II. Class
- Rapidly acting inotropic agent
- Phosphodiesterase Inhibitor
III. Mechanism
- Hemodynamic effects similar to Dobutamine
- Moderate Dose (2.0 to 15 ug/kg/min)
- Increased Cardiac Output
- Decreased Peripheral Resistance
- Decreased Preload
- High Dose
- Tachycardia
- May precipitate Myocardial Ischemia
- Moderate Dose (2.0 to 15 ug/kg/min)
- Inotropic and Vasodilator effects not reversed
- Adrenergic blocking drugs do not effect
- Norepinephrine depletion does not effect
IV. Pharmacokinetics
- Long Half-Life: 4-6 hours
V. Indications
- Severe Congestive Heart Failure refractory to:
VI. Contraindications
- Allergy to Sulfating agents
VII. Dosing
- Preparation
- Dilute Amrinone Lactate in NS or 1/2NS
- Do not dilute directly in dextrose solutions
- May be infused in a line with dextrose solution
- Final Concentration: 1-3 mg/ml
- Dilute Amrinone Lactate in NS or 1/2NS
- Load: 0.75 mg/kg (max: 1 mg/kg) bolus over 10-15 min
- Maintenance Infusion
- Start: 2-5 ug/kg/min
- Titrate to: 10-15 ug/kg/min
VIII. Monitoring
- Central hemodynamics
IX. Adverse Effects
-
Thrombocytopenia (2-3%)
- Occurs within 48-72 hours
- Resolves after discontinuing Amrinone
- Dose dependent effect
- Nausea and Vomiting
- Myalgia
- Fever
- Hepatic dysfunction
-
Arrhythmia
- Ventricular irritability
X. Precautions
- May provoke Myocardial Ischemia
- Carefully follow central hemodynamics
- Avoid Tachycardia