Milrinone

Indications
 Intravenous
Short-term management of severe heart failure, Acutely decompensated heart failure
Adult: Initially, a loading dose of 50 mcg/kg by slow IV injection over 10 min then continuous maintenance infusion of 0.375-0.75 mcg/kg/min. Adjust according to haemodynamics and clinical response. Max dose 1.13 mcg/kg/day.
Child: Initial loading dose of 75 mcg/kg by IV injection over 10-60 min followed by continuous infusion of 0.5-0.75 mcg/kg/min.
CrCl (ml/min)Dosage Recommendation
500.43 mcg/kg/min
400.38 mcg/kg/min
300.33 mcg/kg/min
200.28 mcg/kg/min
100.23 mcg/kg/min
50.20 mcg/kg/min


Special Populations: Dose reduction in patients with renal impairment.

Reconstitution: Use 0.45% sodium chloride, 0.9% sodium chloride or 5% dextrose inj as diluents.
Incompatibility: Y-site incompatibility: Imipenem-cilastin, furosemide, procainamide. Syringe incompatibility: Furosemide. Admixture incompatibility: Furosemide, procainamide, bumetanide.
Contraindications
 Heart valve stenosis, acute myocardial infarction.
Warnings / Precautions
 Severe obstructive aortic or pulmonary valvular disease, hypertrophic cardiomyopathy, atrial flutter or fibrillation. Monitor blood pressure, heart rate, ECG, fluid and electrolyte balance. Pregnancy and lactation. Use for >48 hr.
Adverse Reactions
 Angina-like chest pain, headache, hypokalaemia, tremor, thrombocytopenia, bronchospasm.
Potentially Fatal: Supraventricular and ventricular arrhythmias; hypotension.
Drug Interactions
 Potentially Fatal: Avoid anagrelide due the potential for increased inotropic effects.
See Below for More milrinone Drug Interactions
Mechanism of Actions
 Milrinone is a selective phosphodiesterase III inhibitor with positive inotropic and vasodilator activity. It selectively inhibits cyclic adenosine monophosphate (cAMP) phosphodiesterase activity in cardiac and vascular muscles resulting in increased intracellular concentrations of cAMP. It also acts directly on vascular smooth muscle.
Onset: IV: 5-15 minutes.
Distribution: Protein binding: About 70%. Volume of distribution at steady-state: 0.32-0.45 L/kg.
Metabolism: About 12% metabolised hepatically.
Excretion: Eliminated via urine (85% as unchanged drug). Elimination half life: About 2.5 hr.
Storage Conditions
 Intravenous: Store at 15-30°C.
ATC Classification
 C01CE02 - milrinone ; Belongs to the class of phosphodiesterase inhibitors. Used in the treatment of heart failure.
Storage
 Intravenous: Store at 15-30°C.
Available As
  • Milrinone 1 mg

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