Duration of Milrinone Infusion
Milrinone infusions typically last 48 hours during acute hospitalizations for heart failure decompensation, with assessment of oral therapy adequacy requiring at least 48 hours of observation after discontinuation. 1
Acute/Short-Term Use (Standard Duration)
The typical duration for milrinone infusion is 48 hours during hospitalization for acute decompensation of heart failure, as this timeframe allows for hemodynamic stabilization and clinical improvement 2, 3
After the infusion is discontinued, patients require observation in the hospital for at least 48 hours to assess the adequacy and tolerability of the transition to oral therapy 1
The 48-hour duration is based on multicenter trials demonstrating sustained hemodynamic benefits throughout this period, with cardiac index increases of 34-39% and pulmonary wedge pressure reductions of 18-30% maintained over days 1 and 2 2, 3
Pharmacokinetic Considerations
Milrinone has a prolonged elimination half-life of 1-10 hours depending on organ function, meaning it can take 3-30 hours to reach 90% steady state without a loading dose 4, 5
The drug requires normal renal function for clearance, and dosing adjustments are necessary in renal impairment 4
Extended/Continuous Use
Patients who cannot be weaned from intravenous to oral therapy despite repeated attempts may require continuous infusion via an indwelling catheter 1
Continuous infusion is commonly used as bridge therapy for patients awaiting cardiac transplantation 1
For palliative care, continuous home infusion may be used to allow patients to die comfortably at home, though this decision should only be made after all alternative attempts to achieve stability have failed repeatedly 1
Critical Pitfall to Avoid
Intermittent outpatient infusions of milrinone have not been shown to improve symptoms or survival in patients with advanced heart failure and should be distinguished from continuous support 1
The ACC/AHA guidelines emphasize that long-term use outside of palliative care or bridge therapy may be harmful and increase the risk of death 1, 4