Formulary
Milrinone: Indications, Dosing, Side Effects and Interactions
Milrinone is a phosphodiesterase type-3 inhibitor that exerts most effect on the myocardium; it has positive inotropic properties and vasodilator activity.
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Milrinone: Indications, Dosing, Side Effects and Interactions
Milrinone is a phosphodiesterase type-3 inhibitor that exerts most effect on the myocardium; it has positive inotropic properties and vasodilator activity.
Drug action
Milrinone is a phosphodiesterase type-3 inhibitor that exerts most effect on the myocardium; it has positive inotropic properties and vasodilator activity.
Indications and dose
**Congestive heart failure, low cardiac output following cardiac surgery, shock for milrinone**
- **Neonate** (Initially by intravenous infusion): Initially 50-75 micrograms/kg, given over 30-60 minutes, reduce or omit initial dose if at risk of hypotension, then (by continuous intravenous infusion) 30-45 micrograms/kg/hour for 2-3 days (usually for 12 hours after cardiac surgery).
- **Child** (Initially by intravenous infusion): Initially 50-75 micrograms/kg, given over 30-60 minutes, reduce or omit initial dose if at risk of hypotension, then (by continuous intravenous infusion) 30-45 micrograms/kg/hour for 2-3 days (usually for 12 hours after cardiac surgery).
Cautions
Correct hypokalaemia; heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive valvular disease or other outlet obstruction
Contraindications
Severe hypovolaemia
Side effects
Common or very common Arrhythmia supraventricular (increased risk in patients with pre-existing arrhythmias); arrhythmias; headache; hypotension Uncommon Angina pectoris; chest pain; hypokalaemia; thrombocytopenia; tremor Rare or very rare Anaphylactic shock; bronchospasm; skin eruption Frequency not known Renal failure
Interactions
**Other interactions (5):**
- Fluid and electrolyte changes should be monitored as carefully as the serum creatinine level during Milrinone therapy.
- Milrinone and diuretics can mutually reinforce their effects.
- Milrinone enhances renal perfusion by increasing cardiac output, increasing the effect of diuretics and may thus require a reduction in diuretic dosing.
- Therefore, hypokalemia should be corrected before or during milrinone therapy.
- Co-administration of inotropic agents (e.g.
Pregnancy
Manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
Manufacturer advises avoid-no information available.
Renal impairment
Dose adjustments Reduce dose and monitor response if eGFR less than 50 mL/minute/1.73 m 2 -consult product literature for details.
Medicinal forms
Solution,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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