Monitor intake, output, and daily weight. Assess patient for resolution of signs and symptoms of HF (peripheral edema, dyspnea, rales/crackles, weight gain) and improvement in hemodynamic parameters (↑ cardiac output and cardiac index, ↓ pulmonary capillary wedge pressure). Correct effects of previous aggressive diuretic therapy to allow for optimal filling pressure.
Monitor BP and ECG continuously during infusion. Arrhythmias are common and may be life-threatening. The risk of ventricular arrhythmias is ↑ in patients with history of arrhythmias, electrolyte abnormalities, abnormal digoxin levels, or insertion of vascular catheters. If hypotension or arrhythmias occurs, slow or discontinue therapy depending on severity.
Lab Test Considerations:
Monitor electrolytes and renal function frequently during therapy. Correct hypokalemia prior to administration to ↓ risk of arrhythmias.
Monitor platelet count during therapy.
Toxicity and Overdose:
High Alert: Overdose manifests as hypotension. Dose should be ↓ or discontinued until patient is stabilized. Provide circulatory support as indicated.
High Alert: Accidental overdose of milrinone can cause patient harm or death. Have 2nd practitioner independently check original order, dose calculations, and infusion pump settings.
IV Push: Dilution: Loading dose may be administered undiluted. May also be diluted in 0.9% NaCl, 0.45% NaCl, or D5W for ease of administration. Concentration: 1 mg/mL.
Rate: Administer loading dose over 10 min.
Continuous Infusion: Dilution: Dilute 10 mg (10 mL) in 40 mL of diluent or 20 mg (20 mL) in 80 mL of diluent. Compatible diluents include 0.45% NaCl, 0.9% NaCl, and D5W. Premixed infusions are already diluted and ready to use. Admixed solutions are stable for 72 hr at room temperature. Do not use solution that is discolored or contains particulates. Concentration: 200 mcg/mL.
Rate: Based on patient's weight (see Route/Dosage section). Titrate according to hemodynamic and clinical response.