Intravenous Acutely decompensated heart failure, Severe congestive heart failure
Adult: As short-term treatment: 50 mcg/kg as a loading dose via slow IV inj over 10 minutes, followed by continuous maintenance infusion of 0.375-0.75 mcg/kg/min. Max total dose: 1,130 mcg/kg daily. Adjust the infusion rate according to clinical and haemodynamic response. Treatment duration must be based on patient response but should not exceed 48 hours. Dosage and treatment recommendations may vary among countries and between individual products (refer to local or specific product guidelines).
What are the brands available for Milrinone in Malaysia?
Primacor
Renal Impairment
Acutely decompensated heart failure; Severe congestive heart failure:
Maintenance infusion:
CrCl (mL/min/1.73 m2)
Dosage
5
0.2 mcg/kg/min
10
0.23 mcg/kg/min
20
0.28 mcg/kg/min
30
0.33 mcg/kg/min
40
0.38 mcg/kg/min
50
0.43 mcg/kg/min
Reconstitution
Loading dose: May be given either undiluted or diluted with compatible diluent. Adult loading dose may be diluted to a rounded total volume of 10 mL or 20 mL. Maintenance dose: Dilute with dextrose 5% in water, NaCl 0.9%, or NaCl 0.45% inj to make a final concentration of 200 mcg/mL. Recommendations for dilution and concentrations may vary among countries and between individual products (refer to specific product guidelines).
Incompatibility
Incompatible with furosemide, bumetanide and sodium bicarbonate IV solution.
Contraindications
Severe hypovolaemia.
Special Precautions
Patient with atrial fibrillation or flutter, hypertrophic subaortic stenosis, hypotension. Not recommended for use in the acute phase of post-myocardial infarction. Avoid extravasation. Milrinone therapy should not replace surgical relief of obstruction in patients with severe obstructive aortic or pulmonary valvular disease. Renal impairment. Neonates. Pregnancy and lactation.
Adverse Reactions
Significant: Supraventricular and ventricular arrhythmias (including non-sustained ventricular tachycardia, ventricular ectopy, torsades de pointes, and ventricular fibrillation), hypotension. Blood and lymphatic system disorders: Thrombocytopenia. Cardiac disorders: Chest pain. General disorders and administration site conditions: Infusion site reaction. Immune system disorders: Very rarely, anaphylactic shock. Investigations: Abnormal LFTs. Metabolism and nutrition disorders: Hypokalaemia. Nervous system disorders: Headache, tremor. Respiratory, thoracic and mediastinal disorders: Very rarely, bronchospasm. Skin and subcutaneous tissue disorders: Very rarely, skin reactions (e.g. rash).
Description: Mechanism of Action: Milrinone, a selective phosphodiesterase type 3 inhibitor, is a positive inotropic agent and vasodilator with minimal chronotropic activity. Although its exact mechanism of action is not fully understood, it is believed to inhibit cAMP phosphodiesterase in cardiac and vascular smooth muscle, thereby increasing intracellular cAMP concentrations. This action results in increased myocardial contractility and vascular muscle relaxation. Onset: 5-15 minutes. Pharmacokinetics: Distribution: Plasma protein binding: Approx 70%. Excretion: Mainly via urine (approx 83% as unchanged drug, 12% as O-glucuronide metabolite). Elimination half-life: 2.3-2.4 hours.
Chemical Structure
Milrinone Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4197, Milrinone. https://pubchem.ncbi.nlm.nih.gov/compound/Milrinone. Accessed Aug. 26, 2025.
Storage
Store below 30°C. Avoid freezing and excessive exposure to heat.
C01CE02 - milrinone ; Belongs to the class of phosphodiesterase inhibitors. Used in the treatment of hypotension.
References
Baxter Healthcare Ltd. Milrinone Baxter 1 mg/mL Concentrate for Injection data sheet 15 October 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 06/05/2025.Brayfield A, Cadart C (eds). Milrinone. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/05/2025.Joint Formulary Committee. Milrinone. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/05/2025.Milrinone 1 mg/mL Solution for Injection/Infusion (Macure Pharma UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 06/05/2025.Milrinone Lactate Injection Solution (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/05/2025.Milrinone Lactate. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/05/2025.Milrinone. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 06/05/2025.Milrinone. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/05/2025.Milrinone. UpToDate Lexidrug, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 06/05/2025.Paediatric Formulary Committee. Milrinone. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 06/05/2025.Primacor 1 mg/mL Solution for Injection (Sanofi-Aventis [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 06/05/2025.
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