| Tolerability of beta-blockers in outpatients with refractory heart failure who were receiving continuous milrinone. | |
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MedLine Citation:
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PMID: 17461705 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Grace L Earl; Marybeth A Verbos-Kazanas; Jane M Fitzpatrick; Jagat Narula |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Pharmacotherapy Volume: 27 ISSN: 0277-0008 ISO Abbreviation: Pharmacotherapy Publication Date: 2007 May |
Date Detail:
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Created Date: 2007-04-27 Completed Date: 2007-06-26 Revised Date: 2013-05-28 |
Medline Journal Info:
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Nlm Unique ID: 8111305 Medline TA: Pharmacotherapy Country: United States |
Other Details:
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Languages: eng Pagination: 697-706 Citation Subset: IM |
Affiliation:
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Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania 19104, USA. g.earl@usip.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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administration & dosage,
adverse effects,
therapeutic use* Aged 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 Female Heart Rate / drug effects Hospitals, University Humans Hypotension / chemically induced Male Metoprolol / administration & dosage, adverse effects, therapeutic use Middle Aged Milrinone / therapeutic use* Oxygen Consumption / drug effects Propanolamines / administration & dosage, adverse effects, therapeutic use Retrospective Studies Sodium / blood Vasodilator Agents / therapeutic use |
| Chemical | |
Reg. No./Substance:
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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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