milrinone

High Alert

Short-term treatment of HF unresponsive to conventional therapy with digoxin, diuretics, and vasodilators.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Severe aortic or pulmonic valvular heart disease;
Hypertrophic subaortic stenosis (may ↑ outflow tract obstruction).

Use Cautiously in:

History of arrhythmias, electrolyte abnormalities, abnormal digoxin levels, or insertion of vascular catheters (↑ risk of ventricular arrhythmias);
Renal impairment (↓ infusion rate if CCr is <50 mL/min);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding.

Adv. Reactions/Side Effects ⬆ ⬇

CV: angina pectoris, chest pain, hypotension, supraventricular arrhythmias, VENTRICULAR ARRHYTHMIAS

Derm: rash

GI: ↑liver enzymes

Hemat: thrombocytopenia

Neuro: headache, tremor

Interactions ⬆ ⬇

Drug-drug:

None reported.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 1 mg/mL
Premixed infusion: 20 mg/100 mL; 40 mg/200 mL

Route/Dosage ⬆ ⬇

IV (Adults ): Loading dose: 50 mcg/kg followed by Continuous infusion at 0.5 mcg/kg/min (range 0.375–0.75 mcg/kg/min).
IV (Infants and Children): Loading dose: 50 mcg/kg over 10 min followed by Continuous infusion at 0.5 mcg/kg/min (range 0.25–0.75 mcg/kg/min).

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Increases myocardial contractility.
Decreases preload and afterload by a direct dilating effect on vascular smooth muscle.

Therapeutic effects:

Increased cardiac output (inotropic effect).

Classifications ⬆ ⬇

Therapeutic Classification: inotropics

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Moderately distributed to tissues.

Metabolism/Excretion: 80–90% excreted unchanged by the kidneys.

Half-Life: 2.3 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(hemodynamic effects)

ROUTE	ONSET	PEAK	DURATION
IV	5–15 min	unknown	3–6 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care provider immediately if bronchospasm or other signs of anaphylaxis occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇