RCH logo

PIPER - Paediatric Infant Perinatal Emergency Retrieval

Milrinone

  • Description and indication for use

    Milrinone is a phosphodiesterase inhibitor which reduces systemic vascular resistance and increases cardiac output.  It may be used in combination with Adrenaline.  It may be used in short term (<48hours) after cardiac surgery.

    Dose

    IV Load:

    75 micrograms/kg over 60 minutes.2

    Maintenance infusion:

    0.5 micrograms/kg/min to 0.75 micrograms/kg/min depending on response.2

    Reconstitution/Dilution

    Vial = 10 mg/10 mL (1 mg/mL = 1000micrograms/mL).

    Load:

    Administer undiluted.

    IV Infusion: 

    Drug How to make up Dose equivalent Dose range
    Milrinone   3 mg/kg in 50 mL in glucose 5% 1 mL/hr = 1 micrograms/kg/min 0.5 to 0.75 micrograms/kg/min

    Route and method of administration

    Not for IM use.

    Administration may be via central line or peripheral line.

    INF:

    Continuous infusion using an infusion pump.

    NOTE: Consider administering a fluid bolus prior to starting milrinone infusion.

    Side effects

    Hypotension initially then blood pressure normalizes.  Hypotension may be prolonged in renal failure.

    Ventricular arrhythmias.

    Thrombocytopaenia.

    Hypokalaemia and hypomagnesaemia.

    Spontaneous bronchospasm has been reported.

    Contraindications

    Decreased dose in impaired renal function.

    Should not be used >48 hours in patients with heart failure.

    Nursing responsibilities

    Monitor blood pressure, heart rate.

    Monitor fluid balance and electrolytes.

    Monitor infusion site carefully– avoid extravasation.

    Compatability Information3,6,7

    IMPORTANT:  Contact pharmacy for drugs not appearing in the table below. Uncommon drugs have been omitted and may be incompatible.

      Compatible Incompatible
    Fluids Glucose 5%, Sodium Chloride 0.45% and 0.9%  
    Drugs   Frusemide
    Y-Site Aciclovir, Adrenaline, Amikacin, Amiodarone, Calcuim Gluconate, Dexamethasone, Digoxin, Dobutamine, Dopamine, Fentanyl, Heparin, Insulin Soluble, Magnesium Sulphate, Midazolam, Morphine Sulphate, Noradrenaline, Pancuronium, Potassium Chloride, Ranitidine, Rocuronium, Sodium Bicarbonate, Sodium Nitroprusside, Vancomycin, Vecuronium.  

    References:

    1.        The Royal Children’s Hospital (RCH), Paediatric Pharmacopoeia, 13th ed. 2002.

    2.        Thomas Young et al. Neofax 22nd ed. 2009.

    3.        Phelps, Hak, Crill. Paediatric Injectable Drugs (The Teddy Bear Book), 9th ed.  American society of Health-System Pharmacists 2007.

    4.        Australian Injectables Handbook, The Society of Hospital Pharmacists, Australia (SHPA), 5th ed. 2011.

    5.        Neonatal Formulary: Drug use in pregnancy and the first year of life, 5th ed. 2007.

    6.        British National Formulary for Children 2013 – 2014.

    7.        Lawrence Trissel, Handbook on Injectable Drugs, 17th ed. 2013.

    8.        James King, King Guide To Parenteral Admixtures, Issued 2013 (quarterly update).

Disclaimer:  This Drug information was designed for use by PIPER Neonatal. Whilst great care has been taken to check the information is accurate, it is possible that errors may have been missed. Furthermore, dosage schedules are continually being revised and new side effects recognised. For these reasons, the reader is strongly advised to consult the drug companies' printed information before administering any of the drugs recommended in this book.
Most drugs in this document are appropriate only for specialist use in hospitals.  A number of drugs should only be used in consultation with the appropriate Paediatric subspecialist. 

Note: The electronic version of this guideline is the version currently in use.  Any printed version cannot be assumed to be current. Printed copies of this document are valid for