Know the Inotropic Agent


Inotropic agents, or inotropes, are drugs that change the pressure of the contraction of the heart muscle (heart rate). There are two different types of inotropic drugs: negative and positive. There are 2 types of inotropes: positive inotropes and negative inotropes. Positive inotropes strengthen heart rate pressure. Inotropes negatively weaken heart rate pressure and make the heart beat weaker. Both are used to treat various conditions that affect heart function.

Inotropic agents include:

  • Amrinone
  • Digoxin
  • Dobutamine
  • Dopamine
  • Inamrinone
  • Intropin
  • Lanoxin
  • Milrinone


In addition to digoxin, other positive inotropic drugs should only be used for acute or end-stage heart failure because long-term use has worsened the disease, and may increase the risk of death in some heart failure patients. These drugs can provide short-term benefits in some patients but are dangerous for long-term use.

How do inotropic agents work?

Inotropic agents affect the contraction of the heart muscle. Positive inotropes stimulate and increase the strength of contraction of the heart muscle causing increased heart rate. Negative inotropic agents weaken the pressure of muscle contraction.

The inotropic state depends on the amount of calcium in the cytoplasm of the heart muscle wall, cardiac contractility depends on the control of intracellular calcium, for example, control of calcium intake into the cell membrane and storage of calcium in the sarcoplasmic reticulum. The main factors controlling calcium intake are the voltage-gated calcium channel activity and sodium ions, which affect calcium/sodium ion turnover.

One of the most important factors influencing the strength of heart muscle contraction is the level of imitation in heart muscle cells. Calcium is one of the most common electrolytes in the human body, while other common electrolytes are sodium, potassium, chloride, and magnesium. The right balance of electrolytes for good heart, nerve, muscle and kidney function is very important.

The electrolyte has an electric charge and conducts electrical impulses (electricity). Electric impulses make muscle contraction. The level of each electrolyte must be maintained in a short range so that the body can function properly. In particular, it is important to maintain the right difference between electrolyte levels in the fluid inside and outside the cell. This difference allows cells (especially nerves, heart and muscles) to maintain the electrical voltage between cell membranes, make electrical impulses, and produce muscle contractions.

Calcium plays an important role in the process of contraction of the heart muscle. In general, calcium levels are enhanced by positive inotropic drugs and reduced by negative inotropic drugs. But inotropic drugs can change calcium levels in different ways. Positive and negative inotropes work in different ways.

Positive inotrope helps the heart pump more blood with less heart rate. This means even though the heart rate is less, but the beat is stronger to meet the oxygen demand in the body.

Negative Inotrope includes beta blockers, calcium channel blockers, and antiarrhythmic drugs and all work in different ways:

  • Beta-blockers "block" the effects of adrenaline on your body's beta receptors. This slows down nerve impulses that travel through the heart. As a result, your heart doesn't need to work too hard because it needs less blood and oxygen. Beta-blockers also block impulses that can cause arrhythmias.
  • Calcium channel blockers slow the speed of calcium into the heart muscle and into the blood vessel wall. This will loosen blood vessels. Blood vessels and allow blood to flow more easily, and then lower blood pressure.
  • Antiarrhythmic drugs slow down electrical conduction in the heart


What are the side effects of inotropic agents?

  • When using an inotropic agent, you may get a number of side effects, including vision problems such as blurred vision, double vision, or seeing yellow, green or white patches around objects
  • Low blood pressure (hypotension)
  • Fatigue
  • Loss of appetite or stomach ache
  • Gag
  • A headache
  • Eye sensitivity to light
  • Nosebleeds and bleeding gums
  • Irregular heartbeat then causes dizziness, feeling of heart beat (palpitations), difficulty breathing, sweating, or fainting
  • Dizziness or dizziness
  • Diarrhea
  • Erectile dysfunction
  • Breast enlargement in men
  • Lack of sexual desire
  • Rash or itching


Tell your doctor immediately if you experience these side effects. Do not stop using the drug unless the doctor recommends it, because stopping treatment suddenly can worsen your condition.

What must be considered

Always consult your doctor before using an inotropic agent. Tell your doctor if you are pregnant, plan a pregnancy or are breastfeeding.

Also, tell your doctor about the medicines you use including natural and herbal supplements.

Tell your doctor if you have allergies to drugs that are included in an inotropic agent.

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