Parenteral Manual

Milrinone

Disclaimer: Official controlled document is the CHEO 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: 
Inotropic agent/Vasodilator
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Short-term treatment of refractory congestive heart failure
Reconstitution and Stability: 
  • Available as a colourless to pale yellow solution (1 mg/mL)
  • Store at room temperature, protect from freezing
  • Diluted to 100 mcg/mL in D5W or NS, stable 14 days room temp or refrigerated
  • Diluted to 400 mcg/mL with D5W, NS or RL, stable 14 days at room temp
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl, 0.45% NaCl, ringer's lactate

- Additives/Above Cassette Compatible: atropine, calcium chloride, digoxin, epinephrine, morphine, propanolol, sodium bicarbonate, verapamil

- Y-site Compatible: acyclovir, amikacin, amino acids/dextrose, amiodarone, ampicillin, cefuroxime, ciprofloxacin, clindamycin, dexamethasone, dobutamine, dopamine, fentanyl, hydromorphone, lidocaine, lorazepam, KCl, meropenem, methylprednisolone sodium succinate, metronidazole, nitroglycerin, norepinephrine, piperacillin, propofol, propranolol, vancomycin

- Incompatible: fat emulsion (Intralipid 20%), furosemide, imipenem-cilastatin sodium, SMOF lipid 20%, procainamide

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion

YES
Usual dilution: 100 mcg/mL or 400 mcg/mL
Infusion time: 15 minutes                   

IV Continuous Infusion

YES
Standard concentrations in ER/OR/PICU: 100 mcg/mL, 400 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:                      

  • Loading dose: 50 mcg/kg IV followed by a 0.5 mcg/kg/minute IV infusion
  • Range 0.25-0.75 mcg/kg/minute
  • Maximum: 1.13 mg/kg/day

Adolescent/Adult:       

  • Loading dose: 50 mcg/kg IV followed by a 0.375-0.75 mcg/kg/minute IV infusion
  • Maximum: 1.13 mg/kg/day

DOSAGE ADJUSTMENT IN RENAL IMPAIRMENT:

CrCl (mL/minute)

Infusion Rate (mcg/kg/minute)

50

0.43

40

0.38

30

0.33

20

0.28

10

0.23

5

0.20

Potential hazards of parenteral administration: 
  • Tachyarrhythmias, hypotension, angina/chest pain
  • Headache
  • Hypokalemia
  • Thrombocytopenia
Notes: 
  • Monitor BP, HR, cardiac output, CI, CVP, SVR, PVR, EKG, serum electrolytes, CrCl, platelet count, renal function; clinical signs and symptoms of congestive heart failure
  • Decrease infusion rate if significant hypotension occurs
  • Avoid use in patients with severe obstructive aortic or pulmonic valvular disease
  • Use with caution in patients with a history of ventricular arrhythmias, atrial fibrillation, atrial flutter, impaired renal function
  • There are no controlled trials using milrinone infusions for >48 hours
  • Onset: 5-15 minutes

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