milrinone

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

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