DOSAGE AND ADMINISTRATION
Milrinone should be administered with a loading dose followed by a continuous infusion (maintenance dose) according to the following guidelines:
LOADING DOSE
50 mcg/kg: Administer slowly over 10 minutes
The table below shows the loading dose in milliliters (mL) of milrinone (1mg/mL) by patient body weight (kg).
| Patient Body Weight (kg) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| kg | 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | 110 | 120 |
| mL | 1.5 | 2 | 2.5 | 3 | 3.5 | 4 | 4.5 | 5 | 5.5 | 6 |
The loading dose may be given undiluted, but diluting to a rounded total volume of 10 or 20 mL (see Maintenance Dose for diluents) may simplify the visualization of the injection rate.
| Infusion Rate | Total Daily Dose (24 Hours) | ||
|---|---|---|---|
| Minimum | 0.375 mcg/kg/min | 0.59 mg/kg | Administer as a continuous intravenous infusion. |
| Standard | 0.50 mcg/kg/min | 0.77 mg/kg | |
| Maximum | 0.75 mcg/kg/min | 1.13 mg/kg |
The diluents that may be used are 0.45% Sodium Chloride Injection USP, 0.9% Sodium Chloride Injection USP, or 5% Dextrose Injection USP. The table below shows the volume of diluent in milliliters (mL) that must be used to achieve 200 mcg/mL concentration for infusion, and the resultant total volumes.
| Desired Infusion Concentration mcg/mL | Milrinone 1 mg/mL (mL) | Diluent (mL) | Total Volume (mL) |
|---|---|---|---|
| 200 | 10 | 40 | 50 |
| 200 | 20 | 80 | 100 |
The infusion rate should be adjusted according to hemodynamic and clinical response. Patients should be closely monitored. In controlled clinical studies, most patients showed an improvement in hemodynamic status as evidenced by increases in cardiac output and reductions in pulmonary capillary wedge pressure.
Note: See "Dosage Adjustment in Renally Impaired Patients." Dosage may be titrated to the maximum hemodynamic effect and should not exceed 1.13 mg/kg/day. Duration of therapy should depend upon patient responsiveness.
The maintenance dose in mL/hr by patient body weight (kg) may be determined by reference to the following table.
Note: Milrinone supplied in 100 mL and 200 mL Flexible Containers (200 mcg/mL in 5% Dextrose Injection) need not be diluted prior to use.
| Maintenance Dose (mcg/kg/min) | Patient Body Weight (kg) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 30 | 40 | 50 | 60 | 70 | 80 | 90 | 100 | 110 | 120 | |
| 0.375 | 3.4 | 4.5 | 5.6 | 6.8 | 7.9 | 9 | 10.1 | 11.3 | 12.4 | 13.5 |
| 0.400 | 3.6 | 4.8 | 6 | 7.2 | 8.4 | 9.6 | 10.8 | 12 | 13.2 | 14.4 |
| 0.500 | 4.5 | 6 | 7.5 | 9 | 10.5 | 12 | 13.5 | 15 | 16.5 | 18 |
| 0.600 | 5.4 | 7.2 | 9 | 10.8 | 12.6 | 14.4 | 16.2 | 18 | 19.8 | 21.6 |
| 0.700 | 6.3 | 8.4 | 10.5 | 12.6 | 14.7 | 16.8 | 18.9 | 21 | 23.1 | 25.2 |
| 0.750 | 6.8 | 9 | 11.3 | 13.5 | 15.8 | 18 | 20.3 | 22.5 | 24.8 | 27 |
When administering milrinone lactate by continuous infusion, it is advisable to use a calibrated electronic infusion device.
The Flexible Container has a concentration of milrinone equivalent to 200 mcg/mL in 5% Dextrose Injection.