No

Phosphodiesterase Enzyme Inhibitor

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

C

Hypersensitivity to amrinone or bisulfites (contains sodium metabisulfite); patients with severe aortic or pulmonic valvular disease

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.

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 symptoms): 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

Furosemide: A precipitate forms on admixture with amrinone.

Diuretics may cause significant hypovolemia and decrease filling pressure.

Digitalis: Inotropic effects are additive.

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 amrinone.

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

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

Peak effect: Within 10 minutes

Duration: Dose dependent (~30 minutes low dose, ~2 hours higher doses)

Serum half-life:

Adults, normal volunteers: 3.6 hours

Adults with CHF: 5.8 hours

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

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

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.

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.

None reported

May cause hypotension which may be exacerbated by psychotropics

No information available to require special precautions

No effects or complications reported

Make position changes slowly because of postural hypotension

Do not"Y" furosemide IVP into amrinone solutions; 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.

Monitor 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

Injection, as lactate: 5 mg/mL (20 mL)

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

Allen-Webb EM, Ross MP, Pappas JB, et al, "Age-Related Amrinone Pharmacokinetics in a Pediatric Population," Crit Care Med, 1994, 22(6):1016-24.

Lawless S, Burckart G, Diven W, et al, "Amrinone in Neonates and Infants After Cardiac Surgery," Crit Care Med, 1989, 17(8):751-4.

Lawless ST, Zaritsky A, and Miles MV, "The Acute Pharmacokinetics and Pharmacodynamics of Amrinone in Pediatric Patients," J Clin Pharmacol, 1991, 31(9):800-3.

Lebovitz DJ, Lawless ST, and Weise KL, "Fatal Amrinone Overdose in a Pediatric Patient," Crit Care Med, 1995, 23(5):977-80.

Lynn AM, Sorensen GK, and Williams GD, "Hemodynamic Effects of Amrinone and Colloid Administration in Children Following Cardiac Surgery," J Cardiothorac Vasc Anesth, 1993, 7(5):560-5.

Rich MW, Woods WL, Davila-Roman VG, et al, "A Randomized Comparison of Intravenous Amrinone Versus Dobutamine in Older Patients With Decompensated Congestive Heart Failure," J Am Geriatr Soc, 1995, 43(3):271-4.

Ross MP, Allen-Webb EM, Pappas JB, et al, "Amrinone-Associated Thrombocytopenia: Pharmacokinetic Analysis," Clin Pharmacol Ther, 1993, 53(6):661-7.

Silverman BD, Merrill AJ, and Gerber L, "Clinical Effects and Side Effects of Amrinone," Arch Intern Med, 1989, 145(5):825-9.

Webster MW and Sharpe DN, "Adverse Effects Associated With the Newer Inotropic Agents," Med Toxicol Adverse Drug Exp, 1986, 1(5):335-42.