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Early studies in patients with heart failure showed that amrinone produced short-term hemodynamic improvement, but had limited long-term clinical benefit. [8] Some serious side effects of long term administration included sustained ventricular tachycardia resulting in circulatory collapse, worsening myocardial ischemia, acute myocardial infarction, and worsening congestive heart failure. [8] [12] Amrinone has good absorption from the gastrointestinal tract [13] and may lead to some gastrointestinal upset when taken orally. The oral form of the drug is no longer in use. [12] Currently, only acute intravenous administration takes place. [12] The effects of amrinone vary widely with species and experimental condition; therefore inotropic effects are variable. [4] A loss in sensitivity to PDE III inhibitors has been observed in end stage heart failure in humans and thus other treatment options may be necessary to improvement in these stages. [4]

A significant elevation in blood pressure is rare but has been reported following conjunctival instillation of recommended doses of NEO-SYNEPHRINE (phenylephrine hydrochloride ophthalmic solution) 10 percent ophthalmic solutions. Caution, therefore, should be exercised in administering the 10 percent solutions to children of low body weight, the elderly, and patients with insulin-dependent diabetes , hypertension , hyperthyroidism, generalized arteriosclerosis , or cardiovascular disease . The posttreatment blood pressure of these patients, and any patients who develop symptoms, should be carefully monitored.

Use cautiously in patients with deficiency of spleen and stomach, or during pregnancy. Chih-ko ( zhiqiao ) To move qi; to ease the middle jiao and eliminate distention. Distention and pain in the epigastrium and abdomen and poor appetite due to stagnation of spleen and stomach qi. 3-10 grams Blue citrus ( qingpi ) To regulate liver and break qi; to disperse lumps and relieve stagnant food. Distending pain in the hypochondriac region and breast, hernia caused by stagnation of liver qi; distending pain in the abdomen and epigastrium due to stagnant food with stagnant qi; movable or immovable masses in the abdomen due to stagnation of qi and blood. 3-10 grams

In terms of molecular structure, synephrine has a phenethylamine skeleton, with a phenolic hydroxy - group, an alcoholic hydroxy- group, and an N -methylated amino -group. Alternatively, synephrine might be described as a phenylethanolamine with an N -methyl and p -hydroxy substituent. The amino-group confers basic properties on the molecule, whereas the phenolic –OH group is weakly acidic: the apparent (see original article for discussion) pK a s for protonated synephrine are (phenolic H) and (ammonium H). [52]

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In terms of molecular structure, synephrine has a phenethylamine skeleton, with a phenolic hydroxy - group, an alcoholic hydroxy- group, and an N -methylated amino -group. Alternatively, synephrine might be described as a phenylethanolamine with an N -methyl and p -hydroxy substituent. The amino-group confers basic properties on the molecule, whereas the phenolic –OH group is weakly acidic: the apparent (see original article for discussion) pK a s for protonated synephrine are (phenolic H) and (ammonium H). [52]

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