dobutamine + milrinone

Dobutamine + milrinone is a combination of two intravenous inotropic agents used primarily in the management of acute decompensated heart failure and cardiogenic shock. Both drugs increase cardiac contractility but act via different mechanisms. Dobutamine is a synthetic catecholamine that acts as a β1- and β2-adrenergic receptor agonist, increasing cardiac output by stimulating myocardial contractility and, to a lesser extent, causing vasodilation. Milrinone is a phosphodiesterase type 3 (PDE3) inhibitor that increases intracellular cAMP levels independently of adrenergic receptors, resulting in both positive inotropic effects and significant vasodilation (inodilator effect). The combination may be considered when monotherapy with either agent does not achieve desired hemodynamic goals or when there is partial response to one agent alone. Clinical use of both together can potentially improve hemodynamics more than either drug alone; however, this approach increases the risk for arrhythmias and hypotension[3][7][8]. The combination is typically reserved for severe or refractory cases under close monitoring.

Other names

milrinone and dobutaminemilrinone plus dobutamine