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.

Updated June 19, 2024 - 3:40pm

Alternate Name(s): 
Primacor
Classification: 
Phosphodiesterase Enzyme Inhibitor
Original Date: 
August 2003
Revised Date: 
June 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
  • 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 ​ 
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- milrinone is eliminated by the kidneys and can accumulate in renal failure
  • 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), SMOF (< 200 mcg/mL milrinone) vancomycin, vasopressin

Incompatible: furosemide- a precipitate forms

Notes: 
  • Milrinone is eliminated through renal metabolism and can accumulate in cases of renal failure, thus leading to toxicity, including hypotension and hemodynamic instability. 
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

  • 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.

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