[Dihydroergotamine in the treatment of patients with symptomatic hypotension during regular hemodialysis].

The efficacy and safety of dihydroergotamine (DHE, Ditamin) in the treatment of symptomatic hypotension in regularly dialysed patients were tested in comparison to placebo in a single-blind, randomised clinical trial. Ten adult uremic patients (5 men and 5 women) with acute hypotension during hemodialysis, at least once weekly associated with symptoms of cerebral hypoperfusion, were included into the study. The administration of DHE during hemodialysis in a dose of 10 micrograms/kg body weight intravenously resulted in an increase in blood pressure (BP) from 91 +/- 13 to 114 +/- 14 and from 60 +/- 12 to 78 +/- 11 mmHg for systolic and diastolic BP, respectively (p less than 0.01). The maximum effect on BP (systolic and diastolic) was achieved 15 to 30 min after DHE administration; thereafter a gradual decline of effect on BP was observed, the t1/2 of disappearance of effect being 46 min. The use of isotonic or hypertonic saline solution in the treatment of hypotension decreased under the administration of DHE from 1200 +/- 600 ml to 70 ml and from 34 +/- 28 to 10 +/- 17 ml per patient and dialysis, respectively (p less than 0.01). In spite of a higher ultrafiltration rate resulting in a greater body weight reduction after hemodialysis, the incidence of symptomatic hypotension decreased after DHE administration from 1.46 +/- 0.52 to 0.14 episodes per patient and dialysis (p less than 0.01). It may be concluded that the resistance of uremic patients to hypovolemic stress occurring during hemodialysis is markedly increased after intravenous administration of DHE in a dose of 10 micrograms/kg.