16, 2013 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary October 15, 2013:1495 539 CLASS III: HARM 1. Long-term use of either continuous or intermittent, intrave- nous parenteral positive inotropic agents, in the absence of speci c indications or for reasons other than palliative care, is potentially harmful in the patient with HF (172,283 288). (Level of Evidence: B) 2. Use of parenteral inotropic agents in hospitalized patients without documented severe systolic dysfunction, low blood pressure, or impaired perfusion and evidence of signi cantly depressed cardiac output, with or without congestion, is potentially harmful (277 279). (Level of Evidence: B) Table 20. Intravenous Inotropic Agents Used in Management of HF Inotropic Agent Dose (mcg/kg) Drug Kinetics and Metabolism Effects Adverse Effects Special Considerations Bolus Infusion (/min) CO HR SVR PVR Adrenergic agonists R,H,P [ [ 4 4 T, HA, N, tissue necrosis Caution: MAO-I N/A 10 to 15 [ [ [ 4 H [ [ Y 4 [/YBP, HA, T, N, F, hypersensitivity Caution: MAO-I; CI: sulfite allergy PDE inhibitor Milrinone N/R 0.125 to 0.75 t1/2: 2.5 h H [ [ Y Y T, YBP Renal dosing, monitor LFTs BP indicates blood pressure; CI, contraindication; CO, cardiac output; F, fever; H, hepatic; HA, headache; HF, heart failure; HR, heart rate; LFT, liver function test; MAO-I, monoamine oxidase inhibitor; N, nausea; N/A, not applicable; N/R, not recommended; P, plasma; PDE, phosphodiesterase; PVR, pulmonary vascular resistance; R, renal; SVR, systemic vascular resistance; T, tachyarrhythmias; and t1/2, elimination half-life. Table 21. 