Milrinone
Classification
Inotrope; Phosphodiesterase-3 Enzyme Inhibitor
Indications
CCP: Acute decompensated heart failure
CCP: Inotropic support
Contraindications
- Hypersensitivity
- Avoid use in patients with severe obstructive aortic or pulmonic valvular disease
Cautions
- Arrhythmias
- Hypotension
- Renal dysfunction
Adult dosages
CCP: All indications
- Initial: 0.125 mcg/kg/minute IV infusion
- Dosing range: 0.125 to 0.75 mcg/kg/minute
Pediatric Considerations And Dosing
CCP: All indications
- Infants, Children, and Adolescents:
- Loading dose (optional): 50 mcg/kg IV administered over 10 to 60 minutes
- Maintenance: IV infusion dose range: 0.25 to 0.75 mcg/kg/minute
Mechanism Of Action
A selective phosphodiesterase inhibitor in cardiac and vascular tissue, resulting in vasodilation and inotropic effects with little chronotropic activity.
Pharmacokinetics
Onset: 5-15 minutes
Half-life: 2.3 hours
Adverse Effects
Cardiovascular:
- Ventricular arrhythmia (ventricular ectopy, non-sustained ventricular tachycardia, ventricular tachycardia, ventricular fibrillation, atrial fibrillation, torsades de pointes
- Supraventricular cardiac arrhythmia, hypotension, angina pectoris, chest pain, myocardial infarction, thrombocytopenia,
Central nervous system
- Headache
Inflammatory
- Anaphylaxis
Dermatology
- Skin rash, injection site reaction
MSK
- Tremor
Respiratory
- Bronchospasm
Hepatic
- Hepatic insufficiency
Warning And Precautions
- Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use.
- Immediate treatment of potential cardiac events, including life-threatening ventricular arrhythmias, must be available.
- Safe and effective use beyond 48 hours (prolonged use) has not been demonstrated.
- It is not known if milrinone is present in breast milk.
Drug Interactions
- Anagrelide
- Riociguat