Milrinone
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gerald Chi
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Overview
Milrinone is a inotropic agent and vasodilator that is FDA approved for the {{{indicationType}}} of acute decompensated heart failure. Common adverse reactions include hypotension, ventricular arrhythmia, and headache.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Acute Decompensate Heart Failure
- Dosing Information
- Milrinone should be administered with a loading dose followed by a continuous infusion (maintenance dose) according to the following guidelines:
- Loading Dose
This image is provided by the National Library of Medicine.
- The loading dose may be given undiluted, but diluting to a rounded total volume of 10 or 20 mL (see Maintenance Dose for diluents) may simplify the visualization of the injection rate.
This image is provided by the National Library of Medicine.
- Milrinone drawn from vials should be diluted prior to maintenance dose administration. The diluents that may be used are 0.45% Sodium Chloride Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose Injection. The table below shows the volume of diluent in milliliters (mL) that must be used to achieve 200 mcg/mL concentration for infusion, and the resultant total volumes.
This image is provided by the National Library of Medicine.
- The infusion rate should be adjusted according to hemodynamic and clinical response. Patients should be closely monitored. In controlled clinical studies, most patients showed an improvement in hemodynamic status as evidenced by increases in cardiac output and reductions in pulmonary capillary wedge pressure.
- Maintenance Dose
- The maintenance dose in mL/hr by patient body weight (kg) may be determined by reference to the following table.
This image is provided by the National Library of Medicine.
- When administering milrinone lactate by continuous infusion, it is advisable to use a calibrated electronic infusion device.
Dosage Adjustment in Renally Impaired Patients
- Data obtained from patients with severe renal impairment (creatinine clearance = 0 to 30 mL/min) but without congestive heart failure have demonstrated that the presence of renal impairment significantly increases the terminal elimination half-life of milrinone. Reductions in infusion rate may be necessary in patients with renal impairment. For patients with clinical evidence of renal impairment, the recommended infusion rate can be obtained from the following table:
This image is provided by the National Library of Medicine.
- Intravenous drug products should be inspected visually and should not be used if particulate matter or discoloration is present.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
Condition1
- Developed by:
- Class of Recommendation:
- Strength of Evidence:
- Dosing Information
- Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Milrinone in adult patients.
Non–Guideline-Supported Use
Condition1
- Dosing Information
- Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Milrinone in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
Condition1
- Dosing Information
- Dosage
Condition2
There is limited information regarding FDA-Labeled Use of Milrinone in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Condition1
- Developed by:
- Class of Recommendation:
- Strength of Evidence:
- Dosing Information
- Dosage
Condition2
There is limited information regarding Off-Label Guideline-Supported Use of Milrinone in pediatric patients.
Non–Guideline-Supported Use
Condition1
- Dosing Information
- Dosage
Condition2
There is limited information regarding Off-Label Non–Guideline-Supported Use of Milrinone in pediatric patients.
Contraindications
- Condition1
Warnings
- Description
Precautions
- Description
Adverse Reactions
Clinical Trials Experience
There is limited information regarding Clinical Trial Experience of Milrinone in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Milrinone in the drug label.
Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous
Drug Interactions
- Drug
- Description
Use in Specific Populations
Pregnancy
- Pregnancy Category
- Australian Drug Evaluation Committee (ADEC) Pregnancy Category
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Milrinone in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Milrinone during labor and delivery.
Nursing Mothers
There is no FDA guidance on the use of Milrinone with respect to nursing mothers.
Pediatric Use
There is no FDA guidance on the use of Milrinone with respect to pediatric patients.
Geriatic Use
There is no FDA guidance on the use of Milrinone with respect to geriatric patients.
Gender
There is no FDA guidance on the use of Milrinone with respect to specific gender populations.
Race
There is no FDA guidance on the use of Milrinone with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Milrinone in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Milrinone in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Milrinone in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Milrinone in patients who are immunocompromised.
Administration and Monitoring
Administration
- Oral
- Intravenous
Monitoring
There is limited information regarding Monitoring of Milrinone in the drug label.
- Description
IV Compatibility
There is limited information regarding IV Compatibility of Milrinone in the drug label.
Overdosage
Acute Overdose
Signs and Symptoms
- Description
Management
- Description
Chronic Overdose
There is limited information regarding Chronic Overdose of Milrinone in the drug label.
Pharmacology
| |
Milrinone
| |
| Systematic (IUPAC) name | |
| 6-methyl-2-oxo-5-pyridin-4-yl-1H-pyridine-3-carbonitrile | |
| Identifiers | |
| CAS number | |
| ATC code | C01 |
| PubChem | |
| DrugBank | |
| Chemical data | |
| Formula | Template:OrganicBox atomTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox |
| Mol. mass | 211.219 g/mol |
| Pharmacokinetic data | |
| Bioavailability | 100% (as IV bolus, infusion) |
| Protein binding | 70 to 80% |
| Metabolism | Hepatic (12%) |
| Half life | 2.3 hours |
| Excretion | Urine (85% as unchanged drug) within 24 hours |
| Therapeutic considerations | |
| Pregnancy cat. |
C(US) |
| Legal status |
Rx Only |
| Routes | IV only |
Mechanism of Action
Structure
This image is provided by the National Library of Medicine.
Pharmacodynamics
There is limited information regarding Pharmacodynamics of Milrinone in the drug label.
Pharmacokinetics
There is limited information regarding Pharmacokinetics of Milrinone in the drug label.
Nonclinical Toxicology
There is limited information regarding Nonclinical Toxicology of Milrinone in the drug label.
Clinical Studies
There is limited information regarding Clinical Studies of Milrinone in the drug label.
How Supplied
Storage
There is limited information regarding Milrinone Storage in the drug label.
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
There is limited information regarding Patient Counseling Information of Milrinone in the drug label.
Precautions with Alcohol
- Alcohol-Milrinone interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
- Primacor®[1]
Look-Alike Drug Names
- N/A[2]
Drug Shortage Status
Price
References
The contents of this FDA label are provided by the National Library of Medicine.
- ↑ "MILRINONE LACTATE injection".
- ↑ "http://www.ismp.org". External link in
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