Drug reference

Milrinone

Vasodilator · Inotropic Agent

Also known as Perfan, Primacor

VasodilatorInotropic Agent

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

1 major

SEVERE in our sources

PREGNANCY

Manufacturer advises use only if potential benefit outweighs risk.

FDA category + note

Top interactions

TizanidineSevereDatabaseDDInter

Mechanism

Milrinone is a phosphodiesterase type-3 (PDE3) inhibitor that primarily affects the myocardium. Inhibition of PDE3 leads to increased intracellular cyclic AMP (cAMP) concentrations. This results in positive inotropic properties and vasodilator activity.

Indications

Short-term treatment of severe congestive heart failure unresponsive to conventional maintenance therapy (not immediately after myocardial infarction)Acute heart failure, including low output states following heart surgeryshort-term circulation support in advanced CHFimprove cardiac contractility in patients with RV dysfunction (in supportive care for PAH)short-term use in severe and refractory CHF

Dosing

Adult: Initially 50 micrograms/kg intravenous injection over 10 minutes, followed by intravenous infusion of 375–750 nanograms/kg/minute. Usually given following surgery for up to 12 hours or in congestive heart failure for 48-72 hours.
Renal adjustment: Reduce dose and monitor response if eGFR less than 50 mL/minute/1.73 m2.
Max dose: 1.13 mg/kg per day

Pharmacokinetics

Half-life

0.5 to 1 hour (normal individuals)

Contraindications

Severe hypovolaemia
Heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive valvular disease or other outlet obstruction
systolic pressure less than 85 mm Hg
oral use (due to increased mortality)

Side effects

Common

Arrhythmia supraventricular (increased risk in patients with pre-existing arrhythmias)ArrhythmiasHeadacheHypotensionthrombocytopenia (not significant)

Serious