Inotropic therapy for heart failure - an unfulfilled promise

Article Abstract:

An article in the November 21, 1991 issue of The New England Journal of Medicine reports study results indicating that the use of a drug, milrinone, is decidedly not advisable for treating advanced heart failure. In addition to the importance of the specific findings, the report shows how influential a well-designed clinical trial can be. Milrinone is an inotropic agent (one that affects the heart's contractility) derived from amrinone, a drug initially thought to hold great promise for treating chronic heart failure. However, amrinone was discovered to exert potent toxic effects such as thrombocytopenia (decrease in platelets, cells essential for clotting) and ventricular arrhythmia. In the current study, milrinone was associated with an increase in mortality of 30 percent and was particularly dangerous for the sickest patients. Milrinone, unlike some other drugs later found to be detrimental to health in some cases (such as flecainide and encainide), had not yet been approved for general use by the Food and Drug Administration. Milrinone appeared to prolong life in laboratory animals, but apparently its physiological actions are different in humans. The drug increases the levels of cyclic AMP in cells, but these levels may fall in the diseased heart as an adaptive mechanism. When increased, arrhythmia may result. Recent encouraging developments in the treatment of heart failure include vasodilator therapy (to dilate blood vessels) with several drugs, some of which have additional beneficial effects. These drugs are briefly described. Two million people in the US have congestive heart failure; drugs that enhance the force of heart contraction have not yet proved therapeutically useful to them. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Milrinone

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Diet pills redux

Article Abstract:

The appetite suppressants fenfluramine, dexfenfluramine and phentermine should only be used in patients with severe obesity. Several reports in the 1990's have linked these diet pills to pulmonary hypertension even when the drugs were used for one month or less. This same phenomenon occurred between 1967 and 1972 and was linked to the appetite suppressant aminorex. In 1997, a study revealed that 24 women developed heart valve disease after using fenfluramine and phentermine, a combination commonly called fen-phen. These drugs should not be used for cosmetic weight loss.

Causes of, Pulmonary hypertension, Fenfluramine, Dexfenfluramine, Heart valve diseases, Phentermine

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Inotropic therapy for heart failure

Article Abstract:

Some patients with severe heart failure may choose to take a drug that relieves their symptoms even though it may reduce their life expectancy. One class of drugs used in heart failure is inotropes, which stimulate heart contraction. However, most have been found to increase death rates compared to a placebo. Thus, they probably have no place in the treatment of most patients. But patients who do not respond to other drugs such as ACE inhibitors, diuretics and beta blockers may be willing to take these drugs in order to feel better.

Cardiotonic agents

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