Heart failure with reduced ejection fraction: Short-term IV therapy for patients with acute decompensated heart failure with reduced ejection fraction in need of inotropic support

Phosphodiesterase-3 Enzyme Inhibitor
The primary usefulness of milrinone is limited to the short-term intravenous treatment of congestive heart failure; milrinone does not arrest the natural progression of the disease, and may actually worsen CHF and shorten patient survival.

Onset of action:
5 to 15 minutes
Distribution:
1. Vd beta (after cardiac surgery): (Infants) 0.9 ± 0.4 L/kg; (Children): 0.7 ± 0.2 L/kg; (Adults) 0.3 ± 0.1 L/kg
2. Protein binding, plasma: ~70%
Metabolism:
Hepatic (minor); majority is not metabolized
Half-life elimination:
1. Infants (after cardiac surgery): 3.15 ± 2 hours
2. Children (after cardiac surgery): 1.86 ± 2 hours
3. Adults: (Heart failure) 2.3 to 2.4 hours; (Severe heart failure undergoing CVVH) 20.1 ± 3.3 hours
Excretion: Urine (83% as unchanged drug; 12% as 0-glucuronide metabolite); active tubular secretion is a major elimination pathway for milrinone

Hypersensitivity to milrinone or any component of the formulation

C; Adverse events have not been observed in animal reproduction studies

The manufacturer recommends that caution be exercised when administering milrinone to breastfeeding women.

Ventricular arrhythmia, headache, atrial fibrillation, bronchospasm, hepatic insufficiency, hypokalemia, injection site reaction, myocardial infarction, skin rash, thrombocytopenia, torsades de pointes, tremor

Heart failure with reduced ejection fraction:
1. Initial 0.125 mcg/kg/minute (dosing range: 0.125 to 0.75 mcg/kg/minute); titrate based on clinical end point
2. Use the lowest effective dose to minimize adverse effects (eg, arrhythmia, hypotension)

1. Loading dose (optional, some do not utilize due to the risk of hypotension): 50 mcg/kg administered over 10 to 60 minutes
2. Followed by a continuous IV or intraosseous infusion: 0.25 to 0.75 mcg/kg/minute; titrate dose to effect

CrCl 10 to 50 mL/minute:
1. Initial 0.0625 to 0.125 mcg/kg/minute depending on indication and degree of kidney impairment
2. Titrate cautiously, >0.375 mcg/kg/minute in significant renal impairment is generally not recommended due to likelihood for accumulation
CrCl <10 mL/minute:
Not established; consider alternative therapy

There are no dosage adjustments provided in the manufacturer's labeling.