From the Guidelines
Milrinone is recommended for short-term treatment of acute decompensated heart failure in patients who have not responded adequately to diuretics and vasodilators, with a loading dose of 50 mcg/kg administered intravenously over 10 minutes, followed by a continuous infusion of 0.375-0.75 mcg/kg/minute, as supported by the most recent guidelines 1.
The standard dosing regimen for milrinone is as follows:
- Loading dose: 50 mcg/kg administered intravenously over 10 minutes
- Continuous infusion: 0.375-0.75 mcg/kg/minute The infusion rate should be adjusted based on hemodynamic and clinical response, with lower doses often used in patients with renal impairment (reduce by 50% if creatinine clearance <50 mL/min).
Milrinone works as a phosphodiesterase-3 inhibitor that increases cardiac contractility (positive inotropic effect) and causes vasodilation (reducing afterload and preload), thereby improving cardiac output without substantially increasing myocardial oxygen demand, as described in previous studies 1.
Common side effects of milrinone include:
- Hypotension
- Arrhythmias
- Headache So, blood pressure should be monitored closely during administration, and the drug should be used cautiously in patients with history of ventricular arrhythmias or recent myocardial infarction.
It is essential to assess baseline blood pressure, heart rate, and renal function before initiating milrinone, with continuous cardiac monitoring during administration, as recommended in the guidelines 1.
Treatment duration with milrinone is typically limited to 48-72 hours, as prolonged use has been associated with increased mortality, highlighting the need for careful patient selection and monitoring 1.
In summary, milrinone is a valuable treatment option for acute decompensated heart failure, but its use requires careful consideration of the patient's clinical status, renal function, and potential side effects, as well as close monitoring during administration, as supported by the most recent and highest quality evidence 1.
From the FDA Drug Label
Milrinone Lactate Injection is indicated for the short-term intravenous treatment of patients with acute decompensated heart failure. The recommended use of Milrinone (amrinone) in patients with acute decompensated heart failure is for short-term intravenous treatment.
- The dosage is not explicitly stated in the provided drug labels, therefore, no conclusion can be drawn regarding the specific dosage. 2
From the Research
Recommended Use of Milrinone
- Milrinone is a phosphodiesterase F-III inhibitor with positive inotropic and vasodilating activities, used in the treatment of acute decompensated heart failure 3.
- It is recommended for patients with low cardiac index and evidence of systemic hypoperfusion or congestion 4, 5.
- Milrinone can be employed as a home infusion therapy or a bridge to cardiac transplant 6.
Dosage of Milrinone
- A 50-micrograms/kg intravenous loading dose, followed by a continuous infusion of 0.25 to 0.75 microgram/kg/min, is effective for inotropic/vasodilating hemodynamic support in patients with acute or decompensated heart failure 3.
- The dose-response relationship and adverse events of milrinone are not well established, and there is no clear guidance on dosing 6.
- Caution is advised when using milrinone in patients with acute renal failure or end-stage renal disease, as the drug is primarily cleared by renal excretion 6.
Comparison with Other Agents
- Milrinone has been compared to dobutamine in the management of acute decompensated heart failure, with no significant differences in outcomes except for longer intensive care unit length of stay in the milrinone group 4.
- The choice of agent depends on patient characteristics, such as presence of ischemia, degree of congestion, and renal function 5.
- Milrinone may be preferable in patients with significant pulmonary venous hypertension 5.