Dose: 3.0 to 4.5 mg/kg as
loading dose IV
(given in 0.75 mg/kg increments each infused over 5 minutes)
3.0 to 5.0 mcg/kg/min as a continuous infusion
Amrinone
Use Milrinone instead due to less platelet and GI toxicity.
| Dose: 3.0 to 4.5 mg/kg as
loading dose IV |
| Frequency: Continuous infusion |
| Comments: Amrinone is a positive inotropic agent for treatment of postoperative congestive heart failure. It is a potent systemic and pulmonary vasodilator. Its mode of action appears to be a selective inhibition of the myocardial C-AMP phosphodiesterase which results in elevated cellular levels of C-AMP. Clinically amrinone has the ability to increase the inotropy of the heart and reduce the after load without increasing myocardial oxygen consumption. To obtain levels considered therapeutic in adults (2-7 mcg/ml), the dosing regimen listed above was used. The loading dose is given in increments of 0.75 mg/kg over 5 minutes every 15 minutes for 4 or 5 doses to avoid arrhythmias. Amrinone can be used in conjunction with other sympathomimetic amines in neonates with congestive heart failure and offers an alternative form of treatment of CHF when sympathomimetic amines are contraindicated. Further comments amrinone. |
| Toxicity: No adverse effects were reported by Lawless (1989) during the bolus or continuous infusion though transient hypotension occurred during the bolus "which resolved with a decrease in the rate of delivery of the bolus. The most common adverse effect in adults is an arrhythmia, either supraventricular or ventricular. Hypotension can occur, especially in the presence of hypovolemia. Thrombocytopenia is more likely to be seen with prolonged therapy. Platelet counts may stabilize at a lower level requiring no change or may respond to a decrease in the dose of amrinone. In some cases the drug will need to be discontinued. Hepatotoxicity is usually manifested by marked increases in liver enzymes (Facts and Comparisons, Inc. Drug Facts and Comparisons. Olin, B.R. ed. St. Louis, MO:Facts and Comparisons, Inc; 1996, page 142c). |
| Preparation: Amrinone (Inocor) is available in a 20 ml ampule as amrinone lactate (5 mg/ml). Dilute in either normal saline or half normal saline to a concentration of 1 mg/ml to 3 mg/ml. Do not mix with dextrose containing fluids. To prepare a 1 mg/ml solution used in the the tables below, mix the 20 ml ampule with 80 ml normal or half normal saline. Diluted solution stable for 24 hours at room temperature. |
| Compatibility: No information available about compatibility with TPN or filter. Amrinone is compatible with sodium chloride, aminophylline, atropine, calcium chloride, digoxin, dobutamine, dopamine, epinephrine, famotidine, heparin, hydrocortisone, isoproterenol, lidocaine, nitroprusside, potassium chloride and propranolol.. It is incompatible with dextrose containing solutions (but may be infused into dextrose-containing fluids at a "Y" site), furosemide, and sodium bicarbonate. It has equivocal compatibility with procainamide. |
Weight |
3 mg/kg total loading dose (ml) |
0.75 mg/kg aliquot infused over 5 minutes (ml) |
Weight |
3 mg/kg total loading dose (ml) |
0.75 mg/kg aliquot infused over 5 minutes (ml) |
500 |
1.50 |
0.38 |
3000 |
9.00 |
2.25 |
750 |
2.25 |
0.56 |
3250 |
9.75 |
2.44 |
1000 |
3.00 |
0.75 |
3500 |
10.50 |
2.63 |
1250 |
3.75 |
0.94 |
3750 |
11.25 |
2.81 |
1500 |
4.50 |
1.13 |
4000 |
12.00 |
3.00 |
1750 |
5.25 |
1.31 |
4250 |
12.75 |
3.19 |
2000 |
6.00 |
1.50 |
4500 |
13.50 |
3.38 |
2250 |
6.75 |
1.69 |
4750 |
14.25 |
3.56 |
2500 |
7.50 |
1.88 |
5000 |
15.00 |
3.75 |
2750 |
8.25 |
2.06 |
5250 |
15.75 |
3.94 |
Weight (grams) |
3 mcg/kg/min |
4 mcg/kg/min |
5 mcg/kg/min |
IV rate (ml/hr) |
IV rate (ml/hr) |
IV rate (ml/hr) |
|
500 |
0.09 |
0.12 |
0.15 |
750 |
0.14 |
0.18 |
0.23 |
1000 |
0.18 |
0.24 |
0.30 |
1250 |
0.23 |
0.30 |
0.38 |
1500 |
0.27 |
0.36 |
0.45 |
1750 |
0.32 |
0.42 |
0.53 |
2000 |
0.36 |
0.48 |
0.60 |
2250 |
0.41 |
0.54 |
0.68 |
2500 |
0.45 |
0.60 |
0.75 |
2750 |
0.50 |
0.66 |
0.83 |
3000 |
0.54 |
0.72 |
0.90 |
3250 |
0.59 |
0.78 |
0.98 |
3500 |
0.63 |
0.84 |
1.05 |
3750 |
0.68 |
0.90 |
1.13 |
4000 |
0.72 |
0.96 |
1.20 |
4250 |
0.77 |
1.02 |
1.28 |
4500 |
0.81 |
1.08 |
1.35 |
4750 |
0.86 |
1.14 |
1.43 |
5000 |
0.90 |
1.20 |
1.50 |
5250 |
0.95 |
1.26 |
1.58 |