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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