MILRINONE SUMMARY
Milrinone Lactate Injection
Rx only
Milrinone Lactate Injection, is a member of a new class of bipyridine inotropic/vasodilator agents with phosphodiesterase inhibitor activity, distinct from digitalis glycosides or catecholamines.
Milrinone lactate injection is indicated for the short-term intravenous treatment of patients with acute decompensated heart failure. Patients receiving milrinone should be observed closely with appropriate electrocardiographic equipment. The facility for immediate treatment of potential cardiac events, which may include life threatening ventricular arrhythmias, must be available. The majority of experience with intravenous milrinone has been in patients receiving digoxin and diuretics. There is no experience in controlled trials with infusions of milrinone for periods exceeding 48 hours.
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NEWS HIGHLIGHTS
Published Studies Related to Milrinone
Randomized trial of milrinone versus placebo for prevention of low systemic blood flow in very preterm infants. [2009.02]
OBJECTIVE: To assess the effectiveness of early prophylactic milrinone versus placebo for prevention of low systemic blood flow in high-risk preterm infants... CONCLUSIONS: Milrinone did not prevent low systemic blood flow during the first 24 hours in very preterm infants, and no adverse effects were attributable to milrinone. Use of a preventative treatment with rescue model allowed comparison of an inotrope with placebo in this high-risk group of infants.
Milrinone use is associated with postoperative atrial fibrillation after cardiac surgery. [2008.10.14]
CONCLUSIONS: Milrinone use is an independent risk factor for postoperative AF after elective cardiac surgery.
Randomized Trial of Milrinone Versus Placebo for Prevention of Low Systemic Blood Flow in Very Preterm Infants. [2008.09.24]
OBJECTIVE: To assess the effectiveness of early prophylactic milrinone versus placebo for prevention of low systemic blood flow in high-risk preterm infants... CONCLUSIONS: Milrinone did not prevent low systemic blood flow during the first 24 hours in very preterm infants, and no adverse effects were attributable to milrinone. Use of a preventative treatment with rescue model allowed comparison of an inotrope with placebo in this high-risk group of infants.
Nitric oxide and milrinone: combined effect on pulmonary circulation after Fontan-type procedure: a prospective, randomized study. [2008.09]
BACKGROUND: Early morbidity and mortality after Fontan operations are related to the elevation of postoperative pulmonary vascular resistance. Inhalation of nitric oxide (iNO) and intravenous milrinone are two options capable of reducing pulmonary vascular resistance. We hypothesized that their combined use could maximally stabilize the pulmonary circulation after Fontan operation... CONCLUSIONS: Combined use of iNO and milrinone optimally stabilized pulmonary hemodynamics after Fontan operation.
[Efficacy of continuous intraoperative administration of low-dose milrinone during the circumflex artery anastomosis of off-pump coronary artery bypass] [2007.06]
BACKGROUND : We have experienced instability of hemodynamic state during off-pump coronary artery bypass (OPCAB), especially, circumflex (Cx) artery anastomosis. Although some reports have implied the efficacy of mirlinone in OPCAB anastomosis due to its characteristic inotropic effect without increasing myocardial oxygen consumption, we examined the effect of smaller doses of mirlinone during Cx anastomosis.
Clinical Trials Related to Milrinone
Milrinone Inhaled in Cardiac Surgery [Recruiting]
Pulmonary hypertension is an important morbidity factor in patients having to undergo
cardiac surgery with cardiopulmonary bypass (ECC). Milrinone used in inhalation, shows
evidence of being a pulmonary vasodilator able to possibly contribute to the reduction of
pressure on the pulmonary artery.
Effects of Perioperative Nesiritide or Milrinone Infusion on Recovery From Fontan Surgery [Recruiting]
The staged surgical pathway to treat children with single ventricle heart defects culminates
with the Fontan operation. In this procedure, systemic venous return is rerouted directly to
the pulmonary arteries, which serves to separate the systemic and pulmonary circulations.
Although mortality following the Fontan operation is now uncommon, early postoperative
morbidity including prolonged postoperative chest tube drainage and hospitalization remains
significant. The efficacy of empiric inotropic, vasodilator and neurohumoral-inhibitory
therapies in the perioperative period is unknown and practice varies widely between centers.
The investigators will propose a single-center, randomized, double-blind, phase II clinical
trial in children undergoing Fontan surgery. The investigators plan to compare the effects
of perioperative nesiritide, milrinone and placebo infusions on the early postoperative
clinical course and neurohumoral profile. The investigators hypothesize that, when compared
to the milrinone and placebo groups, the nesiritide group will have more days alive and out
of the hospital within the first 30 days after surgery.
The Effects of Adrenaline and Milrinone in Patients With Myocardial Dysfunction After CABG [Suspended]
Myocardial dysfunction necessitating inotropic support is a typical complication after
on-pump cardiac surgery. This prospective, randomized pilot-study analyses the metabolic and
renal effects of the inotropes adrenaline and milrinone in patients needing inotropic support
after coronary-artery-bypass-grafting. With respect to data derived from patients with sepsis
shock and results from studies using phosphodiesterase-inhibitors prophylactically, the
hypothesis is tested that adrenaline may be associated with unwarranted metabolic effects
(hyperlactatemia and hyperglycemia) and renal dysfunction.
Prophylactic Use of Levosimendan Versus Milrinone in Open Heart Surgery in Infants [Recruiting]
Pediatric patients, especially infants undergoing open heart surgery have a predictable fall
in cardiac index 6 to 18 hours after surgery, the so-called low cardiac output syndrome
(LCOS). Patients, who have LCOS require more monitoring, more medication and a longer stay
in intensive care unit. To prevent LCOS the phosphodiesterase inhibitor milrinone is
routinely used during the first 24 hours after surgery. Levosimendan, a calcium- sensitizer
improves cardiac muscle contractile force, vascular smooth muscle relaxation and coronary
blood flow through calcium sensitization of the myocardial contractile filaments and
opening of potassium channels without increasing oxygen consumption of the heart muscle
cells. As the myocardium of infants is more calcium dependent than in later life,
levosimendan should be of special benefit in this age group. The purpose of this study is to
investigate whether levosimendan is superior to milrinone in preventing LCOS in infants
after corrective open heart surgery.
Nesiritide in Transplant-Eligible Management of Congestive Heart Failure-TMAC [Terminated]
The purposes of this study in United Network for Organ Sharing (UNOS) Status 1B (or country
equivalent) cardiac transplant candidates are to assess the safety and efficacy of
nesiritide. The study will evaluate the drug's ability to prevent clinical worsening when
administered as a 28-day continuous intravenous infusion in patients receiving standard care
and continuous intravenous infusion of dobutamine or milrinone.
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