Milrinone Dw5 Inj, 200ml
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 what to do next.
Lifestyle & Tips
- This medication is administered in a hospital setting, typically in an intensive care unit. Lifestyle modifications are not directly applicable during treatment.
- Patients should follow all instructions from their healthcare team regarding activity, diet, and fluid restrictions.
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
Seek Immediate Medical Attention If You Experience:
- Feeling dizzy or lightheaded
- Feeling like your heart is racing or skipping beats (palpitations)
- Chest pain or discomfort
- Headache
- Nausea or vomiting
- Any new or worsening symptoms
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 and its symptoms.
If you have a history of heart valve problems or have recently experienced 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 adjust the dosage of any medication without first consulting your doctor to ensure your safety.
Precautions & Cautions
Overdose Information
Overdose Symptoms:
- Severe hypotension (very low blood pressure)
- Ventricular arrhythmias (abnormal heart rhythms, potentially life-threatening)
What to Do:
Treatment is supportive. If hypotension occurs, milrinone administration should be reduced or discontinued. General measures to support circulation should be taken, such as fluid replacement and vasopressors if necessary. Close monitoring of cardiac rhythm is essential. Call 1-800-222-1222 (Poison Control) for further guidance.
Drug Interactions
Major Interactions
- Disopyramide (risk of severe hypotension and arrhythmias)
- Furosemide (physical incompatibility, precipitate formation if mixed directly)
Moderate Interactions
- Other vasodilators (e.g., nitrates, ACE inhibitors, ARBs): May cause additive hypotensive effects.
- Other inotropes (e.g., dobutamine, dopamine): May cause additive effects on heart rate and contractility, increasing risk of arrhythmias.
- Antiarrhythmics (e.g., amiodarone, sotalol): Increased risk of ventricular arrhythmias, especially in patients with underlying cardiac disease.
- Digoxin: No direct interaction, but monitor for additive effects on cardiac contractility and potential for arrhythmias if hypokalemia occurs.
Monitoring
Baseline Monitoring
Rationale: To assess baseline cardiac rhythm and identify pre-existing arrhythmias.
Timing: Prior to initiation
Rationale: To establish baseline hemodynamic status and guide initial dosing.
Timing: Prior to initiation
Rationale: To establish baseline and monitor for tachycardia.
Timing: Prior to initiation
Rationale: Milrinone is primarily renally excreted; renal impairment necessitates dose adjustment.
Timing: Prior to initiation
Rationale: Hypokalemia and hypomagnesemia can predispose to arrhythmias.
Timing: Prior to initiation
Rationale: To assess volume status and guide fluid management, especially in heart failure.
Timing: Prior to initiation
Routine Monitoring
Frequency: Continuously
Target: Normal sinus rhythm, absence of significant arrhythmias
Action Threshold: New onset or worsening ventricular arrhythmias (e.g., PVCs, VT, VF); significant bradycardia or tachycardia.
Frequency: Continuously
Target: Maintain systolic BP >90 mmHg or as clinically appropriate for patient's condition
Action Threshold: Significant hypotension (e.g., SBP <90 mmHg or >20% drop from baseline); requires dose reduction or discontinuation.
Frequency: Continuously
Target: Maintain within physiological limits, avoid excessive tachycardia
Action Threshold: Persistent tachycardia (>120 bpm) or bradycardia (<50 bpm) not explained by other factors.
Frequency: Every 1-4 hours
Target: Maintain euvolemia or achieve negative fluid balance as indicated
Action Threshold: Significant fluid retention or excessive diuresis.
Frequency: Daily or more frequently if abnormal
Target: Potassium 4.0-5.0 mEq/L; Magnesium 1.8-2.5 mg/dL
Action Threshold: Hypokalemia (<3.5 mEq/L) or hypomagnesemia (<1.8 mg/dL); requires prompt correction.
Frequency: Daily
Target: Stable or improving renal function
Action Threshold: Worsening renal function (e.g., increasing creatinine); requires milrinone dose adjustment.
Frequency: As clinically indicated (e.g., every 4-8 hours or with dose changes)
Target: Improved cardiac index, decreased PAWP, decreased SVR
Action Threshold: Lack of hemodynamic improvement or worsening parameters.
Symptom Monitoring
- Hypotension (dizziness, lightheadedness, syncope)
- Palpitations or irregular heartbeat
- Chest pain or discomfort (angina)
- Headache
- Nausea/vomiting
- Tremor
- Fever
Special Patient Groups
Pregnancy
Category C. Animal studies have shown adverse effects on the fetus, but there are no adequate and well-controlled studies in pregnant women. Milrinone should be used 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. 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 has been used in pediatric patients, including neonates, infants, and children, for acute heart failure or low cardiac output states. Dosing is weight-based and requires careful titration. Pharmacokinetics can be variable in this population, especially in neonates and infants, necessitating close monitoring of hemodynamic response 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. Monitor closely for adverse effects, particularly hypotension and arrhythmias.
Clinical Information
Clinical Pearls
- Milrinone is typically used for short-term management of acute decompensated heart failure, particularly in patients with low cardiac output and elevated filling pressures.
- It provides both inotropic support and vasodilation, making it useful in situations where both are desired (e.g., cardiogenic shock, bridge to transplant).
- Close hemodynamic monitoring (e.g., arterial line, central venous pressure, pulmonary artery catheter) is crucial during milrinone infusion due to the risk of hypotension and arrhythmias.
- Renal function must be assessed prior to and during therapy, as dose adjustments are critical in renal impairment to prevent drug accumulation and toxicity.
- Correct hypokalemia and hypomagnesemia prior to and during milrinone therapy to minimize the risk of arrhythmias.
- Do not mix milrinone with furosemide in the same IV line due to physical incompatibility and precipitate formation.
Alternative Therapies
- Dobutamine (another inotropic agent, beta-1 agonist)
- Dopamine (dose-dependent inotropic and vasopressor effects)
- Norepinephrine (primarily vasopressor, some inotropic effect)
- Levosimendan (calcium sensitizer, also has PDE3 inhibitory properties, not FDA approved in US)
- Nitroglycerin (vasodilator, primarily venodilator)
- Nitroprusside (balanced arterial and venous vasodilator)