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Milrinone

Milrinone

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Milrinone, commonly known and marketed as the drug Primacor, is a medication used in patients suffering from heart failure.

MP >300°C
storage temp.
2-8°C
Solubility DMSO: >10 mg/mL
Stability Stable. Incompatible with strong oxidizing agents.
Positive Inotropic drugs Milrinone, also known as bipyridine ketone, methyl cyanide topiramate ketone, is a drug for the treatment of heart failure ,it is a homolog of amrinone, having positive inotropic and vasodilatory effects, its mechanism of action is the same as ammonia milrinone , but the strength of its effect is 10 to 30 times of amrinone,without side effects of reducing platelets,it is well tolerated. Oral or intravenous way has a good effect, it can increase cardiac output and cardiac index, reduce left ventricular end diastolic pressure, pulmonary wedge pressure and right atrial pressure, it has no significant effect on blood pressure and heart rate,it takes effect within 0.5 hours after oral administration,and achieves to maximum effect after 1 to 3 hours , the half-life is 2 hours, the effect can be maintained for 4-6 hours, it is mainly metabolically inactivated in the liver , 80% of it is excreted unchanged in the urine. It is clinically used in the treatment of various acute and chronic heart failure,it is effective in digitalis and diuretics invalid refractory heart failure . This product is the same as amrinone, significant short-term effect, long-term efficacy remains to be further confirmed, but the side effects are little.
Compared with amrinone, milrinone has the following characteristics:
1, small doses mainly have positive inotropic effect, vasodilator effect is gradually enhanced while increasing the dose ,its positive inotropic effect accounts for 1/3 of the total effect in the treatment of heart failure, vasodilation effect accounts for2 / 3 of the total effect.
2,not significantly increasing myocardial oxygen consumption.
3, to improve peripheral circulatory disorders in heart failure, to increase exercise capacity of patients with heart failure and improve their quality of life.
4, for cardiac β receptors in a low-key and reduced β agonistssusceptibility heart failure patients, the drug is still valid.
5, the positive inotropic effect does not produce tachyphylaxis phenomenon.
6, no significant effect on blood pressure and heart rate.
Mechanism Milrinone is non-digitalis, non-catecholamines cardiac drug , it is representative drug of phosphodiesterase inhibitor,selectively inhibiting phosphodiesterase in myocardial cells, increasing intracellular cyclic adenosine monophosphate, alter intracellular calcium transport, thereby increasing myocardial contractility and expanding peripheral vessel . An increase in myocardial oxygen consumption caused by Milrinone increasing myocardial contractility may be offset by its vasodilator effect. Milrinone is an ideal drug for the treatment of coronary artery stenosis, decompensated heart failure led by myocardial ischemia . Because milrinone hasβ receptor down features, it is an ideal drug for the treatment of decompensated heart failure in patients applying β-blocker . Because milrinone has effect on expanding small arteries and veins, it is more beneficial than dobutamine for the traetment of decompensated heart failure with severe pulmonary hypertension.
Dosage First dose is slow intravenous injection (50 μg / kg, intravenous injection after dilution, time is not less than 10 min), then with 0.375 ~ 0.750 μg / (kg · min), continuous intravenous drip. The maximum daily dose is 1.13 mg / kg. Patients with renal insufficiency reduce the use according to creatinine clearance level, for example, creatinine clearance rate is 20 ml / (min · 1.73 m2), intravenously at a dose of 0.28 μg / (kg · min). 80% of Milrinone is excreted from the kidneys, in general,for renal insufficiency patients, the dose should be halved.
Drug Interactions 1, showing ventricular arrhythmia, supraventricular arrhythmias; few are headache, ventricular arrhythmias, weakness, low platelet count, etc; overdose may lead to low blood pressure, tachycardia; occasionally bronchospasm, fever .
2, acute myocardial infarction patients are disabled.
3, patients with hypotension, tachycardia, renal insufficiency, atrial fibrillation or flutter, electrolyte imbalance, drug-induced arrhythmias, kidney disease, severe aortic or pulmonary valve disease , pregnant women, lactating women should use with caution.
4,the elimination half-life of this product is significantly prolonged in patients with renal insufficiency , it should be reduced in patients with renal insufficiency, and the infusion rate should be slow . Elderly patients do not need to adjust the dose.
Biological Activity     Potent cAMP phosphodiesterase inhibitor (IC 50 = 56 nM for inhibition of PDE III). Has inotropic and vasodilator effects following oral or intravenous administration in vivo . Also available as part of the Phosphodiesterase Inhibitor Tocriset™ .
Application New non-glycosides non-catecholamines cardiac drug , its function is similar to amrinone ,positive inotropic effect is strong and about 20 to 50 times of amrinone, and it has significant effect on expanding smooth muscle,it can reduce the load on the heart, it can also improve kidney and muscle blood supply. Oral and intravenous are valid, no serious adverse reactions. It is used For severe heart failure such as chronic heart failure and congestive heart failure.
Usage Selective phosphodiesterase inhibitor with vasodilating and positive inotropic activity. Cardiotonic

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