milrinone (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

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: 0.38 mcg/kg/min
  • CrCl <30 mL/min: 0.33 mcg/kg/min
  • CrCl <20 mL/min: 0.28 mcg/kg/min
  • CrCl <10 mL/min: 0.23 mcg/kg/min
  • CrCl <5 mL/min: 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

Dosage Forms & Strengths

infusion solution, in D5W

  • 20mg/100mL
  • 40mg/200mL

injectable solution

  • 1mg/mL

Not FDA-approved in children

Low Cardiac Output, Septic Shock

50 mcg/kg loading dose by IV push over 10-60 minutes, then 0.25-0.75 mcg/kg/min IV  

Monitor electrolytes, renal function, blood pressure

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Interactions

Interaction Checker

and milrinone

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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

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            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

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            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.

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            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)

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            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

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Compare formulary status to other drugs in the same class.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.