|Tolerability of beta-blockers in outpatients with refractory heart failure who were receiving continuous milrinone.|
|PMID: 17461705 Owner: NLM Status: MEDLINE|
|STUDY OBJECTIVE: To investigate the dosing, tolerability, and outcomes associated with the use of concomitant beta-blockers and inotropic therapy in patients with refractory heart failure during the first 6 months of their therapy.
DESIGN: Retrospective review.
SETTING: University-based, tertiary care heart failure and transplant center.
PATIENTS: Sixteen inotrope-dependent outpatients with end-stage refractory heart failure who were receiving continuous intravenous milrinone. Of these patients, 12 also received an oral beta-blocker; the remaining four patients who did not receive beta-blockers served as the comparator group.
MEASUREMENTS AND MAIN RESULTS: For each patient, the initial and final study drug doses of continuous intravenous milrinone and oral beta-blocker treatment, when applicable, were recorded over the 6-month period. Mean heart rate, blood pressure, ejection fraction, and oxygen consumption were measured, and 95% confidence intervals were calculated. Serum sodium and creatinine concentrations, as well as the creatinine clearance, were measured. In the 12 patients who received concomitant milrinone and beta-blockers, the mean baseline ejection fraction was approximately 18%, and they received milrinone for 18.6 weeks. Seven patients received carvedilol for 16.1 weeks, and five received metoprolol tartrate for 17.6 weeks. Dosages of the beta-blockers were titrated. Final daily doses were carvedilol 42.8 mg (95% confidence interval 20.3-65.4) and metoprolol 42.5 mg (95% confidence interval 28.0-57.2). Patients continued to receive other standard oral drug therapy for heart failure. One patient discontinued metoprolol and one discontinued carvedilol because of hypotension and/or worsening heart failure. Cardiac adverse events in the concomitant milrinone plus beta-blocker group were heart failure requiring hospitalization in 10 patients and ventricular arrhythmias in one.
CONCLUSION: Inotrope-dependent patients with refractory end-stage heart failure tolerated continuous intravenous milrinone plus beta-blockers in addition to diuretics and vasodilators for the 6-month observation period. Beta-blocker dosages were titrated, and three patients achieved the target beta-blocker dosage established for stage A-C heart failure. Additional studies are needed to determine the optimal selection and dosing of drug combinations in this population.
|Grace L Earl; Marybeth A Verbos-Kazanas; Jane M Fitzpatrick; Jagat Narula|
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|Type: Journal Article|
|Title: Pharmacotherapy Volume: 27 ISSN: 0277-0008 ISO Abbreviation: Pharmacotherapy Publication Date: 2007 May|
|Created Date: 2007-04-27 Completed Date: 2007-06-26 Revised Date: 2013-05-28|
Medline Journal Info:
|Nlm Unique ID: 8111305 Medline TA: Pharmacotherapy Country: United States|
|Languages: eng Pagination: 697-706 Citation Subset: IM|
|Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania 19104, USA. firstname.lastname@example.org|
|APA/MLA Format Download EndNote Download BibTex|
administration & dosage,
Arrhythmias, Cardiac / chemically induced
Blood Pressure / drug effects
Carbazoles / administration & dosage, adverse effects, therapeutic use
Cardiac Output, Low / drug therapy*
Cardiotonic Agents / therapeutic use*
Creatinine / blood, urine
Diuretics / therapeutic use
Drug Therapy, Combination
Heart Rate / drug effects
Hypotension / chemically induced
Metoprolol / administration & dosage, adverse effects, therapeutic use
Milrinone / therapeutic use*
Oxygen Consumption / drug effects
Propanolamines / administration & dosage, adverse effects, therapeutic use
Sodium / blood
Vasodilator Agents / therapeutic use
|0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Cardiotonic Agents; 0/Diuretics; 0/Propanolamines; 0/Vasodilator Agents; 0K47UL67F2/carvedilol; 37350-58-6/Metoprolol; 60-27-5/Creatinine; 7440-23-5/Sodium; 78415-72-2/Milrinone|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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