Milrinone

PRIMACOR

Open Milrinone in the interactive console ↗

Pronunciation: MIL-ri-noen

Milrinone ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Milrinone ballicule

What it isPDE3 inhibitor raising cardiac cAMP; acute decompensated heart failure and bridge to transplant.

Why this oneIt increases contractility while reducing afterload, and works independently of beta receptors, so it still works in beta blockade.

What limits itHypotension and arrhythmia. Renally cleared, so it accumulates; no mortality benefit and worse outcomes with long-term use.

Milrinone molecular structure (skeletal formula) — Molecular structure: Milrinone

FDA label

Read the full label on DailyMed ↗

FDA dosing	Population	Start	Target	Max
IV inotropic therapy (Indications section not in fetched label; trials in congestive heart failure patients)	Adults	IV loading 50 mcg/kg over 10 min	IV infusion 0.375–0.75 mcg/kg/min, adjusted to hemodynamic/clinical response	IV 1.13 mg/kg/day (0.75 mcg/kg/min)

Renal Reduce infusion rate by CrCl (mL/min/1.73m2): 5 → 0.2; 10 → 0.23; 20 → 0.28; 30 → 0.33; 40 → 0.38; 50 → 0.43 mcg/kg/min

Hepatic Undefined

Instructions

Loading dose may be given undiluted (or diluted to 10–20 mL); dilute maintenance infusion to 200 mcg/mL in 0.45% NaCl, 0.9% NaCl, or D5W
Use a calibrated electronic infusion device; monitor patients closely
Duration of therapy depends on responsiveness
Inspect visually; do not use if particulate matter or discoloration present

Available strengths

inj 1 mg/mL

Adverse reactions

Ventricular arrhythmias 12.1% (ectopy 8.5%, nonsustained VT 2.8%, sustained VT 1%, VF 0.2%); risk with preexisting arrhythmias, hypokalemia, abnormal digoxin levels
Supraventricular arrhythmias 3.8%; rare torsades de pointes (postmarketing)
Hypotension 2.9%; angina/chest pain 1.2%
Headache 2.9%; hypokalemia, tremor, thrombocytopenia
Rare bronchospasm, anaphylactic shock; LFT abnormalities, rash; infusion site reaction

Pregnancy Undefined

Lactation Undefined

Cost

Milrinone (PRIMACOR)

Strength		#/mo	generic $/unit	CostPlus
1 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Milrinone is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskHypotension and arrhythmia; it accumulates in renal failure

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades1 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Defining liabilityVentricular arrhythmias and hypotension requiring continuous monitoring

Open Milrinone in the interactive console ↗