Amrinone

Indications

Amrinone is used for: Congestive Heart Failure

Adult Dose

Intravenous Heart failure Adult: Loading dose: 750 mcg/kg by slow inj over 2-3 min (may be repeated after 30 minutes if necessary). Maintenance: 5-10 mcg/kg/min by infusion. Max cumulative dose: 10 mg/kg in 24 hr.

Child Dose

Congestive Heart Failure <28 days old Load as in adults, 0.75 mg/kg IV over 3-5 minutes, THEN 3-5 mcg/kg/min IV maintenance infusion Bolus dose may need to be repeated after 30 minutes Total daily dose should not exceed 10 mg/kg/day Therapeutic dosage range: 0.5-7 mcg/mL >28 days old Load as in adults, 0.75 mg/kg IV over 3-5 minutes, THEN 5-15 mcg/kg/min IV Not to exceed 10 mg/kg/day Therapeutic dosage range: 0.5-7 mcg/mL

Renal Dose

Renal Impairment CrCl <10 mL/min: Administer 50-75% of the dose CrCl ?10 mL/min: Dosage adjustment not required

Administration

IV Preparation Dilute inamrinone with 1/2NS or NS to 1-2 mg/mL concentration for IV infusion Use within 24 hr IV Administration IV injection May administer undiluted Use only for initial loading & additional bolus doses Over 2-3 min IV infusion Use for maintenance doses Infuse continuously at 5-15 mcg/kg/min

Contra Indications

Hypersensitivity to inamrinone, milrinone and bisulfites

Precautions

Obstructive pulmonary or aortic disease, hypertrophic cardiomyopathy; BP and heart rate monitored during drug administration; fluid and electrolyte balance should be maintained; platelet counts and liver function should be monitored; protect amp from light. Pregnancy and lactation.

Pregnancy-Lactation

Pregnancy Category: C Lactation: excretion in milk unknown; use with caution

Interactions

Chemical interaction with precipitation occurs with amrinone and dextrose or furosemide. Thus drug mixing should be avoided. Potentially Fatal: Concurrent usage with disopyramide may lead to severe hypotension.

Adverse Effects

Side effects of Amrinone : 1-10% Arrhythmia (3%) Thrombocytopenia (2.4%) Nausea (1.7%) Hypotension (1.3%) <1% Fever (0.9%) Vomiting (0.9%) Abdominal pain (0.4%) Anorexia (0.4%) Chest pain (0.2%) Injections site pain (0.2%) Hepatotoxicity (rare)

Mechanism of Action

Amrinone is a phosphodiesterase inhibitor which has vasodilating and positive inotropic properties. It causes an increase in cyclic adenosine monophosphate conc leading to greater contractile force in cardiac muscle.