Ibopamine: A Drug That Has Opposite Effects Depending on the Severity of a Patient's Disease. Ann Intern Med. 2001;134:S95. doi: 10.7326/0003-4819-134-7-200104030-00005
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Published: Ann Intern Med. 2001;134(7):S95.
Ibopamine is a drug that was used in Europe to treat heart failure, a condition in which the heart cannot pump blood normally. In 1995, a study showed that ibopamine increased death rates in patients who had moderate to severe heart failure. In September 1995, doctors and pharmacists in the Netherlands were officially notified that ibopamine should be used only in patients with mild heart failure. Moreover, the official recommendations for when to use ibopamine were changed according to whether patients had mild or severe heart failure. Whether the change in recommendations resulted in fewer deaths related to ibopamine was not known.
To see if an official change in the specific indications for using the drug ibopamine affected death rates related to that drug.
Researchers followed 739 patients who were taking ibopamine before September 1995 and 407 patients who were taking it after September 1995. All patients had heart failure.
The researchers identified patients who had received ibopamine from community-based drug-dispensing outlets in the Netherlands. They contacted these patients' general practitioners and asked about patients' medical history and heart failure severity. Prescription data were obtained from computer records. Patients were followed from the date of their first ibopamine prescription until death or the end of the study period.
About three fourths of the patients who died before 1995 were using ibopamine up to the time of their death. Only half of the patients who died after 1995 were taking ibopamine at the time of death. The risk for death increased among patients who took ibopamine before 1995 and decreased among those who took ibopamine after 1995. Overall, patients taking ibopamine before 1995 had about a threefold higher risk for death than patients who were taking ibopamine after 1995.
The actual severity of heart failure at the time of death was not clear and was not measured precisely in some patients.
Certain drugs have different and seemingly opposite effects in patients, even when those drugs are used to treat the same condition or disease. Such confusing differences in effects may be related to several factors, including whether the drug is preferentially avoided in patients with severe underlying disease and whether the drug itself is harmful for particular groups of people but not others.
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Cardiology, Heart Failure.
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