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
    • Administer loading dose from the infusion bag; programme the infusion pump to deliver the bolus dose over 10 minutes
  • Maintenance Infusion:
    • 0.375-0.75 mcg/kg/min, adjusted to cardiac index, venous oxygen saturation or other marker of cardiac output
    • dose reduction required in renal dysfunction (e.g. infusion rate starting at 0.2 mcg/kg/min)
Administration: IV Infusion:
50 mg in 250 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.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: January 12, 2017; Revised March 27, 2017

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Last Updated March 27, 2017 | © 2007, LHSC, London Ontario Canada