| Name: |
MILRINONE (PrimacorR) |
| Classification: |
inotropic agent (phosphodiesterase inhibitor)
- increases contractility and cardiac index
- lowers capillary wedge pressure
- lowers pulmonary artery pressures
- increases the rate of myocardial relaxation (lusitropic effect)
|
| Dose: |
- Loading Dose:
- 50 mcg/kg IV over 10 minutes
- Maintenance Infusion:
- 0.375-0.75 mcg/kg/min, adjusted to hemodynamic parameters
- dose reduction required in renal dysfunction (e.g. infusion rate starting at 0.2 mcg/kg/min)
|
| Administration: |
IV Infusion:
20 mg in 100 ml NS or D5W
- hypovolemia, acidosis and hypoxemia should be corrected concurrently with therapy
|
| Adverse Effects: |
- arrhythmias (supraventricular and ventricular)
- hypotension
- headache, angina/chest pain
- hypokalemia
- thrombocytopenia (0.5% vs amrinone 2.4%)
- tremor
|
| Caution: |
- use with caution in patients with uncontrolled atrial fibrillation/flutter as will enhance AV node conduction; consider digitalizing these patients first
|
| Monitoring Therapy: |
- HR, ECG
- BP
- urine output
- cardiac index
- PWP
- SVRI
- arterial lactate
- platelet count
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in CCTC.
- Must be administered via a central line.
- Continuous infusion must be administered via an infusion pump.
- May be titrated by an approved nurse in CCTC.
- Should not be administered via the proximal injectate port (blue) of the Swan Ganz catheter.
- Patient requires placement of an arterial line to monitor BP.
|
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