Inotropes

Inotropes bear a non-negligible risk of important adverse events - Dimitrios Farmakis

Inotropes

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A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus

Inotropes increase cardiac output by enhancing cardiac contractility through different mechanisms of action, but they also bear variable vasodilatory or vasoconstrictive effects depending on agent and dosage. They constitute an important tool for the treatment of patients with AHF or AdvHF, as they are often effective in improving hemodynamics and symptoms. However, their administration has been associated with increased short and long-term mortality due to frequent adverse effects, but also due to their improper use. The classes of inotropes currently used in HF are the β-adrenergic receptor agonists including dopamine, dobutamine and the catecholamines norepinephrine and epinephrine, the…

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 A pragmatic approach to the use of inotropes for the management of acute and advanced heart failure: An expert panel consensus

Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators. Three classes of parenterally administered inotropes are currently indicated for decompensated heart failure, (i) the beta adrenergic agonists, including dopamine and dobutamine and also the catecholamines epinephrine and norepinephrine, (ii) the phosphodiesterase III inhibitor milrinone and (iii) the calcium sensitizer levosimendan. These three families of drugs share some pharmacologic traits, but differ profoundly in many of their pleiotropic effects. Identifying the patients in need of inotropic support and selecting the proper inotrope in each case remain challenging.

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