1655 Levosimendan and Milrinone: A Safe Combination?

Background/Aims Levosimendan is an inotropic and vasodilator drug. Most protocols suggest avoiding other vasodilators, inodilators after its introduction. The technical data recommends not using with other vasodilators. We report our experience of concomitant use of levosimendan and milrinone in a series of patients. Methods Observational study. Review of medical records of concomitant use of levosimendan (24 hours infusion without loading dose) and milrinone, from June 2009 to December 2011. Multivariant analysis of epidemiologic data, pathology, type of heart failure, indication of the drug and side effects. Results 81 cases received levosimendan. Among them,64(79%) received simultaneously milrinone. Mean age 14.8 months (5 days-112 months) 57.8% males.87.5% were postoperative cardiac surgical patients (41% tetralogy of Fallot). Right ventricular failure was the most common indication (56.9%) followed by left ventricular failure (29.2%) and biventricular failure (12.3%).Diastolic dysfunction was reported in 49.2% of our patients,46.1% systolic dysfunction and 4.6% both. In 31% of cases both drugs were initiated simultaneously(operating theatre).Milrinone was the first drug in 41.5% cases. The average dose of milrinone was 0.8 mcg/kg/min. 19/63 cases (30%) suffered from hypotension. In 7 cases (11% of total) milrinone was suspended (without association to type of pathology or dysfunction). In the other 12 patients, infusion of milrinone was decreased, but not suspended. Among the cases of right ventricular failure, hypotension appeared in 32.4%,in 10.5% with left ventricular failure and in 55.5% with biventricular. There were no complications associated. Conclusions In our series, administration of levosimendan and milrinone was safe. The appearance of hypotension was controlled and was not associated with other complications. Patients at increased risk of hypotension were those with biventricular dysfunction. Larger prospective studies are necessary to test the safety of this combination.