Cardiac Agent
PREGNANCY RECOMMENDATION: Limited Human Data—Animal Data Suggest Low Risk
BREASTFEEDING RECOMMENDATION: No Human Data—Probably Compatible
PREGNANCY SUMMARY
The data are too limited to assess the risk to the embryo–fetus. The drug probably crosses the placenta. If the maternal condition requires amrinone, it should not be withheld because of pregnancy.
FETAL RISK SUMMARY
Amrinone is a cardiac inotropic agent that also has a vasodilatory effect (1). The drug is unrelated to cardiac glycosides or catecholamines. The principal indication for amrinone is the short-term management of congestive heart failure.
Amrinone is teratogenic in some animal species, producing skeletal and gross external malformations in one type of rabbits but not in other types, and having no effect on fetal rats (1). In pregnant baboons, amrinone infusion did not significantly affect uterine artery blood flow (2).
A single case report has described the use of amrinone in a human pregnancy (3). A 34-year-old woman at 18 weeks’ gestation was treated with an amrinone IV infusion (0.5 mg/kg loading dose followed by 2 mcg/kg/minute) for refractory congestive heart failure secondary to bacterial endocarditis. A higher dose was not used because of premature ventricular contractions. Although no fetal adverse effects attributable to the drug were noted, fetal death occurred 11 days after discontinuance of amrinone because of the deteriorating medical condition of the mother (3).
BREASTFEEDING SUMMARY
No reports describing the use of amrinone during lactation have been located. The molecular weight of amrinone (about 187) is low enough, however, that passage into milk should be expected.
References
1.Product information, Inocor. Sanofi Winthrop Pharmaceuticals, 1997.
2.Fishburne JI Jr, Dormer KJ, Payne GG, Gill PS, Ashrafzadeh AR, Rossavik IK. Effects of amrinone and dopamine on uterine blood flow and vascular responses in the gravid baboon. Am J Obstet Gynecol 1988;158:829–37.
3.Jelsema RD, Bhatia RK, Ganguly S. Use of intravenous amrinone in the short-term management of refractory heart failure in pregnancy. Obstet Gynecol 1991;78:935–6.