III. OTHER POSITIVE INOTROPIC DRUGS Amrinone, dobutamine, and dopamine are +quot;non-digit

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III. OTHER POSITIVE INOTROPIC DRUGS Amrinone, dobutamine, and dopamine are "non-digitalis positive in- otropic drugs" currently approved for short-term use in congestive heart failure. Pharmacokinetics (see also ). * Absorption: These drugs are approved for parenteral use only. * Elimination: Amrinone is eliminated by both hepatic and renal mechan- isms. Dobutamine and dopamine are both catecholamines and are metabol- ized by catechol-O-methyltransferase (COMT). Dopamine is also metabol- ized by monoamine oxidase (MAO). Other Indications These digitalis substitutes are not approved for any other uses and unlabelled uses are insignificant at present. Contraindications and Warnings * Obstructive cardiomyopathy * Digitalis toxicity * Ventricular arrhythmias * Sympathomimetic toxicity, eg, pheochromocytoma (PgDn key for more text) Adverse Reactions and Toxicities * Amrinone: - Hematologic: thrombocytopenia. - GI: nausea, vomiting, abdominal pain, hepatotoxicity. - CV: arrhythmias, hypotension. - Treatment: Monitor platelet count; reduce dosage or stop drug if platelet count drops below 150000/mm3. * Dobutamine: - CV: hypotension, tachycardia, angina, arrhythmia - Miscellaneous: headache, gi distress, shortness of breath. * Dopamine: - CV: arrhythmias, tachycardia, angina, hypertension - Miscellaneous: nausea and vomiting, headache, dyspnea Interactions * MAO inhibitors: potentiate dopamine and to a lesser extent, dobutamine. * Halogenated hydrocarbon anesthetics: sensitize the myocardium to the arrhythmogenic actions of the positive inotropic agents. (Home key to return to top of file)

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