Milrinone

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

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

• 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