Medication

Recommended Dose for Children^2,3

Recommended Dose for Adults^2,3

Pharmacology

Monitoring

Benzodiazepines

Diazepam (L)

(Rarely used)

IV/PO: 0.05-0.25 mg/kg

IV/ IM/ PO: 2-10 mg (up to 20 mg may be used for procedures after careful patient assessment)

Anxiolysis, sedation, and amnesia; no analgesia

Problems:

Rapid IV may cause hypotension;

Excessive sedation and apnea can occur suddenly;

may cause disinhibition with increased agitation⁴ in some patients;

Lorazepam has the slowest onset and longest duration among all 3 agents

Mental alertness, Airway patency,

BP,

Pulse,

Respiratory rate,

Tissue oxygenation

(with pulse oximetry)

For high risk patients⁶, consider:

EKG monitoring,

End tidal CO₂ monitoring

(with capnometry)

Lorazepam (I)

(Rarely used)

IV: 0.05-0.1 mg/kg; mainly in status epilepticus

PO: 0.05 mg/kg

IV/IM: 0.01-0.05 mg/kg (Max. 4 mg)

PO: 0.5-5 mg

Midazolam(S)*

- for ICU use and certain procedures

IV/IM: 0.025-0.08 mg/kg over 2 mins

(max. 2.5 mg)

PO: 0.25-0.75 mg/kg (Max. 20 mg)

IV: 0.5-2 mg over 2 mins, repeat q 2-3 mins until desired effect, or, by continuous IV in ICU setting

IM: 0.02-0.1mg/kg (1-7.5 mg)

PO: 0.5-0.8 mg/kg (Max. 50 mg)

Opioids

Fentanyl(I-L)*

- for ICU use and certain procedures

IV: 1-3 µg/kg as 10 µg/ml solution in increments of 0.5-1 µg/kg until desired effect

PO (transmucosal):5-15 µg/kg (Max. 400 µg)

IV/IM: 0.5-2 µg/kg (25-100 mg), repeat q 5 mins-2 hrs as indicated, or by continuous IV (20 µg/ml) in ICU setting

PO (transmucosal): 5 µg/kg (Max. 400 µg)

Analgesia and sedation

Problems:

Rapid IV may cause hypotension , especiallly with morphine;

Excessive sedation and apnea can occur suddenly;

Meperidine has the shortest duration, also, its toxic metabolite may accumulate in renal patients after repeated dosing and cause CNS problems (seizures)

Meperidine(S)

IV/IM: 1-3 mg/kg (Max. 4-5 mg/kg)

IV/IM: 1-3 mg/kg (50-150 mg)

Morphine(S)

IV/IM: 0.05-0.3 mg/kg

IV: 0.05-0.1 mg/kg (2-15 mg), repeat q 15 mins-4 hrs as indicated; or by continuous IV (1 mg/ml) in ICU setting

IM: 2-20 mg

Miscellaneous

Diphenhydramine

not recommended for children

PO/IV/IM: 25-50 mg (as an adjunct only)

May cause disinhibition with increased agitation in some patients

Chloral Hydrate

(single dose, single use)

PO: 25-100 mg/kg; may repeat with 25-50 mg/kg after 30 mins (Max. 2 g or 100 mg/kg)

not recommended for adults

Sedation and anxiolysis; no analgesia

May cause paradoxical excitement

Barbiturates

Pentobarbital

PO: 3-5 mg/kg (max. 200 mg)

not recommended for adults

Excessive sedation and apnea can occur suddenly

Antidotes⁵

Flumazenil

IV: 0.003 mg/kg (max. 0.2 mg) over 30 secs, the dose may be repeated after 30 secs (Max. 2 mg)

IV: 0.2 mg over 30 secs, the dose may be repeated after 30 secs (Max. 2 mg)

Reverse the effect of benzodiazepines

Continuous IV infusion is required to reverse serious

overdose;

May precipitate withdrawal in some patients.

Naloxone

IV/IM/SC: 0.005-0.01 mg/kg q 2-3 mins prn (Max. 1mg)

IV/IM/SC: 0.1-0.2 mg q 2-3 mins prn (Max. 1mg)

Reverse the effect of opioids