What is the difference between milrinone and dobutamine?

Both dobutamine and milrinone have a rapid onset of action within 10 minutes (min) but differ in that dobutamine has a half-life of approximately 2 minutes while milrinone has a half-life of about 2.4 hours. Overall, there is limited and inconclusive evidence comparing the efficacy of milrinone versus dobutamine.

What is the mechanism of action of milrinone?

Milrinone is a bipyridine derivative commonly classified as an “inodilator” whose mechanism of action is through the inhibition of phosphodiesterase type III (PDE3).

How does milrinone work in heart failure?

The phosphodiesterase inhibitor milrinone is both an inotropic agent and a vasodilator that acts by inhibiting the breakdown of—and thus increasing the level of—intracellular cAMP. Milrinone also increases myocardial contractility without increasing regional myocardial oxygen consumption.

Is milrinone for right or left heart failure?

Milrinone acts as both an inotropic agent and a direct vasodilator, and thus may avoid the need for mechanical support for right ventricular failure due to residual pulmonary hypertension after left ventricular assist device implantation.

Why would you use milrinone over dobutamine?

Milrinone was introduced as an agent which, compared to dobutamine, cause reduced left and right heart filling pressures due to its greater reduction in vascular resistance, and thus superior to dobutamine in treatment of low cardiac output syndrome following cardiac surgery [30, 31].

What are the most common adverse reactions for milrinone?

What are the side effects of Milrinone (Primacor)?

• chest pain;
• a light-headed feeling, like you might pass out; or.
• low potassium level–leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

How does milrinone increase cardiac output?

At lower filling pressures, milrinone increases cardiac output more markedly than equally hypotensive doses of pure vasodilators. This response is accompanied by an increased left ventricular dPldtmax and a shift in the left ventricular performance is associated with a lower myocardial energy requirement.

Does milrinone need a central line?

May be administered by IV infusion by a nurse in Adult Critical Care. Each loading dose and infusion rate must be ordered by physician; nurses are not approved to titrate milrinone. Must be administered via central venous access device.

What is milrinone contraindicated for?

Milrinone is contraindicated in patients with a milrinone hypersensitivity. Solutions containing dextrose may be contraindicated in those with a known corn hypersensitivity. Do not use milrinone in patients with severe obstructive aortic or pulmonic valvular heart disease in lieu of surgical relief of the obstruction.

What is a normal BNP level?

For people who don’t have heart failure, normal BNP levels are less than 100 picograms per milliliter (pg/mL). BNP levels over 100 pg/mL may be a sign of heart failure. For NT-proBNP, normal levels are less than 125 pg/mL for people under 75 years old and less than 450 pg/mL for people over age 75.

What labs are important for CHF?

A thorough laboratory workup including a CBC and urinalysis, as well as electrolyte, blood urea nitrogen (BUN), creatinine, glucose, hemoglobin A1c, liver enzyme, lipid, and thyroid function tests is recommended to evaluate for risk factors and comorbidities in HF.

Does milrinone increase SVR?

Conclusion: Milrinone lactate is an inotropic dilating drug that, when administered intravenously, has beneficial effects on cardiac performance and myocardial contractility. It also promotes reduction of SVR and PVR in patients with DCM and NYHA class III and IV of heart failure.

Does milrinone increase systemic vascular resistance?

Milrinone caused heart rate, stroke volume, and dP/dt to increase, and systemic vascular resistance to decrease in a concentration-related manner.

Can you run milrinone through a peripheral IV?

Based on the properties of dobutamine and milrinone, medication administration and respective venous access may play a role in medication selection as dobutamine generally must be given via central line (e.g., peripherally inserted central catheter, tunneled line, and port) where as milrinone may be given via a …

How do you titrate a milrinone drip?

50 mcg/kg IV load, then 0.33 to 0.5 mcg/kg/minute continuous IV infusion, initially. Titrate by 0.33 mcg/kg/minute every 2 hours until clinical response is attained.