Milrinone 1mg/ml Inj, 10ml
Overview
What is this medicine?
How to Use This Medicine
For proper storage and disposal, consult with your doctor, nurse, or pharmacist if you need to keep this medication at home, as they can provide guidance on the correct storage procedures.
If you miss a dose, contact your doctor promptly to determine the best course of action.
Lifestyle & Tips
- This medication is administered in a hospital setting under close medical supervision.
- Report any unusual symptoms immediately to your healthcare team.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
Side Effects
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
* Fast or abnormal heartbeat
Other Possible Side Effects
Like all medications, this drug can cause side effects. However, many people do not experience any side effects or only have mild ones. If you have any side effects that bother you or do not go away, contact your doctor for advice.
Reporting Side Effects
This list does not include all possible side effects. If you have questions or concerns about side effects, talk to your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Feeling dizzy or lightheaded
- Feeling your heart race or skip beats (palpitations)
- Chest pain
- Severe headache
- Numbness or tingling in your hands or feet
Before Using This Medicine
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have a history of heart valve problems or have recently had a heart attack.
This list is not exhaustive, and it is crucial to discuss all your medications (including prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication in conjunction with your other treatments and health issues.
Remember, do not start, stop, or modify the dosage of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
Overdose Information
Overdose Symptoms:
- Profound hypotension (very low blood pressure)
- Cardiac arrhythmias (irregular heartbeats)
What to Do:
Treatment is supportive. If hypotension occurs, administer fluids and vasopressors. Continuous ECG and hemodynamic monitoring are essential. Call 1-800-222-1222 (Poison Control) for further guidance.
Drug Interactions
Major Interactions
- Disopyramide (risk of severe hypotension)
- Furosemide (physical incompatibility, precipitate formation)
Moderate Interactions
- Other vasodilators (additive hypotensive effects)
- Diuretics (may exacerbate hypokalemia, increasing arrhythmia risk)
- Digoxin (may increase risk of arrhythmias, though often used together with careful monitoring)
Monitoring
Baseline Monitoring
Rationale: Hypokalemia should be corrected prior to or during milrinone administration to reduce the risk of arrhythmias.
Timing: Prior to initiation
Rationale: Milrinone is primarily renally excreted; dose adjustments are necessary in renal impairment.
Timing: Prior to initiation
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Routine Monitoring
Frequency: Continuous
Target: Normal sinus rhythm, absence of significant arrhythmias
Action Threshold: Development of new or worsening ventricular arrhythmias (e.g., PVCs, VT, VF) requires immediate assessment and potential dose reduction or discontinuation.
Frequency: Continuous
Target: Maintain adequate perfusion pressure, avoid symptomatic hypotension
Action Threshold: Symptomatic hypotension or significant drop in BP requires dose reduction or discontinuation.
Frequency: Continuous
Target: Maintain within acceptable limits
Action Threshold: Significant tachycardia or bradycardia.
Frequency: Daily or more frequently as clinically indicated
Target: Potassium 3.5-5.0 mEq/L
Action Threshold: Hypokalemia requires correction.
Frequency: Daily or every other day, as clinically indicated
Target: Stable or improving renal function
Action Threshold: Worsening renal function may necessitate dose adjustment.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Palpitations
- Chest pain
- Shortness of breath
- Headache
- Nausea
- Vomiting
- Fever
- Tremor
Special Patient Groups
Pregnancy
Milrinone is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects at doses higher than human therapeutic doses.
Trimester-Specific Risks:
Lactation
It is not known whether milrinone is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from milrinone, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.
Pediatric Use
Use in pediatric patients is off-label and based on limited data. Dosing is weight-based and requires careful titration. Neonates and infants may have different pharmacokinetic profiles. Close monitoring of hemodynamics, fluid balance, and electrolytes is crucial due to increased risk of hypotension and arrhythmias.
Geriatric Use
No specific dose adjustment is required based solely on age, but elderly patients are more likely to have decreased renal function, which necessitates dose adjustment. They may also be more sensitive to the hypotensive and arrhythmogenic effects of milrinone. Close monitoring is essential.
Clinical Information
Clinical Pearls
- Milrinone is for short-term use in acute decompensated heart failure; long-term use is associated with increased mortality.
- Correct hypokalemia and hypovolemia prior to and during milrinone administration to minimize arrhythmia risk and optimize hemodynamic response.
- Monitor ECG continuously for arrhythmias, especially ventricular arrhythmias.
- Monitor blood pressure closely; milrinone can cause significant hypotension.
- Dose must be adjusted in patients with renal impairment.
- Do not mix milrinone with furosemide in the same IV line due to physical incompatibility and precipitate formation.
Alternative Therapies
- Dobutamine (beta-1 adrenergic agonist, positive inotrope)
- Dopamine (dose-dependent effects, inotropic and vasopressor)
- Levosimendan (calcium sensitizer, K-ATP channel opener - not FDA approved in US)
- Norepinephrine (vasopressor, some inotropic effect)
- Epinephrine (inotropic and vasopressor)
Cost & Coverage
General Drug Facts
Store all medications in a secure location, out of reach of children and pets, to prevent accidental ingestion. Dispose of unused or expired medications properly. Unless instructed to do so by a healthcare professional or pharmacist, avoid flushing medications down the toilet or pouring them down the drain. If you are unsure about the correct disposal method, consult your pharmacist for guidance. Many communities have drug take-back programs, which can be an alternative disposal option.
Some medications may come with an additional patient information leaflet. Check with your pharmacist to see if this applies to your prescription. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider.
In the event of a suspected overdose, immediately contact your local poison control center or seek emergency medical attention. Be prepared to provide information about the medication taken, the amount, and the time it was taken, as this will aid in providing appropriate treatment.