Milrinone lactate is available as an injection solution containing the equivalent of milrinone 1 mg/mL in 10-, 20-, and 50-mL single-dose vials.3682 Each mL also contains dextrose anhydrous 47 mg in water for injection.3682 Lactic acid or sodium hydroxide is used to adjust the pH.3682 The total lactic acid concentration may vary between 0.95 and 1.29 mg/mL.3682
Milrinone lactate also is available as a ready-to-use solution in 100- and 200-mL flexible containers at a concentration equivalent to milrinone 200 mcg/mL (0.2 mg/mL).3681 Lactic acid and/or sodium hydroxide are used to adjust the pH.3681 The solution has a nominal lactic acid concentration of 0.282 mg/mL and also contains dextrose hydrous 54.3 mg/mL.3681
pH
Milrinone lactate injection has a pH ranging from 3.2 to 4.3682 Milrinone lactate ready-to-use solution has a pH of 3.5 with a range from 3.2 to 4.3681
Milrinone lactate is administered intravenously.3681; 3682 Loading doses of milrinone lactate are administered slowly over 10 minutes.3682 While loading doses may be administered undiluted as the 1-mg/mL injection solution, diluting the dose to a rounded total volume of 10 or 20 mL in a compatible infusion solution may help facilitate slow intravenous injection.3682 Milrinone lactate should be administered by continuous intravenous infusion for maintenance administration.3681; 3682 For maintenance dosing, milrinone lactate injection from vials should be diluted in a compatible infusion solution to a milrinone concentration of 200 mcg/mL or the premixed 200-mcg/mL ready-to-use solution should be used.3681; 3682 When milrinone lactate is administered by continuous infusion, the use of a calibrated electronic infusion device is advised.3681; 3682
Milrinone lactate solutions are clear and colorless to pale yellow.3681; 3682 The 1-mg/mL concentration should be stored at controlled room temperature and protected from freezing and exposure to excessive heat.3682 The 200-mcg/mL ready-to-use solution should be stored at controlled room temperature and protected from freezing and exposure to excessive heat; however, brief exposure to temperatures up to 40°C does not adversely affect the product.3681
Standardize 4 Safety
One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.
Table 1. Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Milrinone3635; 3636
| Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
| Adults | 200 mcg/mL | mcg/kg/minute |
| Pediatric patients (50 kg) | 100 mcg/mL 200 mcg/mL | mcg/kg/minute |
Drugs in Syringe Compatibility
Y-Site Injection Compatibility (1:1 Mixture)
Additional Compatibility Information
Infusion Solutions
Milrinone lactate (West-Ward) at a milrinone concentration of 1 mg/mL with dextrose 5% in sodium chloride 0.9% and 20 mEq/L of potassium chloride was physically compatible for up to 48 hr at 20 to 25°C protected from light during a simulated Y-site administration study.3665
For a list of references cited in the text of this monograph, search the monograph titled References.