Oral Terbutaline in Replacement for Intravenous Dopamine in a Patient with End-Stage Heart Failure

OBJECTIVE: To describe the replacement of intravenous dopamine with oral terbutaline in a patient with American College of Cardiology/American Heart Association stage D heart failure (HF). CASE SUMMARY: A 54-year-old male was admitted for acute decompensated HF, which was successfully managed by aggressive diuresis and intravenous dopamine 3 μg/kg/min. Multiple attempts to taper dopamine to discontinuation led to hypotension and bradycardia. In view of his hemodynamic response to dopamine weaning, oral terbutaline 5 mg every 8 hours was recommended to replace intravenous dopamine. With the addition of terbutaline, the patient continued to be hemodynamically stable, and dopamine was successfully discontinued, allowing the patient to be discharged home. DISCUSSION: Radioligand binding studies have shown that both β-1 and β-2 receptors exist in human myocardium. Terbutaline is a β-2 agonist available in oral dosage form. Small single-dose studies have demonstrated that terbutaline improved cardiac output and increased heart rate, either directly by its positive inotropic effect or indirectly by its pulmonary vasodilatory effect. There are no long-term efficacy and safety data on the use of oral terbutaline in the management of HF. However, in our case, in which symptomatic improvement and comfort measure were our main goals of therapy, the use of oral terbutaline allowed us to successfully discontinue dopamine and maintain hemodynamic stability. CONCLUSIONS: The use of oral terbutaline to replace intravenous dopamine led to a successful maintenance of hemodynamic stability in a patient with advanced stage HF. To our knowledge, there have been no previous reports describing the use of oral terbutaline to replace intravenous inotropes for maintaining hemodynamic stability.