Drug Interactions between dobutamine and sulfur hexafluoride

MONITOR: Stress echocardiography with dobutamine can mimic an ischemic episode and increase the risk of rare but serious cardiopulmonary reactions associated with the use of sulfur hexafluoride and other ultrasound contrast agents. These reactions typically occur within 30 minutes of contrast administration, and the risk is increased in patients with cardiovascular instability such as recent acute coronary syndrome, unstable ischemia, evolving or ongoing myocardial infarction, angina at rest within last 7 days, recent coronary artery intervention, recent deterioration of ECG or laboratory/clinical findings, acute cardiac failure, Class III/IV cardiac failure, or severe rhythm disorders.

MANAGEMENT: Sulfur hexafluoride may be used during stress echocardiography with dobutamine in patients who are in stable condition verified by the absence of chest pain or ECG modification during the two preceding days. However, vital signs, ECG, and blood pressure monitoring are recommended during and for at least 30 minutes after sulfur hexafluoride administration. Use of sulfur hexafluoride in patients with cardiovascular instability should only be undertaken after careful risk/benefit assessment and with close monitoring. Sulfur hexafluoride should not be used under circumstances where dobutamine is considered contraindicated.