View source for Milrinone

==General==
*Type:  [[Is DrugClass::Vasopressors]]
*Dosage Forms: INJ
*Common Trade Names: Milrinone

==Adult Dosing==
===Dosing===
*Normal renal function:
0.25 - 0.75 mcg/kg/min
*Creatinine clearance < 50mL/min, reduce infusion rate
===Rate of Titration===
*Q2H; slower titration rate if renal insufficiency

==Pediatric Dosing==

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C; Caution advised
*Lactation: Safety unknown
*Renal Dosing
**Adult
***CrCl 50: Start 0.43 mcg/kg/min
***CrCl 40: Start 0.38 mcg/kg/min
***CrCl 30: Start 0.33 mcg/kg/min
***CrCl 20: Start 0.28 mcg/kg/min
***CrCl 10: Start 0.23 mcg/kg/min
***CrCl  5: Start 0.20 mcg/kg/min
**Pediatric
***CrCl 50: Start 0.43 mcg/kg/min
***CrCl 40: Start 0.38 mcg/kg/min
***CrCl 30: Start 0.33 mcg/kg/min
***CrCl 20: Start 0.28 mcg/kg/min
***CrCl 10: Start 0.23 mcg/kg/min
***CrCl  5: Start 0.20 mcg/kg/min
*Hepatic Dosing
**Adult
***Not defined
**Pediatric
***Not defined

==Contraindications==
*Allergy to class/drug
*Aortic valve disease, severe
*Pulmonic valve disease, severe
*[[MI]], acute

==Adverse Reactions==
*Tachyarrhythmias
*[[Hypotension]]
*[[Torsades de pointes]]
*[[Anaphylaxis]]
*Bronchospasm

==Pharmacology==
*Half-life: 2.3h
*Metabolism: Glucouronidation
*Excretion: Urine primarily
*Mechanism of Action: inhibits cAMP phosphodiesterase 
===Primary Receptor===
*PDE-3 inhibitor 
===Relative Effects===
*↑HR 
*↑↑↑SV
*↓SVR

==Notes==
*Can use as alternative to dobutamine in patients with cardiogenic shock and on b-blockers
*Causes pulmonary vasodilation, may be good choice in patients with RV failure
*↑cAMP in cardiac myocytes and vascular smooth muscle, thereby ↑HR and ↑SV while decreasing ↓SVR
*Use with caution in patient with renal failure and hypovolemia

===Indication===
*low cardiac output states due to impaired myocardial contractility

==See Also==


==References==
<references/>

[[Category:Pharmacology]]
[[Category:Cardiology]]