinephrine in the treatment of milrinone-induced hypotension.

Objective: To determine whether vasopressin could be effective in treating the hypotension associated with phosphodiesterase III inhibition. Phosphodiesterase III inhibitors are cardiotonic agents that increase myocardial contractility and decrease vascular smooth muscle tone. The vasodilatory effect can be profound, and the resulting hypotension frequently requires the administration of catecholamine pressors.

Design: Retrospective analysis of existing data.

Setting: The medical or surgical intensive care unit of Columbia-Presbyterian Medical Center.

Patients: Three consecutive patients receiving milrinone and requiring catecholamine pressors to maintain systolic arterial pressure of > or =90 mm Hg.

Interventions: Vasopressin was administered to the three patients.

Measurements And Main Results: Vasopressin (0.03-0.07 units/min) increased systolic arterial pressure from 90+/-4.7 to 130+/-2.3 mm Hg while reducing the administration of catecholamine pressors.

Conclusions: Vasopressin at very low doses appears to be an effective vasopressor for milrinone-induced hypotension.