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Drugs in Pediatric cardiology
img Dr Manisha Chakrawarti
Sr Consultant
Max Heart & Vasular Institute ,Saket New Delhi
 
Atropine 0.01-0.03 mg/kg IV/IM ,then 0.01 mg/kg 4-6 H, (max 2 mg)
Calcium chloride 10% solution(0.22mmol/ml Ca):0.5 ml/kg(max 20 ml) slow IV stat.Inotrope- 0.5- 2 mmol/kg/day(0.1 - 0.4 ml/kg/hr) undiluted via CVC.
Epinephrine 0.1 ml/kg of 1/10,000 IV or intracardiac; via ETT 0.1 ml/kg of 1/1000.
Sodium bicarbonate Slow IV: dose(m mol) = BE x Wt /4 (< 5 kg) ,Be x WT/6 (child),BE x Wt /10 ( adult).Alkalinise urine 0.25 mmol/kg 6-12 H oral
Inotropic Agent
Digoxin 15 mcg/kg stat,5 mcg/kg after 6 H,then 3-5 mcg/kg (usual max 200 mcg IV,250 mcg oral) 12H slow IV or oral.
Dopamine 5-20mcg/kg/min via CVC
Dobutamine 5-20 mcg/kg/min
Epinephrine 0.05-1.0 mcg/kg/min
Isoproterenol 0.05- 1.5 mcg/kg/h
Norepinephrine 0.05-1.0mcg/kg/min
Vasodilators
Amlodepine 0.05 - 0.2 mg/kg daily oral
Hydralazine 0.1 -0.2 mg/kg stat IV/IM,then 4 - 6 mcg/kg/min.Oral: 0.4 mg/kg 12H,slow incr to 1.5 mg/kg (usual max 50 mg) 6-8 H.
Isosorbide dinitrate Sublingual: 0.1 - 0.2 mg/kg ( max 10 mg) 2 H .Oral: 0.5 -1 mg/kg 6 H .Slow release tab : 20 -80 mg 12 H.OV infusion: 0.6 -2 mcg /kg/min.
Nifedipine 0.25 - 0.5 mg/kg 6-8H(caps),0.5 - 1 mg/kg (tabs) 12H oral/sublingual
Nitroglycerine 0.3-5 mcg/kg/min,use special non-PVC tubing
Nitroprusside 0.3 -10 mcg/kg/min
PrazosinHCL 5 mcg/kg as test dose, 6 -35 mcg/kg/(max 15 mg/day) QID

Phosphodiesterase Inhibitors
Amrinone 1-3 mg/kg over 1 hr,then 5-15 mcg/kg/min
Milrinone 75mcg/kg bolus,then 0.50-0.75 mcg/kg/min
Diuretic agents
Acetazolamide 5 mg/kg QID
Furosemide 1-2 mg/kg Q 6-12 h,bolus 0.1 mg/kg,0.1 -0.4 mg/kg/h IV infusion
Hydrochlorothiazide 1-2 mg/kg/dose oral BID
Spironolactone 0.5 - 1.5 mg/kg/dose QID
Metolazone 0.1 - 0.2 mg/kg,max 5 mg ,BID
ß blockers
Bisoprolol 0.2 - 0.4 mg /kg daily oral
Carvedilol 0.08 mg./ kg 12 H oral, if tolerated incr by 0.08mg/kg every 1-2 wk to max 0.5 -0.75 mg/kg 12 H.
Esmolol 500 mcg/kg iv bolus over 1 min,infusion(undiluted 10 mg/kg solution): 25 -250 mcg/kg/min,rarely given for >48 hr.
Labetolol 1-2 mg/kg 12H oral,may incr wkly to max 10 mg/kg 6 h.
Propanolol 0.02 mg/kg test dose if IV , then 0.1 mg/kg over 10 min ,then 0.1 -0.3 mg/kg 3 H.Oral: 0.2 -0.5 mg/kg 6-12H,slow incr to max 1.5 mg/kg 6-12 H if reqd.
Metoprolol 0.1 mg/kg over 5 min IV,repeat every 5 min to max 3 doses,then 1-5 mcg/kg/min.Oral:1-2 mg/kg 6-12 H.
Sotalol 0.5-2 mg/kg over 10 min IV 6 H.Oral: 1-4 mg/kg 8-12 H.
Angiotensin converting enzyme inhibitors
Captopril Test dose-0.01 mg/kg oral, if tolerated 0.05 - 0.1 mg/kg 8H oral,incr if reqd to max 2 mg/kg 8 H.
Enalapril 0.1 mg/kg/d oral ,incr over 2 wks if reqd to max 1 mg/kg /d,Q 12-24 H
Ramipril 0.05 mg/kg oral daily ,may incr over 4 - 6 wk to 0.1-0.2 mg/kg daily
Antiarrythmic drugs
Adenosine 50 - 200 mcg/kg(0.1 mg/kg stat by rapid IV push,incr by 0.1mg/kg every 2 min to max 0.5mg/kg.PAH : 50 mcg/kg/min iv infusion into central vein
Amiodarone 10 - 15 mg/kg/d for 4 hrs , then 5-15 mcg/kg/min infusion;oral-4 mg/kg 8 hrly x 1 wk,then 12 hrly x 1 wk,then 12- 24 hrly.
Pulseless VF./VT - 5 mg/kg IV over 3-5 min.
Bretylium 5 - 10 mg/kg IV over 1 hr,then 5-30 mcg/kg/min.
Diltiazem 1 mg/kg 8H,incr if reqd to 3 mg/kg 8 H oral.Slow release - 120 - 240 mg/day.
Lignocaine 1% solution- 0.1 ml/kg(1 mg/kg) over 2 min,then 0.09 - 0.3 ml/kg/hr(15 - 50 mcg/kg/ min for 2 min); then 1.5 15 ml/hr( 15 - 50 mcg/kg/min).Nerve block: without adrenaline max 4 mg/kg/,with adrenaline 7 mg/kg.Topical spray(10 % spray pack-10 mg/puff)
Procainamide 0.4 mg/kg/min for max 25 min,then 20 - 80 mcg/kg/min infusion(max 2 g/day).oral: 5 -8 mg/kg 4 h.Level- 3-10 mcg/ml.
Propafenone: 70 mg/m2 8 H oral,incr if rqd to max 165 mg/m2 8 H.IV 2 mg/kg over 2 hr ,then 4 m,cg/kg/min incr if reqd to max 8 mcg/kg/min.
Quinidine 10 mg/kg stat, then 5mg/kg (max 333 mg) Q 4-6 H oral. IV- 6.3 mg/kg(10 mg/kg of gluconate) over 2 hr,then 0.0125 mg/kg/min;IM 15 mg/kg stat,then 7.5 mg/kg ( max 400 mg) 8 H.
Verapamil 0.1- 0.2 mg/kg over 10 min IV, then 5 mcg/kg/min.Oral: 1-3 mg/kg 8-12 hrly.
Ductal manipulation
Indomethacin 0.5 -1 mg/kg 8 H (max 6 H) oral or PR.PDA: 0.1 mg/kg (< 1 kg) or 0.2 mg/kg (>= 1 kg) on day 1,then 0.1 mg/kg daily days 2-7 oral or IV over 1 hr.
ProstaglandinE1 0.01 - 0.6 mcg/kg/min
Miscellaneous
Acetylsalicylic acid 3-10 mg/kg/day(anti platelet) ; 15-25 mg/kg/day(anti inflammatory)
Atorvastatin 0.2 mg/kg daily ,incrif reqd every week to max 1.6 mg/kg 'daily.
Dexamethasone 0.1-0.25mg/kg QID oral/IM/IV
Digoxin immune FAB(Ab) Dose (to nearest 40 mg) = serum digoxin (nmol/L) x Wt(kg) x 0.3,or mg ingested x 55,given IV over 30 min
Heparin 1mg=100 IU.Low dose: 75μg/kg IV stat,then 10-15μg/kg /hr Infusion,Full dose:75 μg/kg IV stat, 20-40 μg/kg/hr infusion(adjusted to keep APTT-60-85 sec).
Ibuprofen 5-10 mg/kg TID/QID.For PDA- 10 mg/kg stat, then 5 mg/kg after 24 and 48 hrs
Indomethecin 0.5-1 mg/kg 8 H(max 6 H) oral or PR.PDA 0.1 mg/kg(<1 kg)or 0.2 mg/kg (> = 1kg) day 1, then 0.1 mg/kg daily days 2-7 oral or IV over 1 hr.
Isoproterenol 0.05 -1 mcg/kg/hr as IV infusion
ProstaglandinE1 10 - 60 ng/kg/min
Protamine sulfate 1mg/ 100 U heparin
Streptokinase 30,000 U/kg IV over 60 min,repeat if occlusion recurs < 5 days.Long term(DVT,Pulm emb,art thrombosis): 2000U/kg(max 100,000 U/hr);if PTT < x2 normal at 4 hr give extradose of 10,000 u/kg IV over 30 min, stop SK if PTT > x 5 normal then give 15 U/kg/hr.
Urokinase 4000U/kg IV over 10 min,then 4000U/kg/hr for 12 hr(start heparin 3-4 hr later).

Vitamin K1 10 ml/kg,then 0.3 mg/kg ( max 10 mg),IM or IV over 1 hr.Warfarin reversal: 0.1 mg/kg (max 5 mg) SC or oral (repeat if reqd).
Warfarin 0.2 mg/kg stat,0.2 mg/kg next day providing INR < 1.3,then 0.05-0.2 mg/kg (adult 2-5 mg) daily oral.
Sedatives
Chloral hydrate 20- 100 mg/kg ( max 2 gm) Q 6-8 hr
Chlorpromazine 0.5 - 2 mg/kg(max 100 mg) Q 4-6 H oral,0.25 - 1 mg/kg(usual 50 mg) 6-8 H.
Fentanyl . Not ventilated:1-3 mcg/kg Q 2hr, IV,IM;1-5 mcg/kg/hr infusion.Ventilated: 5-10 mcg/kg stat or 50 mcg/kg IV infusion over 1 hr;infusion 5-10 mcg/kg/hr
Diazepam 0.1 - 0.4 mg/kg IV or PR.0.04 - 0.25 mg/kg Q 8 - 12 H oral
Midazolam 0.1- 0.2 mg / kg IV/IM (max 0.5 mg/kg);nasal:0.2 mg/kg(repeated in 10 mins if required);1-4 mcg/kg/min IV infusion
Morphine sulfate 0.1 - 0.2 mg/kg/dose,10-30 mcg/kg/hr iv infusion in ventilated neonate, 20 - 80 mcg/kg/hr in children
Promethazine . Antiemetic / anti histaminic:0.2- 0.5 mg/kg 6- 8 hrIV,IM or oral; 0.5 -1 .5 mg/kg 6-8 hr as hypnotic/sedative