Milrinone

Milrinone - is a selective phosphodiesterase III inhibitor resulting in ↑ CO, and ↓ PCWP and SVR, without significant ↑ in HR and myocardial oxygen consumption. It produces slight enhancement in AV node conduction and may ↑ ventricular rate in uncontrolled AF/atrial flutter.

Uses
Severe congestive cardiac failure

Contraindications
Severe aortic or pulmonary stenosis (exaggerated hypotension)
Hypertrophic obstructive cardiomyopathy (exaggerated hypotension)

Administration
• IV infusion: 50 μg/kg loading dose over 10 min, then maintain on 0.375–0.75 μg/kg/min to a maximum haemodynamic effect

Requires direct arterial BP monitoring Adjustment of the infusion rate should be made according to haemodynamic response
Available in 10-ml ampoules containing 10 mg milrinone (1 mg/ml) Dilute this 10 ml solution with 40 ml sodium chloride 0.9% or glucose 5% giving a solution containing milrinone 200 μg/ml

Dose (ug/kg/min)	Infusion rate (ml/kg/h)
0.375	0.11
0.4	0.12
0.5	0.15
0.6	0.18
0.7	0.21
0.75	0.22

Maximum daily dose: 1.13 mg/kg

In renal impairment:

CC (ml/min)	Dose (ug/kg/min)
20–50	0.28–0.43
<10–20	0.23–0.28
<10	0.2–0.23

How not to use milrinone
Furosemide and bumetanide should not be given in the same line as milrinone (precipitation)

Adverse effects
Hypotension
Arrhythmias

Cautions
Uncontrolled AF/atrial flutter

Organ failure
Renal: reduce dose

Renal replacement therapy

No further dose modification is required during renal replacement therapy