Vasopressors and inotropes
Milrinone (Primacor) drip
Primacor
Dosing
| Start | 0.125–0.375 mcg/kg/min; the 50 mcg/kg load is often skipped (hypotension) |
|---|---|
| Titrate | Slowly: effects build over hours (long half-life) |
| Maximum | 0.75 mcg/kg/min; lower doses in kidney impairment |
| Common bags | 20 mg in 100 mL (200 mcg/mL); 40 mg in 200 mL (200 mcg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Peripheral or central
Watch for
- Hypotension
- Arrhythmias
- Builds up in AKI
Milrinone: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Vasopressors and InotropesReceptors and effects: Milrinone: PDE3 inhibitor (no receptor): ↔ / ↑↑ / ↓
- LVAD BasicsSelection, implant and the early postoperative course: The first week is about the right ventricle. Unloading pulls the septum leftward and removes its help to RV contraction while pump flow raises venous return to an RV still facing high pulmonary pressures; it dilates, the LV under-fills, and flow and PI fall with a high CVP. INTERMACS counts right heart failure as needing an RVAD, prolonged inh
- Obstetric EmergenciesAmniotic fluid embolism: Right heart failure: echo, 500 mL boluses with reassessment, norepinephrine, adding dobutamine 2.5–5 or milrinone 0.25–0.75 mcg/kg/min
- Shock Types at a GlanceCardiogenic shock: LV, RV, SCAI and MCS escalation: RV shock follows RV infarct (inferior STEMI, ST elevation in V4R), PE, ARDS, pulmonary hypertension and LVAD implantation. The dilated RV pushes the septum into the LV, so LV filling falls even with normal LV muscle. Give fluid until CVP is about 10–15 mm Hg, then stop; keep AV synchrony (pace heart block); avoid hypoxemia, hypercapnia, acidosis
- ACS and STEMIMechanical complications, RV infarction and shock: Cardiogenic shock complicates 5–10% of MIs. Revascularize the culprit emergently whatever the delay (SHOCK, CULPRIT-SHOCK), transfer to a shock center (2025, Class 1), start norepinephrine and add dobutamine or milrinone, and track lactate, urine output and cardiac power output (<0.6 W is high risk). A microaxial pump is 2a in selected STEMI sh
- Pulmonary EmbolismSupporting the failing RV: fluids, drugs, oxygen and the airway: Norepinephrine restores the coronary perfusion gradient without raising PVR (ESC 2019); above about 15 mcg/min it may raise PVR, so AHA/ACC 2026 suggests adding vasopressin or phenylephrine rather than pushing it higher. Dobutamine (2–20 mcg/kg/min, ESC 2019) can raise a low cardiac index once pressure holds but alone can drop BP; AH
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Other vasopressors and inotropes
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.