Milrinone vs Dobutamine

  1. Have you found CV surgeons or cardiologists to prefer one over the other in your facilities? If so, why?
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  2. 20 Comments

  3. by   Dinith88
    Quote from mark2climb
    Have you found CV surgeons or cardiologists to prefer one over the other in your facilities? If so, why?
    Depends on which company they've invested in

    I see Dobutrex WAY more than Primacor...not sure why. I suppose i can ask because now i'm curious as well...
  4. by   incublissRN
    I see dobutamine more often than milrinone also. We use milrinone depending on pulmonary pressures and SVR.
  5. by   mark2climb
    Most of my cardiac care experience have been with the pediatric population but I am now learning about adults. Milrinone seems to be the inodilator of choice for children because most of them do have pulmonary htn. I am learning that lots of adults with cardiac history also have some degree of pulmonary htn. Is that the experience for most of you? If that's the case, I wonder why not use more milrinone.
  6. by   suanna
    I assume you can look up the PDR info so I will give you the practical viewpoint.
    Dobutamine- cheap, fast onset fast wean if not tolerated. Increases heart rate and contractility and provides some drop in SVR. Pushes the heart a bit so it can increase myocardial O2 demands. Prone to cause tachy arrythmias.
    Primacor-slower onset to full load, much less direct rate stimulation. Very little increase in myocardial O2 demand. Profound dilater- if you are volume low the BP is going to crash and it takes a LONG time to wear off. A bit pricier than dobutamine.
    Conclusion:
    You could use a bit faster rate and the SVR is somewhat high? Is the heart healthy enough to tolerate a bit more work?= dobutamine.
    Prone to tachycardia/a-fib SVT? ischemic or weak heart? SVR>1400. =Primacor.
  7. by   heartrn35
    Flat out--MD PREFERENCE
  8. by   cvicugirl
    Think of it this way: Dobutamine is an inotrope, milrinone is an inodilator. Dobutamine will increase CO/CI and heart rate (and cardiac O2 consumption) with a small decrease in SVR. Milrinone will increase CO/CI with little effect on HR and cardiac O2 consumption (all inotropic effects), while seriously decreasing your SVR (dilator effect.) Milrinone has a more profound effect on systemic BP and has a longer half-life than dobutamine. It is very useful in primary pulmonary HTN. In my opinion and experience, milrinone and levophed is the best combo to treat low output states in a normovolemic surgical or medical heart.
  9. by   nurseabc123
    Any experiences with using both at the same time? Last night, I had a heart - I had levo, epi, vaso, milrinone running. And near my end of my shift, we added dob because we still couldn't couldn't get the CI >2.
  10. by   hrvojefranjic
    Quote from nurseabc123
    Any experiences with using both at the same time? Last night, I had a heart - I had levo, epi, vaso, milrinone running. And near my end of my shift, we added dob because we still couldn't couldn't get the CI >2.
    wow....to many medications for my taste....
  11. by   mummer43
    It seems that where I work we see more Primacor. I guess it's just the doc's preference.
  12. by   haitham abo majed
    this is data is very very nice thank for all
  13. by   nurseabc123
    Quote from haitham abo majed
    this is data is very very nice thank for all
    If the patient needs to sit on an inotrope for a few days, our CV surgeons almost always prefer Dobutamine 2.5 mcg /5 mcg (not to titrate). Dobutamine is less arrythamogenic (sp?) than primacor.
  14. by   Wile E Coyote
    Quote from nurseabc123
    Dobutamine is less arrythamogenic (sp?) than primacor.
    It seems I see it the other way 'round.

    Not challenging you, but in the interest of clarity, and perhaps a learning experience for one of us, care to site your source for that comparison?:an!:

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