MILRINONE LACTATE IN DEXTROSE 5% IN PLASTIC CONTAINER
Clinical safety rating: safe
No significant drug interactions Can cause ventricular arrhythmias and hypotension.
Selective phosphodiesterase III (PDE3) inhibitor in cardiac and vascular smooth muscle, increasing intracellular cAMP, leading to positive inotropy and vasodilation.
| Metabolism | Primarily hepatic metabolism via glucuronidation; minimal cytochrome P450 involvement. |
| Excretion | Primarily renal; approximately 80-85% of the dose excreted unchanged in urine within 24 hours; minor biliary/fecal elimination (<5%). |
| Half-life | Terminal elimination half-life in healthy adults: 2.3-2.4 hours; in patients with heart failure, half-life prolonged to ~3-4 hours due to reduced renal function. |
| Protein binding | 70% bound (primarily to albumin). |
| Volume of Distribution | 0.3-0.4 L/kg; relatively small, reflecting limited extravascular distribution. |
| Bioavailability | Intravenous only; oral bioavailability not applicable (only IV formulation). |
| Onset of Action | Intravenous bolus: 5-15 minutes; continuous IV infusion: effects noted within 15-30 minutes. |
| Duration of Action | Hemodynamic effects persist for 30-60 minutes after discontinuation of infusion; clinical effects may last 2-3 hours due to prolonged inotropic action. |
Intravenous loading dose of 50 mcg/kg over 10 minutes, followed by a continuous infusion of 0.375-0.75 mcg/kg/min. Adjust dose based on hemodynamic response.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 50-60 mL/min: reduce infusion rate by 25%; CrCl 40-50 mL/min: reduce by 40%; CrCl 30-40 mL/min: reduce by 50%; CrCl 20-30 mL/min: reduce by 60%; CrCl <20 mL/min: use with caution and consider alternative therapy. |
| Liver impairment | No specific Child-Pugh based adjustments; use with caution in severe hepatic impairment (Child-Pugh C) due to risk of altered metabolism, monitor closely and consider dose reduction. |
| Pediatric use | Loading dose: 50-75 mcg/kg IV over 15-30 minutes; continuous infusion: 0.5-0.75 mcg/kg/min, titrate to clinical response. |
| Geriatric use | Elderly patients may have reduced renal function; initial dose reduction recommended based on creatinine clearance. Consider starting at the lower end of the infusion range (0.375 mcg/kg/min) and titrate slowly. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause ventricular arrhythmias and hypotension.
| FDA category | Animal |
| Breastfeeding | It is unknown if milrinone is excreted in human breast milk. M/P ratio not established. Because of potential for cardiovascular effects in nursing infants, caution is advised. Consider discontinuing breastfeeding or drug, taking into account importance of drug to mother. |
| Teratogenic Risk | Milrinone is a pregnancy category C drug. Animal studies have shown teratogenic effects (e.g., cardiovascular malformations) at doses 2-4 times the human dose. No adequate human studies exist. Risk to fetus cannot be ruled out; use only if benefit outweighs risk. First trimester: potential for major malformations. Second/third trimesters: may cause fetal tachycardia, hypotension, or altered placental perfusion. |
■ FDA Black Box Warning
May cause ventricular arrhythmias and increase mortality in patients with severe heart failure (NYHA class IV) when used long-term; not indicated for chronic use.
| Common Effects | Arrhythmias |
| Serious Effects |
["Severe aortic stenosis","Hypertrophic cardiomyopathy","Hypersensitivity to milrinone or any excipient","Acute myocardial infarction","Concurrent use with other PDE inhibitors"]
| Precautions | ["Monitor for hypotension and supraventricular/ventricular arrhythmias","Can exacerbate myocardial ischemia","Use with caution in patients with severe aortic stenosis or hypertrophic cardiomyopathy","Renal impairment requires dose adjustment","Electrolyte imbalances should be corrected before use"] |
Loading safety data…
| Fetal Monitoring | Monitor maternal heart rate and blood pressure continuously; watch for hypotension, tachycardia, or arrhythmias. Fetal heart rate monitoring for signs of distress. Assess maternal fluid status, electrolytes, and renal function. Monitor platelet count due to risk of thrombocytopenia. |
| Fertility Effects | No adequate studies on fertility effects in humans. In animal studies, no significant impairment of fertility was observed at doses up to 4 times the human dose. However, milrinone's hemodynamic effects could theoretically impact uteroplacental perfusion, potentially affecting conception or implantation. |