milrinone (Primacor Corotrope)
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Introduction
Tradenames: Primacor, Corotrope. (milrinone lactate)
Indications
- short term treatment of refractory acute heart failure & cardiogenic shock[6]
- may improve hemodynamics in patients receiving:
- hemodynamic support for patients awaiting cardiac transplant
- calcium channel blocker intoxication
Contraindications
Cautions:
- severe aortic or pulmonic valvular disease
- history of ventricular arrhythmias
- atrial fibrillation/flutter
- renal insufficiency
Dosage
- load 50 ug/kg bolus IV over 10 min, then infusion 0.375-0.75 ug/kg/min.
Injection: 1 mg/mL (10 mL, 20 mL). Dosage adjustment with renal failure:
| creatinine clearance | dosage |
|---|---|
| 30 mL//min | 0.33 ug/kg/min |
| 5 mL/min | 0.20 ug/kg/min |
Pharmacokinetics
- 70% bound to plasma proteins
- excreted primarily unchanged in the urine
- elimination 1/2life 0.94 hours, increased to > 3 hours in patients with renal failure
- dose adjustment necessary with renal insufficiency
elimination via kidney
1/2life = 1.8-3.2 hours
Monitor
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
* hypotension, especially in patients receiving vasodilators or with volume contraction
Drug interactions
- do NOT add furosemide (Lasix) in same line as milrinone; a precipitate forms
Mechanism of action
- bipyridine phosphodiesterase inhibitor
- increases cAMP & Ca+2 concentrations in myocardial cells
- hemodynamic effects:
- positive inotrope
- similar to dobutamine, but more vasodilatory properties
- comparable to amrinone
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 124
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Deprecated Reference
- ↑ 6.0 6.1 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015