Used for cardiac support in patients with acute heart failure, pulmonary hypertension, or chronic heart failure
Used for treating cerebral vasospasm in subarachnoid hemorrhage patients
It is a Phosphodiesterase-3 inhibitor, which in turn prevents the degradation of cyclic adenosine monophosphate (cAMP)- thereby leading to increased cardiac contractility.
Milrinone also results in peripheral vasodilation with minimal chronotropic effects.
Concentration: 20 mg/ 100 mL NS/D5W
Starting Dose Range: 0.1 mcg/kg/min (cardiac)
0.5 mcg/kg/min (cerebral)
(Note: Dose reduced in renal impairment)
Titration Dose Increment (increase): as per MD (cardiac)
0.125 mcg/kg/min (cerebral)
Rate of Titration: see note below (cardiac)
12 hours (cerebral)
Maximum Dose*: 0.75 mcg/kg/min (cardiac)
1.25 mcg/kg/min (cerebral)
*NOTE: dose reduced in renal impairment
Maximum Peripheral Dose: n/a
Central/Peripheral: either
NOTE:
For cardiac indications, in CICU MD usually orders a fixed dose, reassesses after a few hours and determines next dose
For cerebral indications, decreasing dose by 0.25 mcg/kg/min every 24-48 hours until discontinuation
Adverse Effects
CV: ventricular arrythmia, hypotension, angina
CNS: headache
Hematologic: thrombocytopenia (rare)
Electrolytes: hypokalemia, hypomagnesemia