Usual Adult Dose for Ventricular Fibrillation

Initial dose: 50 to 100 mg IV bolus once over 2 to 3 minutes; may repeat after 5 minutes if necessary not to exceed up to 300 mg in a 1-hour period
Following bolus administration: 1 to 4 mg/min continuous IV infusion

Comments:

• Patients should be under constant ECG monitoring during administration of this drug.
• Sufficient time should be allowed to enable a slow circulation to carry this drug to the site of action.
• The rate of the IV infusion should be reassessed as soon as the patient's basic cardiac rhythm appears stable or at the earliest signs of toxicity.

Uses: For the acute management of ventricular arrhythmias occurring during cardiac manipulations, such as cardiac surgery; and for life-threatening arrhythmias which are ventricular in origin, such as those that occur during acute myocardial infarction

The American Heart Association (AHA) recommends:
IV:

• Initial dose: 1 to 1.5 mg/kg IV bolus once; may repeat if necessary at a dose of 0.5 to 0.75 mg/kg IV every 5 to 10 minutes up to a maximum cumulative dose of 3 mg/kg
• Following bolus administration: 1 to 4 mg/min continuous IV infusion (30 to 50 mcg/kg/min)

Endotracheal: May be administered endotracheally (bolus dose only) if IV access unavailable at a dose of 2 to 2.5 times the IV dose diluted in 5 to 10 mL NS or distilled water

Uses: For the treatment of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) unresponsive to CPR, defibrillation, and vasopressor therapy as an alternative to amiodarone

Usual Adult Dose for Ventricular Tachycardia

Initial dose: 50 to 100 mg IV bolus once over 2 to 3 minutes; may repeat after 5 minutes if necessary not to exceed up to 300 mg in a 1-hour period
Following bolus administration: 1 to 4 mg/min continuous IV infusion

Comments:

• Patients should be under constant ECG monitoring during administration of this drug.
• Sufficient time should be allowed to enable a slow circulation to carry this drug to the site of action.
• The rate of the IV infusion should be reassessed as soon as the patient's basic cardiac rhythm appears stable or at the earliest signs of toxicity.

Uses: For the acute management of ventricular arrhythmias occurring during cardiac manipulations, such as cardiac surgery; and for life-threatening arrhythmias which are ventricular in origin, such as those that occur during acute myocardial infarction

The American Heart Association (AHA) recommends:
IV:

• Initial dose: 1 to 1.5 mg/kg IV bolus once; may repeat if necessary at a dose of 0.5 to 0.75 mg/kg IV every 5 to 10 minutes up to a maximum cumulative dose of 3 mg/kg
• Following bolus administration: 1 to 4 mg/min continuous IV infusion (30 to 50 mcg/kg/min)

Endotracheal: May be administered endotracheally (bolus dose only) if IV access unavailable at a dose of 2 to 2.5 times the IV dose diluted in 5 to 10 mL NS or distilled water

Uses: For the treatment of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) unresponsive to CPR, defibrillation, and vasopressor therapy as an alternative to amiodarone

Usual Adult Dose for Cardiac Arrhythmia

Initial dose: 50 to 100 mg IV bolus once over 2 to 3 minutes; may repeat after 5 minutes if necessary not to exceed up to 300 mg in a 1-hour period
Following bolus administration: 1 to 4 mg/min continuous IV infusion

Comments:

• Patients should be under constant ECG monitoring during administration of this drug.
• Sufficient time should be allowed to enable a slow circulation to carry this drug to the site of action.
• The rate of the IV infusion should be reassessed as soon as the patient's basic cardiac rhythm appears stable or at the earliest signs of toxicity.

Uses: For the acute management of ventricular arrhythmias occurring during cardiac manipulations, such as cardiac surgery; and for life-threatening arrhythmias which are ventricular in origin, such as those that occur during acute myocardial infarction

The American Heart Association (AHA) recommends:
IV:

• Initial dose: 1 to 1.5 mg/kg IV bolus once; may repeat if necessary at a dose of 0.5 to 0.75 mg/kg IV every 5 to 10 minutes up to a maximum cumulative dose of 3 mg/kg
• Following bolus administration: 1 to 4 mg/min continuous IV infusion (30 to 50 mcg/kg/min)

Endotracheal: May be administered endotracheally (bolus dose only) if IV access unavailable at a dose of 2 to 2.5 times the IV dose diluted in 5 to 10 mL NS or distilled water

Uses: For the treatment of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) unresponsive to CPR, defibrillation, and vasopressor therapy as an alternative to amiodarone

Usual Adult Dose for Anesthesia

Local Injectable Anesthesia:

• Maximum individual dose: 4 mg/kg (IV regional anesthesia); 4.5 mg/kg (infiltration)
• Maximum total dose: 300 mg

Comments:

• The manufacturer product information should be consulted.
• Dose varies with procedure, depth of anesthesia and degree of muscle relaxation needed, duration of anesthesia required, and physical condition of patient.
• For continuous epidural or caudal anesthesia, the maximum recommended dose should not be administered at intervals of less than 90 minutes.
• The maximum recommended dose per 90-minute period for paracervical block is 200 mg total.
• In all cases the lowest effective dose that will produce the desired result should be used.

Use: For the production of local or regional anesthesia by infiltration techniques such as percutaneous injection and IV regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed

Usual Pediatric Dose for Ventricular Fibrillation

The manufacturer gives no specific dosing instructions.

The AHA recommends:
IV:

• Initial dose: 1 mg/kg IV or intraosseous once
• Maintenance infusion: 20 to 50 mcg/kg/min IV

Endotracheal: May be administered endotracheally (bolus dose only) if IV or intraosseous access unavailable at a dose of 2 to 3 times the dose (2 to 3 mg/kg) followed by a flush with at least 5 mL of NS and 5 consecutive positive-pressure ventilations

Use: For use in shock-refractory VF or pVT after resuscitation from cardiac arrest in infants and children

Usual Pediatric Dose for Ventricular Tachycardia

The manufacturer gives no specific dosing instructions.

The AHA recommends:
IV:

• Initial dose: 1 mg/kg IV or intraosseous once
• Maintenance infusion: 20 to 50 mcg/kg/min IV

Endotracheal: May be administered endotracheally (bolus dose only) if IV or intraosseous access unavailable at a dose of 2 to 3 times the dose (2 to 3 mg/kg) followed by a flush with at least 5 mL of NS and 5 consecutive positive-pressure ventilations

Use: For use in shock-refractory VF or pVT after resuscitation from cardiac arrest in infants and children

Usual Pediatric Dose for Anesthesia

3 years or older with normal lean body mass and normal body development: Maximum dose based on patient's age and weight

Comments:

• The manufacturer product information should be consulted.
• Dose varies with procedure, depth of anesthesia and degree of muscle relaxation needed, duration of anesthesia required, and physical condition of patient.
• In all cases the lowest effective dose that will produce the desired result should be used.

Use: For the production of local or regional anesthesia by infiltration techniques such as percutaneous injection and IV regional anesthesia by peripheral nerve block techniques such as brachial plexus and intercostal and by central neural techniques such as lumbar and caudal epidural blocks, when the accepted procedures for these techniques as described in standard textbooks are observed

Renal Dose Adjustments

Use with caution; renal dysfunction may increase the accumulation of metabolites, leading to toxicity.

Liver Dose Adjustments

Patients with reduced hepatic function or diminished hepatic blood flow should receive half the usual loading dose and lower maintenance doses IV:
Adult:

• Loading dose: 25 to 50 mg IV bolus once

Pediatric: Data not available

Dose Adjustments

Dosages should be reduced for children, the elderly, and debilitated patients and those with cardiac and/or liver disease.

Patients with shock, congestive heart failure, or cardiac arrest:

• Drug clearance may be reduced in these patient populations and a continuous infusion when treating ventricular arrhythmias should not exceed 20 mcg/kg/min

Precautions

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• The manufacturer product information should be consulted.
• Caudal and Lumbar Epidural Block: A test dose (e.g., 2 to 3 mL) of solution should be administered at least 5 minutes prior to injecting the total volume required as a precaution against unintentional penetration of the subarachnoid space.
• Do not administer unless solution is clear and seal is intact.

Storage requirements:

• Store at controlled room temperature.
• Protect from light.

Reconstitution/preparation techniques:

• The manufacturer product information should be consulted.

Monitoring:

• Cardiovascular: Continuous ECG monitoring should occur during IV administration.