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Discussion

Milrinone or Lasix?

Can someone help explain how a doctor chooses between using a lasix or milrinone drip? Is one better than the other?

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  • Guides

Are you sure you mean lasix or milrinone? They are totally different drugs, in different classes. Lasix is a loop diuretic given to increase urine output, generally to remove excess circulating volume.

Milrinone is a phosphodiesterase inhibitor, positive inotrope and vasodilator. It's given for heart failure. There may be an increase in urine output indirectly due to improved cardiac output. It may be used after lasix fails in heart failure, or more commonly with concurrent lasix therapy.

What sort of patient are you talking about, heart failure?

Sounds like a CHF patient in question.

I would think the doctor would choose the Lasix gtt if the goal is to treat pulmonary edema related to LV failure, or to decrease preload in order to decrease the workload on the heart. The doctor would choose the Primacor if the goal is to increase CO by increasing the force of contraction and to decrease afterload through vasocdilation.

  • Author

Sorry I was vague. In patients with CHF, the doctor usually puts them on lasix or milrinone and I was just wondering why they choose one over the other.

  • Guides
I would think the doctor would choose the Lasix gtt if the goal is to treat pulmonary edema related to LV failure, or to decrease preload in order to decrease the workload on the heart.

It would be very rare to want to reduce preload to "decrease the workload on the heart" in a CHF/cardiomyopathy patient. Per Starling's law, it's very rare to be be able to overload a patient's LV in CHF. It's more likely that lasix is to decrease pulmonary edema or peripheral edema related to congestion from RV failure.

To the original poster, again you need to realize that the drugs are not either/or. They are totally different drugs, given for different reasons (but often used concurrently).

General therapeutic objectives for drug management of chronic CHF include the following: (1) identification of the type of CHF and underlying causes, (2) correction of sodium and water retention and volume overload, (3) reduction of cardiac work-load, (4) improvement of myocardial contractility, and (5) control of precipitating and complicating factors. The aims of treating CHF are to improve symptoms, minimize side effects of treatment, prevent morbidity, and prolong survival.11 Current therapeutic approaches stress the role of ACE inhibitors, diuretics, inotropic agents, and vasodilator drugs.

(Medical-Surgical Nursing, 6th Edition, Lewis, Heitkemper, Dirksen)

Either way, wouldn't the doctor choose the drug based upon the patient's clinical presentation?

  • Guides

I agree that medication management of CHF aims to decrease cardiac workload, generally by vasodilation. You do want to reduce filling pressures without excessively reducing preload.

Of course the doctor would choose the drug based on the symptomatology that they are treating.

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