Review ArticlesMilrinone Dosing and a Culture of Caution in Clinical PracticeChong, Luke Yong Zheng MD*; Satya, Kumar MD, FRCP†; Kim, Bernard MD†; Berkowitz, Robert MD, PhD†Author Information From the *Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; and †Heart Failure and Pulmonary Hypertension Program, Heart and Vascular Center, Hackensack University Medical Center, Hackensack, NJ. Disclosure: The authors have no conflicts of interest to report. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.cardiologyinreview.com). Correspondence: Luke Yong Zheng Chong, MD, Department of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, UH I-248, Newark, NJ 07101. E-mail: [email protected]. Cardiology in Review: January/February 2018 - Volume 26 - Issue 1 - p 35-42 doi: 10.1097/CRD.0000000000000165 Buy SDC Metrics Abstract Milrinone is an invaluable agent in the treatment of end-stage heart failure patients who are refractory to optimal medical therapy. In addition to its use in acute decompensated heart failure, milrinone can also be employed as a home infusion therapy or a bridge to cardiac transplant. Concerns about its adverse effects, such as an increased risk of arrhythmias and hypotension, often limit the doses of milrinone used in clinical practice. In addition, milrinone is infrequently used or avoided entirely in patients with acute renal failure or end-stage renal disease because the drug is primarily cleared by renal excretion. Despite these concerns, studies that comprehensively reconcile the dose–response relationship and adverse events are scarce, and no clear provisions exist to guide milrinone dosing. After a brief discussion of the pharmacokinetics of milrinone, this article examines milrinone dosing, observed hemodynamic benefits, and documented adverse events across different studies. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.