CHI Paediatric Formulary

Prescribing and Administration Monographs

General Information

Clinical Guidelines and Protocols

Antimicrobial Guidelines

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Milrinone       Renal    €€€    




Milrinone



Aliases:

Registered Trademarks:

Warnings: Renal, €€€

Dosage:

Milrinone may only be initiated under the direction of a Consultant Cardiologist / Intensivist for use in the PICU setting. It may, in certain circumstances, be given on the Children's Heart Centre in accordance with the SOP for the Prescribing and Administration of Milrinone on the CHC

Neonate:

Congestive heart failure, low cardiac output following cardiac surgery, shock:
Intravenous:
Initially 50–75 micrograms/kg IV load over 30-60 minutes, followed by continuous infusion at 0.25–0.75 micrograms/kg/minute. Adjust dose according to response. Loading dose may be reduced or omitted, particularly where there is a risk of hypotension.

Over one month:

Congestive heart failure, low cardiac output following cardiac surgery, shock:
Intravenous:
Initially 50–75 micrograms/kg IV load over 30-60 minutes, followed by continuous infusion at 0.25–0.75 micrograms/kg/minute. Adjust dose according to response. Loading dose may be reduced or omitted, particularly where there is a risk of hypotension.

Renal impairment: Dose adjustment required. Reduce dose by 25-50% and monitor response if estimated glomerular filtration rate less than 50 mL/minute/1.73 m2.

Contraindications: Hypersensitivity to milrinone or any of the excipients, severe hypovolaemia.

Cautions: Correct hypokalaemia; heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive valvular disease or other outlet obstruction, hypotension, decreased platelet count or decreased haemoglobin.


Monitoring:

Monitor blood pressure, heart rate, ECG, central venous pressure, fluid and electrolyte status, renal function, platelet count and hepatic enzymes.

Monitor renal function carefully.

Note: Improvement in cardiac output, and consequently diuresis, may require reduction in the dose of a diuretic agent.
Potassium loss due to excessive diuresis may predispose digitalised patients to arrhythmias. Hypokalaemia should be corrected prior to / during milrinone use


Administration:

Intravenous: Available as Primacor® 1mg/mL 

Compatible Infusion Fluids: Sodium Chloride 0.9%w/v or Glucose 5%w/v

Method of administration: 
Continuous intravenous infusion via the CHI smart-pump drug library (in PICU/Theatre/CHC/Emergency Department ONLY)

Note: Where deemed appropriate, an initial loading dose may given over 30-60 minutes. This is programmed separately using the 'Milrinone Load' drug line on the smart-pump drug library. A single syringe should be prepared for both the load and the subsequent infusion.

The National Neonatal_SCI_Drug Library (a subsidiary of the CHI Paediatric SCI Drug Library) is in use in a number of neonatal units and by the National Neonatal Transport Programme (NNTP). Milrinone SCIs are the same across both libraries.

May cause extravastation. Give via CVC where possible. Resite cannula at first signs of inflammation.

 


Interactions:

Milrinone has a favourable inotropic effect in fully digitalised patients without causing signs of glycoside toxicity.

This list is not exhaustive. For full details see SPC


Adverse Effects:

Ventricular ectopic activity, ventricular tachycardia, supraventricular arrhythmias, ventricular fibrillation, hypotension, headaches, thrombocytopenia (risk increased significantly with duration of infusion), anaphylaxis, hypokalaemia, tremor, abnormal liver function tests. 

The incidence of arrhythmias (rarely life threatening) has not been related to dose or plasma levels of milrinone. They are often associated with underlying factors such as pre-existing arrhythmias, metabolic abnormalities (e.g. hypokalaemia) abnormal digoxin levels and catheter insertion. 

This list is not exhaustive. For full details see SPC


Preparations:

Primacor 1mg/mL solution for injection (10mg/10mL glass ampoules).




Milrinone may only be initiated under the direction of a Consultant Cardiologist / Intensivist for use in the PICU setting. It may, in certain circumstances, be given on the Children's Heart Centre in accordance with the SOP for the Prescribing and Administration of Milrinone on the CHC

Neonate:

Congestive heart failure, low cardiac output following cardiac surgery, shock:
Intravenous:
Initially 50–75 micrograms/kg IV load over 30-60 minutes, followed by continuous infusion at 0.25–0.75 micrograms/kg/minute. Adjust dose according to response. Loading dose may be reduced or omitted, particularly where there is a risk of hypotension.

Over one month:

Congestive heart failure, low cardiac output following cardiac surgery, shock:
Intravenous:
Initially 50–75 micrograms/kg IV load over 30-60 minutes, followed by continuous infusion at 0.25–0.75 micrograms/kg/minute. Adjust dose according to response. Loading dose may be reduced or omitted, particularly where there is a risk of hypotension.

Renal impairment: Dose adjustment required. Reduce dose by 25-50% and monitor response if estimated glomerular filtration rate less than 50 mL/minute/1.73 m2.

Contraindications: Hypersensitivity to milrinone or any of the excipients, severe hypovolaemia.

Cautions: Correct hypokalaemia; heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive valvular disease or other outlet obstruction, hypotension, decreased platelet count or decreased haemoglobin.




Monitor blood pressure, heart rate, ECG, central venous pressure, fluid and electrolyte status, renal function, platelet count and hepatic enzymes.

Monitor renal function carefully.

Note: Improvement in cardiac output, and consequently diuresis, may require reduction in the dose of a diuretic agent.
Potassium loss due to excessive diuresis may predispose digitalised patients to arrhythmias. Hypokalaemia should be corrected prior to / during milrinone use




Intravenous: Available as Primacor® 1mg/mL 

Compatible Infusion Fluids: Sodium Chloride 0.9%w/v or Glucose 5%w/v

Method of administration: 
Continuous intravenous infusion via the CHI smart-pump drug library (in PICU/Theatre/CHC/Emergency Department ONLY)

Note: Where deemed appropriate, an initial loading dose may given over 30-60 minutes. This is programmed separately using the 'Milrinone Load' drug line on the smart-pump drug library. A single syringe should be prepared for both the load and the subsequent infusion.

The National Neonatal_SCI_Drug Library (a subsidiary of the CHI Paediatric SCI Drug Library) is in use in a number of neonatal units and by the National Neonatal Transport Programme (NNTP). Milrinone SCIs are the same across both libraries.

May cause extravastation. Give via CVC where possible. Resite cannula at first signs of inflammation.

 




Milrinone has a favourable inotropic effect in fully digitalised patients without causing signs of glycoside toxicity.

This list is not exhaustive. For full details see SPC




Ventricular ectopic activity, ventricular tachycardia, supraventricular arrhythmias, ventricular fibrillation, hypotension, headaches, thrombocytopenia (risk increased significantly with duration of infusion), anaphylaxis, hypokalaemia, tremor, abnormal liver function tests. 

The incidence of arrhythmias (rarely life threatening) has not been related to dose or plasma levels of milrinone. They are often associated with underlying factors such as pre-existing arrhythmias, metabolic abnormalities (e.g. hypokalaemia) abnormal digoxin levels and catheter insertion. 

This list is not exhaustive. For full details see SPC




Primacor 1mg/mL solution for injection (10mg/10mL glass ampoules).




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