Naples and Milan, Italy - Driving another nail into the fenoldopam coffin, a new study shows that the drug, approved for the treatment of hypertension, is ineffective at preventing contrast-induced nephropathy. This latest information comes from an Italian randomized trial comparing fenoldopam mesylate to N-acetylcysteine (NAC) in patients with renal insufficiency undergoing coronary or peripheral procedures.

As Dr Carlo Briguori (Vita e Salute University School of Medicine, Milan, Italy) and colleagues note, fenoldopam is a dopamine-1 receptor agonist that has been hypothesized to prevent renal vasoconstriction through peripheral vasodilation. By contrast, NAC is an antioxidant believed to preserve renal function by scavenging reactive oxygen that could otherwise lead to tissue damage. As previously reported by heartwire, the results of the Controlled Multicenter Trial Evaluating Fenoldopam Mesylate for the Prevention of Contrast-Induced Nephropathy (CONTRAST), comparing fenoldopam with placebo, showed that fenoldopam was no better than hydration alone at reducing contrast-induced nephropathy. Now, Briguori et al's study, appearing in the August 18, 2004 issue of the Journal of the American College of Cardiology, reaffirms the CONTRAST findings by stacking fenoldopam against NAC.1

"Although preliminary studies suggest that the administration of fenoldopam protects against [contrast-agent-associated nephrotoxicity], our finding confirms the results of the recent CONTRAST trial," Briguori et al write.