Drugs Used in Pediatric Cardiology






TABLE E-1

DRUG INDEX (FOR DRUGS USED IN PEDIATRIC CARDIOLOGY)
















































































































































































































































































































































































































































































































Trade Name Generic Name Class
Abbokinase Urokinase Thrombolytic agent
Actiq Fentanyl Narcotic analgesic
Adalat Nifedipine Calcium channel blocker
Adalat CC Nifedipine, sustained release Calcium channel blocker
Adenocard Adenosine Antiarrhythmic
Adrenaline Epinephrine HCl Nonselective adrenergic stimulator
Aldactone Spironolactone Aldosterone antagonist
Aldomet Methyldopa Antihypertensive
Alprostadil Prostaglandin E 1 Vasodilator
Anacin Aspirin Antiplatelet agent, analgesic
Apresoline Hydralazine HCl Peripheral vasodilator
Aquachloral Supprettes Chloral hydrate Sedative and hypnotic
Aramine Metaraminol α- and β-Adrenoceptor stimulant
Atarax Hydroxyzine Sedative
Atromid-S Clofibrate Antilipidemic, triglyceride-lowering agent
Bretylol Bretylium tosylate Class III antiarrhythmic
Brevibloc Esmolol β 1 -Selective adrenergic blocking agent, antihypertensive
Bumex Bumetanide Loop diuretic
Calan Verapamil Class IV antiarrhythmic agent
Capoten Captopril Angiotensin-converting enzyme (ACE) inhibitor
Cardioquin Quinidine Class IA antiarrhythmic agent
Cardizem Diltiazem Calcium channel blocker
Carnitor Carnitine L-carnitine
Colestid Colestipol Lipid-lowering agent
Cordarone Amiodarone Class III antiarrhythmic
Coreg Carvedilol Nonselective β adrenergic blocker
Coreg Tiltab Carvedilol Nonselective β adrenergic blocker
Coumadin Warfarin Anticoagulant
Cozaar Losartan Angiotensin receptor blocker
Demerol Meperidine Narcotic analgesic
Digibind Digoxin immune Fab (ovine) Antidigoxin antibody
Dilacor XR Diltiazem Calcium channel blocker
Dilantin Phenytoin Class IB antiarrhythmic
Diulo Metolazone Thiazide-like diuretic
Diurigen Chlorothiazide Thiazide diuretic
Diuril Chlorothiazide Diuretic
Dobutrex Dobutamine β1-Adrenergic stimulator
Dopastat Dopamine Sympathomimetic agent
Duragesic Fentanyl Narcotic analgesic
DynaCirc Isradipine Calcium channel blocker
Dyrenium Triamterene Potassium-conserving diuretic
Edecrin Ethacrynic acid Loop diuretic
Esidrix Hydrochlorothiazide Hydro-Par, Oretic Thiazide diuretic
Florinef Fludrocortisone acetate Corticosteroid
Fluohydrisone Fludrocortisone acetate Corticosteroid
Furomide Furosemide Loop diuretic
Hyperstat Diazoxide Peripheral vasodilator
HydroDIURIL Hydrochlorothiazide Diuretic
Hydro-Par Hydrochlorothiazide Thiazide diuretic
Imuran Azathioprine Immunosuppressive
Inderal Propranolol β-Adrenoceptor blocker, class II antiarrhythmic agent
Indocin Indomethacin Nonsteroidal antiinflammatory agent
Inocor Amrinone lactate Noncatecholamine inotropic agent with vasodilating effects
Intropin Dopamine Natural catecholamine inotropic agent
Isoptin Verapamil Class IV antiarrhythmic agent
Isuprel Isoproterenol β1 and β2 adrenergic stimulator
Kabikinase Streptokinase Thrombolytic agent
Kayexalate Sodium polystyrene sulfonate Potassium-lowering agent
Ketalar Ketamine Dissociate anesthetic
Kionex Sodium polystyrene sulfonate Potassium-lowering agent
Lanoxin Digoxin Cardiac glycoside
Lasix Furosemide Loop diuretic
Levocarnitine Carnitine L-carnitine
Levophed Norepinephrine bitartrate α- and β-Adrenergic stimulator
Lipitor Atorvastatin Lipid-lowering agent, “statin”
Loniten Minoxidil Peripheral vasodilator
Lopressor Metoprolol β-Adrenoceptor blocker
Lovenox Enoxaparin Low-molecular weight heparin (anticoagulant)
Mevacor Lovastatin HMG-CoA reductase inhibitor, lipid-lowering agent
Mexitil Mexiletine Class IB antiarrhythmic
Minipress Prazosin HCl Postsynaptic α-adrenergic blocker, antihypertensive
Mykrox Metolazone Thiazide-like diuretic
Narcan Naloxone Narcotine antagonist
Neo-Calglucon Calcium glubionate Calcium supplement
Neo-Synephrine Phenylephrine HCl α-Adrenoceptor stimulant
Neoral Cyclosporin microemulsion Immunosuppressive agent
Nipride Nitroprusside Peripheral vasodilator
Nitro-bid Nitroglycerin Peripheral vasodilator
Nitrostat Nitroglycerin Peripheral vasodilator
Noctec Chloral hydrate Sedative, hypnotic
Normodyne Labetalol α- and β-Adrenergic antagonist
Norpace Disopyramide phosphate Class IA antiarrhythmic agent
Norvasc Amlodipine Calcium channel blocker
Oretic Hydrochlorothiazide Thiazide diuretic
Phenergan Promethazine Sedative, antiemetic
Pravachol Pravastatin Lipid-lowering agent, HMG-CoA reductase inhibitor
Prevalite Cholestyramine Cholesterol-lowering agent
Primacor Milrinone Phosphodiesterase inhibitor, noncatecholamine inotropic, vasodilator
Prinivil Lisinopril ACE inhibitor
Priscoline Tolazoline α-Adrenoceptor blocker
Procan SR Procainamide Class IA antiarrhythmic
Procardia Nifedipine Calcium channel blocker
Procardia XL Nifedipine, sustained release Calcium channel blocker
Proglycem Diazoxide Antihypertensive agent
Prograf Tacrolimus Immunosuppressive agent
Pronestyl Procainamide Class IA antiarrhythmic
Prostin VR Prostaglandin E 1 Vasodilator
Questran Cholestyramine Cholesterol-lowering agent
Questran Light Cholestyramine Lipid-lowering agent
Quinidex Quinidine sulfate Class IA antiarrhythmic
Quinaglute Quinidine gluconate Class IA antiarrhythmic
Regitine Phentolamine mesylate α-Adrenoceptor blocker
Rogaine Minoxidil Peripheral vasodilator
Sandimmune Cyclosporine Immunosuppressive
Sofarin Warfarin Anticoagulating agent
Streptase Streptokinase Thrombolytic agent
Sublimaze Fentanyl Narcotic analgesic
Tambocor Flecainide acetate Class IC antiarrhythmic
Tenormin Atenolol β 1 -Adrenoceptor blocker
Thorazine Chlorpromazine Sedative, antiemetic
Tiazac Diltiazem Calcium channel blocker
Tonocard Tocainide Class IB antiarrhythmic agent
Trandate Labetalol α- and β-Adrenergic antagonist
Tridil Nitroglycerin Peripheral vasodilator
Valium Diazepam Sedative, antianxiety, antiseizure agent
Vasotec Enalapril maleate ACE inhibitor, vasodilator
Vistaril Hydroxyzine Sedative
VitaCarn Carnitine L-carnitine
Xylocaine Lidocaine Class IB antiarrhythmic
Zestril Lisinopril ACE inhibitor
Zocor Simvastatin Lipid-lowering agent, HMG-CoA reductase inhibitor
Zoraxolyn Metolazone Thiazide-like diuretic


TABLE E-2

DOSAGES OF DRUGS USED IN PEDIATRIC CARDIOLOGY









































































































































































































































































































































































































































































































Drug Route and Dosage Toxicity or Side Effects How Supplied
Acetazolamide (Diamox) (carbonic anhydrase inhibitor, diuretic)
Acetylsalicylic acid (aspirin)
Children:
IV, PO: 5 mg/kg/dose QD–QOD
Adults:
IV, PO: 250–375 mg/dose QD–QOD
Children and adults:
Antiplatelet therapy:
PO: 3–5 mg/kg QD
Antipyretic/analgesic:
PO, PR: 10–15 mg/kg/dose q4–6 hr
(Max, 4 g/24 hr)
Antiinflammatory:
PO: 80–100 mg/kg /24 hr TID–QID
GI irritation, paresthesia, sedation, hypokalemia, acidosis, reduced urate secretion, aplastic anemia, polyuria, renal calculi
Contraindications: hepatic failure, severe renal failure, sulfonamide hypersensitivity
Rash, nausea, hepatotoxicity, GI bleeding, bronchospasm, GI distress, tinnitus
Contraindications: hepatic failure, bleeding disorder, hypersensitivity, children <16 yr old with chickenpox or flu symptoms (because of the association with Reye’s syndrome)
Tab: 125, 250 mg
Susp: 25, 50 mg/mL
Caps, sustained release: 500 mg
Inj: 500 mg/mL
Tab: 325, 500 mg
Tab, enteric coated:
81,165, 325, 500, 650 mg
Tab, chewable: 81 mg
Supp: 60, 80, 120, 125, 200, 300, 325, 600, 650 mg, and 1.2 g
Adenosine (Adenocard) (antiarrhythmic) For SVT:
Children and adults:
IV: 100–200 mcg/kg
Repeat q1–2 min, with increment of 50 mcg/kg to max of 250 mcg/kg
(Max single dose, 12 mg)
Bronchospasm, chest pain, transient asystole, bradycardia and tachycardia
Transient AV block in atrial flutter or fibrillation (±)
Inj: 3 mg/mL (2, 4 mL)
Amiodarone (Cordarone) (class III antiarrhythmic) Children:
IV (in emergency situation): Loading: 5 mg/kg, slow infusion over 30 min followed by infusion of 7 mcg/kg/min (which is calculated to deliver 10 mg/kg/24 hr); switch to oral maintenance dose as soon as clinical condition permits
PO: 10–20 mg/kg/24 hr ( infants ) or 10 mg/kg/24 hr ( children and adolescents ) in 2 doses for 5–14 days followed by maintenance dose of 5–7 mg/kg once a day
( Therapeutic level: 0.5–2.5 mg/L)
Adults:
PO: Loading: 800–1600 mg QD for 1–3 wk; then reduce to 600–800 mg QD for 1 mo
Maintenance: 200–400 mg QD
Progressive dyspnea and cough (pulmonary fibrosis), worsening of arrhythmias, hepatotoxicity, nausea and vomiting, corneal microdeposits, hypotension, heart block, ataxia, hypo- or hyperthyroidism, photosensitivity
Contraindications: AV block, sinus node dysfunction, sinus bradycardia
Tab: 200, 400 mg
Susp: 5 mg/mL
Inj: 50 mg/mL
Amlodipine (Norvasc) (calcium channel blocker, antihypertensive) For hypertension:
Children:
PO: Initial 0.1 mg/kg/dose QD–BID; may be increased gradually to a max, 0.6 mg/kg/24 hr
Adults:
PO: 5–10 mg/dose QD (max, 10 mg/24 hr)
Edema, dizziness, flushing, palpitation, headache, fatigue, nausea, abdominal pain, somnolence Tab: 2.5, 5, 10 mg
Susp: 1 mg/mL
Atenolol (Tenormin) (β 1 -adrenoceptor blocker, antihypertensive, antiarrhythmic) Children:
PO: 1–2 mg/kg/dose QD
Adults:
PO: 25–100 mg/dose QD for 1–2 wk (alone or with diuretic for hypertension); may increase to 200 mg QD
CNS symptoms (dizziness, tiredness, depression), bradycardia, postural hypotension, nausea and vomiting, rash, blood dyscrasias (agranulocytosis, purpura) Tab: 25, 50, 100 mg
Susp: 2 mg/mL
Inj: 0.5 mg/mL (10 mL)
Atorvastatin (Lipitor) (antilipemic, “statin,” HMG-CoA reductase inhibitor) Children:
PO: Starting dose, 10 mg QD for 4–6 wk; increase to 20 mg QD and 40 mg QD as needed
(Adult max dose, 80 mg/24 hr)
Headache, constipation, diarrhea, elevated liver enzymes, rhabdomyolysis, myopathy Tab: 10, 20, 40, 80 mg
Azathioprine (Imuran, Azasan) (immunosuppressant) Children:
IV, PO: Initial: 3–5 mg/kg/24 hr QD
Maintenance: 1–3 mg/kg/24 hr (to produce WBC count ≈5000/mm 3 ); may be reduced if WBC count falls below 4000/mm 3
Bone marrow suppression (leukopenia, thrombocytopenia, anemia), GI symptoms (nausea and vomiting) Tab: 25, 50, 75, 100 mg
Susp: 50 mg/mL
Inj: 100 mg powder for reconst
Bosentan (Tracleer) (nonselective endothelin receptor blocker) For pulmonary hypertension:
Children:
PO: <20 kg: 31.25 mg BID
20–40 kg: 62.5 mg BID
>40 kg: 125 mg BID
Adults:
PO: 125 mg BID
Liver dysfunction, decrease in hemoglobin, fluid retention, heart failure, headache Tab: 62.5, 125 mg
Bumetanide (Bumex) (loop diuretic) Children:
PO, IM, IV: >6 mo: 0.015–0.1 mg/kg/dose QD–QOD
Adults:
PO: 0.5–2 mg/dose QD–BID
IV: 0.5–1 mg over 1–2 min q2–3 hr PRN
(Max, 10 mg/24 hr)
Hypotension, cramps, dizziness, headache, electrolyte losses (hypokalemia, hypocalcemia, hyponatremia, hypochloremia), metabolic alkalosis Tab: 0.5, 1, 2 mg
Inj: 0.25 mg/mL
Calcium glubionate (Neo-Calglucon 6.4% elemental calcium) (calcium supplement) For neonatal hypocalcemia:
PO: 1200 mg/kg/24 hr q4–6 hr
Maintenance:
Infants and children:
PO: 600–2000 mg/kg/24 hr QID (max, 9 g/24 hr)
Adults:
PO: 6–18 g/24 hr QID
GI irritation, diarrhea, dizziness, headache
Best absorbed when given before meals
Syrup: 1.8 g/5 mL (480 mL)
(1.2 mEq Ca/mL)
Captopril (Capoten) (ACE inhibitor, antihypertensive, vasodilator) Neonates:
PO: 0.1–0.4 mg/kg/24 hr TID–QID
Infants:
PO: Initially 0.15–0.3 mg/kg/dose QD–QID; titrate upward if needed
Neutropenia or agranulocytosis, proteinuria, hypotension and tachycardia, rash, taste impairment, hyperkalemia
Evidence of fetal risk if given during second and third trimesters (same with all other ACE inhibitors)
Tab: 12.5, 25, 50, 100 mg
Susp: 0.75, 1 mg/mL
(Max, 6 mg/kg/24 hr)
Children:
PO: Initially 0.3–0.5 mg/kg/dose TID; titrate upward if needed
(Max, 6 mg/kg/24 hr BID–QID)
Adolescents and adults:
PO: Initially 12.5–25 mg/dose BID–TID; increase weekly if needed by 25 mg/dose to max dose, 450 mg/24 hr
(Adjust dose with renal failure)
Carnitine (Carnitor) Children:
PO: 50–100 mg/kg/24 hr BID–TID; increase slowly as needed
(Max, 3 g/24 hr)
Adults:
PO: 330 mg–1 g/dose BID–TID
IV ( child and adult ): 50 mg/kg as loading dose; then 50 mg/kg/24 hr q4–6 hr
Nausea and vomiting, abdominal cramping, diarrhea, seizure Tab: 330, 500 mg
Caps: 250 mg
Oral sol: 100 mg/mL (118 mL)
Inj: 200 mg/mL (5 mL)
Carvedilol (Coreg, Coreg CR) (nonselective α- and β-adrenergic blocker) Children:
PO: Initial 0.09 mg/kg/dose BID; increase gradually to 0.36 and 0.75 mg/kg as tolerated to adult max dose of 50 mg/24 hr
Adults:
PO: 3.125 mg BID for 2 wk; increase slowly to a max dose of 25 mg BID as needed (for heart failure)
(Max, 25 mg BID for <85 kg; 50 mg BID for >85 kg)
Dizziness, hypotension, headache, diarrhea, rarely AV block Tab: 3.125, 6.125, 12.5, 25 mg
Tab, extended release: 10, 20, 40, 80 mg
Chloral hydrate (Noctec, Aquachloral) (sedative, hypnotic) As sedative:
Children:
PO, PR: 25–50 mg/kg/dose q6–8 hr
Sedation for procedures: 25–100 mg
(Max dose, 2 g)
Adults:
PO, PR: 250 mg/dose q8 hr
As hypnotic:
Adults:
PO, PR: 500–2000 mg/dose
Mucous membrane irritation (laryngospasm if aspirated), GI irritation, excitement or delirium, hypotension
Contraindicated in hepatic and renal impairment
Caps: 500 mg
Syrup: 250, 500 mg/5 mL
Supp: 324, 500, 648 mg
Chlorothiazide (Diuril) (diuretic) Children:
PO: 20–40 mg/kg/24 hr BID
IV: 2–8 mg/kg/24 hr BID
Adults:
PO, IV: 250–2000 mg/dose QD–BID
Hypercalcemia, hyperbilirubinemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis, hypokalemia, hyponatremia, prerenal azotemia, hyperlipidemia, rarely pancreatitis, blood dyscrasias, allergic reactions Tab: 250, 500 mg
Susp: 250 mg/5 mL (237 mL)
Inj: 500 mg powder for reconst with 18 mL sterile water
Cholestyramine (Questran, Prevalite) (antilipemic, bile acid sequestrant) Children:
PO: 250–1500 mg/kg/24 hr BID–QID
Adults:
PO: Starting: 1 packet (or scoopful) of Questran powder or Questran Light 1–2 times/day
Maintenance: 2–4 packets or scoopfuls/24 hr in 2 doses (or 1–6 doses)
(Max, 6 packets/24 hr)
Constipation and other GI symptoms, bleeding, hyperchloremic acidosis Packet of 9-g Questran powder or 5-g Questran Light, each packet containing 4 g of anhydrous cholestyramine resin
Clofibrate (Atromid-S) (antilipemic, triglyceride-lowering agent) Children:
PO: 0.5–1.5 mg/24 hr BID–TID
Adults:
PO: Initial and maintenance: 2 g/24 hr BID–TID
Nausea and other GI symptoms (vomiting, diarrhea, flatulence), headache, dizziness, fatigue, rash, blood dyscrasias, myalgia, arthralgia, hepatic dysfunction Caps: 500 mg
Clopidogrel (Plavix) (antiplatelet) Children:
PO: 1 mg/kg/24 hr to max (adult dose) of 75 mg/24 hr
Adults:
PO: 75 mg/dose QD
Bleeding, especially when used with aspirin, neutropenia or agranulocytosis, abdominal pain constipation, rash, syncope, palpitation Tab: 75 mg
Colestipol (Colestid) (antilipemic, bile acid sequestrant) Children:
PO: 300–1500 mg/24 hr in 2–4 doses
Adults:
PO: Starting dose: 5 g 1–2 times/24 hr; increment of 5 g q1–2 mo
Maintenance: 5–30 g/24 hr BID–QID (mix with 3–6 or water or another fluid)
Constipation and other GI symptoms (abdominal distention, flatulence, nausea and vomiting, diarrhea), rarely rash, muscle and joint pain, headache, dizziness Packet: 5 g
Cyclosporine, Cyclosporine microemulsion (Sandimmune, Gengraf, Neoral) (immunosuppressant) Children:
PO: 15 mg/kg as a single dose given 4–12 hr pretransplant; give same daily dose for 1–2 wk posttransplant; then reduce by 5% per wk to 5–10 mg/kg/24 hr QD–BID
Nephrotoxicity, tremor, hypertension, less commonly hepatotoxicity, hyperlipidemia, hirsutism, gum hypertrophy, rarely lymphoma, hypomagnesemia Oral sol: 100 mg/mL (50 mL)
Neoral sol: 100 mg/mL (50 mL)
Caps: 25, 50, 100 mg
Neoral caps: 25, 100 mg
Inj: 50 mg/mL
( Therapeutic level: 100–300 ng/mL)
IV: 5–6 mg/kg as a single dose given 4–12 hr pretransplant; administer over 2–6 hr; give same dose posttransplant until patient able to tolerate oral form
Diazoxide (Hyperstat IV, Proglycem) (antihypertensive, peripheral vasodilator) For hypertensive crisis:
Children and adults:
IV: 1–3 mg/kg (max, 150 mg single dose); repeat q5–15 min; titrate to desired effect
Hypotension, transient hyperglycemia, nausea and vomiting, sodium retention (CHF ±) Inj: 15 mg/mL
Digoxin (Lanoxin, Digitek) (cardiac glycoside, antiarrhythmic, inotrope) Children:
PO: Total digitalizing dose:
Premature infants: 20 mcg/kg;
Full-term newborns: 30 mcg/kg;
Children 1 mo–2 yr: 40–50 mcg/kg;
Children >2–10 yr: 30–40 mcg/kg;
>10 yr and <100 kg: 10–15 mcg/kg
PO: Maintenance: 25%–30% of TDD/24 hr BID
IV: 75%–80% of PO dose
Adults:
PO: Loading: 8–12 mcg/kg
Maintenance: 0.10–0.25 mg/24 hr
( Therapeutic level: 0.8–2 ng/mL)
AV conduction disturbances, arrhythmias, nausea and vomiting Elixir: 50 mcg/mL (60 mL)
Tab: 125, 250, mcg
Caps: 50, 100, 200 mcg
Inj: 100, 250 mcg/mL
Digoxin immune Fab (Digibind, Digifab) (antidigoxin antibody) Infants and children:
IV: 1 vial (40 mg) dissolved in 4 mL H 2 O over 30 min
Adults:
IV: 4 vials (240 mg)
Allergic reaction (rare), hypokalemia, rapid AV conduction in atrial flutter Inj: 38, 40 mg powder for reconst
Diltiazem (Cardizem, Cardizem SR, Cardizem CD, Dilacor XR, Tiazac) (calcium channel blocker, antihypertensive) Children:
PO: 1.5–2 mg/kg/24 hr TID–QID
(Max, 3.5 mg/kg/24 hr)
Adolescents:
Immediate release:
PO: 30–120 mg/dose TID–QID; usual range, 180–360 mg/24 hr
Dizziness, headache, edema, nausea and vomiting, heart block, and arrhythmias
Contraindicated in second- and third-degree AV block, sinus node dysfunction, acute MI with pulmonary congestion
Maximum antihypertensive effect seen within 2 weeks
Tab: 30, 60, 90, 120 mg
Tab, extended release: 120, 180, 240, 300, 360, 420 mg
Caps extended release: 60, 90, 120, 180, 240, 300, 360, 420 mg
Inj: 5 mg/mL (5, 10 mL)
Extended release:
PO: 120–300 mg/24 hr QD–BID
(BID dosing with Cardizem SR; QD dosing with Cardizem CD, Dilacor XR, and Tiazac)
Dipyridamole (Persantine) (antiplatelet) Children:
PO: 2–6 mg/kg/24 hr TID
Adults:
PO: 75–100 mg QID
(As an adjunct to warfarin therapy; not to use with aspirin)
Vasodilation, rarely dizziness, angina Tab: 25, 50, 75 mg
Disopyramide (Norpace) (class IA antiarrhythmic) Children:
PO: <1 yr: 10–30 mg/kg/24 hr q6 hr
1–4 yr: 10–20 mg/kg/24 hr q6 hr
4–12 yr: 10–15 mg/kg/24 hr q6 hr
12–18 yr: 6–15 mg/kg/24 hr q6 hr (q4 hr dosing when using regular caps)
Adults:
PO: 150 mg/dose q6 hr or
300 mg (extended release) q12 hr
(Max, 1.6 g/24 hr)
( Therapeutic level: 3–7 mg/L)
Heart failure or hypotension, anticholinergic effects (urinary retention, dry mouth, constipation), nausea and vomiting, hypoglycemia Caps: 100, 150 mg
Caps, CR: 100, 150 mg
Susp: 1 mg/mL, 10 mg/mL
Dobutamine (Dobutrex) (β-adrenergic stimulator) Children:
IV infusion: 2.5–15 mcg/kg/min in D 5 W or NS (incompatible with alkali solution)
(Max, 40 mcg/kg/min)
Adults:
IV infusion: 2.5–10 mcg/kg/min
(Max, 40 mcg/kg/min)
Tachyarrhythmias, hypertension, nausea and vomiting, headache
Contraindicated in HOCM and atrial flutter or fibrillation
Inj: 12.5 mg/mL (20 mL)
Dopamine (Intropin, Dopastat) (natural catecholamine inotropic agent) Children:
IV: Effects are dose dependent:
2–5 mcg/kg/min: increases RBF and urine output (minimum effects on heart rate and cardiac output)
5–15 mcg/kg/min: increases heart rate, cardiac contractility, and cardiac output
Tachyarrhythmias, nausea and vomiting, hypotension or hypertension, extravasation (tissue necrosis [treat with local infiltration of phentolamine]) Inj: 40, 80, 160 mg/mL (5, 10, 20 mL)
>20 mcg/kg/min: α-adrenergic effects with decreased RBF (±)
(Incompatible with alkali solution)
Enalapril, Enalaprilat (Vasotec) (ACE inhibitor, vasodilator) Children:
PO: 0.1 mg/kg/dose QD or BID
Increase PRN over 2 wks
(Max, 0.5 mg/kg/24 hr)
Adults:
For CHF:
PO: Start with 2.5 mg QD or BID
(Usual range, 5–20 mg/24 hr)
For hypertension:
PO: Start with 5 mg QD
(Usual dose, 10–40 mg/24 hr)
Hypotension, dizziness, fatigue, headache, rash, diminishing taste, neutropenia, hyperkalemia, chronic cough
Evidence of fetal risk if given during second and third trimesters (same with all other ACE inhibitors)
Tab: 2.5, 5, 10, 20 mg (Enalapril)
Oral susp: 1 mg/mL
Inj: 1.25 mg/mL (Enalaprilat)
Enoxaparin (Lovenox) (low-molecular-weight heparin, anticoagulant) For DVT treatment:
Infants <2 months:
SC: 1.5 mg/kg/dose q12 hr
Infants 2 months to adults:
SC: 1 mg/kg/dose q12 hr
(Adjust dose to achieve target antifactor Xa levels of 0.5–1 units/mL)
For DVT prophylaxis:
Infants <2 months:
SC: 1 mg/kg/dose q12 hr
Infants 2 mo to 18 yr:
SC: 0.5 mg/kg/dose q12 hr
Adults:
SC: 30 mg BID for 7–10 days
Bleeding
Contraindicated in major bleeding and drug-induced thrombocytopenia
Protamine sulfate is the antidote; 1 mg protamine sulfate neutralizes 1 mg enoxaparin
Inj: 100 mg/mL (3 mL)
Epinephrine (Adrenalin) (α-, β 1 , and β 2 -adrenergic stimulator) For asystole and bradycardia:
Children:
IV/ET: 0.1–0.3 mL/kg of 1:10,000 sol (or 0.01–0.03 mg/kg) q3–5 min
For circulatory shock or heart failure:
Children:
IV: 0.1–1 mcg/kg/min; titrate to effect
Tachyarrhythmias, hypertension, nausea and vomiting, headache, tissue necrosis (±) Inj: 0.1 mg/mL (1:10,000 sol, 10 mL prefilled syringe)
1 mg/mL (1:1000 sol, 1, 30 mL)
Esmolol (Brevibloc) (β 1 -selective adrenergic blocking agent, antihypertensive, class II antiarrhythmic) Children:
Loading:
IV: 100–500 mcg/kg over 1 min
Maintenance:
IV: 25–100 mcg/kg/min; increase by 25–50 mcg/kg to a max of 300 mcg/kg/min
(Usual maintenance dose, 50–500 mcg/kg/min)
Bronchospasm, CHF, hypotension, nausea and vomiting Inj: 10, 20, 250 mg/mL
Ethacrynic acid (Edecrin) (loop diuretic) Children:
PO: 1 mg/kg/dose QD–TID
(Max, 3 mg/kg/24 hr)
IV: 1 mg/kg/dose
Adults:
PO: 50–100 mg QD
(Max, 400 mg)
IV: 0.5–1 mg/kg/dose or 50 mg/dose
Dehydration, hypokalemia, prerenal azotemia, hyperuricemia, eighth cranial nerve damage (deafness), abnormal LFT, agranulocytosis or thrombocytopenia, GI irritation, rash Tab: 25 mg
Inj: 50 mg vial for reconstruction with 50 mL D 5 W
Flecainide (Tambocor) (class IC antiarrhythmic) For sustained VT:
Children:
PO: Initial 1–3 mg/kg/24 hr q8 hr
(Usual range: 3–6 g/kg/24 hr q8 hr)
Monitor serum level to adjust dose if needed
Adults:
PO: 100 mg/dose BID; may increase by 50 mg q12 hr every 4 days to max dose of 600 mg/24 hr
( Therapeutic level: 0.2–1 mg/L)
Worsening of CHF, bradycardia, AV block, dizziness, blurred vision, dyspnea, nausea, headache, increased PR and QRS duration Tab: 50, 100, 150 mg
Susp: 5, 20 mg/mL
Fludrocortisone acetate (Florinef, Fluohydrisone) (corticosteroid) For syncopal episodes:
Children:
PO: 0.1 mg/dose QD
Adults:
PO: 0.2 mg/dose QD
Hypertension, hypokalemia, acne, rash, bruising, headache, GI ulcers, and growth suppression
Weight gain (1–2 kg in 2–3 wk)
Tab: 0.1 mg
Furosemide (Lasix, Furomide) (loop diuretic) Children:
IV: 0.5–2 mg/kg/dose BID–QID
PO: 1–2 mg/kg/dose QD–TID
(Max, 6 mg/kg/dose)
Adults:
IV, PO: 20–80 mg/24 hr BID–QID
Hypokalemia, hyperuricemia, prerenal azotemia, ototoxicity, rarely bloody dyscrasias, rash Oral liquid: 10 mg/mL, 40 mg/5 mL
Tab: 20, 40, 80 mg
Inj: 10 mg/mL
Heparin (anticoagulant) Infants and children:
IV: Initial: 50 U/kg IV bolus
Maintenance: 10–25 U/kg/hr or 50–100 U/kg q4 hr
(Adjust dose to give APTT 1.5–2.5 times control, 6–8 hr after IV infusion [or 3.5–4 hr after intermittent injection])
Adults:
IV: Initial: 10,000 U IV injection
Maintenance: 5000–10,000 U q4–6 hr
IV drip: Initial dose: 5000 U followed by 20,000–40,000 U/24 hr
Bleeding
Antidote: protamine sulfate (1 mg per 100 U heparin used in previous 4 hr)
Inj: 1000, 2000, 2500, 5000, 7500, 10,000, 20,000, 40,000 U/mL
Hydralazine (Apresoline) (peripheral vasodilator, antihypertensive) For hypertensive crisis:
Children:
IM, IV: 0.15–0.2 mg/kg/dose; may be repeated q4–6 hr
(Max, 20 mg/dose)
Adults:
IM, IV: 20–40 mg/dose; repeat q4–6 hr PRN
For chronic hypertension:
Children:
PO: 0.75–3 mg/kg/24 hr BID–QID
Adults:
PO: Start with 10 mg 4 times/24 hr for 3–4 days; increase to 25 mg/dose QID for 3–4 days; then up to 50 mg QID
Hypotension, tachycardia and palpitation, lupus-like syndrome with prolonged use (fever, arthralgia, splenomegaly and positive LE cell preparation), blood dyscrasias Tab: 10, 25, 50, 100 mg
Oral liquid: 1.25, 2, 4 mg/mL
Inj: 20 mg/mL
Hydrochlorothiazide (HydroDIURIL, Esidrix, Hydro-Par, Oretic) (thiazide diuretic) Children:
PO: 2–4 mg/kg/24 hr BID
(Max, 100 mg/24 hr)
Adults:
PO: 25–100 mg/24 hr QD–BID
(Max, 200 mg/24 hr)
Same as for chlorothiazide Tab: 25, 50, 100 mg
Caps: 12.5 mg
Sol: 10 mg/mL (500 mL)
Ibuprofen (NeoProfen) (nonsteroidal antiinflammatory) For PDA closure in premature infants:
Neonates ≤32 weeks (500–1500 g):
Sepsis, anemia, intraventricular hemorrhage, apnea, GI disorders, renal impairment
Inj: 17.1 mg/mL ibuprofen lysine equivalent to 10 mg/mL of ibuprofen (2 mL)







Inamrinone (Inocor) (phosphodiesterase type III inhibitor)








Indomethacin (Indocin) (Nonsteroidal antiinflammatory, antipyretic agent, PG synthesis inhibitor)
IV: Initial dose 10 mg/kg followed by two doses of 5 mg/kg after 24 and 48 hr
(Hold second and third dose if urine output is <0.6 mL/kg/hr.)

Children:
IV: Loading: 0.75 mg/kg over 2–3 min
Maintenance: 5–10 mcg/kg/min
Adults:
IV: Loading: 0.75 mg/kg over 2–3 min
Maintenance: 5–10 mcg/kg/min

For PDA closure in premature infants:
IV: <48 hr: 0.2, 01, and 0.1 mg/kg/dose q12–24 hr
2–7 days: 0.2, 0.2, and 0.2 mg/kg/dose q12–24 hr
>7 days: 0.2, 0.25, and 0.25 mg/kg/dose q12–24 hr
Contraindicated in intraventricular hemorrhage, thrombocytopenia, necrotizing enterocolitis, significant renal dysfunction


Thrombocytopenia, hypotension, tachyarrhythmias, hepatotoxicity, nausea and vomiting, fever








GI or other bleeding, GI disturbances, renal impairment, electrolyte disturbances (↓ Na, ↑ K levels)






Inj: 5 mg/mL (20 mL)










Vial: 1 mg
Isoproterenol (Isuprel) (β 1 – and β 2 -adrenergic stimulator) Children:
IV: 0.1–2 mcg/kg/min titrated to desired effect
Adults:
IV: 2–20 mcg/min titrated to desired effect (incompatible with alkali solution)
Similar to epinephrine Inj: 0.2 mg/mL (1: 5000 sol: 1, 5 mL)
Ketamine (Ketalar) (General anesthetic) For cyanotic spells:
Infants:
IM: 2–3 mg/kg
Repeat smaller doses q30 min PRN
IV: 1–3 mg/kg/dose over 60 sec
Repeat smaller doses q30 min PRN
Hypertension, tachycardia, respiratory depression or apnea, CNS symptoms (dreamlike state, confusion, agitation) Inj: 10, 50, 100 mg/mL
Ketorolac (Toradol) (nonsteroidal antiinflammatory, agent) Children:
IV, IM: 0.5 mg/kg/dose q6 hr (Max single dose, 30 mg)
Adults:
IV, IM: 30 mg/dose q6 hr
PO ( adults and children >50 kg ): 10 mg PRN q6 hr
GI bleeding, nausea, dyspepsia, decreased platelet function, interstitial nephritis
Consider adding acid blocker with systemic use
Contraindicated in patients with hepatic or renal failure
Tab: 10 mg
Inj: 15 mg/mL (1 mL), 30 mg/mL (1, 2 mL)
Labetalol (Normodyne, Trandate) (α- and β-adrenergic antagonist) Children:
PO: Initial 4 mg/kg/24 hr BID
(Max, 40 mg/kg/24 hr)
IV: (for hypertensive emergency)
Initial 0.2–1 mg/kg/dose q10 min PRN
(Max, 20 mg/dose)
Orthostatic hypotension, edema, CHF, bradycardia
Contraindicated in asthma
Tab: 100, 200, 300 mg
Susp: 10, 40 mg/mL
Inj: 5 mg/mL (20, 40 mL)
Lidocaine (Xylocaine) (class IB antiarrhythmic) Children:
IV: Loading: 1 mg/kg/dose slow IV q5–10 min PRN
Maintenance: 30 mcg/kg/min
(Range, 20–50 mcg/kg/min)
Adults:
IV: Loading: 1 mg/kg/dose q5 min
Maintenance: 1–4 mg/min
( Therapeutic level: 1.5–5 mg/L)
Seizure, respiratory depression, CNS symptoms (anxiety, euphoria or drowsiness), arrhythmias, hypotension or shock Inj: 0.5%, 1%, 1.5%, 2%, 4%, 10%, 20% (1% = 10 mg/mL)
Lisinopril (Zestril, Prinivil)
(ACE inhibitor, antihypertensive)
For hypertension:
Children ≥6 yr:
PO: Initial 0.07 mg/kg/24 hr; (max initial dose, 5 mg/24 hr), increase dose at 1–2 week intervals
(Max, 0.6 mg/kg/day or 40 mg/24 hr)
Adults:
PO: Initial 10 mg QD; may increase upward as needed to max dose, 80 mg/24 hr
Dry nonproductive cough, rash, hypotension, hyperkalemia, angioedema, rarely bone marrow depression
Evidence of fetal risk if given during second and third trimesters (same with all other ACE inhibitors)
Tab: 2.5, 5, 10, 20, 30, 40 mg
Losartan (Cozaar) (angiotensin II receptor blocker) For hypertension:
Children ≥6 yr:
PO: 0.7 mg/kg/24 hr QD–BID
(Max, 50 mg/24 hr)
Adults:
PO: Initial dose 50 mg QD
(Max, 100 mg QD)
Hypotension, dizziness, nasal congestion, muscle cramps
Evidence of fetal risk if given during second and third trimesters
Tab: 25, 50, 100 mg
Lovastatin (Mevacor) (antilipemic, HMG-CoA reductase inhibitor) Adolescents:
PO: Starting dose, 10 mg/24 hr QD for 6–8 wk; increase to 20 mg/24 hr for 8 wk and then increase to 40 mg/24 hr for 8 wk, as needed.
Mild GI symptoms, myositis syndrome, elevated transaminase levels, increased CK levels Tab: 10, 20, 40 mg
Adults:
PO: Starting dose, 20 mg/day QD–BID (range, 40–80 mg/24 hr)
(Max dose with concurrent amiodarone or verapamil use, 40 mg/24 hr)
Methyldopa (Aldomet) (antihypertensive) For hypertensive crisis:
Children:
IV: Start at 2–4 mg/kg/dose q6–8 hr
(Max dose, 65 mg/kg/24 hr or 3 g/24 hr whichever is less)
Adults:
IV: 250–500 mg q6 hr
(Max, 1 g q6 hr)
For hypertension:
Children:
PO: 10 mg/kg/24 hr BID–QID
May be increased or decreased
(Max dose, 65 mg/kg/24 hr or 3 g/24 hr, whichever is less)
Adults:
PO: 250 mg/dose BID–TID for 2 days
May be increased or decreased q2 days. (Usual dose: 0.5–2 g/24 hr BID–QID)
(Max, 3 g/24 hr)
Sedation, orthostatic hypotension and bradycardia, lupus-like syndrome, Coombs (+) hemolytic anemia and leukopenia, hepatitis or cirrhosis, colitis, impotence Inj: 50 mg/mL (5 mL)
Susp: 50 mg/mL
Tab: 250, 500 mg
Metoprolol (Lopressor) (β-adrenoceptor blocker) Children >2 yr:
PO: Initially 0.1–0.2 mg/kg/dose BID; gradually increase to 1–3 mg/kg/24 hr
CNS symptoms (dizziness, tiredness, depression), bronchospasm, bradycardia, diarrhea, nausea and vomiting, abdominal pain Tab: 25, 50, 100 mg
Tab, extended release: 25, 50, 100, 200 mg
Adults:
PO: Initially 100 mg/24 hr QD–TID
May increase to 450 mg/24 hr BID–TID
(Usual dose, 100–450 mg/24 hr)
(Usually used with hydrochlorothiazide 25–100 mg/24 hr)
Metolazone (Zaroxolyn, Diulo, Mykrox) (thiazide-like diuretic) Children:
PO: 0.2–0.4 mg/kg/24 hr QD–BID
Adults:
PO: For hypertension: 2.5–5 mg QD
For edema: 5–20 mg QD
Electrolyte imbalance, GI disturbance, hyperglycemia, bone marrow depression, chills, hyperuricemia, hepatitis, rash
May be more effective than thiazide diuretics in impaired renal function
Tab: 0.5 (Mykrox), 2.5, 5, 10 mg
Susp: 1 mg/mL
Mexiletine (Mexitil) (Class IB antiarrhythmic) Children:
PO: 6–8 mg/kg/24 hr BID–TID for 2–3 days; then 2–5 mg/kg/dose q6–8 hr
Increase 1–2 mg/kg/dose q2–3 days until desired effect achieved (with food or antacid)
Adults:
PO: 200 mg q8 hr for 2–3 days
Increase to 300–400 mg q8 hr
(Usual dose, 200–300 mg q8 hr)
( Therapeutic level: 0.75–2 mcg/mL)
Nausea and vomiting, CNS symptoms (headache, dizziness, tremor, paresthesia, mood changes), rash, hepatic dysfunction (±) Caps: 150, 200, 250 mg
Milrinone (Primacor) (phosphodiesterase type III inhibitor) Children:
IV: Loading: 10–50 mcg/kg over 10 min; then 0.1–1 mcg/kg/min
Adults:
IV: Loading: 50 mcg/kg over 10 min
0.5 mcg/kg/min
(Range, 0.375–0.75 mcg/kg/min)
Arrhythmias, hypotension, hypokalemia, thrombocytopenia Inj: 1 mg/mL (5, 10, 20 mL)
Inj, premixed in D 5 W: 200 mcg/mL (100, 200 mL)
Minoxidil (Loniten) (peripheral vasodilator) Children <12 yr:
PO: 0.2 mg/kg/24 hr QD–BID initially
Increase 0.1–0.2 mg/kg/24 hr q3 days until desired effect achieved
(Usual dose, 0.25–1 mg/kg/24 hr QD–BID; Max, 50 mg/24 hr)
Reflex tachycardia and fluid retention (used with a beta-blocker and diuretic), pericardial effusion, hypertrichosis, rarely blood dyscrasias (leukopenia, thrombocytopenia) Tab: 2.5, 10 mg
Children >12 yr and adults:
PO: 5 mg/dose QD initially
May be increased to 10, 20, 40 mg QD–BID q3-day interval
(Usual dose, 10–40 mg/24 hr QD–BID; max, 100 mg/24 hr)
Morphine sulfate (narcotic, analgesic) Children:
SC, IM, IV: 0.1–0.2 mg/kg/dose q2–4 hr
(Max, 15 mg/dose)
Adults:
SC, IM, IV: 2.5–20 mg/dose q2–6 hr PRN
CNS depression, respiratory depression, nausea and vomiting, hypotension, bradycardia Inj: 0.5, 1, 2, 4, 5, 8, 10, 15, 25, 50 mg/mL
Mycophenolate mofetil (CellCept) (immunosuppressant) Children:
PO: 600 mg/m 2 /dose BID
(Max, 2000 mg/24 hr)
( Therapeutic level: 5–7 ng/mL)
Adults:
PO/IV: 2000–3000 g/24 hr BID
Headache, GI symptoms, hypertension, bone marrow suppression (anemia), fever, increased risk of developing lymphomas or other malignancies Tab: 500 mg
Caps: 250 mg
Oral susp: 200 mg/mL
Inj: 500 mg
Nifedipine (Procardia, Adalat) (calcium channel blocker) For hypertrophic cardiomyopathy:
Children:
PO: 0.5–0.9 mg/kg/24 hr TID–QID
For hypertension:
Children:
PO: 0.25–0.5 mg/kg/24 hr QD–BID
(Max, 3 mg/kg/24 hr up to 120 mg/24 hr)
Adults:
PO: Initially 10 mg/dose TID
Titrate up to 20 to 30 mg/dose TID–QID over 7–14 days
(Usual dose, 10–20 mg TID; max dose, 180 mg/24 hr)
Hypotension, peripheral edema, CNS symptoms (headache, dizziness, weakness), nausea Caps: 10, 20 mg
Tab, sustained release (Adalat CC, Procardia XL): 30, 60, 90 mg.
Nitroglycerine (Nitro-Bid, Tridil, Nitrostat) (peripheral vasodilator) Children:
IV: 0.5–1 mcg/kg/min
Increase 1 mcg/kg/min q20 min to titrate to effect
(Max, 6 mcg/kg/min)
(Dilute in D 5 W or NS with final concentration <400 mcg/mL; light sensitive)
Adults:
IV: Initial dose: 5 mcg/min through infusion pump
Increase 5 mcg/min q3–5 min until desired effect achieved
Hypotension, tachycardia, headache, nausea and vomiting Inj: 0.5, 5 mg/mL
Inj, premixed in D 5 W: 100, 200, 400 mcg/mL
Nitroprusside (Nipride) (peripheral vasodilator) Children:
IV: 0.3–0.5 mcg/kg/min; titrate to effect with BP monitoring
(Usual dose, 3–4 mcg/kg/min; max dose, 10 mcg/kg/min)
(Dilute stock solution [50 mg] in 250–2000 mL D 5 W; light sensitive)
Hypotension, palpitation, and cyanide toxicity (metabolic acidosis earliest and most reliable evidence)
Monitor thiocyanate level when used >48 hr and in patients with renal or hepatic dysfunction. Thiocyanate level should be <50 mg/L; cyanate levels >2 mcg/mL are toxic levels
Inj: 25 mg/mL (2 mL)
Inj: 50 mg for reconst with 2–3 mL D 5 W)
Norepinephrine (Levophed, levarterenol) (α 1 – and β 1 -adrenoceptor stimulant) Children:
IV: 0.1 mcg/kg/min IV infusion initially; increase dose to attain desired effect
(Max, 2 mcg/kg/min)
Adults:
IV: Start at 4 mcg/min IV infusion; titrate to effect
(Usual dose range, 8–12 mcg/min)
Hypertension, bradycardia (reflex), arrhythmias, tissue necrosis (treat with phentolamine infiltration) Inj: 1 mg/mL (4 mL)
Omega-3-acid ethyl ester (Lovaza; Omarcor) As an adjunct to diet for high triglyceride levels
PO: 4 g/day, with meal
Occasional gastrointestinal complaints (anorexia, belching, constipation, colitis) Caps: 1 g soft gelatin capsule (60 caps)
Phentolamine (Regitine) (α-adrenoceptor blocker) For diagnosis of pheochromocytoma:
Children:
IM, IV: 0.05–0.1 mg/kg/dose; repeat q5 min until hypertension is controlled; then q2–4 hr PRN
Adults:
IM, IV: 2.5–5 mg/dose; repeat q5 min until hypertension is controlled; then q2–4 hr PRN
For treatment of extravasated α -adrenergic drugs:
SC: Make a solution of 0.5–1 mcg/mL with NS. Inject 1–5 mL (in 5 divided doses) around the site of extravasation
(Max, 0.1–0.5 mg/kg or 5 mg total)
Hypotension, tachycardia or arrhythmias, nausea and vomiting Inj: 5 mg powder for reconst
Phenylephrine (Neo-Synephrine) (α 1 -adrenoceptor stimulant) For hypotension:
Children:
IM, SC: 0.1 mg/kg/dose q1–2 hr PRN
(Max dose, 5 mg)
IV: 5–10 mcg/kg/dose IV bolus q10–15 min or 0.1–0.5 mcg/kg/min
Arrhythmias, hypertension, angina Inj: 10 mg/mL
Adults:
IM, SC: 2–5 mg/dose q1–2 hr PRN
(Max dose, 5 mg)
IV: 0.1–0.5 mg/dose IV bolus q10–15 min PRN
Start IV drip at 100–180 mcg/min; (Usual maintenance dose, 40–60 mcg/min)
Phenytoin (Dilantin) (class IB antiarrhythmic, anticonvulsant) Children:
IV: 2–4 mg/kg/dose over 5–10 min followed by PO dose
PO: 2–5 mg/kg/24 hr BID–TID
( Therapeutic level: 5–18 mcg/mL for arrhythmias, 10–20 mcg/mL for seizures)
Adults:
IV: 100 mg q5 min (total, 500 mg)
PO: 250 mg QID for 1 day, 250 mg/dose BID for 2 days, and 300–400 mg/24 hr QD–QID
Rash, Stevens-Johnson syndrome, CNS symptoms (ataxia, dysarthria), lupus-like syndrome, blood dyscrasias, peripheral neuropathy, gingival hypertrophy Susp: 125 mg/5 mL (240 mL)
Tab, chewable: 50 mg (Infatab)
Caps: 100 mg
Caps, extended release: 30, 100, 200, 300 mg
Inj: 50 mg/mL
Potassium chloride Supplement in diuretic therapy:
Children:
PO: 1–2 mEq/kg/24 hr TID–QID
(or 0.8–1.5 mL 10% potassium chloride/kg/24 hr, or 0.4–0.7 mL 20% potassium chloride/kg/24 hr TID–QID)
GI disturbances, ulcerations, hyperkalemia Oral sol: 10% (1.3 mEq/mL), 20% (2.7 mEq/mL)
Caps, sustained release: 8, 10 mEq
Tabs, sustained release: 8, 10, 15, 20 mEq
Potassium gluconate Supplement in diuretic therapy:
Children:
PO: 1–2 mEq/kg/24 hr TID–QID or 0.8–1.5 mL/kg/24 hr TID–QID
Same as for potassium chloride Elixir: 1.3 mEq/mL
Pravastatin (Pravachol) (antilipemic, HMG-CoA reductase inhibitor) Children (8–13 yr):
PO: Starting dose, 10 mg QD for 4–6 wk
Increase to 20 QD as needed
Adolescents (14–18 yr):
PO: 40 mg QD
(Adult max dose, 80 mg/day)
Headache, constipation, diarrhea, elevated liver enzymes, rhabdomyolysis, myopathy Tabs: 10, 20, 40, 80 mg
Prazosin (Minipress) (postsynaptic α 1 -adrenergic blocker, antihypertensive) Children:
PO: 5 mcg/kg as a test dose; then 25–150 mcg/kg/24 hr QID
Adults:
PO: 1 mg/dose BID–TID initially
Increase to 20 mg/24 hr BID–QID
(Usual dose, 6–15 mg/24 hr)
CNS symptoms (dizziness, headache, drowsiness), palpitation, nausea Caps: 1, 2, 5 mg
Procainamide (Procanbid, Pronestyl) (class IA antiarrhythmic) Children:
IV: Loading: 2–6 mg/kg/dose over 5 min repeated q10–30 min
(Max, 100 mg)
Maintenance: 20–80 mcg/kg/min
(Max, 2 g/24 hr)
PO: 15–50 mg/kg/24 hr q3–6 hr
(Max, 4 g/24 hr)
Adults:
IV: Loading: 50–100 mg/dose q5 min PRN
Maintenance: 1–6 mg/min
PO: Immediate release 250–500 mg/dose q3–6 hr (sustained release 500–1000 mg/dose q6 hr)
( Therapeutic level: 4–10 mcg/mL)
Nausea and vomiting, blood dyscrasias, rash, lupus-like syndrome, hypotension, confusion or disorientation Tab, sustained release: 250, 500, 750, 1000 mg
Caps: 250, 375, 500 mg
Susp: 5, 50, 100 mg/mL
Inj: 100, 500 mg/mL
Propranolol (Inderal) (β-adrenoceptor blocker, class II antiarrhythmic) For hypertension:
Children:
PO: 0.5–1 mg/kg/24 hr BID–QID; may increase q 3–5 days
(Usual dose, 2–4 mg/kg/24 hr; max dose, 8 mg/kg/24 hr)
For arrhythmias:
Children:
IV: 0.01–0.15 mg/kg/dose over 10 min; repeat q6–8 hr PRN
(Max, 1 mg/dose for infants; 3 mg/dose for children)
PO: Start at 0.5–1 mg/kg/24 hr TID–QID; increase dose q3–5 days PRN
(Usual dose, 2–4 mg/kg/24 hr; max dose, 16 mg/kg/24 hr)
Adults:
IV: 1 mg/dose q5 min (max, 5 mg)
PO: 10–20 mg/dose TID–QID; increase PRN (Usual dose, 40–320 mg/24 hr TID–QID)
Hypotension, syncope, bronchospasm, nausea and vomiting, hypoglycemia, lethargy or depression, heart block Tab: 10, 20, 40, 60, 80, 90 mg
Caps, extended release: 60, 80, 120, 160 mg
Oral sol: 20, 40 mg/5 mL
Concentrated sol: 80 mg/mL
Inj: 1 mg/mL
Prostaglandin E 1 or alprostadil (Prostin VR, PGE 1 ) (vasodilator) For patency of ductus arteriosus:
IV: Begin infusion at 0.05–0.1 mcg/kg/min
When desired effect achieved, reduce to 0.05, 0.025, and 0.01 mcg/kg/min
If unresponsive, dose may be increased to 0.4 mcg/kg/min
Apnea, flushing, bradycardia, hypotension, fever Inj: 500 mcg/mL
Protamine sulfate (heparin antidote) Antidote to heparin overdose:
IV: Each 1 mg of protamine neutralizes ≈100 U heparin given in preceding 3–4 hr; slow IV infusion at rate not exceeding 20 mg/min or 50 mg/10 min
(Check APTT)
Hypotension, bradycardia, dyspnea, flushing, coagulation problem Inj: 10 mg/mL
Quinidine (Cardioquin, Quinidex, Quinaglute) (class IA antiarrhythmic) Children:
Test dose for idiosyncrasy: 2 mg/kg once (PO as sulfate; IM/IV as gluconate)
Therapeutic dose:
IV (as gluconate): 2–10 mg/kg/dose q3–6 hr PRN
PO (as sulfate): 15–60 mg/kg/24 hr q6 hr
Adults:
Test dose: 200 mg once PO/IM
Therapeutic dose:
PO (as sulfate, immediate release):
100–600 mg/dose q4–6 hr
Begin at 200 mg/dose and titrate to desired effect, or
PO (sulfate, sustained release): 300–600 mg/dose q8–12 hr
PO (as gluconate): 324–972 mg q8–12 hr
IM (as gluconate): 400 mg/dose q4–6 hr
IV (as gluconate): 200–400 mg/dose, infused at a rate of ≤10 mg/min
( Therapeutic level: 3–7 mg/L)
Nausea and vomiting, ventricular arrhythmias, prolonged QRS complex, depressed myocardial contractility, blood dyscrasias, symptoms of cinchonism Gluconate (62% quinidine):
Tab, slow release: 324 mg
Inj: 80 mg/mL
Sulfate (83% quinidine):
Tabs: 200, 300 mg
Tab, slow release: 300 mg
Susp: 10 mg/mL
Sildenafil (Revatio, Viagra) (phosphodiesterase type V inhibitor)




Simvastatin (Zocor) (antilipemic, HMG-CoA reductase inhibitor)



Sirolimus (Rapamune) (immunosuppressant)
For pulmonary hypertension:
Neonates: PO: 0.25–1 mg/kg/dose BID–QID
Infants and children: PO: 0.25–1 mg/kg/dose q4–6 hr
Adults: PO: 20 mg TID


Children:
PO: Starting dose, 10 mg QD
Increment of 10 mg q6–8 wk to max dose of 40 mg QD as needed
(Adult max, 80 mg/24 hr)

Children:
PO: Loading, 3 mg/m 2 ; maintenance, 1 mg/m 2 /day QD
Adults:
PO: Loading, 6 mg; maintenance, 2 mg/day QD
(Therapeutic level: 6–15 ng/mL)
Hypotension, tachycardia, flushing, headache, rash, nausea, diarrhea, priapism, platelet dysfunction, myalgia, paresthesia, blurred vision, epistaxis, dyspnea
Contraindicated in concurrent use of organic nitrates

Headache, constipation, diarrhea, elevated liver enzymes, rhabdomyolysis, myopathy



Hypertension, peripheral edema, chest pain, fever, headache, acne, hirsutism, hypercholesterolemia, neurotoxicity, abdominal pain, anemia, pneumonitis
Tab: 20, 25, 50, 100 mg









Tab: 5, 10, 20, 40, 80 mg





Tab: 1, 2 mg
Oral sol: 1 mg/mL
Sodium polystyrene sulfonate (Kayexalate, Kionex) (potassium-removing resin) For hyperkalemia (slowly effective, taking hours to days):
Children:
PO, NG: 1 g/kg/dose q6 hr PR: 1 g/kg/dose q2–6 hr
Adults:
PO, NG, PR: 15 g QD–QID
(Cation exchange resin with practical exchange rates of 1 mEq potassium per 1 g resin)
(Note: Delivers 1 mEq sodium for each mEq of potassium removed)
Nausea and vomiting, constipation, severe hypokalemia (muscle weakness, confusion [monitor serum potassium levels, ECG]), hypocalcemia or hypernatremia (edema) Powder: 454, 480 g
Susp: 15 g/60 mL
Sotalol (Betapace) (class II and III antiarrhythmic) For SVT and VT:
PO: 80–120 mg/m 2 /24 hr TID ( infants ) BID ( older children and adults )
Chest pain, palpitation, hypoglycemia, hypotension, torsade de pointes, nausea and vomiting, abdominal pain, CNS symptoms (depression, weakness, dizziness), bronchospasm, heart block, bradycardia, negative inotropic effects, QT prolongation
(Discontinue if QTc >550 msec)
Tab: 80, 120, 160, 240 mg
Syrup: 5 mg/mL
Spironolactone (Aldactone) (potassium-sparing diuretic, aldosterone antagonist) Children:
PO: 3 mg/kg/24 hr BID–TID
Adults:
PO: 50–100 mg/24 hr TID–QID
(Max, 200 mg/24 hr)
Hyperkalemia (when given with potassium supplements and ACE inhibitors), GI distress, rash, gynecomastia, agranulocytosis
Contraindicated in renal failure
Tab: 25, 50, 100 mg
Susp: 1, 2, 2.5, 5, 25 mg/mL
Streptokinase (Streptase, Kabikinase) (thrombolytic enzyme) For thrombolysis:
(Use in consultation with a hematologist)
Children:
IV: 3500–4000 U/kg over 30 min followed by 1000–1500 U/kg/hr, or
2000 U/kg load over 30 min followed by 2000 U/kg/hr
(Duration of infusion based on response but generally does not exceed 3 days; obtain tests at baseline and q4 hr: APTT, TT, fibrinogen, PT, hematocrit, platelet count; APTT and TT should be <2 times control)
Potential for allergic reaction with repeated use; premedicate with acetaminophen and antihistamine and repeat q4–6hr Inj: 250,000, 750,000, 1,500,000 IU powder for reconstruction
Tacrolimus (Prograf) (immunosuppressant) Children and adults:
PO: 0.15–0.4 mg/kg/day BID
IV: 0.03–0.15 mg/kg/day continuous infusion
( Therapeutic level: 5–15 ng/mL)
Hypertension, hypotension, peripheral edema, myocardial hypertrophy, chest pain, fever, headache, encephalopathy, pruritus, hypercholesterolemia, electrolyte imbalance, neurotoxicity, nephrotoxicity, diarrhea, anemia, dyspnea Caps: 0.5, 1, 5 mg
Susp: 0.5 mg/mL
Inj: 5 mg/mL (1 mL)
Tolazoline (Priscoline) (α-adrenoceptor blocker) For neonatal pulmonary hypertension:
IV: Loading: 1–2 mg/kg over 10 min
Maintenance: 1–2 mg/kg/hr
Hypotension and tachycardia, pulmonary hemorrhage, GI bleeding, arrhythmias, thrombocytopenia, leukopenia Inj: 25 mg/mL
Triamterene (Dyrenium) (potassium-sparing diuretic) Children:
PO: 2–4 mg/kg/24 hr QD–BID
May increase up to max of 6 mg/kg/24 hr or 300 mg/24 hr
Adults:
PO: 50–100 mg/24 hr QD–BID
(Max, 300 mg/24 hr)
Nausea and vomiting, leg cramps, dizziness, hyperuricemia, rash, prerenal azotemia Caps: 50, 100 mg
Urokinase (Abbokinase) (thrombolytic enzyme) For thrombolysis (in vein thrombosis or pulmonary embolism):
(Should be used in consultation with a hematologist)
Children:
IV: Loading: 4400 U/kg over 10 min
Bleeding, allergic reactions, rash, fever and chills, bronchospasm Inj: 5000 U/mL
Maintenance: 4400 U/kg/hr for 6–12 hr. Some patients may require 12–72 hr of therapy
(Monitor same laboratory tests as for streptokinase)
For occluded IV catheter clearance:
Aspiration method: Use 5000 U/mL concentrate; instill into the catheter a volume equal to the internal volume of catheter over 1–2 min; leave in place for 1–4 hr; then aspirate; may repeat with 10,000 U/mL if no response; do not infuse into the patient
IV infusion method: 150–200 U/kg/hr in each lumen for 8–48 hr at a rate of at least 20 mL/hr
Adults:
For pulmonary embolism:
IV: Priming dose: 4400 U/kg
IV infusion: 4400 U/kg/hr for 12 hr by infusion pump
Verapamil (Isoptin, Calan) (calcium channel blocker, class IV antiarrhythmic) For dysrhythmia (SVT):
Children:
IV: 1–15 yr (for SVT): 0.1–0.3 mg/kg over 2 min
May repeat same dose in 15 min
(Max dose, 5 mg first dose; 10 mg second dose)
Hypotension, bradycardia, cardiac depression Tab: 40, 80, 120 mg
Tab, extended release: 120, 180, 240 mg
Caps, extended release: 100, 120, 180, 200, 240, 300, 360 mg
Susp: 50 mg/mL
Inj: 2.5 mg/mL
Adults:
IV: 5–10 mg, 10 mg second dose
For hypertension:
Children:
PO: 4–8 mg/kg/24 hr TID
Adults:
PO: 240–480 mg/24 hr TID
Vitamin K 1 Antidote to dicumarol or warfarin:
PO/IM/SC/IV: 2.5–10 mg/dose in 1 dose for correction of excessive PT from dicumarol or warfarin overdose
Tab: 5 mg
Inj: 2, 10 mg/mL
Warfarin (Coumadin, Safarin) (anticoagulant) Children:
PO: Initial: 0.1–0.2 mg/kg/dose QD in evening for 2 days
(Max dose, 10 mg/dose)
(In liver dysfunction, 0.1 mg/kg/day; max, 5 mg/dose)
Maintenance: 0.1 mg/kg/24 hr QD
(Monitor INR after 5–7 days of new dosage; keep INR at 2.5–3.5 for mechanical prosthetic valve; 2–3 for prophylaxis of DVT, pulmonary emboli)
(Heparin preferred initially for rapid anticoagulation; warfarin may be started concomitantly with heparin or may be delayed 3–6 days)
Adults:
PO: Initial: 5–15 mg/dose QD for 2–5 days
Maintenance: 2–10 mg/day
(Adjust dosage based on INR)
Bleeding (antidote: vitamin K or fresh-frozen plasma)
Increased PT response: salicylates, acetaminophen, alcohol, lipid-lowering agents, phenytoin, ibuprofen, some antibiotics
Decreased PT response: antihistamines, barbiturates, oral contraceptives, vitamin C, diet high in vitamin K
Onset of action: 36–72 hr. and full effects in 4–5 days
Mode of action: inhibits hepatic synthesis of vitamin K–dependent factors (I, VII, IX, X)
Tab: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg
Inj: 5 mg

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Apr 15, 2019 | Posted by in CARDIOLOGY | Comments Off on Drugs Used in Pediatric Cardiology
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