Cardiac Index Increase with Milrinone

Milrinone Pharmacodynamics and Cardiac Output Effects

• Milrinone is a phosphodiesterase type III inhibitor (PDEI) with significant inotropic, lusitropic, and peripheral vasodilating effects that increase cardiac output and stroke volume 1
• The European Heart Journal recommends that milrinone be used with caution in patients with ischemic heart failure due to safety concerns 1

Clinical Administration Considerations

• Hypotension is the most common side effect of milrinone due to its vasodilatory properties and may require fluid boluses or vasopressors 2 3
• In patients with low filling pressures, consider starting the infusion without a bolus to avoid excessive hypotension 1

Monitoring and Optimization

• Milrinone may be preferred over dobutamine in patients on concomitant β-blocker therapy as its site of action is distal to beta-adrenergic receptors 1 2

Cautions and Considerations

• Milrinone can increase the risk of atrial fibrillation, particularly in post-cardiac surgery patients 4 5
• Discontinue milrinone at the first sign of arrhythmia or excessive hypotension 3