Primacor Disease Interactions

The use of milrinone both intravenously and orally has been associated with increased frequency of ventricular arrhythmias, including nonsustained ventricular tachycardia. Long-term oral use has been associated with an increased risk of sudden death. Hence, patients receiving milrinone should be observed closely with the use of continuous electrocardiographic monitoring to allow the prompt detection and management of ventricular arrhythmias.

Milrinone should not be used in patients with severe obstructive aortic or pulmonic valvular disease in lieu of surgical relief of the obstruction. Like other inotropic agents, it may aggravate outflow tract obstruction in hypertrophic subaortic stenosis.

No clinical studies have been conducted with milrinone in patients in the acute phase of post myocardial infarction. Until further clinical experience with this class of drugs is gained, milrinone is not recommended in these patients.

The use of inamrinone (former amrinone) has been associated with hepatotoxicity, manifested as marked alterations in liver function tests and clinical symptoms suggestive of idiosyncratic hypersensitivity. This especially after long-term use. Therapy with inamrinone should be administered cautiously if at all in patients with liver disease and discontinuation of the drug may be required if symptoms worsen. Monitoring of liver functions tests prior to and during therapy is recommended.

The use of amrinone or milrinone is associated with a fall in blood pressure. Some patients have required correction by intravenous infusion of plasma. Therapy with amrinone or milrinone should be administered cautiously in hypotensive patients. Monitoring fluid and electrolyte status, renal function, blood pressure, and heart rate is recommended.

The use of amrinone, and infrequently, milrinone, can cause thrombocytopenia. This appears to be dose-dependent and usually occurs during prolonged therapy. Therapy with amrinone and milrinone should be administered cautiously in patients with thrombocytopenia. The dosage may need to be reduced or the drug discontinued if platelet count falls below 150,000/mm3 or if symptoms develop. Platelet counts prior and during therapy are recommended.