Milrinone

Classification

• Bipyridine phosphodiesterase III inhibitor that causes inotropy and peripheral vasodilation

Indication

• Heart failure and cardiogenic shock, generally indicated by renal failure despite aggressive diuresis
• Especially useful in right heart failure or biventricular failure, as it dilates the pulmonary veins.

Starting

• Bolus: 50 mcg/kg bolus over 10 to 30 min
• Infusion: 0.375 to 0.75 mcg/kg/min (dose adjustment necessary for renal impairment)

Stopping

• Titrate off by first replacing with hydralazine/ramipril and digoxin, which replace it's two main effects

Half-life

• 2-4 hours

Adverse effects

• Hypotension
• Ventricular arrhythmias