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Milrinone
Systematic (IUPAC) name
2-methyl-6-oxo-1,6-dihydro-3,4'-bipyridine-5-carbonitrile
Identifiers
CAS number 78415-72-2
ATC code C01CE02
PubChem 4197
DrugBank APRD00010
Chemical data
Formula C 12H9N3O 
Mol. mass 211.219 g/mol
SMILES eMolecules & PubChem
Pharmacokinetic data
Bioavailability 100% (as IV bolus, infusion)
Protein binding 70 to 80%
Metabolism Hepatic (12%)
Half life 2.3 hours (mean, in CHF)
Excretion Urine (85% as unchanged drug) within 24 hours
Therapeutic considerations
Pregnancy cat. C(US)
Legal status Prescription only
Routes IV only

Milrinone (Primacor) is a phosphodiesterase III inhibitor. It potentiates the effect of cyclic adenosine monophosphate (cAMP).

Milrinone also enhances relaxation of the left ventricle by increasing Ca2+-ATPase activity on the cardiac sarcoplasmic reticulum. This increases calcium ion uptake.

It has positive inotropic, vasodilating and minimal chronotropic effects. It is used in the management of heart failure only when conventional treatment with vasodilators and diuretics has proven insufficient. This is due to the potentially fatal adverse effects of milrinone, including ventricular arrhythmias.

Whereas beneficial hemodynamic effects are shown (at least short-term), several studies have shown no or a negative effect on mortality rates of hospitalized patients receiving milrinone.

One negative side to the use of milrinone is the prolonged half-life (1 to 2 hours). This can result in a prolonged weaning and possible adverse outcomes from stopping this medication rapidly.

See also

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