Pharmacokinetics
Extremely pre-term infants for prevention of low systemic blood flow: T ½ averaged 10 hours. Milrinone loading infusion 0.75 microgram/kg/min for 3 hours followed by maintenance infusion 0.2 microgram/kg/min achieved target (180–300 nanogram/mL).5 (LOE IV GOR C)
Term infants with pulmonary hypertension: Half-life (t½) averaged 4 hours. Loading dose 50 microgram/kg resulted in sub- therapeutic concentrations. Maintenance infusion 0.33–0.99 microgram/kg/min resulted in concentrations above target range (180–300 nanogram/mL).1 (LOE IV GOR C)
Term newborns with hypoplastic left heart undergoing surgery: Neonates received an initial dose of either a 100 or 250 microgram/kg of milrinone into the cardiopulmonary bypass circuit. A constant infusion of 0.5 microgram/kg/min resulted in drug accumulation during the initial 12 h of drug administration. Postoperatively, milrinone clearance was significantly impaired. Initial loading dose of 100 microgram/kg on cardiopulmonary bypass resulted in plasma concentrations similar to those observed in other therapeutic settings. In the postoperative setting of markedly impaired renal function, an infusion rate of 0.2 microgram/kg/min should be considered.12
Paediatric patients with septic shock: T½ averaged 1.47 hours (range, 0.62 to 10.85 hours). Loading dose 75 microgram/kg and starting infusion rates 0.75–1.0 microgram/kg/min for patients with normal renal function recommended.13
Prevention of low cardiac output syndrome post cardiac surgery in infants: Loading dose 50 microgram/kg then infusion 3 microgram/kg/min for 30 minutes and then a maintenance infusion 0.5 microgram/kg/min, with adjustment for age.14 (LOE IV GOR C).
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