DOSAGE AND ADMINISTRATION
Milrinone lactate injection 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 lactate injection (1mg/mL) by patient body weight (kg).
Loading Dose (mL) Using 1 mg/mL Concentration | ||||||||||
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.
MAINTENANCE DOSE | |||
|
| Total Daily (24 hours) |
|
Minimum | 0.375 mcg/kg/min | 0.59 mg/kg | Administer as a continuous intravenous infusion. |
Standard | 0.5 mcg/kg/min | 0.77 mg/kg | |
Maximum | 0.75 mcg/kg/min | 1.13 mg/kg | |
Milrinone lactate injection drawn from vials should be diluted prior to maintenance dose administration. 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.
Milrinone Infusion Rate (mL) Using 200 mcg/mL Concentration | ||||||||||
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 |
0.4 | 3.6 | 4.8 | 6 | 7.2 | 8.4 | 9.6 | 10.8 | 12 | 13.2 | 14.4 |
0.5 | 4.5 | 6 | 7.5 | 9 | 10.5 | 12 | 13.5 | 15 | 16.5 | 18 |
0.6 | 5.4 | 7.2 | 9 | 10.8 | 12.6 | 14.4 | 16.2 | 18 | 19.8 | 21.6 |
0.7 | 6.3 | 8.4 | 10.5 | 12.6 | 14.7 | 16.8 | 18.9 | 21 | 23.1 | 25.2 |
0.75 | 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.
Dosage Adjustment in Renally Impaired Patients
Data obtained from patients with severe renal impairment (creatinine clearance = 0 to 30 mL/min) but without congestive heart failure have demonstrated that the presence of renal impairment significantly increases the terminal elimination half-life of milrinone. Reductions in infusion rate may be necessary in patients with renal impairment. For patients with clinical evidence of renal impairment, the recommended infusion rate can be obtained from the following table:
Creatinine Clearance (mL/min/1.73 m 2 ) | Infusion Rate (mcg/kg/min) |
5 | 0.2 |
10 | 0.23 |
20 | 0.28 |
30 | 0.33 |
40 | 0.38 |
50 | 0.43 |
Intravenous drug products should be inspected visually and should not be used if particulate matter or discoloration is present.