Usual Adult Dose for Congestive Heart Failure

Loading dose: 50 mcg/kg IV over 10 minutes.
Maintenance infusion: 0.375 to 0.75 mcg/kg/min.

Usual Pediatric Dose for Congestive Heart Failure

less than 1 month:
Hemodynamic support: Full term neonates: Loading dose: 50 to 75 mcg/kg IV administered over 15 minutes followed by a continuous infusion of 0.5 mcg/kg/minute; titrate to effect; range: 0.25 to 0.75 mcg/kg/minute has been used by several centers. One report used a loading dose of 50 mcg/kg IV administered over 15 minutes, followed by a continuous infusion of 0.5 mcg/kg/minute for 30 minutes in 10 neonates (3 to 27 days old, median age: 5 days) with low cardiac output after cardiac surgery; results showed improved hemodynamic parameters and milrinone was well tolerated.
Prevention of postoperative low cardiac output syndrome (CHD corrective surgery): Full term neonates: Loading dose: 75 mcg/kg IV administered over 60 minutes followed by a continuous IV infusion of 0.75 mcg/kg/minute for 35 hours was used in a randomized, placebo controlled trial of 227 patients (age: 2 days to 6.9 years, median: 3 months) and showed 64% relative risk reduction for development of low cardiac output syndrome compared to placebo; a lower milrinone dose used in the study did not show a statistically significant relative risk reduction compared to placebo for the same endpoint.

1 month and older:
Loading dose: 50 mcg/kg IV over 15 minutes.
Maintenance infusion: 0.25-1 mcg/kg/min.

Renal Dose Adjustments

CrCl 5 mL/min:Maintenance infusion: 0.2 mcg/kg/min.

CrCl 10 mL/min: Maintenance infusion: 0.23 mcg/kg/min.

CrCl 20 mL/min: Maintenance infusion: 0.28 mcg/kg/min.

CrCl 30 mL/min: Maintenance infusion: 0.33 mcg/kg/min.

CrCl 40 mL/min: Maintenance infusion: 0.38 mcg/kg/min.

CrCl 50 mL/min: Maintenance infusion: 0.43 mcg/kg/min.

Liver Dose Adjustments

Data not available

Dose Adjustments

The maintenance infusion should be adjusted to the patient's response.

Precautions

Patients should be monitored by telemetry when on milrinone infusions.

Infusion site reactions have been reported. The manufacturers recommends monitoring the infusion site to avoid extravasation.

Dialysis

Data not available

Other Comments

The maximum recommended daily dose is 1.13 mg/kg.

Experience with infusions of milrinone for periods exceeding 48 hours has not been documented.