From the Guidelines
The recommended dosage of milrinone for heart failure management is a loading dose of 50 mcg/kg administered intravenously over 10 minutes, followed by a continuous infusion of 0.125-0.75 mcg/kg/minute, as indicated in the most recent guidelines 1. This dosage should be adjusted based on clinical response and hemodynamic parameters.
- Patients with renal impairment require dose reduction, with recommendations to decrease the dose by 50% in those with creatinine clearance less than 50 mL/minute.
- Milrinone works by inhibiting phosphodiesterase 3, which increases intracellular cyclic adenosine monophosphate (cAMP) levels in cardiac and vascular smooth muscle.
- This leads to enhanced cardiac contractility (positive inotropic effect) and vasodilation (afterload reduction), improving cardiac output without significantly increasing myocardial oxygen demand. Some key points to consider when administering milrinone include:
- Continuous monitoring of blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, and renal function is essential.
- Common side effects include hypotension, arrhythmias, and headache.
- Milrinone is typically reserved for short-term treatment of acute decompensated heart failure in hospitalized patients who have not responded adequately to diuretics and vasodilators, as supported by recent guidelines 1. The choice of milrinone dosage is based on the most recent and highest quality study available, which provides the best evidence for minimizing morbidity, mortality, and improving quality of life in patients with heart failure 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Milrinone Lactate Injection, USP 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 MAINTENANCE DOSE Infusion Rate Total Daily Dose (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
The recommended dosage of milrinone for heart failure management is as follows:
- Loading dose: 50 mcg/kg administered slowly over 10 minutes
- Maintenance dose:
- Minimum: 0.375 mcg/kg/min
- Standard: 0.5 mcg/kg/min
- Maximum: 0.75 mcg/kg/min The total daily dose should not exceed 1.13 mg/kg/day 2
From the Research
Milrinone Dosage for Heart Failure Management
The recommended dosage of milrinone for heart failure management varies depending on the specific patient population and the desired hemodynamic response.
- The intravenous dose is typically 50 micrograms/kg given over ten minutes, followed by a maintenance infusion of 0.375-0.75 micrograms/kg/min titrated to the desired hemodynamic response 3.
- The average effective oral dosage is 7.5-10 mg four to six times daily 3.
- In patients with severe chronic heart failure, a loading dose of 37.5 to 75 micrograms/kg/10 min, followed by a maintenance infusion of 0.375,0.50, or 0.75 micrograms/kg/min, has been shown to be effective 4, 5.
- A Canadian multicentre study used a loading dose of 50 micrograms/kg and a 48 h continuous infusion of 0.5 micrograms/kg/min, resulting in significant hemodynamic benefits 6.
- A multicenter study in Japan used a loading dose of 50 micrograms/kg, followed by a continuous infusion of 0.25,0.5, or 0.75 micrograms/kg/min, and found that the higher doses were more effective 7.
Key Considerations
- The dosage of milrinone should be individualized based on the patient's hemodynamic response and clinical condition.
- The drug should be used with caution in patients with certain medical conditions, such as ventricular arrhythmias or supraventricular arrhythmias.
- ECG monitoring is recommended during milrinone infusion to detect potential arrhythmias 6.
- The safety and efficacy of milrinone in patients with heart failure have been established in several clinical trials 3, 4, 7, 5, 6.