milrinone lactate

milrinone lactate Warning - High-alert drug!

Pharmacologic class: Bipyridine phosphodiesterase inhibitor

Therapeutic class: Inotropic

Pregnancy risk category C

Action

Increases cellular levels of cyclic adenosine monophosphate, causing inotropic action that relaxes vascular smooth muscle and increases myocardial contractility

Availability

Injection: 1 mg/ml in 10-, 20-, and 50-ml vials

Injection (premixed): 200 mcg/ml in dextrose 5% in water (D₅W)

⊘Indications and dosages

➣ Heart failure

Adults: Initially, 50 mcg/kg I.V. bolus given slowly over 10 minutes, followed by continuous I.V. infusion of 0.375 to 0.75 mcg/kg/minute. Don't exceed total daily dosage of 1.13 mg/kg.

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:
• atrial flutter or fibrillation, supraventricular and ventricular arrhythmias, renal impairment, electrolyte abnormalities, decreased blood pressure, severe aortic or pulmonic valvular disease, acute phase of myocardial infarction (not recommended), electrolyte abnormalities, abnormal blood digoxin level
• elderly patients
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Dilute 1 mg/ml solution with half-normal saline solution, normal saline solution, or D₅W per manufacturer's instructions.
☞ Don't administer through same I.V. line as furosemide or torsemide (precipitate will form).
• Deliver I.V. slowly over 10 minutes.
• Expect to titrate infusion rate depending on response.

Route	Onset	Peak	Duration
I.V.	5-15 min	1-2 hr	3-6 hr

Adverse reactions

CNS: headache

CV: hypotension, chest pain, angina, ventricular or supraventricular arrhythmias, ventricular tachycardia or fibrillation

Interactions

None significant

Patient monitoring

• Monitor vital signs and ECG. Watch closely for ventricular arrhythmias, sustained tachycardia, and fibrillation.
• Assess cardiovascular status closely. Stay alert for complaints of chest pain.
☞ Stop drug and contact prescriber immediately if patient's systolic pressure drops 30 mm Hg or more.

Patient teaching

• Instruct patient to change position slowly, to avoid light-headedness or dizziness from hypotension.
• As appropriate, review all other significant and life-threatening adverse reactions.