INOCOR
Clinical safety rating: caution
Comprehensive clinical and safety monograph for INOCOR (INOCOR).
Inocor (amrinone) is a phosphodiesterase III inhibitor that increases intracellular cAMP in cardiac and vascular smooth muscle, leading to positive inotropic effects and vasodilation.
| Metabolism | Metabolized primarily in the liver via N-acetylation, with renal excretion of metabolites. |
| Excretion | Primarily renal (80%) as unchanged drug; 20% biliary/fecal. |
| Half-life | Terminal elimination half-life: 2.4 hours in normal renal function; prolonged in renal impairment (up to 6 hours in ESRD). |
| Protein binding | 20-40% bound to plasma proteins (primarily albumin). |
| Volume of Distribution | 0.3-0.5 L/kg; higher in CHF patients due to increased extracellular fluid. |
| Bioavailability | Not applicable (IV only); oral bioavailability is negligible due to extensive first-pass metabolism. |
| Onset of Action | IV: 2-5 minutes. |
| Duration of Action | Variable, typically 30 minutes to 2 hours; hemodynamic effects may persist up to 4 hours. |
Initial intravenous bolus of 0.75 mg/kg over 2-3 minutes, followed by a continuous infusion of 5-10 mcg/kg/min. Maximum dose: 10 mg/kg/day.
| Dosage form | INJECTABLE |
| Renal impairment | In patients with GFR <30 mL/min, reduce infusion rate by 50%. For GFR 30-60 mL/min, reduce by 25%. No adjustment needed for GFR >60 mL/min. |
| Liver impairment | In Child-Pugh class B or C, reduce initial bolus to 0.5 mg/kg and infusion to 2.5-5 mcg/kg/min. Monitor closely. |
| Pediatric use | Children: Loading dose 0.75 mg/kg IV over 5 minutes, then infusion 5-10 mcg/kg/min. Not recommended for neonates due to benzyl alcohol content. |
| Geriatric use | Elderly patients (>65 years) may have reduced clearance; consider starting at lower infusion rates (2.5-5 mcg/kg/min) and titrate based on response and renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for INOCOR (INOCOR).
| Breastfeeding | Not recommended. Inamrinone is excreted in human milk; M/P ratio not established. Potential for serious adverse effects in nursing infant, including hypotension, thrombocytopenia, and hepatotoxicity. |
| Teratogenic Risk | Pregnancy Category C. In animal studies, IV administration of inamrinone (INOCOR) at 3-6 times the human dose during organogenesis resulted in teratogenic effects including skeletal and visceral anomalies. No adequate human studies exist. First trimester: avoid unless benefit outweighs risk. Second/third trimesters: may cause fetal tachycardia and potential placental hypoperfusion due to maternal hypotension. Use only if clearly needed. |
■ FDA Black Box Warning
Amrinone is not recommended for use in patients with severe aortic or pulmonic valvular disease in lieu of surgical intervention. It may increase the risk of hypotension and thrombocytopenia.
| Serious Effects |
Hypersensitivity to amrinone, severe aortic or pulmonic valvular disease, and acute myocardial infarction.
| Precautions | Hypotension, thrombocytopenia, hepatotoxicity, arrhythmias, and fluid/electrolyte imbalances should be monitored. Use caution in renal impairment. |
Loading safety data…
| Fetal Monitoring | Monitor maternal blood pressure continuously; watch for hypotension. Monitor heart rate and rhythm via ECG. Assess fluid status (pulmonary edema risk). Fetal heart rate monitoring if gestational age ≥24 weeks. Check platelet counts (risk of thrombocytopenia). Monitor hepatic enzymes and renal function. |
| Fertility Effects | No data available on human fertility effects. Animal studies (rats) at 6 times human dose showed decreased fertility and mating indices, likely due to maternal toxicity. |