Saturday, March 19, 2016

Milrinone in congestive heart failure

Today, my resident was teaching us about different drugs used in heart failure when he started talking about ionotropes like milrinone and dobutamine.

For those of you who don't know, Milrinone is a phosphodiesterase inhibitor and it enhances cardiac contractility by increasing intracellular levels of cyclic AMP.

Milrinone has a lot of beneficial hemodynamic actions short term. It can provide acute hemodynamic and symptomatic benefit in patients with advanced heart failure with reduced ejection fraction, improving functional status and reduce hospitalization [1].

BUT long-term therapy with oral milrinone increases the morbidity and mortality of patients with severe chronic heart failure [2]. The mechanism by which the drug exerts its deleterious effects is unknown.

Milrinone causes more harm than benefit in patients with ischemic cardiomyopathy [3].

That's why, like my resident called it, milrinone is also known as Killrinone! I just like how he made the kill pun, so I wrote about it and wanted to let you guys know :D

To summarize: Even though milrinone is used in patients with refractory heart failure for symptomatic relief, it has no long term mortality benefit.

That's all!

If you've noticed, I am trying to level up my blogs by referencing articles, I won't get too technical and you will still see the smiley faces. But I think it's time for Medicowesome to grow up and be more evidence based :)

-IkaN

References:
[1] Safety and clinical utility of long-term intravenous milrinone in advanced heart failure.
AUMehra MR, Ventura HO, et-al. Am J Cardiol. 1997;80(1):61. PMID 9205021
[2] Effect of Oral Milrinone on Mortality in Severe Chronic Heart Failure
Milton Packer, Joseph R. Carver, et-al. N Engl J Med 1991; 325:1468-1475 November 21, 1991 DOI: 10.1056/NEJM199111213252103
[3] Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study.
Felker GM1, Benza RL, et-al. J Am Coll Cardiol. 2003 Mar 19;41(6):997-1003. PMID: 12651048

2 comments:

  1. MILRINONE=KILLRINONE.......i like the style, it is really funny but also useful. because it helps us to keep it at the back of our minds that "long-term use of oral milrinone can result in killrinone in patient with severe CHF.

    ReplyDelete
    Replies
    1. Yes! :D

      We should keep in mind that it is a last resort drug just to help in symptom management when nothing else seems to help :)

      Delete

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