We recently reported that pretreatment with the type IV phosphodiesterase inhibitor Ro 20-1724 attenuates the development of endotoxin-induced acute renal failure in rats. Norepinephrine is an important therapeutic agent in human endotoxemia, but its efficacy is limited by its deleterious side effect of potent renal and mesenteric vasoconstriction. In this study we examined whether posttreatment with Ro 20-1724 after endotoxin infusion 1) attenuates increased renal vascular resistance and the development of acute renal failure in the absence and presence of norepinephrine infusion, 2) improves mesenteric blood flow in the presence of norepinephrine and 3) improves survival rates in the absence and presence of norepinephrine infusion. Forty-eight rats were anesthetized and instrumented, and eight 20-min clearance periods were performed. Endotoxin (20 mg/kg i.v.) was administered after the first period, and a constant-rate i.v. infusion of either Ro 20-1724 (10 micrograms/kg/min) or vehicle was initiated after period 3, in the absence and presence of norepinephrine infusion (1 microgram/kg/ min, begun after period 4). Urinary cAMP excretion in the Ro 20-1724-treated groups was 2- to 3-fold (P < .001) higher, compared with the vehicle-treated groups. Ro 20-1724 markedly attenuated endotoxin-induced (P < .01) increases in renal vascular resistance and attenuated norepinephrine-induced (P < .05) increases in renal vascular resistance in rats pretreated with endotoxin. Moreover, Ro 20-1724 reduced endotoxin-induced decreases in renal blood flow (P < .05) and glomerular filtration rate (P < .01) in the absence and presence of norepinephrine. In animals pretreated with endotoxin, Ro 20-1724 attenuated norepinephrine-induced increases in mesenteric vascular resistance (P = .054) and decreases in mesenteric blood flow (P < .01). Ro 20-1724 also improved survival rates for endotoxin-treated rats, whether or not the rats were administered norepinephrine (P < .01). Type IV-specific phosphodiesterase inhibitors warrant further study as selective therapeutic agents that protect against endotoxin/vasopressor-induced renal and mesenteric ischemia and death.