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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
Milrinone has a half-life of 2–4 hours and is almost completely eliminated renally as unchanged drug.115,122 Enoximone has a half-life of 4–7 hours and is hepatically metabolized to active metabolites, which are eliminated renally and more slowly than enoximone.123,124 The onset of action for both enoximone and milrinone is often delayed. Consequently, if a more rapid response is desired and blood pressure is adequate, both milrinone and enoximone can be initiated with bolus doses prior to starting continuous infusions.6 However, the bolus doses of these drugs are often avoided due to the risk of hypotension. Because of their longer half-lives, particularly in the setting of renal dysfunction, the effects of both enoximone and milrinone may be prolonged for hours.
Heart failure
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Short-term infusions of positive inotropes (dobutamine with or without dopamine to improve renal perfusion) may be used in severe cardiac decompensation. Prolonged use of inotropes does not improve survival. Milrinone and enoximone increase mortality.
Cardiac surgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
It has been suggested that faster, fuller and vasodilated are the principles on which forward flow in mitral regurgitation may be maintained. In these circumstances (especially when using potent vasodilators and with the dangers of vascular overfilling) a pulmonary artery catheter allows assessment of intravascular filling, measurement of cardiac output and evaluation of therapeutic intervention. In patients with high pulmonary artery pressures, evidence of tricuspid regurgitation should be looked for in the central venous pressure trace. Passive tricuspid regurgitation results from right ventricle dilatation in the face of increased afterload from pulmonary hypertension (PHT). There are few attractive therapies for this combination of PHT and right ventricular failure and attention should be paid to basic principles, including the avoidance of hypoxia, hypercarbia and acidosis. One promising therapeutic strategy for the treatment of PHT is the use of prostaglandin E1 (prostacyclin), a potent dilator of pulmonary arterial smooth muscle. It has been noted that prostacyclin is also a systemic vasodilator. However, it has the theoretical advantage of having pulmonary endothelial first-pass metabolism, and may be considered a ‘pulmonary-specific’ vasodilator when given via the right atrium. Enoximone and milrinone may be used as they reduce systemic and pulmonary vascular resistance as well as improving inotropy.
PDE3-inhibitor enoximone prevented mechanical ventilation in patients with SARS-CoV-2 pneumonia
Published in Experimental Lung Research, 2021
Jan Beute, Pieter Boermans, Bart Benraad, Jan Telman, Zuzana Diamant, Alex KleinJan
While the initial (marketed) indication for enoximone is heart failure at daily i.v. doses up to 2400 mg, administered at the ICU with close monitoring,17 much lower oral doses (150 mg daily, 6 months) have been safely given to patients (n = 1854) with advanced heart failure in an ambulatory setting and were found to be similar to placebo in regard to adverse events.18 In another study, low-dose oral enoximone was safely administered to young children (aged 0.5–191 months) with congenital heart failure in an ambulatory setting upon discharge from ICU (0.5 mg/kg3 × daily).19 In addition, patients with advanced COPD have been previously reported to benefit from low-dose enoximone (unpublished observation; see also Table 1 – patients 3 and 4).