- Treatment of persistent pulmonary hypertension of the newborn.
- Short term treatment of acute decompensated heart failure.
- IV continuous infusion: usual concentration < 400 mcg/mL
- Usual dosage range: 0.25-0.75 mcg/kg/minute
- Loading doses not recommended
- Titration recommendations: titrate by 0.25 mcg/kg/minute (frequency based on echo findings, BP goal, etc. )1
1meant to be general guidance for titrations, use clinical judgment
- CVS: ventricular arrhythmias (ectopic activity, tachycardia, fibrillation), hypotension
- Endocrine and metabolic: hypokalemia
- Hematologic: thrombocytopenia
- Neuromuscular: tremor
- BP, HR, cardiac output, ECG
- Electrolytes
- Platelet count
- Renal function- milrinone is eliminated by the kidneys and can accumulate in renal failure
- Signs and symptoms of congestive heart failure
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
-
- 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), SMOF (< 200 mcg/mL milrinone) vancomycin, vasopressin
Incompatible: furosemide- a precipitate forms
- Milrinone is eliminated through renal metabolism and can accumulate in cases of renal failure, thus leading to toxicity, including hypotension and hemodynamic instability.
- 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
-
Children’s Hospital of Eastern Ontario/Ottawa Hospital General Campus Division of Neonatology- Neonatal Mortality Review July 2018 - June 2019 (Summary of Recommendations)
-
Ross EL, Salinas A, Petty K, et al. Compatibility of medications with intravenous lipid emulsions: Effects of simulated Y-site mixing. Am J Health-Syst Pharm. 2020;77:1980-1985.