Dopexamine hydrochloride (Dopacard) has been developed as a peripherally acting dopamine receptor agonist with afterload reducing properties for use in the acute management of low cardiac output states. Dopexamine hydrochloride is one-third as potent as dopamine in stimulating DA1 receptors but 60 times as potent as a beta 2-adrenoceptor agonist. Unlike dopamine, it is a weak beta 1-adrenoceptor agonist and does not stimulate vascular alpha adrenoceptors. Its stimulant properties at vascular DA1 receptors and at vascular beta 2 adrenoceptors endow it with the ability to improve renal blood flow and to increase cardiac output secondary to afterload reduction. In addition, mild positive inotropic activity arises from stimulation of cardiac beta 2 adrenoceptors, potentiation of endogenous norepinephrine due to uptake-1 blockade, and activation of the baroreceptor reflex. Other features of dopexamine hydrochloride that should enhance its clinical use are lack of arrhythmogenicity and rapid responsiveness to alterations in infusion rate.