Home > Medical Reference > Encyclopedia (English)

Please install flash player to see this video.

Hospital Virtual Tour

Related Content

Pronunciation:

(eye NAM ri none)

Synonyms:

Amrinone Lactate

Generic Available:

Yes

Use:

Infrequently used as a last resort, short-term therapy in patients with intractable heart failure

Pregnancy Risk Factor:

Contraindications:

Hypersensitivity to inamrinone, any component of the formulation, or bisulfites (contains sodium metabisulfite); patients with severe aortic or pulmonic valvular disease

Warnings/Precautions:

Due to a slight effect on AV conduction, may increase ventricular response rate in atrial fibrillation/atrial flutter; prior treatment with digoxin is recommended. Monitor liver function. Discontinue therapy if alteration in LFTs and clinical symptoms of hepatotoxicity occur. Observe for arrhythmias in this very high-risk patient population. Not recommended in acute MI treatment. Monitor fluid status closely; patients may require adjustment of diuretic and electrolyte replacement therapy. Can cause thrombocytopenia (dose dependent). Correct hypokalemia before initiating therapy. Increase risk of hospitalization and death with long-term therapy.

Adverse Reactions:

1% to 10%:

Cardiovascular: Arrhythmias (3%, especially in high-risk patients), hypotension (1% to 2%) (may be infusion rate-related)

Gastrointestinal: Nausea (1% to 2%)

Hematologic: Thrombocytopenia (may be dose related)

<1% (Limited to important or life-threatening): Chest pain, fever, vomiting, abdominal pain, anorexia, hepatotoxicity, pain or burning at injection site, hypersensitivity (especially with prolonged therapy); contains sulfites resulting in allergic reactions in susceptible people

Drug Interactions:

Furosemide: A precipitate forms on admixture with inamrinone.

Diuretics may cause significant hypovolemia and decrease filling pressure.

Digitalis: Inotropic effects are additive.

Stability:

May be administered undiluted for I.V. bolus doses. For continuous infusion: Dilute with 0.45% or 0.9% sodium chloride to final concentration of 1-3 mg/mL; use within 24 hours; do not directly dilute with dextrose-containing solutions, chemical interaction occurs; may be administered I.V. into running dextrose infusions. Furosemide forms a precipitate when injected in I.V. lines containing inamrinone.

Compatibility:

Stable in NS, ¹/2NS; incompatible in D5W

Y-site administration: Compatible: Aminophylline, atropine, bretylium, calcium chloride, cimetidine, cisatracurium, digoxin, dobutamine, dopamine, epinephrine, famotidine, hydrocortisone sodium succinate, isoproterenol, lidocaine, metaraminol, methylprednisolone sodium succinate, nitroglycerin, nitroprusside, norepinephrine, phenylephrine, potassium chloride, propofol, propranolol, remifentanil, verapamil. Incompatible: Sodium bicarbonate. Variable (consult detailed reference): Procainamide

Compatibility in syringe: Compatible: Propranolol, verapamil

Compatibility when admixed: Compatible: Propafenone. Incompatible: Furosemide

Mechanism of Action:

Inhibits myocardial cyclic adenosine monophosphate (cAMP) phosphodiesterase activity and increases cellular levels of cAMP resulting in a positive inotropic effect and increased cardiac output; also possesses systemic and pulmonary vasodilator effects resulting in pre- and afterload reduction; slightly increases atrioventricular conduction

Pharmacodynamics/Kinetics:

Onset of action: I.V.: 2-5 minutes

Peak effect: ~10 minutes

Duration (dose dependent): Low dose: ~30 minutes; Higher doses: ~2 hours

Half-life elimination, serum: Adults: Healthy volunteers: 3.6 hours, Congestive heart failure: 5.8 hours

Dosage:

Dosage is based on clinical response (Note: Dose should not exceed 10 mg/kg/24 hours).

Infants, Children, and Adults: 0.75 mg/kg I.V. bolus over 2-3 minutes followed by maintenance infusion of 5-10 mcg/kg/minute; I.V. bolus may need to be repeated in 30 minutes.

Dosing adjustment in renal failure: Clcr<10 mL/minute: Administer 50% to 75% of dose.

Administration:

May be administered undiluted for I.V. bolus doses. For continuous infusion: Dilute with 0.45% or 0.9% sodium chloride to final concentration of 1-3 mg/mL use within 24 hours.

Monitoring Parameters:

Cardiac index, stroke volume, systemic vascular resistance, and pulmonary vascular resistance (if Swan-Ganz catheter available); CVP, SBP, DBP, heart rate; platelet count, CBC, liver function and renal function tests

Patient Education:

Make position changes slowly because of postural hypotension

Additional Information:

To avoid confusion with similarly sounding medication names, the name "amrinone" was changed to "inamrinone" in July, 2000.

Anesthesia and Critical Care Concerns/Other Considerations:

To avoid confusion with similarly sounding medication names, the generic name "amrinone" changed to "inamrinone" in July, 2000.

Preliminary pharmacokinetic studies estimate total initial bolus doses of 3-4.5 mg/kg given in divided doses in neonates and infants to obtain serum concentrations similar to therapeutic adult levels; the actual use of these higher doses has been reported in a very small number of infants (n=7). Further studies are needed to define pediatric dosing guidelines.

Although the phosphodiesterase inhibitor drugs may induce short-term improvement in clinical status in patients with intractable heart failure, longer-term studies of these drugs in heart failure have suggested that there is a net increase in mortality.

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

None reported

Mental Health: Effects on Psychiatric Treatment:

May cause hypotension which may be exacerbated by psychotropics

Dosage Forms:

Injection, solution, as lactate: 5 mg/mL (20 mL) [contains sodium metabisulfite]

References

Feldman AM, Bristow MR, Parmley WW, et al, "Effects of Vesnarinone on Morbidity and Mortality in Patients With Heart Failure. Vesnarinone Study Group,"N Engl J Med, 1993, 329(3):149-55.

Hunt SA, Baker DW, Chin MH, et al, "ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure),"J Am Coll Cardiol, 2001, 38(7):2101-13.

Packer M, Carver JR, Rodeheffer RJ, et al, "Effect of Oral Milrinone on Mortality in Severe Chronic Heart Failure. The PROMISE Study Research Group,"N Engl J Med, 1991, 325(21):1468-75.

Packer M, Medina N, and Yushak M, "Hemodynamic and Clinical Limitations of Long-Term Inotropic Therapy With Amrinone in Patients With Severe Chronic Heart Failure,"Circulation, 1984, 70(6):1038-47.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.