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Milrinone Lactate

Pronunciation

Pronunciation: MILL-rih-nohn LAK-tate
Class: Inotropic agent

Trade Names

Primacor
- Injection, premixed 200 mcg/mL in dextrose 5% injection

Apo-Milrinone Injectable (Canada)

Pharmacology

Has direct arterial vasodilator activity and positive inotropic effect; increases myocardial contractility.

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Pharmacokinetics

Absorption

Steady state is reached after approximately 6 to 12 h of infusion of 0.5 mcg/kg/min. Therapeutic range is 100 to 300 ng/mL.

Distribution

Approximately 70% is protein bound and Vd is 0.38 L/kg.

Metabolism

Metabolite is 0-glucuronide.

Elimination

Primary route of excretion is via urine. Major urinary excretions of orally administered milrinone is 83% and 12% for 0-glucuronide metabolite. Mean t ½ is 2.3 h and Cl is 0.13 L/kg/h.

Duration

Duration depends on patient's responsiveness (approximately 5 days).

Indications and Usage

Short-term treatment of CHF.

Contraindications

Standard considerations.

Dosage and Administration

Adults Loading dose

IV 50 mcg/kg over 10 min; adjust infusion rate according to hemodynamic and clinical response.

Storage/Stability

Store at room temperature (59° to 86°F) and protect from light.

Drug Interactions

None well documented.

Incompatibility

Precipitate forms if furosemide is injected into same IV line as milrinone; do not administer both in same IV line.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Ventricular arrhythmia (eg, ventricular ectopic activity, nonsustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation); supraventricular arrhythmia; hypotension; angina.

CNS

Headaches; tremor.

Hematologic

Thrombocytopenia.

Miscellaneous

Hypokalemia.

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Renal Function

Use drug with caution; monitor renal function. Dosage reduction, based on CrCl, may be needed.

CV effects

Do not use in patients with severe obstructive aortic or pulmonic valvular disease; may exacerbate hypertrophic subaortic stenosis; may cause supraventricular and ventricular arrhythmias; may shorten atrioventricular node conduction.

Overdosage

Symptoms

Hypotension.

Patient Information

  • Inform patient that treatment with this drug usually does not exceed 5 days.
  • Instruct patient to report the following symptoms to health care provider: headache or tremors.

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