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Disclaimer - Please see package insert if applicable for additional information. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer   |   <BACK

 Drug Dosing  top of page

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Drug

Standard dose

ROSC / Comments

Cardiac arrest - VF - Pulseless VT

Epinephrine

1 mg q3-5 min.
Drip: 0.1- 0.5 mcg/kg/min

Drip1mg/250ml --> (ml/hr) = wt x mcg/kg x 15.  1mg/100ml --> wt x mcg/kg x 6.  Endotracheal: 2-2.5 mg diluted with 10ml NS

Vasopressin

40 units IV x 1

0.01 - 0.03 units/min. Drip: 40 units/100ml NS
0.01 units/min = 1.5 ml/hr;   0.03 units/min = 4.5 ml/hr.

Amiodarone

300mg IV over 1-2 seconds
May repeat 150 mg IV x 1.

Drip: 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs.

Lidocaine

1 - 1.5 mg/kg over 2-3 min, then may repeat 0.5-0.75 mg/kg in 5-10 min. Max: 3 mg/kg.

Drip: 1 - 4 mg/min.  1 gram/250 ml (ml/hr) =  mg/min x 15

Calcium Chloride

5-10 ml (0.5-1 gm) over 2-5min

Calc gluc: 15-30 ml over 2 to 5 minutes.

Dopamine

5 - 10 mcg/kg/min.

Drip: 400mg/250ml (ml/hr)= (wt)  x  (mcg/min)  x 0.0375

Norepinephrine

0.1 - 0.5 mcg/kg/min

Drip: 4 mg/250ml (ml/hr) = (wt)  x  (mcg/min)  x 3.75

Magnesium

VF/pulseless VT:  1-2 grams/ 10ml D5W over 2-5 minutes.

Ventricular tachycardia (VT)

Procainamide

25-50 mg/min until arrhy suppressed or hypoten or QRS prolonged by 50%

Max cumulative dose: 17 mg/kg,.. Alt: 100mg q5min until arrhythmia is controlled or side effects listed.
Hemodynamically stable monomorphic VT

Amiodarone

150mg/100 ml D5W IV over 10 min. Repeat if necessary.

F/b 1 mg/min IV x 6hrs,  then 0.5 mg/min IV x 18hr. (900mg/500 ml D5W).

Lidocaine

See above.

 

Magnesium

Polymorphic VT: 1-2 grams/50-100ml D5W over 15 min.

Supraventricular tachycardia -  narrow complex tachycardias

Adenosine

6mg rapid iv, may repeat after 1-2 min 12mg rapid IV

2nd 12mg dose may be given if needed in 1-2 minutes. Max cumulative dose: 30 mg.

Diltiazem

15 to 20 mg (0.25 mg/kg) IV over 2 minutes; additional 20 to 25 mg (0.35 mg/kg) IV in 15 minutes if needed; 5 to 15 mg/hour IV maintenance infusion (titrated to AF heart rate if given for rate control)

Verapamil

2.5 to 5 mg IV over 2 minutes; may repeat  5 to 10 mg q15-30 min to total dose of 20-30 mg

Esmolol

500 mcg/kg (0.5 mg/kg) IV over 1 min, f/b  50 mcg/kg/min; if response is inadequate, repeat load,  f/b 100 mcg/kg/min.   Max  rate of 300 mcg/kg/min.

Metoprolol

5 mg over 1 to 2 min  repeat as needed q5min to max dose of 15 mg

Amiodarone

See under VT

 

Digoxin

8 to 12 mcg/kg total loading dose, give 50% IV over 5 min, then 25% of dose x 2  at 4-8hr  intervals

Bradycardia

Atropine

0.5 mg  rapid IV. May repeat q3-5min as needed up to  max cumulative dose of 3 mg.

Dopamine

Refractory hypotension: IV infusion: 2-10 mcg/kg/minute- titrate dosage to desired effect.

Epinephrine

Continuous IV infusion: 2-10 mcg/min - titrate dosage to desired effect.

Other Meds

Cisatracurium (Nimbex)

100 mg/250 mL D5W or NS. Loading dose: 0.1 to 0.2 mg/kg IV f/b  infusion at 1-3 mcg/kg/min  (0.06-0.18 mg/kg/hour) and adjust rate accordingly

Etomidate

Peak effect: 1 min. Duration: 3-5 min. Procedural sedation (unlabeled use): I.V.: Initial: 0.1-0.2 mg/kg, followed by 0.05 mg/kg q3-5 min prn. Other: 0.2-0.6 mg/kg IV over 30-60 sec for induction

Phenylephrine

Shock/hypotension: I.V. bolus: 100- 500 mcg/dose q 10-15min prn as needed   I.V. infusion: Ini dose: 100-180 mcg/min, or alt  0.5 mcg/kg/min; titrate. Dosing ranges between 0.4-9.1 mcg/kg/min.

Propofol

Induction:  Healthy adults <55 yrs: I.V.: 2-2.5 mg/kg (~40 mg q10 sec). [Elderly, debilitated: 1-1.5 mg/kg (~20 mg  q10 sec).  ICU sedation: 5 mcg/kg/min ( 0.3 mg/kg/hour); inc by 5-10 mcg/kg/min (or 0.3-0.6 mg/kg/hour) q5-10 min desired sedation. usu maint: 5-50 mcg/kg/min (or 0.3-3 mg/kg/hr)

Fentanyl

Pain management: Adults: Bolus at start of infusion: 1-2 mcg/kg or 25-100 mcg/dose; continuous infusion rate: 1-2 mcg/kg/hour or 25-200 mcg/hour.      Severe: I.M, I.V.: 50-100 mcg/dose every 1-2 hours as needed; patients with prior opioid exposure may tolerate higher initial doses

Succinylcholine

Duration: I.V.: 4-6 minutes.   I.V.: Intubation: 0.6 mg/kg (range: 0.3-1.1 mg/kg).  

Vecuronium(Norcuron®)

Ini bolus dose: 0.08-0.1 mg/kg, f/b  cont IV infusion  0.8-1.7 mcg/kg/min (0.048-0.102 mg/kg/hr)

MI / Stroke

Alteplase

Any quantity of drug not to be administered to the patient must be removed from vial(s) prior to admin of remaining dose.

ST-elevation MI (STEMI): I.V. Accelerated regimen:  Maximum total dose: 100 mg.   
Patients >67 kg: Total dose: 100 mg over 1.5 hours --> [15 mg I.V. bolus over 1-2 minutes] then   [50 mg over 30 min], then [ 35 mg over 1 hour].   
Patients  leq67 kg
: [15 mg I.V. bolus over 1-2 minutes] then   [0.75 mg/kg (not to exceed 50 mg) over 30 minutes]  then  [0.5 mg/kg (not to exceed 35 mg) over 1 hour].  Note: Thrombolytic should be administered within 30 minutes of hospital arrival. Administer concurrent aspirin, clopidogrel, and anticoagulant therapy (ie, unfractionated heparin, enoxaparin, or fondaparinux) with alteplase

Acute ischemic stroke: Alteplase within 3-4.5 hrs of sx onset. Note: Perform noncontrast-enhanced CT or MRI prior to admin.  Recommended total dose: 0.9 mg/kg (max total dose: 90 mg)   
Patients leq100 kg
: Load with 0.09 mg/kg (10% of 0.9 mg/kg dose) as an I.V. bolus over 1 minute, f/b 0.81 mg/kg (90% of 0.9 mg/kg dose) as a cont infusion over 60 min. 
Patients >100 kg
: Load with 9 mg (10% of 90 mg) as an I.V. bolus over 1 min, f/b  81 mg (90% of 90 mg) as a continuous infusion over 60 min.

 

 


Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

Listed dosages are for - Adult patients ONLY. if applicable for additional information. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer   |   <BACK
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