PMID- 11526366
OWN - NLM
STAT- MEDLINE
DCOM- 20010920
LR  - 20181130
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 142
IP  - 3
DP  - 2001 Sep
TI  - Carvedilol titration in patients with congestive heart failure receiving 
      inotropic therapy.
PG  - 512-5
AB  - BACKGROUND: Carvedilol has been shown to improve morbidity and mortality in 
      patients with congestive heart failure (CHF). There are limited data of 
      carvedilol use in patients on inotrope therapy. We present our experience with 
      carvedilol titration in New York Heart Association (NYHA) class IIIb/IV patients 
      stabilized on milrinone therapy, as a nonrandomized study with a parallel control 
      group of patients never on inotropes. These patients achieved volume control and 
      stabilization of their symptoms during the course of milrinone therapy. METHODS 
      AND RESULTS: Seventeen patients in class IIIb/IV CHF (group 1) on intermittent 
      intravenous milrinone therapy and 15 patients in class II/IIIa compensated CHF 
      (group 2) on standard triple heart failure therapy were titrated on carvedilol. 
      Success and adverse events during titration were compared between the 2 groups. 
      Fifteen (88%) patients in group 1 and 14 (93%) patients in group 2 were 
      successfully titrated on carvedilol over 8.1 +/- 1.8 weeks and 6.7 +/- 2.8 weeks, 
      respectively. The target dose of carvedilol (25 or 50 mg twice daily) was 
      achieved in 13 (87%) patients (group 1) and 14 (93%) patients (group 2). Seven 
      (47%) patients in group 1 and 4 (28%) patients in group 2 had adverse events 
      during carvedilol titration. Eight (53%) patients in group 1 were weaned off 
      milrinone over a period of 8.4 weeks after carvedilol titration, whereas the rest 
      of the patients had reduction in the frequency of infusion. Ten (63%) patients in 
      group 1 improved by one or more functional classes. CONCLUSIONS: Patients in NYHA 
      class IIIb/IV who are treated with inotropic therapy can be titrated on 
      carvedilol after reaching a stable state while on milrinone and standard oral 
      drugs. Most of these patients can be successfully weaned off of milrinone or have 
      decreased frequency of infusions and demonstrate improved functional status. 
      Prospective randomized trials are required to evaluate these observations made in 
      a limited number of patients in class IIIb and IV CHF because the combination of 
      milrinone and beta-blockers has never been adequately evaluated.
FAU - Kumar, A
AU  - Kumar A
AD  - Michael Reese Hospital, Chicago, Ill., USA.
FAU - Choudhary, G
AU  - Choudhary G
FAU - Antonio, C
AU  - Antonio C
FAU - Just, V
AU  - Just V
FAU - Jain, A
AU  - Jain A
FAU - Heaney, L
AU  - Heaney L
FAU - Papp, M A
AU  - Papp MA
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Carbazoles)
RN  - 0 (Cardiotonic Agents)
RN  - 0 (Propanolamines)
RN  - 0K47UL67F2 (Carvedilol)
RN  - JU9YAX04C7 (Milrinone)
SB  - IM
MH  - Adrenergic beta-Antagonists/*administration & dosage/pharmacology
MH  - Aged
MH  - Carbazoles/*administration & dosage/pharmacology
MH  - Cardiotonic Agents/*therapeutic use
MH  - Carvedilol
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Milrinone/*therapeutic use
MH  - Propanolamines/*administration & dosage/pharmacology
MH  - Retrospective Studies
EDAT- 2001/08/30 10:00
MHDA- 2001/09/21 10:01
CRDT- 2001/08/30 10:00
PHST- 2001/08/30 10:00 [pubmed]
PHST- 2001/09/21 10:01 [medline]
PHST- 2001/08/30 10:00 [entrez]
AID - S0002-8703(01)24787-5 [pii]
AID - 10.1067/mhj.2001.117605 [doi]
PST - ppublish
SO  - Am Heart J. 2001 Sep;142(3):512-5. doi: 10.1067/mhj.2001.117605.