Milrinone: Difference between revisions
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Latest revision as of 21:56, 20 March 2026
General
- Type: Vasopressors
- Dosage Forms: INJ
- Common Trade Names: Milrinone
Adult Dosing
Dosing
- Normal renal function:
0.25 - 0.75 mcg/kg/min
- Creatinine clearance < 50mL/min, reduce infusion rate
Rate of Titration
- Q2H; slower titration rate if renal insufficiency
Pediatric Dosing
Special Populations
- Pregnancy Rating: C; Caution advised
- Lactation: Safety unknown
- Renal Dosing
- Adult
- CrCl 50: Start 0.43 mcg/kg/min
- CrCl 40: Start 0.38 mcg/kg/min
- CrCl 30: Start 0.33 mcg/kg/min
- CrCl 20: Start 0.28 mcg/kg/min
- CrCl 10: Start 0.23 mcg/kg/min
- CrCl 5: Start 0.20 mcg/kg/min
- Pediatric
- CrCl 50: Start 0.43 mcg/kg/min
- CrCl 40: Start 0.38 mcg/kg/min
- CrCl 30: Start 0.33 mcg/kg/min
- CrCl 20: Start 0.28 mcg/kg/min
- CrCl 10: Start 0.23 mcg/kg/min
- CrCl 5: Start 0.20 mcg/kg/min
- Adult
- Hepatic Dosing
- Adult
- Not defined
- Pediatric
- Not defined
- Adult
Contraindications
- Allergy to class/drug
- Aortic valve disease, severe
- Pulmonic valve disease, severe
- MI, acute
Adverse Reactions
- Tachyarrhythmias
- Hypotension
- Torsades de pointes
- Anaphylaxis
- Bronchospasm
Pharmacology
- Half-life: 2.3h
- Metabolism: Glucouronidation
- Excretion: Urine primarily
- Mechanism of Action: inhibits cAMP phosphodiesterase
Primary Receptor
- PDE-3 inhibitor
Relative Effects
- ↑HR
- ↑↑↑SV
- ↓SVR
Notes
- Can use as alternative to dobutamine in patients with cardiogenic shock and on b-blockers
- Causes pulmonary vasodilation, may be good choice in patients with RV failure
- ↑cAMP in cardiac myocytes and vascular smooth muscle, thereby ↑HR and ↑SV while decreasing ↓SVR
- Use with caution in patient with renal failure and hypovolemia
Indication
- low cardiac output states due to impaired myocardial contractility
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Congestive heart failure | 0.375-0.75 mcg/kg/min IV drip | Inotrope (if on beta-blockers) | IV drip | Adult |
| Vasopressors | 0.375-0.75 mcg/kg/min (loading often omitted) | Inodilator | IV drip | Adult |