Which medications in the drug class Inotropic Agents are used in the treatment of Cardiac Amyloidosis?

Updated: Mar 25, 2020
  • Author: Gyanendra K Sharma, MD, FACC, FASE; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Inotropic Agents

Inotropic agents are reserved for patients who need hemodynamic-directed treatment during acute decompensation, those refractory to maximal standard therapy, as palliation for end-stage heart failure, or as a bridge to transplantation for appropriate candidates.

Digoxin (Lanoxin)

Digoxin is a cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. It acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Digoxin binds to amyloid fibrils and predisposes these patients to digoxin toxicity. [62] A low dose of digoxin should be used when indicated, as toxicity can occur even when serum digoxin level is in the therapeutic range. No precise dose recommendation can be made due to lack of evidence. Patients receiving digoxin should be closely monitored for electrocardiographic evidence of digoxin toxicity (eg, heart block, ventricular arrhythmia, junctional rhythm).


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