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. Recommendations for Inotropic Support, MCS, and Cardiac Transplantation Recommendations COR LOE References Inotropic support Cardiogenic shock pending definitive therapy or resolution I C N/A BTT or MCS in stage D refractory to GDMT IIa B 275,276 Short-term support for threatened end-organ dysfunction in hospitalized patients with stage D and severe HFrEF IIb B 277 279 Long-term support with continuous infusion palliative therapy in select stage D HF IIb B 280 282 Routine intravenous use, either continuous or intermittent, is potentially harmful in stage D HF III: Harm B 172,283 288 Short-term intravenous use in hospitalized patients without evidence of shock or threatened end-organ performance is potentially harmful III: Harm B 277 279 MCS MCS is beneficial in carefully selected* patients with stage D HF in whom definitive management (e.g.