Milrinone Brand Name– Primacor
What is Milrinone
Milrinone is a cardiac agent that belongs to a unique class of bipyridine inotropic/vasodilator agents.
It possesses positive inotropic and vasodilatory activity, with minimal chronotropic activity.
Milrinone has a shorter half-life than inamrinone and is less likely to cause thrombocytopenia.
Milrinone differs in mechanism and structure from other inotropes such as digoxin and the catecholamines.
Milrinone is FDA-approved for the short-term intravenous treatment of patients with acute decompensated heart failure.
The ACC/AHA guidelines for the management of chronic heart failure recommend that intermittent intravenous positive inotropic therapy has no proven value in patients with Stage C chronic heart failure (Class III recommendation); however, the guidelines suggest that continuous intravenous inotrope infusions may be considered for palliation of symptoms in patients with end-stage heart failure (i.e., Stage D).
Short-term milrinone infusions did not improve morbidity or mortality outcomes, but resulted in increased adverse effects when compared to placebo in patients hospitalized with worsened systolic heart failure; the study excluded patients who required continuous IV inotropic support.
Indications
- cerebral vasospasm
- heart failure
For the short-term treatment of acute decompensated heart failure
Side Effects
- anaphylactic shock
- angina
- atrial fibrillation
- atrial flutter
- atrial tachycardia
- bronchospasm
- elevated hepatic enzymes
- headache
- hypokalemia
- hypotension
- injection site reaction
- nausea
- premature ventricular contractions (PVCs)
- rash
- supraventricular tachycardia (SVT)
- thrombocytopenia
- torsade de pointes
- tremor
- ventricular fibrillation
- ventricular tachycardia
- vomiting
Monitoring Parameters
- serum creatinine/BUN
- serum electrolytes
Contraindications
- acute myocardial infarction
- atrial fibrillation
- atrial flutter
- breast-feeding
- electrolyte imbalance
- hypotension
- hypovolemia
- idiopathic hypertrophic subaortic stenosis
- orthostatic hypotension
- pregnancy
- renal disease
- renal failure
- renal impairment
- syncope
- valvular heart disease
Milrinone is contraindicated in those patients with milrinone hypersensitivity.
Interactions
- Acebutolol
- Alpha-blockers
- Anagrelide
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Atenolol
- Atenolol; Chlorthalidone
- Bendroflumethiazide; Nadolol
- Beta-blockers
- Betaxolol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Brimonidine; Timolol
- Bumetanide
- Calcium-channel blockers
- Carteolol
- Carvedilol
- Central-acting adrenergic agents
- Dorzolamide; Timolol
- Eplerenone
- Epoprostenol
- Esmolol
- Ethacrynic Acid
- Furosemide
- Ginger, Zingiber officinale
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Iloprost
- Labetalol
- Levobetaxolol
- Levobunolol
- Loop diuretics
- Mecamylamine
- Metoprolol
- Nadolol
- Nebivolol
- Nebivolol; Valsartan
- Penbutolol
- Pindolol
- Potassium-sparing diuretics
- Propranolol
- Reserpine
- Riociguat
- Sotalol
- Thiazide diuretics
- Timolol
- Torsemide
- Treprostinil
- Vasodilators
