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 o f a single oral dose (2.5, 5, or 10 mg) of milrinone in 31 patients wi th acute or decompensated heart failure. We found a significant increa se in cardiac index (29, 31, and 29%, respectively, p < 0.01) and a si gnificant decrease in pulmonary capillary wedge pressure (39, 43, and 47%, respectively, p < 0.01) accompanied with improvement in subjectiv e symptoms and physical findings. These hemodynamic effects persisted for 4-8 h after each dosage of milrinone. Dose-dependent hemodynamic r esponse was observed between the drug concentration and percent maximu m changes in pulmonary capillary wedge pressure (peak milrinone concen tration, 2.5 mg: 99.99 +/- 57.49, 5 mg: 187.11 +/- 71.37, and 10 mg: 3 00.94 +/- 158.5 ng/ml). The finding, together with results of the Pros pective Randomized Milrinone Survival Evaluation (PROMISE) study, sugg ests lower dose of milrinone will be useful for the short-term inodila tor support in patients with acute or decompensated heart failure.