Ibopamine is the prodrug of epinine or N-methyl dopamine. Ibopamine stimulates the DA1 and DA2 dopaminergic receptors, the beta 1 and beta 2 adrenoceptors, and the alpha 1 and alpha 2 adrenoceptors. Ibopamine has varying degrees of affinity for these various families, being the highest for the dopamine receptors and the lowest for the alpha adrenergic receptors. Ibopamine reduces systemic vascular resistance, increases cardiac output, and increases renal flow. Ibopamine also modulates the neuroendocrine reflexes in heart failure; plasma renin activity and norepinephrine and aldosterone plasma concentrations are reduced, both immediately and during sustained administration. In patients with heart failure (HF), low doses appear to exert beneficial neurohormonal, hemodynamic, and renal effects, without increased inotropic effects. However, at higher doses (> 200 mg) ibopamine exerts effects that do not appear to be clinically useful in long-term treatment of chronic HF. Several small trials have suggested a benefit of ibopamine on exercise performance in patients with mild to moderate HF. On the basis of these studies, ibopamine is now being used in Europe to treat patients with mild to moderate congestive heart failure (CHF). At doses of 100 or 200 mg/t.i.d., there has been no evidence of significant safety problems. Ibopamine was used in Europe to treat heart failure. In 1995, a study showed that ibopamine increased death rates in patients who had moderate to severe heart failure. In September 1995, doctors and pharmacists in the Netherlands were officially notified that ibopamine should be used only in patients with mild heart failure. Moreover, the official recommendations for when to use ibopamine were changed according to whether patients had mild or severe heart failure. Ibopamine, a sympathomimetic drug, is used in ophthalmology. t has a not-cycloplegic mydriatic activity. Its peak of action is at 45 minutes after instillation in the conjunctival sac. Its action lasts after about 360 minutes. Its D1-dopaminergic stimulation increases the aqueous humor production and it is a provocative test for evaluating the function of aqueous humor outflow structures also in relatives of glaucomatous patients. It is also useful to treat ocular hypotension. Its main use is in every ophthalmological assessment, either diagnostic or preoperative, where the cycloplegia is not adviced. It is useful for the safe mydriasis of patients treated with α-1 adrenergic receptor antagonists.