Inamrinone (previously called amrinone) and milrinone arebipyridine compounds that
inhibit phosphodiesterase isozyme 3 (PDE-3). They are active orally as well as
parenterally but are available only in parenteral forms. They have elimination
half-lives of 3–6 hours, with 10–40% being excreted in the urine.
bipyridines increase myocardial contractility by increasing inward calcium flux
in the heart during the action potential; they may also alter the intracellular
movements of calcium by influencing the sarcoplasmic reticulum. They also have
an important vasodilat-ing effect. Inhibition of phosphodiesterase results in
an increase in cAMP and the increase in contractility and vasodilation.
toxicity of inamrinone includes nausea and vomiting; arrhythmias,
thrombocytopenia, and liver enzyme changes have also been reported in a
significant number of patients. This drug has been withdrawn in some countries.
Milrinone appears less likely to cause bone marrow and liver toxicity than
inamrinone, but it does cause arrhythmias. Inamrinone and milrinone are now
used only intravenously and only for acute heart failure or severe exacerbation
of chronic heart failure.