Milrinone Lactate and Nicotine

• Generic Name: milrinone
• Dosage Forms: n.a.
• Other Brand Names: Primacor, Primacor IV.

Short-term management of acute decompensated heart failure. In most clinical studies, used in patients with NYHA class III or IV CHF who were receiving cardiac glycosides (e.g., digoxin) and diuretics. No evidence to date that milrinone decreases mortality.

Not found to be safe and effective in the long-term (>48 hours) treatment of heart failure. (See Mortality Associated with Long-term Use under Cautions.) Some clinicians recommend reserving milrinone therapy for patients with severe heart failure whose condition is refractory to therapy with cardiac glycosides, diuretics, ACE inhibitors, and/or β-adrenergic blocking agents.

Because positive inotropic agents have not demonstrated improved outcomes and can be potentially harmful (e.g., increased risk of arrhythmias in patients with heart failure), the ACCF and AHA recommend that these drugs be reserved for patients with severe systolic dysfunction who have low cardiac index and evidence of systemic hypoperfusion and/or congestion, or for palliative therapy in those with end-stage heart failure. To minimize risk of adverse effects, use lowest possible dosage and evaluate regularly for need for continued inotropic therapy.

Has been used for treatment of heart failure associated with cardiac surgery.

Also has been used for postresuscitation stabilization in patients who require additional cardiac output and BP support following cardiac arrest.