Milrinone

Max concentration: 0.2 mg/ml

Solution: NSS, D5W, NS/2

Dosing instruction: Bolus Dose 50 µg/kg over 10 min.

Infusion rate: 0.375 - 1 µg/kg/min (1.13 mg/kg/day)

Dose increase per CO/CI or SVO2 and can be discontinued without weaning

True body weight

Body Weight

kg.

Milrinone 20mg/100ml (0.2 mg/ml)

Rate (ml/hr)

Dose (µg/kg/h)

Weight descriptors for dose adjustment of ICU drugs in obese patients

Group	Drug	Recommended Dosing
Analgesic	Fentanyl	LBW [1]
	Morphine	LBW [1]
Sedative	Dexmedetomidine	LBW [2]
	Midazolam	LD: TBW, MD: LBW [3]
	Propofol	LD: LBW, MD: TBW [1]
Vasopressor & Inotropic	Dobutamine	IBW [7]
	Dopamine	IBW [7]
	Epinephrine	IBW [7]
	Levosimendan	TBW [8]
	Milrinone	TBW [7]
	Norepinephrine	IBW [7]
Beta-blocker	Esmolol	TBW [4]
	Labetalol	IBW [6]
Anti-arrhythmic	Lidocaine	LBW [5]
Neuromuscular Blocking agent	Atracurium	IBW [1]
	Cisatracurium	IBW [1]
Anticoagulant	Enoxaparin	TBW [7]

TBW: True body weight, LBW: Lean body weight, IBW: Ideal body weight, LD: loading dose, MD: maintenance dose

References

1) Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.

2) Rolle A, Paredes S, Cortínez LI, Anderson BJ, Quezada N, Solari S, Allende F, Torres J, Cabrera D, Contreras V, Carmona J, Ramírez C, Oliveros AM, Ibacache M. Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients. Br J Anaesth. 2018 May;120(5):969-977. doi: 10.1016/j.bja.2018.01.040. Epub 2018 Mar 28. PMID: 29661414.

3) Bian L. Critical Care Pharmacotherapy. 1 st ed. the United States of America: American College of Clinical Pharmacy; 2016.

4) Kane-Gill S, Dasta J, editors. High-Risk IV Medications in Special Patient Populations [Internet]. London: Springer London 2011 [cited 2025 May 8] Available from: https://link.springer.com/book/10.1007/978-0-85729-606-1

5) Tognolini AR, Liu X, Pandey S, Roberts JA, Wallis SC, Jackson D, Eley VA. Dosing optimisation of intravenous lidocaine in patients with class 1-3 obesity by population pharmacokinetic analysis. Anaesthesia. 2025 May;80(5):511-521. doi: 10.1111/anae.16531. Epub 2025 Jan 2. PMID: 39745506.

6) Cheymol G, Poirier JM, Carrupt PA, Testa B, Weissenburger J, Levron JC, Snoeck E. Pharmacokinetics of beta-adrenoceptor blockers in obese and normal volunteers. Br J Clin Pharmacol. 1997 Jun;43(6):563-70. doi: 10.1046/j.1365-2125.1997.00609.x. PMID: 9205815; PMCID: PMC2042788.

7) Erstad BL, Barletta JF. Drug dosing in the critically ill obese patient: a focus on medications for hemodynamic support and prophylaxis. Crit Care. 2021 Feb 23;25(1):77. doi: 10.1186/s13054-021-03495-8. PMID: 33622380; PMCID: PMC7901103.

8) Simdax. Simdax SPC [Internet] 2021 [Cited 08 May 2025]. Available from: https://www.simdax.com/siteassets/simdax-spc.pdf