Adult Dosing

CHF

• 0.375-0.75 mcg/kg/min IV
• Start: 50 mcg/kg IV x 1 dose; Max: 0.75 mcg/kg/min IV
• Dose should be titrated to desired effect. Do not exceed infusions >48 hrs as they are not shown to be safe or effective

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

Calcium Channel Blocker Overdose [Non-FDA Approved]

• 50 mcg/kg IV bolus over 10 min followed by 0.5 to 1 mcg/kg/min IV infusion

• Short-term treatment of CHF unresponsive to conventional therapy with digoxin, diuretics, and vasodilators

• Hypersensitivity to any of the ingredients of the product
• Severe aortic valve disease
• Severe pulmonary valve disease
• Acute MI

• N/A

Renal Dose Adjustment (Based on CrCl)

• 50 mL/min: Start 0.43 mcg/kg/min IV
• 40 mL/min: Start 0.38 mcg/kg/min IV
• 30 mL/min: Start 0.33 mcg/kg/min IV
• 20 mL/min: Start 0.28 mcg/kg/min IV
• 10 mL/min: Start 0.23 mcg/kg/min IV
• 5 mL/min: Start 0.20 mcg/kg/min IV

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Do not exceed infusions >48 hrs as they are not shown to be safe or effective
• Therapy is associated with increased frequency of ventricular arrhythmias, including nonsustained ventricular tachycardia.
• Closely observe patients receiving milrinone with continuous ECG monitoring to allow the prompt detection and management of ventricular arrhythmias
• Do not use therapy in patients with severe obstructive aortic or pulmonic valvular disease in lieu of surgical relief of the obstruction because it may aggravate outflow tract obstruction in hypertrophic subaortic stenosis
• Shortening of AV node conduction time has been reported with milrinone indicating a potential for an increased ventricular response rate in patients with atrial flutter/fibrillation which is not controlled with digitalis therapy
• Monitor blood pressure and heart rate during therapy with milrinone, the rate of infusion slowed or stopped in patients showing excessive decreases in blood pressure
• Infusion site reaction may occur with the therapy. Careful monitoring of the infusion site should be maintained to avoid possible extravasation
• Milrinone is not recommended in Acute Myocardial Infarction

Cautions: Use cautiously in

• Renal impairment
• Atrial fibrillation
• Aatrial flutter

Pregnancy Category:C

Breastfeeding: Safety unknown. Manufacturer advises caution when milrinone is administered to nursing women.

• CNS: Headache, tremor
• CV: Ventricular arrhythmias, torsades de pointes, angina pectoris, chest pain, hypotension, supraventricular arrhythmias, ventricular ectopy, ventricular tachycardia, atrial fibrillation
• RESP: Bronchospasm
• DERM: Skin rash
• GI: Liver function tests
• METABOLIC: Hypokalemia
• HEMA: Thrombocytopenia
• HYPERSENSITIVITY: Anaphylactic shock, severe infusion site reaction

• Bipyridine inotropic/vasodilator agent: it inhibits cAMP phosphodiesterase
• IV administration results in complete bioavailability
• Metabolism: Glucuronidation; CYP450: unknown
• 83% excreted unchanged by the kidneys
• Half-life: 2,3 hrs

US Trade Name(s)

• Only generic available

US Availability

milrinone (generic)

• INJ: 0.2 mg/mL (100, 200 mL plastic container)
• INJ: 1 mg/mL

Canadian Trade Name(s)

• Only generic available

Canadian Availability

milrinone (generic)

• INJ: 1 mg/mL (20 mL vial)

UK Trade Name(s)

• Primacor

UK Availability

Primacor

• INJ: 1 mg/mL (10 mL ampoule)

Australian Trade Name(s)

• Primacor

Australian Availability

Primacor

• INJ: 1 mg/mL (10 mL ampoule)

Cardiovascular

Inotropic Agents