Milrinone Dosing and a Culture of Caution in Clinical Practice

Abstract

Milrinone is an invaluable agent in the treatment of end-stage heart failure patients who are refractory to optimal medical therapy. In addition to its use in acute decompensated heart failure, milrinone can also be employed as a home infusion therapy or a bridge to cardiac transplant. Concerns about its adverse effects, such as an increased risk of arrhythmias and hypotension, often limit the doses of milrinone used in clinical practice. In addition, milrinone is infrequently used or avoided entirely in patients with acute renal failure or end-stage renal disease because the drug is primarily cleared by renal excretion. Despite these concerns, studies that comprehensively reconcile the dose-response relationship and adverse events are scarce, and no clear provisions exist to guide milrinone dosing. After a brief discussion of the pharmacokinetics of milrinone, this article examines milrinone dosing, observed hemodynamic benefits, and documented adverse events across different studies.

Therapeutic targeting of 3′,5′-cyclic nucleotide phosphodiesterases: inhibition and beyond

“…Milrinone increases contractility of the heart and is FDA approved for short-term management of severe congestive heart failure. It is particularly used in the context of end-stage heart failure for patients who prove resistant to optimal therapy and for those awaiting cardiac transplant (46). That said, the clinical utility of milrinone has been limited by significant side effects (Table 1) and the fact that it is cleared through the kidneys (i.e., generally not used in patients with renal failure) (46).…”

The effect of dobutamine vs milrinone in sepsis: A big data, real‐world study

“…However, there were more tachyarrhythmias in levosimendan group than those in placebo group (absolute difference, 2.7%, 95% CI 0.1‐5.3%) 31 . Previous study demonstrated that the major concerns about adverse effects of milrinone were increased risk of arrhythmias and hypotension 32 . Our study also found that cardiac arrhythmias occurred frequently in milrinone group, though there was no significant difference between both groups (56.4% vs 65.2%, P = .334).…”

Albumin Nanoparticle Formulation for Heart-Targeted Drug Delivery: In Vivo Assessment of Congestive Heart Failure

“…Milrinone has been widely used for the treatment congestive heart failure resulting in a low cardiac output, right ventricular failure, and pulmonary tension [ 23 , 32 ]. For patients with end stage heart failure, awaiting heart transplantation or ventricular assist devices, milrinone is used as a long-term continuous infusion [ 33 , 34 ]. In this study, the recovery of heart function was evaluated by measuring both LVEF and LVFS.…”