Names and pronunciation
(mill′rih-nohn)
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Drug reference
(mill′rih-nohn)
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Func. class.: Inotropic/vasodilator agent
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Chem. class.: Bipyridine phosphodi- esterase inhibitor
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ACTION: Positive inotropic agent; increases contractility of cardiac muscle with vasodilator properties; reduces pre- load and afterload by direct relaxation on vascular smooth muscle
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USES: Short-term management of advanced heart failure that has not responded to other medication
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Unlabeled uses: Adolescents, children, infants
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CONTRAINDICATIONS: Hyper- sensitivity to this product, severe aortic disease, severe pulmonic valvular dis- ease, acute MI Precautions: Pregnancy, breastfeeding, children, geriatric patients, renal/hepatic disease, atrial flutter/fibrillation
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SIDE EFFECTS CNS: Headache CV: Dysrhythmias, hypotension, chest pain, PVCs, palpitations, angina HEMA: Thrombocytopenia MISC: Inj site reactions
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INTERACTIONS Increase: effects of antihypertensives, diuretics
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TREATMENT OF OVERDOSE: Discontinue product, support circulation
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DOSAGE AND ROUTES Short-term treatment of acutely decompensated heart failure • Adult: IV BOL 50 mcg/kg given over 10 min (loading dose); start infusion of 0.375-0.75 mcg/kg/min, titrate based on response • Adolescent/child/infant (unlabeled): IV 50 mcg/kg over 10-60 min, then 0.5- 0.75 mcg/kg/min continuous infusion Renal dose • Adult: IV CCr 41-50 mL/min, 0.43 mcg/kg/ min, titrate up; CCr 31-40 mL/min, 0.38 mcg/ kg/min, titrate up; CCr 21-30 mL/min, 0.33 mcg/kg/min, titrate up; CCr 11-20 mL/min, 0.28 mcg/kg/min; CCr 6-10 mL/min, 0.23 mcg/kg/min; CCr ≤5 mL/min, 0.20 mcg/kg/ min; max for all doses 0.75 mcg/kg/min
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Available forms: Inj 1 mg/mL; pre- mixed inj 200 mcg/mL in D5W
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Administer: • Potassium supplements if ordered for potassium levels <3 mg/dL Direct IV route • Give IV loading dose undiluted over 10 min, use infusion device Continuous IV route • Dilute 20-mg vial with 80, 113, 180 mL of 0.45% NaCl, 0.9% NaCl, or D5W to a concentration of 200, 150, 100 mcg/ mL, respectively • Titrate rate based on hemodynamic and clinical response, use infusion device • Diluted solution must be kept at room temperature and used within 24 hr • Precipitation will form when furose- mide is injected into line with milrinone Y-site compatibilities: Acyclovir, alfent- anil, allopurinol, amifostine, amikacin, aminocaproic acid, aminophylline, amio- darone, amphotericin B liposome, ampi- cillin, ampicillin-sulbactam, anidulafun- gin, argatroban, atenolol, atracurium, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride/ gluconate, CARBOplatin, caspofungin, ceFAZolin, cefepime, cefotaxime, cefo- TEtan, cefOXitin, cefTAZidime, ceftizox- ime, cefTRIAXone, cefuroxime, chloram- phenicol, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clindamycin, cyclophosphamide, cyclo- SPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiaZEM, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, DOXOrubicin, doxycycline, droperidol, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, eptifibatide, ertapenem, erythromycin, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludar abine, fluorouracil, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydrALAZINE, hydrocortisone, HYDROmorphone, IDArubicin, ifos- famide, insulin (regular), irinotecan, iso- M proterenol, ketorolac, labetalol, levo- FLOXacin, linezolid, LORazepam, magnesium sulfate, mannitol, mechlor- ethamine, melphalan, meperidine, meropenem, methohexital, methotrexate, methyldopate, methylPREDNISolone, metoclopramide, metoprolol, metroNI- DAZOLE, micafungin, midazolam, mito- XANTRONE, morphine, mycophenolate, nafcillin, nalbuphine, naloxone, nesirit- ide, niCARdipine, nitroglycerin, nitro- prusside, norepinephrine, octreotide, oxacillin, oxaliplatin, oxytocin, PACLi- taxel, palonosetron, pamidronate, pan- curonium, PEMEtrexed, pentamidine, pentazocine, PENTobarbital, PHENobar- bital, phenylephrine, piperacillin, piper- acillin-tazobactam, polymyxin B, potas- sium chloride/phosphates, prochlorperazine, promethazine, propofol, propranolol, quiNIDine, quinupristin-dalfopristin, raNITIdine, remifentanil, rocuronium, sodium acetate/bicarbonate/phosphates, streptozocin, succinylcholine, SUFentanil, sulfamethoxazole-trimethoprim, tacroli- mus, teniposide, theophylline, thiopental, thiotepa, ticarcillin, ticarcillin-clavula- nate, tigecycline, tirofiban, tobramycin, torsemide, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
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Assess: • Monitor ECG continuously during IV; ventricular dysrhythmia can occur, PEWP, CVP index often during infusion; B/P, pulse q5min during infusion; if B/P drops 30 mm Hg, stop infusion, call pre- scriber • Electrolytes: potassium, sodium, chlo- ride, calcium, correct as needed; renal studies: BUN, creatinine; blood studies: platelet count • ALT, AST, bilirubin daily • I&O ratio, weight daily; diuresis should increase with continuing therapy • Pregnancy/breastfeeding: use in pregnancy if benefit outweighs risk to fetus; no well-controlled studies; cau- tious use in breastfeeding, not known if excreted in breast milk
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Evaluate: • Therapeutic response: increased car- diac output, decreased PCWP, adequate CVP; decreased dyspnea, fatigue, edema, ECG
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report angina, palpitations immedi- ately during infusion • To report headache, which can be treated with analgesics
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PHARMACOKINETICS IV: Onset 2-5 min, peak 10 min, duration variable; half-life 2.3 hr; metabolized in liver; excreted in urine as product (83%), metabolites (12%)
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• Adolescent/child/infant (unlabeled): IV 50 mcg/kg over 10-60 min, then 0.5- 0.75 mcg/kg/min continuous infusion Renal dose
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