|
Milrinone: |
PDE Inhibitor |
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IVP DOSING |
| 50 mcg/kg | Alway give SLOW IV over 10 minutes/ |
| 1.13 mg/kg | MAX daily dose. |
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INFUSION DOSING |
|
This is the infusion dose for patients who have impared hepatic or renal function. Titrate in 0.125 mcg/kg/min increments every 15-30 minutes. as needed. |
0.2-0.33 mcg/kg/min |
|
This is the infusion dose for patients who do not have impared hepatic or renal function [yet]. Titrate in 0.125 mcg/kg/min increments every 15-30 minutes. as needed. |
.375-.75 mcg/kg/min |
| MAX daily dose. | 1.13 mg/kg |
Used
for urgent short-term management of severe CHF.
PDE inhibitors inhibit the breakdown of cAMP in both cardiac and
peripheral smooth muscle, thus increasing calcium ion entry to cells, and
therefore sympathomimetic effect.
The result is positive inotropy combined with arterial and venous
peripheral vasodilation (thus the term "inodilator").
For unknown reasons, they do not increase HR or BP.
Can be combined with dobutamine to improve inotropic effect while
decreasing preload.
Side
Effects:
cAMP in the heart
the risk of ventricular arrhythmias!
May shorten AV nodal conduction time, and thereby
ventricular response in A fib/flutter (use with caution).
Also may cause HA, hypotension, and myocardial ischemia/angina.
NOT
a first line drug.
Contraindicated:
Aortic/pulmonary valve dz., impaired renal/hepatic function (¯
dose), pregnancy/lactation.
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