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Milrinone

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Milrinone, Primacor

  • See Also
  1. Vasopressor
  2. Amrinone
  • Indications
  1. Refractory NYHA Class 3 to 4 Systolic Dysfunction
  • Mechanism
  1. Phosphodiesterase (PDE) inhibitor Type 3
    1. Blocks breakdown of cyclic Adenosine monophosphate (cAMP) in Myocardium and vascular Smooth Muscle
    2. Sustains Catecholamine activity (even when B-adrenergic Antagonists are present)
    3. Ineffective when cellular cAMP is depleted
  2. Activity
    1. Strong inotropy with increased contractility
      1. Derived from Amrinone, which is 20-30 times less potent than Milrinone
    2. Increases Stroke Volume and ejection fraction
    3. Increases sinus rate
    4. Decreases Afterload by dilating arterioles
      1. Decreases Peripheral Vascular Resistance
  • Dosing
  • Adults
  1. Load: 50 mcg/kg IV infused over 10 minutes
  2. Maintenance
    1. CrCl >50 ml/min: 0.125 to 0.5 mcg/kg/min (up to 0.75 mcg/kg/min) titrated to effect
    2. CrCl 41 to 50 ml/min: 0.43 mcg/kg/min
    3. CrCl 31 to 40 ml/min: 0.38 mcg/kg/min
    4. CrCl 21 to 30 ml/min: 0.33 mcg/kg/min
    5. CrCl 11 to 20 ml/min: 0.28 mcg/kg/min
    6. CrCl 6 to 10 ml/min: 0.23 mcg/kg/min
    7. CrCl <=5 ml/min: 0.2 mcg/kg/min
  • Dosing
  • Children
  1. Load: 50 mcg/kg IV infused over 10 minutes
  2. Maintenance: 0.5 to 1 mcg/kg/min titrated to effect
  • Pharmacokinetics
  1. Half life: 1.5 hours
  • Adverse Effects
  1. Hypotension risk (avoid in Hypovolemia)
  2. Ventricular Arrhythmias
    1. Monitor on telemetry during infusion
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Resources
  1. Milrinone Injection Solution
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=88f78780-399f-4780-be19-205739db1682
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia