inamrinone (Rx)

Brand and Other Names:amrinone
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 5mg/mL

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

Renal Impairment

CrCl <10 mL/min: Administer 50-75% of the dose

CrCl ≥10 mL/min: Dosage adjustment not required

Dosage Forms & Strengths

injectable solution

  • 5mg/mL

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 ≥30 mL/min: Dose adjustment not necessary

CrCl 10-29 mL/min: Administer 50% of dose

CrCl <10 mL/min: Administer 25% of dose

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

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Interactions

Interaction Checker

and inamrinone

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (0)

              Serious - Use Alternative (2)

              • ozanimod

                ozanimod increases toxicity of inamrinone by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

              • ponesimod

                ponesimod, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              Monitor Closely (2)

              • anagrelide

                anagrelide, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              • milrinone

                milrinone, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (1)

              • digoxin

                inamrinone, digoxin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown.

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              Adverse Effects

              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)

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              Warnings

              Contraindications

              Hypersensitivity to inamrinone, milrinone and bisulfites

              Cautions

              Recent MI

              Electrolyte abnormalities

              Hypotension

              Proarrhythmic effects

              Insufficient cardiac filling pressure

              Severe aortic or pulmonic valvular diseas

              Renal impairment

              Concurrent use of disopyramide (may cause hypotension)

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: excretion in milk unknown; use with caution

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Positive inotrope with direct pulmonary vasodilator (decrease both preload & afterload) activity, which increases cardiac output; these effects result from increases in cellular levels of cAMP as inamrinone inhibits myocardial cAMP phosphodiesterase

              Pharmacokinetics

              Half-Life: 3.6-5.8 hr (longer in CHF)

              Onset: 5-10 min (initial effect); within 10 min (max effect)

              Duration: 0.5-2 hr, duration depends on dose, mutiple doses: 8 hr

              Protein Bound: 10-49%

              Vd: 1.2 L/kg

              Metabolism: In the liver, main metabolic pathway is conjugation

              Metabolites: N-glycolate, N-acetate, N-glucuronide, O-glucuronide (inactive)

              Excretion: Urine 10-40%, feces 18%

              Dialyzable: No (HD or PD)

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              Administration

              IV Incompatibilities

              Solution: D5W

              Additive: furosemide

              Y-site: procainamide(?), Na bicarb

              IV Compatibilities

              Solution: 1/2NS

              Additive: propafenone

              Syringe: propranolol, verapamil

              Y-site (partial list): atropine, CaCl2, digoxin, dobutamine, dopamine, epinephrine, hydrocortisone, isoproterenol, methylprednisolone, nitroglycerin, norepinephrine, phenylephrine, KCl, propofol, propranolol, verapamil

              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

              Storage

              Store intact vials at room temp; protect from light

              Use diluted soln within 24 hr

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              Images

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.