Milrinone 1mg/ml Inj, 50ml
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. They will provide guidance on how to store it safely.
If you miss a dose, contact your doctor immediately 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.
- Strict fluid intake and output monitoring will be performed.
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 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:
- Severe dizziness or fainting (signs of low blood pressure)
- Fast, pounding, or irregular heartbeat (signs of arrhythmia)
- Chest pain or discomfort
- 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 allergic reaction you experienced, including any symptoms that occurred.
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 medications and health issues. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
Overdose Information
Overdose Symptoms:
- Profound hypotension (low blood pressure)
- Cardiac arrhythmias (e.g., ventricular tachycardia, fibrillation)
What to Do:
Treatment is supportive. If hypotension occurs, reduce or discontinue milrinone administration. Fluid replacement and vasopressors may be used to support blood pressure. Correct electrolyte imbalances. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Major Interactions
- Disopyramide (may cause severe hypotension)
- Furosemide (physical incompatibility, do not mix directly)
Moderate Interactions
- Other vasodilators (additive hypotensive effects)
- Diuretics (may exacerbate hypokalemia, increasing risk of arrhythmias)
- Calcium channel blockers (additive effects on cardiac contractility and blood pressure)
Monitoring
Baseline Monitoring
Rationale: To assess for pre-existing arrhythmias and establish baseline cardiac rhythm.
Timing: Prior to initiation
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Rationale: To establish baseline and assess for tachycardia.
Timing: Prior to initiation
Rationale: Milrinone is primarily renally eliminated; renal impairment requires dose adjustment.
Timing: Prior to initiation
Rationale: Hypokalemia and hypomagnesemia can increase the risk of arrhythmias; correct prior to infusion.
Timing: Prior to initiation
Rationale: To optimize preload and prevent hypotension.
Timing: Prior to initiation
Routine Monitoring
Frequency: Continuously (invasive arterial line preferred)
Target: Maintain systolic BP >90 mmHg or as clinically indicated
Action Threshold: Hypotension (e.g., SBP <90 mmHg or significant drop from baseline); reduce infusion rate or discontinue.
Frequency: Continuously (ECG monitor)
Target: Maintain within acceptable limits, avoid significant tachycardia
Action Threshold: Significant tachycardia or new onset arrhythmias; reduce infusion rate or discontinue.
Frequency: Continuous monitoring
Target: Normal sinus rhythm or stable baseline rhythm
Action Threshold: New onset or worsening arrhythmias (e.g., ventricular ectopy, non-sustained VT); reduce infusion rate or discontinue.
Frequency: Every 4-8 hours (I&O), daily (weights)
Target: Maintain euvolemia or achieve negative fluid balance as indicated
Action Threshold: Signs of fluid overload or dehydration; adjust fluid management.
Frequency: Daily or more frequently if abnormal
Target: Potassium 4.0-5.0 mEq/L, Magnesium >2.0 mg/dL
Action Threshold: Hypokalemia or hypomagnesemia; replete electrolytes promptly.
Frequency: Daily
Target: Stable or improving
Action Threshold: Worsening renal function; consider dose adjustment.
Symptom Monitoring
- Hypotension (dizziness, lightheadedness, syncope)
- Arrhythmias (palpitations, chest discomfort, shortness of breath)
- Headache
- Tremor
- Nausea/Vomiting
- Chest pain (angina)
Special Patient Groups
Pregnancy
Category C. There are no adequate and well-controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
Lactation
L3 (Moderately Safe). 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
Milrinone has been used in pediatric patients with heart failure, including neonates, infants, and children. Dosing requires careful titration based on age, weight, and clinical response. Pharmacokinetics can vary significantly with age, especially in neonates and infants, requiring close monitoring of hemodynamic parameters and renal function.
Geriatric Use
No specific dose adjustment is required based solely on age. However, elderly patients are more likely to have impaired renal function, which necessitates dose adjustment based on creatinine clearance. They may also be more susceptible to adverse effects like hypotension and arrhythmias, requiring careful monitoring.
Clinical Information
Clinical Pearls
- Milrinone is a potent vasodilator; monitor blood pressure continuously, preferably with an arterial line.
- Correct hypokalemia and hypomagnesemia prior to and during milrinone infusion to minimize the risk of arrhythmias.
- Dose adjustments are crucial in patients with renal impairment.
- Do not mix milrinone with furosemide in the same IV line due to physical incompatibility (precipitation).
- Milrinone is typically used for short-term therapy (e.g., 48-72 hours) in acute decompensated heart failure; long-term use is associated with increased mortality.
- Monitor for signs of increased ventricular ectopy or other arrhythmias, especially in patients with pre-existing arrhythmias or electrolyte imbalances.
Alternative Therapies
- Dobutamine (beta-1 adrenergic agonist, positive inotrope)
- Dopamine (dose-dependent effects, inotropic and vasopressor)
- Levosimendan (calcium sensitizer, not FDA approved in US)
- Norepinephrine (vasopressor, some inotropic effect)
- Epinephrine (inotropic and vasopressor)