Fenoldopam is a selective D1-receptor agonist that has many of the benefits of DA but with little or no α- or β-adrenoceptor or D2-receptor agonist activ-ity. Fenoldopam has been shown to exert hypoten-sive effects characterized by a decrease in peripheral vascular resistance, along with an increase in renal blood flow, diuresis, and natriuresis. It is indicated for patients undergoing cardiac surgery and aortic aneu-rysm repair with potential risk of perioperative renal impairment. Fenoldopam exerts an antihypertensive effect, but helps to maintain renal blood flow. It is also indicated for patients who have severe hypertension, particularly those with renal impairment. Along with its recommended use in hypertensive emergencies, fenoldopam is also indicated in the prevention of contrast media-induced nephropathy. Fenoldopam has a fairly rapid onset of action and is easily titrat-able because of its short elimination half-life. The ability of fenoldopam to “protect” the kidney periop-eratively remains the subject of ongoing studies.
Fenoldopam is supplied in 1-, 2-, and 5-mL ampules, 10 mg/mL. It is started as a continuous infusion of 0.1 mcg/kg/min, increased by increments of 0.1 mcg/ kg/min at 15- to 20-min intervals until target blood pressure is achieved. Lower doses have been associ-ated with less reflex tachycardia.