ICU Drugs · Phosphodiesterase-3 inhibitor (inodilator)
Milrinone
Dose
Loading 50 mcg/kg over 10 min (often omitted); infusion 0.375–0.75 mcg/kg/min
Mechanism
↑ cAMP → ↑ inotropy + vasodilation; pulmonary vasodilator
Indications
- • Decompensated heart failure
- • Right ventricular failure / pulmonary hypertension
- • Post-cardiac surgery low CO
Dose adjustment
Reduce in renal impairment (renally excreted)
Dilution & preparation
20 mg in 100 mL D5W = 200 mcg/mL
Use
Inotrope with pulmonary vasodilation; useful when β-blocker on board.
Monitoring
BP (hypotension common), ECG (arrhythmia), platelets, renal function.
Side effects
- • Hypotension
- • Ventricular arrhythmia
- • Thrombocytopenia
Pregnancy safety
Use if benefit > risk
Always confirm dose against your local formulary / BNF before prescribing.
