Milrinone

Intravenous
Acutely decompensated heart failure, Short-term management of severe heart failure
Adult: For patients unresponsive to conventional standard therapy or with low cardiac output post-cardiac surgery: Initially, a loading dose of 50 mcg/kg by slow inj over 10 minutes followed by continuous maintenance infusion of 0.375-0.75 mcg/kg/min. Adjust according to haemodynamics and clinical response. Max total dose: 1.13 mg/kg daily.
Renal impairment: Reductions in infusion rate may be necessary. Refer to individual product information for detailed recommendations.

Severe obstructive aortic or pulmonary valvular disease or hypertrophic subaortic stenosis in lieu of surgical relief of obstruction; severe hypovolaemia.

Patients with CV disease, electrolyte imbalance (e.g. hypokalaemia). Not recommended for use in patients with acute MI. Renal impairment. Pregnancy and lactation. Monitoring Parameters Monitor blood pressure, heart rate, ECG, electrolyte level (e.g. K, Mg) and fluid balance, renal function (e.g. serum creatinine), platelet count. Assess for signs of decreasing cardiac function (e.g. arrhythmia, hypotension).

Significant: Ventricular arrhythmias (e.g. nonsustained ventricular tachycardia, sustained ventricular tachycardia, ventricular ectopy, ventricular fibrillation, supraventricular arrhythmias, supraventricular tachycardia), hypotension. Blood and lymphatic system disorders: Thrombocytopenia, anaemia. Cardiac disorders: Angina pectoris, atrial fibrillation, torsades de pointes. General disorders and administration site conditions: Injection site reaction. Investigations: Abnormal LFT. Metabolism and nutrition disorders: Hypokalaemia. Nervous system disorders: Headache, tremors. Respiratory, thoracic and mediastinal disorders: Bronchospasm. Skin and subcutaneous tissue disorders: Rash.
Potentially Fatal: Very rarely, anaphylactic shock.

Symptoms: Hypotension, cardiac arrhythmia. Management: General supportive treatment.

Adverse effects may be enhanced when given concomitantly with anagrelide. May increase the hypotensive effect of riociguat.

Milrinone is a selective phosphodiesterase III inhibitor with positive inotropic and vasodilator activity but has minimal chronotropic activity. It acts on the cardiac and vascular muscles by selectively inhibiting the cyclic adenosine monophosphate (cAMP) phosphodiesterase activity resulting in an increased intracellular concentration of cAMP which produces increased myocardial contractility and vascular muscle relaxation.
Onset: 5-15 minutes.
Distribution: Volume of distribution: Approx 0.38-0.45 L/kg. Plasma protein binding: Approx 70%.
Excretion: Via urine (approx 83% as unchanged drug, 12% as 0-glucuronide metabolite). Elimination half-life: Approx 2.3-2.4 hours.

Intravenous: Store below 25°C. Protect from excessive heat.

Cardiac Drugs

C01CE02 - milrinone ; Belongs to the class of phosphodiesterase inhibitors. Used in the treatment of heart failure.