Milrinone

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Milrinone
Systematic (IUPAC) name
6-methyl-2-oxo-5-pyridin-4-yl-1H-pyridine-3-carbonitrile
Identifiers
CAS number	78415-72-2
ATC code	C01CE02
PubChem	4197
DrugBank	APRD00010
Chemical data
Formula	C₁₂H₉N₃O
Mol. mass	211.219 g/mol
Pharmacokinetic data
Bioavailability	?
Protein binding	70 to 80%
Metabolism	?
Half life	2.3 hours
Excretion	?
Therapeutic considerations
Pregnancy cat.	?
Legal status
Routes	?

Milrinone 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 (US English)/haemodynamic (British English) effects are shown (at least short-term), several studies have shown no or a negative effect on mortality rates of hospitalized patients receiving milrinone. And as such is beginning to be used more frequently in the critical and acute phases of cardiogenic shock.

One negative side to the use of milrinone is the prolonged half-life (2.5 hrs). This can result in a prolonged weaning and possible adverse outcomes from stopping this medication rapidly.