Download Drug Manual

Emergency
fellowship
exam Drug
manual
January 16
2011
This list is neither exhaustive nor complete. Feel free to add more to the
table. I have not had time to edit every durg yet. Not for public
distribution. Large contributions from 5-minute Pediatric consult on
CIAP.
Amit Shetty
Drug Manual
Acetylcysteine
ADMINISTRATION ROUTES:
 PO, IV & NG
ALTERNATIVE NAMES:
 Acetadote, Parvolex
ICU INDICATIONS:
1. Paracetamol overdose
2. Non-paracetamol induced fulminant hepatic failure
3. Prevention of contrast-induced nephropathy
PRESENTATION AND ADMINISTRATION:
 PO / NG:
Give IV solution orally (unlicensed section 29 use)
 IV: Acetadote and Parvolex are supplied as sterile solutions in 10ml vials containing 20% (200 mg/ml)
acetylcysteine. Compatible with 5% dextrose. Prepare immediately before use and discard any
solution not used within 24 hours.
DOSAGE:
 Prevention of Contrast Induced Nephropathy:
The preferred dosage regime is 1200mg IV by Slow IV Push prior to taking the patient down for
angiography or CT with contrast followed by 1200mg IV BD for 48 hours after the investigation.
 Paracetamol Overdose:
150mg/kg over 15 minutes; 50mg/kg over the next 4 hours,100mg per kg over the next 16 hours.
Total dose 300mg/kg in 20 hours
o Initial dose: 150mg/kg in 200ml of D5W over 15 minutes
o Second dose: 50mg/kg in 500ml of D5W over 4 hours
o Third dose: 100mg/kg in 1000ml of D5W over 16 hours
PAEDIATRIC DOSAGE
 Paracetamol Overdose:
150mg/kg over 15 minutes; 50mg/kg over the next 4 hours, 100mg per kg over the next 16 hours.
Total dose 300mg/kg in 20 hours
Note: In children, N-acetylcysteine should be given intravenously as a 40 mg/mL solution in 5% dextrose in
water. This is to prevent possible hyponatremia.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
 No dose adjustment is required.
CLINICAL PHARMACOLOGY
 Paracetamol Overdose:
Acetylcysteine likely protects the liver by maintaining or restoring the glutathione levels, or by acting
as an alternate substrate for conjugation with, and thus detoxification of, the reactive metabolite.
WARNINGS
 Serious anaphylactoid reactions, including death in a patient with asthma, have been reported in
patients administered acetylcysteine intravenously.
PRECAUTIONS
 General:The total volume administered should be adjusted for patients less than 40 kg and for those
requiring fluid restriction (use paediatric dosage regimen).
ADVERSE REACTIONS
 Body as a Whole: Urticaria, vasodilatation, rash and itch
 Cardiovascular System:Hypotension
 Digestive System: Dyspepsia, nausea, vomiting
 Nervous System:Abnormal thinking (dysphoria), Gait disturbances
 Respiratory System: Bronchospasm, coughing, dyspnoea
 Skin & Appendages: Angioedema, facial erythema, palmar erythema, pruritus, pruritus, rash, sweating
1
Adenosine
ADMINISTRATION ROUTES: IV
ICU INDICATIONS:
1. Conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that
associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome).
PRESENTATION AND ADMINISTRATION:
 IV: Adenosine comes in a vial containing 6mg in 2mls solution
 Compatible with the following IV fluids: Normal Saline Store at room temperature
 DO NOT REFRIGERATE as crystallisation may occur. The solution must be clear at the time of use.
DOSAGE:
 Adenosine injection should be given as a rapid bolus by the peripheral IV route. It should be given as
close to the patient as possible and followed by a rapid saline flush (this is best achieved by using a
three-way tap system) The recommended IV doses for adults are as follows: Initial dose: 6 mg given as
a rapid IV bolus (administered over a 1-2 second period).
 Repeat administration: If the first dose does not result in elimination of the supraventricular
tachycardia within 1-2 minutes, 12 mg should be given as a rapid IV bolus. This 12 mg dose may be
repeated a second time if required. Central venous administration of adenosine has not been
systematically studied; however, in the ICU setting this route of administration is acceptable.
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
 No dosage adjustment is required in renal failure or renal replacement therapy.
DOSAGE IN PAEDIATRICS:
 Paediatric Patients with a Body Weight < 50 kg:
o Initial dose: Give 0.05 to 0.1 mg/kg as a rapid IV bolus given either centrally or peripherally. A
saline flush should follow.
o Repeat administration: If conversion of PSVT does not occur within 1-2 minutes, additional
bolus injections of adenosine can be administered at incrementally higher doses, increasing
the amount given by 0.05 to 0.1 mg/kg. Follow each bolus with a saline flush. This process
should continue until sinus rhythm is established or a maximum single dose of 0.3 mg/kg is
used.
 Paediatric Patients with a Body Weight > 50 kg: Administer the adult dose.
CLINICAL PHARMACOLOGY:
 Adenosine slows conduction time through the A-V node, can interrupt the reentry pathways through
the AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular
tachycardia (PSVT), including PSVT associated with Wolff- Parkinson-White Syndrome. Intravenously
administered adenosine is rapidly cleared from the circulation via cellular uptake, primarily by
erythrocytes and vascular endothelial cells. Adenosine has a half- life of less than 10 seconds in whole
blood.
CONTRAINDICATIONS:
1. Second- or third-degree A-V block (except in patients with a functioning artificial pacemaker).
2. Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with
a functioning artificial pacemaker).
3. Known hypersensitivity to adenosine.
WARNINGS
 Asystole and VF: Transient or prolonged episodes of asystole have been reported with fatal outcomes
in some cases. Rarely, ventricular fibrillation has been reported following adenosine administration,
including both resuscitated and fatal events. In most instances, these cases were associated with the
concomitant use of digoxin and, less frequently with digoxin and verapamil. Although no causal
relationship or drug-drug interaction has been established, adenosine should be used with caution in
patients receiving digoxin or digoxin and verapamil in combination.
 Bronchoconstriction: Adenosine has been administered to a limited number of patients with asthma
and mild to moderate exacerbation of their symptoms has been reported. Adenosine should be used
with caution in patients with obstructive lung disease or asthma. Adenosine should be discontinued in
any patient who develops severe respiratory difficulties.
IMPORTANT DRUG INTERACTIONS FOR THE ICU
 Digoxin with or without verapamil use may be rarely associated with ventricular fibrillation when
combined with adenosine (see WARNINGS).
2

The effects of adenosine are antagonised by methylxanthines such as caffeine and theophylline. In
the presence of these methylxanthines, larger doses of adenosine may be required or adenosine may
not be effective.
 Adenosine effects are potentiated by dipyridamole (persantin). Thus, smaller doses of adenosine may
be effective in the presence of dipyridamole.
 Carbamazepine has been reported to increase the degree of heart block produced by adenosine.
ADVERSE REACTIONS
 The half-life of adenosine is less than 10 seconds. Thus, adverse effects are generally rapidly selflimiting.
 Body as a Whole: Apprehension
 Cardiovascular System: Facial flushing, headache, sweating, palpitations, chest pain, hypotension
 Respiratory System: Bronchospasm, shortness of breath/dyspnea, chest pressure
 Digestive System: Nausea, metallic taste, tightness in throat, pressure in groin.
 Nervous System: Lightheadedness, dizziness, tingling in arms, numbness, blurred vision, burning
sensation
3
Adrenaline
ADMINISTRATION ROUTES:
 IV, IM, SC, Nebulised
ICU INDICATIONS:
1. cardiac arrest
2. anaphylaxis
3. upper airway obstruction
4. inotrope/vasopressor
PRESENTATION AND ADMINISTRATION:
 IV:
Adrenaline comes in ampoules containing 1mg in 1ml (1:1000) and ampoules containing 1mg in 10ml
(1:10000). Mini-jets that contain 1mg in 10ml are also available. The standard dilution for adrenaline
by infusion in the ICU is 10mg in 100ml of compatible IV fluid
Compatible with the following IV fluids:
Normal saline, D5W, Glucose and Sodium Chloride, Hartmann’s
Store at room temperature. Protect from light. Do not refrigerate.
Solutions that are discoloured pink or brown should not be used.
 IM:
Although IM use is said to be preferred in anaphylaxis and other emergencies, the IV route is
generally more appropriate in the ICU setting. Use 1:1000 solution undiluted for administration by the
IM route.
 Nebulised :
Use 1:1000 solution and (if required) make up to a total of 5ml using normal saline prior to
administration
DOSAGE:
 Cardiac arrest:
10ml of 1:10000 (i.e 1mg) IV OR 3-10mg of 1:1000 via ETT can be used if IV access cannot be obtained
NOTE: in cardiac arrest after cardiac surgery, consideration should be given to immediate sternotomy.
If adrenaline is administered in this setting, a standard 1mg dosage is inappropriate due to the risk of
rebound hypertension leaking to fatal haemorrhage. Give bolus doses of 1ml of 1:10000 and uptitrate
gently if circulation is not restored.
 Anaphylaxis:
0.05ml/kg of 1:10000 IV with dose titrated to effect followed by IV infusion if required. OR 0.01ml/kg
of 1:1000 IM (avoid administration in the buttocks)
 Post-extubation stridor or other upper airway obtruction:
Use the 1:1000 ampoules up to max. dose 5ml and administer via a nebuliser (if giving less than 4mg,
make up to at least 4ml with 0.9% saline).
 IV Infusion:
10mg in 100ml of D5W or normal saline at up to 20ml/hr titrated to effect
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
 No dosage adjustment is required in renal failure or renal replacement therapy.
DOSAGE IN PAEDIATRICS:
 Cardiac arrest:
0.1ml/kg of 1:10000 IV 0.1ml/kg of 1:1000 via ETT
 Anaphylaxis:
0.05ml/kg of 1:10000 IV OR 0.01ml/kg of 1:1000 IM
 Severe Croup:
Use the 1:1000 ampoules at a dose of 0.5ml/kg/dose, max. dose 5ml and administer via a nebuliser
(make up to at least 4ml with 0.9% saline).
 IV Infusion:
0.3mg/kg in 50ml D5W at 0.5-10ml/hr (0.05-1mcg/kg/min)
CLINICAL PHARMACOLOGY:
 Adrenaline is a sympathomimetic drug. It activates an adrenergic receptive mechanism on effector
cells and imitates all actions of the sympathetic nervous system except those on the arteries of the
face and sweat glands. Adrenaline acts on both alpha and beta receptors.
CONTRAINDICATIONS:
4
 There are no absolute contraindications to the use of adrenaline in a life-threatening situation.
WARNINGS
 Adrenaline by infusion commonly leads to hyperlactataemia and hyperglycaemia. Adrenaline by
infusion may worsen dynamic outflow tract obstruction and paradoxically reduce cardiac output
(particularly if used in the setting of hypovolaemia)
PRECAUTIONS
 General:
Some patients may be at greater risk of developing adverse reactions after adrenaline administration.
These include:
hyperthyroid individuals, individuals with cardiovascular disease, hypertension, or diabetes, and the
elderly.
 Laboratory Tests:
Adrenaline infusion commonly leads to increased lactate. It may be necessary to measure lactate
levels if there are clinical concerns.
 Drug/Laboratory Test Interactions:
None reported
IMPORTANT DRUG INTERACTIONS FOR THE ICU
 The effects of adrenaline may be potentiated by tricyclic antidepressants and monoamine oxidase
inhibitors.
ADVERSE REACTIONS
 Body as a Whole:
Apprehension, nervousness, anxiety and sweating.
 Cardiovascular System:
Palpitations, tachycardia, pallor.
 Respiratory System:
Hyperventilation, pulmonary oedema
 Digestive System:
Nausea and vomiting,
 Nervous System:
Headache, tremor, dizziness, weakness, cerebrovascular haemorrhage
5
Drug name
Acetaminophen
Dosages
PO or rectally:
Premature infants, age <3 months: 10–12
mg/kg q8–12h.
Infants, age <3 months: 10–15 mg/kg
repeated q8h.
Children: 10–15 mg/kg repeated q4–6h, up
to 5 doses daily.
Adults: 325–650 mg q4–6h or 1 g t.i.d. or
q.i.d. Do not exceed 4 g/d.
Acetazolamide (Diamox)
PO or IV:
Children and adults: 8–30 mg/kg/d in 4
divided doses. Do not exceed 1 g/d. Lower
doses are used for diuresis or correction of
metabolic acidosis. The higher doses are
used for the treatment of hydrocephalus or
seizures.
Altitude sickness (adults): 250 mg q8–12h
beginning 24–48 hours before ascent and
continuing for at least 48 hours after arrival.
Acetaminophen poisoning:
IV: 150 mg/kg as an initial infusion over 1
hour followed by a 2nd infusion of 50 mg/kg
over 4 hours, followed by a 3rd infusion of
100 mg/kg over 16 hours. Therapy may
continue at a rate of 6.25 mg/kg/hr until
acetaminophen level reaches 0 and AST/ALT
levels decrease.
PO: 140 mg/kg PO followed by 70 mg/kg for
17 doses administered q4h until
acetaminophen levels are nontoxic. Usually
administered as a 5% solution diluted in
juice or soda.
Inhalation (administer 10% solution
undiluted):
Infants: 2–4 mL repeated t.i.d. or q.i.d.
Children and adolescents: 6–10 mL
repeated t.i.d. or q.i.d.
PO doses for children and adults:
Varicella zoster (chickenpox): 80 mg/kg/d in
4 divided doses for 5 days. Do not exceed
800 mg/dose (3,200 mg/d).
Herpes simplex virus:
Children: 40–80 mg/kg/d in 3–4 divided
doses.
Adults: 200 mg q4h while awake (5 doses
daily). Chronic suppressive therapy at a
dose of 400 mg b.i.d. may be used for up to
1 year or longer.
IV doses for children and adults:
Neonatal HSV encephalitis:
Full term infants: 60 mg/kg/d in 3 divided
doses for 10–14 days.
HSV encephalitis: 1,500 mg/m2/d in 3
Acetylcysteine
Acyclovir
Dosage Forms
Drops: 100 mg/mL
Suspension: 160 mg/5 mL
Suppositories: 120 mg, 325
mg, 650 mg
Tablets: 160 mg, 325 mg, 500
mg
Tablets, chewable: 80 mg
Also available in combination
with codeine; see codeine
monograph.
Injection: 500 mg
Tablets: 250 mg
Injection: 200 mg/mL in 30
mL vials
Solution for inhalation: 10%
or 20% in 10-mL and 30-mL
vials
Capsules: 200 mg
Injection: 500-mg, 1-g vials
Ointment: 5%, 15 g
Suspension: 200 mg/5 mL
6
Adenosine
Albuterol (Salbutamol)
Allopurinol
Aminocaproic acid
Amiodarone (Cordarone)
divided doses for at least 10 days and up to
21 days.
Other HSV infections: 750 mg/m2/d in 3
divided doses for 7 days.
Varicella zoster infections: 1,500 mg/m2/d
in 3 divided doses for 7 days.
Topically: Apply ointment q3h up to 6 times
daily for 7 days. Use a disposable finger cot
or glove when applying the ointment to
avoid transmission of the virus.
Dosage may need to be adjusted in patients
with renal dysfunction.
IV (given via rapid push followed by a
saline flush):
Neonates: 0.05 mg/kg initially followed by
doses increasing in 0.05 mg/kg increments
q2min to a maximum dose of 0.25 mg/kg.
Do not exceed 12 mg/dose.
Children: 0.1 mg/kg initially, followed by
doses increasing in 0.05 mg/kg increments
q2min to a maximum dose of 0.35 mg/kg or
12 mg/dose.
Adults: 6 mg followed by 12 mg with a
repeat dose of 12 mg, if needed.
Inhalation:
Metered-dose inhaler:
Age <12 years: 1–2 inhalations q.i.d.
Age >12 years: 1–2 inhalations up to 6 times
a day.
Nebulization: 0.01–0.05 mL/kg usually
repeated q4–6h, but may be administered
more frequently in severely ill patients
under controlled conditions.
PO for neoplastic diseases:
Age <10 years: 10 mg/kg/d in 3 divided
doses to a maximum of 800 mg/d.
Age >10 years: 600–800 mg/d in 2 or 3
divided doses.
Note: The metabolism of mercaptopurine
and azathioprine is decreased by
allopurinol. Decrease dose of
mercaptopurine or azathioprine by 75%.
IV:
Children: 100 mg/kg over the 1st hour
followed by an infusion of 33.3 mg/kg/hr or
100 mg/kg q6h. Maximum daily dose is 30
g.
Older children and adults: 4–5 g over the
1st hour followed by an infusion of 1 g/hr
for 8 hours or until control is achieved.
PO:
Doses are the same or alternatively, 100
mg/kg may be administered q4–6h to a
maximum of 5 g/dose.
PO:
Children (use body surface area for children
Injection: 3 mg/mL (2-mL vial)
Aerosol: 90 mcg/actuation
Solution for inhalation: 0.5%
Syrup: 10 mg/5 mL
Tablets: 2 mg, 4 mg
Tablets, extended release: 4
mg, 8 mg
Tablets: 100 mg, 300 mg
Injection: 250 mg/mL (20-mL
vial)
Solution: 1.25 g/5 mL (16-oz
bottle)
Tablet: 500 mg
Injection: 50 mg/mL
Tablets: 200 mg
7
Amoxicillin
Ampicillin (Principen)
age 1 year or under): Loading dose of 10–15
mg/kg/d or 600–800 mg/1.73 m2/d in 1–2
divided doses for 4–14 days or until
adequate control of arrhythmia is achieved
or prominent adverse effects occur. Then
reduce dosage to 5 mg/kg/d or 200–400
mg/1.73 m2/d as a single dose for several
weeks. A further dose reduction to 2.5
mg/kg/d should be attempted if the
arrhythmia does not recur.
Adults: Loading dose of 800–1,600 mg/d in
1–2 divided doses for 1–3 weeks, followed
by dose of 600–800 mg/d in 1–2 divided
doses for 1 month. Maintenance dose
usually 400 mg/d, but may be lower for
supraventricular arrhythmias.
IV:
Children (only limited information is
available): Initial loading dose of 5 mg/kg
over 1 hour followed by a continuous
infusion of 5 mcg/kg/min has been used.
The continuous infusion dosage may be
increased to 10 mcg/kg/min and then to 15
mcg/kg/min until the desired effect is
achieved. Due to the leaching of DEHP from
IV administration sets, especially at the slow
rates usually used in infants, bolus dosing
q6h should be considered if IV therapy is
expected to be long term.
Adults: Loading dose of 150 mg
administered over 10 minutes (15 mg/min)
followed by 360 mg over 6 hours at a rate
of 1 mg/min, followed by the maintenance
dose of 540 mg over 18 hours at a rate of
0.5 mg/min. If necessary, maintenance
infusion of 0.5 mg/min may be continued
past the initial 24 hours. Additional bolus
doses of 150 mg may be administered over
10 minutes for breakthrough arrhythmias.
PO:
Children ≤20 kg: 20 mg/kg/d in 2 or 3
divided doses for UTIs. 40 mg/kg/d in 2 or 3
divided doses for otitis media, upper
respiratory infection, or skin infections.
Acute otitis media due to highly resistant
strains of S. pneumoniae may require doses
of 80–90 mg/kg/d in 2 or 3 divided doses.
Children >20 kg and adults: 250–500
mg/dose t.i.d. or 500–875 mg b.i.d.
Maximum daily dose is 3 g.
Endocarditis prophylaxis: 50 mg/kg (up to 2
g) 1 hour before procedure.
IV:
Meningitis:
Neonates, age <7 days:
<2,000 g: 100 mg/kg/d in 2 divided doses.
Capsules: 250 mg, 500 mg
Drops: 50 mg/mL
Suspension: 125 mg/5 mL,
200 mg/5 mL, 250 mg/5 mL,
400 mg/5 mL
Tablets, chewable: 125 mg,
200 mg, 250 mg, 400 mg
Tablets: 500 mg, 875 mg
Capsules: 250 mg, 500 mg
Injection: 125-mg, 250-mg,
500-mg, 1-g, 2-g vials
Suspension: 125 mg/5 mL,
8
Aspirin
Atropine sulfate
Calcium salts
≥2,000 g: 150 mg/kg/d in 3 divided doses.
Neonates, age >7 days:
<1,200 g: 100 mg/kg/d in 2 divided doses.
1,200–2,000 g: 150 mg/kg/d in 3 divided
doses.
>2,000 g: 200 mg/kg/d in 4 divided doses.
Infants and children: 150–300 mg/kg/d in
4–6 divided doses to a maximum of 12 g/d.
Adults: 150–200 mg/kg/d in 6–8 divided
doses to a maximum total daily dose of 14
g.
Moderate infections:
Neonates, age <7 days:
<2,000 g: 50 mg/kg/d in 2 divided doses.
>2,000 g: 75 mg/kg/d in 3 divided doses.
Neonates, age <7 days:
<1,200 g: 50 mg/kg/d in 2 divided doses.
1,200–2,000 g: 75 mg/kg/d in 3 divided
doses.
>2,000 g: 100 mg/kg/d in 4 divided doses.
Infants, children, and adults: 50–100
mg/kg/d in 4–6 divided doses to a
maximum total dose of 12 g/d.
PO (mild to moderate infections):
Children <20 kg: 50–75 mg/kg/d in 4 divided
doses. Do not exceed adult doses for the
same degree of infection.
Children >20 kg and adults: 1–2 daily (250–
500 mg/dose) in 4 divided doses.
PO or rectally:
Analgesic, antipyretic:
Children: 10–15 mg/kg q4–6h.
Adults: 325–1,000 mg q4–6h, up to 4 g/d.
Anti-inflammatory:
Children ≤25 kg: 60–90 mg/kg/d in 3–4
divided doses initially, with a usual range of
80–100 mg/kg/d. Monitor serum levels.
Children >25 kg and adults: 2.4–3.6 g/d in 4
divided doses. Maximum total daily dose
usually should not exceed 5.4 g.
Kawasaki syndrome: 100 mg/kg/d in 4
divided doses until fever resolves; then 3–8
mg/kg once daily for 6–10 weeks after
onset of the disease, or longer.
Preoperative PO or IM:
0.02 mg/kg to a maximum dose of ~1 mg.
Bradycardia: 0.02 mg/kg with a minimum
dose of 0.1 mg and a maximum dose of 0.5
mg in children, 1 mg in adolescents, and 2
mg in adults.
Ophthalmic: 1–2 drops of 0.5–1% solution
in the eye.
See dosage forms for calcium content of
various salts. Dosage should be adjusted
based on the desired response and serum
calcium levels.
250 mg/5 mL
Suppositories: 300 mg, 325
mg, 600 mg, 650 mg
Tablets: 325 mg, 500 mg, 650
mg
Tablets, chewable: 81 mg
Tablets, extended release:
165 mg, 325 mg, 500 mg, 650
mg, 975 mg
Also available in buffered
formulation, enteric-coated
tablets, and chewing gum.
Injection: 0.3 mg/mL, 0.4
mg/mL, 0.5 mg/mL, 0.8
mg/mL, 1 mg/mL
Ointment, ophthalmic: 0.5%,
1%
Solution, ophthalmic: 0.5%,
1%, 2%
Calcium chloride = 27% Ca =
270 mg Ca per 1 g Ca chloride
Calcium gluconate = 9% Ca =
90 mg Ca per 1 g Ca
9
Carbamazepine (Carbatrol,
Tegretol, Tegretol-XR)
Cefazolin (Ancef)
Cefotaxime (Claforan)
Ceftriaxone (Rocephin)
IV (gluconate or chloride salts):
Cardiac resuscitation:
Calcium gluconate:
Children: 60–100 mg/kg/dose to a
maximum of 3 g.
Adults: 500 mg to 1 g/dose.
Calcium chloride:
Children: 20 mg/kg/dose to a maximum of 1
g.
Adults: 2–4 mg/kg/dose to a maximum of 1
g.
Hypocalcemia (usually the gluconate salt):
Neonates: 200–800 mg/kg/d, usually as a
continuous infusion.
Infants and children: 200–500 mg/kg/d as a
continuous infusion or in 4 divided doses.
Adults: 2–15 g/d as a continuous infusion or
in divided doses.
PO:
Initially 5–10 mg/kg/d in 2–4 divided doses,
increasing slowly to a maximum of 35
mg/kg/d (1.6–2.4 g in adults).
Suspension formulation should be
administered in 3–4 daily doses; regular
tablet formulations may be administered in
2–3 divided doses, extended release
formulations may be administered in 2
divided doses.
IV or IM:
50–100 mg/kg/d in 3 divided doses to a
maximum of 6 g/d. Usual adult doses are
500 mg to 2 g/dose q8h.
Dosing adjustment is necessary in renal
impairment.
IV:
Sepsis:
Infants and children: 100–120 mg/kg/d in
3–4 divided doses.
Adults: 1–2 g q6–8h.
Meningitis:
Neonates, age <1 week: 50 mg/kg q12h.
Neonates, age ≥1 week: 50 mg/kg q8h.
Infants, age >4 weeks and children: 200
mg/kg/d in 4 divided doses. A dose of 300
mg/kg/d in 4 divided doses has been used
for the treatment of pneumococcal
meningitis. Maximum total daily dose is 12
g.
Adults: 2 g q4–6h.
Dosing adjustment is necessary in renal
impairment.
IV or IM:
PPNG (uncomplicated pharyngeal, urethral,
endocervical, rectal):
<45 kg: 125 mg IM as a single dose.
≥45 kg: 250 mg IM as a single dose.
gluconate
Chloride salt: 1 g (100 mg/mL)
= 27 mg Ca/mL
Gluconate salt: 1 g (100
mg/mL) = 9 mg Ca/mL
Capsules, extended release:
200 mg, 300 mg.
Suspension: 100 mg/5 mL
Tablets, chewable: 100 mg
Tablets: 200 mg
Tablets, extended release:
100 mg, 200 mg, 400 mg
Injection: 500-mg, 1-g vials
Injection: 1-g, 2-g vials
Injection: 250-mg, 500-mg, 1g, 2-g vials
10
Cephalexin (Keflex)
Charcoal (Actidose-Aqua,
Actidose with Sorbitol,
CharcoAid, Liqui-Char)
Chloral hydrate
(Aquachloral)
Chlorpromazine
Infants born to a mother infected with
PPNG: 50 mg/kg IM to a maximum of 125
mg as a single dose.
Other serious infections (not including
meningitis):
Children: 50–75 mg/kg/d in 2 divided doses.
Do not exceed 2 g/d.
Adults: Usually 1–2 g as a single daily dose
or in 2 divided doses.
Otitis media: 50 mg/kg as a single dose to a
maxium dose of 1 g.
Meningitis:
Children: 100 mg/kg/d in 1–2 divided doses
to a maximum total daily dose of 4 g.
PO:
Children: 50–100 mg/kg/d in 4 divided
doses for otitis media and serious
infections. Doses of 25–50 mg/kg/d in 2–4
divided doses may be used for less serious
infections. Do not exceed adult doses.
Adults: 1–4 g/d in 4 divided doses.
PO:
Usually available as premixed solutions.
Solutions containing sorbitol should be used
for multiple doses only with care because
diarrhea may occur. Do not administer
concomitantly with ipecac because charcoal
will adsorb and inactivate the ipecac. Do not
administer with milk, ice cream, or sherbet
because adsorptive capacity of the charcoal
will be decreased.
Single dose:
Children: 1–2 g/kg up to 15–30 g as soon as
possible after the ingestion, preferably after
emesis.
Adults: 30–100 g.
Dose should be 5–10 times the amount of
the ingested poison.
Multiple dose (products without sorbitol):
Infants: 1 g/kg q4–6h.
Children and adults: 1–2 g/kg (up to 60 g)
q2–6h.
PO or rectally:
Sedation before procedures: 60–75 mg/kg
30 minutes to 1 hour before the procedure.
May repeat with a half-dose (30–37.5
mg/kg) if the 1st dose is ineffective. Do not
exceed 120 mg/kg or 2 g total.
Nausea and vomiting or psychosis:
Age >6 months: 0.3–0.5 mg/kg IV q6–8h or
0.5–1 mg/kg PO q4–6h or 1 mg/kg rectally
q6–8h as needed. Do not exceed adult
doses.
Adults: 25–50 mg IV q6–8h or 10–25 mg PO
q4–6h or 50–100 mg rectally q6–8h. Doses
may be increased in the treatment of
Capsules: 250 mg, 500 mg
Suspension: 125 mg/5 mL,
250 mg/5 mL
Liquid: 25 g/120 mL, 50 g/240
mL
Liquid, with sorbitol: 25 g/120
mL, 50 g/240 mL
Capsules: 500 mg
Suppositories: 325 mg, 650
mg
Syrup: 500 mg/5 mL
Injection: 25 mg/mL
Injection: 25 mg/mL
Tablets: 10 mg, 25 mg, 50 mg,
100 mg, 200 mg
11
Clindamycin (Cleocin)
Codeine
Co-trimoxazole
(trimethoprim and
sulfamethoxazole; Bactrim,
Septra)
psychoses; some adults may require as
much as 800 mg/d until control is achieved.
Dose should then be decreased to the usual
maintenance levels of 200 mg/d for adults.
IV:
Neonates, age <7 days:
≤2,000 g: 10 mg/kg/d in 2 divided doses.
>2,000 g: 15 mg/kg/d in 3 divided doses.
Neonates, age >7 days:
<1,200 g: 10 mg/kg/d in 2 divided doses.
1,200–2,000 g: 15 mg/kg/d in 3 divided
doses.
>2,000 g: 20 mg/kg/d in 3–4 divided doses.
Infants and children: 25–40 mg/kg/d in 3–4
divided doses.
Adults: 1.2–2.7 g/d in 2–4 divided doses.
Maximum total daily dose should not
exceed 4.8 g and should be used for lifethreatening infections only.
PO:
Infants and children: 15–25 mg/kg/d in 3–4
divided doses for moderate to severe
infections.
Adults: 150–450 mg q6–8h to a maximum
total daily dose of 1.8 g.
Topically:
Apply to the affected area b.i.d. Avoid the
eyes, abraded skin, and mucous
membranes.
PO:
Analgesic: 0.5–1 mg/kg q4–6h as needed, to
a maximum of 60 mg. Usual adult dose is 30
mg.
Antitussive: 0.2–0.25 mg/kg q4–6h as
needed, to a maximum of 30 kg.
SC:
Same doses as above may be used,
although the oral route is only 2/3 as
effective as the SC route. It should not be
used IV. (For IV route, use morphine)
PO or IV (based on trimethoprim):
Age >2 months:
Treatment doses:
Mild-to-moderate infections (urinary tract
Capsules: 150 mg
Injection: 150 mg/mL
Solution, oral: 75 mg/5 mL
Solution, topical: 1%
Injection (phosphate): 30
mg/mL, 60 mg/mL
Solution, oral (phosphate): 15
mg/5 mL
Tablets (sulfate): 15 mg, 30
mg, 60 mg
Also available in various
combinations with
acetaminophen:
Elixir, oral: 12 mg codeine
with 120 mg acetaminophen
Tablets: 7.5 mg codeine with
acetaminophen 300 mg
(Tylenol w/Codeine No. 1), 15
mg codeine with
acetaminophen 300 mg
(Tylenol w/Codeine No. 2),
300 mg codeine with
acetaminophen 300 mg
(Tylenol w/Codeine No. 3), 60
mg codeine with
acetaminophen 300 mg
(Tylenol w/Codeine No. 4)
Injection: 16 mg
trimethoprim and 80 mg
sulfamethoxazole per 1 mL
Suspension: 8 mg
12
Deferoxamine (Desferal)
Desmopressin acetate
(DDAVP)
Dexamethasone
(Decadron, Maxidex)
or otitis media): 8 mg trimethoprim/kg/d in
2 divided doses. Maximum dose is 320 mg
trimethoprim/d.
Pneumocystis carinii pneumonitis: 20 mg
trimethoprim/kg/d in 4 divided doses.
Prophylaxis doses:
UTI: 2 mg trimethoprim/kg/d as a single
dose.
Pneumocystis carinii: 150 mg/m2/d in 1 or 2
divided doses daily on 3 consecutive or
alternating days per week.
Dosage adjustment is necessary in patients
with renal impairment.
IV doses must be administered over 60–90
minutes and should be well diluted (1 mL
injection in 25 mL infusate).
Children:
Acute iron intoxication: 15 mg/kg/hr IV
continuous infusion; maximum 6 g/24 hr.
Chronic iron overload: 20–25 mg/kg/d IM or
500 mg-2 g IV with each unit of blood
transfused, or 20–40 mg/kg/d SC over 8–12
hours up to 1–2 g/d.
Intranasally:
Nocturnal enuresis in patients over age 6:
20 mcg at bedtime with 1/2 of dose in each
nostril. Dose may be increased or decreased
depending on the patient's response. Usual
range is 10–40 mcg/d.
Diabetes insipidus in patients ≥7 years of
age: Initially 5 mcg/d as a single dose or in 2
divided doses. Dosage should be titrated to
the patient's response. The usual range is
5–40 mcg/d.
PO:
Diabetes insipidus:
Children: Initially, 0.05 mg/dose with careful
monitoring to prevent hyponatremia or
water intoxication.
Age >12 years: Initially, 0.05 mg b.i.d.
Dosage may then be adjusted to maintain
normal diurnal water turnover. The usual
total daily dosage is in the range of 0.1–1.2
mg and may be administered in 2–3 divided
doses.
Nocturnal enuresis in children >12 years:
0.2–0.4 mg/d at bedtime.
IV:
To increase factor VIII level: 0.3 mcg/kg over
30 minutes.
Diabetes insipidus: Adult doses are 2–4
mcg/d in 2 divided doses or ~1/10 of the
intranasal dose necessary to control the
patient's symptoms, if that is known.
IV or PO:
Bacterial meningitis: 0.6 mg/kg/d in 4
trimethoprim and 40 mg
sulfamethoxazole per 1 mL
Tablets: 80 mg trimethoprim
and 400 mg sulfamethoxazole
Tablets, double strength: 160
mg trimethoprim and 800 mg
sulfamethoxazole
Injection: 500-mg vial
Injection: 4 mcg/mL
Solution, nasal: 100
mcg/mL/2.5 mL bottle with
calibrated intranasal tube
Spray, intranasal: 10
mcg/actuation metered dose
Tablets: 0.1 mg, 0.2 mg
Elixir: 0.5 mg/5 mL
Injection: 4 mg/mL, 10
13
Diazepam (Diastat Rectal,
Valium)
Digoxin (Lanoxicaps,
Lanoxin)
Dimercaprol [BAL (British
anti-lewisite)]
Diphenhydramine
divided doses for the 1st 4 days of antibiotic
therapy. It must be started at the same time
or before the 1st dose of antibiotic.
Cerebral edema: 1–1.5 mg/kg/d in 4 divided
doses to a maximum total daily dose of 16
mg.
Antiemetic therapy (chemotherapy-induced
emesis): 20 mg/m2/d in 4 divided doses.
Airway edema or extubation: 0.5–2 mg/kg/d
in 4 divided doses beginning 24 hours
before and continuing for at least 24 hours
after extubation. Maximum dose of 16
mg/d.
Doses should be tapered when
discontinuing long-term therapy.
Ophthalmic: Instill drops or apply ointment
t.i.d. or q.i.d.
IV:
Status epilepticus: 0.05–0.3 mg/kg
administered over 2–3 minutes and
repeated q15–30min to a total maximum
dose of 0.75 mg/kg or 30 mg, whichever is
less. May be repeated in 2–4 hours, if
necessary.
Sedation: 0.04–0.2 mg/kg q2–4h to a
maximum of 0.6 mg/kg within an 8-hour
period.
PO for sedation or muscle relaxant:
0.12–0.8 mg/kg/d in 3–4 divided doses to
an adult dose of 6–40 mg/d.
Rectally (round dose off to closest dose
available from manufacturer):
Age 2–5 years: 0.5 mg/kg.
Age 6–11 years: 0.3 mg/kg
Age ≥12 years: 0.2 mg/kg.
Dose may be repeated q4–12h as
necessary.
Should be based on lean body weight.
Dosage adjustment is required in patients
with impaired renal function. Total
digitalizing dose (TDD) is administered as
follows: 1/2 TDD initially, then 1/4 TDD 8–
12 hours later, then 1/4 TDD 8–12 hours
after that. Maintenance doses are
administered in 2 divided doses beginning
12 hours after the last digitalizing dose.
Patients should be under continuous
cardiographic monitoring during
digitalization. IM doses are the same as oral
doses, but that route of administration
should be avoided.†
Deep IM:
Lead toxicity (in conjunction with calcium
EDTA): 4 mg/kg 6 times a day for 3–5 days.
IV, PO, IM:
Children: 5 mg/kg/d in 3 or 4 divided doses
mg/mL,
Solution, ophthalmic: 0.05%,
0.1%
Solution, oral: 1 mg/mL
Tablets: 0.5 mg, 0.75 mg, 1
mg, 1.5 mg, 2 mg, 4 mg, 6 mg
Gel, rectal (in rectal delivery
system): 2.5 mg, 5 mg, 10 mg,
20 mg
Injection: 5 mg/mL
Solution, oral: 5 mg/5 mL
Solution, concentrated oral: 5
mg/mL
Tablets: 2 mg, 5 mg, 10 mg
Capsules, liquid filled
(Lanoxicaps): 0.1 mg, 0.2 mg
(90–100% bioavailable)
Injection: 0.1 mg/mL, 0.25
mg/mL (100% bioavailable IV)
Solution: 0.05 mg/mL (75–
87% bioavailable)
Tablets: 0.125 mg, 0.25 mg
(60–80% bioavailable)
Injection: 100 mg/mL (3-mL
ampul)
Capsules, tablets: 25 mg, 50
mg
14
Dobutamine hydrochloride
(Dobutrex)
Dopamine hydrochloride
(Dopastat, Intropin)
Doxycycline (Doxy-100,
Vibramycin)
Edetate calcium disodium
(Calcium Disodium
Versenate, Calcium EDTA)
Enoxaparin (Lovenox)
Epinephrine (Adrenalin)
to a maximum of 300 mg/d.
Adults: 10–50 mg repeated as often as q4h,
not to exceed 400 mg/d.
The drug may cause paradoxical excitement
in children.
IV infusion:
2–15 mcg/kg/min to a maximum of 40
mcg/kg/min. Start at the lower end of the
range and titrate upward based on the
patient's response.
Continuous IV infusion:
Initially 1 mcg/kg/min titrated upward
based on patient's response to a maximum
of 20 mcg/kg/min in neonates or 50
mcg/kg/min in all other patients. The
hemodynamic effects of dopamine occur
only at doses >15 mcg/kg/min.
PO or IV:
Age <8 years: Should not be used unless
there is no alternative.
Age ≥8 years: 2–5 mg/kg/d to a maximum
of 200 mg/d in 1 or 2 divided doses.
Adults: 100–200 mg/d in 1 or 2 divided
doses. Inpatient treatment of PID 100 mg IV
b.i.d. with cefoxitin 2 g IV q6h for at least 4
days or 2 days after patient improves,
whichever is longer. Doxycycline should be
continued PO to complete 10–14 days of
therapy.
Usual dosage (children):
Asymptomatic lead toxicity:
Initial: Up to 1 g/m2/24 hr or 50 mg/kg/24
hr in a continuous IV drip if possible or in 2–
4 divided doses for 5 days.
Subsequent courses: Up to 50 mg/kg/24 hr
in a continuous IV drip if possible or in 2–4
divided doses for 3–5 days.
Symptomatic lead toxicity or lead
encephalopathy:
Initial: 50 mg/kg/d or 1–1.5 g/m2/24 hr in a
continuous IV drip if possible or in 4 divided
doses for 5–7 days; give with dimercaprol
(BAL).
SC:
Prophylaxis:
Age <2 months: 0.75 mg/kg/dose q12h
Age ≥2 months: 0.5 mg/kg/dose q12h.
Adults >45 kg: 30 mg q12h.
Treatment of DVT or PE:
Age <2 months: 1.5 mg/kg/dose q12h.
Age ≥2 months: 1 mg/kg/dose q12h.
Adults >45 kg: 1 mg/kg/dose q12h.
Doses should be adjusted based on
antifactor Xa levels.
IV for asystole, or pulseless arrest:
Neonates: 0.01–0.03 mg/kg (0.1–0.3 mL/kg
Elixir, solution, syrup: 12.5
mg/5 mL
Injection: 10 mg/mL, 50
mg/mL
Injection: 12.5 mg/mL
Injection in 5% dextrose: 0.8
mg/mL, 1.6 mg/mL, 3.2
mg/mL (premixed infusions)
Injection: 40 mg/mL, 80
mg/mL, 160 mg/mL
Capsules or tablets: 50 mg,
100 mg
Injection: 100 mg, 200 mg
Injection: 200 mg/mL
For intravenous infusion,
dilute to a maximum
concentration of 5 mg/mL
with D5W or normal saline.
Infusions should be
administered either
continuously or over 1–2
hours if intermittent doses
are used. Rapid infusion may
increase intracranial
pressure.
Injection: 100 mg/mL
Injection: 1:10,000 (0.1
mg/mL), 1:1,000 (1 mg/mL)
15
Erythromycin (Ery-Tab,
Eryc, Erythrocin, E.E.S.)
Fentanyl citrate
(Sublimaze)
Ferrous sulfate (Feosol,
Fer-In-Sol)
of a 1:10,000 solution) q3–5min as
necessary.
Infants to adults: An initial dose of 0.01
mg/kg; subsequent doses of 0.1 mg/kg may
be repeated q3–5min as necessary. A
continuous infusion may be started at a
dose of 0.1–1 mcg/kg/min and titrated to
effect.
Nebulization: 0.25–0.5 mL of a 2.25%
racemic epinephrine solution diluted in 2.5–
3 mL of normal saline for inhalation.
PO (do not exceed 2 g/d):
Infants and children:
Base, ethylsuccinate or stearate: 30–50
mg/kg/d in 3 or 4 divided doses.
Adults:
Base: 250–500 mg q6–12h.
Ethylsuccinate: 400–800 mg q6–12h.
Endocarditis prophylaxis (penicillin-allergic
patients): 20 mg/kg to a maximum of 1 g 2
hours before the procedure and 10 mg/kg
to a maximum of 500 mg 6 hours later.
Bowel preparation (erythromycin base,
only): 20 mg/kg to a maximum of 1 g
administered at 1:00, 2:00, and 11:00 P.M.
on the day before surgery, usually
combined with neomycin and mechanical
cleansing of the bowel.
IV:
15–50 mg/kg/d to a maximum of 4 g/d
administered in 4 divided doses.
Ophthalmic ointment for prophylaxis of
neonates:
Apply a 0.5–1 cm ribbon of the ointment to
each conjunctival sac.
Topically for acne:
Apply to the affected areas b.i.d. The skin
should be washed, rinsed well, and dried
before applying the erythromycin. Keep
away from the eyes, nose, and mouth.
IV (slowly over a period of 3–5 minutes to
avoid chest wall rigidity and to titrate to
effect):
Children: 1–2 mcg/kg may be repeated at
30–60-minute intervals. For continuous
therapy, after a bolus dose, a dose of 1
mcg/kg/hr initially may be increased or
decreased as necessary to response.
Older children and adults: 0.5–1 mcg/kg
(25–50 mcg) may be repeated at 30–60minute intervals.
The doses listed are analgesic/sedation
doses. Doses used for general anesthesia
may be higher.
PO (doses are expressed as elemental iron;
ferrous sulfate contains 20% iron):
Injection pre-filled automatic
syringe: 1:200 (EpiPen
delivers 0.3 mg IM, EpiPen Jr.
delivers 0.15 mg IM)
Solution, racemic for
inhalation: 2.25%
Base:
Capsules, enteric-coated
pellets: 250 mg
Ointment, ophthalmic: 0.5%
Gel, topical: 2%
Solution, topical: 1.5%, 2%
Tablets, enteric coated: 250
mg, 333 mg, 500 mg
Tablets, film coated: 250 mg,
500 mg
Ethylsuccinate:
Suspension: 200 mg/5 mL,
400 mg/5 mL
Tablets: 400 mg
Stearate: Tablets: 250 mg,
500 mg
Injection: 50 mcg/mL
Drops: 15 mg Fe/0.6 mL
Elixir: 44 mg Fe/5 mL
16
Flumazenil (Mazicon,
Romazicon)
Folic acid
Gentamicin (Garamycin)
Iron deficiency anemia:
Children: 3–6 mg/kg/d depending on the
severity of the deficiency. Higher doses
should be administered in 3 divided doses;
moderate doses may be administered in 2
divided doses to avoid GI upset. For
prophylaxis, 1–2 mg/kg/d in a single dose
may be used.
Adults: 120–240 mg iron daily in 2–4
divided doses. For prophylaxis, 60 mg iron
daily as a single dose.
Administration between meals increases
absorption, but may result in more GI
upset. Do not administer with antacids,
eggs, or milk because they may decrease
absorption of the iron.
IV:
Children: 0.01 mg/kg (to a maximum of 0.2
mg) initially, followed by 0.005 mg/kg (to a
maximum of 0.2 mg) every minute until a
total cumulative dose of 1 mg has been
reached.
Adults:
Reversal of sedation: 0.2 mg over 15
seconds; may repeat 0.2-mg dose q60sec to
a maximum of 1 mg. May repeat doses
q20min to a maximum of 3 mg in 1 hour.
Benzodiazepine overdose: 0.2 mg over 30
seconds, then 0.3 mg over 30 seconds if
desired level of consciousness is not
reached. Additional 0.5-mg doses may be
given every minute until a cumulative dose
of 3 mg has been reached. If a partial
response is noted, further 0.5-mg doses
may be given until a cumulative dose of 5
mg is reached.
Resedation may occur in patients who
received long-acting benzodiazepines.
PO, parenterally:
Age <1 year: 0.1 mg/d.
Age ≥1 year: 1 mg/d initially, then 0.1–0.4
mg/d.
IV or IM (in obese patients it should be
based on ideal, rather than actual, body
weight):
Age <7 days:
<1,000 g: 2.5 mg/kg q24h.
1,000–1,500 g: 2.5 mg/kg q18h.
>1,500 g: 2.5 mg/kg q12 h.
Age >7 days:
1,200–2,000 g: 2.5 mg/kg q12h.
>2,000 g: 2.5 mg/kg q8h.
ECMO patients: 2.5 mg/kg q18h.
Age <10 years: 2.5 mg/kg q8h.
Age >10 years: 5–6 mg/kg/d administered in
3 divided doses.
Tablets: 65 mg Fe
Injection: 0.1 mg/mL
Injection: 5 mg/mL
Tablets: 0.4 mg, 0.8 mg, 1 mg
Injection: 10 mg/mL, 40
mg/mL
Ointment, ophthalmic: 0.3%
Solution, ophthalmic: 0.3%
17
Glucagon
Glycopyrrolate (Robinul)
Haloperidol (Haldol)
Heparin sodium
Ophthalmic solution:
1–2 drops in the affected eye q2–4h. More
frequent application (up to every hour) may
be used initially in severe infections.
Ophthalmic ointment:
Apply a ribbon of ointment to the eye b.i.d.
or t.i.d.
Intrathecal/intraventricular (use only a
preservative-free product):
Neonates: 1 mg/d as a single dose.
Age >3 months: 1–2 mg/d.
Older children and adults: 4–8 mg/d.
Dosage must be adjusted in renal
dysfunction.
Serum levels should be monitored during
therapy in all patients.
IV, IM, or SC:
Hypoglycemia (dose may be repeated in 20
minutes if necessary):
Neonates: 0.025 mg/kg/dose.
Children: 0.025–0.1 mg/kg/dose to a
maximum of 1 mg.
Adults: 0.5–1 mg/dose.
IM:
Preoperatively:
Age <2 years: 4.4–8.8 mcg/kg 30–60
minutes before the procedure.
Age ≥2 years: 4.4 mcg/kg 30–60 minutes
before the procedure.
PO:
To control secretions (glycopyrrolate is
poorly absorbed from the GI tract): 50–100
mcg/kg administered t.i.d. or q.i.d.
Reversal of neuromuscular blockade: 0.2 mg
for each 1 mg neostigmine or 5 mg
pyridostigmine administered.
PO:
Age 3–12 years:
Agitation or hyperkinesia: 0.01–0.03
mg/kg/d once daily.
Tourette disorder: 0.05–0.075 mg/kg/d in 2
or 3 divided doses.
Psychotic disorders: 0.05–0.15 mg/kg/d in 2
or 3 divided doses.
IM:
1–3 mg q4–8h; maximum, 0.1 mg/kg/d.
Dose should be individually adjusted to
patient. Not recommended for children
under age 3. Oral dosage range is 2–100
mg/24 hr.
IV:
Anticoagulation:
Children and adults:
Continuous infusion: 50 U/kg then 15–25
U/kg/hr. Dose may be increased by 2–4
U/kg/hr q6–8hbased on the results of the
Injection: 1 mg-vial
Injection: 0.2 mg/mL
Tablets: 1 mg, 2 mg
Injection: 5 mg/mL
Solution, concentrated oral: 2
mg/mL
Tablets: 0.5 mg, 1 mg, 2 mg, 5
mg, 10 mg, 20 mg
Injection: 1,000 U, 5,000 U,
10,000 U, 20,000 U, 40,000
U/mL
Injection, preservative-free:
1,000 U, 5,000 U, 10,000
U/mL
18
Hydralazine (Apresoline)
Hydrochlorothiazide
(Esidrix, HydroDIURIL,
Oretic)
Hydrocortisone (Cortef,
Cortenema, Cortifoam,
Solu-Cortef)
APTT.
Intermittent infusion: 50–100 U/kg q4h.
This method is less desirable than
continuous infusion.
Line flushing:
Central catheters: May be flushed as
infrequently as once daily with 2–3 mL of
solution containing 10 U/mL for patients
under age 1 or 100 U/mL for patients age 1
or older.
Peripheral catheters, locks: Usually flushed
q6–8h with 10 U/mL concentration with a
volume determined by the length of the
catheter, but usually ~1 mL.
Lines should be flushed before and after
medication or blood administration or if
blood is seen in the catheter.
Preservativefree heparin solutions should
be used for all line flushes in children under
age 2 months.
PO:
Children: 0.75–1 mg/kg/d in 2–4 divided
doses, but not to exceed 25 mg/dose
initially. May be increased slowly over 3 or 4
weeks to a maximum of 7.5 mg/kg/d (or
200 mg).
Adults: Initially 10 mg q.i.d. May be
increased by 10–25 mg/dose q2–5d to a
maximum of 300 mg/d.
IV (ratio of PO to IV dosing is ~4:1):
Children: Initially 0.1–0.2 mg/kg (to a
maximum of 20 mg) q4–6h. May be
increased to a maximum of 1.7–3.5
mg/kg/d.
Adults: Initially 10–20 mg q4–6h. May be
increased to 40 mg/dose. Dose must be
adjusted in renal impairment.
PO (chlorothiazide, which is available as a
suspension, is usually a better choice for
children requiring low doses):
Age >6 months:
2 mg/kg/d in 2 divided doses.
Adults: 25–100 mg/d in 1 or 2 doses.
PO:
Congenital adrenal hyperplasia: Initially 30–
36 mg/m2/d divided as 1/3 in the morning
and 2/3 in the evening or 1/4 in the
morning, 1/4 midday, and 1/2 in the
evening.
Physiologic replacement: 0.5–0.75 mg/kg/d.
Anti-inflammatory: 2.5–10 mg/kg/d in 3 or
4 divided doses.
IV:
Adrenal insufficiency:
Infants and young children: 1–2 mg/kg
bolus, then 25–150 mg/d in 3 or 4 divided
Solution, lock flush: 10 U/mL,
100 U/mL (available
preserved and preservativefree)
Injection: 20 mg/mL
Tablets: 10 mg, 25 mg, 50 mg,
100 mg
Tablets: 25 mg, 50 mg
Cream, topical: 0.5%, 1%,
2.5%
Enema: 100 mg/60 mL
(Cortenema)
Foam, intrarectal: 90 mg/full
applicator (Cortifoam),
rectal/anal 1% (ProctofoamHC)
Injection (sodium phosphate):
50 mg/mL
Injection (sodium succinate):
100-mg, 250-mg, 500-mg, 1-g
vials
19
Hydromorphone (Dilaudid)
Ibuprofen (Advil, Motrin,
Nuprin)
doses.
Older children: 1–2 mg/kg bolus, then 150–
250 mg/d in 3 or 4 divided doses.
Adults: 15–240 mg/d in 1 or 2 divided
doses.
Anti-inflammatory:
Infants and children: 1–5 mg/kg/d in 2–4
divided doses.
Adults: 15–240 mg q12h.
Stress coverage (all patients): 100 mg/m2 as
a single dose followed by 100 mg/m2/d in 6
divided doses.
Shock (succinate salt):
Children: 50 mg/kg then in 4 hours or q24h
as needed.
Adults: 500 mg to 2 g q2–6h.
Rectal retention enemas: 1 enema nightly
for 21 days. May be continued for a longer
period if effective or discontinued if no
effect is seen.
Intrarectal foam: 1 full applicator rectally
nightly or b.i.d. for 2 or 3 weeks. Absorption
of hydrocortisone may be greater from the
foam formulation than the enema.
Discontinue if not effective after 3 weeks.
Topically (low-potency corticosteroid in
most formulations):
Apply a thin layer to the affected area t.i.d.
or q.i.d.
IV:
Young children: 0.015–0.03 mg/kg q3–4h.
Older children and adults: 1–4 mg q3–4h.
PO:
Young children: 0.04–0.07 mg/kg q3–4h.
Older children and adults: 1–6 mg q3–4h
depending on size and pain severity.
To convert a patient from oral to IV therapy:
Start with a ratio of 5:1. Ratios of up to 2:1
may be required in some patients on longterm chronic therapy.
To convert a patient from IV to oral therapy:
In a patient who is receiving a stable dose,
use an IV to oral ratio of 1:3.
Equianalgesic doses:
Oral: 7.5 mg hydromorphone = 30 mg
morphine.
Parenteral: 1.5 mg hydromorphone = 10 mg
morphine.
PO:
Antipyretic:
Age 6 months to 12 years (repeat doses up
to q6h):
Temperature <39°C (102.2°F): 5
mg/kg/dose.
Temperature ≥39°C (102.2°F): 10
mg/kg/dose.
Ointment, topical: 0.5%, 1%,
2.5%
Suspension (cypionate): 10
mg/5 mL
Tablets: 5 mg, 10 mg, 20 mg
Injection: 1 mg/mL, 2 mg/mL,
4 mg/mL, 10 mg/mL
Solution, oral: 1 mg/mL
Suppositories, rectal: 3 mg
Tablets: 2 mg, 4 mg, 8 mg
Suspension, oral: 100 mg/5
mL
Tablets: 200 mg, 300 mg, 400
mg, 600 mg, 800 mg
20
Immune globulin,
intramuscular
Immune globulin,
intravenous (Gammagard
S/D, Gammar-P IV,
Gamunex, Iveegam,
Octagam, Polygam S/D)
Indomethacin IV (Indocin
IV)
Age >12 years: 200–400 mg/dose to a
maximum of 1,200 mg/d.
Juvenile rheumatoid arthritis: 30–70
mg/kg/d in 4 divided doses to a maximum
of 2,400 mg/d.
Adult anti-inflammatory dose: 400–800 mg
q6–8h to a maximum of 3,200 mg/d.
IM:
Measles prophylaxis: 0.25 mL/kg within 6
days of exposure. In immunocompromised
patients, use 0.5 mL/kg (15 mL maximum).
Hepatitis A pre-exposure prophylaxis:
Risk of exposure within 3 months: 0.02
mL/kg.
Risk of exposure >3 months: 0.06 mL/kg.
Hepatitis A postexposure: 0.02 mL/kg given
within 2 weeks of exposure.
Immunodeficiency: IV has largely replaced
use of the IM form.
IV as a slow infusion:
The rate of infusion varies from product to
product but should always be initiated at a
very slow rate and may be increased
q30min to the manufacturer's maximum
recommended rate or less as the patient
tolerates.
Infusion-related reactions usually abate if
the rate of infusion is decreased.
Anaphylactic hypersensitivity reactions may
occur and are more likely in patients with
IgA deficiency.
Immunodeficiency syndromes: 100–400
mg/kg q2–4wks.
Idiopathic thrombocytopenic purpura:
Either 400 mg/kg/d for 2–5 consecutive
days or 1 g/kg/d for 1 or 2 consecutive days
may be used for induction. Maintenance
doses are usually 400 mg/kg/dose q4–6wk
but may be increased to 800–1,000 mg/kg if
the lower dose is insufficient and are based
on platelet counts and clinical response.
Kawasaki disease: Usually 2 g/kg as a single
dose. Alternatively, 400 mg/kg/d for 4 days
may be used.
IV push:
Further dilution of the reconstituted
injection may result in precipitation of
insoluble indomethacin. An initial 0.2
mg/kg/dose is followed by 2 doses based on
the patient's postnatal age (PNA) at the
time of the 1st dose:
PNA <48 hours: 0.1 mg/kg at 12–24-hour
intervals.
PNA 2–7 days: 0.2 mg/kg at 12–24-hour
intervals.
PNA >7 days: 0.25 mg/kg at 12–24-hour
Injection, IM: 165 ± 15 mg (of
protein) per mL (2 mL and 10
mL)
Gammagard S/D: Powder
with diluent to make 5%
solution
Gammar-P IV: Powder with
diluent to make 5% solution
Gamunex solution 10%
Iveegam: Powder with diluent
to make 5% solution
Octagam solution: 10%
Polygam S/D: Powder with
diluent to make 5% solution
Injection (sodium trihydrate):
1 mg
21
Insulin
Ipratropium bromide
(Atrovent)
Isoproterenol (Isuprel)
Levothyroxine sodium
(Levothroid, Synthroid)
intervals.
The patient's renal and hepatic function
should be monitored.
Oral use in children is generally not
recommended.
IV:
Treatment of diabetic ketoacidosis: Loading
dose of 0.1 U/kg followed by a continuous
infusion of 0.1 U/kg/hr (usual range 0.05–
0.2 U/kg/hr) to maintain steady, but slow,
decrease of serum glucose levels of 80–100
mg/dl/hr. Only regular insulin should be
used by this route.
SC:
Maintenance: Most patients require 0.5–1
U/kg/d in 2–4 divided doses depending on
how well controlled the patient's glucose
levels have been.
Patients should be warned not to change
insulins without prior approval of their
physicians.
If regular insulin is to be mixed with other
types of insulin, the regular insulin should
always be measured 1st.
Extemporaneously prepared doses of mixed
insulins should be used as soon as possible
after mixing to minimize the amount of the
regular insulin that will be bound by excess
protamine or zinc in the other insulin. The
activity of regular insulin has a time to onset
of 1/2–1 hour, peaks at 2–3 hours, and has
a duration of 5–7 hours. The activity of
isophane (NPH) insulin has a time to onset
of ~1–2 hours, peaks at 4–12 hours, and has
a duration of 18–24 hours.
Oral metered dose inhalation:
Age 3–12 years: 1–2 inhalations t.i.d.
Age >12 years: 2 inhalations q.i.d. Maximum
dose should not exceed 12 inhalations in 24
hours.
Nebulization:
Age 3–14 years: 125–250 mcg t.i.d.
Age >14 years: 500 mcg t.i.d.–q.i.d.
Intranasal:
Age ≥6 years: 2 sprays of 0.03% solution in
each nostril b.i.d. or t.i.d.
IV (by continuous infusion):
0.05–3 mcg/kg/min up to 2–10 mcg/min.
PO:
Age 0–6 months: 8–10 mcg/kg or 25–50
mcg/d.
Age >6–<12 months: 6–8 mcg/kg or 50–75
mcg/d.
Age 1–5 years: 5–6 mcg/kg or 75–100
mcg/d.
Age 6–12 years: 4–5 mcg/kg or 100–150
All insulins below are 100
U/mL
Rapid acting:
Aspart (NovoLog)
Lispro (Humalog)
Glulisine (Apidra)
Short acting:
Regular insulin
Intermediate acting:
Detemir
Isophane (NPH)
Zinc suspension (Lente)
Long acting:
Glargine (Lantus)
Fixed combinations: regular
insulin 30 U/mL with
isophane insulin 70 U/mL;
regular insulin 50 U/mL with
isophane insulin 50 U/mL;
aspart insulin 30 U/mL with
aspart protamine insulin 70
U/mL; lispro 25 U/mL with
lispro protamine 75 U/mL
Aerosol, metered dose: 17
mcg/actuation
Intranasal solution: 0.03%
Solution for nebulization:
0.02%, 2.5 mL
Injection: 1:5,000 (0.2
mg/mL, 1 mg/5 mL)
Injection: 200 mcg, 500 mcg
Tablets: 25 mcg, 50 mcg, 75
mcg, 88 mcg, 100 mcg, 112
mcg, 125 mcg, 150 mcg, 175
mcg, 200 mcg, 300 mcg
22
Lidocaine hydrochloride
(Xylocaine)
Magnesium sulfate (Epsom
Salts)
Mannitol (Osmitrol)
mcg/d.
Age >12 years: 2–3 mcg/kg or >150 mcg/d.
IV:
1/2–3/4 of the oral dose for children or
about half the oral dose for adults. The
parenteral form of the drug is very unstable
and should be used immediately after
reconstitution without admixing with other
solutions.
IV for cardiac arrhythmias:
1 mg/kg loading dose followed by a
continuous infusion of 20–50 mcg/kg/min.
The loading dose may be repeated twice at
10–15-minute intervals, if necessary.
Infiltration for local anesthesia:
Dose depends on procedure, degree, and
duration of anesthesia required and the
vascularity of the site. Maximum
recommended dose is 4.5 mg/kg. Doses
should not be repeated sooner than 2
hours.
Topical:
Apply to affected area as needed. Maximum
dose should not exceed 3 mg/kg or be
repeated within 2 hours. Patients treated
with oral lidocaine viscous should be
cautioned about the hazards of biting the
numbed areas and swallowing difficulties.
IV [expressed in terms of magnesium
sulfate (and mEq Mg)]:
Hypomagnesemia (monitor serum
magnesium levels closely):
Neonates: 25–50 mg/kg (0.2–0.4 mEq/kg)
q8–12h for 2–3 doses.
Infants and children: 25–50 mg/kg (0.2–0.4
mEq/kg) q4–6h for 3 or 4 doses with a
maximum single dose of 2,000 mg (16 mEq).
Doses up to 100 mg/kg have been used in
severe hypomagnesemia.
Adults: 1 g (8 mEq) q6h for 4 doses. Doses
of 2–3 g (16–24 mEq) have been used for
severe hypomagnesemia.
Maintenance dose: 30–60 mg/kg/d (0.25–
0.5 mEq/kg/d) in 3 or 4 divided doses.
Management of seizures or hypertension in
children: 25–100 mg/kg (0.2–0.8 mEq/kg)
q4–6h as needed. Administer the drug
slowly (over 1–2 hours) in a concentration
not >10 mg/mL. BP should be monitored
frequently during infusions because
hypotension has been reported with toofast administration.
IV:
Initial dose of 2 g/kg followed by doses of
0.25–0.5 g/kg q4–6h.
A test dose of 0.2 g/kg (to a maximum of
Injection: 0.5%, 1%, 1.5%, 2%,
4%; 0.5% with epinephrine
1:200,000; 1% with
epinephrine 1:100,000 or
1:200,000; 1.5% with
epinephrine 1:200,000; 2%
with epinephrine 1:100,000
or 1:200,000
Jelly: 2%
Liquid, viscous: 2%
Ointment: 2.5%, 5%
Solution, topical: 2%, 4%
Injection: 500 mg/mL (4 mEq
magnesium = 49 mg Mg)
Injection: 5%, 10%, 15%, 20%,
25%
23
Methylene blue (Urolene
Blue)
Methylprednisolone (AmethaPred, Depo-Medrol,
Medrol, Solu-Medrol)
Metoclopramide (Reglan)
Metronidazole (Flagyl,
Protostat)
12.5 g) over 3–5 minutes should produce a
urine flow of about 1 mL/kg/hr for 2 or 3
hours. It should be used for patients with
marked oliguria or inadequate renal
function.
IV for methemoglobinemia:
1–2 mg/kg injected slowly over a period of
several minutes. The dose may be repeated
in 1 hour, if necessary.
PO for adults with chronic
methemoglobinemia:
100–300 mg/d.
IV:
Status asthmaticus: 1 mg/kg q6h.
Acute spinal cord injury: 30 mg/kg over 15
minutes followed in 45 minutes by an
infusion of 5.4 mg/kg/hr for 23 hours.
Shock: 30 mg/kg and may be repeated q4–
12h, but not to continue for longer than 48–
72 hours.
“Pulse” therapy for lupus nephritis in older
children and adults: 1 g/d for 3 days. A dose
of 30 mg/kg every other day for 6 doses has
been used for children.
PO:
Children: 0.117–1.6 mg/kg/d in 4 divided
doses. Adults: 2–60 mg/d in 4 divided
doses.
Intra-articular, intralesional doses (acetate):
4–40 mg or up to 80 mg for large joints q1–
5wk.
PO or IV:
Gastroesophageal reflux:
Children: Initially 0.1–0.5 mg/kg/d in 4
divided doses before meals. Dosage may be
increased to a maximum of 0.8 mg/kg/d.
Adults: 10–15 mg 30 minutes before meals
and at bedtime.
IV:
Antiemetic in chemotherapy-induced
nausea: 1–2 mg/kg administered 30
minutes before the chemotherapy and q2–
4h as necessary thereafter to a maximum of
3 doses. Extrapyramidal reactions are
common at this dose and may be treated
with diphenhydramine IV (1 mg/kg up to 50
mg) q6h.
PO or IV:
Anaerobic bacterial infections (IV initially,
then PO):
Infants other than neonates to adults: 30
mg/kg/day in 4 divided doses, not to exceed
4 g/d.
Amebiasis (usually PO):
Infants and children: 35–50 mg/kg/d in 3
divided doses.
Injection: 10 mg/mL
Tablets: 65 mg
Injection (acetate; DepoMedrol): 20 mg/mL, 40
mg/mL, 80 mg/mL
Injection (sodium succinate):
40-mg, 125-mg, 500-mg, 1-g,
2-g vials
Tablets: 2 mg, 4 mg, 8 mg, 16
mg, 24 mg, 32 mg
Injection: 5 mg/mL
Solution, oral: 5 mg/5 mL, 10
mg/5 mL
Tablets: 5 mg, 10 mg
Injection: Available 5 mg/mL
ready to infuse solution or
500-mg vial
Tablets: 250 mg, 500 mg
24
Midazolam (Versed)
Morphine sulfate
(Astramorph PF,
Duramorph, MSIR, MS
Contin, Roxanol)
Adults: 500–750 mg q8h.
Other parasitic infections (usually PO):
Infants and children: 15–30 mg/kg/d in 3
divided doses.
Adults: 250 mg q8h or a single 2-g dose.
Pelvic inflammatory disease:
Adults: 500 mg q12h.
Antibiotic-associated pseudomembranous
colitis:
Infants and children: 20 mg/kg/d in 4
divided doses.
Adults: 250–500 mg t.i.d. or q.i.d.
Oral doses may be taken with food to
minimize stomach upset.
IV (titrate dose slowly to avoid excessive
dosing):
Conscious sedation:
Children: 0.05 mg/kg just before the
procedure to a maximum dose of 2 mg.
Dose may be repeated q3 or 4 minutes up
to 4 times.
Adults: 0.5–2 mg over 2 minutes. Titrate to
effect by repeating doses q2–3 minutes to a
usual dose of 2.5–5 mg.
Infusion for sedation during mechanical
ventilation: Administer a loading dose of
0.05–0.2 mg/kg followed by a continuous
infusion of 1–2 mcg/kg/min and titrate to
effect.
PO:
0.5 mg/kg to a maximum dose of 15 mg.
Intranasally:
0.2–0.3 mg/kg/dose.
The intranasal route of administration ia not
FDA approved.
IV or IM:
Neonates and infants under age 6 months:
These patients are particularly sensitive to
the respiratory depressant effects of
opiates; therefore, the doses recommended
are lower: 0.03 mg/kg every 3 or 4 hours.
Infusions have been used in neonatal
patients at a dose of 0.01 mg/kg/hr. The
dose may be increased if necessary but
should not exceed 0.015–0.02 mg/kg/hr.
Infants over 6 months and children: 0.025–
0.1 mg/kg q3–6h. Doses of up to 2.5 mg/kg
have been used in severe pain such as sickle
cell or cancer pain. The usual maximum
dose is 10 mg.
Adults: 2.5–10 mg q2–6h.
Epidurally:
0.5–5 mg in the lumbar region. Dose may be
repeated q24h. Maximum dose is 10 mg/24
hr.
Intrathecally:
Injection: 1 mg/mL, 5 mg/mL
Solution: 2 mg/mL
Injection: 0.5 mg/mL, 1
mg/mL, 2 mg/mL, 3 mg/mL, 4
mg/mL, 5 mg/mL, 8 mg/mL,
10 mg/mL, 15 mg/mL
Solution: 10 mg/5 mL, 20
mg/5 mL, 20 mg/mL
Suppositories: 5 mg, 10 mg,
20 mg, 30 mg
Tablets: 15 mg, 30 mg
Tablets, controlled release:
15 mg, 30 mg, 60 mg, 100 mg
25
Naloxone (Narcan)
Neostigmine (Prostigmin)
Nitroprusside sodium
(Nipride, Nitropress)
1/10 of epidural dose or about 0.2–1
mg/dose. Repeat doses are not
recommended.
PO:
Prompt-release preparations are
administered every 3 or 4 hours; controlledrelease preparations are administered q8–
12h. Oral doses are ~1/3 as effective as IV
doses.
Infants over 6 months and children: 0.3
mg/kg every 3 or 4 hours (prompt release)
or 0.3–0.6 mg/kg q8–12h (extended
release).
Adults: 10–30 mg q3–4h (prompt release)
or 15–30 mg q8–12h (extended release).
IV (preferred), IM, or SC:
Neonatal opiate depression: 0.01 mg/kg q2–
3min until the desired response is obtained.
Additional doses may be necessary at 1–2hour intervals.
Opiate overdosage: 0.1 mg/kg to a dose of 2
mg administered q2–3min until 5 doses (up
to 10 mg) have been given. If the depressive
condition is not reversed, causes other than
opiate ingestion should be considered.
Additional doses may be necessary because
the duration of effect of the opiate is
generally longer than that of naloxone. The
drug may also be administered via
continuous infusion, especially if higher
doses are necessary.
Postoperative narcotic reversal (partial
reversal): 0.005–0.01 mg/kg q2–3min until
the desired degree of reversal is achieved.
Care should be taken to avoid excessive
dosage because that might result in a
decrease in analgesia and an increase in BP.
IM:
Myasthenia gravis test: 0.04 mg/kg single
dose
IV:
Reversal of nondepolarizing neuromuscular
blockade after surgery in conjunction with
atropine or glycopyrrolate:
Infants: 0.025–0.1 mg/kg/dose.
Children: 0.025–0.08 mg/kg/dose.
Adults: 0.5–2.5 mg, total dose not to exceed
5 mg.
IV as a continuous infusion:
0.3–0.5 mcg/kg/min initially, then titrate to
effect. Usual dose is 3 mcg/kg/min. The
maximum dose is 10 mcg/kg/min.
Cyanide toxicity may occur during
prolonged therapy or in patients with
hepatic dysfunction.
Administration of sodium thiosulfate may
Injection (neonatal): 0.02
mg/mL
Injection: 0.4 mg/mL, 1
mg/mL
Injection: 0.25 mg/mL, 0.5
mg/mL, 1 mg/mL
Injection: 50 mg
Protect solutions from light.
Do not use if highly colored
(blue, green, or red).
26
Norepinephrine
(Levarterenol, Levophed,
Noradrenalin)
Octreotide (somatostatin
analog; Sandostatin)
Oseltamivir (Tamiflu)
Oxycodone
Penicillamine (Cuprimine,
Depen)
Penicillin G, aqueous
(potassium or sodium salt)
decrease blood cyanide levels. Thiocyanate
may accumulate in patients with renal
impairment.
IV as a continuous infusion:
Initially 0.05–0.1 mcg/kg/min, titrated to
response. Maximum dose: 1–2 mcg/kg/min.
IV or SC:
The SC route is generally preferred because
absorption is not immediate and the activity
is somewhat prolonged. The drug may also
be administered as a continuous infusion.
Pediatric experience is limited, but initial
doses of 1–10 mcg/kg with total daily doses
of 2–50 mcg/kg in 2–4 divided doses. Usual
adult doses are 50 mcg 1 or 2 times daily
initially, then titrate dose to the patient's
response.
The long-term effects of octreotide on
growth hormone release have not been
determined.
PO (within 2 days of onset of symptoms
and continue for 5 days):
Age 1–12 years:
≤15 kg: 30 mg/dose b.i.d.
15 kg–23 kg: 45 mg/dose b.i.d.
23 kg–≤40 kg: 60 mg b.i.d.
Age ≥13 years or >40 kg: 75 mg b.i.d.
PO (oxycodone component for combination
products):
Children: 0.05–0.15 mg/kg/dose q4–6h.
Adults: 5 mg q6h initially; may be increased
to 10 mg q4h if necessary. Higher doses
may be necessary for severe pain, using a
plain oxycodone product.
Do not exceed a dose of 30 mg/kg/d.
Rheumatoid arthritis:
Children:
Initial: 3 mg/kg/d (≤250 mg/d) for 3 months,
then 6 mg/kg/d (≤500 mg/d) in divided
doses b.i.d. for 3 months. Maximum: 10
mg/kg/d in 3 or 4 divided doses.
Wilson disease:
Children: 20 mg/kg/d in 4 divided doses to a
maximum of 1 g daily. Round dose off to
the nearest 250 mg.
IV:
Neonates, age <7 days:
<2,000 g: 25,000 U/kg q12h. For meningitis,
use 50,000 U/kg q12h.
>2,000 g: 20,000 U/kg q8h. For meningitis,
50,000 U/kg q8h.
Neonates, age >7 days:
<2,000 g: 25,000 U/kg q8h. For meningitis,
Injection: 1 mg/mL
Injection: 50 mcg/mL, 100
mcg/mL, 200 mcg/mL, 500
mcg/mL, 1,000 mcg/mL
Capsules: 75 mg.
Powder for suspension: 12
mg/mL
Capsule: 5 mg
Solution: 1 mg/mL
Solution (concentrate): 20
mg/mL
Tablets: 5 mg, 15 mg, 30 mg
Also available in fixed
combinations with
acetaminophen or aspirin in
capsule, liquid and tablet
dosage forms.
Capsules: 250 mg
Tablets: 250 mg
Injection, potassium salt: 1
million U, 5 million U, 10
million U
Injection, sodium salt: 5
million U
27
Penicillin G procaine,
benzathine
Penicillin V potassium
Phenobarbital
Phenytoin
(Dilantin)/Fosphenytoin
(Cerebyx)
50,000 U/kg q8h.
>2,000 g: 25,000 U/kg q6h. For meningitis,
50,000 U/kg q6h.
Infants and children: 100,000–250,000
U/kg/d in 6 divided doses. Up to 500,000
U/kg/d may be used for severe infections to
a maximum of 20 million U/d.
Adults: 2–20 million U/d in 6 divided doses.
The potassium salt contains 1.7 mEq of
potassium and 0.3 mEq of sodium per 1
million U.
The sodium salt contains 2 mEq of sodium
per 1 million U.
The potassium salt must be administered
slowly at high doses due to the effect of the
potassium.
Deep IM:
Results in low but prolonged serum levels.
May be given as a single daily dose. A dose
of penicillin G benzathine will result in low
serum levels for up to 4 weeks.
Newborns: Avoid use in these patients
because sterile abscess and procaine
toxicity are of greater concern.
Infants: 50,000 U/kg up to 600,000 U.
Children and adults: 600,000–1.2 million
U/d. Maximum dose is 4.8 million U.
PO:
Children: 25–50 mg/kg/d in 4 divided doses.
Adults: 125–500 mg/dose q6h.
Prophylaxis:
Age <5 years: 125 mg b.i.d.
Age >5 years: 250 mg b.i.d.
IV or PO:
Loading doses (usually IV for status
epilepticus):
Neonates: 20 mg/kg in a single or 2 divided
doses.
Infants, children, and adults: 15–18 mg/kg a
single or 2 divided doses.
Allow 15–30 minutes for the drug to
distribute into the CNS and for the seizures
to stop.
Maintenance doses:
Neonates: 5 mg/kg/d in 2 divided doses.
Infants: 5–6 mg/kg/d in 2 divided doses.
Age 1–5 years: 6 mg/kg/d in 2 divided
doses. Age >5–12 years: 4 mg/kg/d in 1 or 2
divided doses.
Age >12 years: 1–2 mg/kg/d in 1 or 2
divided doses.
Care must be taken when changing from
one dosage form of the drug to another
because some contain phenytoin sodium
and some contain the free acid form of the
drug. The free acid form is used for the
Injection, benzathine:
600,000 U/mL
Injection, benzathine and
procaine: Combined equal
parts of each in 300,000 U,
600,000 U, 1.2 million U, 2.4
million U; 900/300 (900,000
U benzathine, 300,000 U
procaine)
Injection, procaine: 600,000
U/mL
Liquid, oral: 125 mg/5 mL,
250 mg/5 mL
Tablets: 250 mg, 500 mg
Elixir: 15 mg/5 mL, 20 mg/5
mL
Injection (sodium): 65
mg/mL, 130 mg/mL
Tablets: 15 mg, 30 mg, 32 mg,
60 mg, 65 mg 100 mg
Capsule, phenytoin sodium,
extended: 30 mg, 100 mg
Injection, (fosphenytoin): 75
mg/1 mL (equivalent to 50
mg phenytoin sodium)
28
Infatabs and the suspension. Phenytoin
sodium is used for the injection and
capsules. Phenytoin sodium contains 92%
phenytoin. Injection labeled as 50 mg/mL
phenytoin sodium contains 46 mg of
phenytoin and capsules labeled 100 mg
contain 92 mg phenytoin.
Fosphenytoin should be ordered in terms of
phenytoin equivalents.
The patient's serum levels should be
monitored whenever the dosage form is
changed. In addition, the different brands of
phenytoin capsules have different
dissolution characteristics. Dilantin capsules
are considered extended and may be dosed
in adults as a single daily dose. The serum
level range usually associated with clinical
effectiveness is 10–20 mcg/mL; that
associated with mild-to-moderate toxicity
may be as low as 25–30 mcg/mL.
Loading dose (IV or PO): 15–20 mg/kg in a
single or divided doses.
Maintenance dose (IV or PO): 5 mg/kg/d in
2 or 3 divided doses initially and then
adjusted to response and serum levels.
Usual ranges based on age (divided into 2 or
3 doses daily).
Neonates: 5–8 mg/kg/d.
Age 6 months to 3 years: 8–10 mg/kg/d.
Age 4–6 years: 7.5–9 mg/kg/d.
Age 7–9 years: 7–8 mg/kg/d.
Age 10–16 years: 6–7 mg/kg/d.
Adults: 5–6 mg/kg/d may be given as
asingle dose if extended-capsule
preparation is used.
Higher doses are required in infants and
young children due to lower absorption of
the drug from the GI tract.
IV doses of phenytoin should be
administered at a maximum rate of about 1
mg/kg/min (50 mg/min in adults) to avoid
cardiovascular side effects. The injection is
not compatible with many solutions or
medications. The line must be flushed well
with saline before administration to avoid
precipitation of phenytoin in the line.
Extravasation of the drug must also be
avoided because it is very alkaline and may
cause severe tissue necrosis. Thorough
flushing of the vessel after phenytoin
administration will also decrease the
incidence of local tissue inflammation that
may occur even in the absence of
extravasation.
Fosphenytoin injection should be diluted
with either 5% dextrose or normal saline to
a concentration of 1.5–25 mg of phenytoin
Injection, phenytoin sodium:
50 mg/mL
Suspension, phenytoin: 125
mg/5 mL
Tablet, chewable, phenytoin:
50 mg
29
Phytonadione (vitamin K,
Mephyton)
Polyethylene glycol
electrolyte solution (Colyte,
GoLYTELY, NuLytely)
Potassium chloride
equivalents (2.3–37.5 mg fosphenytoin) per
mL of diluent and may be administered at a
rate of 2–3 mg phenytoin
equivalents/kg/min (100–150 mg phenytoin
equivalents/min in adults).
IM or SC:
Hemorrhagic disease of the newborn,
prophylaxis: 0.5–1 mg within 1 hour of birth
and again 6–8 hours later, if needed.
Treatment: 1–2 mg/d.
Treatment of deficiency caused by
malabsorption or decreased synthesis or
due to drugs (administer IV cautiously and
slowly):
Children: 1–2 mg/d.
Adults: 10 mg/d.
Treatment of oral anticoagulant overdose:
Infants: 1–2 mg repeated q4–8h.
Children and adults: 2.5–10 mg repeated in
6–8 hours.
PO:
Prevention of deficiency in malabsorption:
Children: 2.5–5 mg every other day or daily.
Adults: 5–25 mg/d.
PO or NG after a 3–4-hour fast for bowel
cleansing:
Children: 25–40 mL/kg/hr.
Adults: 240 mL q10min.
The patient should continue to drink the
solution until the rectal effluent is clear.
Rapid drinking of each portion is more
effective than slow consumption. The 1st
bowel movement should occur about an
hour after starting. The solution is more
palatable if chilled, but must not be poured
over ice. Nothing, including other flavorings,
should be added to the solution.
PO:
Liquid doses must be well diluted before
administration to avoid GI adverse effects.
Capsules or tablets should be taken with a
full glass of water. Capsules may be opened
and emptied onto a soft food, but the beads
should not be crushed or chewed. Total
daily dose may be given in 1 or 2 divided
doses if tolerated, or may be given in 3 or 4
divided doses to decrease GI upset. Dose is
usually based on each patient's
requirements and may depend on
concurrent medications or medical
conditions that result in potassium losses.
The following may be used as general
Injection: 2 mg/mL, 10
mg/mL
Tablets: 5 mg
Powder for oral solution to
make 4 L (GoLytely): PEG3350
236 g, sodium sulfate 22.74 g,
sodium bicarbonate 6.74 g,
sodium chloride 5.86 g, and
potassium chloride 2.97 g
Powder for oral solution to
make 4L (Colyte): PEG3350
227.1 g, sodium sulfate 21.5
g, sodium bicarbonate 6.36 g,
sodium chloride 5.53 g, and
potassium chloride 2.82 g.
Powder for oral solution to
make 4L (Nulytely): PEG3350
420 g, sodium bicarbonate
5.72 g, sodium chloride 11.2
g, potassium chloride 1.48 g
Capsules, controlled release:
8 mEq (600 mg), 10 mEq (750
mg)
Infusions diluted in D5W, NS
or SWFI: 10 mEq, 20 mEq, 30
mEq, 40 mEq
Injection, concentrated: 2
mEq/mL, 3 mEq/mL
Liquids: 20 mEq/15 mL (10%),
40 mEq/15 mL (20%)
Powders, effervescent
packets: 20 mEq, 25 mEq
Tablets, extended release: 8
mEq (600 mg), 10 mEq (750
mg), 20 mEq (1500 mg)
30
Prednisolone
Prednisone
guidelines:
Normal daily requirement for either PO or IV
replacement:
Newborn: 2–6 mEq/kg/d.
Children: 2–3 mEq/kg/d.
Adults: 40–80 mEq/d.
During diuretic therapy:
Children: 1–2 mEq/kg/d.
Adults: 20–40 mEq/d.
For treatment of hypokalemia:
Children: 2–5 mEq/kg/d.
Adults: 40–100 mEq/d.
IV:
Doses should be well diluted. Usually they
are incorporated into the patient's daily
fluid requirement. The maximum desirable
concentration is 80 mEq/L. Greater
concentrations should be used cautiously
and only in patients with documented
hypokalemia with a serum potassium level
<2.5 mEq/L.
In the case of a patient in whom a shorter
infusion of potassium is necessary, the
following guidelines may be used:
Maximum concentration of the solution
must not exceed 30 mEq/100 mL (1 mEq/3
mL) and rate of infusion should not exceed
1 mEq/kg/hr in children or 40 mEq/hr in
adults. The solutions should be infused
using a pump to control the infusion rate.
Infusion over 2–3 hours (0.3–0.5
mEq/kg/hr) is more desirable.
Administration of doses >0.3 mEq/kg/hr
should be done only if the patient has an
ECG monitor in place. Solutions should be
mixed well to prevent layering of the
potassium chloride, which may result in
inadvertent rapid administration.
PO:
Depends on the condition being treated and
the patient's response. The lowest dose
possible should be used. Withdrawal of
long-term therapy must be accomplished
slowly by gradually tapering the dose. The
guidelines below may be used for initial
dosing.
Children: Anti-inflammatory or
immunosuppressive: 0.1–2 mg/kg/d in 1–4
divided doses.
Acute asthma: 1 mg/kg/dose q6–12h
depending on the severity of the attack q6h
dosing should be limited to 48 hours and
then should be decreased to q12h.
Inflammatory bowel disease: 1–3 mg/kg/d
in 1–2 divided doses.
Nephrotic syndrome: 2 mg/kg/d in 3 or 4
Other potassium salts are
also available and may be
desirable in patients who are
acidotic. They include
bicarbonate, citrate, acetate,
and gluconate salts.
Liquid, as sodium phosphate:
5 mg/5 mL (Pediapred), 15
mg/5 mL (OraPred)
Syrup (Prelone): 15 mg/5 mL
Tablets: 5 mg
Prednisone:
Solution: 1 mg/mL, 5 mg/mL
Syrup (Liquid Pred): 5 mg/5
mL
Tablets: 1 mg, 2.5 mg, 5 mg,
10 mg, 20 mg, 50 mg
31
Prochlorperazine
(Compazine)
Promethazine (Phenergan)
Propylthiouracil
Protamine sulfate
divided doses.
Organ transplants: 1 mg/kg/d in 2 divided
doses, tapering gradually to 0.15 mg/kg/d
or lowest effective dose.
PO or rectally as an antiemetic:
0.4 mg/kg/d in 3 or 4 divided doses or
alternatively by the patient's weight:
9–14 kg: 2.5 mg q12–24h as needed, to a
maximum of 7.5 mg/d.
>14–18 kg: 2.5 mg q8–12h as needed, to a
maximum of 10 mg/d.
>18–39 kg: 2.5 mg q8h or 5 mg q12h as
needed, to a maximum of 15 mg/d.
>40 kg:
Rectally: 25 mg q12h.
PO: 5–10 mg t.i.d. or q.i.d.
IM (IV is not recommended in children):
0.13 mg/kg; may be repeated if necessary
up to t.i.d. or q.i.d. Usual adult dose is 5–10
mg q4h to a maximum of 40 mg/d.
Antihistamine (usually PO):
Children: 0.1 mg/kg q6h during the day. A
dose of 0.5 mg/kg may be used at bedtime.
Adults: 12.5 mg q6h during the day with a
25-mg dose at bedtime.
Antiemetic (PO, IV, IM, or rectally):
Children: 0.5 mg/kg up to q4h.
Adults: 12.5–25 mg q4h as needed.
Motion sickness (PO):
Children: 0.5 mg/kg 30 minutes to 1 hour
before traveling; then q12h as needed.
Adults: 25 mg 30 minutes to 1 hour before
traveling; then q12h as needed.
Sedation (all routes):
Children: 0.5–1 mg/kg q6h as needed.
Adults: 25–50 mg q6h as needed.
PO:
Initially:
Neonates: 5–10 mg/kg/d in 3 divided doses.
Age <10 years: 5–7 mg/kg/d in 3 divided
doses.
Age ≥10 years: 150–300 mg/d in 3 divided
doses.
Adults: 300 mg/d in 3 divided doses.
After control of symptoms has been
achieved, the dose may be decreased to the
lowest dose possible, usually 1/3–2/3 of the
initial dose, administered in 3 doses daily.
IV:
1 mg of protamine sulfate neutralizes 90 mg
of lung-derived heparin or 115 U of
intestinal mucosa-derived heparin. Because
heparin disappears rapidly from the
circulation, the dose of protamine
decreases rapidly with time elapsed since
the heparin infusion. The dose of protamine
Injection: 5 mg/mL
Suppositories: 2.5 mg, 5 mg,
25 mg
Syrup: 5 mg/5 mL
Tablets: 5 mg, 10 mg
Injection: 25 mg/mL, 50
mg/mL
Suppositories: 12.5 mg, 25
mg, 50 mg
Syrup: 6.25 mg/5 mL
Tablets: 12.5 mg, 25 mg, 50
mg
Tablets: 50 mg
Injection: 10 mg/mL
32
Ranitidine (Zantac)
Rifampin (Rifadin,
Rimactane)
Sodium bicarbonate
(baking soda, NaHCO3)
necessary after 30 minutes is half the dose
above and that necessary after 2 hours is
1/4 the dose above. Because protamine
itself is an anticoagulant, avoid overdosing.
Protamine should be administered slowly,
over a 1-minute period, and the dose
should not exceed 50 mg.
PO:
Children: 2–4 mg/kg/d in 2 divided doses
initially. Dose may be higher, up to 8
mg/kg/d in GERD and hypersecretory
conditions.
Adults: 150 mg b.i.d. or 300 mg at bedtime.
Dose may be higher or more frequently
administered. Up to 6 g/d has been used in
hypersecretory conditions.
IV:
Children: 1–2 mg/kg/d in 3 or 4 divided
doses. Do not exceed 6 mg/kg/d or 300
mg/d.
Adults: 50 mg q8h. Do not exceed 400
mg/d.
Dosage should be adjusted for renal
dysfunction.
PO (on an empty stomach):
Tuberculosis:
Children: 10–20 mg/kg/d as a single daily
dose to a maximum of 600 mg.
Adults: 600 mg/d.
Meningococcal carriers:
Age <1 month: 10 mg/kg/d in 2 divided
doses for 2 days.
Infants and children: 20 mg/kg/d in 2
divided doses for 2 days, to a maximum
dose of 1,200 mg/d.
Adults: 600 mg/dose b.i.d. for 2 days.
Haemophilus influenzae type b prophylaxis:
Age <1 month: 10 mg/kg/d as a single dose
for 4 days.
Age >1 month and children: 20 mg/kg/d as
a single dose for 4 days.
Adults: 600 mg/d for 4 days.
Nasal carriers of Staphylococcus aureus:
Children: 15 mg/kg/d in 2 divided doses in
combination with other antibiotics.
Adults: 600 mg daily in combination with
other antibiotics.
IV (over 30 minutes to 3 hours):
Same doses as for the oral route. Rifampin
may cause a red-orange discoloration of the
sweat, urine, tears, and other body fluids;
soft contact lenses may be permanently
stained.
IV:
Cardiac arrest (only after adequate
ventilation has been established): 1 mEq/kg
Capsule: 150 mg, 300 mg
Injection: 25 mg/mL
Syrup: 15 mg/mL
Tablets: 75 mg, 150 mg, 300
mg
Tablets, effervescent: 25 mg,
150 mg
Capsules: 150 mg, 300 mg
Injection: 600 mg
Suspension: Not
commercially available, but
may be made by mixing the
powder from the capsules
with simple syrup to form a
10 mg/mL suspension. Such
suspensions are stable for 4
weeks at room temperature
or refrigerated.
Injection: 4.2% (0.5 mEq/mL),
7.5% (0.9 mEq/mL), 8.4% (1
mEq/mL)
33
Sodium polystyrene
sulfonate (Kayexalate)
Tetracycline (Achromycin
V, Panmycin, Robitet,
Sumycin)
Vancomycin (Vancocin)
IV push initially; may repeat with a dose of
0.5 mEq/kg. Further doses should not be
given until the patient's acid-base status has
been determined. In infants, the
concentration should not exceed 4.2% (0.5
mEq/mL).
Metabolic acidosis (after measurement of
blood gases and pH):
Children: mEq HCO3 = 0.3 × weight (kg) ×
base deficit (mEq/L) OR mEq HCO3 = 0.5 ×
weight (kg) × [24-serum HCO3 (mEq/L)].
Adults: mEq HCO3 = 0.2 × weight (kg) × base
deficit (mEq/L) OR mEq HCO3 = 0.5 × weight
(kg) × [24-serum HCO3 (mEq/L)].
Doses should be administered slowly with
frequent monitoring of acid-base balance.
PO:
Urine alkalinization (titrate dose to desired
pH):
Children: 1–10 mEq/kg/d in divided doses.
Adults: 48 mEq initially followed by 12–24
mEq q4h. Doses up to 192 mEq/d have been
used.
PO:
Children: Base the dose on the exchange
rate of 1 mEq K+/g of resin in smaller
children.
Alternatively, a dose of 1 g/kg q6h may be
used.
Adults: 15 g administered once daily to
q.i.d.
Rectally as a retention enema:
Children: 1 g/kg q2–6h.
Adults: 30–50 g q6h.
Enemas should be retained for as long as
possible to increase ion exchange.
Evacuation of the enema should be
followed by a non-sodium-containing
cleansing enema. Sorbitol is frequently used
for making solutions because it helps to
prevent constipation.
Administer cautiously to patients who may
be at risk of serum sodium level increases. It
is not totally selective for potassium; small
amounts of calcium and magnesium may
also be lost.
PO (should be given on an empty
stomach):
Age >8 years: 25–50 mg/kg/d in 4 divided
doses.
Adults: 1–2 g/d in 2–4 divided doses.
IV (over at least 1 hour):
Neonates, age <7 days:
<1,000 g: 10 mg/kg q24h.
1,000–2,000 g: 10 mg/kg q18h.
>2,000 g: 10 mg/kg q12h.
Tablets: 325 mg, 650 mg
Powder for oral or rectal use
Suspension: 15 g/60 mL (with
sorbitol) for oral or rectal use
Capsules: 250 mg, 500 mg
Suspension: 125 mg/5 mL
Tablets: 250 mg, 500 mg
Capsules: 125 mg, 250 mg
Injection: 500 mg, 1 g (5-g,
10-g pharmacy bulk
packages)
34
Neonates, age 7–30 days:
<1,000 g: 10 mg/kg q18h.
1,000–2,000 g: 10 mg/kg q12h.
>2,000 g: 10 mg/kg q8h.
Infants, age 31–60 days: 10 mg/kg q8h.
Age >2 months: 40 mg/kg/d in 4 divided
doses to a maximum dose of 2 g/d.
Adults: 0.5 g q6h or 1 g q12h. Dosage
adjustment is necessary in renal
impairment.
Higher doses, up to 60 mg/kg/d, may be
required in children with staphylococcal
CNS infections.
Intrathecal:
Neonates: 5–10 mg/d.
Children: 5–20 mg/d.
Adults: 20 mg/d.
PO (not absorbed; do not use for systemic
infections):
Children: 40 mg/kg/d in 4 divided doses to a
maximum daily dose of 2 g. The injectable
form may be used PO.
Adults: 0.5–2 g/d in 3 or 4 divided doses.
35
A
Acetaminophen
Acetazolamide (Diamox)
Acetylcysteine
Acyclovir
Adenosine
Adrenaline
Albuterol (Salbutamol)
Allopurinol
Aminocaproic acid
Amiodarone (Cordarone)
Amoxicillin
Ampicillin (Principen)
Aspirin
Atropine sulfate
6
6
1, 6
6
2, 6
4
6
6
6
6
6
6
6
6
C
Calcium salts
Carbamazepine (Carbatrol, Tegretol, Tegretol-XR)
Cefazolin (Ancef)
Cefotaxime (Claforan)
Ceftriaxone (Rocephin)
Cephalexin (Keflex)
Charcoal (Actidose-Aqua, Actidose with Sorbitol, CharcoAid, Liqui-Char)
Chloral hydrate (Aquachloral)
Chlorpromazine
Clindamycin (Cleocin)
Codeine
Co-trimoxazole (trimethoprim and sulfamethoxazole; Bactrim, Septra)
6
6
6
6
6
6
6
6
6
6
6
6
D
Deferoxamine (Desferal)
Desmopressin acetate (DDAVP)
Dexamethasone
Diazepam (Diastat Rectal, Valium)
Digoxin (Lanoxicaps, Lanoxin)
Dimercaprol [BAL (British anti-lewisite)]
Diphenhydramine
Dobutamine hydrochloride (Dobutrex)
Dopamine hydrochloride (Dopastat, Intropin)
Doxycycline (Doxy-100, Vibramycin)
6
6
6
6
6
6
6
6
6
6
E
Edetate calcium disodium (Calcium Disodium Versenate, Calcium EDTA)
Enoxaparin (Lovenox)
Epinephrine (Adrenalin)
Erythromycin (Ery-Tab, Eryc, Erythrocin, E.E.S.)
6
6
6
6
36
F
Fentanyl citrate (Sublimaze)
Ferrous sulfate (Feosol, Fer-In-Sol)
Flumazenil (Mazicon, Romazicon)
Folic acid
6
6
6
6
G
Gentamicin (Garamycin)
Glucagon
Glycopyrrolate (Robinul)
6
6
6
H
Haloperidol (Haldol)
Heparin sodium
Hydralazine (Apresoline)
Hydrochlorothiazide (Esidrix, HydroDIURIL, Oretic)
Hydrocortisone (Cortef, Cortenema, Cortifoam, Solu-Cortef)
Hydromorphone (Dilaudid)
6
6
6
6
6
6
I
Ibuprofen (Advil, Motrin, Nuprin)
Immune globulin, intramuscular
Immune globulin, intravenous (Gammagard S/D, Gammar-P IV, Gamunex, Iveegam, Octagam, Polygam S/D)
Indomethacin IV (Indocin IV)
Insulin
Ipratropium bromide (Atrovent)
Isoproterenol (Isuprel)
6
6
6
6
6
6
6
L
Levothyroxine sodium (Levothroid, Synthroid)
Lidocaine hydrochloride (Xylocaine)
6
6
M
Magnesium sulfate (Epsom Salts)
Mannitol (Osmitrol)
Methylene blue (Urolene Blue)
Methylprednisolone (A-methaPred, Depo-Medrol, Medrol, Solu-Medrol)
Metoclopramide (Reglan)
Metronidazole (Flagyl, Protostat)
Midazolam (Versed)
Morphine sulfate (Astramorph PF, Duramorph, MSIR, MS Contin, Roxanol)
6
6
6
6
6
6
6
6
N
Naloxone (Narcan)
Nitroprusside sodium (Nipride, Nitropress)
Norepinephrine (Levarterenol, Levophed, Noradrenalin)
6
6
6
37
O
Octreotide (somatostatin analog; Sandostatin)
Oseltamivir (Tamiflu)
Oxycodone
6
6
6
P
Penicillamine (Cuprimine, Depen)
Penicillin G procaine, benzathine
Penicillin G, aqueous (potassium or sodium salt)
Penicillin V potassium
Phenobarbital
Phenytoin (Dilantin)/Fosphenytoin (Cerebyx)
Phytonadione (vitamin K, Mephyton)
Polyethylene glycol electrolyte solution (Colyte, GoLYTELY, NuLytely)
Potassium chloride
Prednisolone
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Propylthiouracil
Protamine sulfate
6
6
6
6
6
6
6
6
6
6
6
6
6
6
R
Ranitidine (Zantac)
Rifampin (Rifadin, Rimactane)
6
6
S
Sodium bicarbonate (baking soda, NaHCO3)
6
T
Tetracycline (Achromycin V, Panmycin, Robitet, Sumycin)
6
V
Vancomycin (Vancocin)
6
38