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milrinone (Primacor Corotrope)
Tradenames: Primacor, Corotrope. (milrinone lactate)
Indications:
1) short term treatment of refractory acute heart failure & cardiogenic shock [6]
2) may improve hemodynamics in patients receiving:
a) dopamine
b) dobutamine
c) digoxin
3) hemodynamic support for patients awaiting cardiac transplant
4) calcium channel blocker intoxication
Contraindications:
Cautions:
1) severe aortic or pulmonic valvular disease
2) history of ventricular arrhythmias
3) atrial fibrillation/flutter
4) renal insufficiency
Dosage:
- load 50 ug/kg bolus IV over 10 min, then infusion 0.375-0.75 ug/kg/min.
Injection: 1 mg/mL (10 mL, 20 mL). Dosage adjustment with renal failure:
creatinine clearance dosage
30 mL//min 0.33 ug/kg/min
5 mL/min 0.20 ug/kg/min
Pharmacokinetics:
1) 70% bound to plasma proteins
2) excreted primarily unchanged in the urine
3) elimination 1/2life 0.94 hours, increased to > 3 hours in patients with renal failure
4) dose adjustment necessary with renal insufficiency
Monitor:
1) cardiac monitor
2) serum K+
Adverse effects:
1) common (> 10%)
- ventricular arrhythmias
- ventricular ectopy
- non-sustained ventricular tachycardia
2) less common (1-10%)
- supraventricular arrhythmias, hypotension*, angina, headache
3) uncommon (< 1%)
- ventricular fibrillation, hypokalemia, thrombocytopenia, tremor
* hypotension, especially in patients receiving vasodilators or with volume contraction
Drug interactions:
- do NOT add furosemide (Lasix) in same line as milrinone; a precipitate forms
Mechanism of action:
1) bipyridine phosphodiesterase inhibitor
2) increases cAMP & Ca+2 concentrations in myocardial cells
4) hemodynamic effects:
a) positive inotrope
b) similar to dobutamine, but more vasodilatory properties
c) comparable to amrinone
Interactions
drug interactions
drug adverse effects of antihypertensive agents
General
amine
enzyme inhibitor
inotropic agent
nitrile
vasodilator agent
Properties
INHIBITS: phosphodiesterase
MISC-INFO: elimination route KIDNEY
1/2life 1.8-3.2 HOURS
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 124
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Deprecated Reference
- Medical Knowledge Self Assessment Program (MKSAP) 17,
American College of Physicians, Philadelphia 2015