Amrinone (inamrinone)

Congestive Heart Failure

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.

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

Congestive Heart Failure Load: 0.75 mg/kg IV bolus over 2-3 minutes, THEN 5-10 mcg/kg/min IV Total daily dose (including loading dose) should not exceed 10 mg/kg/day Therapeutic dosage range: 0.5-7 mcg/mL

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

Hypersensitivity to inamrinone, milrinone and bisulfites

Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people; overall prevalence of sulfite sensitivity in the general population is unknown and probably low; sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people This drug should not be used in patients with severe aortic or pulmonic valvular disease in lieu of surgical relief of the obstruction; like other inotropic agents, it may aggravate outflow tract obstruction in hypertrophic subaortic stenosis Patients who have received vigorous diuretic therapy may have insufficient cardiac filling pressure to respond adequately to therapy, in which case cautious liberalization of fluid and electrolyte intake may be indicated Supraventricular and ventricular arrhythmias have been observed in the very high-risk population treated; while inamrinone per se has not been shown to be arrhythmogenic, the potential for arrhythmia, present in congestive heart failure itself, may be increased by any drug or combination of drugs Thrombocytopenia and hepatotoxicity reported No clinical trials have been carried out in patients in the acute phase of postmyocardial infarction; this drug is not recommended in these cases Monitoring Parameters During intravenous therapy, blood pressure and heart rate should be monitored and the rate of infusion slowed or stopped in patients showing excessive decreases in blood pressure. Fluid and electrolyte balance should be maintained; platelet counts and liver function should be monitored.

Not Classi Pregnancy There are no adequate and well-controlled studies in pregnant women; this drug should be used during pregnancy only if potential benefit justifies potential risk to fetus Animal data In New Zealand white rabbits, inamrinone has been shown to produce fetal skeletal and gross external malformations at oral doses of 16 mg/kg and 50 mg/kg which were toxic for the rabbit; studies in French Hy/Cr rabbits using oral doses up to 32 mg/kg/day did not confirm this finding; no malformations were seen in rats receiving inamrinone intravenously at maximum dose used, 15 mg/kg/day (approximately the recommended daily intravenous dose for patients with congestive heart failure) Lactation Exercise caution when this drug is administered to nursing women; not known whether it is excreted in human milk

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. Contraindicated (0) Serious - Use Alternative (2) ozanimod ponesimod

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)

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.