Complications
Commonly causes headache and hypotension. The headache is usually mild to moderate in severity and either resolves or diminishes in intensity with continued nitrate therapy. If hypotension occurs then the infusion rate should be decreased. If hypotension persists then the infusion should be discontinued and restarted when the patient is hemodynamically stable.
Overdiuresis leads to worsening of renal function, hypotension, and hypokalemia, and also activation of neurohormones including renin-angiotensin system and the sympathetic system. It may potentiate the toxicity of other agents like digoxin, either by causing hypokalemia or by decreasing the glomerular filtration.
In cases of worsening renal impairment due to overdiuresis, the dose of diuretics should be decreased. In case of severe renal impairment the diuretic can be withheld and the patients assessed daily, with reintroduction of diuretic at lower doses.
Dobutamine and milrinone can cause arrhythmias and worsening of coronary ischemia.
The occurrence of sustained arrhythmias should lead to discontinuation. In cases where these medications are absolutely needed, concomitant use of amiodarone may be advisable, although there are no large-scale data on the use of antiarrhythmics in this setting. If the patient has symptomatic coronary ischemia, these infusions should be discontinued.
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