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/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

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

            All Interactions Sort By:
             activity indicator 

            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)

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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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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial
                milrinone intravenous
                -
                1 mg/mL vial
                milrinone intravenous
                -
                1 mg/mL vial
                milrinone intravenous
                -
                1 mg/mL vial
                milrinone intravenous
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                1 mg/mL vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                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 persists or worsens, tell your doctor promptly.Remember that your doctor has prescribed this medication because he or she 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: Laboratory and/or medical tests (such as blood pressure, heart rate/rhythm, kidney function, blood mineral levels) should be performed periodically to monitor your progress or check for side effects. 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 May 2017. Copyright(c) 2021 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.

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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.

                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.

                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.