Neonatal Drug Therapy Manual

Milrinone

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Primacor
Classification: 
Phosphodiesterase Enzyme Inhibitor
Original Date: 
August 2003
Revised Date: 
Feb 2024
Indications: 
  • Treatment of persistent pulmonary hypertension of the newborn.
  • Short term treatment of acute decompensated heart failure.
Administration: 
  • IV continuous infusion: usual concentration < 400 mcg/mL
Dosage: 
  • Usual dosage range: 0.25-0.75 mcg/kg/minute; titrate dose to effect
  • Loading doses not recommended 
Side Effects: 
  • CVS: ventricular arrhythmias (ectopic activity, tachycardia, fibrillation), hypotension
  • Endocrine and metabolic: hypokalemia
  • Hematologic: thrombocytopenia
  • Neuromuscular: tremor
Parameters to Monitor: 
  • BP, HR, cardiac output, ECG
  • Electrolytes
  • Platelet count
  • Renal function
  • Signs and symptoms of congestive heart failure
Reconstitution and Stability: 

CHEO:

  • Milrinone 1 mg/mL
    • Take 2 mL (2 mg) and add to 18 mL D5W
    • Final concentration: 100 mcg/mL
  • Milrinone 1 mg/mL
    • Take 8 mL (8 mg) and add to 12 mL D5W
    • Final concentration: 400 mcg/mL

 

TOH:

  • Milrinone 1 mg/mL

    • Take 1 mL (1 mg) and add to 19 mL of D5W

    • Final concentration: 50 mcg/mL

  • Milrinone 1 mg/mL

    • Take 4 mL (4 mg) and add to 16 mL of D5W

    • Final concentration: 200 mcg/mL

Compatibility: 

- Solutions Compatible: 0.45% NaCl, 0.9% NaCl, D5W

- Y-site Compatible: acyclovir, ampicillin, calcium gluconate, cefazolin, dobutamine, dopamine, epinephrine, fentanyl, heparin, lorazepam, midazolam, morphine, norepinephrine, piperacillin/tazobactam, potassium chloride, propranolol, ranitidine, sodium bicarbonate, tobramycin, TPN (amino acids- dextrose), vancomycin, vasopressin

Incompatible: furosemide- a precipitate forms, SMOF

References: 

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015.

-American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: ASHP 2017.

-Bassler D, Kreutzer K, McNamara P, Kirpalani H. Milrinone for persistent pulmonary hypertension of the newborn. Cochrane Database of Systematic Reviews 2010, Issue 11. Art. No.: CD007802. DOI: 10.1002/14651858.CD007802.pub2.

- Evidence-based Practice for Improving Quality  (EPIQ) Recommendations on Hemodynamics, 2023

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