Milrinone 1mg/ml Inj, 20ml
Overview
What is this medicine?
How to Use This Medicine
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
If you miss a dose, contact your doctor immediately to receive guidance on the appropriate course of action.
Lifestyle & Tips
- This medication is given in a hospital setting under close medical supervision.
- Report any unusual symptoms or discomfort 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. Immediately contact your doctor or seek medical attention if you experience any of the following symptoms, which may indicate a serious reaction:
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. Although many people do not experience any side effects or only have mild ones, it is essential to discuss any concerns with your doctor. If you experience any side effects that bother you or persist, contact your doctor for advice.
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult 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:
- Dizziness or lightheadedness (signs of low blood pressure)
- Palpitations or a racing heart (signs of irregular heart rhythm)
- Chest pain
- Shortness of breath
- Headache
- Nausea or vomiting
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 as a result of the allergy.
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 issues with your doctor and pharmacist. They will help determine whether it is safe to take this medication in conjunction with your other medications and health conditions.
Remember, do not start, stop, or adjust the dosage of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
Regularly undergo blood work and other laboratory tests as directed by your doctor to monitor your condition.
Also, check your blood pressure and heart rate as instructed by your doctor to ensure your safety while taking this medication.
If you are pregnant, planning to become pregnant, or are breastfeeding, notify your doctor immediately. You and your doctor will need to discuss the potential benefits and risks of this medication to both you and your baby to make an informed decision.
Overdose Information
Overdose Symptoms:
- Profound hypotension (very low blood pressure)
- Cardiac arrhythmias (irregular heartbeats)
What to Do:
Treatment is supportive. Discontinue or reduce milrinone infusion. Administer fluids and vasopressors (e.g., norepinephrine) to support blood pressure. Correct electrolyte imbalances. Continuous ECG monitoring. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Major Interactions
- Furosemide (precipitation when mixed directly in IV line)
- Other inotropes/vasodilators (potential for additive hemodynamic effects, requiring close monitoring)
Moderate Interactions
- Digoxin (potential for additive effects on cardiac contractility, monitor for arrhythmias)
- Antiarrhythmics (potential for increased risk of arrhythmias, especially ventricular)
Monitoring
Baseline Monitoring
Rationale: Hypokalemia can increase the risk of arrhythmias; correct before or during milrinone therapy.
Timing: Prior to initiation
Rationale: Milrinone is primarily renally eliminated; dose adjustment required for impairment.
Timing: Prior to initiation
Rationale: To establish baseline and monitor for hypotension.
Timing: Prior to initiation
Rationale: To establish baseline and monitor for arrhythmias.
Timing: Prior to initiation
Routine Monitoring
Frequency: Continuously or frequently (e.g., every 15-60 minutes initially, then as clinically indicated)
Target: Individualized based on patient's condition and therapeutic goals (e.g., MAP >65 mmHg, CI >2.2 L/min/m2)
Action Threshold: Significant hypotension (e.g., SBP <90 mmHg or symptomatic hypotension), tachycardia, or arrhythmias; adjust dose or discontinue.
Frequency: Continuously
Target: Normal sinus rhythm, absence of significant arrhythmias
Action Threshold: Development of new or worsening arrhythmias (e.g., ventricular tachycardia, fibrillation); consider dose reduction or discontinuation.
Frequency: Daily or more frequently if abnormalities detected
Target: Potassium 4.0-5.0 mEq/L, Magnesium 1.8-2.5 mg/dL
Action Threshold: Hypokalemia or hypomagnesemia; replete electrolytes promptly.
Frequency: Every 4-8 hours for urine output, daily for weights
Target: Adequate urine output (>0.5 mL/kg/hr), stable or decreasing weight (if fluid overloaded)
Action Threshold: Oliguria, anuria, or significant fluid retention; assess renal function and fluid status.
Symptom Monitoring
- Hypotension (dizziness, lightheadedness, syncope)
- Arrhythmias (palpitations, chest pain, shortness of breath)
- Headache
- Tremor
- Nausea/vomiting
- Fever
- Chest pain (angina)
Special Patient Groups
Pregnancy
Category C. Milrinone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects at high doses.
Trimester-Specific Risks:
Lactation
L3 (Moderately safe). Milrinone is excreted into breast milk in animals. It is unknown if it is excreted in human milk. Caution should be exercised when milrinone is administered to a nursing mother. Consider the benefits of breastfeeding versus the potential risks to the infant.
Pediatric Use
Milrinone has been used in pediatric patients for acute heart failure, including neonates, infants, and children. Dosing is weight-based and often requires careful titration. Pharmacokinetics can vary significantly with age, especially in neonates, leading to longer half-lives and requiring lower doses or longer dosing intervals. Close hemodynamic and ECG monitoring is essential.
Geriatric Use
No specific dose adjustment is required based solely on age, but elderly patients are more likely to have impaired renal function. Dosage adjustments should be made based on renal function (CrCl) in elderly patients. They may also be more sensitive to the hypotensive effects.
Clinical Information
Clinical Pearls
- Milrinone is a potent inodilator; monitor blood pressure and heart rate closely, especially during the loading dose.
- Correct hypokalemia prior to or during milrinone administration to minimize the risk of arrhythmias.
- Dose must be adjusted for renal impairment; calculate creatinine clearance before initiating therapy.
- Do not mix milrinone directly with furosemide in the same IV line due to precipitation.
- Long-term oral use of milrinone in chronic heart failure is associated with increased mortality and is contraindicated.
- Often used as a bridge to transplant or mechanical circulatory support in severe heart failure.
Alternative Therapies
- Dobutamine (beta-1 adrenergic agonist, positive inotrope)
- Dopamine (dose-dependent effects, inotropic at moderate doses)
- Norepinephrine (vasopressor, some inotropic effect)
- Levosimendan (calcium sensitizer, inodilator - not FDA approved in US)
- Digoxin (cardiac glycoside, positive inotrope)