Milrinone

I've noticed some patients on continuous milrinone and dobutamine infusions on step-down units in the past at hospitals with cardiac programs and no plans to move them to a higher acuity floor. What is your trepidation with the drug? It has a long half-life that is not amendable to titration that would require more frequent monitoring. As long as the patient is stable what is the issue with them being on a step down unit?

I think milrpinone has less adverse effects than dobutamine. If a pt is stable on a low dose milrinone, that pt may be able to stay on a med-surg floor. 

We have initiated milrinone on my step down unit . Some tolerate it , some not. If we have the right ratio of patients (4-5, we've had 7-10 lately ?  ) ) we can keep a better eye on them , like vs Q 15 mins for a bit. Some do not tolerate it ( much ectopy or hypotension ) and we have to either lower the dose from 0.375mcg /kg /min or stop it all together. 

We frequently get home drips of milrinone, those people are usually fairly stable. Unless their weight drastically changes, then the dose needs to be updated.

There was a shortage of milrinone for a while, and patients would be started on dobutamine. I notice LOTS more ectopy when a patient is on dobutamine.