Milrinone, intravenous, acute heart failure

The toxicity of inamrinone includes nausea and vomiting arrhythmias, thrombocytopenia, and liver enzyme changes have also been reported in a significant number of patients. This drug has been withdrawn in some countries. Milrinone appears less likely to cause bone marrow and liver toxicity than inamrinone, but it does cause arrhythmias. Inamrinone and milrinone are now used only intravenously and only for acute heart failure or severe exacerbation of chronic heart failure. 

OPTIME-CHF (5) was a randomized, placebo-controlled study in which 951 patients (mean age 65 years 92% with baseUne NYHA class III or IV mean left ventricular ejection fraction 23%) with acute exacerbations of chronic heart failure in 78 community and tertiary care hospitals in the USA were randomly assigned to a 48-hour infusion of either milrinone (0.5 micrograms/kg/minute initially for 24 hours) or saline (6). The median number of days in hospital for cardiovascular causes within 60 days after randomization did not differ significantly between patients given milrinone (6 days) or placebo (7 days). Sustained hypotension requiring intervention (11 versus 3.2%) and new atrial dysrhythmias (4.6 versus 1.5%) were more common in the patients who received milrinone. There was no difference in hospital mortality (3.8 versus 2.3%), 60-day mortality (10 versus 8.9%), or the composite incidence of death or readmission (35 versus 35%). The authors concluded that these results do not support the routine use of intravenous milrinone as an adjunct to standard therapy in patients with an exacerbation of chronic heart failure. 

Cnffe MS, Cahff RM, Adams KF Jr, Benza R, Bourge R, Coined WS, Massie BM, O Connor CM, Pina I, Quigg R, Silver MA, Gheorghiade M Ontcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Short-term intravenous mihinone for acute exacerbation of chronic heart failure a randomized controlled trial. JAMA 2002 287(12) 1541-7. 

Cuffe MS, Califf RM, Adams KF, et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure A randomized, controlled trial. JAMA 2002 287 1541-1547. 

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