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Milrinone Lactate

Pfizer Inc. · FDA-approved approved Small molecule Quality 66/100

Phosphodiesterase-3 inhibitor that increases cardiac contractility and promotes vasodilation through cAMP elevation.

Milrinone Lactate Injection is indicated for short-term intravenous treatment of acute decompensated heart failure. The drug carries significant cardiovascular risks including ventricular arrhythmias (12.1%), supraventricular arrhythmias (3.8%), and hypotension (2.9%), requiring close electrocardiographic monitoring. Post-marketing reports document rare but serious events including torsades de pointes, bronchospasm, anaphylactic shock, and liver function abnormalities. Clinical use requires immediate availability of cardiac event treatment facilities and careful patient selection, particularly in those with preexisting arrhythmias or metabolic abnormalities.

At a glance

Generic nameMilrinone Lactate
SponsorPfizer Inc.
Drug classInotropic agent; Phosphodiesterase-3 inhibitor; Vasodilator
TargetPhosphodiesterase-3 (PDE-3) enzyme
ModalitySmall molecule
Therapeutic areaCardiovascular
PhaseFDA-approved

Mechanism of action

Milrinone works by inhibiting phosphodiesterase-3 (PDE-3), an enzyme responsible for breaking down cyclic adenosine monophosphate (cAMP) in cardiac and vascular smooth muscle cells. By preventing cAMP degradation, milrinone increases intracellular cAMP levels, leading to enhanced cardiac contractility (positive inotropic effect) and peripheral vasodilation (positive lusitropic effect). This dual mechanism improves cardiac output and reduces afterload, providing hemodynamic support in patients with acute decompensated heart failure. Unlike traditional beta-agonists, milrinone's mechanism is independent of beta-adrenergic receptors, making it effective in patients on concurrent beta-blocker therapy. The vasodilatory properties help reduce pulmonary and systemic congestion while improving coronary perfusion. However, the increased contractility and heart rate can increase myocardial oxygen demand, necessitating careful patient monitoring.

Approved indications

Common side effects

Serious adverse events

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