Amrinone

Aka: Amrinone

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II. Class

  1. Rapidly acting inotropic agent
  2. Phosphodiesterase Inhibitor

III. Mechanism

  1. Hemodynamic effects similar to Dobutamine
    1. Moderate Dose (2.0 to 15 ug/kg/min)
      1. Increased Cardiac Output
      2. Decreased Peripheral Resistance
      3. Decreased Preload
    2. High Dose
      1. Tachycardia
      2. May precipitate Myocardial Ischemia
  2. Inotropic and Vasodilator effects not reversed
    1. Adrenergic blocking drugs do not effect
    2. Norepinephrine depletion does not effect

IV. Pharmacokinetics

  1. Long Half-Life: 4-6 hours

V. Indications

  1. Severe Congestive Heart Failure refractory to:
    1. Diuretics
    2. Vasodilators
    3. Conventional inotropic agents (Digoxin)

VI. Contraindications

  1. Allergy to Sulfating agents

VII. Dosing

  1. Preparation
    1. Dilute Amrinone Lactate in NS or 1/2NS
      1. Do not dilute directly in dextrose solutions
      2. May be infused in a line with dextrose solution
    2. Final Concentration: 1-3 mg/ml
  2. Load: 0.75 mg/kg (max: 1 mg/kg) bolus over 10-15 min
  3. Maintenance Infusion
    1. Start: 2-5 ug/kg/min
    2. Titrate to: 10-15 ug/kg/min

VIII. Monitoring

  1. Central hemodynamics

IX. Adverse Effects

  1. Thrombocytopenia (2-3%)
    1. Occurs within 48-72 hours
    2. Resolves after discontinuing Amrinone
    3. Dose dependent effect
  2. Nausea and Vomiting
  3. Myalgia
  4. Fever
  5. Hepatic dysfunction
  6. Arrhythmia
    1. Ventricular irritability

X. Precautions

  1. May provoke Myocardial Ischemia
    1. Carefully follow central hemodynamics
    2. Avoid Tachycardia

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