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Milrinone

Classification

Inotrope; Phosphodiesterase-3 Enzyme Inhibitor

Indications

CCP: Acute decompensated heart failure

CCP: Inotropic support

Contraindications

Hypersensitivity
Avoid use in patients with severe obstructive aortic or pulmonic valvular disease

Cautions

Arrhythmias
Hypotension
Renal dysfunction

Adult dosages

CCP: All indications

Initial: 0.125 mcg/kg/minute IV infusion
Dosing range: 0.125 to 0.75 mcg/kg/minute

Pediatric Considerations And Dosing

CCP: All indications

Infants, Children, and Adolescents:
- Loading dose (optional): 50 mcg/kg IV administered over 10 to 60 minutes
- Maintenance: IV infusion dose range: 0.25 to 0.75 mcg/kg/minute

How Supplied

Not supplied by BCEHS

Solution, Intravenous:

Generic: 1 mg/mL (10 mL, 20 mL)

Mechanism Of Action

A selective phosphodiesterase inhibitor in cardiac and vascular tissue, resulting in vasodilation and inotropic effects with little chronotropic activity.

Pharmacokinetics

Onset: 5-15 minutes

Half-life: 2.3 hours

Adverse Effects

Cardiovascular:

Ventricular arrhythmia (ventricular ectopy, non-sustained ventricular tachycardia, ventricular tachycardia, ventricular fibrillation, atrial fibrillation, torsades de pointes
Supraventricular cardiac arrhythmia, hypotension, angina pectoris, chest pain, myocardial infarction, thrombocytopenia,

Central nervous system

Headache

Inflammatory

Anaphylaxis

Dermatology

Skin rash, injection site reaction

MSK

Tremor

Respiratory

Bronchospasm

Hepatic

Hepatic insufficiency

Warning And Precautions

Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use.
Immediate treatment of potential cardiac events, including life-threatening ventricular arrhythmias, must be available.
Safe and effective use beyond 48 hours (prolonged use) has not been demonstrated.
It is not known if milrinone is present in breast milk.

Drug Interactions

Anagrelide
Riociguat