Milrinone Dw5 Inj, 100ml
Overview
What is this medicine?
How to Use This Medicine
To use this medication correctly, follow your doctor's instructions and read all the information provided. It is essential to follow the instructions carefully. This medication is administered as an infusion into a vein over a specified period.
Storing and Disposing of Your Medication
If you need to store this medication at home, consult with your doctor, nurse, or pharmacist to determine the proper storage procedure.
Missing a Dose
If you miss a dose, contact your doctor to receive guidance on the next steps to take.
Lifestyle & Tips
- Not applicable as this is an acute, inpatient IV medication.
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. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience side effects that bother you or persist, contact your doctor for guidance.
Reporting Side Effects
This list is not exhaustive, and you may have questions about other potential side effects. If you do, don't hesitate to reach out 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. Your doctor is available to provide medical advice about side effects, so don't hesitate to contact them if you have any concerns.
Seek Immediate Medical Attention If You Experience:
- Feeling dizzy or lightheaded (especially when standing up)
- Chest pain or discomfort
- Feeling your heart race or beat irregularly (palpitations)
- Severe 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.
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. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.
Precautions & Cautions
Overdose Information
Overdose Symptoms:
- Profound hypotension (very low blood pressure)
- Cardiac arrhythmias (irregular heartbeats, potentially life-threatening)
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. Monitor ECG continuously. Call 1-800-222-1222 (Poison Control).
Drug Interactions
Major Interactions
- Furosemide (precipitation if mixed directly in IV line)
- Other inotropic agents (e.g., dobutamine, dopamine) - potential for additive effects leading to excessive hypotension or arrhythmias. Use with caution and close monitoring.
- Vasodilators (e.g., nitrates, hydralazine) - potential for additive hypotensive effects.
Moderate Interactions
- Digoxin (may be used concomitantly, but monitor for additive inotropic effects and potential for arrhythmias)
- Antihypertensives (additive hypotensive effects)
Monitoring
Baseline Monitoring
Rationale: To assess baseline cardiac function and guide initial dosing.
Timing: Prior to initiation of therapy
Rationale: To assess for pre-existing arrhythmias and monitor for new ones.
Timing: Prior to initiation of therapy
Rationale: Milrinone is primarily renally excreted; renal impairment necessitates dose adjustment.
Timing: Prior to initiation of therapy
Rationale: Hypokalemia or hypomagnesemia can predispose to arrhythmias.
Timing: Prior to initiation of therapy
Routine Monitoring
Frequency: Continuously (invasive monitoring) or frequently (non-invasive BP, HR)
Target: Individualized based on patient's condition and goals (e.g., MAP >65 mmHg, CI >2.2 L/min/m2)
Action Threshold: Significant hypotension (e.g., MAP <60 mmHg or symptomatic drop), tachycardia, or arrhythmias; adjust infusion rate or administer vasopressors.
Frequency: Continuous
Target: Normal sinus rhythm, absence of significant arrhythmias
Action Threshold: Development of new or worsening arrhythmias (e.g., ventricular ectopy, non-sustained VT, atrial fibrillation with rapid ventricular response); consider dose reduction or antiarrhythmics.
Frequency: Every 1-4 hours
Target: Appropriate for patient's fluid status (e.g., euvolemic, negative balance if overloaded)
Action Threshold: Significant fluid overload or dehydration; adjust fluid administration or diuretic therapy.
Frequency: Daily or as clinically indicated
Target: Stable or improving renal function
Action Threshold: Worsening renal function; consider milrinone dose reduction.
Frequency: Daily or as clinically indicated
Target: Within normal limits (e.g., K 3.5-5.0 mEq/L, Mg 1.8-2.5 mg/dL)
Action Threshold: Hypokalemia or hypomagnesemia; replete electrolytes promptly.
Frequency: Periodically (e.g., every few days if prolonged use)
Target: Normal platelet count (>150,000/mm3)
Action Threshold: Thrombocytopenia (<100,000/mm3 or significant drop); consider discontinuation if drug-induced.
Symptom Monitoring
- Hypotension (dizziness, lightheadedness, syncope)
- Chest pain (angina)
- Palpitations or irregular heartbeat
- Headache
- Nausea/vomiting
- Tremor
Special Patient Groups
Pregnancy
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. Animal studies have shown adverse effects at high doses.
Trimester-Specific Risks:
Lactation
Lactation Risk L3 (Moderately Safe). It is not known whether milrinone is excreted in human milk. Due to the potential for serious adverse reactions in nursing infants, 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 is used in pediatric patients, including neonates, for conditions like low cardiac output syndrome after cardiac surgery or in septic shock. Dosing is weight-based and often requires careful titration. Pharmacokinetics can vary significantly with age, especially in neonates and infants, requiring close monitoring and dose adjustment. Renal function is a key determinant of clearance in this population.
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. They may also be more sensitive to the hypotensive effects of milrinone. Close hemodynamic monitoring is essential.
Clinical Information
Clinical Pearls
- Milrinone is a potent inodilator; continuous hemodynamic monitoring (arterial line, CVP, PAWP if available) is crucial during administration.
- Always adjust the maintenance infusion rate based on the patient's hemodynamic response, renal function, and tolerance.
- Correct hypokalemia and hypomagnesemia prior to or during milrinone therapy to minimize the risk of arrhythmias.
- Avoid direct mixing of milrinone with furosemide in the same IV line due to physical incompatibility and precipitation.
- Milrinone is not recommended for long-term outpatient use in chronic heart failure due to increased mortality observed in some studies (e.g., PROMISE trial). It is primarily for acute, short-term management of decompensated heart failure or cardiogenic shock.
- Platelet count should be monitored, especially with prolonged infusions, as thrombocytopenia can occur.
Alternative Therapies
- Dobutamine (beta-1 adrenergic agonist, positive inotrope)
- Dopamine (dose-dependent effects: renal, inotropic, vasopressor)
- Norepinephrine (primarily vasopressor, some inotropic effect)
- Levosimendan (calcium sensitizer, K-ATP channel opener; not FDA approved in US, but used in Europe)
- Intra-aortic balloon pump (IABP) or other mechanical circulatory support devices (for severe cases)