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University of Kentucky Children’s Hospital Common Pediatric IV Drugs Quick Reference for Administration in NICU / 3NEO Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Acyclovir 15-60 mg/kg/day divided Q8H 7 mg/ml final concentration Over at least 1 hr. Pharmacy should dispense in a syringe diluted to <= 7 mg/ml, so no further dilution required. Rapid infusion can cause nephrotoxicity. TPN: no Lipids: no Adenosine Initial 50-100 mcg/kg/dose; if not effective within 1-2 min, increase dose by 50-100 mcg/kg increments every 1-2 min until max single dose of 300 mcg/kg or until termination of PSVT 3 mg/ml For rapid IV bolus Administer over 1-2 seconds at peripheral IV site closest to patient’s heart Follow each bolus dose with a NSS flush TPN: no Lipids: no Albumin 0.5 – 2 gram/kg/day 25% (250 mg/ml) 5% (50 mg/ml) Over 2 – 24 hours (generally a bolus over 4 hrs or continuous infusion) Compatible with TPN. May or may not be filtered prior to administration TPN: yes Lipids: yes Aminophylline Loading dose = 4-6 mg/kg Maintenance dose = 1.5-3 mg/kg/dose IV/po Q8-12H *Adjust dose based on drug levels 25 mg/ml (max) Intermittent infusion: infuse over 15-30 minutes Monitor HR, RR, and check blood glucose Target level for apnea = 7 – 12 mcg/ml Target level for bronchospasm = 10-20 mcg/ml *Monitor by drawing THEOPHYLLINE trough 30 minutes prior to dose. TPN: yes Lipids: no Amphotericin B 0.1-1mg/kg/day PIV: 0.1 mg/ml Central line: 0.5 mg/ml Over 2-6 hours. Usually over 4 hours. Give in DEXTROSE ONLY. Protect from light. TPN: no Lipids: no Amphotericin B liposome (Ambisome) 3-5 mg/kg/day 1 mg/ml (max conc: 2 mg/ml) Over 2 hours. Range= 2-6 hours Give in DEXTROSE ONLY. Stable for 48 hrs when refrigerated or 6 hours at room temperature. Flush line with D5W before infusion or use separate line. TPN: no Lipids:no (Zovirax) Page 1 of 9 Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Ampicillin Neonates: 100 mg/kg/dose IV Q12H Meningitis: 200-400mg/kg/day 30 mg/ml IV push: 100 mg/ml Intermittent infusion over 15-30 min. IVP: doses < 500mg give over 3-5 minutes IVP: not to exceed 100 mg/min Do not administer concurrently with Gentamicin. Ampicillin 125mg vial; add 1.2ml NSS = 125 mg/ml Ampicillin 250mg vial: add 1ml NSS = 250 mg/ml Ampicillin 500mg vial: add 1.8ml NSS = 250 mg/ml TPN: no Lipids: no Azithromycin (Zithromax) Day 1: 10 mg/kg/day Days 2-5: 5 mg/kg/day 2 mg/ml Over 1-3 hours Usually over 60 min Max 500 mg/day TPN: no Lipids: no Bactrim (TMP/SMZ) 6-20 mg TMP/kg/day divided Q12h Serious infections: 15-20mg TMP/kg/day divided Q6-8H Dilute each 1ml of drug in 20-25ml of D5W (diluted by pharmacy prior to administration) Over 60-90 min. Give in D5W only. Maintain adequate fluid intake. Do not refrigerate. Protect from light. TPN: no Lipids: no Caffeine (Calfcit) Loading dose = 10-20 mg/kg Maintenance dose = 5-10 mg/kg/day 20 mg/ml (max) Over 15-30 min. Start maintenance dose 24 hours after loading dose. Consider holding dose if HR > 180 bpm TPN: no Lipids: no Cefazolin (Ancef, Kefzol) 50-100 mg/kg/day divided Q8H 100 mg/ml Over 10-60 min. Do NOT administer concurrently with aminoglycosides TPN: yes Lipids: yes Cefepime (Maxipime) 50mg/kg/dose given Q12H 50mg/kg/dose given Q8H for neutropenic fever (max dose) 100 mg/ml Over 30-60 min. Do NOT administer concurrently with aminoglycosides. TPN: yes Lipids: no Cefotaxime (Claforan) 100-200 mg/kg/day divided Q6-8H; 300 mg/kg/day meningitis 100 mg/ml Over 30 min. Do NOT administer concurrently with aminoglycosides. TPN: yes Lipids: no Ceftazidime (Fortaz) 150 mg/kg/day divided Q8h CF: 320 mg/kg/day 100 mg/ml Over 30 min. Do NOT administer concurrently with aminoglycosides. TPN: yes Lipids: yes Cefuroxime (Zinacef) 75-150 mg/kg/day divided Q8H (300 mg/kg/day MAX) 100 mg/ml Over-30 min. Do OT administer concurrently with aminoglycosides. TPN: yes Lipids: yes Page 2 of 9 Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Clindamycin (Cleocin) 25-40 mg/kg/day divided Q 6-8h 18 mg/ml Over 10-60 min. Not to exceed 30mg/min. Hypotension/cardiac arrest possible after rapid IV administration. TPN: yes Lipids: yes Cosyntropin High dose test: 0.25 mg Low dose test: 1 mg/m2 0.25 mg/ml (max) Dilution of 1 mcg/ml for low dose test IV push over 2 min Draw labs as specified (usually plasma cortisol conc immediately BEFORE and exactly 30 minutes LATER) TPN: no Lipids: no Dexamethasone (Decadron) Anti-inflammatory: 0.08-0.3 mg/kg/day divided Q 6-12h Airway edema: 0.5-2 mg/kg/day divided Q6h 4 mg/ml (MAX) Over 15-30 min. IV Push: over 1-4 min. if dose<10mg. TPN: yes Lipids: yes Digoxin (Lanoxin) Loading dose: 15-50 mcg/kg Maintenance dose: 4-6 mcg/kg/day Over 5-30 min Monitor electrolytes (K+, Mag, Ca++) TPN: yes Lipids: yes Diphenhydramine (Benadryl) 1.25 mg/kg/dose Q 6 hours 25 mg/ml or 1 mg/ml dilution (if dose immeasurable) Over 15 min. Max infusion rate: 25 mg/min. TPN: yes Lipids: yes Erythromycin 5-40 mg/kg/day (lower dose when given as a prokinetic agent) 5 mg/ml Over 20-120 min May be given as a prokinetic agent (if not responsive to metoclopramide) TPN: yes Lipids: yes Erythropoietin (Epotein alfa) (Epogen) 200-400 units/kg/dose 3 times per week Dilute with an equal volume of NSS Over 3 minutes to 4 hours Treatment of anemia TPN: yes Lipids: no Famotidine (Pepcid) 0.5-1 mg/kg/day divided Q12-24h 2 mg/ml Over 15-30 min. May be added into TPN TPN: yes Lipids: yes Fentanyl (Sublimaze, Duragesic) 1-4 mcg/kg/dose Max 50 mcg/ml Over 3-5 min Apnea or chest wall rigidity may occur with rapid bolus injection. Peak respiratory depression occurs 5-15 min after dosing. Respiratory depression reversible with naloxone. TPN: yes Lipids: yes 100 mcg/ml (MAX) Page 3 of 9 Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Filgrastim (Neupogen) 5-10 mcg/kg/day 5-15 mcg/ml; diluted by pharmacy in a syringe Over 15-60 min Albumin added to IV infusions. Albumin acts as a carrier molecule to prevent drug adsorption to the IV tubing TPN: no Lipids: no Fluconazole (Diflucan) 3-12 mg/kg/day once daily 2 mg/ml Over 1-2 hours. Not to exceed 200 mg/hr. Do not mix with any other drugs. TPN: yes Lipids: yes Flumazenil (Romazicon) Initial dose = 0.01 mg/kg; may repeat until max of 0.05 mg/kg Max 1 mg 0.1 mg/ml Over 15 SECONDS Benzodiazepine antagonist – reverses sedative effects of benzodiazepines TPN: no Lipids: no Fosphenytoin (Cerebyx) 5-10 mg/kg/day divided Q 8-12h (Dose varies with drug levels.) 25 mg/ml (MAX) 1-3 mg/kg/MIN Dose adjustments based on drug levels. Obtain post load level 2 hours after end of the infusion or troughs PRIOR to a dose. Compatible with NSS and D5W TPN: no Lipids: no Furosemide (Lasix) 1-2 mg/kg/dose Q 6-12h 10 mg/ml (MAX) Over 10-15 min. IV Push: max rate 0.5mg/kg/min Monitor serum electrolytes TPN: yes Lipids: yes Gentamicin NICU: 4 mg/kg/day IV Q24H Infants: 2.5 mg/kg/dose Q8H (Dose varies with drug levels.) 10 mg/ml 30 min. Serum levels with 3 -4 dose. Obtain trough 30 minutes prior to dose and obtain peak 30 minutes after the 30 minute infusion. Improper administration increases the risk of side effects (renal failure, hearing loss, vertigo). TPN: yes Lipids: yes Glycopyrrolate (Robinul) 0.004-0.01mg/kg Q4-8H or 4-10 mcg/kg/dose Q3-4H IV push conc = 0.2 mg/ml 0.2mg over 1-2 minutes May give IM or IV TPN: no Lipids: no Heparin Art lines = 0.5 - 2 units/ml PIV = 0.5 - 1 unit/ml UAC = 0.5 - 2 units/ml Promotion of lipid clearance=1 unit/ml in TPN Generally continuous infusion Generally continuous infusion HIT (heparin induced thrombocytopenia) is NOT dose related. TPN: yes Lipids: no Hydralazine 0.1-0.6 mg/kg/dose Q3-6H 20 mg/ml (max) or 1 mg/ml DILUTION Over 1-2 min Monitor BP and HR for 30-60 min after infusion TPN: no Lipids: no Hydrocortisone (Solu-cortef) 1-2 mg/kg/dose IV Q6-24H 50 mg/ml (max) Over 10-30 min Uses: treatment of coritsol deficiency, blood pressure support, or adjunctive for persistent hypoglycemia. TPN: yes Lipids: yes rd th Page 4 of 9 TPN/IL compatible Drug Dose Range Ready-toadminister concentration IV Administration Notes Ibuprofen lysine IV for PDA closure: Initial dose = 10 mg/kg nd 2 dose = 5 mg/kg rd 3 dose = 5 mg/kg 4 mg/ml Over 15 min May hold 2 or 3 doses if UOP < 0.6 ml/kg/hr May give second course if first course ineffective. TPN: no Lipids: no Immune globulin (IVIG) 0.4-2 gm/kg/dose Usual 10% solution (100 mg/ml) May use dilution of 1-4 mg/ml Over 2-12 hours Initial infusion rate is 0.5 ml/kg/hr x 15-30 min, then 1 ml/kg/hr x 15-30 min, then 2 ml/kg/hr x 1530 min, and a max rate of 4 ml/kg/hr TPN: no Lipids: no Indomethacin (Indocin) Initial dose = 0.2 mg/kg st PNA at time of 1 dose < 48 hrs = 0.1 mg/kg Q12-24H st PNA at time of 1 dose 2-7 days = 0.2 mg/kg Q12-24H st PNA at time of 1 dose > 7 days= 0.25 mg/kg IV Q12-24H 0.5 mg/ml 30 min – 6 hours Rapid administration causes a significant decrease in mesenteric artery and cerebral blood flow, which may contribute to the development of NEC or cerebral ischemia. Generally use Q12H TPN: no Lipids: no Insulin (Regular insulin) DKA: 0.1 unit/kg, followed by 0.05-0.1 unit/kg/hour Per MD/Pharmacy Continuous infusion Only regular insulin can be given IV. Prime IV tubing with insulin drip to prevent adsorption of the insulin to the tubing. TPN: yes Lipids: yes Levofloxacin (Levaquin) 10 mg/kg/dose IV Q12H 5 mg/ml Over at least 60 minutes Too rapid of infusion may cause hypotension. Flush IV tubing before and after infusion. May alter blood glucose levels. TPN: no Lipids: no Levothyroxine (Synthroid) 5-15 mcg/kg/day 100 mcg/ml Over 2-3 min AAP recommends an initial oral dose of 10-15 mcg/kg/day. IV doses should be 50-75% of oral doses. TPN: no Lipids: no Linezolid (Zyvox) 10 mg/kg/dose IV Q8-12H 2 mg/ml Infuse over 30-120 min (Usually over 1-2 hrs) Sent by pharmacy as 2 mg/ml concentration. Further dilution not required. Administer through dedicated IV line (do not mix with other drugs). Protect from light. TPN: no Lipids: no Lipids 0.5-4 g/kg/day 20% solution Continuous infusion over 24 hours Must turn off lipid infusion off for at least 2 hours prior to drawing a serum triglyceride level. nd rd Page 5 of 9 Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Lorazepam (Ativan) 0.01-0.1 mg/kg/dose Q4-8h 1 mg/ml Max = 2 mg/ml (undiluted drug) IV Push: 2-5 min. not exceeding 2 mg/min. Inadvertent intra-arterial injection can cause vasospasm; could result in gangrene. Use repeated aspiration with slow IV push, to make sure the injection is not intra-arterial and extravasation has not occurred. Flumazenil is antidote. TPN: yes Lipids: no Meropenem (Merrem) 20-40 mg/kg Q8-12H 120 mg/kg/day for meningitis 20 mg/ml Over 30 minutes Restricted – must have ID service approval. TPN: yes Lipids: yes Methadone (Dolophine) 0.05-0.2 mg/kg/dose IV Q12-24H 1 mg/ml 10 mg/ml (max) Over 30 minutes Usually taper dose by 10-20% every 3-7 days TPN: no Lipids: no Methylprednisolone (Solu-Medrol) Anti-inflammatory dose: 0.5-1.7 mg/kg/day divided Q6-12h Asthma: 2mg/kg x 1 dose, then 0.5-1mg/kg/dose Q6H 20 mg/ml IV Push: ≤1.8 mg/kg: 3-15 min. ≥2mg/kg: 15-20 min. >15mg/kg: 30-60 min. Intermittent: 15-60 min. IV push of high dose→ cardiac arrhythmias, hypotension, sudden death. TPN: yes Lipids: yes Metoclopramide 0.1-0.2 mg/kg/dose IV Q6-8H 0.2 mg/ml and 1 mg/ml and 5 mg/ml (max) for fluid restricted patients Over 15 min Same dose IV or po TPN: yes Lipids: yes Metronidazole (Flagyl) 0-4 weeks: <1200 gm = 7.5 mg/kg IV Q48H PNA <= 7 days: 1200-2000 gm = 7.5 mg/kg IV Q24H PNA <= 7 days: >2000 gm = 7.5 mg/kg/dose IV Q12H PNA > 7days: 1200-2000 gm = 7.5 mg/kg/dose IV Q12H PNA > 7 days: > 2000gm = 15 mg/kg/dose IV Q12H Infants & children: 15-30 mg/kg/day divided Q6-8H 5 mg/ml (concentration dispensed by pharmacy) Over 60 min Sent by pharmacy as a ready-to-administer concentration of 5 mg/ml. No further dilution required for administration. TPN: yes Lipids: yes Midazolam 0.05-0.2 mg/kg/dose 1 mg/ml IV push over 20-30 sec Generally given over 5 minutes in neonates Flumazenil is indicated for complete or partial reversal of benzodiazepine toxicity TPN: no Lipids: no Page 6 of 9 Ready-toadminister concentration IV Administration Notes TPN/IL compatible IVP: 0.5-5 mg/ml Continuous IV infusion: 0.1-1 mg/ml IV Push: ≥5 min. Intermittent: 15-30 min Naloxone is reversal agent. Do not administer rapidly IV. TPN: yes Lipids: yes 50-200mg/kg/day divided Q612H 40 mg/ml (100 mg/ml for fluid restricted patients) Over 30-60 min Extravasation may cause tissue sloughing and necrosis. TPN: yes Lipids: yes Naloxone (Narcan) 0.01 – 0.1 mg/kg/dose 4 mcg/ml Over 30 sec for IV push May be given SQ, IM, ET, and IV TPN: no Lipids: no Octreotide (Sandostatin) 1-10 mcg/kg/day 1.5 – 250 mcg/ml Dilute in D5W or NSS 15-30 minutes Usually given SQ (preferred route) TPN: yes Lipids: yes Pantoprazole (Protonix) Dose = 0.5-1 mg/kg/dose; usually Q24h but may be increased to Q12H 4 mg/ml Over 15-30 min Do not exceed 3 mg/min infusion. TPN: no Lipids: no Penicillin G 25,000-400,000 units/kg/day divided Q4-12H (based on PNA & wt) 50,000 units/ml Over 30-60 min Give in NS or D5W. TPN: yes Lipids: yes Pentobarbital (Nembutal) 2-6 mg/kg/dose Max 50 mg/ml Over 10-30 min Rapid administration may cause respiratory depression, apnea, and laryngospasm. Extravasation may cause tissue necrosis. TPN: yes Lipids: no Phenobarbital Hyperbilirubinemia: 3-8 mg/kg/day Sedation: 1-3 mg/kg/dose Seizures: (1-2 doses/day) Neonates: 4-5 mg/kg/day Infants: 5-6 mg/kg/day *Loading dose = 10-20 mg/kg* 10 mg/ml No faster than 1 mg/kg/min. Monitored by levels (saliva or blood). May cause respiratory depression if administered too rapidly or when combined with other sedatives. Extravasation may cause tissue necrosis. Usual loading dose = 10-20 mg/kg IV to po conversion = 1:1 TPN: yes Lipids: no Phenytoin (Dilantin) 5-10 mg/kg/day divided Q 8-12h (Dose varies with drug levels.) 50 mg/ml Max rate of 50mg/min. Flush with NS after giving. Give in NS only TPN: no Lipids: no Phytonadione (Vitamin K) Prophylaxis = 0.5-1 mg at birth 0.5 mg/ml Over 15-30 min Route = IV, IM, SQ Max rate = 1 mg/min TPN: yes Lipids: no Drug Dose Range Morphine 0.05-0.1 mg/kg/dose Nafcillin Q2-4H Page 7 of 9 Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Rifampin 10-20 mg/kg/day divided Q1224H 6 mg/ml 30 min - 3 hours Urine, tears, & sweat may turn orange-red. Protect from light, use separate IV tubing. Give in D5W (preferred) can use NS. TPN: no Lipids: no Sodium Bicarbonate 1-2 meq/kg/dose 0.5 meq/ml (infant bicarb syringe concentration) IV push over 2 minutes Over 2 hours (max rate 1 meq/kg/hour) IV push reserved for cardiac arrest TPN: yes Lipids: yes TPN Infusion rate dependent on total fluids for patient Continuous infusion over 24 hours New orders must be written daily for neonatal TPN. Tobramycin Usual dose = 4 mg/kg/day or 2-2.5 mg/kg/dose Q8H (depending on PNA and age) 10 mg/ml Over 30 min. Serum levels with 3 -4 dose. Obtain trough 30 minutes prior to dose and obtain peak 30 minutes after the 30 minute infusion. Improper administration increases the risk of side effects (renal failure, hearing loss, vertigo). TPN: yes Lipids: yes Tromethamine (Tham) Metabolic acidosis: 1 ml for each pH unit < 7.4 Base deficit: dose in mls = base deficit (meq/L) x body wt (kg) x 1.1 0.3 molar soln (max conc) Minimum 1 hour (3-16 ml/kg/hour) Extravasation may result in tissue necrosis, severe inflammation, and sloughing. THAM is renally eliminated and may accumulate in renal insufficiency. TPN: no Lipids: no TPA (alteplase) <10kg: 0.5mg in NSS Fill to volume size of occluded catheter Instill ordered dose in each port. Leave in port for 1 hour, then aspirate. No established guidelines for use in children. Medication dose ordered will be diluted in varying volumes based on the port size. TPN: no Lipids: no Unasyn (Ampicillin/ sulbactam) 100-200 mg/kg/day divided Q6H (Ampicillin component) meningitis: 400 mg/kg/day 30 mg/ml (RN to further dilute due to short expiration) 15-30 minutes. Mix 1.5 gram vial with 3.2 mL of NS. Mix 3 gm vial with 6.4ml of NS. Final conc = 250 mg/ml Ampicillin component. TPN: yes Lipids: yes Vancomycin 10-20 mg/kg/dose Q8-24h *dose based on age and renal function 5 mg/ml (10 mg/ml for fluid restricted patients) Over at least 1 hour. Rapid infusion associated with red man syndrome, and may also cause hypotension and cardiac arrest. Obtain trough 30 minutes prior to dose and peak one hour after the 1 hour infusion. 0.1 mg/kg/dose 1 mg/ml IV push over seconds Vecuronium rd th Does not alter patient’s state of consiousness; addition of sedation and analgesia is recommended TPN: yes Lipids: yes TPN: yes Lipids: no Page 8 of 9 Drug Dose Range Ready-toadminister concentration IV Administration Notes TPN/IL compatible Zosyn (piperacillin/ tazobactam) 240 mg/kg/day divided Q6-8H CF: 350-450 mg/kg/day (piperacillin component) 200 mg/ml Over 30 minutes Do NOT administer concurrently with aminoglycosides (piperacillin can inactivate aminoglycosides). TPN: yes Lipids: yes Updated: 3/6/12 Approved by: Karen Garlitz, PharmD Contact person for revisions: Karen Garlitz, PharmD ([email protected]) Page 9 of 9