Milrinone lactate
Milrinone lactate (Primacor)
Milrinone Lactate
( MILL-rih-nohn)
Pregnancy Category: C Primacor (Rx)

Classification: Inotropic/vasodilator

Action/Kinetics: Selective inhibitor of peak III cyclic AMP phosphodiesterase isozyme in cardiac and vascular muscle, resulting in a direct inotropic effect and a direct arterial vasodilator activity. Also improves diastolic function as manifested by improvements in LV diastolic relaxation. In clients with depressed myocardial function, produces a prompt increase in CO and a decrease in pulmonary wedge pressure and vascular resistance, without a significant increase in HR or myocardial oxygen consumption. Causes an inotropic effect in clients who are fully digitalized without causing signs of glycoside toxicity. Also, LV function has improved in clients with ischemic heart disease. Therapeutic plasma levels: 150-250 ng/mL. t 1/2: 2.3 hr following doses of 12.5-125 mcg/kg to clients with CHF. Metabolized in the liver and excreted primarily through the urine.

Uses: Short-term treatment of CHF, usually in clients receiving digoxin and diuretics.

Contraindications: Hypersensitivity to the drug. Use in severe obstructive aortic or pulmonic valvular disease in lieu of surgical relief of the obstruction.

Special Concerns: Use with caution during lactation. Safety and efficacy have not been determined in children.

Side Effects: CV: Ventricular and supraventricular arrhythmias, including ventricular ectopic activity, nonsustained ventricular tachycardia, sustained ventricular tachycardia, and ventricular fibrillation. Infrequently, life-threatening arrhythmias associated with preexisting arrhythmias metabolic abnormalities, abnormal digoxin levels, and catheter insertion. Also, hypotension, angina, chest pain. Miscellaneous: Mild to moderately severe headaches, hypokalemia, tremor, thrombocytopenia, bronchospasm (rare).

Overdose Management: Symptoms: Hypotension. Treatment: If hypotension occurs, reduce or temporarily discontinue administration of milrinone until the condition of the client stabilizes. Use general measures to support circulation.

How Supplied: Injection: 1 mg/mL

Dosage
?IV Infusion
Adults, loading dose: 50 mcg/kg administered slowly over 10 min. Maintenance, minimum: 0.59 mg/kg/24 hr (infused at a rate of 0.375 mcg/kg/min); maintenance, standard: 0.77 mg/kg/24 hr (infused at a rate of 0.5 mcg/kg/min); maintenance, maximum: 1.13 mg/kg/24 hr (infused at a rate of 0.75 mcg/kg/min).