Milrinone

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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
  • Hepatic Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined

Contraindications

  • Allergy to class/drug
  • Aortic valve disease, severe
  • Pulmonic valve disease, severe
  • MI, acute

Adverse Reactions

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

See Also

References