Milrinone Macure Pharma Uk (Milrinone)

Milrinone is used as an inotropic agent in conditions characterized by reduced cardiac output and heart failure.

• Acute decompensated heart failure: improves cardiac contractility and reduces systemic vascular resistance, helping to restore adequate perfusion.
• Cardiogenic shock: provides rapid inotropic support and vasodilation to stabilize hemodynamics in critically ill patients.
• Post‑cardiac surgery low cardiac output syndrome: enhances myocardial performance to facilitate recovery after cardiac procedures.

• Milrinone selectively inhibits phosphodiesterase‑3 (PDE‑3) enzymes in cardiac myocytes and vascular smooth‑muscle cells. By preventing the breakdown of cyclic adenosine monophosphate (cAMP), intracellular cAMP concentrations rise, leading to increased calcium influx during systole and enhanced contractile force. In vascular smooth muscle, elevated cAMP causes relaxation, producing vasodilation and reduced afterload, together yielding a positive inotropic and lusitropic effect.

Milrinone may be associated with a range of adverse reactions, which are classified by frequency and clinical significance.

Common Side Effects

• Hypotension: transient drop in blood pressure during infusion.
• Headache: mild to moderate intensity.
• Nausea: occasional gastrointestinal upset.
• Tachycardia: increased heart rate observed in some patients.

Serious or Rare Side Effects

• Severe hypotension: marked blood pressure fall requiring intervention.
• Ventricular arrhythmias: potentially life‑threatening rhythm disturbances.
• Myocardial ischemia: reduced coronary perfusion risk.
• Allergic reactions: including rash, bronchospasm, or anaphylaxis.

Milrinone requires careful monitoring and specific safety considerations before and during therapy.

• Renal impairment: adjust dosing and monitor renal function.
• Hypotension: monitor blood pressure closely during infusion.
• Arrhythmias: continuous ECG monitoring recommended.
• Pregnancy and lactation: use only if benefits outweigh risks.
• Concomitant vasodilators: assess for additive hypotensive effect.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Milrinone can interact with several drug classes, necessitating vigilance to avoid adverse outcomes.

Major Interactions (Avoid)

• Other phosphodiesterase‑3 inhibitors (e.g., enoximone): risk of excessive inotropy and hypotension.
• Strong CYP3A4 inhibitors (e.g., ketoconazole): may increase plasma Milrinone levels.
• Nitrates: additive vasodilation leading to severe hypotension.

Moderate Interactions (Monitor Closely)

• Beta‑adrenergic blockers: may blunt the inotropic response.
• Diuretics: may exacerbate electrolyte disturbances.
• Anticoagulants: monitor for bleeding if profound hypotension occurs.