inamrinone lactate

inamrinone lactate

[am′rinōn]

an IV cardiac inotropic drug. Formerly calledamrinone lactate.

indications It is prescribed in the short-term management of congestive heart failure in patients who do not respond to therapy with digitalis, diuretics, and vasodilators.

contraindications Concomitant use with disopyramide and any combination therapy should be closely monitored for potential interactions.

adverse effects Among the more serious adverse effects are thrombocytopenia, arrhythmias, hypotension, nausea, vomiting, liver impairment, and hypersensitivity effects.

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inamrinone lactate Warning - High-alert drug!

Pharmacologic class: Bipyridine derivative

Therapeutic class: Inotropic, vasodilator

Pregnancy risk category C

Action

Inhibits cyclic adenosine monophosphate (cAMP) phosphodiesterase activity in myocardium, increasing cellular levels of cAMP (which regulates intracellular and extracellular calcium levels). These actions increase myocardial contraction force. Also relaxes and dilates vascular smooth muscle, decreasing preload and afterload.

Availability

Injection: 5 mg/ml in 20-ml ampules

⊘Indications and dosages

➣ Short-term management of heart failure

Adults: Initially, 0.75 mg/kg I.V. bolus over 2 to 3 minutes; may give additional bolus of 0.75 mg/kg over 30 minutes. Then begin maintenance infusion of 5 to 10 mcg/kg/minute. Maximum daily dosage is 10 mg/kg.

Off-label uses

• Open-heart surgery

Contraindications

• Hypersensitivity to drug or bisulfites

Precautions

Use cautiously in:
• renal or hepatic disease, atrial fibrillation or flutter, severe aortic or pulmonic valvular disease, acute phase of myocardial infarction
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Administer either undiluted or diluted in normal or half-normal saline solution to yield a concentration of 1 to 3 mg/ml, as prescribed. Don't mix with solutions containing dextrose.
• Give I.V. bolus over 2 to 3 minutes, followed by maintenance infusion using infusion pump or microdrip (60 gtt/ml) at recommended dosage.
• Protect drug from light.

Route	Onset	Peak	Duration
I.V.	2-5 min	10 min	30-120 min

Adverse reactions

CV: hypotension, arrhythmias

GI: nausea, vomiting

Hematologic: thrombocytopenia

Hepatic: hepatotoxicity

Other: hypersensitivity reaction

Interactions

Drug-drug. Cardiac glycosides: increased inotropic effects

Disopyramide: excessive hypotension

Drug-herbs. Aloe, buckthorn bark, cascara sagrada, ephedra (ma huang), senna leaf: increased drug action

Patient monitoring

☞ Monitor vital signs frequently. Expect to slow or stop infusion if significant hypotension occurs.
• Monitor hemodynamic indicators (including cardiac output, cardiac index, central venous pressure, and pulmonary artery wedge pressure) to assess drug efficacy.
• Assess daily weight and fluid intake and output.
☞ Watch closely for ventricular arrhythmias, especially if patient has atrial flutter or atrial fibrillation.
• Assess for signs and symptoms of thrombocytopenia, such as bleeding or bruising.
• Monitor platelet count and electrolyte levels before and during therapy.

Patient teaching

• Instruct patient to report dizziness or light-headedness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.