Milrinone Lactate

 Action Has direct arterial vasodilator activity and positive inotropic effect; ncreases myocardial contractility.

 Indications Short-term treatment of CHF.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: IV Loading dose: 50 mcg/kg over 10 min; adjust infusion rate according to hemodynamic and clinical response.

 Interactions None well documented. INCOMPATIBILITIES: Precipitate forms if furosemide is injected into same IV line as milrinone; do not administer both in same IV line.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Ventricular arrhythmia (eg, ventricular ectopic activity, nonsustained ventricular tachycardia, sustained ventricular tachycardia, ventricular fibrillation); supraventricular arrhythmia; hypotension; angina. CNS: Headaches; tremor. Thrombocytopenia. OTHER: Hypokalemia.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Cardiovascular effects: Do not use in patients with severe obstructive aortic or pulmonic valvular disease; may exacerbate hypertrophic subaortic stenosis; may cause supraventricular and ventricular arrhythmias; may shorten atrioventricular node conduction. Renal impairment: Use drug with caution; monitor renal function. Dosage reduction, based on creatinine clearance, may be needed.

 Administration/Storage

• For short-term (up to 5 days) IV use only.
• Prepare drug for IV infusion by diluting with 0.45% or 0.9% Sodium Chloride Injection D5W.
• Use infusion pump for administration.
• Adjust maintenance infusion rate on the basis of hemodynamic and clinical response (maximum rate is 0.75 mcg/kg/min or 1.13 mg/kg/day).
• Store at room temperature and protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Evaluate renal function and identify whether patient has severe obstructive aortic or pulmonic valvular disease.
• Provide close cardiac and BP monitoring.
• Be especially observant for supraventricular and ventricular arrhythmias and excessive decreases in BP and report to physician.
• Carefully monitor fluid and electrolyte changes as well as renal function during therapy.
• Observe IV site for signs of irritation. Rotate injection site every 48 hr.
• Correct hypokalemia by potassium supplementation prior to and during use of drug.
• Observe for other common side effects (headaches, hypokalemia, tremor and thrombocytopenia) and report to physician.

 Patient/Family Education

• Explain what medication does.
• Inform patient that treatment with this drug usually does not exceed 5 days.
• Instruct patient to report these symptoms to physician: headache or tremors.