Milrinone

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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

  1. anaphylactic shock
  2. angina
  3. atrial fibrillation
  4. atrial flutter
  5. atrial tachycardia
  6. bronchospasm
  7. elevated hepatic enzymes
  8. headache
  9. hypokalemia
  10. hypotension
  11. injection site reaction
  12. nausea
  13. premature ventricular contractions (PVCs)
  14. rash
  15. supraventricular tachycardia (SVT)
  16. thrombocytopenia
  17. torsade de pointes
  18. tremor
  19. ventricular fibrillation
  20. ventricular tachycardia
  21. 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

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