II. Indications

  1. Refractory NYHA Class 3 to 4 Systolic Dysfunction

III. 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

IV. 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

V. Dosing: Children

  1. Load: 50 mcg/kg IV infused over 10 minutes
  2. Maintenance: 0.5 to 1 mcg/kg/min titrated to effect

VI. Pharmacokinetics

  1. Half life: 1.5 hours

VII. Adverse Effects

  1. Hypotension risk (avoid in Hypovolemia)
  2. Ventricular Arrhythmias
    1. Monitor on telemetry during infusion

VIII. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

X. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Ontology: Milrinone (C0128513)

Definition (MSH) A positive inotropic cardiotonic agent with vasodilator properties. It inhibits cAMP phosphodiesterase type 3 activity in myocardium and vascular smooth muscle. Milrinone is a derivative of amrinone and has 20-30 times the inotropic potency of amrinone.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D020105
SnomedCT 108480007, 373441005
LNC LP171621-8
English Milrinone, milrinone, (3,4'-Bipyridine)-5-carbonitrile, 6-dihydro-2-methyl-6-oxo-, milrinone (medication), inotropes milrinone, Milrinone [Chemical/Ingredient], MILRINONE, Milrinone (product), Milrinone (substance)
Swedish Milrinon
Czech milrinon
Finnish Milrinoni
Russian MILRINON, МИЛРИНОН
Japanese ミルリノン
Croatian MILRINON
Polish Milrynon
Spanish milrinona (producto), milrinona (sustancia), milrinona, milrrinona (sustancia), Milrinona
French Milrinone
German Milrinon
Italian Milrinone
Portuguese Milrinona