see: [Deranged physiology - Milrinone](https://derangedphysiology.com/main/cicm-primary-exam/required-reading/cardiovascular-system/Chapter%20976/milrinone) #incomplete > iono-dilator # indications ## Right heart failure / pulm HTN [Management of Crashing Patients with Pulmonary Hypertension: Milrinone](bookends://sonnysoftware.com/annotation/DL/207779/1729321998/10/-46/-91): - Milrinone is a selective phosphodiesterase-3 inhibitor that increases contractility by increasing cyclic AMP levels and the concentration of intracellular calcium. - In patients with pulmonary vascular dysfunction in the setting of multifactorial PH, LV failure, postventricular assist, or cardiac transplantation, milrinone has been shown to reduce pulmonary pressures and improve RV function **dose:** - start infusion at 0.375 mcg/kg/min and titrated to a maximum of 0.75 mcg/kg/min. - use of milrinone is limited by systemic hypotension at higher doses and might require the coadministration of vasopressor therapy