Hemodynamic effects and pharmacokinetics of oral milrinone for short-term support in acute heart failure.
The present study evaluated the acute hemodynamic response, effects on subjective symptoms and physical findings, and the pharmacokinetics of a single oral dose (2.5, 5, or 10 mg) of milrinone in 31 patients with acute or decompensated heart failure. We found a significant increase in cardiac index (29, 31, and 29%, respectively, p < 0.01) and a significant decrease in pulmonary capillary wedge pressure (39, 43, and 47%, respectively, p < 0.01) accompanied with improvement in subjective symptoms and physical findings. These hemodynamic effects persisted for 4-8 h after each dosage of milrinone. Dose-dependent hemodynamic response was observed between the drug concentration and percent maximum changes in pulmonary capillary wedge pressure (peak milrinone concentration, 2.5 mg: 99.99 +/- 57.49, 5 mg: 187.11 +/- 71.37, and 10 mg: 300.94 +/- 158.5 ng/ml). The finding, together with results of the Prospective Randomized Milrinone Survival Evaluation (PROMISE) study, suggests lower dose of milrinone will be useful for the short-term inodilator support in patients with acute or decompensated heart failure.
Seino
Y
Y
Nippon Medical School Hospital, Japan.
Takano
T
T
Hayakawa
H
H
Kanmatsuse
K
K
Saitoh
S
S
Saitoh
T
T
Kamishima
G
G
Watanabe
K
K
Motomiya
T
T
Murata
M
M
D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D020105:Milrinone; D011446:Prospective Studies; D011728:Pyridones / Q000493:pharmacokinetics* / Q000627:therapeutic use
D011728:Pyridones; D020105:Milrinone