• Clinical Info

Uses

CHF

Short-term management of acutely decompensated heart failure. In most clinical studies, used in patients with NYHA class III or IV CHF who were receiving cardiac glycosides (e.g., digoxin) and diuretics. No evidence to date that milrinone decreases mortality associated with CHF.

Not found to be safe and effective in the long-term (>48 hours) treatment of CHF. (See Mortality Associated with Long-term Use under Cautions.) Some clinicians recommend reserving milrinone therapy for patients with severe heart failure whose condition is refractory to therapy with cardiac glycosides, diuretics, ACE inhibitors, and/or β-adrenergic blocking agents.

ACC and AHA strongly discourage use of intermittent infusions of positive inotropic agents (e.g., milrinone) at home, in outpatient medical facilities (e.g., clinics), or in short-stay medical units for the long-term management of heart failure, even for advanced stages of the disease. However, ACC and AHA state that short-term continuous positive inotropic therapy can be considered for palliative therapy in patients with refractory end-stage heart failure.

Has been used for treatment of heart failure associated with cardiac surgery†.

CPR

An alternative therapy (used in conjunction with catecholamines) in ACLS† for improving cardiac output when catecholamine therapy alone is ineffective in patients with severe heart failure, cardiogenic shock, or other forms of shock.

AMI

Not recommended for use during the acute phase following MI; not included in the ACC and AHA recommendations for management of AMI.

Myocardial Dysfunction in Children

Has been used in children with myocardial dysfunction and increased systemic or pulmonary vascular resistance.† (See Pediatric Use under Cautions.)

Dosage and Administration

General

• Intermittent infusions for long-term management of heart failure are not recommended. However, short-term continuous IV therapy can be considered for palliative therapy in patients with refractory end-stage heart failure. (See CHF under Uses.)

Administration

Administer by slow IV injection followed by IV infusion.

For ACLS during CPR, may be administered by intraosseous injection† in pediatric patients without reliable/immediate IV access.

Oral Administration

Has been administered orally† (oral dosage form not commercially available in US), but increased morbidity and mortality have precluded continued study of this route of administration.

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer as a slow IV injection followed by a continuous IV infusion.

Administer initial dose undiluted or diluted (for better visualization of injection rate).

Administer IV infusions via a calibrated electronic controlled-infusion device.

Do not use premixed IV solution in flexible plastic containers in series connections. For administration instructions for premixed solutions, consult manufacturers’ labelings.

Dilution

Initial dose: May dilute initial dose with 0.45% sodium chloride injection, 0.9% sodium chloride injection, or 5% dextrose injection to a total volume of 10 or 20 mL.

Continuous IV infusion: Dilute contents of vial containing milrinone 10, 20, or 50 mg with 40, 80, or 200 mL, respectively, of 0.45% sodium chloride injection, 0.9% sodium chloride injection, or 5% dextrose injection to provide a solution containing approximately 200 mcg/mL. Alternatively, use premixed solution containing 200 mcg/mL of milrinone in 5% dextrose injection without further dilution.

Rate of Administration

Administer initial dose slowly (e.g., over 10 minutes) as a direct IV injection.

Adjust rate of IV infusion according to hemodynamic and clinical response, including assessment of cardiac output and pulmonary capillary wedge pressure.

Dosage

Available as milrinone lactate; dosage expressed in terms of milrinone.

Pediatric Patients

CPR

ACLS

IV or Intraosseous

Initially, 50–75 mcg/kg as a slow, direct injection over 10–60 minutes, followed by an infusion of 0.5–0.75 mcg/kg per minute.†

Adults

CHF

Decompensated CHF

IV

Initially, 50 mcg/kg as a slow, direct injection, followed by an IV infusion of 0.375– 0.75 mcg/kg per minute. Duration of therapy depends on clinical response.

CPR

ACLS

IV

Initially, 50 mcg/kg as a slow, direct injection over 10 minutes, followed by an IV infusion of 0.375–0.75 mcg/kg per minute for 2–3 days.†

Prescribing Limits

Adults

CHF

Decompensated CHF

IV

Maximum total dosage (including initial and cumulative doses) 1.13 mg/kg daily.

Special Populations

Renal Impairment

CHF

IV

Reduce rate of continuous IV infusion in patients with Cl_cr≤50 mL/minute.

Geriatric Patients

No dosage adjustments except those related to renal impairment. (See Renal Impairment under Dosage and Administration.)