Milrinone

Milrinone

[1 vial $38.50]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Primacor

ICU INDICATIONS:

  1. low cardiac output states due to impaired myocardial contractility

PRESENTATION AND ADMINISTRATION:

  • Milrinone 1mg/ml (10ml vial)
    Dilute 10mg up to 50ml using compatible IV fluid
    Compatible in the following IV fluids:
    0.45% saline, 0.9% saline, 5% dextrose
    Store at room temperature
    Preparations not used in 24 hours should be discarded

DOSAGE:

  • IV infusion:
    0.375-0.75mcg/kg/min

    Note: a loading dose of up to 50mcg/kg may be used but is not used in our ICU due to the risk of hypotension; patients may receive a loading dose in theatre prior to coming of bypass.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose in renal impairment [GFR (ml/min)]
    <10: usual dose 0.2mcg/kg/min
    10-40: usual dose 0.3mcg/kg/min
    >40-50: usual dose 0.4mcg/kg/min
  • Dose in renal replacement therapy
    CAPD: usual dose 0.2mcg/kg/min
    HD: usual dose 0.2mcg/kg/min
    CVVHDF: dose as in normal renal function

    Note: renal impairment significantly increases the terminal elimination half life of milrinone. Patients with renal impairment on milrinone infusions may develop progressive vasodilation leading to escalating noradrenaline requirements. If noradrenaline requirement is increasing consider whether it is appropriate to cease milrinone.

DOSAGE IN PAEDIATRICS:

  • IV infusion:
    <30kg: 1.5mg/kg in 50ml 5% dextrose at 0.5-1.5ml/hr (0.25-0.75mcg/kg/min)
    >30kg: 1.5mg/kg in 100ml 5% dextrose a 1-3ml/hr (0.25-0.75mcg/kg/min)

CLINICAL PHARMACOLOGY:

  • Milrinone lactate is a positive inotrope and vasodilator, with little chronotropic activity different in structure and mode of action from either the digitalis glycosides or catecholamines.
  • Milrinone lactate, at relevant inotropic and vasorelaxant concentrations, is a selective inhibitor of peak III cAMP phosphodiesterase isozyme in cardiac and vascular muscle. This inhibitory action is consistent with cAMP mediated increases in intracellular ionized calcium and contractile force in cardiac muscle, as well as with cAMP dependent contractile protein phosphorylation and relaxation in vascular muscle.

CONTRAINDICATIONS:

  1. hypersensitivity to milrinone

WARNINGS

  • Milrinone is an inodilator. Significant hypotension due to peripheral vasodilation is common and is generally treated with noradrenaline.

PRECAUTIONS

  • General:
    The use of milrinone has been associated with increased frequency of ventricular and atrial arrhythmias. Milrinone may aggravate outflow tract obstruction in hypertrophic subaortic stenosis.
  • Laboratory Tests: No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions: None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • None of note.

ADVERSE REACTIONS

  • Cardiovascular:
    SVT, VT, VF, hypotension
  • Respiratory:
    bronchospasm
  • CNS:
    Headaches, tremor.
  • Haematological:
    Thrombocytopenia
  • Metabolic:
    Hypokalemia

Critical Care Drug Manual

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