Bedside Snapshot
- Use It For
- Low-output acute decompensated heart failure; cardiogenic shock with low output (with norepinephrine for MAP); low output after cardiac surgery; stage D heart failure bridge
- Adult Dose
- Shock (2025 ACC): no load; start 0.125–0.25 mcg/kg/min, usual 0.125–0.5 (max 0.75)
- Differs from FDA label: 50 mcg/kg IV over 10 min, then 0.375–0.75 mcg/kg/min
- Renal: lower the rate by CrCl
- Pediatric Dose
- Specialist use only, not FDA-established. Trial dose after congenital heart surgery (PRIMACORP): 0.25–0.75 mcg/kg/min IV; optional load 25–75 mcg/kg over 60 min, often omitted. No neonatal dose is set
- Onset / Duration
- IV: 5–15 min with load (label); slower without, as levels build (T½ ~2.4 hr). Steady state ~6–12 hr into unchanged 0.5 mcg/kg/min maintenance (label) / fades over hours after stopping, longer in renal impairment
- Do Not Give / Hold If
- Milrinone hypersensitivity; corn allergy (premix, relative). Slow or stop for an excessive BP fall; stop for sustained VT or VF. Not in place of relief of severe aortic or pulmonic stenosis
- Watch For
- Hypotension (arterial line); ventricular ectopy and VT (continuous ECG); AF with faster response; low K⁺ and Mg²⁺ (labs); falling platelets
- Reversal / Rescue
- No antidote: slow or stop (effect lingers for hours). Hypotension: fluid if underfilled, add or raise norepinephrine. VT or VF: ACLS; correct K⁺ and Mg²⁺
- Must Remember
- Renally cleared and long-acting: it accumulates in kidney injury, and hypotension or arrhythmias persist hours after stopping. Cut the rate by CrCl; never give furosemide through the milrinone line
Indications
ED / ICU / Transport
- Acute decompensated heart failure with low cardiac output and hypoperfusion: The FDA label covers short-term IV use in acute decompensated heart failure. Save it for low output with poor perfusion, not routine decompensation
- Cardiogenic shock with low cardiac output: An inotrope to restore perfusion. It is usually run with norepinephrine to hold the mean arterial pressure (MAP). Off-label.
- Low cardiac output after cardiac surgery: The label's clinical program studied it. The surgical or anesthesia team starts and titrates it.
Other Uses
- Stage D (advanced) heart failure: a continuous infusion that bridges to transplant or mechanical circulatory support, or palliates symptoms in patients who are not candidates for either
- Pulmonary hypertension with right ventricular (RV) failure: IV in the ICU; inhaled in some cardiac surgery centers (off-label, specialist use)
- Pediatric low cardiac output after congenital heart surgery: prevention and treatment (off-label, specialist use)
- Persistent pulmonary hypertension of the newborn (PPHN): adjunct or bridge when inhaled nitric oxide is unavailable or not enough (off-label, neonatal specialist use)
Not a vasopressor and not an arrest drug: It lifts cardiac output, but it also drops vascular resistance, and the pressure follows it down. Nothing about CPR calls for it, and it won't fix a low blood pressure. A weak heart with ongoing hypoperfusion in septic shock, even with adequate fluids and MAP? The Surviving Sepsis Campaign (2026) suggests dobutamine added to norepinephrine, or epinephrine alone. Its verdict: the data are too thin to pick dobutamine over milrinone. An inotrope rides on top of a vasopressor and never takes its place. Milrinone's vasodilation and renal accumulation make it a poor fit in vasoplegic shock.
Dosing & Administration
Adult doses below start with the 2025 ACC shock guidance. Where the FDA label differs, the difference is noted.
Available Forms
- Premixed bags in 5% dextrose (D5W), common in ICU and transport: 200 mcg/mL (0.2 mg/mL) in 100 mL (20 mg) and 200 mL (40 mg) bags
- Concentrate vials: 1 mg/mL in 10 mL (10 mg), 20 mL (20 mg) and 50 mL (50 mg) single-dose vials; dilute before a maintenance infusion
High-Alert Medication: Here's how it goes wrong. The 1 mg/mL vial gets programmed as the 200 mcg/mL premix, a 5-fold overdose. mcg/kg/min gets entered as mcg/min. A loading dose gets pushed fast instead of over 10 min. The rate doesn't get cut for renal impairment. Double-check drug, concentration, dosing weight, creatinine clearance (CrCl) and pump rate independently, at the start, at every bag change and at handoff.
Adult Dosing
| Indication | Dose & Route | Repeat / Max | Notes |
|---|---|---|---|
| Cardiogenic shock or borderline blood pressure (2025 ACC guideline) | No load; start 0.125–0.25 mcg/kg/min IV infusion and titrate in 0.125 mcg/kg/min steps; usual shock range 0.125–0.5 mcg/kg/min | Max 0.75 mcg/kg/min (label); lowest dose that restores perfusion, for the shortest time | High-alert Start is below the label range. Differs from FDA label: 50 mcg/kg IV over 10 min, then 0.375–0.75 mcg/kg/min. The 2025 ACC shock guidance lists 0.125–0.5 mcg/kg/min, says inodilators may be considered in normotensive shock, especially with high systemic vascular resistance, and urges care with worsening renal function. DOREMI used 0.125 mcg/kg/min dose stages. Run norepinephrine for MAP. Effect takes longer to build without a load |
| Acute decompensated heart failure with low output (FDA label regimen) | 50 mcg/kg IV over 10 min, then 0.375–0.75 mcg/kg/min IV infusion (standard 0.5 mcg/kg/min) | Max 0.75 mcg/kg/min and 1.13 mg/kg/day; titrate to hemodynamic response | High-alert The label gives the load; it is often omitted in practice when blood pressure is low or borderline. Lower the rate for renal impairment |
| Low output after cardiac surgery | Same regimen as heart failure; often no load if blood pressure is borderline | Max 0.75 mcg/kg/min and 1.13 mg/kg/day | High-alert Set and titrated by the surgical or anesthesia team, usually with invasive monitoring |
| Stage D heart failure (bridge or palliation) | Continuous IV infusion at the lowest effective dose, set by the advanced heart failure team | Specialist-directed; label max 0.75 mcg/kg/min | High-alert Infusions over 48 hr were not studied in controlled trials; long-term oral milrinone raised mortality, and the label warns long-term IV use may carry a similar risk. Home infusions run on an ambulatory pump: see Field & Transport |
| Renal impairment | Reduce the maintenance rate by CrCl: 0.2–0.43 mcg/kg/min (see Special Populations) | Rate set by the CrCl table; titrate to effect | High-alert Clearance falls and half-life lengthens; effects last longer after any change |
Dosing weight: The label doses by body weight and says nothing about obesity. Pick your institution's convention, use it every time, and state the dosing weight at handoff.
Pediatric Dosing
Not FDA-established in children: Safety and effectiveness in children have not been established. The 2025 AHA PALS guideline says it may be reasonable to use milrinone as an inotropic infusion for pediatric cardiogenic shock (Class 2b), but it gives no dose. The one dose below is a specialist trial dose from PRIMACORP, after congenital heart surgery. Pediatric cardiac or critical care teams set the dose.
| Indication | Dose (per kg) & Route | Max Single / Max Total | Notes |
|---|---|---|---|
| Low cardiac output after congenital heart surgery (specialist use; PRIMACORP trial dose) | 0.25–0.75 mcg/kg/min IV infusion; optional load 25–75 mcg/kg IV over 60 min | Usual max 0.75 mcg/kg/min; never above adult dosing | High-alert PRIMACORP: 75 mcg/kg over 60 min, then 0.75 mcg/kg/min for 35 hr, reduced low-output syndrome vs placebo; the 25 mcg/kg + 0.25 mcg/kg/min regimen did not significantly reduce it |
Neither the label nor the 2025 AHA PALS guideline gives a pediatric dose for milrinone. For weight-based checks, use weight-based dosing.
Continuous Infusion
| Setting | Example Concentration | Start | Titrate | Usual Range / Max |
|---|---|---|---|---|
| Adult, shock or borderline pressure (2025 ACC guideline) | 200 mcg/mL, example (institution-specific) | 0.125–0.25 mcg/kg/min, no load | 0.125 mcg/kg/min steps; reassess over hours, not minutes | Usually 0.125–0.5 mcg/kg/min; max 0.75 mcg/kg/min |
| Adult, FDA label regimen | 200 mcg/mL premix, or vial diluted to 200 mcg/mL, example (institution-specific) | 0.375–0.5 mcg/kg/min after the load (load often omitted) | To cardiac output, wedge pressure, blood pressure and response | 0.375–0.75 mcg/kg/min; max 1.13 mg/kg/day |
Pump rate (weight-based)
mL/hr = dose (mcg/kg/min) × weight (kg) × 60 ÷ concentration (mcg/mL). Example: 0.5 mcg/kg/min × 80 kg × 60 ÷ 200 mcg/mL = 12 mL/hr
Preparation & Administration
- Loading dose: give over 10 min, never as a fast push. The label's loading-dose table uses the 1 mg/mL vial (undiluted, or diluted to 10 or 20 mL to make the rate easier to see); the premixed 200 mcg/mL bag is labeled for IV infusion only. Follow your pump library and institutional policy for how the load is given (from the vial, or as a programmed 10-min infusion).
- Dilution: use the premix when available. Vial: 20 mL (20 mg) plus 80 mL diluent, or 10 mL plus 40 mL, gives 200 mcg/mL. Diluents: 0.45% NaCl, 0.9% NaCl or D5W.
- Pump requirement: calibrated smart pump with a drug library; dedicated line or lumen.
- Line: the label sets no central-line requirement; run it peripherally or centrally per institutional policy, on a dedicated line or lumen. Infusion-site reactions occur; check the site often (the label warns of extravasation).
- Premixed bags: do not connect in series (air embolism risk); do not run with blood; use only if clear and colorless to pale yellow.
Contraindications & Precautions
Contraindications
- Hypersensitivity to milrinone.
- Corn or corn-product allergy (relative): applies to dextrose premixed bags.
Precautions
- Severe aortic or pulmonic stenosis: It is no substitute for relieving the obstruction. It may worsen outflow obstruction in hypertrophic cardiomyopathy.
- Pre-existing arrhythmias, low K⁺ or abnormal digoxin levels: The label ties life-threatening arrhythmias to all three, and to catheter insertion. Correct K⁺ and Mg²⁺ first.
- Atrial fibrillation or flutter: Milrinone slightly speeds AV conduction, and it can raise the ventricular rate. Control the rate first.
- Low filling pressures after vigorous diuresis: give cautiously with close blood pressure and heart rate monitoring.
- Acute myocardial infarction: It has not been studied in the acute post-MI phase, and the label does not recommend it there. In post-MI cardiogenic shock, the inotrope choice is a cardiology decision.
- Use beyond 48 hr: There are no controlled-trial data past that point. Long-term oral milrinone increased hospitalization, death and sudden death. The 2022 AHA/ACC/HFSA guideline calls long-term inotropes potentially harmful, unless they bridge to advanced therapy or serve palliation.
Hold / Reassess If
- Excessive fall in blood pressure or MAP below goal: slow or stop; assess volume; add or raise a vasopressor.
- New or increasing ventricular ectopy or non-sustained VT: check K⁺ and Mg²⁺; reduce the rate.
- Sustained VT or VF: stop; treat per ACLS.
- New AF with rapid response or chest pain with ST changes: reduce or stop; treat the rhythm or ischemia.
- Falling CrCl or urine output: recalculate the rate from the renal table.
Effects outlast the infusion: Hypotension and arrhythmias keep going for hours after you stop, and longer in renal impairment. So stop it, and plan on vasopressor support for hours.
Adverse Effects & Toxicity
Common
- Ventricular arrhythmias in 12.1%: ectopy 8.5%, non-sustained VT 2.8%
- Supraventricular arrhythmias in 3.8%
- Hypotension in 2.9% in label trials; sustained hypotension needing treatment in 10.7% (vs 3.2% placebo) in OPTIME-CHF
- Headache in 2.9%, usually mild to moderate
- Angina or chest pain in 1.2%
- Low K⁺ (0.6%), tremor (0.4%), infusion-site reactions
- Post-marketing reports: liver function test abnormalities; skin reactions such as rash
Serious / Life-Threatening
| Effect | Recognition | Management |
|---|---|---|
| Sustained VT (1%) or VF (0.2%) | Monitor alarm; pulseless or unstable patient | Stop the infusion; ACLS; correct K⁺, Mg²⁺ and digoxin level |
| Severe hypotension | MAP falls after the load or a rate increase; poor perfusion | Slow or stop; fluid if underfilled; norepinephrine per protocol |
| AF with rapid response | New irregular narrow-complex tachycardia | Reduce the rate; rate or rhythm control per protocol |
| Torsades de pointes | Polymorphic VT; rare post-marketing reports | Stop; IV magnesium; defibrillate if pulseless |
| Thrombocytopenia (0.4%) | Falling platelet count | Look for other causes; consider stopping |
| Bronchospasm or anaphylaxis | Wheeze, hypotension, rash; isolated reports | Stop; treat anaphylaxis |
Overdose & Toxicity Management
- Signs: hypotension from vasodilation, tachyarrhythmias.
- Immediate: Reduce or stop the infusion until the patient is stable. Give general circulatory support: fluid if underfilled, plus a vasopressor. Effects last hours, longer in renal failure.
- Antidote: none known. Treat arrhythmias per ACLS/PALS.
Monitoring
| Parameter | When / How Often | Target / Act If |
|---|---|---|
| Clinical: ECG rhythm | Continuous; the label directs continuous ECG monitoring | New ectopy or non-sustained VT: check K⁺ and Mg²⁺, reduce. Sustained VT or VF: stop, ACLS. New AF: rate control |
| Clinical: blood pressure | Continuous arterial line in shock; otherwise frequent cuff pressures during the load and each titration | Excessive fall or MAP below goal: slow or stop, assess volume, add or raise a vasopressor |
| Clinical: perfusion and fluid balance | Hourly: mentation, skin, urine output; daily weight | No better perfusion: reassess. Brisk diuresis: the diuretic dose may need lowering |
| Clinical: hemodynamics | Cardiac index, wedge pressure and vascular resistance when a pulmonary artery catheter is in place (see Hemodynamic Monitoring) | Cardiac index not rising: reconsider the drug or the need for mechanical support |
| Laboratory: creatinine and CrCl | Baseline, then at least daily | CrCl falling: recalculate the rate from the renal table |
| Laboratory: potassium and magnesium | Baseline and at least daily, more often with diuresis or arrhythmias | Correct low K⁺ before and during the infusion; replace Mg²⁺ |
| Laboratory: lactate | Baseline, then serially while elevated | Not falling: perfusion not restored; escalate care |
| Laboratory: platelets | Baseline and during prolonged infusions | Falling count: evaluate; consider stopping |
| Infusion safety: site and pump | Site frequently (the label warns of extravasation); concentration and weight at every bag change and handoff | Site reaction: stop and move the line. Pump concentration must match the bag (200 mcg/mL vs 1 mg/mL) |
Interactions & Compatibility
Clinically Significant Interactions
| Drug / Class | Effect | What To Do |
|---|---|---|
| Loop diuretics (furosemide, bumetanide) | Better output brings more diuresis; low K⁺ raises arrhythmia risk. Furosemide precipitates in a milrinone line | Lower the diuretic dose as needed; replace K⁺; never inject furosemide into the milrinone line |
| Digoxin | No glycoside toxicity from milrinone itself; low K⁺ makes digitalized patients prone to arrhythmias | Keep K⁺ normal; in AF, control the rate before starting milrinone |
| Vasodilators and sedatives (nitroglycerin, nicardipine, nitroprusside, propofol) | Additive vasodilation and hypotension | Titrate one drug at a time; watch MAP closely |
| Other inotropes and catecholamines (dobutamine, epinephrine) | Additive tachyarrhythmias | Reassess whether each agent still helps; correct K⁺ and Mg²⁺ |
| β-blockers | Milrinone acts below the β-receptor, so its effect is not blocked. In a post-hoc DOREMI subgroup, β-blocker use in the 24 hr before shock did not worsen outcomes or hemodynamic response with either drug, although vasoactive-inotropic scores differed between the two drugs | No dose change; watch blood pressure |
IV Compatibility
- Diluents: 0.45% NaCl, 0.9% NaCl or D5W; premixed bags are in D5W.
- Incompatible: furosemide, which precipitates immediately, per the label. Other Y-site incompatibilities have been reported, so check a compatibility resource before you co-infuse anything.
- Dedicated line or lumen: no boluses through the milrinone line; do not run premixed bags in series or with blood.
- Verify with an institutional compatibility resource.
Special Populations
- Pediatrics: Not FDA-established. Pediatric cardiac and critical care teams use it for low output after congenital heart surgery. See the Pediatric Dosing table.
- Neonates: Used for PPHN when inhaled nitric oxide falls short or isn't available. In preterm infants the half-life runs up to 10 hr. Hypotension is common. Severe intraventricular hemorrhage has been reported in an extremely preterm infant. No neonatal dose is given here. Neonatal use rests on small case series and pharmacokinetic studies, not randomized trials. Neonatal specialist use only.
- Pregnancy: There are no adequate human studies. Oral and IV animal studies showed no birth defects. IV dosing raised fetal resorption in rabbits. Untreated cardiogenic shock threatens the mother and the fetus, so don't withhold indicated therapy.
- Lactation: It is unknown whether milrinone passes into human milk. Use caution.
- Older Adults: No age-specific dosing and no pharmacokinetic differences. Base the rate on CrCl, which often falls with age. It is not on the AGS Beers Criteria.
- Renal Impairment: The half-life rises significantly. Set the maintenance rate by CrCl from the label table (mL/min/1.73 m²): 50: 0.43, 40: 0.38, 30: 0.33, 20: 0.28, 10: 0.23, 5: 0.2 mcg/kg/min. The label gives no dialysis or continuous renal replacement therapy (CRRT) dosing. Titrate to effect, and expect prolonged effects.
- Hepatic Impairment: No specific adjustment is established. The liver plays a minor role in its metabolism.
- Obesity / Dosing Weight: The label offers no guidance. Use one institutional dosing weight per patient, and document it.
Field & Transport Considerations
- Scope: Critical-care transport (CCT) RN and Paramedic crews usually continue an infusion started at the sending facility. Scope varies by state and agency protocol.
- Home Inotrope Patients (EMS): Patients with stage D heart failure may arrive on continuous milrinone from an ambulatory pump through a PICC. Per local protocol: do not stop, disconnect or flush the infusion. An inotrope-dependent patient can drop into low output. Don't draw from or inject through the milrinone lumen. Use separate IV access. Bring the pump, the bag or cassette and the patient's infusion card. Record the dose and concentration. Contact the patient's advanced heart failure team or home infusion pharmacy, and the receiving facility. Then follow a documented palliative plan.
- Storage & Stability: vials at 20–25°C (68–77°F); premixed bags at 25°C (77°F), with brief exposure up to 40°C (104°F) allowed. Avoid freezing and excessive heat in the vehicle.
- Carried Concentration: confirm 200 mcg/mL premix vs 1 mg/mL vial on the bag, the label and the pump library.
- Infusions in Transport: Give it a dedicated pump channel and line. Carry enough volume for the trip plus delays. Use an arterial line or frequent cuff pressures. Keep a vasopressor ready, because effects persist for hours after any change.
- Handoff Essentials: start time, whether a load was given, current dose in mcg/kg/min with the dosing weight, concentration, last titration and response (MAP, rhythm, urine output, lactate), latest creatinine, K⁺ and Mg²⁺, and other vasoactive drugs.
Clinical Pearls
Inodilator, not pressor: In label studies, a 75 mcg/kg load plus 0.75 mcg/kg/min raised cardiac index 42%. It also dropped MAP 17%. So in a hypotensive patient, start norepinephrine first. Add milrinone for low output, and skip the load.
Slow on, slow off: The label says plasma levels reach steady state after about 6–12 hr of an unchanged 0.5 mcg/kg/min maintenance infusion. Without a load, levels and effect take longer to build (T½ about 2.4 hr). Don't up-titrate every 15 minutes. Each step keeps building for hours. So does any hypotension.
Milrinone vs dobutamine:
- Milrinone: PDE3 inhibitor. Half-life about 2.4 hr. Renally cleared. Lowers systemic and pulmonary vascular resistance.
- Dobutamine: β₁ agonist. Half-life about 2 min. Fast to titrate. Tachycardia and AF.
- DOREMI (2021): No significant difference in death or major outcomes in cardiogenic shock.
- Prior β-blocker: A small post-hoc DOREMI subgroup suggests either drug can work (see Interactions).
Exam discriminator: Cold and wet heart failure with adequate pressure, on a chronic β-blocker. Milrinone is the classic exam answer, because it works below the β-receptor. In shock, though, the evidence for that edge is weak (see Interactions). Hypotension that worsens hours after you stop, with a rising creatinine: think accumulation.
Furosemide in the milrinone line: Contact between the two forms a precipitate. Give the diuretic through a separate line or lumen.
Not for every decompensation: In OPTIME-CHF, routine milrinone in heart failure without hypoperfusion did not shorten hospital stay. It caused more hypotension and new atrial arrhythmias. Save it for low output with poor perfusion.
Pharmacology
Mechanism of Action
- Selective PDE3 inhibition in heart and vascular muscle raises cyclic AMP (cAMP).
- Myocardium: More intracellular calcium means a stronger squeeze and better diastolic relaxation (lusitropy). The result is higher cardiac output and lower wedge pressure.
- Vessels: The smooth muscle relaxes, so systemic and pulmonary vascular resistance drop. Blood pressure may fall.
- Not a β-agonist: It still works during β-blockade. It has little chronotropy, but it slightly speeds AV conduction.
Pharmacokinetics
| Route | Onset | Peak | Duration |
|---|---|---|---|
| IV (load + infusion) | 5–15 min with the load (label); slower without one, as levels build (T½ about 2.4 hr) | Label: plasma steady state after about 6–12 hr of an unchanged 0.5 mcg/kg/min maintenance infusion | Several hours after stopping; longer in renal impairment |
- Half-life: about 2.3–2.4 hr in heart failure; much longer in severe renal impairment.
- Metabolism: minor (O-glucuronide); no CYP interactions described.
- Active metabolites: none described.
- Elimination: renal, by active tubular secretion; after oral dosing urine holds 83% unchanged milrinone and 12% glucuronide, about 90% within 8 hr in normal subjects.
- Protein binding / Vd: about 70% bound; volume of distribution 0.38–0.45 L/kg. Effective plasma levels 100–300 ng/mL.
Names & Classification
- Generic Name
- Milrinone lactate (doses expressed as milrinone)
- Brand Names
- Primacor (original brand, no longer listed on DailyMed); current US products are generic 1 mg/mL vials and 200 mcg/mL premixed bags in D5W
- Pharmacologic Class
- Bipyridine phosphodiesterase-3 (PDE3) inhibitor
- Therapeutic Class
- Inodilator (inotrope and vasodilator)
- Controlled Substance
- Not controlled
- ISMP High-Alert
- Yes: ISMP high-alert medication (inotropic medications, IV; ISMP acute-care list, 2018 edition, reference 12)
- Look-Alike / Sound-Alike
- None commonly reported
References
- Hospira, Inc. (2025). Milrinone lactate injection: prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=813e8ca2-de54-4a7c-a2d2-8bd44396c341. Baxter Healthcare Corporation. (2026). Milrinone lactate in 5% dextrose injection: prescribing information. DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8fd0f93a-6150-4020-b7ee-4b95b520f6ce
- Heidenreich, P. A., Bozkurt, B., Aguilar, D., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation, 145(18), e895–e1032. https://doi.org/10.1161/CIR.0000000000001063
- Sinha, S. S., Morrow, D. A., Kapur, N. K., Kataria, R., et al. (2025). 2025 concise clinical guidance: An ACC expert consensus statement on the evaluation and management of cardiogenic shock. Journal of the American College of Cardiology, 85(16), 1618–1641. https://doi.org/10.1016/j.jacc.2025.02.018
- Prescott, H. C., Antonelli, M., Alhazzani, W., Møller, M. H., et al. (2026). Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2026. Intensive Care Medicine, 52(5), 863–936. https://doi.org/10.1007/s00134-026-08361-1 (co-published in Critical Care Medicine, doi:10.1097/CCM.0000000000007075)
- American Heart Association. (2025). 2025 AHA Guidelines for CPR and ECC, Part 8: Pediatric Advanced Life Support. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/pediatric-advanced-life-support
- Mathew, R., Di Santo, P., Jung, R. G., Marbach, J. A., Hutson, J., Simard, T., et al. (2021). Milrinone as compared with dobutamine in the treatment of cardiogenic shock (DOREMI trial). New England Journal of Medicine, 385(6), 516–525. https://doi.org/10.1056/NEJMoa2026845
- Di Santo, P., Mathew, R., Jung, R. G., Simard, T., et al. (2021). Impact of baseline beta-blocker use on inotrope response and clinical outcomes in cardiogenic shock: A subgroup analysis of the DOREMI trial. Critical Care, 25, 289. https://doi.org/10.1186/s13054-021-03706-2
- Cuffe, M. S., Califf, R. M., Adams, K. F., et al. (2002). Short-term intravenous milrinone for acute exacerbation of chronic heart failure: A randomized controlled trial (OPTIME-CHF; landmark trial). JAMA, 287(12), 1541–1547. https://doi.org/10.1001/jama.287.12.1541
- Felker, G. M., Benza, R. L., Chandler, A. B., Leimberger, J. D., Cuffe, M. S., Califf, R. M., et al. (2003). Heart failure etiology and response to milrinone in decompensated heart failure (OPTIME-CHF post hoc analysis). Journal of the American College of Cardiology, 41(6), 997–1003. https://doi.org/10.1016/S0735-1097(02)02968-6
- Hoffman, T. M., Wernovsky, G., Atz, A. M., et al. (2003). Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease (PRIMACORP; landmark trial). Circulation, 107(7), 996–1002. https://doi.org/10.1161/01.CIR.0000051365.81920.28
- Wasilewska, E., Dera, N., Minarowski, Ł., et al. (2025). Can milrinone be a therapeutic alternative in persistent pulmonary hypertension of the newborn? A case series and narrative review. Pediatric Reports, 17(6), 116. https://doi.org/10.3390/pediatric17060116
- Institute for Safe Medication Practices (ISMP). (2018). ISMP List of High-Alert Medications in Acute Care Settings (2018 edition; lists inotropic medications, IV, e.g., digoxin, milrinone). https://ajemjournal.com/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf. Current ISMP list: https://www.ismp.org/recommendations/high-alert-medications-acute-list
Medical Disclaimer
- For Educational Purposes Only: This content is intended for educational reference and should not be used for clinical decision-making.
- Not a Substitute for Professional Judgment: Always consult your local protocols, institutional guidelines, and supervising physicians.
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