Tetralogy of Fallot (TOF) in Adults Medication

Updated: Nov 18, 2021
  • Author: Shabir Bhimji, MD, PhD; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Medication Summary

The goals of tetralogy of Fallot (TOF) therapy are to reduce the ventilatory drive, increasing systemic venous return, and to increase peripheral vascular resistance.



Class Summary

Analgesic agents reduce ventilatory drive. In addition, pain control ensures patient comfort and promotes pulmonary toilet. Most analgesic agents have sedating properties, which are beneficial for patients who are having hypercyanotic episodes.

Morphine sulfate (Duramorph, Astramorph, MS Contin)

Morphine is the drug of choice (DOC) for narcotic analgesia because of its reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

This agent is administered intravenously (IV), may be dosed in number of ways, and is commonly titrated until the desired effect is obtained.


Alpha-adrenergic Agonists

Class Summary

Alpha-adrenergic agents improve hemodynamic status by improving myocardial contractility and increasing heart rate, resulting in increased cardiac output. Peripheral resistance is increased by vasoconstriction, increased cardiac output, and elevated blood pressure.


Phenylephrine is a strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity. This drug produces vasoconstriction of arterioles, thereby increasing peripheral venous return.