Dosing & Uses
Dosage Forms & Strengths
infusion solution, in D5W
- 20mg/100mL
- 40mg/200mL
injectable solution
- 1mg/mL
Congestive Heart Failure
50 mcg/kg loading dose by IV push over 10 minutes, then 0.375-0.75 mcg/kg/min IV
Maintenance: 1.13 mg/kg/day
Monitor electrolytes, renal function, blood pressure
Dosing Modifications
Renal impairment
- CrCl <50 mL/min: 0.43 mcg/kg/min
- CrCl <40 mL/min/1.73m2: 0.38 mcg/kg/min
- CrCl <30 mL/min/1.73m2: 0.33 mcg/kg/min
- CrCl <20 mL/min/1.73m2: 0.28 mcg/kg/min
- CrCl <10 mL/min/1.73m2: 0.23 mcg/kg/min
- CrCl <5 mL/min/1.73m2: 0.2 mcg/kg/min
Right Heart Failure (Orphan)
Orphan designation for treatment of right heart failure (RHF) in left ventricular assist device (LVAD) patients
Sponsor
- Cardiora Pty Ltd; Level 9, 278 Collins Street Melbourne Australia
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (2)
- ozanimod
ozanimod increases toxicity of milrinone by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.
- ponesimod
ponesimod, milrinone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
Monitor Closely (7)
- anagrelide
anagrelide, milrinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- cilostazol
milrinone, cilostazol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- dichlorphenamide
dichlorphenamide and milrinone both decrease serum potassium. Use Caution/Monitor.
- enoximone
milrinone, enoximone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- inamrinone
milrinone, inamrinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- olprinone
milrinone, olprinone. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.
- riociguat
milrinone, riociguat. Either increases effects of the other by additive vasodilation. Modify Therapy/Monitor Closely. Riociguat is contraindicated with specific PDE-5 inhibitors (eg sildenafil, tadalafil, vardenafil) and nonspecific PDE-5 inhibitors (eg theophylline, dipyridamole) due to risk of hypotension; data are limited with other PDE inhibitors.
Minor (0)
Adverse Effects
>10%
Ventricular arrhythmias
1-10%
Supraventricular arrhythmia (4%)
Headache (3%)
Hypotension (3%)
Angina/chest pain (1%)
<1%
Abnormal liver function test results
Anaphylaxis
Atrial fibrillation
Bronchospasm
Hypokalemia
Injection-site reaction
Rash
Thrombocytopenia
Torsades de pointes
Tremor
Ventricular premature complex
Warnings
Contraindications
Hypersensitivity to milrinone and inamrinone
Cautions
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
Pregnancy Categories
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.Pharmacology
Mechanism of Action
Phosphodiesterase inhibitor; positive inotrope with little chronotropic effect; direct vasodilator (decreases both preload and afterload)
Absorption
Onset: 5-15 min (IV)
Duration: 3-5 hr
Peak plasma time: 2 min
Therapeutic range: 100-300 ng/mL (hemodynamic effect)
Distribution
Protein bound: 70%
Vd: 0.38 L/kg (Injection); 0.45 L/kg (infusion)
Metabolism
Metabolized in liver (12%), mainly via glucuronidation
Metabolites: Milrinone O-glucuronide (activity unknown)
Elimination
Half-life: 2.5 hr
Clearance: 2.3 mL/kg/min
Excretion: Urine (95%; 83% as unchanged drug)
Administration
IV Incompatibilities
Additive: Procainamide
Syringe: Furosemide
Y-site: Furosemide, procainamide
IV Compatibilities
Solution: Most common solvents
Additive: Quinidine
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
IV Preparation
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
IV Administration
Injection: Administer slowly over 10 minutes; may use undiluted for initial direct IV injection
Infusion: Administer via calibrated electronic controlled-infusion device
Storage
Store intact vials at room temperature; protect from excess heat or freezing
Diluted solution may be stored for 72 hours
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  | |
| milrinone intravenous - | 1 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
milrinone intravenous
MILRINONE - INJECTION
(MIL-ri-none)
COMMON BRAND NAME(S): Primacor
USES: This medication is used for the short-term treatment of heart failure. It works by making your heart beat stronger and by relaxing certain blood vessels so that the amount of blood that is pumped from the heart is increased. This effect may help with symptoms of heart failure (such as shortness of breath, tiredness).
HOW TO USE: This medication is given by injection into a vein as directed by your doctor. It is usually first given as a slow injection (over 10 minutes) and then given as a continuous infusion thereafter.If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.Dosage is based on your medical condition, weight, and response to treatment.
SIDE EFFECTS: Headaches may occur. If this effect lasts or gets worse, tell your doctor promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: pain/redness/swelling at the injection site, fast/irregular heartbeat, dizziness, fainting, chest pain.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using milrinone, tell your doctor or pharmacist if you are allergic to it, or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart valve disease, kidney disease, mineral imbalance (low level of potassium in the blood), irregular heartbeat (such as atrial fibrillation).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products have ingredients that could worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.
NOTES: Lab and/or medical tests (such as blood pressure, heart rate/rhythm, kidney function, blood mineral levels) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: This drug is to be given continuously as an infusion. If your infusion is interrupted, contact your doctor or pharmacist right away.
STORAGE: Consult the product instructions and your pharmacist for storage details. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised November 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
