Milrinone vs Dobutamine

[mark2climb]

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

[Dinith88]

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...

[incublissRN, BSN, RN]

I see dobutamine more often than milrinone also. We use milrinone depending on pulmonary pressures and SVR.

[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.

[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.

[heartrn35]

Flat out--MD PREFERENCE

[cvicugirl, BSN, RN]

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.

[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.

[hrvojefranjic]

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....

[mummer43, BSN, RN]

It seems that where I work we see more Primacor. I guess it's just the doc's preference.

[haitham abo majed]

this is data is very very nice thank for all

[nurseabc123]

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.