Milrinone (inotrope, cardiac drug)

Milrinone is a phosphodiesterase inhibitor. It works by making your heart beat stronger and by relaxing certain blood vessels so that the amount of blood that is pumped from the heart is increased. This effect may help with symptoms of heart failure (such as shortness of breath, tiredness).

Uses

What is milrinone used for?

• Acute decompensated heart failure
• Short-term management of severe heart failure

How should I take milrinone?

This medication is given by injection into a vein as directed by your doctor. It is usually first given as a slow injection (over 10 minutes) and then given as a continuous infusion thereafter.

If you are giving this medication to yourself at home, learn all preparation and usage instructions from your health care professional. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard medical supplies safely.

Dosage is based on your medical condition, weight, and response to treatment.

How do I store milrinone?

This product is best stored at controlled room temperature away from direct light and moisture. To prevent drug damage, you should not store it in the bathroom or the freezer. 

There may be different brands of this drug that may have different storage needs. So, it is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush this product down the toilet or pour them into a drain unless instructed to do so. Additionally, it is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using milrinone?

Before using this drug, tell your doctor if you are/have:

• Pregnant or breastfeeding.
• Taking any other medicines. This includes any prescription, OTC, and herbal remedies.
• An allergy to any of the ingredients of this product.
• Any other illnesses, disorders, or medical conditions, especially:

Is it safe during pregnancy or breastfeeding?

Unfortunately, there isn’t enough information about the safety of using this drug during pregnancy and breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking any medication.

This medication is pregnancy risk category C according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

• A=No risk
• B=No risk in some studies
• C=There may be some risk
• D=Positive evidence of risk
• X=Contraindicated
• N=Unknown

Side effects

What side effects can occur from milrinone?

Like all drugs, this product may have side effects. If they occur, side effects are generally mild and resolve once treatment is finished or the dose is lowered. Some reported side effects include:

• Headache
• Allergic reaction
• Irregular heartbeat
• Faster heartbeat
• Dizziness
• Fainting
• Chest pain

However, not everyone experiences these side effects. In addition, some people may experience other side effects. So, if you have any concerns about a side effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with milrinone?

This medication may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. 

To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs, and herbal products) and share it with your doctor and pharmacist. 

Drugs with known interactions:

• Furosemide
• Bumetanide
• IV sodium bicarbonate
• Anagrelide
• Riociguat

If you experience an adverse drug interaction, stop taking this drug and continue taking your other medication. Inform your doctor immediately to reevaluate your treatment plan. Approaches include dose adjustment, drug substitution, or ending therapy.

Does food or alcohol interact with milrinone?

This drug may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with milrinone?

This drug may interact with underlying conditions. This interaction may worsen your health condition or alter the way the drug works. Therefore, it is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. Therefore, you should always consult with your doctor or pharmacist before using any medication.

What is the dose for an adult?

Congestive heart failure

Continuous IV infusion: initially give 0.125 mcg/kg/min.

Dosing range: 0.125 to 0.75 mcg/kg/minute; titrate based on clinical end point.

Renal Dose Adjustments (based on creatinine clearance)

CrCl 10 to 50 mL/min: Initially give 0.0625 to 0.125 mcg/kg/minute depending on indication and degree of kidney impairment.

<10 mL/min: consider alternative therapy.

What is the dose for a child?

There is no established pediatric dose. It may be unsafe for your child. It is always important to fully understand the safety of the drug before using. Please consult with your doctor or pharmacist for more information.

How is Milrinone available?

Milrinone is available in the following dosage forms and strengths:

• IV solution: 1mg/mL
• IV solution, in 5DW: 20mg/100mL, 40mg/200mL

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to the nearest emergency room.

What should I do if I miss a dose?

If you miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.