Oral Milrinone

Q: Oral milrinone can be substituted for intravenous (IV) infusion if a long term central venous access cannot be obtained in a patient? (select one) 

A) True
B) False


Answer:  B

Unfortunately, oral phosphodiesterase inhibitors such as milrinone or vesnarinone failed to show any benefit, instead showed harm in major studies.  In comparison to IV infusion, oral phosphodiesterase inhibitors were found to cause more arrhythmias and so cardiac death. 

It is still not clear why oral form causes more harm. It could be due to longer accumulation and slower metabolism of the drugs.

#cardiology


References:

1. Packer M, Carver JR, Rodeheffer RJ, et al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med 1991; 325:1468. 

2. Amsallem E, Kasparian C, Haddour G, et al. Phosphodiesterase III inhibitors for heart failure. Cochrane Database Syst Rev 2005; :CD002230. 

3. Cohn JN, Goldstein SO, Greenberg BH, et al. A dose-dependent increase in mortality with vesnarinone among patients with severe heart failure. Vesnarinone Trial Investigators. N Engl J Med 1998; 339:1810.