Usual Adult Dose for Adams-Stokes Syndrome

IV Bolus:

• Initial dose: 0.02 to 0.06 mg IV bolus
• Subsequent dose range: 0.01 to 0.2 mg

IV Infusion:

• Initial dose: 5 mcg/min via IV infusion

IM:

• Initial dose: 0.2 mg IM
• Subsequent dose range: 0.02 to 1 mg IM

Subcutaneous:

• Initial dose: 0.2 mg subcutaneously
• Subsequent dose range: 0.15 to 0.2 mg subcutaneously

Intracardiac:

• Initial dose: 0.02 mg via intracardiac route

Comments:

• Subcutaneous, intracardiac, and IM doses should be administered using undiluted solution.
• Bolus IV doses should be administered after diluting 1 mL (0.2 mg) in 9 mL of sodium chloride or 5% dextrose injection.
• IV infusion doses should be administered after diluting 10 mL (2 mg) in 500 mL of 5% dextrose injection.
• Subsequent doses and method of administration depend on ventricular rate and rapidity with which the cardiac pacemaker can take over when the drug is gradually withdrawn.

Uses: For mild or transient episodes of heart block that do not require electric shock or pacemaker therapy; for serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation); and for use in cardiac arrest until electric shock or pacemaker therapy is available

Usual Adult Dose for AV Heart Block

IV Bolus:

• Initial dose: 0.02 to 0.06 mg IV bolus
• Subsequent dose range: 0.01 to 0.2 mg

IV Infusion:

• Initial dose: 5 mcg/min via IV infusion

IM:

• Initial dose: 0.2 mg IM
• Subsequent dose range: 0.02 to 1 mg IM

Subcutaneous:

• Initial dose: 0.2 mg subcutaneously
• Subsequent dose range: 0.15 to 0.2 mg subcutaneously

Intracardiac:

• Initial dose: 0.02 mg via intracardiac route

Comments:

• Subcutaneous, intracardiac, and IM doses should be administered using undiluted solution.
• Bolus IV doses should be administered after diluting 1 mL (0.2 mg) in 9 mL of sodium chloride or 5% dextrose injection.
• IV infusion doses should be administered after diluting 10 mL (2 mg) in 500 mL of 5% dextrose injection.
• Subsequent doses and method of administration depend on ventricular rate and rapidity with which the cardiac pacemaker can take over when the drug is gradually withdrawn.

Uses: For mild or transient episodes of heart block that do not require electric shock or pacemaker therapy; for serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation); and for use in cardiac arrest until electric shock or pacemaker therapy is available

Usual Adult Dose for Cardiac Arrest

IV Bolus:

• Initial dose: 0.02 to 0.06 mg IV bolus
• Subsequent dose range: 0.01 to 0.2 mg

IV Infusion:

• Initial dose: 5 mcg/min via IV infusion

IM:

• Initial dose: 0.2 mg IM
• Subsequent dose range: 0.02 to 1 mg IM

Subcutaneous:

• Initial dose: 0.2 mg subcutaneously
• Subsequent dose range: 0.15 to 0.2 mg subcutaneously

Intracardiac:

• Initial dose: 0.02 mg via intracardiac route

Comments:

• Subcutaneous, intracardiac, and IM doses should be administered using undiluted solution.
• Bolus IV doses should be administered after diluting 1 mL (0.2 mg) in 9 mL of sodium chloride or 5% dextrose injection.
• IV infusion doses should be administered after diluting 10 mL (2 mg) in 500 mL of 5% dextrose injection.
• Subsequent doses and method of administration depend on ventricular rate and rapidity with which the cardiac pacemaker can take over when the drug is gradually withdrawn.

Uses: For mild or transient episodes of heart block that do not require electric shock or pacemaker therapy; for serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation); and for use in cardiac arrest until electric shock or pacemaker therapy is available

Usual Adult Dose for Shock

Initial dose: 0.5 to 5 mcg/min via IV infusion

Comments:

• Dilute 5 mL (1 mg) in 500 mL of 5% dextrose injection prior to administration.
• Consider decreasing or temporarily stopping the infusion if the heart rate exceeds 100 beats per minute.
• Concentrations up to 10 times greater have been used when limitation of volume is essential.
• Rates over 30 mcg per minute have been used in advanced stages of shock.
• The rate of infusion should be adjusted based on heart rate, central venous pressure, systemic blood pressure, and urine flow.

Uses: As an adjunct to fluid and electrolyte replacement therapy and the use of other drugs and procedures in the treatment of hypovolemic and septic shock, low cardiac output (hypoperfusion) states, congestive heart failure, and cardiogenic shock

Usual Adult Dose for Bronchospasm During Anesthesia

Initial dose: 0.01 to 0.02 mg IV bolus; may be repeated when necessary

Comments:

• Dilute 1 mL (0.2 mg) in 9 mL of sodium chloride or 5% dextrose injection.

Use: For the treatment of bronchospasm during anesthesia

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Elderly: Initiate at the low end of the dosing range due to increased likelihood for decreased hepatic, renal, or cardiac function or presence of concomitant diseases or other drug therapy.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Begin therapy with the lowest recommended dose and increase rate of administration gradually if needed while carefully monitoring patient.
• Intracardiac injection should only be used in dire emergencies; if time is not of the utmost importance, initial therapy by IM or subcutaneous injection is preferred.

Storage requirements:

• Protect from light.
• Keep in opaque container until use.

Reconstitution/preparation techniques:

• Do not use if injection is pinkish or darker than slightly yellow or contains precipitate.

Monitoring:

• Cardiovascular: Routinely monitor systemic blood pressure, heart rate, and the electrocardiograph.
• Genitourinary: Routinely monitor urine flow.
• Monitor response to therapy by frequent determination of central venous pressure and blood gases.