Milrinone: Anyone used this?

I like Milrinone a lot. We rarely see problems with it (unless we have hypotension problems). It works well and does not increase myocardial oxygen demand.

My prior place of employment used it often. We had no problems--at least that I know of. I should say--I had no problems with my patients.

We use milrinone a lot in my current unit, it works wonders, it dilates well and really works great for people with right sided heart failure problems. It does have a fairly long half life though compared to inotropes. I have had a patient on this drug, very sick on 13+ gtts, with a low SVR and low BP but a CVP of 18, so I turned the milrinone off and the CVP shot up to 27 within an hour. Sometimes you have to rob peter to pay paul I guess.

When I first started using Primacor, I saw a lot of great effects from it. However I think it is underused in some cases and not used at all in cases where it should be used. Many times it is started in the OR, and one does not see the immediate side effects either.

On the last 3 patients I've had, I've seen some awful side effects with Milrinone. This is because I was just starting the drip, and Primacor can make the heart irritable when you are first starting the drip, especially if you have an unstable patient, which I did in about every case. Primacor has been shown to increase your AV nodal conduction rate, thus increased risk for atrial fib/a-flutter. Milrinone also has an increased risk for ventricular arrythmias. which I have seen more of as of late. I have had to put patient's on amiodarone and lidocaine drips with this drug 2 out of the last 3 times I've used it due to multifocal PVC's and runs of VT. In both cases, electrolytes were normal, or near normal. When this happens, you know you have a sick patient.

David

One of the troublesome side effects when you initiate primacor, like most phosphodiesterase inhibitors, is the hypotension especially with the loading dose.

One of our cardiac surgeons gives his patients the loading dose as they're coming off pump, but does not continue the drip. It's nice for the first few hours post op, but then you see the dump. I, personally, think it is under used at my facility ... but suggesting an inotrope to our surgeons is like ******* in the wind.

WE USE A TON OF PRIMACOR, IT IS THE DRUG OF CHOICE AT THE FACILITY i WORK AT. we RARELY SEE PT'S ON DUBUTAMINE. i LOVE THE STUFF, IT WORKS GREAT.