Dosing & Uses
Dosage Forms & Strengths
infusion solution, in D5W
Congestive Heart Failure
Maintenance: 1.13 mg/kg/day
Monitor electrolytes, renal function, blood pressure
Serious - Use Alternative
Significant - Monitor Closely
Supraventricular arrhythmia (4%)
Angina/chest pain (1%)
Abnormal liver function test results
Torsades de pointes
Ventricular premature complex
Hypersensitivity to milrinone and inamrinone
Use caution in atrial fibrillation/flutter, hypertrophic subaortic stenosis, electrolyte abnormalities, hypotension, recent MI, severe aortic or pulmonic valvular disease, renal impairment
Severe aortic or pulmonic obstruction, acute phase after myocardial infarction (MI)
May increase risk of arrhythmias
Ensure that ventricular rate is controlled in atrial fibrillation/flutter before initiating therapy; may increase ventricular response rate
Concurrent use of disopyramide
Discontinue therapy if symptoms of hepatotoxicity (eg., increased LFTs) occur; monitor liver function
Monitor blood pressure/heart rate closely
Short-term use only
Pregnancy & Lactation
Pregnancy category: C
Lactation: Unknown whether drug is excreted into breast milk; use with caution; nursing is not priority in situations where milrinone is used
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Phosphodiesterase inhibitor; positive inotrope with little chronotropic effect; direct vasodilator (decreases both preload and afterload)
Onset: 5-15 min (IV)
Duration: 3-5 hr
Peak plasma time: 2 min
Therapeutic range: 100-300 ng/mL (hemodynamic effect)
Protein bound: 70%
Vd: 0.38 L/kg (Injection); 0.45 L/kg (infusion)
Metabolized in liver (12%), mainly via glucuronidation
Metabolites: Milrinone O-glucuronide (activity unknown)
Half-life: 2.5 hr
Clearance: 2.3 mL/kg/min
Excretion: Urine (95%; 83% as unchanged drug)
Y-site: Furosemide, procainamide
Solution: Most common solvents
Syringe: Atropine, calcium chloride, digoxin, epinephrine, lidocaine, morphine sulfate, propranolol, sodium bicarbonate, verapamil
Y-site (partial list): Acyclovir, amiodarone, calcium chloride, calcium gluconate, ciprofloxacin, digoxin, diltiazem, dobutamine, dopamine, epinephrine, fentanyl, heparin, lorazepam, magnersium sulfate, metronidazole, midazolam, morphine sulfate, nitroglycerin, norepinephrine, potassium chloride, propofol, propranolol, quinidine, sodium nitroprusside, vancomycin
Injection: Dilute in NS, 1/2NS, or D5W to 10-20 mL
Infusion: Dilute in NS, 1/2NS, or D5W to 200 mcg/mL; use undiluted if giving 20 mg/100 mL in D5W
Injection: Administer slowly over 10 minutes; may use undiluted for initial direct IV injection
Infusion: Administer via calibrated electronic controlled-infusion device
Store intact vials at room temperature; protect from excess heat or freezing
Diluted solution may be stored for 72 hours
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