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Inodilator — Phosphodiesterase III Inhibitor

Milrinone

Brand names: Primacor

Milrinone is a phosphodiesterase-3 inhibitor used as an inotrope and vasodilator (inodilator) in acute decompensated heart failure and in low cardiac output states, including after cardiac surgery.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

By inhibiting phosphodiesterase-3 it raises intracellular cyclic AMP, increasing myocardial contractility while relaxing vascular smooth muscle to reduce both systemic and pulmonary vascular resistance.

Prescribing in practice

  • Its vasodilator action can cause significant hypotension and it may provoke ventricular and supraventricular arrhythmias, so it should be used with continuous monitoring in a critical care setting.
  • It is renally cleared, so accumulation and prolonged effect occur in renal impairment and dose adjustment is required.
  • Because its effect is independent of beta-receptors, it may retain efficacy in patients receiving beta-blockers.

Monitoring

Monitor continuous ECG, blood pressure, fluid balance, renal function, and electrolytes during the infusion.

Counselling the patient

  • This medicine is given as a continuous infusion and monitored closely in critical care.
  • Report palpitations, light-headedness, or chest discomfort to the team.

Evidence & guidelines

Use is supported by critical care and heart failure practice; consult current prescribing references and the SPC.

Reference: OPTIME-CHF Trial (JAMA 2002); ESC Acute Heart Failure Guidelines 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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