Vasopressors and inotropes
Milrinone (Primacor) drip
Primacor
Dosing
| Start | 0.125–0.375 mcg/kg/min; the 50 mcg/kg load is often skipped (hypotension) |
|---|---|
| Titrate | Slowly: effects build over hours (long half-life) |
| Maximum | 0.75 mcg/kg/min; lower doses in kidney impairment |
| Common bags | 20 mg in 100 mL (200 mcg/mL); 40 mg in 200 mL (200 mcg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- Hypotension
- Arrhythmias
- Builds up in AKI
Milrinone: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Milrinone: PDE3 inhibitor (no receptor): ↔ / ↑↑ / ↓
- Heart FailureDecompensated HF and shock: Milrinone (a PDE3 inhibitor) works despite beta-blockers. It vasodilates (watch BP) and needs a lower rate in renal impairment.
- Right Heart Failure and Pulmonary HypertensionManagement priorities: Contractility: dobutamine or milrinone, usually with a pressor.
- After Cardiac SurgeryHemodynamics, low output and vasoplegia: Contractility: epinephrine, dobutamine or milrinone (a vasodilator that often needs norepinephrine alongside). Levosimendan did not improve outcomes as prophylaxis (LEVO-CTS 2017) or rescue (CHEETAH 2017).
- LVAD BasicsSelection, implant and the early postoperative course: The first week is about the right ventricle. Unloading pulls the septum leftward and removes its help to RV contraction while pump flow raises venous return to an RV still facing high pulmonary pressures; it dilates, the LV under-fills, and flow and PI fall with a high CVP. INTERMACS counts right heart failure as needing an RVAD, prolonged inh
- Obstetric EmergenciesAmniotic fluid embolism: Right heart failure: echo, 500 mL boluses with reassessment, norepinephrine, adding dobutamine 2.5–5 or milrinone 0.25–0.75 mcg/kg/min
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.