Milrinone


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Acutely decompensated heart failure; Short-term management of severe heart failure Loading dose: 50 mcg/kg via slow inj. Maintenance: Continuous infusion of 0.375-0.75 mcg/kg/min. Adjust according to haemodynamics and clinical response. Max. 1.13 mg/kg/day.
Dosage Details
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.
Reconstitution
Maintenance: Dilute the solution with NaCl 0.45% inj, NaCl 0.9% inj, or dextrose 5% inj to make a final concentration of 0.2 mg/mL. The loading dose may be given undiluted but may also be diluted to a volume of 10 or 20 mL (see dilution for Maintenance) to simplify the visualisation of the injection rate.
Incompatibility
Incompatible with furosemide, bumetanide and Na bicarbonate IV solution.
Contraindications
Severe obstructive aortic or pulmonary valvular disease or hypertrophic subaortic stenosis in lieu of surgical relief of obstruction; severe hypovolaemia.
Special Precautions
Patients with CV disease, electrolyte imbalance (e.g. hypokalaemia). Not recommended for use in patients with acute MI. Renal impairment. Pregnancy and lactation.
Adverse Reactions
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.
IV/Parenteral: C
MonitoringParameters
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).
Overdosage
Symptoms: Hypotension, cardiac arrhythmia. Management: General supportive treatment.
Drug Interactions
Adverse effects may be enhanced when given concomitantly with anagrelide. May increase the hypotensive effect of riociguat.
Action
Description: 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.
Pharmacokinetics:
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.
Chemical Structure

Chemical Structure Image
Milrinone

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4197, Milrinone. https://pubchem.ncbi.nlm.nih.gov/compound/Milrinone. Accessed Oct. 26, 2020.

Storage
Store below 25°C. Protect from excessive heat.
MIMS Class
ATC Classification
C01CE02 - milrinone ; Belongs to the class of phosphodiesterase inhibitors. Used in the treatment of hypotension.
References
Anon. Milrinone Lactate. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 02/10/2020.

Anon. Milrinone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 02/10/2020.

Baxter Healthcare Ltd. Milrinone-Baxter 1mg/mL, Concentrate for Injection data sheet 15 October 2019. Medsafe. http://www.medsafe.govt.nz/. Accessed 02/10/2020.

Buckingham R (ed). Milrinone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/10/2020.

Joint Formulary Committee. Milrinone. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 02/10/2020.

Milrinone Lactate in Dextrose-Milronone Lactate and Dextrose Monohydrate Injection (B. Braun Medical Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 02/10/2020.

Milrinone. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com/. Accessed 02/10/2020.

Disclaimer: This information is independently developed by MIMS based on Milrinone from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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