Butorphanol Tartrate and Milrinone Lactate

• Generic Name: butorphanol
• Dosage Forms: n.a.
• Other Brand Names: Stadol, Stadol NS

Relief of pain that is severe enough to require an opiate analgesic and for which alternative treatment options (e.g., nonopiate analgesics) have not been, or are not expected to be, adequate or tolerated.

Preoperative sedation and analgesia and as a supplement to surgical anesthesia.

Obstetric analgesia during labor.

Management of pain associated with migraine headache.

In equianalgesic doses, parenteral butorphanol is as effective as morphine, meperidine, and pentazocine, but relative potential for abuse reportedly is less than that of codeine or propoxyphene.

In symptomatic treatment of acute pain, reserve opiate analgesics for pain resulting from severe injuries, severe medical conditions, or surgical procedures, or when nonopiate alternatives for relieving pain and restoring function are expected to be ineffective or are contraindicated. Use smallest effective dosage for shortest possible duration since long-term opiate use often begins with treatment of acute pain. Optimize concomitant use of other appropriate therapies. (See Managing Opiate Therapy for Acute Pain under Dosage and Administration.)

• Generic Name: milrinone
• Dosage Forms: n.a.
• Other Brand Names: Primacor, Primacor IV.

Short-term management of acute decompensated heart failure. In most clinical studies, used in patients with NYHA class III or IV CHF who were receiving cardiac glycosides (e.g., digoxin) and diuretics. No evidence to date that milrinone decreases mortality.

Not found to be safe and effective in the long-term (>48 hours) treatment of heart failure. (See Mortality Associated with Long-term Use under Cautions.) Some clinicians recommend reserving milrinone therapy for patients with severe heart failure whose condition is refractory to therapy with cardiac glycosides, diuretics, ACE inhibitors, and/or β-adrenergic blocking agents.

Because positive inotropic agents have not demonstrated improved outcomes and can be potentially harmful (e.g., increased risk of arrhythmias in patients with heart failure), the ACCF and AHA recommend that these drugs be reserved for patients with severe systolic dysfunction who have low cardiac index and evidence of systemic hypoperfusion and/or congestion, or for palliative therapy in those with end-stage heart failure. To minimize risk of adverse effects, use lowest possible dosage and evaluate regularly for need for continued inotropic therapy.

Has been used for treatment of heart failure associated with cardiac surgery.

Also has been used for postresuscitation stabilization in patients who require additional cardiac output and BP support following cardiac arrest.