Acute haemodynamic effects of different doses of alifedrine in congestive heart failure

The haemodynamic effects of single oral doses of alifedrine 40 mg, 50 mg, 60 mg and placebo were compared in 30 patients with mild to moderate heart failure. Individual patients received either alifedrine 60 mg and placebo (15 patients) or alifedrine 40 mg and 50 mg (15 patients). All doses of alifedrine produced qualitatively similar haemodynamic responses, with maximum changes between 90 and 180 min after drug administration. The cardiac index was increased by +39%, +57% and +50% by 40 mg, 50 mg and 60 mg, respectively. The increases were due to rises in stroke volume index (SVI) and in heart rate of +15%, +20% and +23%. Mean arterial blood pressure fell in a dose-related fashion, with a maximum fall of 11% by 120 min after 60 mg. The systemic vascular resistance index (SVRI) fell by 28%, 39% and 41%, and pulmonary vascular resistance index (PVRI) by 32%, 44% and 32% after 40 mg, 50 mg and 60 mg, respectively. The optimum dose appears to be 40 mg, which caused very little fall in blood pressure or increase in heart rate, yet significantly improved cardiac output. Alifedrine may have a place in the treatment of heart failure as an oral by active, positive inotropic agent.