milrinone
Indication
- An inotropic agent for short term use (less than 72 hours) to improve cardiac output by increasing myocardial contractility and decreasing vascular resistance
- Treatment of persistent pulmonary hypertension of the newborn (PPHN)
Dosage Guidelines
- Hemodynamic Support: 0.25-1 microgram/kg/min IV continuous infusion.
- PPHN: 0.25-1 microgram/kg/min. Use as additive pulmonary vasodilator therapy in conjunction with inhaled Nitric oxide. Titrate as per MD order.
- Maximum rate 1 microgram/kg/min
Administration
- IV continuous infusion
- For patients 2.5 kg or less: Use milrinone 0.1 mg/mL
To make 50 mL of milrinone [0.1 mg/mL] solution:
Add 5 mL (5 mg) of milrinone [1 mg/mL] to 45 mL of solution
- For patients over 2.5 kg: Use milrinone 0.2 mg/mL
To make 50 mL of milrinone [0.2 mg/mL] solution:
Add 10 mL (10 mg) of milrinone [1 mg/mL] to 40 mL of solution
Adverse Effects
- Hypotension, arrhythmias, thrombocytopenia,
Comments
- Monitor blood pressure, heart rate and rhythm, renal function, fluid and electrolyte changes and platelet counts
- If excessive hypotension develops, the infusion rate should be decreased or temporarily discontinued. Concomitant use of vasopressors may be warranted in case of excessive vasodilatation causing hypotension.
- Hypovolemia should be corrected prior to use
- Avoid in patients with severe obstructive aortic or pulmonic valvular disease.
- Caution in patients with hepatic or renal dysfunction
- Use with caution in patients with a history of arrhythmia
- Do not administer furosemide (Lasix®) via Y-site into milrinone solutions as precipitate will occur
Supplied As
- 1 mg/mL injection (10 mL vial)
- Supplied as IV syringes by Pharmacy in standard concentrations:
- 2.5 kg or less: 0.1 mg/mL, supplied as 5 mg in 50 mL solution
- Over 2.5 kg: 0.2 mg/mL, supplied as 10 mg in 50 mL solution
- At LHSC, standard concentration reference charts are available on the NICU Intranet site
References
LexiComp Sick Kids, LexiComp Pediatric and Neonatal, Neofax