Pediatric Drug Reference PDF

Pediatric Drug Reference
2004 Edition
Dosages, Side Effects, and Drug Interactions
Jane L. Gennrich, PharmD
Paul D. Chan, MD
Current Clinical Strategies Publishing
www.ccspublishing.com/ccs
Digital Book and Updates

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using any therapeutic agent. No warranty exists, expressed or implied, for errors or omissions in this text. Current Clinical Strategies is a trademark of
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Individual Drug Preparations
Abacavir (ABC, Ziagen); Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Soln: 20 mg/mL [240 mL]
Tab: 300 mg; >3 months-15 yrs: 8 mg/kg/day PO bid (max 600 mg/day)
>16 yrs: 300 mg PO bid
Always use in combination with other antiretroviral agents. Fatal hypersensitivity reactions may occur; discontinue therapy immediately if reaction
occurs. Symptoms may include skin rash, edema, lethargy, malaise, GI distress. May take with or without food.
Acetaminophen (Tylenol); Analgesic, Antipyretic; Cap: 325, 500 mg

Cap sprinkle: 80, 160 mg
Cplt: 160, 500 mg
Cplt ER: 650 mg
Drops per mL: 100 mg
Elixir per 5 mL: 80, 120, 160 mg
Soln per 15 mL: 500 mg
Supp: 80, 120, 300, 325, 650 mg
Susp per mL: 100 mg
Tab: 160, 325, 500 mg
Tab chew: 80, 160 mg; 10-20 mg/kg/dose PO/PR q4-6h prn
Max 80 mg/kg/day or 4 gm/day (whichever is smaller). Max adult dose 1000 mg. Overdose may result in hepatotoxicity unless treated with N-
Acetylcysteine.
Acetylcysteine (Mucomyst); Antidote to Acetaminophen; Soln, 10%: 4, 10, 30 mL

Soln, 20%: 4, 10, 30, 100 mL; Acetaminophen Overdose: 140 mg/kg PO/NG x 1 dose, followed by 70 mg/kg PO/NG q4h x 17 doses; repeat dose if
emesis occurs within 1 hr of administration.
Dilute solution to 5% with orange juice or carbonated beverage for oral administration. 10% soln = 100 mg/mL; 20% soln = 200 mg/mL.
Acyclovir (Zovirax); Antiviral; Cap: 200 mg

Inj: 500 mg, 1 gm
Oint: 5% [3, 15 gm]
Susp: 200 mg/5 mL
Tab: 400, 800 mg; Herpes zoster (immunocompromised): 500 mg/m2/dose PO 4-5 times daily or 1500 mg/m2/day IV q8h
Herpes zoster (immunocompetent): 80 mg/kg/day PO 5 times daily (max 4000 mg/day) or 30 mg/kg/day IV q8h
Varicella zoster (chicken pox): 80 mg/kg/day PO qid x 5 days (max 3200 mg/day)
Mucocutaneous HSV infection: 750 mg/m2/day IV q8h or 15 mg/kg/day IV q8h x 7 days.
Genital herpes or HSV (immunocompromised): 80 mg/kg/day PO 3-5 times daily (max 1000 mg/day)
Herpes encephalitis:
birth-12 yrs: 60 mg/kg/day IV q8h
>12 yrs: 30 mg/kg/day IV q8h
Infuse each IV dose over 1 hour. Adjust in renal impairment. Patients should be well hydrated to avoid urolithiasis.
Topical: Apply to affected area q3h while awake for 7 days. avoid
Adenosine (Adenocard); Antiarrhythmic ; Inj: 3 mg/mL [2, 4 mL]; Supraventricular tachycardia: 0.1 mg/kg (max 6 mg) rapid IV push over 1-2 seconds;
if not effective within 1-2 minutes, may repeat twice with 0.2 mg/kg (max 12 mg) rapid IV push. Follow each dose with normal saline flush.
Administration of doses <0.6 mg requires dilution.
Albendazole (Albenza); Antihelmintic; Tab: 200 mg; Neurocysticercosis: Patient should also receive appropriate corticosteroid and anticonvulsant
therapy if indicated.
<60 kg: 15 mg/kg/day PO bid for 8-30 days, max 800 mg/day
>60 kg: 400 m PO bid for 8-30 days
Roundworm, hookworm, whipworm:
Children and adults: 400 mg PO x 1
For long-term therapy, monitor CBC and LFTs q2 weeks.
Albumin, human (Albuminar, Albumisol); Plasma Volume Expander; Inj: 5% [50, 250, 500, 1000 mL], 25% [20, 50, 100 mL]; Hypoproteinemia: 0.5-1
gm/kg/dose IV infused over 2-4h; may repeat q1-2 days; (25% concentration preferred, consider giving furosemide afterwards)
Hypovolemia: 0.5-1 gm/kg/dose IV infused over 10-60 minutes (5% concentration preferred, dose equals 10-20 mL/kg)
Contains sodium 130-160 mEq per liter.
Albuterol (Proventil, Ventolin, Volmax, Rotacaps); Bronchodilator, Beta-2 Adrenergic Agonist; MDI: 90 mcg/puff, 200 puffs/canister [17 gm]
Soln for nebulization: 0.5% (5 mg/mL) [20 mL]; 0.083% [3mL unit dose]
Soln for nebulization (AccuNeb): 0.63 mg/3 mL; 1.25 mg/3 mL
Syr: 2 mg/5 mL
Tab: 2, 4 mg
Tab ER: 4, 8 mg; Inhalation: 1-2 puffs q4-6h prn; spacers are recommended for young children.
Oral: 2-6 yrs: 0.1-0.2 mg/kg/dose tid (max 4 mg/day)
6-12 yrs: 2 mg/dose tid-qid or 4 mg ER bid
>12 yrs: 2-4 mg/dose tid-qid or 4-8 mg ER bid
Nebulizer: 0.01-0.05 cc/kg of 0.5% soln (min 0.1 cc, max 1 cc) in 2 cc NS or 0.15 - 0.25 mg/kg of 0.083% soln (0. 83 mg/mL, max 5 mg) q4-6h prn.
AccuNeb: <12 yrs 0.63 - 1.25 mg neb q4-6h prn, >12 yrs 1.25 mg neb q 4-6h prn. Hospitalized patients may require more frequent dosing with higher
concentrations of albuterol.
Tachycardia, hypokalemia, CNS stimulation.
Alclometasone (Aclovate); Corticosteroid; Cream, oint: 0.05% [15, 45 gm]; Apply sparingly to affected area 2-4 times daily.
Low-potency corticosteroid.
Allopurinol (Zyloprim); Hypouricemic; Tab: 100, 300 mg

Inj: 500 mg; PO: 10 mg/kg/day bid-tid (max 800 mg/day)
IV: <10 yrs: 200 mg/m2/day qd-tid (max 600 mg/day); >10 yrs: 200-400 mg/m2/day qd-tid (max 600 mg/day)
Adjust dose in renal impairment. May extemporaneously prepare suspension from tablets with 60-day stability at room temperature.
Alprostadil (Prostin VR); Prostaglandin E1; Inj: 500 mcg/mL [1 mL]; 0.01-0.1 mcg/kg/min continuous IV infusion
Used to temporarily maintain patency of ductus arteriosus in neonates with ductal-dependent congenital heart disease until surgery.
Amantadine (Symmetrel); Antiviral; Cap: 100 mg

Syr: 50 mg/5 mL
Tab: 100 mg; Influenza A prophylaxis and treatment:
1-9 yrs: 5 mg/kg/day PO qd-bid (max 150 mg/day)
10-12 yrs: 5 mg/kg/day PO qd-bid (max 200 mg/day)
>12 yrs: 100 mg PO bid or 200 mg/day PO qd
Dividing the daily dose bid may decrease the incidence of CNS side effects.
For prophylaxis, duration of therapy is 10 days following exposure. For treatment of influenza A, start therapy within 24-48 hrs of symptom onset and
continue for 24-48 hrs after patient is asymptomatic (usual duration of therapy 2-5 days).
Side effects are common and include dizziness, confusion, and headache.
Amcinonide (Cyclocort); Corticosteroid; Cream: 0.1% [15, 30, 60 gm]

Lotion: 0.1% [20, 60 mL]
Oint: 0.1% [15, 30, 60 gm]; Apply sparingly to affected area 2 to 4 times daily.
High-potency corticosteroid.
Amikacin sulfate (Amikin); Antibacterial, Aminoglycoside; Inj: 50 mg/mL [2 mL], 250 mg/mL [2, 4 mL] ; <5 yr (except neonates): 22.5 mg/kg/day IV/IM
q8h
5-10 yrs: 18 mg/kg/day IV/IM q8h
>10 yrs: 15 mg/kg/day IV/IM q8h
Infuse over 30 minutes. Therapeutic peak levels 20-30 mcg/mL and trough levels <8 mcg/mL. Adjust dose in renal impairment. Side effects include
nephrotoxicity and ototoxicity.
Aminocaproic Acid (Amicar); Hemostatic Agent; Syr: 250 mg/mL

Tab: 500 mg
Inj: 250 mg/mL; Loading dose: 100-200 mg/kg PO/IV x 1
Maintenance dose: 100 mg/kg PO/IV q6h, max 30 gm/day
Continuous IV Infusion: 33.3 mg/kg/hr (or 1 gm/m2/hr), max 18 gm.m2/day
Aminophylline (Somophyllin, Truphylline); Bronchodilator; Inj: 25 mg/mL

Liq: 105 mg/5 mL
Tab: 100, 200 mg
Tab CR: 225 mg; IV Loading dose: 5-6 mg/kg IV over 20-30 minutes
Maintenance IV infusion: 1-6 mos: 0.5 mg/kg/hr
6-12 mos: 0.6-0.75 mg/kg/hr
12 mos-10 yrs: 1.0 mg/kg/hr
10-16 yrs: 0.75-0.9 mg/kg/hr
>16 yrs: 0.7 mg/kg/hr
Oral dose:
1-9 yrs: 16-19.2 mg/kg/day q6-12h
9-12 yrs: 12.8 mg/kg/day q6-12h
12-16 yrs: 10.4 mg/kg/day q6-12h
>16 yrs: 8 mg/kg/day q6-12h
Liq or tab: q6-8h; CR tab: q8-12h
Therapeutic Levels: 10-20 mcg/mL.
Aminophylline contains 80% theophylline.
Monitor serum levels and adjust dose as appropriate.
Amitriptyline (Elavil); Tricyclic Antidepressant; Tab: 10, 25, 50, 75, 100, 150 mg; Depression: 1-1.5 mg/kg/day PO qhs-tid (max 150 mg/day)
Chronic Pain: 0.1 mg/kg/day PO qhs, titrate as needed to 0.5-2 mg/kg/day PO qhs
Therapeutic Serum Levels: For amitriptyline plus nortriptyline (active metabolite) 100-250 ng/mL.
Anticholinergic side effects include urinary retention and sedation.
Ammonium Chloride (NH4Cl); Metabolic Alkalosis Agent, Urinary Acidifying Agent; Inj: 5 mEq/mL; Urinary acidification:
75 mg/kg/day PO qid, max 6000 mg/day
Correction of hypochloremia:
mEq NH4Cl = 0.3 L/kg x wt in kg x base excess (mEq/L); give 1/2 to 2/3 of calculated dose then reevaluate
Correction of refractory hypochloremic metabolic acidosis:
mEq NH4Cl = 0.5 L/kg x wt in kg x [serum HCO3 - 24] mEq/L; give 1/2 to 2/3 of calculated dose then reevaluate
May use injectable solution as an oral liquid.
Amoxicillin (Amoxil); Antibacterial, Penicillin ; Cap: 250, 500 mg

Drops: 50 mg/mL
Susp: 125 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL
Tab: 500, 875 mg
Tab, chew: 125, 200, 250, 400 mg; 25-50 mg/kg/day PO bid-tid (max 500 mg/dose); doses as high as 80-90 mg/kg/day PO bid have been used to treat
highly resistant strains of Strep pneumoniae
Anthrax (if penicillin susceptible):
80 mg/kg/day PO q8h to complete 60-day course, max 1500 mg/day
May cause diarrhea.
Amphotericin B (Fungizone); Antifungal; Inj: 50 mg; Test dose: 0.1 mg/kg (max 1 mg) IV over 60 min, followed by remainder of first day's dose. Initial
dose: 0.25 mg/kg; increase by 0.25 mg/kg q1-2 days. Usual dose: 0.5-1 mg/kg/day; max daily dose 50 mg.
Infuse over 2-6 hours. Monitor closely for hypokalemia, hypomagnesemia, renal toxicity.
Amphotericin B cholesteryl (Amphotec); Antifungal; Inj: 50, 100 mg; 3-4 mg/kg/day IV over 3-4 hours
Infuse at 1 mg/kg/hr. Usual concentration is 0.6 mg/mL. The test dose (first dose only) is the first 10 mL of the dose infused over 15-30 minutes, then
wait for 30 more minutes, then may infuse the remainder if no adverse reactions such as fever, nausea, tachypnea have occurred.
Amphotericin B lipid complex (Abelcet); Antifungal; Inj: 5 mg/mL [10, 20 mL]; 2.5-5 mg/kg IV qd.
Infuse over 1-2 hrs. Monitor serum potassium, magnesium, creatinine. Gently shake bag after two hours if drug is still infusing.
Amphotericin B liposomal (AmBisome); Antifungal; Inj: 50 mg; 3-5 mg/kg IV qd. Doses up to 6 mg/kg/day IV qd have been used to treat Aspergillosis.
Infuse over 1-2 hrs. Monitor serum potassium, magnesium, creatinine.
Ampicillin (Omnipen, Principen); Antibacterial, Penicillin ; Cap: 250, 500 mg

Inj: 125, 250, 500, 1000, 2000 mg
Susp per 5 mL: 125, 250 mg; Sepsis: 100-200 mg/kg/day IV/IM q4-6h (max 12 gm/day)
Meningitis: 200-400 mg/kg/day IV/IM q4-6h (max 12 gm/day)
Oral: 50-100 mg/kg/day PO qid (max 2-3 gm/day)
Amprenavir (Agenerase); Antiretroviral, Protease Inhibitor; Cap: 50, 150 mg

Soln: 15 mg/mL; Capsules:
4-12 yrs (also 13-16 yrs if <50kg): 40 mg/kg/day PO bid or 45 mg/kg/day PO tid (max 2400 mg/day)
>12 yrs AND >50 kg: 1200 mg PO bid
Solution:
4-12 yrs (also 13-16 yrs if < 50 kg): 45 mg/kg/day PO bid or 51 mg/kg/day PO tid (max 2800 mg/day)
>13 yrs AND >50 kg: 1400 mg PO bid
The solution is not interchangeable with the capsules on a mg per mg basis. Severe or life-threatening rash occurs in 1% of patients. May take with or
without food.
Arginine (R-Gene); Metabolic Alkalosis Agent; Inj: 10% (0.475 mEq chloride/mL); Hypochloremia:
mEq = 0.2 x wt in kg x [103 - Cl] PO/IV
Cl = patients chloride concentration in mEq/L
Give 1/2 to b calculated dose and re-evaluate. May give injectable solution orally.
Aspirin (Bayer, Ecotrin); Analgesic, Antipyretic, Anti-inflammatory Agent; Caplet, buffered: 325 mg
Supp: 120, 200, 300, 600 mg
Tab: 325, 500 mg
Tab buffered: 325, 500 mg
Tab chew: 81 mg
Tab CR: 800 mg
Tab DR: 81 mg
Tab EC: 81, 165, 325, 500, 650, 975 mg
Tab ER: 650 mg; Kawasaki's Disease: 80-100 mg/kg/day PO/PR q6h; once fever resolves, decrease dose to 3-5 mg/kg/day PO qd.
Analgesic and antipyretic: 10-15 mg/kg/dose PO/PR q4-6h prn (max 4 gm/day)
Anti-inflammatory: 60-90 mg/kg/day PO/PR q6h (max 4 gm/day).
Contraindicated in children with fever because of risk of Reye's Syndrome. May cause GI bleeding and tinnitus. Take with food.
Atenolol (Tenormin); Beta-Adrenergic Blocker; Tabs: 25, 50, 100 mg; 0.8 - 1 mg/kg/day PO qd
May titrate up if needed to 1.5 mg/kg/day (max 100 mg/day)
Extemporaneous suspension may be made with 40-day stability under refrigeration or at room temperature.
Atomoxetine (Strattera); Presynaptic Norepinehprine Transporter; Cap: 10, 18, 25, 40, 60 mg
ADHD:
<70 kg: 0.5 mg/kg PO qam, may increase q3 days to a total of 1.2 mg/kg/day PO qd-bid (bid schedule is AM and later afternoon), max 100 mg/day
>70 kg: Initially 40 mg PO qd, may increase q3 days to 80-100 mg PO qd-bid (bid schedule is AM and later afternoon)
Not a controlled substance. May retard weight and height gain.
Attapulgite (Kaopectate); Antidiarrheal Agent; Caplet: 750 mg

Liquid: 600 mg/15 mL, 750 mg/15 mL
Tab: 600 mg
Oral: give after each bowel movement, maximum 7 days/24 hrs
3-6 yrs: 300-750 mg/dose, max 2250 mg/day
7-12 yrs: 600-1500 mg/dose, max 4500 mg/day
>12 yrs: 1200-3000 mg/dose, max 9000 mg/day
Atovaquone (Mepron); Antiprotozoal Agent; Susp: 750 mg/5 mL

1-3 mos: 30 mg/kg/day PO qd
4-24 mos: 45 mg/kg/day PO qd
>24 mos: 30 mg/kg/day PO qd, max 1500 mg/day
Administer with food or high-fat meal.
Atropine sulfate; Anticholinergic Agent; Inj per mL: 0.05, 0.1, 0.3, 0.4, 0.5, 0.8, 1.0 mg
Ophth oint: 1% [3.5 gm]
Ophth soln: 0.5% [5 mL], 1% [1, 2, 5, 15 mL], 2% [2 mL]
Bradycardia (IV/ET): 0.02 mg/kg (min 0.1 mg; max 0.5 mg in children and 1 mg in adolescents); for intratracheal administration, dilute with normal
saline to total volume of 2 mL
Reserved use for patients unresponsive to improved oxygenation and epinephrine.
Ophthalmic: Instill 1-2 drops of soln prior to procedure.
Azathioprine (Imuran); Immunosuppressant Agent; Inj: 100 mg

Tab: 50 mg; Initial: 2-5 mg/kg/day PO/IV qd
Maintenance: 1-3 mg/kg/day PO/IV qd
Lupus nephritis: 2-3 mg/kg/day PO qd
Extemporaneous suspension can be made from crushed tablet with 60-day stability under refrigeration or at room temperature. Adjust dose in renal
impairment.
Azelastine (Astelin, Optivar); Antihistamine; Nasal spray: 137 mcg/spray [100 sprays]
Ophth soln: 0.05% [6 mL]; Nasal:
5-11 yrs: 1 spray in each nostril bid
>12 yrs: 2 sprays in each nostril bid
Ophthalmic:
Instill one drop into each affected eye bid
Atracurium (Tracrium); Neuromuscular blocker, nondepolarizing; Inj: 10 mg/mL; <2 yrs: 0.3-0.4 mg/kg IV prn or 0.6-1.2 mg/kg/hr continuous IV infusion
>2 yrs: 0.4-0.5 mg/kg x 1 then 0.08-0.1 mg/kg IV prn or 0.4-0.8 mg/kg/hr continuous IV infusion
May reverse with neostigmine.
Azithromycin (Zithromax); Antibacterial, Macrolide ; Packet, oral: 1 gm

Susp per 5 mL: 100, 200 mg
Tab: 250, 500. 600 mg
Otitis Media: 5-day course
>6 months: 10 mg/kg (max 500 mg) PO on day 1 followed by 5 mg/kg (max 250 mg) on days 2-5
Otitis Media: 3-day course
>6 mos: 10 mg/kg PO qd x 3 days, max 500 mg/day
Otitis Media: Single-Dose Regimen
>6 mos: 30 mg/kg PO x 1
Pharyngitis and Tonsillitis: >2 years: 12 mg/kg/day PO qd x 5 days (max 500 mg/day).
Uncomplicated Chlamydial Urethritis or Cervicitis >12 yrs: 10 mg/kg (max 1 gm) PO x 1
Aztreonam (Azactam); Antibacterial, Miscellaneous; Inj: 500, 1000, 2000 mg; 90-120 mg/kg/day IV/IM q6-8h (max 8 gm/day)
Serious Pseudomonal Infections: 200 mg/kg/day IV q6h (max 8 gm/day).
Adjust dose in renal impairment.
Bacitracin (Baciguent); Antibacterial ; Oint: 500 units/gm [0.9, 15, 30, 120, 454 gm]
Ophth oint: 500 units/gm [3.5 gm] ; Topical: Apply to the affected area 1-5 times daily
Ophth: Instill into lower conjunctival sac q3-4h
Baclofen (Lioresal); Skeletal Muscle Relaxant; Inj, intrathecal (preservative free): 005 mg/mL [1 mL], 0.5 mg/mL [20 mL], 2 mg/mL [5 mL]
Tab: 10, 20 mg; Spasticity (Oral):
2-7 yrs: 10-15 mg/day titrate dose q3days in increments of 5-15 mg/day (max 40 mg/day).
>8 yrs: Titrate dose as above to maximum of 60 mg/day.
Extemporaneous suspension can be prepared with 60-day stability under refrigeration.
Intrathecal:
Screening dose: 50 mcg intrathecal x 1, observe for 4-8 hrs; if ineffective may try 75 mcg and then 100 mcg q24h.
If drug is effective, maintenance continuous infusions in the range of 100-300 mcg/day (children <12 yrs) and 300-800 mcg/day (>13 yrs) have been
used.
Beclomethasone dipropionate (QVAR, Beconase, Vancenase, Beconase AQ, Vancenase AQ); Corticosteroid; MDI: 40 mcg/puff, 80 puffs/canister [6.7
gm] or 100 puffs/canister [7.3 gm] or 200 puffs/canister [16.8 gm]
MDI Double Strength: 80 mcg/puff, 40 puffs/canister [5.4 gm] or 100 puffs/canister [7.3 gm] or 120 puffs/canister [12.2 gm]
Nasal aerosol (Beconase/Vancenase): 42 mcg/puff, 80 puffs/canister [6.7 gm] or 200 puffs/canister [16.8gm]
Nasal aerosol, aqueous (Beconase AQ) : 42 mcg/puff, 200 puffs/canister [25 mL]
Nasal aerosol, aqueous: 84 mcg/puff, 120 puffs/canister [19 gm] mcg; Inhalation:
5-11 yrs: start with 40 mcg bid, may increase to 80 mcg bid
>12 yrs: 40-80 mcg bid, may increase to max of 320 mcg bid
Rinse mouth with water after use to prevent oral candidiasis.
Nasal:
6-12 yrs: Beconase/Vancenase: 1 spray in each nostril tid; Beconase AQ: 1 spray in each nostril bid, may increase to 2 sprays bid; Vancenase
Pockethaler: 1 spray in each nostril tid; Vancenase AQ: 1-2 sprays in each nostril qd
>12 yrs: Beconase/Vancenase: 1 spray in each nostril bid-qid; Beconase AQ: 1-2 sprays in each nostril bid; Vancenase Pockethaler: 1 spray in each
nostril bid-qid; Vancenase AQ: 1-2 sprays in each nostril qd
The aqueous formulation is less likely to cause nosebleeds.
Benzoyl peroxide (Benzac, Desquam X, Persa-gel); Anti-acne; Bar: 5, 10%

Cleanser/Wash: 5%, 10% [85.1 gm]
Cream: 5% [18, 113.4 gm], 10% [28.3, 113.4 gm]
Gel: 2.5% [30, 42.5, 45, 57, 60, 90, 113 gm], 4% [42.5, 90 gm], 5% [42.5, 45, 56.7, 60, 90, 113.4 gm], 6% [42.5 gm], 10% [30, 42.5, 45, 60, 90 gm];
20% [30, 60 gm]
Liquid: 2.5% [240 mL], 5% [120, 150, 240 mL], 10% [120, 150, 240 mL]
Lotion: 5%, 10% [12, 25, 30, 50, 60 mL]; Apply topically to affected area qd-tid
May cause skin irritation and bleach clothing
Many products are available OTC.
Betamethasone dipropionate (Alphatrex, Diprosone); Corticosteroid; Aerosol, topical: 0. 1% [85 gm]

Cream, gel, oint: 0.05% [15, 45 gm]
Lotion: 0.05% [20, 30, 60 mL]; Apply topically to affected area qd-tid
Medium-potency corticosteroid.
Betamethasone valerate (Valisone); Corticosteroid; Cream: 0.01% [15, 60 gm], 0.05% [15, 45 gm], 0.1% [15, 45, 110, 430 gm]
Foam: 1.2 mg/gm [100 gm]
Lotion: 0.1% [20, 60 mL]
Oint: 0.1% [15, 45 gm]; Apply topically to affected area qd-tid
Bethanechol (Urecholine); Cholinergic Agent; Tab: 5, 10, 25, 50 mg; GERD:
0.1-0.2 mg/kg/dose qid (30-60 minutes prior to each meal and at bedtime), max 50 mg/dose
Abdominal distention or urinary retention:
0.6 mg/kg/day PO tid-qid, max 50 mg/dose
Extemporaneous suspension can be made with 60-day stability under refrigeration.
Bisacodyl (Dulcolax); Laxative, Stimulant ; Enema, susp: 10 mg/30 mL

Supp: 10 mg
Tab EC: 5 mg; Rectal:
2-11 yrs: 5-10 mg PR qd prn
>12 yrs: 10 mg PR qd prn
Oral:
3-11 yrs: 5 mg PO qd prn
>12 yrs: 5-15 mg PO qd prn
Do not crush or chew tabs. Contraindicated <2 yrs old.
Bismuth subsalicylate (Pepto-Bismol); Antidiarrheal; Cplt: 262 mg

Susp per 15mL: 130, 262, 524 mg
Tab, chew: 262 mg; All doses are PO. Doses may be repeated q1h to a maximum of 8 doses per day.
Diarrhea
3-6 yrs: 87 mg (a tab)
6-9 yrs: 173 mg (b tab)
9-12 yrs: 262 mg (1 tab)
>12 yrs: 524 mg (2 tabs or caplets)
Helicobacter pylori-associated gastritis (in combination with ampicillin/tetracycline and metronidazole)
<10 yrs: 262 mg qid x 6 wks
>10 yrs: 524 mg qid x 6 weeks
Prevention of travelers diarrhea:
Adolescents: 524 mg before meals and at bedtime (qid) Caplets should be swallowed whole.
Bitolterol (Tornalate); Bronchodilator; MDI: 370 mcg/puff [300 puffs/15 mL]

Soln for neb: 0.2% [10, 30, 60 mL]; Approved for >12 yrs.
MDI: 2 puffs q8h, may increase to 3 puffs q6h or 2 puffs q4h.
Nebulizer: 0.5-1.5 mg (0.25-0.75 mL) q8h, may increase to max of 2 mg q6h.
Brompheniramine (Dimetapp); Antihistamine; Elix: 2 mg/5 mL

Tab: 4, 8 mg
Tab, SR: 12 mg; All doses are PO
<6 yrs: 0.125 mg/kg/dose q6h prn (max 8 mg/day).
6-12 yrs: 2-4 mg q6-8h prn (max 16 mg/day)
>12 yrs: 4-8 mg q4-6h prn or 12 mg SR bid (max 24 mg/day).
May cause drowsiness.
Budesonide (Pulmicort Respules, Pulmicort Turbohaler, Rhinocort, Rhinocort Aqua); Corticosteroid ; MDI: 200mcg/puff [200 puffs/canister]
Nasal spray (Rhinocort): 32 mcg/spray [200 sprays/7gm canister]
Nasal spray (Rhinocort Aqua): 32 mcg/spray [120 sprays/8.6 gm]
Susp for inh (Pulmicort Respules): 0.25 mg/2mL, 0.5 mg/2mL; Inh Susp:
1-8 yrs: 0.25 0.5 mg qd-bid
MDI:
>6 yrs: 1-2 puffs BID
Adolescents: 1-4 puffs bid
Titrate to lowest possible dose once asthma is controlled. Not indicated for acute bronchospasm.
Nasal (Rhinocort):
>6yrs: 2 sprays in each nostril bid or 4 sprays in each nostril qAM
Nasal (Rhinocort Aqua):
6-12 yrs: 1 spray in each nostril qd, may increase to 2 sprays in each nostril qd.
>12 yrs: 1 spray in each nostril qd, may increase to max 4 sprays in each nostril qd.
After symptoms decrease (usually by 3-7 days), reduce dose slowly every 2-4 weeks to the smallest effective dose
Bumetanide (Bumex); Diuretic, Loop; Inj: 0.25 mg/mL

Tab: 0.5, 1, 2 mg; 0.015-0.1 mg/kg/dose PO/IV/IM q6-24h (max 10 mg/day).
Caffeine, Citrated
(Cafcit); CNS Stimulant; Inj: 20 mg/mL [3 mL]
Powd: 1 kg
Soln: 20 mg/mL; Apnea of Prematurity: Loading dose 10-20 mg/kg PO, then maintenance dose 5-10 mg/kg/day PO qd-bid.
Therapeutic range: 10-20 mcg/mL Extemporaneously prepared suspension made from caffeine powder is stable for 3 months under refrigeration.
Calcitriol (Rocaltrol, Calcijex); Vitamin D Analog; Cap: 0.25, 0.5 mcg

Inj: 1 mcg/mL, 2 mcg/mL
Soln: 1 mcg/mL (15 mL); Hypocalcemia in patients with chronic renal failure on hemodialysis:
Children: 0.01 - 0.05 mcg/kg IV three times weekly or 0.25 - 2 mcg/day PO.
Hypoparathyroidism:
<1 yr: 0.04 - 0.08 mcg/kg PO qd
1 - 5 yrs: 0.25 - 0.75 mcg PO qd
>6 yrs: 0.5 - 2 mcg PO qd
Monitor serum calcium and phosphorus levels at least twice weekly at the onset of therapy and then weekly for 12 weeks and then monthly once
stabilized on a dose.
Calcium carbonate (Oscal, Tums); Electrolyte Supplement; Cap: 1250 mg
Lozenge: 500 mg
Susp: 1250 mg/5 mL
Tab: 250, 500, 600, 650, 667, 1000, 1250, 1500 mg
Tab, chew: 350, 420, 500, 750, 850, 1000, 1250 mg; RDA of elemental calcium:
<6 months: 400 mg
6-12 months: 600 mg
1-10 yrs: 800 mg
>10 yrs: 1200 mg
Hypocalcemia: Children: 45-65 mg elemental calcium/kg/day PO q6h (max 2000 mg/day).
Calcium carbonate contains 40% elemental calcium by weight.
Calcium chloride; Electrolyte Supplement; Inj: 10% (100 mg/mL) [10 mL] ; Hypocalcemia: 10-20 mg/kg/dose IV
Hypocalcemia Secondary to Citrated Blood Transfusion: Give 0.45 mEq elemental calcium for each 100 mL of citrated blood.
10% injection contains 1.36 mEq calcium/mL.
Maximum infusion rate 80 mg/kg/hr. May not be given IM or SC.
Calcium glubionate (Neocalglucon, Calcionate); Electrolyte Supplement; Syr: 1.8 gm/5 mL; Neonatal Hypocalcemia: 1200 mg/kg/day PO q4-6h.
Children: 600-2000 mg/kg/day PO q6h (max 9 gm/day).
Calcium glubionate contains 6.4% elemental calcium by weight. Syrup contains 115 mg elemental calcium/mL and 1.2 mEq calcium/mL.
Calcium gluconate; Electrolyte Supplement; Inj: 10% (100 mg/mL) [10 mL]
Tab: 500, 650, 975 mg; Cardiac arrest: 50-100 mg/kg/dose IV (max 3 gm)
Hypocalcemia:
200-500 mg/kg/day IV as a continuous infusion or q6h
10% inj = 100 mg/mL = 0.465 mEq/mL
500-725 mg/kg/day PO tid-qid
Caspofungin (Cancidas); Antifungal; Inj: 50, 70 mg; Dose: 1-1.5 mg/kg IV q24h infused over one hour
Dose not well established in pediatrics. Usual adult max 50 mg
Captopril (Capoten); Angiotensin Converting Enzyme Inhibitor; Tab: 12.5, 25, 50, 100 mg; All doses are PO
Neonates: 0.05-0.1 mg/kg/day PO q8-24h
Infants: Initially 0.15-0.3 mg/kg/dose, titrate dose upward to max of 6 mg/kg/day q6-24h
Children: Initially 0.3-0.5 mg/kg/dose (max 12.5-25 mg), titrate dose upward to max of 6 mg/kg/day q6-24h
Adolescents: Initially 12.5-25 mg q8-12h, titrate dose upward by 25 mg/dose to max of 450 mg/day.
Extemporaneous suspension can be made with 30-day stability under refrigeration. Caution in renal failure. Can cause rash, proteinuria, persistent
cough.
Carbamazepine (Tegretol); Anticonvulsant; Cap ER: 200, 300 mg

Susp: 100 mg/5 mL
Tab: 200 mg
Tab chew: 100 mg
Tab ER (Tegretol XR): 100, 200, 400 mg; <6 yrs: Initially 10-20 mg/kg/day PO q6-12h, dosage may be increased every 7 days up to 35 mg/kg/day.
6-12 yrs: Initially 100 mg PO bid or 10 mg/kg/day PO bid or 50 mg suspension PO qd. May increase by 100 mg/day at weekly intervals until optimal
response and therapeutic levels are achieved. Usual maintenance range 15-30 mg/kg/day PO q6-12h (max 1000 mg/day).
>12 yrs: Initially 200 mg PO bid, increase by 200 mg/day at weekly intervals until therapeutic levels achieved, usual dose 800-1200 mg/day q6-8h (max
2400 mg/day)
ER tabs can be dosed bid; other products should be dosed tid-qid.
Therapeutic Range: 4-12 mcg/mL
Induces its own metabolism; therefore, upward titration of dose is necessary. Other anticonvulsants can alter levels. Neutropenia, aplastic anemia,
thrombocytopenia; monitor CBC and serum levels.
Carbenicillin (Geocillin); Antibacterial, penicillin; Tab: 382 mg; 30-50 mg/kg/day PO q6h, max 3000 mg/day.
Cascara; Laxative; Liq: 120, 473 mL
Tab: 325 mg; Infants: 1.25 mL PO qd
2-11 yrs: 2.5 mL PO qd
>12 yrs: 5 mL po qd
Carbamide Peroxide (Debrox); Cerumenlytic Agent; Otic soln: 6.5% [15, 30 mL]; Instill drops into the external ear canal. Keep drops in ear for several
minutes by keeping head tilted or placing cotton in ear. Gently irrigate ear canal with warm water to remove loosed cerumen.
<12 yrs: 1-5 drops bid for up to 4 days
>12 yrs: 5-10 drops bid for up to 4 days
Carnitine (Carnitor, Vitacarn); Nutritional Supplement; Cap: 250 mg

Inj: 200 mg/mL
Liq: 100 mg/mL
Tab: 330, 500 mg; Carnitine deficiency:
50 mg/kg IV x 1 then 50 mg/kg/day as a continuous IV infusion or divided IV q4-6h, may titrate up to max 300 mg/kg/day.
50-100 mg/kg/day PO bid-tid (max 3 gm/day)
Supplement to parenteral nutrition: 10-20 mg/kg/day IV in TPN solution
Cefaclor (Ceclor); Cephalosporin, 2nd generation; Cap: 250, 500 mg

Liq per 5 mL: 125, 187, 250, 375 mg
Tab, ER: 375, 500 mg; 20-40 mg/kg/day PO q8-12 (max 2 gm/day)
Adolescents: 250-500 mg PO q8h or 375 mg ER tab PO q12h
Side effects include serum sickness reaction. May dose bid for otitis media and pharyngitis.
Cefadroxil (Duricef); Cephalosporin, 1st generation; Cap: 500 mg

Liq per 5 mL: 250, 500 mg
Tab: 1 gm; 30 mg/kg/day PO bid (max 2 gm/day)
Administration with food may decrease nausea.
Cefazolin (Ancef, Kefzol); Cephalosporin, 1st generation; Inj: 500, 1000 mg; 50-100 mg/kg/day IV/IM q6-8h (max 6 gm/day)
Cefdinir (Omnicef); Cephalosporin, 3rd generation; Cap: 300 mg

Susp: 125 mg/5 mL; 6 mos-12 yrs: 14 mg/kg/day PO q12-24h (max 600 mg/day)
Adolescents: 300 mg PO bid or 600 mg PO qd.
Cefepime (Maxipime); Cephalosporin, 4th generation; Inj: 500 mg; 1, 2 gm.; 100 mg/kg/day IV/IM q12h (max 4 gm/day)
May use 150 mg/kg/day q8h (max 6 gm/day) in cystic fibrosis or immunocompromised patients.
Cefixime (Suprax); Cephalosporin, 3rd generation; Susp: 100 mg/5 mL

Tab: 400 mg; 8 mg/kg/day PO qd-bid (max 400 mg/day)
Suspension results in higher blood levels than tablets; use suspension for otitis media.
Cefoperazone (Cefobid); Cephalosporin, 3rd generation; Inj: 1, 2 gm; 100-150 mg/kg/day IV/IM q8-12h (max 12 gm/day)
Excreted primarily in the bile; disulfiram-like reaction with alcohol is possible.
Cefotaxime (Claforan); Cephalosporin, 3rd generation; Inj: 0.5, 1, 2 gm; 100-200 mg/kg/day IV/IM q6-8h (max 12 gm/day)
For meningitis, use 200 mg/kg/day IV q6h.
Cefotetan (Cefotan); Cephalosporin, 2nd generation; Inj: 1, 2 gm; 40-80 mg/kg/day IV/IM q12h (max 6 gm/day)
Provides good anaerobic coverage.
Cefoxitin (Mefoxin); Cephalosporin, 2nd generation; Inj: 1, 2 gm; Mild-moderate infection: 80-100 mg/kg/day IV/IM q6-8h (max 12 gm/day)
Severe infection: 100-160 mg/kg/day IV/IM q4-6h (max 12 gm/day).
Good anaerobic coverage.
Cefpodoxime (Vantin); Cephalosporin, 3rd generation; Susp per 5 mL: 50 , 100 mg

Tab: 100, 200 mg ; 6 mos-12 yrs: 10 mg/kg/day PO bid (max 800 mg/day)
>12 yrs: 100-400 mg/day PO bid
Uncomplicated gonorrhea: 200 mg PO x 1
Cefprozil (Cefzil); Cephalosporin, 2nd generation; Susp per 5 mL: 125, 250 mg
Tab: 250, 500 mg ; 30 mg/kg/day PO bid (max 1000 mg/day)
Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime); Cephalosporin, 3rd generation; Inj: 0.5, 1, 2 gm; 100-150 mg/kg/day IV/IM q8h (max 6 gm/day)
Good anti-pseudomonal activity.
Ceftibuten (Cedax); Cephalosporin, 3rd generation; Cap: 400 mg

Susp per 5 mL: 90, 180 mg; 9 mg/kg/day PO qd (max 400 mg/day)
Take on an empty stomach (one hour before or two hours after a meal).
Ceftizoxime (Cefizox); Cephalosporin, 3rd generation; Inj: 0.5, 1, 2 gm; 150-200 mg/kg/day IV/IM q6-8h (max 12 gm/day)
Ceftriaxone (Rocephin); Cephalosporin, 3rd generation; Inj: 250, 500 mg; 1, 2 gm; 50-100 mg/kg/day IV/IM q12-24h (max 4 gm/day)
Use 100 mg/kg/day for meningitis;
Long half-life. May be reconstituted with 1% lidocaine for IM administration
Cefuroxime axetil (Ceftin); Cephalosporin, 2nd generation; Susp per 5 mL: 125, 250 mg
Tab: 125, 250, 500 mg; Otitis media:
Suspension: 30 mg/kg/day PO bid (max 1 gm/day)
Tab: 250 mg PO bid
Pharyngitis, tonsillitis:
Suspension: 20 mg/kg/day PO bid (max 500 mg/day)
Tab: >3 mos-12 yrs: 125 mg PO bid; >12 yrs: 250-500 mg PO bid
Suspension and tablets are not bioequivalent. Higher mg doses of the suspension are needed. Crushed tablets are very bitter and not very palatable.
Cefuroxime sodium (Kefurox, Zinacef); Cephalosporin, 2nd generation; Inj: 750 mg, 1.5 gm; 75-150 mg/kg/day IV/IM q8h (max 6 gm/day)
Poor CNS penetration; contraindicated for meningitis.
Cephalexin (Keflex, Keftab); Cephalosporin, 1st generation; Cap: 250, 500 mg

Tab: 250, 500 mg; 25-100 mg/kg/day PO q6h (max 4 gm/day)
Cephalothin (Keflin); Cephalosporin, 1st generation; Inj: 1, 2 gm; 80-150 mg/kg/day IM/IV q4-6h (max 12 gm/day)
Cephradine (Velosef); Cephalosporin, 1st generation; Cap: 250, 500 mg

Susp: 250 mg/5 mL; 25-100 mg/kg/day PO bid-qid (max 4 gm/day)
For otitis media, use 75-100 mg/kg/day PO qid
Cetirizine (Zyrtec); Antihistamine; Tab: 5, 10 mg

Syr: 1 mg/mL; 2-5 yrs: 2.5 mg PO qd
>6 yrs: 5-10 mg PO qd.
Charcoal, activated (Actidose, CharcoAid); Adsorbent; With sorbitol

Liq: 25 gm [120 mL], 50 gm [240 mL]
Susp: 15 gm [120 mL], 30 gm [150 mL]
Aqueous (without sorbitol)
Liq: 12.5 gm [60 mL], 15 gm [75 mL], 25 gm [120 mL], 50 gm [240 mL]; 1 gm/kg/dose (max 50 gm) PO/NG. First dose should be given using product
containing sorbitol as a cathartic. Repeat doses may be advised for enterohepatically excreted agents.
Chloral hydrate (C-IV) (Noctec); Sedative/hypnotic; Cap: 500 mg

Supp: 325, 650 mg
Syr: 100 mg/mL; 25-100 mg/kg/dose PO/PR (max 1.5 gm/dose); give 30 min before procedure.
Chloramphenicol (Chloromycetin); Antibacterial; Cap: 250 mg

Inj: 1 gm; Meningitis: 75-100 mg/kg/day IV/PO q6h (max 4 gm/day)
Other infections: 50-75 mg/kg/day IV/PO q6-8h (max 4gm/day)
Therapeutic Serum Levels: Peak 10-20 mcg/mL; trough 5-10 mcg/mL.
Not recommended for neonates because of risk of gray baby syndrome. Not a first-line agent due to risk of aplastic anemia and bone marrow
suppression.
Chlorhexidine (Peridex, PerioGard); Antiseptic; Rinse, dental: 0.12% [480 mL]; 5-15 mL swish for 30 sec and spit out bid
May discolor teeth. Use after toothbrushing. Do not eat for 2-3 hours after using.
Chlorothiazide (Diuril); Diuretic, Thiazide; Inj: 500 mg

Susp: 250 mg/5 mL
Tab: 250, 500 mg; 20-40 mg/kg/day PO bid, max 375 mg/day
2-8 mg/kg/day IV bid, max 500 mg/day
Poor oral absorption; therefore, oral dose is significantly higher (mg/kg basis) than IV dose.
Chlorpheniramine (Chlor-Trimeton); Antihistamine; Cap, SR: 8, 12 mg

Syr: 2 mg/5 mL
Tab: 4 mg
Tab, chew: 2 mg
Tab, TR: 8, 12 mg; All doses are PO
<2 yrs: 0.35 mg/kg/day q4-6h prn
2- 5 yrs: 1 mg q4-6h prn
6 -12 yrs: 2 mg q4-6h prn (max 12 mg/day)
>12 yrs: 4 mg q4-6h prn or TR 8-12 mg bid (max 24 mg/day).
Chlorpromazine (Thorazine); Phenothiazine; Cap SR: 30, 75, 150 mg

Inj: 25 mg/mL
Oral conc per mL: 30, 100 mg
Supp: 25, 100 mg
Syr: 10 mg/5 mL
Tab: 10, 25, 50, 100, 200 mg
Nausea/vomiting:
PO: 0.5-1 mg/kg/dose q4-6h
PR: 1 mg/kg/dose q6-8h
IM/IV: 0.5-1 mg/kg/dose q6-8h
Psychosis:
0.5-1 mg/kg/dose PO q4-6h; older children may require 200 mg/day
0.5-1 mg/kg/dose IM/IV q6-8h
Maximum single dose is 50 mg.
Cholestyramine (Questran); Antilipemic Agent; Powder for oral susp: 4 gm resin/packet; 240 mg/kg/day PO tid
Hypercholesterolemia:
<10 yrs: 1/2 packet PO qd, titrate based on efficacy and tolerance to max 4 gm/day
>10 yrs: 1/2 packet PO qd, titrate based on efficacy and tolerance to max 4gm PO bid
Choline magnesium trisalicylate (Trilisate, Tricosal); Analgesic, Anti-inflammatory, Salicylate; Doses expressed as total salicylate
Liq: 500 mg/5mL
Tab: 500, 750, 1000 mg; Dose based on total salicylate content:
30-60 mg/kg/day PO tid-qid (max 4500 mg/day)
Do not use if salicylates are contraindicated. Does not inhibit platelet aggregation.
Cimetidine (Tagamet); Histamine-2 Antagonist; Inj: 150 mg/mL

Soln: 60 mg/mL
Tab: 200, 300, 400, 800 mg; 20-40 mg/kg/day PO/IV/IM q6h (max 2400 mg/day)
Adolescents:
Ulcer Treatment: 300 mg IV q6h or 300 mg PO qid or 400 mg PO bid or 800 mg PO qhs
Ulcer prophylaxis: 400-800 mg PO qhs
GERD: 400 mg PO q6h or 800 mg PO q12h
May put the daily dose into TPN. 200 mg tablets are available OTC. Adjust dose for renal impairment.
Choline magnesium trisalicylate (Trilisate, Tricosal); Analgesic, Anti-inflammatory, Salicylate; Doses expressed as total salicylate
Liq: 500 mg/5mL
Tab: 500, 750, 1000 mg; Dose based on total salicylate content:
30-60 mg/kg/day PO tid-qid (max 4500 mg/day)
Do not use if salicylates are contraindicated. Does not inhibit platelet aggregation.
Cimetidine (Tagamet); Histamine-2 Antagonist; Inj: 150 mg/mL

Soln: 60 mg/mL
Tab: 100, 200, 300, 400, 800 mg; 20-40 mg/kg/day IV/PO q6h (max 2400 mg/day)
May put the daily dose into TPN. 100 mg tablets are available OTC.
Ciprofloxacin (Cipro, Ciloxan); Antibacterial, Quinolone; Inj: 200, 400 mg
Ophth oint: 0.3% [3.5 gm[
Ophth soln: 3 mg/mL [2.5, 5, 10 mL]
Tab: 100, 250, 500, 750 mg; PO: 20-30 mg/kg/day bid, may use 40 mg/kg/day bid in cystic fibrosis (max 1500 mg/day)
IV: 20-30 mg/kg/day bid, max 800 mg/day; in cystic fibrosis use 30 mg/kg/day, max 1200 mg/day
Anthrax Treatment:
20-30 mg/kg/day IV q12h x 60 days, max 1000 mg/day; substitute oral for intravenous (same dose) as soon as clinical condition improves
Anthrax Post-exposure Prophylaxis:
20 mg/kg/day PO q12h x 60 days, max 1000 mg/day
Ophth: Instill 1-2 drops in affected eye(s) q2h while awake for 2 days then 1-2 drops q4h while awake for 5 more days OR apply ointment tid x 2 days
then bid x 5 days
Not recommended for use in <18 years because of risk of arthropathy unless benefit outweighs risk. Reduce dosage in renal impairment.
Cisapride (Propulsid); Prokinetic agent; Susp: 1 mg/mL

Tab, scored: 10, 20 mg; 0.15-0.3 mg/kg/dose PO tid-qid (max 10 mg/dose).
Only available via limited-access protocol: Contact Janssen Pharmaceuticals at 1-800-Janssen. 12-lead EKG measuring QTc intervals must be
done for all patients before initiating therapy. Absolutely contraindicated with ketoconazole, fluconazole, erythromycin, and clarithromycin due to rare,
fatal arrhythmias.
Clarithromycin (Biaxin); Antibacterial, Macrolide; Susp: 125 mg/5 mL, 250 mg/5 mL
Tab: 250, 500 mg
Tab, ER: 500 mg; 15 mg/kg/day PO bid (max 1 gm/day)
HIV and disseminated MAC: 30 mg/kg/day PO bid
Adolescents: 1000 mg (two 500 mg ER tabs) PO qd
Clindamycin (Cleocin); Antibacterial; Cap: 75, 150, 300 mg

Gel: 1% [30, 42, 60, 77 gm]
Granules for oral susp: 75 mg/5 mL
Inj: 150 mg/mL
Lotion: 10 mg/mL [60 mL]
Soln, top: 10 mg/mL [30, 60 mL]
Vaginal cream: 1% [30, 60 gm]
Vacinal supp: 100 mg [3's]; PO: 10-30 mg/kg/day q6-8h (max 1800 mg/day)
IV/IM: 25-40 mg/kg/day q6-8h (max 4800 mg/day)
Topical: Apply to affected area bid
Vaginal cream: one applicatorful inserted vaginally qhs x 7 nights
Vaginal supp: 100 mg inserted vaginally qhs x 3 nights
Clobetasol (Temovate); Corticosteroid; Cream, oint: 0.05% [15, 30, 45 gm]; Apply to affected area 2-4 times daily.
Very high-potency corticosteroid.
Clonazepam (Klonopin)
C-IV; Benzodiazepine; Tab: 0.5, 1, 2 mg; <10 yrs or < 30 kg: 0.01-0.03 mg/kg/day PO bid-tid, increase by no more than 0.5 mg/day q3days until
seizures are controlled or adverse effects seen; usual maintenance dose 0.1-0.2 mg/kg/day tid
>10 yrs AND >30 kg: 0.5 mg PO tid, increase by 0.5-1mg/day q3days until seizures are controlled or adverse effects seen; usual maintenance 0.05-0.2
mg/kg/day
Tablets may be broken in half or quarters.
Therapeutic Serum Level: 20-80 ng/mL
Potentiates CNS depressant effects of other drugs. Extemporaneously prepared solution may be made from the crushed tablets with 60- day stability
under refrigeration.
Clonidine (Catapres); Alpha-adrenergic Agonist; Tab: 0.1, 0.2, 0.3 mg

Transdermal patches:
TTS-1 (0.1 mg/day released)
TTS-2 (0.2 mg/day released)
TTS-3 (0.3 mg/day released); Attention Deficit Disorder: Initially 0.05 mg/day PO qAM. Increase q3-7 days by 0.05 mg/day to 3-5 mcg/kg/day PO tid-
qid (max 0.4 mg/day); monitor blood pressure.
Hypertension: Initially 5-10 mcg/kg/day PO bid-tid (max 0.2 mg/day), increase gradually to 5-25 mcg/kg/day PO tid-qid (max 0.9 mg/day).
Stable patients may be switched to the transdermal patches applied once weekly at the equivalent oral dose.
Clorazepate (C-IV) (Tranxene); Benzodiazepine; Tab: 3.75, 7.5, 15 mg

Tab, ER: 11.25, 22.5 mg; 9-12 yrs: 3.75-7.5 mg PO bid, increase dose by 3.75 mg at weekly intervals to max 60 mg/day bid-tid as needed or 0.3
mg/kg/day PO bid and increase to maintenance 0.5-3 mg/kg/day PO bid-qid
>12 yrs: Initially up to 7.5 mg/dose PO bid-tid; increase by 7.5 mg at weekly intervals, usual dose 0.5-1 mg/kg/day (max 90 mg/day).
Therapeutic range: 0.12-1 mcg/mL
Clotrimazole (Lotrimin, Mycelex); Antifungal; Cream: 1%: [12, 15, 24, 30, 45 gm]
Cream, vaginal: 1% [45 gm], 2% [21 gm]
Lotion: 1% [20, 30 mL]
Soln, top: 1% [10, 30 mL]
Tab, vaginal: 100, 200 mg
Troches: 10 mg; Topical: >3 yrs: Apply to affected area bid
Vaginal (>12 yrs):
Insert one applicatorful of vaginal cream or a 100 mg vaginal tablet intravaginally qhs for 7 days or 200 mg vaginal tablet intravaginally qhs x 2 days
The vaginal cream and the 100 mg and 200 mg vaginal tablets are available OTC.
Oral: >3 yrs: Dissolve 1 troche in mouth 5 times daily. Not effective for systemic infections.
Codeine phosphate (C-II); Opioid Narcotic; Inj: 15, 30 mg/mL

Soln: 15 mg/5mL
Tab: 30, 60 mg; Analgesic/Antitussive:
0.5-1 mg/kg/dose SC/IM/PO q4-6h (max 60 mg/dose)
May give the injectable form orally.
Codeine sulfate (C-II); Opioid Narcotic; Tab: 15, 30, 60 mg; Analgesic: 0.5-1 mg/kg/dose PO q4-6h (max 60 mg/dose)
Antitussive: >2 yrs: 1-1.5 mg/kg/day PO q4-6h prn
Corticotropin (Acthar, ACTH); Adrenocortical Steroid; Inj:80 units/mL [5 mL]; Infantile spasms: 20 units/day IM qd; if patient responds taper and
discontinue over a 1-week period; if patient does not respond, increase dose to 30 units/day IM qd x 4 weeks
Cromolyn sodium (Intal, Opticrom, Nasalcrom, Gastrocrom); Antiallergic Agent; MDI: 800 mcg/puff, 112 puffs/canister [8.1 gm]; 800 mcg/puff, 200
puffs/canister [14.2 gm]
Nasal Soln: 5.2 mg/puff, 100 puffs/bottle [13 mL]; 52 mcg/puff, 200 puffs/bottle [26 mL]
Nebulizer soln: 20 mg/2 mL
Ophth soln: 4% [2.5, 10, 15 mL]
Soln, oral: 100 mg/5 mL; Inh: 5-12 yrs: 2 puffs inhaled qid, >12 yrs: 2 puffs inhaled qid, may increase to 4 puffs qid
Neb: >2 yrs: 20 mg q6h
Used as a preventative measure in stable asthma; can cause cough and bronchospasm.
Ophth: >4 yrs: Instill 1-2 drops in eye q4-6h
Nasal: >2 yrs: 1 puff in each nostril 3-6 times daily; maximum effects may not be seen for 1-2 weeks
Oral: 2-12 yrs: 100 mg PO qid (30 min before meals and qhs), max 40 mg/kg/day.
>12 yrs: 200 mg PO qid
Crotamiton (Eurax); Scabicide; Cream: 10% [60 gm]

Lotion: 10% [60 mL]; Apply qd x 2 days followed by cleansing bath 48 hours after last application. Thoroughly rub into skin of whole body from chin
down.
Change clothing and bed linen the following morning.
Cyclosporine (Sandimmune, Neoral, SangCya); Immunosuppressant Agent; Sandimmune

Cap: 25, 50, 100 mg
Inj: 50 mg/mL [5 mL]
Soln: 100 mg/mL
SangCya
Soln: 100 mg/mL
Neoral (microemulsion)
Cap: 25, 100 mg
Soln: 100 mg/mL; IV: 5-6 mg/kg administered 4-12h prior to organ transplantation, followed by 2-10 mg/kg/day q8-24h.
Oral: 14-18 mg/kg administered 4-12h prior to organ transplantation, followed by 5-15 mg/kg/day q12-24h. Taper dosage to 3-10 mg/kg/day q12-24h.
Monitor serum levels; therapeutic range depends on which organ transplanted and which assay used. An initial 1:1 conversion from
Sandimmune/SangCya to Neoral is recommended, but lower doses of the microemulsion dosage form may be required.
Cyproheptadine (Periactin); Antihistamine; Syr: 2 mg/5 mL

Tab: 4 mg; 2-6 yrs: 2 mg PO q8-12h (max 12 mg/day)
>6 yrs: 4 mg PO q8-12h (max 16 mg/day)
Dantrolene sodium (Dantrium); Muscle Relaxant; Cap: 25, 50, 100 mg

Inj: 20 mg; Spasticity (oral): 1 mg/kg/day bid initially; may increase by 0.5 mg/kg/day q4-7 days to max 3 mg/kg/day bid-qid (max 400 mg/day)
Malignant Hyperthermia prophylaxis: 4-8 mg/kg/day PO q6h given 1-2 days prior to surgery and continued for 3 days after surgery
Malignant Hyperthermia treatment: 1 mg/kg IV prn, max 10 mg/kg total cumulative dose
Monitor liver function tests
Dapsone (Avlosulfon); Leprostatic Agent; Tab: 25, 100 mg; PCP Prophylaxis: >4 wks: 2 mg/kg/day PO qd (max 100 mg/day) or 4 mg/kg PO q week
(max 200 mg/dose)
Deferoxamine (Desferal); Antidote - Iron, Chelator; Inj: 500 mg; Acute Iron Intoxication: 15 mg/kg/hr IV (max 6 gm/day) or 50 mg/kg/dose IM q6h
(max 6gm/day)
Chronic Iron Overload: 15 mg/kg/hr continuous IV infusion x 48-72 hr (max 12 gm/day) or 20-50 mg/kg/day SC over 8-12h using an infusion pump
(max 2 gm/day)
Delavirdine (DLV, Rescriptor); Antiretroviral, Non-nucleoside Analog Reverse Transcriptase Inhibitor; Tab: 100 mg; >13 yrs: 400 mg PO q8h
Side effects include rash, fever, and headache. Oral solution can be made my dissolving 4 tablets in at least three ounces of water. Must be taken one
hour apart from antacids and didanosine.
Desipramine (Norpramin); Tricyclic Antidepressant; Tab: 10, 25, 50, 75, 100, 150 mg; 6-12 yrs: 1-3 mg/kg/day PO qhs-tid, max 5 mg/kg/day
>12 yrs: Initially 25-50 mg/day PO qhs-tid; gradually increase to max of 150 mg/day
Therapeutic Range: 150-300 mg/mL
Anticholinergic side effects include dry mouth, blurred vision, tachycardia.
Desloratidine (Clarinex); Antihistamine ; Tab: 5 mg

Tab, rapidly disintegrating: 5 mg; >12 yrs: 5 mg PO qd
Rapidly disintegrating tablet dissolves on the tongue without water.
Desmopressin (DDAVP, Stimate); Pituitary Hormone; Inj: 4 mcg/mL

Nasal soln, 0.1 mg/mL: 5 mL pump bottle (contains 50 doses of 10 mcg)
Nasal soln, 1.5 mg/mL (Stimate): 2.5 mL pump bottle (contains 25 doses of 150 mcg)
Rhinal tube delivery system: 2.5 mL vial with applicator tubes [0.1 mg/mL]
Tab: 0.1, 0.2 mg; Diabetes Insipidus:
Oral: <12 yrs: 0.05 mg bid, titrate to desired response, range 0.1-0.8 mg/day; >12 yrs: start with 0.05 mg bid and titrate to response, range 0.1-1.2
mg/day bid-tid
Intranasal: >3 mos-12 yrs: 5 mcg/day q12-24h (range 5-30 mcg/day); >12 yrs: 5-40 mcg/day q8-24h
Must use rhinal tube for doses other than 10 mcg.
IV/SC: 1/10th of the maintenance intranasal dose or if >12 years start with 2-4 mcg/day q12-24h
Titrate dose to achieve control of excessive thirst and urination.
Hemophilia: >3 mos: 0.3 mcg/kg IV over 30 minutes
Nocturnal Enuresis: >6 yrs: 20 mcg intranasal qhs (range 10-40 mcg) or 0.2-0.6 mg/day PO qhs
Divide intranasal doses between the two nostrils.
Desonide (Desowen, Tridesilon); Corticosteroid; Cream, oint: 0.05% [15, 60 gm]

Lotion: 0.05% [60, 120 mL]; Apply to affected area 2-4 times daily.
Low-potency corticosteroid.
Desoximetasone (Topicort); Corticosteroid; Cream: 0.05% [15, 60 gm]

Cream: 0.25% [15, 60, 120 gm]
Gel: 0.05% [15, 60 gm]
Oint: 0.25% [15, 60 gm]; Apply to affected area 2-4 times daily.
Dexamethasone (Decadron, Decadron Turbinaire, Decadron Respihaler); Corticosteroid; Inj (as phosphate salt) per mL: 4, 10, 20, 24 mg
Ophth oint: 0.05% [3.5 gm]
Ophth soln: 0.1% [5 mL]
Ophth susp: 0.1% [5, 15 mL]
Oral soln: 0.1 mg/mL
Oral soln conc: 1 mg/mL
Tab: 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; Airway edema: 0.5-2 mg/kg/day IV/IM/PO q6h
Antiemetic (chemotherapy induced): 10 mg/m2 IV x 1, then 5 mg/m2 IV q6h prn
Anti-inflammatory: 0.08-0.3 mg/kg/day PO/IV/IM or 2.5-10 mg/m2/day PO/IV/IM q6-12h
Bacterial meningitis: 0.6 mg/kg/day IV q6h x 4 days
Cerebral edema: 1-2 mg/kg/dose IV x 1, then 1-1.5 mg/kg/day IV q4-6h (max 16 mg/day)
Physiologic replacement: 0.03-0.15 mg/kg/day PO/IV/IM or 0.6-0.75 mg/m2/day PO/IV/IM q6-12h
Ophth: Instill two drops or apply ointment to conjunctival sac q3-4h
Dexmethylphenidate (Focalin); Stimulant Agent ; Tabs: 2.5, 5, 10 mg; ADDH:

Stimulant naive: 2.5 mg PO bid, adjust dose weekly to max of 10 mg PO bid
Dextroamphetamine sulfate (Dexedrine) (C-II) ; CNS Stimulant; Cap SR: 5, 10, 15 mg

Tab: 5, 10 mg; Attention Deficit Disorder:
3-5 yrs: Initially 2.5 mg/day PO qAM, increase by 2.5 mg/day at weekly intervals; range 0.1-0.5 mg/kg qAM; maximum 40 mg/day in 1-3 doses.
>6 yrs: 5 mg qd-bid, increase by 5 mg/day at weekly intervals; range 0.1-0.5 mg/kg qAM; max 40 mg/day in 1-3 doses
For daily dosing, dose in AM. For twice-daily dosing, dose in morning and at noon. For three-times-a-day dosing, dose in AM, noon, and afternoon (last
dose must be given at least six hours before bedtime)
SR capsules must be swallowed whole.
Dextromethorphan (Delsym, Robitussin Pediatric, Benylin Pediatric); Antitussive; Cap: 30 mg

Liq: 3.33 mg/5 mL, 7.5 mg/5 mL, 10 mg/5 mL, 15 mg/5 mL
Lozenge: 5, 7.5 mg
Syr: 2 7.5 mg/5 mL, 10 mg/5 mL, 15 mg/5 mL
Syr SR: 30 mg/5mL; Cap, Liquid, Syrup:
1-3 mos: 0.5-1 mg PO q6-8h prn
3-6 mos: 1-2 mg PO q6-8h prn
7-23 mos: 2-4 mg PO q6-8h prn
2-6 yrs: 2.5-7.5 mg PO q4-8h prn
7-12 yrs: 5-10 mg PO q4h prn or 15 mg PO q6-8h prn (max 60 mg/day)
>12 yrs: 10-30 mg PO q4-8h prn (max 120 mg/day)
SR Syrup:
2-6 yrs: 15 mg PO bid prn
7-12 yrs: 30 mg PO bid prn
>12 yrs: 60 mg PO bid prn
Lozenges:
4-6 yrs: Dissolve 1 lozenge in the mouth q4h prn
7-12 yrs: Dissolve 1-2 lozenges in the mouth q4h prn
>12 yrs: Dissolve 2-4 lozenges in the mouth q4h prn
Diazepam (C-IV) (Valium, Diastat); Benzodiazepine; Gel, rectal (5 mg/mL): Peds rectal tip: 2.5, 5 mg
Universal rectal tip (for pediatric or adult use): 10 mg
Adult rectal tip: 15, 20 mg
Inj: 5 mg/mL [2. 10 mL]
Soln per mL: 1, 5 mg
Tab: 2, 5, 10 mg; Anxiety or Sedation:
0.12-0.8 mg/kg/day PO q6-8h
0.04-0.3 mg/kg/dose IV q4h prn
Status epilepticus (IV):
0.05-0.3 mg/kg/dose q15-30 min to max cumulative dose of 5 mg (<5 yrs) or 10 mg (>5 yrs).
Status epilepticus (rectal gel):
2-5 yrs: 0.5 mg/kg/dose (max 10 mg)
6-11 yrs: 0.3 mg/kg/dose (max 10 mg)
>12 yrs: 0.2 mg/kg/dose (max 20 mg)
Conscious sedation: 0.2-0.3 mg/kg PO/IV/IM (max 10 mg) 45-60 min prior to procedure.
May cause significant respiratory depression.
Diflorasone (Psorcon, Maxiflor); Corticosteroid; Cream: 0.05% [15, 30, 60 gm]
Oint: 0.05% [15, 30, 60 gm]; Apply sparingly to affected area 2-4 times daily.
Dicloxacillin (Dycill, Dynapen, Pathocil); Antibacterial, Penicillin; Cap: 250, 500 mg

Susp: 62.5 mg/5 mL; 25-100 mg/kg/day PO qid (max 2000 mg/day)
Suspension is unpalatable. Open capsule and sprinkle powder on food for young children if possible. Take on an empty stomach.
Didanosine (DDI, Videx); Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Cap, DR and EC: 125, 200, 250, 400 mg
Powd pkt, buffered: 100, 167, 250 mg
Susp: 10 mg/mL or 20 mg/mL when admixed with antacid (single strength or double strength)
Tab, chew/buffered: 25, 50, 100, 150, 200 mg; <90 days: 100 mg/m2/day PO q12h
90 days to 13 yrs:
180-300 mg/m2/day PO bid
>13 yrs:
<60 kg: 125 mg q12h (tablets or powder packets) or 167 mg q12h (oral susp)
>60 kg: 200 mg q12h (tablets or powder packets) or 250 mg q12h (oral susp) or 400 mg qd (DR cap)
OR >35 kg: 5-10 mg/kg/day PO q12h
Children >1 yr should take drug as two chewable tablets or as powder packets or as suspension to ensure that adequate buffering is obtained; must be
taken on an empty stomach. Peripheral neuropathy, pancreatitis, headache.
Digoxin (Lanoxin); Cardiac Glycoside; Cap: 50, 100, 200 mcg

Elixir: 50 mcg/mL [60 mL]
Inj: 100, 250 mcg/mL
Tab: 125, 250, 500 mcg; Digoxin Total Digitalizing Dose:
Preterm: 15-30 mcg/kg IV; 20-30 mcg/kg PO
Term 0-4 wk: 20-30 mcg/kg IV; 25-35 mcg/kg PO
1-23 mos: 30-50 mcg/kg IV; 40-50 mcg/kg PO
2-4.99 yrs: 25-35 mcg/kg IV; 30-40 mcg/kg PO
5 yrs-10 yrs: 15-30 mcg/kg IV; 20-35 mcg/kg PO
11-17 yrs: 8-12 mcg/kg IV; 10-15 mcg/kg PO
>18 yrs: 0.5-1 mg IV; 0.75-1.5 mg PO
Give 1/2 total dose initially, then 1/4 of dose q8-12h x 2 doses (EKG 2h before each dose).
Max total digitalizing dose: 1000 mcg IV, 1500 mcg PO
Digoxin Maintenance Dose:
Preterm: 4-9 mcg/kg/day IV; 4-12 mcg/kg/day PO
Term 0-2 wk: 6-8 mcg/kg/day IV; 6-10 mcg/kg/day PO
2 wk-2 yrs: 8-10 mcg/kg/day IV; 10-15 mcg/kg/day PO
2 yrs-5 yrs: 6-8 mcg/kg/day IV; 8-10 mcg/kg/day PO
5 yrs-10 yrs: 4-8 mcg/kg/day IV; 5-10 mcg/kg/day PO
>10 yrs: 2-3 mcg/kg/day IV; 2.5-5 mcg/kg/day PO
Maximum daily maintenance dose: 500 mcg PO, 400 mcg IV
Divide IV maintenance doses bid. Divide oral doses bid if <10 yrs and qd if >10 yrs.
Low serum potassium or magnesium potentiates toxicity. Reduce dose in renal failure. Toxicity is indicated by nausea, vomiting, headache, visual
disturbances (yellow-green halos around lights), arrhythmias.
Digoxin immune Fab (Digibind, DigiFab); Antidote - Digoxin; Vial: 38 mg (Digibind), 40 mg (DigiFab); Dose of Digibind (in mg) = total body load x 76
Dose of DigiFab (in mg) = total body load x 80
Total body load of digoxin (in mg) = C (in ng/mL) x 5.6 x body weight (in kg) 1000
C = post-distribution serum digoxin level
Total body load (TBL) = mg of digoxin ingested (if known) x 0.8
Number of vials to use = TBL 0.5
Each vial will bind approximately 0.5 mg digoxin.
May interfere with digoxin measurement. Patient should be on continuous EKG monitor.
Dimenhydrinate (Dramamine); Antivertigo Agent, Antihistamine, Antiemetic; Liq: 12.5 mg/4 mL, 15.62 mg/5mL
Tab: 50 mg
Tab, chew: 50 mg; 2-5 yrs: 12.5-25 mg PO q6-8h prn (max 75 mg/day)
6-11 yrs: 25-50 mg PO q6-8h prn (max 150 mg/day)
>12 yrs: 50-100 mg PO q4-6h prn (max 400 mg/day)
Not recommended in patients <12 yrs due to high incidence of extrapyramidal side effects.
Dimercaprol (BAL); Antidote - Gold, Arsenic, Mercury, Lead; Inj: 100 mg/mL ; Lead Poisoning (use with edetate calcium disodium):
Mild: 3 mg/kg/dose IM q4h x 2-7days
Severe: 4 mg/kg/dose IM q4h x 2-7days
Mild Arsenic or Gold Poisoning: 2.5 mg/kg/dose IM q6h x 2days, then q12h x 1 day, then qd x 10days
Severe Arsenic or Gold Poisoning: 3 mg/kg/dose IM q4h x 2days, then q6h x 1 day, then q12h x 10days
Mercury Poisoning: 5 mg/kg/dose IM x 1, then 2.5 mg/kg/dose IM q12-24h x 10days
Give undiluted by deep IM injection. Has strong odor. May not give IV.
Diphenhydramine (Benadryl, Benylin); Antihistamine; Cap: 25, 50 mg

Cplt: 25, 50 mg
Cream: 1% [30gm], 2% [30 gm]
Inj: 50 mg/mL
Syr: 12.5 mg/5 mL
Tab: 25, 50 mg
Tab, chew: 12.5 mg
Spray, top: 1, 2% [60 mL]; 1 mg/kg/dose IM/IV/PO qid (max 50 mg/dose)
Apply topically to affected area qd-qid
Diphtheria and tetanus toxoids, adult (Td); Vaccine; Inj: 0.5 mL; 0.5 mL IM
See Immunization Schedule in appendix for timing. The adult formulation contains a smaller dose of diphtheria toxoid than the pediatric formulation.
Diphtheria and tetanus toxoids, pediatric (DT); Vaccine; Inj: 0.5 mL; 0.5 mL IM
See Immunization Schedule in appendix for timing.
Diphtheria, tetanus, acellular pertussis (Tripedia, Infanrix); Vaccine; Inj: 0.5 mL; 0.5 mL IM
Diphtheria, tetanus, acellular pertussis, haemophilus influenzae vaccine (TriHIBit); Vaccine; Inj: 0.5 mL; 0.5 mL IM
Dobutamine (Dobutrex); Adrenergic Agonist; Inj: 12.5 mg/mL [20 mL]; 2.5-15 mcg/kg/min continuous IV infusion, max of 40 mcg/kg/min
Usual maximum concentration 6000 mcg/mL.
Docusate (Colace); Stool Softener; Cap: 50, 100, 240, 250 mg

Liq: 10 mg/mL
Syr: 50 mg/15 mL, 60 mg/15 mL, 100 mg/30 mL
Tab: 100 mg; <3 yrs: 10-40 mg/day PO q6-24h
3-5 yrs: 20-60 mg/day PO q6-24h
6-12 yrs: 50-150 mg/day PO q6-24h
>12 yrs: 50-400 mg/day PO q6-24h
Liquid is bitter. Take with adequate fluids.
Dolasetron (Anzemet); Antiemetic ; Inj: 20 mg/mL

Tab: 50, 100 mg; Chemotherapy Antiemetic:
2-16 yrs: 1.8 mg/kg PO/IV 30 minutes prior to chemo, max 100 mg
Post-op nausea/vomiting:
2-16 yrs: 1.2 mg/kg PO x 1, max 100 mg or 0.35 mg/kg IV x 1, max 12.5 mg
Can mix injectable solution in apple juice for oral dosing; stable for 2 hours at room temperature.
Dopamine (Intropin); Adrenergic Agonist; Inj: 40, 80, 160 mg/mL; 1-20 mcg/kg/min continuous IV infusion; titrate to desired cardiac output and blood
pressure. May titrate up to 30 mcg/kg/min.
Dose Dependent Effects:
<5 mcg/kg/min: Primarily increases renal blood flow and urine output.
5-15 mcg/kg/min: Primarily increases renal blood flow, heart rate, cardiac contractility, and cardiac output.
>15 mcg/kg/min: Alpha-adrenergic effects result in vasoconstriction and increased blood pressure.
Patient should be on continuous cardiac monitor.
Dornase alfa (Pulmozyme); Recombinant Human Deoxyribonuclease; Soln for neb per mL: 1 mg/mL [2.5 mL single use amp]; >5 yrs: 2.5 mL dornase
alfa (1 amp) inhaled qd-bid; do not dilute or mix with any other drugs in the nebulizer.
Used in cystic fibrosis to improve pulmonary function.
Doxycycline (Vibra Tab, Vibramycin); Antibacterial, Tetracycline; Cap: 20, 50, 100 mg
Inj: 100, 200 mg
Syr per 5 mL: 25, 50 mg
Tab: 50, 100 mg; >8 yrs: 2-4 mg/kg/day IV/PO bid (max 200 mg/day)
Anthrax Post-exposure Prophylaxis:
<45 kg: 4.4 mg/kg/day PO bid x 60 days
>8 yrs AND > 45 kg: 100 mg PO bid x 60 days
Use of tetracyclines in childhood (<8 yrs of age) may cause permanent dental discoloration and enamel hypoplasia. Take on an empty stomach (1 hour
before or 2 hours after meals); do not give with dairy products or antacids
Dronabinol (C-III) (Marinol); Antiemetic, Marijuana Derivative; Cap: 2.5, 5, 10 mg; Antiemetic for chemotherapy: 5 mg/m2/dose PO beginning 1-3h
prior to chemotherapy, then q2-4h prn (max six doses per day); increase by 2.5 mg/m2/dose as needed to control nausea and vomiting (max 15
mg/m2/dose)
Appetite Stimulant: Adolescents: 2.5-5 mg PO before lunch and dinner (max 20 mg/day). If intolerant, try 2.5 mg PO qhs.
May cause drowsiness and depression. Impairs mental alertness and physical coordination.
Droperidol (Inapsine); Antiemetic; Inj: 2.5 mg/mL [1, 2, 5, 10 mL]; 2-12 yrs: Nausea and Vomiting: 0.05 mg/kg/dose IV/IM q4-6h prn
Post-operative nausea: 0.01-0.03 mg/kg/dose IV/IM q6-8h prn
>12 yrs: Nausea and Vomiting: 2.5-5 mg/dose IM/IV q4h prn
Prior to use, 12 lead EKG to identify patients with baseline QT prolongation is recommended. Drug is contraindicated if patients baseline QT interval is
prolonged.
Drotrecogin alfa (Xigris); Human Activated Protein C; Inj: 5, 20 mg; Patients with severe sepsis with organ dysfunction at high risk of death:
>18 yrs: 2.4 mcg/kg/hr continuous IV infusion for 96 hrs
Not approved for children <18 yrs.
Contraindications: active bleeding, head trauma.
Econazole (Spectazole, Ecostatin); Antifungal, Topical ; Cream: 1% [15, 30, 85 gm]; Apply qd-bid
Edetate calcium disodium (Calcium EDTA); Antidote - Lead ; Inj: 200 mg/mL [5 mL]; Lead Mobilization Test: 500 mg/m2/dose (max 1000 mg) IV over
one hour; a positive test occurs if the ratio of mcg of lead in urine to mg of calcium EDTA given is >1
Treatment of Lead Poisoning Encephalopathy: 250 mg/m2/dose IM q4h or 50 mg/kg/day continuous IV infusion or 1-15 gm/m2 IV as either an 8hr or
24 hr infusion. Concomitant treatment with dimercaprol is necessary.
Edetate disodium (EDTA); Chelator; Inj: 150 mg/mL [20 mL]; Hypercalcemia: 40-70 mg/kg (max 3000 mg) IV over 3-4 hours
May repeat daily for five days.
Efavirenz (EFZ, Sustiva); Antiretroviral, Non-nucleoside Analog Reverse Transcriptase Inhibitor; Cap: 50, 100, 200 mg
Tab: 600 mg; 10-14.9 kg: 200 mg PO qd
15-19.9 kg: 250 mg PO qd
20-24.9 kg: 300 mg PO qd
25-32.4 kg: 350 mg PO qd
32.5-39.9 kg:400 mg PO qd
>40 kg: 600 mg PO qd
Bedtime dosing is recommended to improve tolerability of CNS side effects (dizziness, agitation, somnolence). Capsule may be opened and added to
food. Grape jelly hides the peppery taste.
Emedastine (Emadine); Antihistamine; Ophth soln: 0.05% [5 mL]; >3 yrs: Instill one drop in affected eye(s) qid
Patients should not wear contact lenses. Indicated for temporary relief of signs and symptoms of allergic conjunctivitis.
Enalapril (Vasotec); Angiotensin Converting Enzyme Inhibitor; Tab: 2.5, 5, 10, 20 mg; Initial starting dose: 0.1 mg/kg/day PO q12-24h (max 5 mg)
Maintenance dose: Titrate up to 0.5 mg/kg/day PO q12-24h (max 40 mg/day)
An extemporaneously prepared suspension can be made with 90-day stability under refrigeration.
Enalaprilat IV (Vasotec IV); Angiotensin Converting Enzyme Inhibitor; Inj: 1.25 mg/mL [1, 2 mL]; 5-10 mcg/kg/dose IV q8-24h (usual adult dose 1.25
mg)
This product should not be given orally because it is a pro-drug and is not orally absorbed.
Enoxaparin (Lovenox); Anticoagulant; Low Molecular Weight Heparin; Inj: 100 mg/mL; >2 mos for deep vein thrombosis or pulmonary embolism
Prophylaxis: 0.5 mg/kg SC q12h
Treatment: 1 mg/kg SC q12h
Titrate dose to desired antifactor Xa level (usual desired range 0.1-1 unit/mL).
Do not administer IM or IV.
Epinephrine (Epi-pen, Adrenalin); Adrenergic Agonist; EpiPen delivers 0.3 mg IM

EpiPen Jr delivers 0.15 mg IM
Inj: 1 mg/mL [1:1000], 0.1 mg/mL [1:10000]
Racemic soln for neb: 2.25% [15, 30 mL]
Soln for inhalation: 1:100 [7.5 mL], 1:1000 [30 mL]; Nebulized: 0.25-0.5 mL of 2.25% racemic epinephrine diluted in 3 mL NS
Continuous IV infusion: 0.1-1.0 mcg/kg/min
CPR: 0.01 mg/kg IV/IO (max 1 mg) or high dose: 0.1 mg/kg IV/IO; 0.1 mg/kg ET
Subcutaneous: 0.01 mg/kg using 1:1000 conc (max 0.5 mg)
EpiPen:
<30 kg: max 0.15 mg SC (EpiPen Jr)
>30 kg: max 0.3 mg SC (EpiPen)
Epoetin alfa (Epogen, EPO); Recombinant Human Erythropoietin; Inj per mL: 2000, 3000, 4000, 10000, 20000, 40000 U [1 mL]; Anemia in Cancer:
150-300 u/kg SC three times weekly
Anemia of Prematurity: 100-200 U/kg/dose IV/SC three times weekly
Renal Failure: 50-150 U/kg/dose IV/SC three times weekly
Zidovudine-treated HIV patient: 100 U/kg IV/SC three times weekly
Evaluate iron stores prior to initiation of therapy. May need to supplement iron. Monitor hematocrit, hemoglobin, and reticulocyte count.
Ergocalciferol (Calciferol, Drisdol, Vitamin D); Vitamin; Cap: 50,000 units

Inj: 500,000 U/mL
Oral soln: 8000 U/mL [60 mL] (200 U/drop); Dietary Supplementation: Premature Infants: 400-800 units/day PO qd-bid
Infants and Children: 400 units/day PO qd-bid
Vitamin D Dependent Rickets: 3000-5000 U per day PO/IM qd-bid
Nutritional Rickets and Osteomalacia: 1000-5000 U/day PO/IM x 6-12 weeks
40 units = 1 mcg
Oral dosing is preferred. Injectable product may only be given IM (not IV). Drops are available OTC.
Erythromycin base (E-Mycin, Ery-Tab, Eryc); Antibacterial, Macrolide; Cap, DR: 250 mg
Gel: 2% [30, 60 gm]
Oint: 2% [25 gm]
Ophth oint: 5 mg/gm [1, 3.5 gm]
Soln, topical: 1.5% [60 mL], 2% [60 mL]
Tab: 250, 333, 500 mg
Tab. DR: 250, 333, 500 mg; Oral: 30-50 mg/kg/day q6-8h (max 2 gm/day)
Ophthalmic: Apply to the infected eye one or more times daily
Prophylaxis of neonatal gonococcal or chlamydial conjunctivitis: 0.5-1 cm ribbon of ointment instilled into each conjunctival sac
Pre-op for bowel surgery: 20 mg/kg PO at 1 pm, 2 pm, 11 pm the day before surgery (in combination with oral neomycin and mechanical cleansing)
May increase theophylline level; frequent GI upset.
Topical: Apply bid.
Erythromycin estolate (Ilosone); Antibacterial, Macrolide; Cap: 250 mg

Tab: 500 mg; 50 mg/kg/day PO q6-12h (max 2 gm/day)
May increase theophylline level; frequent GI upset. Estolate is the preferred salt when treating pertussis.
Erythromycin ethyl succinate (EES, Eryped); Antibacterial, Macrolide; Drops: 100 mg/2.5 mL [50 mL]
Tab: 400 mg
Tab, chew: 200 mg; 30-50 mg/kg/day PO q6-8h (max 3.2 gm/day)
Ethyl succinate is the usual salt form used in pediatrics.

Erythromycin lactobionate (Erythrocin); Antibacterial, Macrolide; Inj: 500, 1000 mg; 20-50 mg/kg/day IV q6h (max 4 gm/day)
Etanercept (Enbrel); Immunomodulator; Inj: 25 mg; 4-17 yrs: 0.4 mg/kg (max 25 mg) SC twice weekly for 3 months
>17 yrs: 25 mg SC twice weekly for 3 months
Used for juvenile rheumatoid arthritis. Discontinue immediately if serious Infection develops.
Ethambutol (Myambutol); Tuberculostatic; Tab: 100, 400 mg; 15-25 mg/kg/day PO qd (max 1 gm/day) or 50 mg/kg/dose PO twice weekly (max 2500
mg/dose)
Monitor visual acuity and color discrimination monthly.
Ethosuximide (Zarontin); Anticonvulsant; Cap: 250 mg

Syr: 250 mg/5 mL; 3-6 yrs: Initially 15 mg/kg/day PO bid (max 250 mg/dose), increase q4-7days; usual maintenance dose 15-40 mg/kg/day bid
>6 yrs: Initially 250 mg PO bid, increase by 250 mg/day prn q4-7days; usual maintenance dose 20-40 mg/kg/day bid (max 1500 mg/day)
Therapeutic serum range: 40-100 mcg/mL
Famciclovir (Famvir); Antiviral; Tab: 125, 250, 500 mg; Herpes zoster (adolescents): 500 mg PO tid for 7 days.
Genital herpes: 250 mg PO tid x 7-10 days
Genital herpes, recurrent episodes (adolescents): 125 mg PO bid for 5 days.
Daily suppressive therapy: 250-500 mg/day PO bid x 1 year then reassess for recurrence
Not a cure for genital herpes.
Famotidine (Pepcid); Histamine-2 Antagonist; Cap: 10 mg

Inj: 5 mg/mL
Susp: 40 mg/5 mL
Tab: 10, 20, 40 mg
Tab, chew: 10 mg; Peptic Ulcer: 0.5 mg/kg/day PO/IV qhs-bid, max 40 mg/day
GERD: 1 mg/kg/day PO/IV q12h, max 80 mg/day
10 mg tablets are available OTC. Adjust for renal impairment.
Felbamate (Felbatol); Anticonvulsant; Susp: 600 mg/5 mL

Tab: 400, 600 mg ; 2-14 yrs: Initial: 15 mg/kg/day PO tid-qid; titrate by 15 mg/kg/day at weekly intervals to max of 45 mg/kg/day or 3600 mg/day
(whichever is less) tid-qid
>14 yrs: Initial: 1200 mg/day PO tid-qid; titrate by 600 mg/day increments at 2-wk intervals prn until max of 3600 mg/day
Increases concentrations of phenytoin and valproic acid. Associated with aplastic anemia and acute liver failure; therefore, not a first-line
anticonvulsant. Written informed consent necessary. Monitor CBC, liver function, and bilirubin.
Fentanyl (C-II) (Sublimaze); Opioid Narcotic; Inj: 50 mcg/mL

Transdermal Patch:
25 mcg/hr [10 cm2]
50 mcg/hr [20 cm2]
75 mcg/hr [30 cm2]
100 mcg/hr [40 cm2]; 1-2 mcg/kg/dose (max 100 mcg/dose) IV q1-2h prn or 1-2 mcg/kg/hr continuous IV infusion (may need to titrate to higher dose).
Reversible with naloxone.
May convert patient over to transdermal patch when stabilized on a dose. Replace patch q72h. Patches may not be cut in half.
Ferrous gluconate (Fergon); Iron Salt; Tab: 300 mg (34 mg elemental Fe); Oral dosages in mg elemental iron:
Children (iron deficiency anemia):
Mild-Moderate: 3 mg/kg/day PO qd-bid
Severe: 4-6 mg/kg/day PO tid
Prophylaxis: 1-2 mg/kg/day PO qd
Adults: Iron deficiency: 60 mg PO bid-qid
Prophylaxis: 60 mg/day PO qd
May turn stools and urine dark; GI upset, constipation; vitamin C will increase absorption. Contains 12% elemental iron.
Ferrous sulfate (Fer-In-Sol, Fer-Iron); Iron Salt; Cap: 250 mg (50 mg elemental Fe)
Drops (Fer-In-Sol): 75 mg (15 mg elemental Fe)/0.6 mL [50 mL]
Drops (Fer-Iron): 125 mg (25 mg elemental Fe)/1 mL [50 mL]
Elixir: 220 mg (44 mg elemental Fe)/5 mL [480 mL]
Syr: 90 mg (18 mg elemental Fe)/5 mL [480 mL]
Tab: 195 mg (39 mg elemental Fe); 300 mg (60 mg elemental Fe); 324 mg (64 mg elemental Fe)
Tab, TR: 525 mg (105 mg elemental Fe); Oral dosages in mg elemental iron:
Premature infants: 7.5-15 mg/day qd-bid. Doses at the higher end of the range may be necessary for infants on concomitant erythropoietin.
Children (Iron deficiency anemia):
Mild-moderate: 3 mg/kg/day PO qd-bid
Severe: 4-6 mg/kg/day PO tid
Prophylaxis: 1-2 mg/kg/day PO qd
Adults:
Iron deficiency: 60 mg PO bid-qid
Prophylaxis: 60 mg/day PO qd
Ferrous sulfate exsiccated (Feratab, Feosol, Slow Fe); Iron Salt; Cap, TR: 160 mg (50 mg elemental Fe)
Tab: 187 mg (60 mg elemental Fe), 200 mg (65 mg elemental Fe)
Tab SR: 160 mg (50 mg elemental Fe); Oral dosages in mg elemental iron:
Adults:
Iron deficiency: 60 mg bid-qid
Prophylaxis: 60 mg/day qd
Fexofenadine (Allegra); Antihistamine; Cap: 60 mg
Tab: 30, 60, 180 mg; 6-11 yrs: 30 mg PO bid
>12 yrs: 60 mg PO bid or 180 mg/day PO qd
Filgrastim (G-CSF, Neupogen); Colony Stimulating Factor; Inj: 300 mcg/mL [1, 1.6 mL]; 5 mcg/kg/day IV/SC qd. May increase to 10 mcg/kg/day.
Administer daily for up to 14 days until absolute neutrophil count >10,000
Fluoride; Mineral; Tab, chew (sodium): 0.25, 0.5, 0.55, 1 mg; The recommended daily fluoride intake is adjusted in proportion to the fluoride content of
drinking water (see table below). Fluoride is also available in multivitamin preparations.
Fluoride content of ; Daily dose of oral

drinking water; fluoride
<0.3 parts per million;
birth-6 mos; 0
6 mos - 3 yrs; 0.25 mg
3-6 yrs; 0.5 mg
6-16 yrs; 1 mg
0.3-0.6 parts per million;
birth-3 yrs; 0
3-6 yrs; 0.25 mg
6-16 yrs; 0.5 mg
>0.6 parts per million;
All ages; 0
Fluconazole (Diflucan); Antifungal; Inj: 2 mg/mL

Susp per mL: 10, 40 mg
Tab: 50, 100, 150, 200 mg; 3-6 mg/kg/dose PO/IV qd (max 400 mg/dose). Doses as high as 10-12 mg/kg/day qd (max 800 mg/day) have been used in
immunocompromised children.
Vaginal Candidiases: Adolescents: 150 mg PO x 1 (single dose)
Adjust dosage in renal insufficiency. Oral dosing produces the same blood levels as intravenous.
Flucytosine (5-FC) (Ancobon); Antifungal; Cap: 250, 500 mg; 100-150 mg/kg/day PO qid for 4-6 weeks
Therapeutic Range: 25-100 mcg/mL
Nausea, vomiting, diarrhea; bone marrow depression. Monitor serum levels. Extemporaneously prepared suspension can be made with 14 days
stability under refrigeration or at room temperature.
Fludrocortisone (Florinef); Mineralocorticoid; Tab, scored: 0.1 mg; Infants and Children: 0.05-0.1 mg/day PO qd
Adults: 0.05-0.2 mg/day PO qd
Flumazenil (Romazicon); Antidote - Benzodiazepine; Vial: 0.1 mg/mL [5, 10 mL]; Reversal of benzodiazepine: Children: 0.01 mg/kg IV (max 0.2mg),
repeat as needed
Adolescents: 0.2 mg IV over 30 seconds, wait 30 seconds, then give 0.3-0.5 mg over 30 seconds if needed
Continuous infusion: 0.005-0.01 mg/kg/hr
May need to repeat doses because the half-life of flumazenil may be significantly shorter than the half-life of the benzodiazepine being reversed.
Flunisolide (Aero-Bid, Aero-Bid M, Nasalide, Nasarel); Corticosteroid; Aerosol: 250 mcg/puff, 100 puffs/canister [7gm]
Spray, nasal: 0.025% (25 mcg/spray, 200 doses/spray bottle) [25 mL]; Inhalation: 6-15 yrs: 2 puffs bid; >15 yrs: 2 puff bid, may increase to 4 puffs bid
Intranasal: 6-14 yrs: 1 spray in each nostril tid or 2 sprays in each nostril bid
>14 yrs: Start with 2 sprays in each nostril bid, may increase to tid-qid
May cause oral candidiasis. Aero-bid M has a menthol taste.
Fluocinolone (Synalar, Flurosyn); Corticosteroid; Cream: 0.01% [15, 30, 60, 425 gm], 0.025 % [15, 30, 60, 425 gm], 0.2% [12 gm]
Oil: 0.01% [120 mL]
Oint: 0.025% [15, 30, 60 gm]
Shampoo: 0.01% [180 mL]
Soln: 0.01% [20, 60 mL]; Apply to affected area bid
Low potency: 0.01% ; medium potency: 0.025% ; high potency: 0.2 %
Fluocinonide (Lidex); Corticosteroid; Cream, gel, oint: 0.05% [15, 30, 60, 120 gm]
Soln: 0.05% [20, 60 mL] ; Apply to affected area bid-qid
Fluoxetine (Prozac, Sarafem); Antidepressant, SSRI; Cap: 10, 20 mg

Cap, DR: 90 mg
Liq: 20 mg/5 mL
Tab: 10, 20 mg; Depression:
5-18 yrs: initially 5-10 mg PO qAM, may increase to 20 mg PO qam
>18 yrs: initially 20 mg PO qAM, may increase after several weeks by 20mg/day to max of 80 mg/day
Premenstrual Dysphoric Disorder:
Adolescents: 20 mg PO qd
Doses >20 mg may be given qd or qam and q noon.
If maintained at 20 mg/day, may change to DR capsule 90 mg PO q week.
Fluticasone (Flonase, Flovent); Corticosteroid; MDI: 44mcg/puff, 60 puffs/canister [7.9gm]; 44 mcg/puff, 120 puffs/canister [13gm]; 110 mcg/puff, 60
puffs/canister [7.9gm] or 120 puffs/canister [13 gm], 220 mcg/puff, 60 puffs/canister [7.9 gm] or 120 puffs/canister [13 gm]
Nasal spray: 50 mcg/spray, 120 sprays/canister [16 gm]
Rotadisk powder for inhalation: 50, 100, 250 mcg; MDI: 1-2 puffs bid
Nasal: >4 yrs: 1 spray in each nostril qd, may increase to 2 sprays in each nostril qd. Once symptoms are controlled, reduce dose to 1 spray in each
nostril qd.
Nasal pump must be primed before first use or after >one week of non-use by actuating six times.
Rotadisk: 4-11 yrs: 50 mcg bid, may increase to 100 mcg bid; >12 yrs: 100 mcg bid, may increase to max 500 mcg bid. Dry powder inhaler - cannot be
used with spacer.
Not indicated for relief of acute bronchospasm.
Folic acid (Folvite); Vitamin; Inj: 5 mg/mL [10 mL]

Tab: 0.4, 0.8, 1 mg; Folic Acid Deficiency (PO/IV/IM/SC):
Infants: 15 mcg/kg/dose or 50 mcg qd
Children 1-10 yrs: Initial: 1 mg/day qd; maint: 0.1-0.4 mg/day qd
>11 yrs: Initial: 1 mg/day qd; maint: 0.5 mg/day qd
Fomepizole; Antidote; Inj: 1 gm/mL [1.5 mL]; Methanol or ethylene glycol ingestion not requiring hemodialysis:
15 mg/kg IV loading dose, then 10 mg/kg IV q12h x 4 doses, then 15 mg/kg IV q12h
Formoterol (Foradil); Beta-2 Adrenergic Agonist; Capsule for oral inhalation: 12 mcg; >5 yrs: 12 mcg inhaled bid
Contents of capsule are aerosolized via a device called an Aerolizer.
Foscarnet (Foscavir); Antiviral; Inj: 24 mg/mL; Cytomegalovirus Retinitis:

Adolescents and Adults: Induction: 180 mg/kg/day IV q8-12h x 14-21 days; maintenance: 90-120 mg/kg/day IV qd
Maximum infusion rate 60 mg/kg/hr. Adjust dose in renal impairment.
Fosphenytoin (Cerebyx); Anticonvulsant; Inj: 150 mg [equivalent to phenytoin sodium 100 mg] in 2 mL vial; 750 mg [equivalent to phenytoin sodium 500
mg] in 10 mL vial; The drug must be ordered as mg of phenytoin equivalent (PE):
>5 yrs: Loading dose 10-20 mg/kg PE IV/IM, maintenance dose 4-6 mg/kg/day PE IV/IM q12-24h.
Maximum infusion rate 3 mg PE /kg/min (max 150 mg PE per min)
Fosphenytoin 1.5 mg is equivalent to phenytoin 1 mg which is equivalent to fosphenytoin 1 mg PE (phenytoin equivalent unit); fosphenytoin is a water-
soluble pro-drug of phenytoin.
Furazolidone (Furoxone); Antibacterial, Antiprotozoal; Liq: 50 mg/15 mL

Tab, scored: 100 mg; >1 month: 5-8.8 mg/kg/day PO qid (max 400 mg/day)
May discolor urine to a brown tint; avoid alcohol due to possible disulfiram-like reaction.
Furosemide (Lasix); Diuretic, Loop; Inj: 10 mg/mL

Soln per mL: 8, 10 mg
Tab: 20, 40, 80 mg; 1 mg/kg/dose IV/IM/PO q6-12h prn; may increase to 2 mg/kg/dose IV/IM/PO (usual max 80 mg PO, 40 mg IV).
Continuous IV infusion: 0.05 mg/kg/hr, titrate to desired effect.
Monitor serum magnesium and potassium levels. High doses may cause ototoxicity; supplemental potassium is often necessary.
Gabapentin (Neurontin); Anticonvulsant; Cap: 100, 300, 400 mg

Soln: 250 mg/5 mL
Tab: 600, 800 mg; Anticonvulsant:
3-12 yrs: 10-15 mg/kg/day PO tid, titrate as tolered q3d to max 50 mg/kg/day
>12 yrs: 300 mg PO tid, titrate if necessary. Usual dose 800-1800 mg PO tid, max 3600 mg/day
Neuropathic Pain:
5 mg/kg PO qhs on day 1, 5 mg/kg/dose PO bid on day 2, 5 mg/kg/dose PO tid on day 3. Titrate to effect. Usual range 8-35 mg/kg/day PO tid; max
1800 mg/day.
Ganciclovir (Cytovene); Antiviral; Cap: 250, 500 mg

Inj: 500 mg; Cytomegalovirus Retinitis: Induction: 10 mg/kg/day IV bid x 14-21 days. Maintenance: 5 mg/kg/day IV q24h x 7 days/week or 6
mg/kg/day IV q24h x 5 days/week
Oral maintenance following IV induction: 6 mos-16 yrs: 30 mg/kg/dose PO q8h, >16 yrs: 1000 mg tid or 500 mg q3h while awake (6 times daily)
Other CMV Infections:
Induction: 10 mg/kg/day IV q12h or 7.5 mg/kg/day IV q8h x 14-21 days
Oral maintenance following IV induction: 6 mos-16 yrs: 30 mg/kg/dose PO q8h, >16 yrs: 1000 mg tid or 500 mg q3h while awake (6 times daily)
Granulocytopenia and thrombocytopenia; adjust dose in renal failure. Extemporaneous suspension can be made.
Gentamicin (Garamycin); Antibacterial, Aminoglycoside; Cream: 0.1% [15 gm]

Inj: 10 mg/mL, 40 mg/mL
Oint: 0.1% [15 gm]
Ophth soln: 0.3% [1, 5, 15 mL]; IV/IM: <5 yrs (except neonates): 7.5 mg/kg/day q8h.
5-10 yrs: 6.0 mg/kg/day q8h.
>10 yrs: 5.0 mg/kg/day q8h.
Therapeutic peak levels 4-10 mcg/mL; trough levels <2 mcg/mL. Adjust dose in renal failure; potential side effects include nephrotoxicity and ototoxicity.
Ophth: Apply ointment to conjunctival sac bid-tid or instill 1-2 drops into eye(s) q4h
Topical: Apply topically bid-qid
Glucagon (GlucaGen); Antihypoglycemic Agent; Inj: 1 mg; Hypoglycemia:

<20 kg: 0.02-0.03 mg/kg/dose (max 0.5 mg) IM/IV/SC. May repeat in 20 minutes if needed.
>20 kg: 1 mg IM/IV/SC. May repeat in 20 minutes if needed.
1 unit = 1 mg
Glycerin
(Fleet Baby Lax); Laxative, Hyperosmolar; Liquid, rectal: 4 mL per applicator
Supp: Infant and adult sizes; <6 yrs: use infant suppository
>6 yrs: use adult suppository
Insert 1 suppository rectally prn or use rectal liquid and squeeze applicator unit, then remove it
Glycopyrrolate (Robinul); Anticholinergic Agent; Inj: 0.2 mg/mL

Tab: 1, 2 mg; Control of oral secretions:
40-100 mcg/kg/dose PO/NG tid-qid (max 1 mg/dose)
4-10 mcg/kg/dose IV/IM qid (max 0.2 mg/dose)
Extemporaneously prepared suspension can be made from the tablets with 2 weeks stability under refrigeration. Discontinue use if secretions become
too thick.
Granisetron (Kytril); Antiemetic; Inj: 1 mg/mL

Soln: 1 mg/5 mL
Tab: 1 mg; >2 yrs: 10-20 mcg/kg IV x 1 given just prior to chemotherapy, max 1 mg
Adolescents: 1 mg PO bid or 2mg PO qd. Give the first dose one hour before chemotherapy.
Post-op nausea/vomiting: 20-40 mcg/kg IV x 1, max 1 mg
Oral dose not established in children. Extemporaneously prepared suspension can be made from the tablets with 2 weeks stability under refrigeration
or at room temperature.
Griseofulvin (Fulvicin PG, Fulvicin UF, Grisactin,

Gris-Peg); Antifungal; Microsize:
Cap: 250 mg
Susp: 125 mg/5 mL
Tab: 250, 500 mg
Ultramicrosize:
Tab: 125, 165, 250, 330 mg; >2 yrs: Microsize 10-20 mg/kg/day PO qd-bid (max 1000 mg/day). Ultramicrosize 5-10 mg/kg/day PO qd-bid
(usual max 375 mg/day, may use up to 750 mg/day)
Adolescents: Microsize 500-1000 mg/day PO qd-bid or Ultramicrosize 330-375 mg/day PO qd-tid
Duration of therapy depends on site of infection: tinea corporis 2-4 weeks, tinea capitis 4-6 weeks or longer, tinea pedis 4-8 weeks, tinea inguium 3-6
months or longer.
Patients on extended therapy should be monitored for renal, hepatic, and hematopoietic function. Absorption is improved with fatty food. Ultramicrosize
is better absorbed; therefore, a smaller mg dose is effective.
Guaifenesin (Robitussin); Expectorant; Cap: 200 mg

Cap SR: 300 mg
Liq: 100/5 mL
Syr: 100 mg/5 mL
Tab: 100, 200 mg
Tab SR: 600, 800, 1200 mg; <2 yrs: 12 mg/kg/day PO q4-6h prn
2-5 yrs: 50-100 mg q4h PO prn (max 600 mg/day)
6-12 yrs: 100-200 mg q4h PO prn (max 1.2 gm/day)
>12 yrs: 200-400 mg q4h PO prn or 600-1200 mg SR q12h prn (max 2.4 gm/day)
Administer with plenty of fluids.
Halobetasol (Ultravate); Corticosteroid; Cream: 0.05% [15, 45 gm]

Oint: 0.05% [15, 45 gm]; Apply to affected area 2 to 4 times daily.
Haloperidol (Haldol); Antipsychotic; Inj (lactate): 5 mg/mL

Oral conc: 2 mg/mL
Tab: 0.5, 1, 2, 5, 10, 20 mg ; 3-12 yrs PO: initially 0.25-0.5 mg/day bid-tid; increase by 0.25-0.5 mg every 5-7 days (max 0.15 mg/kg/day)
>12 yrs PO: initially 0.5-5 mg PO bid-tid; increase by 2.5-5 mg/day prn (usual max 30 mg/day)
6-12 yrs IM: 1-3 mg/dose q4-8h to a max of 0.15 mg/kg/day
>12 yrs IM: 2-5 mg q4-8h prn
Agitation/hyperkinesia: 0.01-0.03 mg/kg/day PO qd
Switch to oral therapy as soon as possible.
Heparin sodium; Anticoagulant; Inj per mL: 10, 50, 100, 1000, 5000, 10,000, 40,000 U; Anticoagulation: Loading dose 50 U/kg IV, then 15-25 U/kg/hr
continuous IV infusion.
Titrate to desired APTT. Monitor closely for bleeding.
Hepatitis A vaccine (Havrix, Vaqta); Vaccine; Inj: 0.5 mL, 1 mL; 2-18 yrs: 0.5 mL IM; booster dose 6-12 mos after primary immunization
>18 yrs: 1 mL IM; booster dose 6-12 mos after primary immunization
Do not administer IV or ID or SC.
Hepatitis B immune globin (BayHep B, Nabi-HB); Immune Globulin; Inj: 0.5, 1, 5 mL; Post-exposure prophylaxis
<12 mos: 0.5 mL IM.
>12 mos: 0.06 mL/kg (minimum dose 0.5 mL, maximum dose 5 mL). Repeat dose in 30 days.
Hepatitis B vaccine (Recombivax HB, Engerix-B); Vaccine; Inj: 0.5 mL; Recombivax HB:
<20 yrs: 5 mcg (0.5 mL) IM
>20 yrs: 10 mcg (1mL) IM
Immunosuppressed adults or adults receiving hemodialysis: 40 mcg (1 mL) IM
Engerix B:
<20 yrs: 10 mcg (0.5 mL) IM
>20 yrs: 20 mcg (1mL) IM
Immunosuppressed adults or adults receiving hemodialysis: 40 mcg (2 mL) IM
Hetastarch (Hespan); Plasma Volume Expander; Inj: 6% [500, 1000 mL]; 10 mL/kg/dose IV over at least 30 minutes. Maximum daily dose 20 mL/kg.
Diluted in normal saline (Na 154 mEq/liter).
Use with caution in patients with thrombocytopenia.
Hydralazine (Apresoline); Vasodilator, Antihypertensive; Inj: 20 mg/mL

Tab: 10, 25, 50, 100 mg; PO: Initially 0.75-1 mg/kg/day bid-qid (max 25 mg/dose), increase to max 7.5 mg/kg/day bid-qid (max 200 mg/day).
IV/IM: Initially 0.1-0.2 mg/kg/dose (max 20 mg) q4-6h prn, may increase to 1.7-3.5 mg/kg/day q4-6h prn (max 40 mg/dose).
Extemporaneous suspension can be made with two weeks stability under refrigeration.
Hydrochlorothiazide (Hydrodiuril); Diuretic, Thiazide; Cap: 12.5 mg
Soln: 50 mg/5 mL
Tab: 25, 50, 100 mg ; 2 mg/kg/day PO bid (max 100 mg/dose)
Hydrocortisone acetate; Corticosteroid; Cream: 0.5% [15, 30 gm], 1% [15, 20, 30, 120 gm]
Oint: 0.5% [15, 30 gm], 1% [21, 30 gm]; Inj: Inject intra-articular, intrasynovial, or intralesional only (not IV).
Topical: Apply a thin layer to affected area tid-qid
Hydrocortisone base (Hydro-Cortone,

Cort-Dome, Cortef,
Cortisol, Cortifoam, Cortenema); Corticosteroid; Cream: 0.5 %[15, 30, 60, 90, 120, 454 gm], 1% [1, 20, 30, 60, 120, 240, 454 gm], 2.5% [15,
20, 30, 60, 120, 240, 454 gm]
Gel: 1% [15, 30 gm]
Lotion: 0.25% [120 mL], 0.5% [30, 60, 120 mL], 1% [60, 120 mL], 2% [30 mL], 2.5% [60 mL]
Oint: 0.5,% [30 gm], 1% [15, 20, 30, 60, 120, 240, 454 gm], 2.5% [20, 30 gm]
Soln, topical: 1% [30, 60 mL]
Tab: 5, 10, 20 mg
Enema: 100 mg/60 mL
Rectal cream: 1% [30 gm]
Rectal foam: 10% [90 mg/applicatorful, 14 applicatorfuls/20 gm]; Topical: Apply a thin layer to affected area tid-qid
Hydrocortisone is a low-potency corticosteroid.
Physiologic oral replacement: 0.5-0.75 mg/kg/day PO qd
Anti-inflammatory: 2.5-10 mg/kg/day PO q6-8h
Rectal: Apply 1 applicatorful qd-bid for 2-3 weeks
Hydrocortisone butyrate (Locoid); Corticosteroid; Cream: 0.1% [15, 45, gm]

Oint: 0.1% [15, 45 gm]
Soln, topical: 0.1% [20, 60 mL]; Apply topically to affected area bid-tid
Hydrocortisone cypionate (Cortef); Corticosteroid; Susp: 2 mg/mL; Physiologic replacement: 0.5-0.75 mg/kg/day PO qd
Anti-inflammatory: 2.5-10 mg/kg/day PO q6-8h
Hydrocortisone sodium phosphate; Corticosteroid; Inj: 50 mg/mL [2, 10 mL]; Status asthmaticus: 1-2 mg/kg/dose IV/IM q6h x 24 hours, then decrease
dose to 0.5 mg/kg/dose IV/IM q6h
Anti-inflammatory: 1-5 mg/kg/day IV/IM q12-24h
Acute adrenal insufficiency: 1-2 mg/kg IV/IM x1, then 25-150 mg/day IV/IM q6-8h
Hydrocortisone sodium succinate (Solu-Cortef); Corticosteroid; Vial: 100, 250, 500, 1000 mg; Shock:
Children: Initial 50 mg/kg IV/IM, repeat in 4 hours and again qd prn (max 2000 mg)
Adolescents: 500 mg IV/IM q6h
Hydrocortisone valerate (Westcort); Corticosteroid; Cream: 0.2% [15, 45, 60, 120 gm]
Oint: 0.2% [15, 45, 60 gm]; Apply to affected area bid-tid
Medium-potency corticosteroid
Hydromorphone (Dilaudid); Opioid Narcotic; Inj: 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mL

Liq: 1 mg/mL
Supp: 3 mg
Tab: 1, 2, 3, 4, 8 mg; Oral: 0.03-0.08 mg/kg/dose q4-6h (max 4 mg/dose)
IV/IM: 0.015 mg/kg/dose q4-6h (usual adult dose 2 mg)
Continuous IV infusion: Start at 0.0075 mg/kg/hr and titrate to desired effect
PCA (patient controlled analgesia): 0.0015-0003 mg/kg/hr continuous IV basal rate and/or bolus doses 0.0015-0.0045 mg/kg IV q6-15 minutes.
Delivery limit (basal rate and boluses): 2 mg/hr or 0.014 mg/kg/hr (whichever is smaller).
Effects are reversible with naloxone.
Hydroxychloroquine (Plaquenil); Antimalarial; Tab: 200 mg (155 mg base); Oral Doses are expressed as mg of base
Chemoprophylaxis of Malaria: 5 mg/kg once weekly (max 310 mg/dose); begin 1-2 weeks before exposure and continue for 4 weeks after leaving
endemic area
Malaria: Initial dose 10 mg/kg (max 620 mg/dose), followed by 5 mg/kg (max 310 mg) 6 hours later on day one; 5 mg/kg as single daily dose on day
two and day three (max 310 mg/dose).
Juvenile Rheumatoid Arthritis or SLE: 2.3-4 mg/kg/day qd-bid to a max of 400 mg/day; not to exceed 7 mg/kg/day.
Hydroxyzine (Atarax, Vistaril); Antihistamine; Cap: 25, 50, 100 mg

Syr: 10 mg/5 mL, 25 mg/5 mL
Tab: 10, 25, 50, 100 mg; 2 mg/kg/day PO q6-8h (max 100 mg/dose)
0.5-1 mg/kg/dose IV/IM q4-6h (max 100 mg/dose)
Drowsiness and anticholinergic effects.
Ibuprofen (Motrin, Advil, Pediaprofen); NSAID; Cap: 200 mg

Cplt: 200 mg
Oral Drops: 40 mg/mL [15 mL]
Susp: 100 mg/5 mL, 200 mg/5 mL
Tab: 100, 200, 400, 600, 800 mg
Tab, chew: 50, 100 mg; Antipyretic and Analgesic: 5-10 mg/kg/dose PO q6-8h (max 600 mg/dose)
Administer with food to decrease GI upset. May alternate with acetaminophen to control fever.
Juvenile Rheumatoid Arthritis: 30-50 mg/kg/day PO q6h (max 2.4 gm/day)
Dosage forms <300 mg are available OTC. May cause GI distress.
Imipramine (Tofranil); Tricyclic Antidepressant; Cap: 75, 100, 125, 150 mg

Tab: 10, 25, 50 mg; Depression: 1.5 mg/kg/day PO with dosage increments of 1 mg/kg/day q3-4days to max dose of 5 mg/kg/day qd-qid.
Enuresis: >6 years: Initial: 10-25 mg PO qhs x 1 wk; if inadequate response, increase by 25 mg/day to max 2.5 mg/kg/day or 50 mg qhs if 6-12 yrs or
75 mg qhs if >12 yrs.
Adolescents: Initial: 25-50 mg/day PO; max 200 mg/day in single or divided doses
Therapeutic serum levels (imipramine and desipramine): 150-250 ng/mL
Immune globulin, intramuscular (BayGam); Immune Globulin, Intramuscular; Inj: 2, 10 mL; Immunoglobulin deficiency: Initial dose 1.3 mL/kg IM,
followed by 0.66 mL/kg IM q3-4 weeks
Measles exposure: 0.25 mL/kg IM x 1 (double dose if immunocompromised), maximum dose is 15 mL.
Hepatitis A - Pre-exposure prophylaxis:
<2 yrs and likely exposure <3 mos: 0.02 mL/kg IM
<2 yrs and likely exposure 3-5 months: 0.06 mL/kg IM
<2 yrs and likely exposure >5 months: 0.06 mL/kg IM q5 months
>2 yrs and likely exposure <3 months: 0.02 mL/kg IM OR vaccine
>2 yrs and likely exposure 3-5 months: 0.06 mL/kg IM OR vaccine
>2 yrs and likely exposure >5 months: vaccine
Hepatitis A - Post-exposure:
May not be given IV.
Immune globulin, intravenous (IVIG, Gamimune N, Gammagard, Gammar-P, Iveegam, Panglobulin, Polygam, Sandoglobulin, Venoglobulin); Immune
Globulin, Intravenous; Inj: 1, 2.5, 3, 5, 10 gm
Inj: 5% (50 mg/mL) [10, 50, 100, 200, 250 mL], 10% (100 mg/mL) [10, 50, 100, 200 mL]; Kawasaki disease: 2 gm/kg IV as a single dose (preferred) or
400 mg/kg/day x 4 days.
Immunodeficiency syndrome: 200-400 mg/kg/dose IV q2-4 wk.
Idiopathic thrombocytopenic purpura: 400-1000 mg/kg/day x 2-5days; maintenance dose: 400-1000 mg/kg/dose q3-6 wk based on clinical response
and platelet count.
Bone marrow transplant: 400-500 mg/kg/dose q week for three months then q month
Severe systemic viral and bacterial infections: 500-1000 mg/kg x 1, may repeat in 1 week prn
Hypotension can be prevented by starting infusion at 0.02 mL/kg/hr. If there are no adverse reactions, increase to 0.04 mL/kg/hr for 30 min, then
increase to max of 0.08 mL/kg/hr.
Prevention of gastroenteritis:
Infants/children: 50 mg/kg/day PO q6h (give injectable soln orally)
Polio vaccine, inactivated (IPV, IPOL); Vaccine; Inj: 0.5 mL; 0.5 mL SC
See Immunization schedule in appendix for timing.
Indinavir (Crixivan, IDV); Antiretroviral, Protease Inhibitor; Cap: 100, 200, 333, 400 mg; 350-500 mg/m2/dose PO q8h (max 800 mg/dose)
Adverse drug reactions include kidney stones, abdominal pain, and fatigue. Take on an empty stomach with ample fluids. Extemporaneous suspension
can be made with 2-week stability under refrigeration.
Infliximab (Remicade); Antitumor Necrosis Factor; Inj: 100 mg; Crohns Disease:
5 mg/kg IV, may repeat q4-6 weeks x 2 more doses
Influenza vaccine, subvirion (Fluzone, Fluvirin, FluShield); Vaccine; Inj: 0.5 mL (split virus); 0.5 mL IM
Insulin Regular (Regular Iletin, Humulin R, Novolin R, Velosulin BR); Hypoglycemic ; Inj: 100 Units/mL [10 mL]; Diabetic Ketoacidosis: 0.05-0.1
U/kg/hr continuous IV infusion.
Maintenance: 0.5-1 U/kg/day SC, titrate to desired effect.
Only regular insulin may be given IV. May be used in insulin SC pumps.
Insulin lispro (Humalog); Hypoglycemic; Inj: 100 Units/mL [10 mL]; Maintenance: 0.5-1 U/kg/day SC, titrate to desired effect.
Lispro has an onset of action within 15 minutes and can be administered just prior to meals. May be used in insulin SC pumps.
Insulin NPH (Humulin N, Novolin N, NPH Iletin); Insulin; Inj: 100 U/mL [10 mL]; 0.5-1 u/kg/day SC (dose usually split between regular and NPH)
Intermediate acting, with onset of action within 1-15 hours, peak effect within 4-12 hours, and duration of effect from 18-24 hours. May not be given IV.
Insulin Zinc Suspension Lente (Lente Iletin, Humulin L, Novolin L); Insulin; Inj: 100 U/mL [10 mL]; Titrate dose.
Insulin Zinc Suspension Ultralente (Humulin U); Insulin; Inj: 100 U/mL [10 mL]; Titrate dose.
Insulin Lantus; Insulin; Inj: 100 U/mL [10 mL]; Titrate dose.
Long acting - usually given SQ qhs.
Iodoquinol (Yodoxin); Amebicide; Powder for reconstitution
Tabs: 210, 650 mg; 30-40 mg/kg/day PO tid, max 1950 mg/day
Tablets may be crushed and mixed with applesauce or chocolate syrup.
Ipecac syrup; Emetic; Syr: 15, 30 mL ; <1 yr: not recommended

1-12 yrs: 15 mL PO taken with ample water (at least 10-20 mL/kg)
>12 yrs: 30 mL PO taken with ample water (at least 200-300 mL)
May repeat x 1 if no emesis occurs within 20-30 minutes. Contraindicated if patient is unconscious, has no gag reflex, is seizing, ingested
corrosives/alkali/volatile hydrocarbons, or has potential to become unconscious.
Ipratropium bromide (Atrovent); AnticholinergicMDI:

Agent;18 mcg/puff, 200 puffs/canister [14 gm]
Nasal spray: 0.03% (21 mcg/spray) [345 sprays/30 mL]; 0.06% (42 mcg/spray) [165 sprays/15 mL]
Soln for inhalation: 0.02% in 500 mcg unit dose vials; MDI:
3-12 yrs: 1-2 puffs tid
>12 yrs: 2 puffs qid up to 12 puffs/day
The MDI is contraindicated in patients with allergies to soybeans or peanuts (the solution for nebulizer and the nasal spray do not contain soya lecithin
so these food allergies are not a contraindication for these products).
Nebulizer:
3-12 yrs: 125-500 mcg tid
>12 yrs: 500 mcg tid-qid
Nasal spray:
>6 yrs: two sprays of 0.03% or 0.06% in each nostril bid-qid
Isoniazid (INH, Laniazid, Nydrazid); Tuberculostatic; Inj: 100 mg/mL

Syr: 10 mg/mL
Tab: 100, 300 mg; Active Tuberculosis: 10-15 mg/kg/day PO/IM qd-bid (max 300 mg/day).
Prophylaxis: 10 mg/kg/day PO/IM qd (max 300 mg/day)
American Thoracic Society and CDC recommend twice-weekly oral therapy as part of a short-course regimen, which follows 1-2 months of daily
treatment:
Children: 20-30 mg/kg/dose (up to 900 mg/dose) twice weekly
May cause severe hepatitis. Pyridoxine 1-2 mg/kg/day PO qd prevents peripheral neuropathy.
Isoproterenol (Isuprel); Bronchodilator; Inj: 0.02 mg/mL [10 mL]; IV: 0.05-2 mcg/kg/min continuous IV infusion
Itraconazole (Sporanox); Antifungal; Cap: 100 mg

Inj: 10 mg/mL
Soln: 10 mg/mL; Cap: 3-5 mg/kg/day PO qd. For severe infections, 5-10 mg/kg/day PO qd may be used. Maximum daily dose is 600 mg.
Soln: Oral solution is for oral or esophageal candidiasis only. Adolescents: 10 mL swish and swallow qd-bid.
IV: Dose not well established in pediatrics. Information extrapolated from adult data suggests using same dose as orally to a maximum of 400 mg/day.
Ketoconazole (Nizoral); Antifungal; Tab: 200 mg

Cream: 2% [15, 30, 60 gm]
Shampoo: 2% [120, 210 mL]; PO: 5-10 mg/kg/day q12-24h (max 800 mg/day)
Hepatotoxic with long-term use; monitor liver function. Antacids decrease gastric acid and prevent absorption. QT interval prolongation with cisapride,
astemizole, loratadine.
Topical: Apply to affected area qd-bid; causes stinging on inflamed areas
Shampoo: Apply twice weekly x 4 weeks.
Ketorolac (Acular, Toradol); NSAID; Inj per mL: 15, 30 mg

Ophth soln: 0.5% [3. 5, 10 mL]
Tab: 10 mg; IV/IM:
2-16 yrs: 0.4-1 mg/kg x 1 (single dose) or 0.4 mg/kg/dose q6h prn (max 30 mg/dose IV, 60 mg/dose IM)
>16 yrs: 60 mg IM x 1 or 30 mg IV x 1 (single dose) or 30 mg IV q6h
PO: >16 yrs: 10 mg qid.
Do not use for longer than 72 hours due to risk of gastric bleeding.
Ophth soln: >3 yrs: Instill one drop in affected eye(s) qid for seasonal allergic conjunctivitis
Ketotifen fumarate (Zaditor); Antihistamine, Mast Cell Stabilizer; Ophth soln: 0.025% [5, 7.5 mL]; Adolescents: Instill one drop in affected eye(s) q8-12h
Indicated for allergic conjunctivitis. Do not wear contact lenses.
Labetalol (Normodyne, Trandate); Alpha/beta- Adrenergic Blocker ; Inj: 5 mg/mL

Tab: 100, 200, 300 mg; PO: Initially 3-4 mg/kg/day bid, titrate up to 20-40 mg/kg/day q6-8h (max 2.4gm/day).
IV: 0.25-1 mg/kg/dose q10-15 min (max 20 mg), titrate to effect
Continuous IV Infusion: 0.4-1 mg/kg/hr (max or 3 mg/kg/hr)
Contraindicated in heart failure, bronchospastic lung disease, and diabetes.
Lactulose (Cephulac); Laxative, Ammonia Detoxicant; Syr: 10 gm/15 mL; Infants: 2.5-10 mL/day PO divided 3-4 times/day; adjust dosage to produce 2-
3 soft stools per day
Children: 40-90 mL/day PO divided 3-4 times/day; adjust dosage to produce 2-3 soft stools per day
Lamivudine (Epivir, 3-TC); Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Soln: 10 mg/mL
Tab: 150 mg; 3 mos-12 yrs: 2-4 mg/kg/dose PO bid (max 150 mg/dose)
>12 yrs:
<50 kg: 2 mg/kg/dose PO bid
>50 kg: 150 mg PO bid
Pancreatitis, increased liver enzymes, peripheral neuropathy.
Lamotrigine (Lamictal); Anticonvulsant; Tab: 25, 100, 150, 200 mg

Tab, chew: 2, 5, 25 mg; Round all doses to nearest tablet size.
Adding to regimen containing valproic acid:
2-12 yrs: 0.15 mg/kg/day PO qd-bid weeks 1-2, then increase to 0.3 mg/kg/day PO qd-bid weeks 3-4, then increase q1-2 weeks by 0.3 mg/kg/day to
usual maintenance dose 1-5 mg/kg/day qd-bid (max 200 mg/day)
>12 yrs: 25 mg PO qOD weeks 1-2, then increase to 25 mg PO qd weeks 3-4, then increase q1-2 weeks by 25-50 mg/day to maintenance dose 100-
400 mg/day PO qd-bid
Adding to enzyme-inducing antiepileptic regimen without valproic acid:
2-12 yrs: 0.6 mg/kg/day PO bid during weeks 1-2, then increase to 1.2 mg/kg/day PO bid weeks 3-4, then increase q1-2 weeks by 1.2 mg/kg/day to
usual maintenance dose 5-15 mg/kg/day PO bid (max 400 mg/day)
>12 yrs: 50 mg PO qd during weeks 1-2, then increase to 50 mg PO bid weeks 3-4, then increase q1-2 weeks by 100 mg/day to usual maintenance
dose 300-500 mg/day PO bid
Round dose down to the nearest 5 mg to use whole tablets.
Lansoprazole (Prevacid); Proton Pump Inhibitor; Cap, DR: 15, 30 mg

Granules for oral suspension: 15, 30 mg; GERD:
<10 kg: 7.5 mg PO qd
10-20 kg: 15 mg PO qd
>20 kg: 30 mg PO qd
>12 yrs: 15-30 mg PO qd
Helicobacter pylori:
>20 kg: 30 mg PO bid (with amoxicillin and clarithromycin)
Granules must be mixed in 30 mL water, stirred well, and drunk immediately. The granules cannot be chewed. This dosage form is not for NG use due
to increased viscosity from xanthan gum used in the formulation which will result in tube blockage.
Simplified lansoprazole suspension can be made by dissolving the contents of the capsules in sodium bicarbonate. Stable for 14 days at room
temperature or for 30 days under refrigeration. Capsule contents may be mixed with applesauce.
Leucovorin (Wellcovorin); Folic Acid Derivative; Inj: 10 mg/mL

Tab: 5, 10, 15, 25 mg; Adjunctive treatment with sulfadiazine to prevent hematologic toxicity: 5-10 mg PO/IV qd
Adjunctive treatment with pyremethamine: 25 mg PO q week
Levalbuterol (Xopenex); Beta-2 Adrenergic Agonist; Soln for inh per 3 mL: 0.63, 1.25 mg; 6 -11 yrs: 0.31 mg nebulized tid
>12yrs: 0.63 mg nebulized tid, may increase if needed to 1.25 mg tid
0.63 mg levalbuterol is comparable to 1.25 mg albuterol.
The R-isomer (active isomer) of racemic albuterol.
Levetiracetam (Keppra); Anticonvulsant; Tab: 250, 500, 750 mg; 4-16 yrs: 10-20 mg/kg/day PO bid (max 1000 mg/day), may increase by 10-20
mg/kg/day q2 weeks to max of 60 mg/kg/day bid (max 3000 mg/day)
>16 yrs: 500 mg PO bid, may increase as needed to max of 3000 mg/day
May cause dizziness and somnolence.
Levothyroxine (Levothroid, Synthroid, Unithroid); Thyroid Hormone; Inj: 0.2, 0.5 mg/vial
Tab: 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 mcg; PO:
0-6 mos: 8-10 mcg/kg/day qd (or 25-50 mcg/day)
6-12 mos: 6-8 mcg/kg/day qd (or 50-75 mcg/day)
1-5 yrs: 5-6 mcg/kg/day qd (or 75-100 mcg/day)
6-12 yrs: 4-5 mcg/kg/day qd (or 100-150 mcg/day)
>12 yrs: 2-3 mcg/kg/day qd (or >150 mcg/day)
Adolescents/Adults: 12.5-50 mcg/day qd to start, titrate as needed (average 100-200 mcg/day)
IV/IM: Use 50% of oral dose.
Monitor thyroid function tests and clinical signs of hyperthyroidism and hypothyroidism.
Lidocaine (Xylocaine); Antiarrhythmic, Class 1B; Cream: 0.5% [120 gm], 4% [5, 30 gm]
Gel: 0.5% [85, 120, 240 gm], 2.5% [15 gm]
Inj: 0.5, 1, 2, 4, 10, 20%
Jelly: 2% [15, 30, 240 mL]
Liq, topical: 5% [30 mL]
Liq, viscous: 2% [20, 100 mL]
Oint: 2.5% [37.5 gm], 5% [3.5, 35, 50 gm]
Patch, transdermal: 5%
Soln, topical: 2% [20, 50, 100, 450 mL], 4% [50 mL]
Spray: 0.5% [135 mL], 10% [1, 30 mL]; IV: 0.5-1.0 mg/kg IV bolus (may repeat in 10-15 minutes), followed by 20-50 mcg/kg/min continuous IV infusion
ET: 1 mg/kg/dose, repeat prn
SC: Infiltrate desired area SC for local anesthesia to max dose of 4.5 mg/kg
Topical: Apply to affected area prn pain (max 3 mg/kg/dose)
Transdermal patch: for herpetic neuralgia, apply 12 hours on then 12 hours off to most painful area
Therapeutic serum levels: 1.5-5 mcg/mL
Lidocaine, liposomal (ELA-Max); Topical Anesthetic; Cream: 4% [5, 30 gm]; Topical Analgesia:
Apply to skin for 10-60 minutes. Occlusive dressing is optional.
Available OTC.
Lindane (B-Well); Antiparasitic, Scabicidal Agent; Lotion: 1% [30, 60 mL]

Shampoo: 1% [30, 60 mL]; Do not use in <2 yrs or in pregnant or lactacting women. Not for internal use (topical only).
Scabies: Massage a thin layer of cream or lotion from neck to toes (including soles). Do not apply to face, eyes, or mucous membranes. Bathe after 6-
8 hours for children and after 8-12 hours for adolescents. May repeat in one week. For <6 yrs, 30 mL lotion is sufficient. For >6 yrs, maximum is 60 mL
lotion.
Lice (pediculosis, crabs): Apply 30-60 mL of shampoo to dry hair. Work thoroughly into hair and allow to remain for 4 min. Add small amount of
water to lather. Rinse thoroughly and towel dry. Use fine tooth comb to remove nits. May repeat in one week.
Overdosage can cause neurotoxicity. Use with caution in infants and small children.
Linezolid; Antibacterial, Oxazolidinone; Inj: 200, 400, 600 mg

Susp: 20 mg/mL
Tabs: 400, 600 mg; Complicated skin infections, pneumonia, VRE infections:
Birth-11 yrs: 30 mg/kg/day PO/IV q8h
>12 yrs: 600 mg PO/IV q12h
Uncomplicated skin infection:
<5 yrs: 30 mg/kg/day PO/IV q8h
5-11 yrs: 20 mg/kg/day PO/IV q12h
12-17 yrs: 600 mg PO q12h
>18 yrs: 400 mg PO q12h
Reserve use for vancomycin-resistant Enterococcus, Strep pneumo, Staph aureus, and Streptococcus species.
Lodoxamide (Alomide); Ophthalmic Decongestant; Ophth soln: 0.1% [10 mL]; >2 yrs: 1-2 drops in each eye qid
Transient burning or stinging. Do not wear contact lenses.
Loperamide (Imodium AD); Antidiarrheal; Cap: 2 mg

Cplt: 2 mg
Liq: 1 mg/5 mL
Tab: 2 mg
Tab, chew: 2 mg; Acute Diarrhea:
2-5 yrs: 1 mg PO tid
6-8 yrs: 2 mg bid
8-12 yrs: 2 mg tid
>12 yrs: 4 mg x 1, then 2 mg after each loose stool (max 16 mg/day)
Discontinue if no improvement in 48 hours.
Chronic diarrhea: 0.08-0.24 mg/kg/day PO bid-tid; max 2 mg/dose.
Available OTC. Drink ample fluids to avoid dehydration.
Loracarbef (Lorabid); Antibacterial, Carbacephem; Cap: 200, 400 mg

Susp per 5 mL: 100, 200 mg; 15-30 mg/kg/day PO bid (max 800 mg/day)
Administer on an empty stomach. The suspension produces higher serum levels than the capsules due to better bioavailability.
Loratidine (Claritin)
Antihistamine; Syr: 1 mg/mL
Tab: 10 mg
Tab, rapidly disintegrating: 10 mg; 2 -5 yrs: 5 mg PO qd
>6 yrs: 10 mg PO qd
May cause drowsiness. The 10-mg tablet is available as a Reditab - a rapidly disintegrating tablet that will dissolve on the tongue without water. All
dosage forms available OTC.
Lorazepam (Ativan)
(C-IV) ; Benzodiazepine; Inj per mL: 2 , 4 mg
Soln, conc oral: 2 mg/mL
Tab: 0.5, 1, 2 mg; 0.05-0.1 mg/kg/dose IM/IV/PO q4h prn (max 4 mg/dose)
Reversible with flumazenil.
Magnesium chloride (Slow-Mag); Electrolyte Supplement; Tab SR: 535 mg [5.2 mEq]; One tablet PO qd. Titrate to desired serum magnesium level.
One tablet contains 64 mg elemental Mg. Tablet must be swallowed whole.
Magnesium citrate; Cathartic; Soln: 6% [300 mL]; <6 yrs: 2-4 mL/kg/dose PO (max 100 mL)
6-12 yrs: 100-150 mL PO
>12 yrs: 150-300 mL PO
Contains 3.85-4.71 mEq magnesium per 5 mL.
Magnesium gluconate (Magonate); Electrolyte Supplement; Liq: 1000 mg/5mL (54 mg elemental Mg/5 mL, 4.8 mEq/5 mL)
Tab: 500 mg (27 mg elemental Mg, 2.4 mEq); 10-20 mg/kg/dose elemental magnesium PO qid
Magnesium hydroxide (Milk of Magnesia); Laxative; Susp: 400 mg/5 mL, 800 mg/5 mL
Tab, chew: 311 mg; <2 yrs: 40 mg/kg/dose (max 400 mg) PO q6h prn
2-5 yrs: 400-1200 mg/dose PO q6h prn
6-12 yrs: 1200-2400 mg/dose PO q6h prn
>12 yrs: 4800 mg/dose PO q6h prn
Magnesium sulfate; Electrolyte Supplement; Inj: 10% [100 mg/mL], 12.5% [125 mg/mL]; 50% [500 mg/mL]
Soln: 50% [500 mg/mL]; 100-200 mg/kg/dose PO q6h prn
25-50 mg/kg/dose IV q4-6h prn (max single dose 2000 mg)
Daily Maintenance (IV): 30-60 mg/kg/day in maintenance IV solution.
500 mg MgSO4 = 4.06 mEq elemental magnesium = 49.3 mg elemental magnesium. Maximum infusion rate 125 mg/kg/hr.
Magnesium oxide; Electrolyte supplement; Tab: 400, 420, 500 mg

Cap: 140 mg; 10-20 mg/kg/dose elemental magnesium PO qid.
Contains 60.4% elemental magnesium (25 mEq per 500 mg salt).
Malathion (Ovide); Scabicide; Lotion: 0.5% [59 mL]; Apply to dry hair and rub gently until scalp is thoroughly moistened. Allow to dry naturally (use no
heat and leave uncovered). After 8-12 hours wash hair with nonmedicated shampoo. Rinse and use fine-toothed comb to remove dead lice and eggs.
May repeat in 7-9 days.
Not for internal use.
Mannitol (Osmitrol); Diuretic, osmotic; Inj: 5, 10, 15, 20, 25%; 0.25-1 gm/kg/dose IV q4-6h prn
Use in-line filter when infusing. Visually inspect for precipitation.
Measles Virus Vaccine (Attenuvax); Vaccine; Inj: 0.5 mL; 0.5 mL SC

Measles and Rubella Vaccine (M-R-Vax II); Vaccine; Inj: 0.5 mL; 0.5 mL SC
Measles, mumps, rubella vaccine (M-M-R II); Vaccine; Inj: 0.5 mL; 0.5 mL SC
Mebendazole (Vermox); Anthelmintic; Tab, chew: 100 mg; >2 yrs

Pinworms: 100 mg PO as a single dose; may require repeat course in 2 weeks.
Other helminths (eg, hookworms, roundworms, whipworms): 100 mg PO bid for 3 days. May repeat course in 3-4 weeks.
Administer with food. May swallow tablet whole or crush.
Meclizine (Antivert, Bonine); Antihistamine; Cap: 25, 30 mg

Tab: 12.5, 25, 50 mg
Tab, chew: 25 mg
Tab, film coated: 25 mg; >12 yrs
Motion Sickness: 25-50 mg PO 1h before travel, repeat q24h prn
Vertigo: 25-100 mg/day PO bid-qid
Medroxyprogesterone (ProVera, Depo-ProVera); Progestin; Inj: 150 mg/mL
Tab: 2.5, 5, 10 mg; Adolescents:
Amenorrhea: 5-10 mg PO qd x 5-10 days OR 2.5 mg PO qd
Abnormal Uterine Bleeding: 5-10 mg PO qd for 5-10 days starting on day 16 or 21 of menstrual cycle.
Contraception: 150 mg deep IM q3 months. Exclude pregnancy before administering
Meningococcal polysaccharide vaccine (Menomune); Vaccine; Inj: 0.5 mL; 0.5 mL SC
Consider administration in high-risk patient populations (eg, college students, military recruits, known exposure to disease).
Meperidine (Demerol) (C-Il); Opioid Narcotic ; Inj per mL: 10, 25, 50, 75, 100 mg
Syr: 50 mg/5 mL
Tab: 50, 100 mg; 1-1.5 mg/kg/dose IM/IV/PO/SC q3-4h prn pain (max 100 mg/dose)
Use with caution in renal failure; the active metabolite, normeperidine, has a prolonged half-life and can cause seizures.
Meropenem (Merrem); Antibacterial, Carbapenem; Inj: 500, 1000 mg; >3 mos: 60 mg/kg/day IV q8h. For meningitis or cystic fibrosis patients or febrile
neutropenic patients, use 120 mg/kg/day IV q8h (max dose 6 gm/day)
Less likely than Primaxin to cause seizures.
Mesalamine (Asacol, Pentasa, Rowasa, 5-aminosalicylic acid, 5-ASA); Anti-inflammatory Agent; Cap CR: 250 mg
Supp: 500 mg
Susp, rectal: 4 gm/60 mL
Tab, DR: 400 mg; Adolescents with Ulcerative Colitis
Cap: 50 mg/kg/day PO qid or 1 gm PO qid
Retention enema: 60 mL qhs, retained overnight (for approximately 8 hrs) for 3-6 weeks
Rectal suppository: 500 mg PR bid (retained for 1-3 hours) for 3-6 weeks, may increase to tid
Tab, DR: 50 mg/kg/day PO q8-12h (max 2400 mg/day)
Metaproterenol (Alupent); Beta-2 Adrenergic Agonist; MDI: 0.65 mg/puff [100 puffs/7 gm, 200 puffs/14 gm]
Soln for inhalation: 0.4%, 0.6%, 5%
Syr: 2 mg/mL
Tab: 10, 20 mg; MDI: 2-3 puffs q3-4h prn (max 12 puffs/day)
PO:
<2 yrs: 0.4 mg/kg/dose tid-qid
2-5 yrs: 1.3-2.6 mg/kg/day tid-qid
6-9 yrs: 10 mg tid-qid
>9 yrs: 20 mg tid-qid
Nebulizer: 0.01-0.02 mL/kg of 5% soln (min 0.1 mL, max 0.3 mL) diluted in 2-3 mL NS q4h prn or equivalent dose of 0.4% or 0.6% soln
Methadone (C-II) (Dolophine); Opioid Narcotic ; Soln: 1 mg/mL, 2 mg/mL, 10 mg/mL

Tab: 5, 10 mg; 0.4-0.7 mg/kg/day PO q4-12h (max 10 mg/dose)
Used for drug withdrawal and analgesia.
Methamphetamine (C-II) (Desoxyn); CNS Stimulant; Tab: 5 mg; Attention-Deficit Disorder: >6yrs: Initially 5 mg PO qd-bid; may increase in
increments of 5 mg/day weekly. Usual dose is 20-25 mg/day qAM or bid (in AM and at noon).
Methenamine hippurate (Hiprex); Antibacterial; Tab: 1000 mg; >12 yrs: 1 gm PO bid.
Administer with food.
Methenamine mandelate (Mandelamine); Antibacterial; Susp: 250 mg/5 mL

Tab, EC: 500, 1000 mg ; 6-12 yrs: 50-75 mg/kg/day PO q6-8h or 75 mg/kg/day PO q12h (max 4 gm/day)
>12 yrs: 1 gm PO qid after meals and at bedtime.
Administer with food to minimize GI upset.
Methylphenidate (C-II) (Concerta, Metadate ER, Ritalin); CNS Stimulant; Cap, CR (Metadate CD): 20 mg
Cap, LA (Ritalin LA): 20, 30, 40 mg
Tab: 5, 10, 20 mg
Tab, SR (Concerta): 18, 27, 36, 54 mg
Tab, SR (Metadate ER): 10, 20 mg
Tab, SR (Ritalin SR): 20 mg; Attention-Deficit Disorder (PO): >6 yrs: Initially 0.3 mg/kg/dose or 2.5-5 mg/dose given before morning meal and before
midday meal; increase by 0.1 mg/kg/dose or by 5-10 mg/day at weekly intervals; usual maintenance dose 0.5-1 mg/kg/day (max 2 mg/kg/day or 60
mg/day). Once titrated to effective dose, may change to SR tab qAM.
Concerta is an SR product with part of the dose being immediately released and part being sustained release. Dose of 18 mg PO qAM can be used in
patients receiving 5 mg PO bid-tid or 20 mg SR qAM. Dose of 36 mg PO qAM can be used in patients receiving 10 mg PO bid-tid or 40 mg SR qAM.
Dose of 54 mg PO qAM can be used in patients receiving 15 mg PO bid-tid or 60 mg PO qAM.
Metadate contains both immediate-release beads (30%) and extended-release beads (70%).
Methylprednisolone base (Medrol); Corticosteroid; Tab: 2, 4, 8, 16, 24, 32 mg; Anti-inflammatory: 0.5-1.7 mg/kg/day PO q6-12h or 5-25 mg/m2/day PO
q6-12h (usual max 60 mg/day)
Take with food to decrease GI upset.
Methylprednisolone acetate (Depo-Medrol); Corticosteroid; Inj: 20, 40, 80 mg/mL; Adolescents: 10-80 mg IM qd
The acetate salt cannot be given IV.
Methylprednisolone sodium succinate (Solu-Medrol); Corticosteroid; Inj: 40, 125, 500 mg; 1, 2 gm; Status Asthmaticus: 2 mg/kg/dose IV/IM q6h x 1-4
doses, then 0.5-1 mg/kg/dose IV/IM q6h (usual max 125 mg/dose)
Anti-inflammatory: 0.5-1.7 mg/kg/day IV/IM q6-12h.
Lupus nephritis: 30 mg/kg IV qod x 6 doses. Infuse each dose over at least 30 minutes
Acute spinal cord injury: 30 mg/kg IV over 15 min, followed by 5.4 mg/kg/hr infusion for 23 hrs
Metoclopramide (Reglan); Gastrointestinal Stimulant, Antiemetic; Inj: 5 mg/mL

Soln, concentrate: 10 mg/mL
Syr: 1 mg/mL
Tab: 5, 10 mg; Gastroesophageal Reflux (PO/IM/IV): 0.4-0.8 mg/kg/day qid (max 10 mg/dose)
Antiemetic, chemotherapy induced: 1 mg/kg IV q4h prn. To prevent extrapyramidal reactions associated with this high dose, pretreat with
diphenhydramine 1 mg/kg IV.
Nasojejunal tube placement: 0.1 mg/kg IV (max 10 mg/dose)
Metolazone (Zaroxolyn); Diuretic, Thiazide; Tab: 0.5, 2.5, 5, 10 mg; 0.2-0.4 mg/kg/day PO q12-24h (max 10 mg/day)
Administer with food to decrease GI upset. Extemporaneously prepared suspension can be made with three months stability under refrigeration.
Metronidazole (Flagyl); Antibacterial; Cap: 375 mg

Cream: 0.75% [45 gm], 1% [30, 45 gm]
Gel: 0.75% [30, 45 gm]
Inj: 500 mg
Lotion: 0.75% [60 mL]
Tab: 250, 500 mg
Tab ER: 750 mg; Anaerobic infections: 30 mg/kg/day PO/ IV q6-8h (max 4 gm/ day).
Clostridium difficile: 20-35 mg/kg/day PO/IV q6h (max 4 gm/ day). Oral route is preferred.
Amebiasis: 35-50 mg/kg/day PO tid (max 2250 mg/day)
Other parasitic infections: 15-30 mg/kg/day PO tid (max 750 mg/day).
Helicobacter: 15-20 mg/kg/day PO bid x 4 weeks (max 1500 mg/day) with amoxicillin and bismuth subsalicylate
Topical: Apply to affected area bid.
Reduce dosage in hepatic failure. Avoid alcohol due to risk of disulfiram-like reaction. May cause metallic taste.
Extemporaneously prepared suspension may be made from the tablets with 30-day stability under refrigeration.
Miconazole (Micatin, Monistat); Antifungal; Cream, topical: 2% [9, 15, 30, 90 gm]
Cream, vag: 2% [45 gm]
Liquid, spray: 2% [105, 113 mL]
Lotion: 2% [30, 60 mL]
Oint: 2% [28.4 gm]
Powd: 2% [70, 90 gm]
Powder, spray: 2% [42.5, 90, 100 gm]
Soln, topical: 2% [7, 29 mL]
Spray, topical: 2% [105, 113 mL]
Supp, vag: 100 mg [7's], 200 mg [3's], 1200 mg [1 dose]; Vaginal: Insert one applicatorful of vaginal cream or 100 mg suppository qhs x 7days or 200
mg suppository qhs x 3 days or 1200 mg suppository x 1 (single dose)
Topical: Apply to affected area bid
Midazolam (Versed) (C-IV); Benzodiazepine; Inj: 1 mg/mL, 5 mg/mL

Syr: 2 mg/mL [118 mL]; Preoperative Sedation:
IV: 0.05-0.1 mg/kg/dose; repeat q2-3 min prn up to total dose 0.1-0.2 mg/kg
IM: 0.05-0.15 mg/kg 30-60 min before surgery (max 5 mg/dose)
Sedation:
0.1 mg/kg IV q1-2h prn or loading dose 0.05-0.2 mg/kg IV, then continuous infusion 0.05-0.12 mg/kg/hr. Titrate as needed.
Oral: 0.2-0.4 mg/kg (max 15 mg) 30-45 minutes prior to procedure.
Intranasal: 0.2 mg/kg x 1 (using 5 mg/mL injectable product in a needleless syringe)
Respiratory depression, hypotension; reversible with flumazenil.
Milrinone (Primacor); Phosphodiesterase Enzyme Inhibitor; Inj: 1 mg/mL; Loading dose: 25-50 mcg/kg IV over 15 minutes followed by
Continuous IV infusion: 0.25-0.75 mcg/kg/min
Titrate dose to desired effect. Patient should be on continuous cardiac monitor. Monitor for hypotension.
Mineral oil (Fleet Mineral Oil Enema, Haleys MO); Laxative; Liquid, oral: 480 mL
Liq, rectal: 133 mL; Oral: 5-11 yrs: 5-15 mL qd-tid
>11 yrs: 15-45 mL qd-tid
Rectal: 2-11 yrs: 30-60 mL PR qd
>11 yrs: 60-150 mL PR qd
Mometasone (Elocon); Corticosteroid; Oint, cream: 0.1% [15, 45 gm]

Lotion: 0.1% [27.5, 55 mL]; Apply sparingly to affected area 2 times daily.
Mometasone (Nasonex); Corticosteroid; Nasal spray: 50 mcg/spray [120 sprays/17 gm]; 2-11 yrs:1 spray in each nostril qd
>12 yrs: 2 sprays in each nostril bid
Maximum benefit is usually achieved within 1-2 weeks. Decrease dose as tolerated to qd dosing.
Montelukast (Singulair); Leukotriene Receptor Antagonist; Granules for oral susp: 4 mg/packet [30's]
Tab: 10 mg
Tab, chew: 4, 5 mg; 12-23 mos: 4 mg PO qhs
2-5 yrs: 4 mg PO qhs
6-14 yrs: 5 mg PO qhs
>14 yrs: 10 mg PO qhs
No additional clinical benefits found for doses >10 mg/day.
Morphine sulfate (C-II)
(Astramorph, Duramorph, Oramorph, Roxanol, MS Contin); Opioid Narcotic ; Cap: 15, 30 mg
Cap SR: 20, 50, 100 mg
Inj per mL: 0.5, 1, 2, 4, 5, 8, 10, 15, 25, 50 mg
Soln: 10 mg/5 mL, 20 mg/5 mL, 20 mg/1 mL
Supp: 5, 10, 20, 30 mg
Tab: 15, 30 mg
Tab, ER: 15, 30, 60, 100, 200 mg
Tab, SR: 15, 30, 60, 100 mg; IV/IM/SC: 0.05-0.1 mg/kg/dose q2-4h prn (max 15 mg/dose)
IV infusion: Starting rate 0.01-0.05 mg/kg/hr; titrate to desired effect.
PCA (patient-controlled analgesia): 0.01-0.03 mg/kg/hr IV continuous infusion basal rate (max 2 mg/hr) and/or bolus doses 0.01-0.03 mg/kg IV q6-15
minutes. Delivery limit (basal rate and boluses): 10 mg/hr or 0.14 mg/kg/hr (whichever is smaller).
PO prompt release: 0.2-0.5 mg/kg/dose q4-6h prn (usual adult dose 30 mg).
PO sustained release: 0.3-0.6 mg/kg/dose bid prn
As tolerance develops, the dose should be titrated to desired effect. Reversible with naloxone.
Mumps vaccine (Mumpsvax); Vaccine; Inj: 0.5 mL; 0.5 mL SC
Mupirocin (Bactroban); Antibacterial; Cream: 2% [15, 30 gm]

Oint: 2% [15, 30 gm]
Oint, nasal: 2% [1 gm]; Topical: Apply 3-5 times daily.
Eradication of nasal colonization with MRSA: Apply 0.5 gm of nasal ointment to both nares bid for 5 days.
Nafcillin (Nafcil, Unipen); Antibacterial, Penicillin ; Inj: 1, 2 gm; IV/IM: Mild-Moderate infections: 50-100 mg/kg/day q6h
Severe infections: 100-200 mg/kg/day q4-6h (max 12 gm/day)
Naloxone (Narcan); Opioid Antagonist; Inj per mL: 0.02, 0.4, 1 mg; Opioid Intoxication:
0.1 mg/kg IV/IM/ET/SC (max 2 mg); repeat dose in 2-5 min as needed. If no improvement after 3 doses, a non-opioid drug overdose should be
suspected. May precipitate acute withdrawal in addicts and newborns
Post-anesthesia narcotic reversal: 0.01 mg/kg IV, may repeat q2-3 minutes.
Naftifine (Naftin); Antifungal; Cream: 1% [15, 30, 60 gm]

Gel: 1% [20, 40, 60 gm]; Apply topically bid.
Naphazoline (Privine, VasoClear); Adrenergic Agonist; Drops, ophth: 0.012 , 0.02, 0.1% [15 mL]
Drops, nasal: 0.05% [25 mL]
Spray, nasal: 0.05% [20 mL]; Ophthalmologic: >6 yrs: Instill 1-2 drops into conjunctival sac of affected eye(s) q3-4h
Nasal:
6-12 yrs: 1 drop/spray q6h prn
>12 yrs: 1-2 drops/sprays q3-6h prn
Therapy should not exceed 3-4 days. Not for use <6 yrs due to CNS depression.
Naproxen (Naprosyn); NSAID; Susp: 125 mg/5 mL

Tab: 250, 375, 500 mg
Tab, DR: 375, 500 mg; >2 yrs:
Analgesia: 5-7 mg/kg/dose PO q8-12h
Inflammatory disease: 10-15 mg/kg/day PO bid (max 1000 mg/day). Take with food.
Naproxen sodium (Aleve, Anaprox); NSAID; Tab: 220, 275, 550 mg

Tab, CR: 412.5, 550 mg; >2 yrs:
Analgesia: 5-7 mg/kg/dose PO q8-12h
inflammatory: 10-15 mg/kg/day PO bid (max 1000 mg/day).
Take with food. 200 mg naproxen = 220 mg naproxen sodium.
Nedocromil (Alocril, Tilade); Antihistamine, Mast Cell Stabilizer; MDI: 1.75 mg/puff, 112 puffs/canister [16.2 gm]
Ophth soln: 2% [5 mL]; MDI: >6 yrs: 2 inhalations qid. May reduce dose to bid-tid once desired clinical response to initial dose is observed.
Ophth soln: >3 yrs: instill 1-2 drops in affected eye(s) bid
Nelfinavir (Viracept, NFV); Antiretroviral, Protease Inhibitor; Powd: 50 mg/scoop

Tab: 250 mg; 2-13 yrs: 20-30 mg/kg/dose PO q8h (max 750 mg/dose)
>13 yrs: 750 mg PO q8h or 1250 mg PO q12h
Diarrhea, abdominal cramps, flatulence; take with food. Oral powder may be mixed with a small amount of water or dietary supplement. Once mixed, it
must be used within six hours.
Neomycin (Mycifradin); Antibacterial, Aminoglycoside; Cream: 0.5% [15 gm]

Oint: 0.5% [15, 30 gm]
Soln: 125 mg/5 mL
Tab: 500 mg; Topical: Apply to affected area bid
Oral: 50-100 mg/kg/day q6-8h (max 8 gm/day)
Pre-op Bowel Cleansing: 90 mg/kg/day PO q4h for 2 days (max 6 gm/day) or 25 mg/kg/dose PO (max 1 gm/dose) at 1 PM, 2 PM, 11 PM on day
preceding surgery in combination with erythromycin and mechanical cleansing of bowel
Hepatic Coma: 2.5-7 g/m2/day PO q4-6h (max 12 gm/day)
Diarrhea caused by enteropathogenic E coli:
50 mg/kg/day PO q6h x 2-3 days
Nevirapine (Viramune, NVP); Antiretroviral, Non-nucleoside Reverse Transcriptase Inhibitor; Susp: 10 mg/ml
Tab, scored: 200 mg
>3 mos-12 yrs: 120 mg/m2/dose qd x 14 days, then increase to 120-200 mg/m2/dose q12h if no rash or other adverse reactions occur (max 200
mg/dose)
>12 yrs: initially 200 mg PO qd x 14 days, then increase to 200 mg PO bid
Severe life-threatening hepatotoxicity has been reported. Rash, fever, headache. Rash is less common when patients are started with a lower initial
dose and then escalated up to usual maintenance dose. If rash develops, do not use prednisone as it may increase the incidence and severity of the
rash. May take with or without food.
Nifedipine (Adalat, Procardia); Calcium Channel Blocker; Cap: 10, 20 mg

Tab SR: 30, 60, 90 mg; Hypertension: 0.6-0.9 mg/kg/day PO tid-qid (max 120-180 mg/day). May dose SR tablet q12-24h.
Hypertensive emergency: 0.25-0.5 mg/kg/dose (max 10 mg) PO/SL, may repeat in 4-6 hrs
Nitrofurantoin (Furadantin, Macrodantin); Antibacterial; Cap: 25, 50, 100 mg

Susp: 25 mg/5 mL; Over 1 mos:
Acute infection: 5-7 mg/kg/day PO qid (max 400 mg/day)
Chronic suppressive therapy for UTIs: 1-2 mg/kg/day PO q24h (max 100 mg/day)
Nitroprusside sodium (Nipride, Nitropress); Vasodilator; Inj: 25 mg/mL, 50 mg/mL ; 0.5-10 mcg/kg/min continuous IV infusion, titrate to desired effect
Monitor cyanide and thiocyanate levels if therapy is prolonged (>24 hours) or if renal function is impaired.
Norepinephrine (Levophed); Alpha-adrenergic Agent; Inj: 1 mg/mL; 0.05-2 mcg/kg/min continuous IV infusion; titrate to desired effect.
Increases contractility, tachycardia, vasoconstriction.
Nortriptyline (Aventyl, Pamelor); Tricyclic Antidepressant; Cap: 10, 25, 50, 75 mg

Soln: 10 mg/5mL; Nocturnal enuresis (give dose 30 minutes prior to bedtime):
6-7 yrs (20-25 kg): 10 mg PO qhs
8-11 yrs (25-35 kg): 10-20 mg PO qhs
>11 yrs (35-54 kg): 25-35 mg PO qhs
Depression:
6-12 yrs: 1-3 mg/kg/day PO tid-qid (max 20 mg/day)
>12 yrs: 1-3 mg/kg/day PO tid-qid (max 150 mg/day)
Therapeutic serum range 50-150 ng/mL.
Nystatin (Mycostatin, Nilstat); Antifungal; Cream/Oint: 100,000 U/gm [15, 30 gm]

Powder: 100,000 U/gm [15, 56.7 gm]
Susp: 100,000 U/mL [5, 60, 480 mL)
Tab: 500,000 U
Troche: 200,000 U
Vaginal tablet: 100,000 U; Oral candidiasis:
Infants: 1 mL of susp in each side of the mouth qid
Children: 5 mL swish and swallow qid
Adolescents: 5-10 mL swish and swallow qid
Topical: Apply topically bid-qid.
Troche: Dissolve 1-2 in mouth 4-5 times daily. Not absorbed orally; therefore, not effective for systemic infections.
Vaginal: Adolescents: 1 tablet vaginally qhs x 14 days
Octreotide (Sandostatin); Somatostatin Analog; Inj per mL: 0.05, 0.1, 0.2, 0.5, 1 mg; Intermittent dosing: 1-10 mcg/kg/dose SC/IV bid (max 50
mcg/dose)
Continuous infusion: 1 mcg/kg IV x 1 followed by 1 mcg/kg/hr
Ofloxacin (Floxin); Antibacterial, Fluoroquinolone; Inj: 4 mg/mL

Ophth soln: 0.3% [1, 5, 10 mL]
Tab: 200, 300, 400 mg; Pelvic Inflammatory Disease (Adolescents): 400 mg PO bid x 14 days (in combination with metronidazole 500 mg PO bid)
Bacterial corneal ulcer (ophth soln): instill 1-2 drops q 30 minutes while awake and awaken 4-6 hours after sleep to instill more (days 1-2), followed
by 1-2 drops q1h while awake (days 3-7), followed by 1-2 drops qid (day 8 until treatment completion)
Conjunctivitis (ophth soln): instill 1-2 drops q2-4h (days 1-2) followed by 1-2 drops qid (days 3-7)
Otic use (ophth soln used as no otic product commercially available): instill 2 drops IN EARS qid
Olopatadine (Patanol); Antihistamine, ophthalmic; Ophth Soln: 0.1% [5 mL]; Instill 1-2 drops in affected eye(s) bid
Contact lenses should not be worn.
Olsalazine sodium (Dipentum); Bowel Anti-inflammatory Agent; Cap: 250 mg; >12 yrs: 250-500 mg/dose PO bid with food
Diarrhea often occurs.
Omeprazole (Prilosec); Proton Pump Inhibitor; Cap, DR: 10, 20, 40 mg; 1 mg/kg/day PO q12-24h (max 20 mg/day for duodenal ulcer, 40 mg/day for
gastric ulcer, 60 mg/day for hypersecretory conditions).
Helicobacter pylori: 15-30kg: 10 mg PO bid, >30 kg: 20 mg PO bid
Simplified omeprazole suspension (SOS) is made by dissolving contents of capsule in sodium bicarbonate. SOS is stable for 14 days at room
temperature or for 45 days under refrigeration. Diarrhea is a common side effect.
Ondansetron (Zofran); Antiemetic; Inj: 2 mg/mL

Soln: 4 mg/5 mL
Tab: 4, 8, 24 mg
Tab, orally disintegrating: 4, 8 mg; Chemotherapy Induced Nausea (IV): 0.15 mg/kg/dose (usual adult max 8 mg) given 30 min prior to chemotherapy
and 4 hr and 8 hr later or 0.3 mg/kg/dose x 1 thirty minutes prior to chemotherapy or for severe cases, 0.15 mg/kg x 1, followed by 0.45 mg/kg/day
(max 32 mg/day) as a continuous IV infusion
Post-op nausea and vomiting (IV): >2 yrs and <40 kg: 0.1 mg/kg IV x 1, >40 kg: 4 mg IV x 1
Oral: 4-11 yrs: 4 mg/dose PO 30 min prior to chemotherapy; may repeat 4h and 8h after 1st dose
>11 yrs: 8 mg/dose PO 30 min prior to chemotherapy; may repeat 4h and 8h after 1st dose
Most frequent side effects are diarrhea and headache. The orally disintegrating tablets dissolve on the tongue without any water.
Oral Polio vaccine (OPV, Orimune); Vaccine; PO: 0.5 mL; 0.5 mL PO
Oseltamivir (Tamiflu); Antiviral, Neuraminidase Inhibitor; Cap: 75 mg
Susp: 12 mg/mL; >1 year old to 12 yrs:
<15 kg: 2 mg/kg/dose PO bid
15.1-23 kg: 45 mg PO bid
23.1-40 kg: 60 mg PO bid
>40 kg: 75 mg PO bid
>13 years (including adults):
Approved for treatment of uncomplicated influenza A or B when patient has been symptomatic for no longer than 48 hrs. Treatment duration is 5 days.
Oxacillin (Prostaphlin, Bactocill); Antibacterial, Penicillin; Inj: 1, 2 gm ; 100-200 mg/kg/day IV/IM q4-6h (max 12 gm/day)
Oxybutynin (Ditropan); Urinary

Antispasmodic; Syr: 1 mg/mL
Tab: 5 mg
Tab ER: 5, 10, 15 mg; 1-5 yrs: 0.2 mg/kg/dose PO bid-qid
>5 yrs: 5 mg PO bid, may increase to tid or qid prn
When stabilized on dose, may change to same mg/day as ER tab PO qd.
Oxcarbazepine (Trileptal); Anticonvulsant; Susp: 300 mg/5 mL

Tab: 150, 300, 600 mg; 4-16 yrs: 8-10 mg/kg/day PO bid (max 600 mg/day), increase dose slowly over 2 weeks to: 20-29 kg 450 mg PO bid, 29.1-39kg
600 mg PO bid, >39 kg 900 mg PO bid
>16 yrs: 300 mg PO bid, increase by 600 mg/day q week to maximum of 1200 mg PO bid
Oxiconazole (Oxistat); Antifungal; Cream: 1% [15, 30, 60 gm]

Lotion: 1% [30 mL]; Apply topical qd.
Oxycodone (OxyContin, Roxicodone); Opioid Narcotic; Cap: 5 mg

Soln: 5 mg/mL, 20 mg/mL
Tab: 5, 15, 30 mg
Tab, CR: 10, 20, 40, 80, 160 mg
Immediate Release:
0.05 - 0.1 mg/kg PO q4-6h prn (max 5 mg/dose initially); titrate as needed for pain relief, usual max 30 mg PO q4h
Controlled Release:
>18 yrs: 10 mg PO q12h, titrate as needed for pain relief
Use immediate release drug for breakthrough pain-usual dose 1/4 to 1/3 of q12h dose
Oxymetazoline (Afrin); Decongestant; Soln, ophth: 0.025 % [15, 30 mL]

Spray, nasal: 0.05% [15, 30 mL]
Ophth: >6yrs: 1-2 drops 2-4 times daily (at least six hours apart)
Nasal: >6yrs: Instill 2-3 drops or spray of 0.05% in each nostril bid
Rebound rhinitis is common; do not use longer than 3-5 days.
Palivizumab (Synagis); RSV Monoclonal Antibody; Inj: 50, 100 mg; 15 mg/kg IM once a month during RSV season (usually Nov-April). May not be given
IV.
AAP-approved indications: (1) <2 yrs with chronic lung disease that has required medical treatment within the past six months; (2) chronological age <1
yr at start of RSV season and gestational age <28 weeks; (3) chronological age <6 months at start of RSV season and gestational age 29-32 weeks
Not indicated for treatment of RSV infection.
Pancuronium bromide (Pavulon); Neuromuscular Blocker, Nondepolarizing; Inj per mL: 1, 2 mg; 0.1 mg/kg IV prn
Continuous IV infusion: start at 0.1 mg/kg/hr and titrate as needed. Use peripheral nerve stimulator to assess level of paralysis.
Paromomycin (Humatin); Amebicide; Cap: 250 mg; Intestinal amebiasis: 25-30 mg/kg/day PO q8h x 7 days
Pemoline (Cylert) C-IV; CNS Stimulant; Tab: 18.75, 37.5, 75 mg

Tab, chew: 37.5 mg; All doses are oral. Clinical improvement is gradual; may require 3-4 weeks to see effect.
>6 yrs: Initially 37.5 mg qAM, increase by 18.75 mg/day at weekly intervals if needed. Usual dosage range 56.25-75 mg/day (max dose 112.5 mg/day)
May cause increased liver enzymes, which is usually reversible upon discontinuation of drug.
Penicillamine (Cuprimine); Antidote - Lead, Copper ; Cap: 125, 250 mg

Tab: 250 mg; Lead Poisoning: 20-30 mg/kg/day PO q6-8h (max 1.5 gm/day).
Rheumatoid Arthritis: Initially 3 mg/kg/day (max 250 mg/day) PO bid for 3 months, then 6 mg/kg/day PO (max 500 mg/day) bid for 3 months, then may
increase to the maximum of 10 mg/kg/day PO tid-qid (max 1500 mg/day)
Take on an empty stomach.
Penicillin G benzathine (Bicillin L-A); Antibacterial, Penicillin; Inj: 600,000 Units/mL; Group A Streptococcal pharyngitis: 25,000-50,000 units/kg IM as
a single dose (max 1.2 million units)
Primary Syphilis: 50,000 units/kg per week IM for 3 doses (max 2.4 million units/dose)
May not be given IV.
Penicillin G (Pentids); Antibacterial, Penicillin; Inj: 1, 2, 3, 5 MU (million units); IV/IM: 100,000-250,000 U/kg/day q4-6h, for severe infections may use up
to 400,00 U/kg/day (max 24 million U/day)
Penicillin G Sodium contains 2 mEq Na/million unit.

Penicillin G Potassium contains 1.7 mEq K/million unit and 0.3 mEq Na/million unit.
Penicillin G procaine (Wycillin); Antibacterial, Penicillin; Inj: 600,000 U/mL [1, 2 mL]; 25,000-50,000 units/kg/day IM q12-24h (max 4.8 million unit/day)
This product may not be given IV.
Penicillin V potassium (Pen-Vee K, Veetids); Antibacterial, Penicillin; Soln per 5 mL: 125, 250 mg
Tab: 250, 500 mg; Systemic Infections: 25-50 mg/kg/day PO q6-8h (max 3 gm/day)
Prophylaxis of Pneumococcal Infections:
<2 mos to 3 yrs: 125 mg PO bid
4-5 yrs: 250 mg PO bid
>5 yrs: 250 mg PO bid. May discontinue penicillin prophylaxis after 5 years of age in children who have not experienced invasive pneumococcal
infections and who have received the pneumococcal vaccine.
Pentamidine isethionate (Nebupent, Pentam); Antiprotozoal; Inhalation: 300 mg

Inj: 300 mg; Prophylaxis for of PCP (Pneumocystis carinii pneumonia): 4 mg/kg/dose IV /IM q2-4 weeks or
<5 yrs: 8 mg/kg inhaled q3-4 wk (max 300 mg)
>5 yrs: 300 mg inhaled q3-4 wk
Treatment of PCP: 4 mg/kg/dose IV/IM qd x 10-14d (IV therapy is preferred)
Pentobarbital (Nembutal) (C-II); Barbiturate; Cap: 50, 100 mg

Elix: 20 mg/5 mL
Inj: 50 mg/mL
Supp: 30, 60, 120, 200 mg
Sedation (PR):
2-12 mos: 30 mg
1-4 yrs: 30-60 mg
5-12 yrs: 60 mg
>12yrs: 60-120 mg
Pre-op sedation: 2-6 mg/kg PO/IM x 1 (max 100 mg) or 1-3 mg/kg IV x 1
Pentobarbital coma: loading dose 10-15 mg/kg IV over 1-2 hours followed by 2-3 mg/kg/hr continuous IV infusion
Therapeutic serum levels for pentobarbital coma: 20-40 mcg/mL
Permethrin (Acticin, Elimite, Nix); Antiparasitic; Cream: 5% [60 gm]

Liquid cream rinse: 1% [60 mL]; Scabies: Massage in cream from head to soles of feet. Remove by washing after 8-14 hours. 30 gm is sufficient for an
adult. May repeat in one week.
Head Lice: Saturate hair and scalp (especially behind ears and on nape of neck). Allow to remain on the hair for 10 min before rinsing. Towel dry hair.
Single treatment is sufficient. Alternatively, may apply to clean dry hair and leave on overnight (8-14 hours) under a shower cap) and then rinse hair in
the morning. May repeat in one week of live mites appear. Must also clean bedding.
Phenazopyridine (Pyridium); Local Urinary Anesthetic; Tab: 100, 150, 200 mg; >6yrs: 12 mg/kg/day PO tid (max 200 mg/dose) for 2 days only.
Causes red-orange urine color which can stain clothing. This drug has topical analgesic effect on urinary tract mucosa for relief of symptoms of a UTI.
It is NOT an antibiotic and does NOT cure an infection.
Phenobarbital (C-IV) (Luminal); Barbiturate; Cap: 16 mg

Elixir: 20 mg/5 mL
Inj per mL: 30, 60, 65, 130 mg
Tab: 15, 16, 30, 60, 90, 100 mg; Status Epilepticus: 15-18 mg/kg IV in a single or divided dose; may give additional 5 mg/kg/dose every 15-30 min
until seizure is controlled or a total dose of 30 mg/kg is reached; respiratory support may be needed.
Anticonvulsant Maintenance:
;Infants: 5-6 mg/kg/day PO/IV q12-24h; 1-5 yrs: 6-8 mg/kg/day PO/IV q12h
5 - 12 yrs: 5 mg/kg/day PO/IV qd-bid
>12 yrs: 1-3 mg/kg/day PO/IV qd-bid
Sedation: 2 mg/kg/dose PO tid (max 120 mg/day)
Hypnotic (IM/IV/SC): 3-5 mg/kg qhs. Adults: 100-320 mg qhs.
Hyperbilirubinemia: <12 yrs: 3-8 mg/kg/day PO q12h
Therapeutic serum levels: 15-40 mcg/mL
Phenylephrine (Neo-Synephrine); Alpha-adrenergic Agent; Drops, nasal: 0.25, 0.5, 1% [15, 30 mL]
Inj: 10 mg/mL
Ophth soln: 0.12% [0.3, 15, 20 mL], 2.5% [2, 3, 5, 15 mL], 10% [2, 5 mL]
Spray, nasal: 0.25, 0.5, 1% [15, 30 mL]; Nasal:
Infants: 1-2 drops in each nostril q3-4h using 0.125% concentration
1-5 yrs: 2-3 drops in each nostril q3-4h prn using 0.125% concentration
6-12 yrs: 2-3 drops/spray in each nostril q3-4h prn using 0.25% concentration
>12 yrs: 2-3 drops or 1-2 sprays in each nostril q3-4h prn using 0.25-0.5 % concentration
Note: 0.125% concentration no longer commercially available; dilute 0.25% with an equal volume of normal saline.
Ophth: Use 1 drop of 2.5% soln prior to procedure
IV: 0.1-0.5 mcg/kg/min IV continuous infusion
Phenytoin (Dilantin); Anticonvulsant; Cap: 100 mg

Cap ER: 30, 100 mg
Inj: 50 mg/mL
Susp: 125 mg/5 mL
Tab, chew: 50 mg; Status Epilepticus: 15-18 mg/kg IV in a single or divided dose.
Oral Loading dose: 15-20 mg/kg PO; administer oral loading dose in 3 divided doses given q2-4h.
Maintenance; Infants and Children: Initially 5 mg/kg/day PO/IV q12h; may need to increase up to 10 mg/kg/day PO/IV q8-12h.
Adults: 300 mg/day PO/IV or 4-6 mg/kg/day in 2-3 divided doses or in 1-2 divided doses using extended-release capsules.
Therapeutic serum levels: 10-20 mcg/mL
Cardiac depressant side effects with IV administration; maximum infusion rate is 1 mg/kg/min (up to max rate 50 mg/min). Nystagmus and ataxia are
early signs of toxicity. Gum hyperplasia and hirsutism occur with long-term use. Only Kapseals (ER caps) may be dosed qd.
Phytonadione (Aqua-mephyton); Vitamin K1; Inj per mL: 2, 10 mg

Tab: 5 mg; Hemorrhagic Disease in Newborns:
Prophylaxis: 0.5-1 mg IM/SC within 1 hour after birth
Treatment: 1-2 mg SC or IM
Oral anticoagulant overdose:
If no bleeding and rapid reversal needed and patient will require further oral anticoagulation therapy, give 0.5-2mg IV/SC
If no bleeding and rapid reversal needed and patient will not require further oral anticoagulation therapy, give 2-5 mg IV/SC
If significant bleeding but not life-threatening, give 0.5-2 mg IV/SC
If significant bleeding and life-threatening, give 5 mg IV
Vitamin K deficiency:
Infants and Children: 2.5-5 mg PO qd or 1-2 mg SC/IV/IM qd
Adults: 5-10 mg PO/SC/IV/IM qd
Note: IV administration can cause hypotension and anaphylactic reactions.
Pirbuterol (Maxair); Beta-2 Adrenergic Agonist; MDI: 200 mcg/puff [80 puffs/2.8 gm, 300 puffs/25.6gm; 400 puffs/14 gm]; >12 yrs: 1-2 puffs q4-6h (max
12 puffs/day)
Pneumococcal conjugate vaccine (Prevnar); Vaccine; Inj: 0.5 mL; 0.5 mL IM

Prevnar is the first multivalent conjugate pneumococcal vaccine approved for children <2 yrs.
Pneumococcal Polyvalent Vaccine (Pneumovax, Pnu-Imune); Vaccine; Inj: 0.5 mL; >2 yrs: 0.5 mL SC/IM
Polyethylene glycol solution (MiraLax); Laxative; Bulk powder: 14, 26 ounces; Children: 1 tsp (a capful) powder dissolved in 3 ounces fluid.
Adolescents: 1 tablespoon (17gm = 1 capful) powder dissolved in 8 ounces fluid.
The bottle cap is marked with a line to indicate 17 gm of powder (which equals one tablespoon or three teaspoons).
Tasteless, therefore quite palatable. Can dissolve in water or any beverage.
Polymyxin B (Poly-Rx); Antibacterial; Inj: 500,000 units

Powder for prescription compounding: 100 million units; Continuous Bladder irrigation: 20 mg (200,000 units) added to 1 L of normal saline;
administration rate is adjusted to patients urine output (max 1 L of irrigant per day).
Gut sterilization: 100,00-200,000 units/kg/day PO q6-8h using injectable solution orally.
Polyethylene glycol - electrolyte solution (PEG-ES, CoLyte, Golytely, Nu-Lytely, OCL); Bowel Evacuant; Bottle: 1500, 4000 mL; 25-40 mL/kg/hr PO/NG
until rectal effluent is clear (usually 4-10 hours)
Adolescents: drink 240 mL (eight ounces) q10 minutes or 20-30 mL/min via NG until 4 liters are consumed or rectal effluent is clear
Chill solution to improve palatability. NG administration is often necessary in children. Depending on brand, contains varying amounts of sodium,
potassium, chloride, and bicarbonate.
Potassium acetate; Electrolyte Supplement; Inj: 2 mEq/mL, 4 mEq/mL; 0.5-1 mEq/kg/dose IV (max: 30 mEq/dose) to infuse at 0.25-0.5 mEq/kg/hr (max
1 mEq/kg/hr)
Requires EKG monitoring during infusion. Must be diluted prior to administration.
Potassium chloride (Kaon-Cl, KCl, Micro-K, Slow-K); Electrolyte Supplement; Cap CR: 600 mg [8 mEq]; 750 mg [10 mEq]
Inj: 2, 3 mEq/mL
Liq: 10% (20 mEq/15 mL), 15% (30 mEq/15 mL), 20% (40 mEq/15 mL)
Tab, CR: 500 mg [6.7 mEq], 600 mg [8 mEq]
Tab SR: 500 mg [6.7 mEq], 600 mg [8 mEq], 750 mg [10 mEq], 1500 mg [20 mEq]; Maintenance requirements:
Newborns: 2-6 mEq/kg/day
Children: 2-3 mEq/kg/day
Prevention of hypokalemia during diuretic therapy: 1-2 mEq/kg/day PO qd-bid
Treatment of hypokalemia (PO/IV): Children: 2-5 mEq/kg/day in divided doses
Adults: 40-100 mEq/day in divided doses
IV intermittent infusion: 0.5-1 mEq/kg/dose (max: 30 mEq/dose) to infuse at 0.25-0.5 mEq/kg/hr (max 1 mEq/kg/hr). IV bolus potassium requires EKG
monitoring.
Potassium phosphate
(K-Phos); Electrolyte Supplement; Inj per mL: potassium 4.4 mEq, phosphate 3 mM
Powder (Neutra-Phos-K): phosphorus 250 mg [8 mM] and potassium 556 mg [14.25 mEq] per packet; Severe Hypophosphatemia (IV):
Low Dose (phosphorus >1.0 mg/dL): 0.08 mM/kg over 6h
Intermediate Dose (phosphorus 0.5-1 mg/dL): 0.16-0.24 mM/kg over 4-6h
High Dose (phosphorus <0.5 mg/dL): 0.36 mM/kg over 6h
Maintenance: Children: 0.5-1.5 mM/kg/24h IV or 2-3 mM/kg/day PO in divided doses.
Daily maximum 50-70 mM IV or 50-150 mM PO.
Maximum concentration for IV administration: Central line: 0.12 mM/mL; peripheral line: 0.05 mM/mL.
Intermittent IV infusion should be reserved for severe depletion and requires continuous EKG monitoring.
Praziquantel (Biltricide); Anthelmintic; Tab, tri-scored: 600 mg; >4 yrs:

Schistosomiasis mansoni, S. haematobium: 20 mg/kg/dose PO bid x 1 day
S. japonicum, S. mekongi: 20 mg/kg/dose PO q4-6h for 3 doses
Flukes: 75 mg/kg/day PO tid for 1 day (liver, intestinal infection) or 2 days (lung infection)
Cysticercosis: 50 mg/kg/day PO tid for 15 days
Tapeworms: 5-10 mg/kg PO x 1
H Nana: 25 mg/kg PO x 1
Take with food.
Prednisolone (Delta-Cortef, Prelone); Corticosteroid; Syr per mL: 1, 3 mg

Tab: 5 mg; Acute asthma: 1-2 mg/kg/day PO qd-bid
Anti-inflammatory or immunosuppressive: 0.1-2 mg/kg/day PO qd-qid
Prednisolone acetate (Econopred, Key-Pred, Predcor); Corticosteroid; Inj per mL: 25, 50 mg
Ophth susp: 0.12% [5, 10 mL], 0.125% [5, 10 mL], 1% [1, 5, 10, 15 mL] ; Intralesional or intra-articular: 4-100 mg (not for IV administration)
Ophth: Instill 1-2 drops into eye(s) q2-4h. Shake suspension prior to administration.
Prednisolone sodium phosphate (AK-Pred, Inflamase, Pediapred); Corticosteroid; Inj: 20 mg/mL [2, 5, 10 mL]
Liq, oral: 1 mg/mL
Ophth soln: 0.125% [3, 5, 10, 15 mL], 1% [3, 5, 10, 15 mL]; Acute asthma: 1-2 mg/kg/day PO qd-bid or 2-4 mg/kg/day IV q6-8h
Anti-inflammatory or immunosuppressive: 0.1-2 mg/kg/day PO/IV qd-qid
Consider alternate day schedule for long-term therapy. Discontinuation of long-term therapy requires gradual withdrawal by tapering dose. Burst
therapy of 3-5 days usually does not require tapering dose.
Prednisone (Deltasone, Liquid Pred, Orasone); Corticosteroid; Soln: 1 mg/mL, 5 mg/mL

Tab: 1, 2.5, 5, 10, 20, 50 mg; Acute asthma: 1-2 mg/kg/day PO qd-bid
Anti-inflammatory or immunosuppressive: 0.05-2 mg/kg/day PO qd-qid (usual max 60 mg/day)
Physiologic replacement: 4-5 mg/m2/day PO qd
Consider alternate day schedule for long-term therapy. Discontinuation of long-term therapy requires gradual withdrawal by tapering dose. Burst
therapy of 3-5 days usually does not require tapering dose.
Primidone (Mysoline); Anticonvulsant; Tab: 50, 250 mg; <8 yrs: 50-125 mg/day PO qhs, increase by 50-125 mg/day q3-7d; usual dose 10-25
mg/kg/day tid-qid
>8 yrs: 125-250 mg PO qhs; increase by 125-250 mg/day q3-7d, usual dose 750-1500 mg/day tid-qid (max 2 gm/day).
Therapeutic serum levels: 5-12 mcg/mL. Unlike phenobarbital, primidone is not a scheduled drug. It is metabolized in the liver to phenobarbital.
Probenecid (Benemid); Uricosuric Agent; Tab: 500 mg; Adolescents with PID: 1000 mg PO x 1 (in combination with other antibiotics)
Procainamide (Pronestyl); Antiarrhythmic Agent; Cap: 250, 375, 500 mg

Inj per mL: 100, 500 mg
Tab: 250, 375, 500 mg
Tab ER: 500, 750, 1000 mg; Oral:
15-50 mg/kg/day q3-6h (max 4000 mg/day)
IM:
20-30 mg/kg/day q4-6h, max 4000 mg/day
IV loading dose:
3-6 mg/kg over 5 minutes (max 100 mg), may repeat q5-10 minutes to cumulative maximum of 15 mg/kg
IV continuous infusion:
20-80 mcg/kg/min (max 2000 mg/day)
Extemporaneously prepared suspension may be made with six months stability under refrigeration or at room temperature.
Prochlorperazine (Compazine); Phenothiazine; Cap SR: 10, 15, 30 mg

Inj: 5 mg/mL
Supp: 2.5, 5, 25 mg
Syr: 1 mg/mL
Tab: 5, 10, 25 mg; 0.1-0.15 mg/kg/dose IM
0.4 mg/kg/day PO/PR q6-8h prn (10-14 kg: max 7.5 mg/day, 15-18kg: max 10 mg/day, 19-39 kg: max 15 mg/day)
IV therapy is not recommended.
Not recommended in children <12 yrs due to increased incidence of extrapyramidal side effects (EPS). Treat with diphenhydramine 1 mg/kg (max 50
mg) IV/IM/PO prn if EPS occur.
Propofol (Diprivan); General Anesthetic; Inj: 10 mg/mL; IV induction: 2.5-3.5 mg/kg over 30 seconds
Maintenance IV infusion: 125-300 mcg/kg/min
Promethazine (Phenergan); Phenothiazine; Inj per mL: 25, 50 mg

Rectal supp: 12.5, 25, 50 mg
Syr: 6.25 mg/5 mL
Tab: 12.5, 25, 50 mg; Antiemetic (PO/IV/IM/PR): 0.25-1 mg/kg/dose q4-6h prn (max 50 mg/dose)
Propranolol (Inderal); Beta-adrenergic Blocker; Cap, SR: 60, 80, 120, 160 mg
Inj: 1 mg/mL
Soln: 4 mg/mL, 8 mg/mL
Soln, conc oral: 80 mg/mL
Tab: 10, 20, 40, 60, 80 mg;
Arrhythmias and hypertension:
0.5-1 mg/kg/day PO q6-8h, may titrate up to 2-5 mg/kg/day (usual max 60 mg/day), may dose SR product q12h
0.01-0.1 mg/kg slow IVP over 10 min (max 1 mg/dose in infants, 3 mg/dose in children)
Migraine Prophylaxis: 0.6-1.5 mg/kg/day PO q8h
Tetralogy spells:
1-2 mg/kg/dose PO q6h prn
0.15-0.25 mg/kg/dose slow IVP (max 1 mg/dose in infants, 3 mg/dose in children)
Contraindicated in bronchospastic lung disease, diabetes, heart block or failure.
Protamine sulfate; Antidote - Heparin; Inj: 10 mg/mL; Dose of Protamine (mg) to

Time Elapsed: Neutralize 100 U of Heparin:
Immediate; 1
30-60 min ; 0.5-0.75
60-120 min 0.375-0.5
>2h; 0.25-0.375
Used to treat heparin overdosage. Infuse protamine over 10 minutes. Monitor APTT and blood pressure.
Low-Molecular-Weight Heparin (LMWH) overdose:
If given within 4 hours, 1 mg per 1 mg of LMWH then repeat with 0.5mg per 1 mg of LMWH if APTT still prolonged in 2-4 hours
Pseudoephedrine (Pediacare, Sudafed); Decongestant; Cap: 30, 60 mg
Drops: 7.5 mg/0.8 mL
Liq: 15 mg/5 mL, 30 mg/5 mL
Tab: 30, 60 mg
Tab, chew: 15 mg
Tab, CR: 240 mg
Tab, ER: 120 mg; <2 yrs: 4 mg/kg/day PO q6h
2-5 yrs: 15 mg PO q6h
6-12 yrs: 30 mg PO q6h
>12 yrs: 60 mg PO q6h or 120 mg SR bid or 240 mg CR qd
Psyllium (Fiberall, Konsyl, Genfiber, Hydrocil, Metamucil, Perdiem Fiber); Laxative, Bulk ; Granules per rounded teaspoon: 2.5, 4 gm
Powder packets: 3.4, 6 gm
Wafers: 3.4 gm; Children 6-11 yrs: 1/2 of adult dose
>12 yrs and adults: 1-2 rounded teaspoonfuls of granules or 1-2 packets 1-3 times daily with 8 oz of water.
Important to drink a full glass of water with each dose.
Pyrazinamide; Tuberculostatic; Tab, scored: 500 mg; 20-40 mg/kg/day PO q12-24h (max 2 gm/day) or directly observed therapy 50-70 mg/kg/dose PO
twice weekly (max 3 gm/dose).
Extemporaneous suspension can be made with 2 months stability under refrigeration or at room temperature.
Pyrantel Pamoate (Pin-X, Reeses Pinworm Medicine); Anthelmintic; Susp: 50 mg/mL

Tab: 62.5 mg; Children and adults:
Roundworm, pinworm, trichostrongyliasis: 11 mg/kg PO x 1 (max 1000 mg). Repeat dose in two weeks to treat pinworm.
Hookworm: 11 mg/kg/day PO qd x 3 days (max 1000 mg/day)
Pyrethrin (Rid); Pediculosis Agent; Shampoo: pyrethrins 0.3%, piper only butoxide 3% [60, 120, 240 mL]; Apply shampoo to the scalp and hair for 10
minutes. A repeat application 7-10 days is necessary to kill newly hatched lice as there is no residual activity.
Pyridoxine (Vitamin B6); Vitamin; Cap: 250 mg

Inj: 100 mg/mL
Tab: 25, 50, 100, 250, 500 mg
Tab EC: 20 mg; Prophylaxis against drug-induced neuritis: 1-2 mg/kg/day PO/IV/IM qd (max 100 mg/day)
Dietary deficiency: 5-25 mg/day PO qd x 3 weeks, then 1.5-2.5 mg/day in oral multivitamin
Pyrimethamine (Daraprim); Antimalarial; Tab, scored: 25 mg; Toxoplasmosis treatment:

2 mg/kg/day PO q12h x 3 days then 1 mg/kg/day PO qd-bid x 4 weeks (max 25 mg/day)
Give with sulfadiazine and folic acid. Administer with meals to avoid vomiting.
Extemporaneous suspension can be made with 3 months stability under refrigeration or at room temperature.
Rabies immune globulin (Hyperab, Imogam); Immune Globulin; Inj: 150 IU/mL; 20 IU/kg (0.133 mL/kg). Use up to half the dose to infiltrate the wound
site. Administer the balance of the dose IM at a different site.
Not to be given IV. Also give rabies vaccine if bitten.
Rabies Vaccine (Imovax, RabAvert); Vaccine; Inj: > 2.5 IU of whole virus rabies antigen; Administer IM x 5 doses after exposure - now and in 3, 7, 14,
and 28 days post exposure.
Ranitidine (Zantac); Histamine-2

Antagonist; Cap: 150, 300 mg
Granules: 150 mg
Inj: 25 mg/mL
Syr: 15 mg/mL
Tab: 75, 150, 300 mg
Tab, Effer: 150 mg; IV: 2-4 mg/kg/day q6-8h (max 200 mg/day), may put daily dose in TPN
Continuous IV infusion: loading dose 1 mg/kg, followed by 0.08-0.17 mg/kg/hr
PO: 4-5 mg/kg/day q8-12h (max 10 mg/kg/day or 300 mg/day for GERD or 600 mg/day for erosive esophagitis)
The 75-mg tablet is available OTC. Adjust dose for renal impairment.
Respiratory syncytial virus immune globulin intravenous (RespiGam); Immune Globulin; Inj: 2.5 gm/50 mL; 750 mg/kg (15 mL/kg) IV monthly, beginning
typically in November and lasting through April (depending on local RSV season). Start infusion at 1.5 mL/kg/hr for 15 minutes. If no adverse reactions
occur, may advance rate to 3 mL/kg/hr for 15 minutes and then to the maximum rate of 6 mL/kg/hr until infusion is completed.
AAP-approved indications: (1) <2 yrs with chronic lung disease that has required medical treatment within the past six months; (2) chronological age <1
yr at start of RSV season and gestational age <28 weeks; (3) chronological age <6 months at start of RSV season and gestational age 29-32 weeks.
Rho (D) immune globulin (WinRhoSD); Immune Globulin; Inj: 600, 1500, 5000 IU; Immune thrombocytopenic purpura: 250 IU/kg (50 mcg/kg) IV over
3-5 min.
Monitor platelet count, red blood cell count, hemoglobin, and reticulocytes. 250 IU equals 50 mcg. Only use for Rho(D) antigen-positive patients.
Monitor for hemolysis. A hemoglobin drop of more than 2 gm/dL occurs in 5-10% of patients with ITP. If hemoglobin <10 gm/dL, give 50% dose to
minimize risk of increasing severity of anemia. Do not use if baseline hemoglobin is less than 8 gm/dL.
Ribavirin (Virazole); Antiviral; Aerosol: 6 gm; 6 gm vial (diluted to 20 mg/mL) aerosolized over 18-20h qd or 2 gm (diluted to 60 mg/mL) aerosolized over
2 hours tid.
Duration of therapy is 3-7 days. Teratogenic. Used to treat respiratory syncytial virus (RSV) infections. Do not use tid treatment schedule in ventilated
patients.
Riboflavin (Vitamin B2); Vitamin; Cap: 100 mg

Tab: 25, 50, 100 mg; Deficiency:
Children: 3-10 mg PO qd
Adults: 5-30 PO mg qd
Urine will turn bright yellow.
Rifabutin (Mycobutin); Tuberculostatic; Cap: 150 mg; 5 mg/kg/day PO qd-bid (max 300 mg/day)
Extemporaneous suspension can be made with 12-week stability under refrigeration or at room temperature. Will cause orange discoloration of body
fluids.
Rifampin (Rifadin); Tuberculostatic; Cap: 150, 300 mg

Inj: 600 mg; Tuberculosis:
10-20 mg/kg/day PO/IV q12-24h
Adults: 10 mg/kg/day PO/IV q12-24h (max 600 mg/day).
Twice-Weekly Oral Therapy:10-20 mg/kg/dose (max 600 mg) twice weekly under direct supervision.
Adults: 10 mg/kg (max 600 mg) twice weekly.
Twice-weekly therapy should follow 1-2 months of daily treatment.
H influenza prophylaxis:
Neonates <1 month: 10 mg/kg/day PO q24h for 4 days
Infants and children: 20 mg/kg/day PO q24h for 4 days (not to exceed 600 mg/dose)
Meningococcal Prophylaxis:
Neonates <1 mos: 10 mg/kg/day PO bid for 2 days
Rimantadine (Flumadine); Antiviral; Syr: 10 mg/mL

Tab: 100 mg; <10 yrs: 5 mg/kg/day PO qd (max 150 mg/day)
>10yrs:100 mg PO bid
For prophylaxis, treat for 10 days after exposure or for 6-8 weeks during influenza A season. For treatment of active influenza A infection, treat for 5-7
days. Must initiate therapy within 48 hours of symptom onset.
Not active against Influenza B.
Ritonavir (Norvir, RIT); Antiretroviral, Protease Inhibitor; Cap: 100 mg

Soln: 80 mg/mL; <12 yrs: 250 mg/m2/dose PO bid, titrate upward by 50 mg/m2/dose over 5 days to max of 400 mg/m2/dose bid (max 600 mg/dose)
>12 yrs: 300 mg PO bid, increase by 100 mg/dose up to 600 mg PO bid over 5 days
Paresthesias, anorexia, increased liver function tests. Take with food. Capsules and solution must be kept refrigerated. Both products contain alcohol.
Rubella vaccine (Meruvax II); Vaccine; Inj: 0.5 mL; 0.5 mL SC

Rubella and mumps vaccine (Biavax II); Vaccine; Inj: 0.5 mL; 0.5 mL SC
Salmeterol (Serevent); Beta-2 Adrenergic Agonist; Diskus inhalation powder: 50 mcg/blister [28 blisters/pack]
MDI: 25 mcg/puff, 60 puffs/canister [6.5 gm]; 25 mcg/puff, 120 puffs/canister [13 gm]; MDI: >4 yrs: 2 puffs bid
Diskus: >4 yrs: 1 puff bid
Cannot use spacer device with Diskus powder for inhalation.
Saquinavir (Fortavase, Invirase, SQV); Antiretroviral, Protease Inhibitor; Cap: 200 mg; 1050 mg/m2/day PO q8h (max 3600 mg/day)
Diarrhea, abdominal cramps, hyperglycemia. Take with a full meal for better absorption.
Sargramostim (GMCSF, Leukine); Granulocyte Macrophage Colony Stimulating Factor; Inj: 250, 500 mcg; Cancer Chemotherapy Recovery: 3-15
mcg/kg/day IV/SC qd for 14-21 days.
Bone Marrow Transplant: 250 mcg/m2/day IV/SC qd x 21 days.
Monitor CBC, platelets, renal and liver function.
Scopolamine (Transderm Scop); Anticholinergic Agent; Disc, transdermal: 1.5 mg/disc

Inj per mL: 0.3, 0.4, 0.86, 1 mg
Ophth soln: 0.25% [5, 15 mL]; Transdermal: >12 yrs: 1 disc behind ear eery 3 days; apply 4h prior to travel
IM/IV/SC: 6 mcg/kg/dose q6-8h prn (max 0.3 mg/dose)
Ophth: Instill 1 drop to eye prior to procedure
Selenium Sulfide (Selsun); Antipsoriatic; Lotion/Shampoo: 1% [120, 210, 240, 330 mL]
Tinea Versicolor:
-Cover body surface from face to knees with lotion or shampoo daily for 30 minutes for 1 week, then monthly x 3 to help prevent recurrences.
Senna (Senokot, Senna-Gen); Laxative, Stimulant; Granules: 362 mg/teaspoon

Supp: 652 mg
Syr: 218 mg/5 mL; 10-20 mg/kg PO/PR qhs prn (max 872 mg)
Sennosides (Agoral, Senokot, Senna-Gen); Laxative, Stimulant; Tab: 6, 8.6, 15, 17, 25
Granules per 5 mL: 8.3, 15, 20 mg
Liq conc: 33 mg/mL
Syr: 8.8 mg/5mL; 2-5 yrs: 3-8.6 mg/dose PO qd-bid
6-11 yrs: 7.5-15 mg/dose PO qd-bid
>12 yrs: 12-25 mg/dose PO qd-bid
Silver sulfadiazine (Silvadene, Thermazene); Antibacterial; Cream: 1% [20, 25, 50, 85, 400, 1000 gm]; Apply topically qd-bid
Smallpox Vaccine (Dryvax)

Vaccine; Inj: 2.5 x 105 PFU; Inject percutaneously using multiple-puncture technique.
Available from the CDC.
Stable for 30 days after reconstitution.
Simethicone (Mylicon, Phazyme)

Antiflatulent; Cap: 125 mg
Drops: 40 mg/0.6 mL
Tab: 60, 95 mg
Tab, chew: 40, 80, 125 mg; <2 yrs: 20 mg PO qid after meals and before bedtime
2-12 yrs: 40 mg PO qid after meals and before bedtime
>12 yrs: 40-250 mg PO qid after meals and before bedtime (max 500 mg/day)
Sodium bicarbonate; Electrolyte Supplement; Inj: 4.2% (0.5 mEq/mL), 5% (0.6 mEq/mL), 7.5% (0.9 mEq/mL), 8.4% (1 mEq/mL)
Tab: 325 mg (3.8 mEq), 650 mg (7.6 mEq); Cardiac Arrest: 1 mEq/kg IV initially; may repeat with 0.5 mEq/kg IV after 10 min (max 50 mEq/dose).
Patient must be adequately ventilated before administering sodium bicarbonate.
Chronic Renal Failure: 1-3 mEq/kg/day PO bid-qid.
Metabolic acidosis: HCO3- (mEq) = 0.3 x weight in kg x base deficit (mEq/L) or HCO3- (mEq) = 0.5 x weight (kg) x [24 - serum HCO3- (mEq)]
Urinary Alkalinization: 120-200 mEq/m2/day diluted in maintenance IV fluids of 3000 mL/m2/day to maintain urine pH in the desired range.
1 mEq = 84 mg
Sodium chloride; Electrolyte Supplement; Inj: 0.45% (77 mEq/L), 0.9% (154 mEq/L), 3% (513 mEq/L), 5% (855 mEq/L), 23.4% (4 mEq/mL)
Tab: 650 mg (11.3 mEq), 1000 mg (17 mEq), 2250 mg (38.5 mEq)
Tab SR: 600 mg (10.3 mEq); Maintenance Sodium Requirements (PO/IV): 3-4 mEq/kg/day (max 100-150 mEq/day)
Acute Hyponatremia: mEq sodium = [desired sodium (mEq/L)-actual sodium (mEq/L)] x 0.6 x wt (kg); usual desired sodium goal for acute correction is
125 mEq/L
Normal saline = 0.9% = 154 mEq/L. Maximum infusion rate is 1 mEq/kg/hr.
Sodium phosphate (Fleet Enema, Phosphosoda); Electrolyte Supplement; Enema: sodium phosphate 7 gm and sodium biphosphate 19 gm [118 mL]
Inj per mL: phosphate 3 mM, sodium 4 mEq
Soln per 100 mL: sodium phosphate 18 gm and sodium biphosphate 48 gm [contains phosphate 4 mM/mL]; Severe Hypophosphatemia (IV):
Low Dose: (phosphorus >1.0): 0.08 mM/kg over 6h
Intermediate Dose (phosphorus 0.5-1 mg/dL): 0.16-0.24 mM/kg over 4-6h
High Dose (phosphorus <0.5 mg/dL): 0.36 mM/kg over 6h
Maintenance: Children: 0.5-1.5 mM/kg/24h IV or 2-3 mM/kg/day PO in divided doses
Laxative:
2-11 yrs: 59 mL (1/2 of enema) PR, repeat prn
>12: One 118 mL enema as a single dose, repeat prn
Sodium polystyrene sulfonate (Kayexalate); Potassium-binding Agent; Powd for susp: 454 gm
Susp: 15 gm/60 mL (contains sorbitol 33%)
0.5-1 gm/kg PO/PR q6h prn (max 15 gm/dose PO and 50 gm/dose PR)
1 gm resin binds 1 mEq potassium. Suspension can be used orally or rectally.
Somatrem (Protropin); Growth Hormone; Inj: 5, 10 mg; Up to 0.1 mg/kg SC/IM 3 times weekly
5 mg equals approximately 13 units
Somatropin (Genotropin, Humatrope); Growth Hormone; Inj: 0.2, 0.4, 0.6, 0.8, 1, 1.2, 1.4, 1.5, 1.6, 1.8, 2, 4, 5, 5.8, 6, 8, 10, 12, 13.8, 18, 22.5, 24 mg;
Individualize dose based on clinical condition and patient response. Depot formulations available for once- to twice-monthly injections.
0.3 mg ~ 0.9 IU
Sorbitol; Hyperosmotic Agent; Oral soln: 70% [480 mL]; Hyperosmotic Laxative:
Use 70% solution for oral use and 30% solution for rectal use.
2-11 yrs: 2 mL/kg PO (max 150 mL) or 30-60 mL PR
>12 yrs: 30-150 mL PO or 120 mL PR
With charcoal (for ingestion):
4.3 mL/kg of 35% solution PO/NG with 1 gm/kg activated charcoal PO/NG
Spironolactone (Aldactone); Diuretic, Potassium Sparing; Tab: 25, 50, 100 mg; 1.5-3 mg/kg/day PO q6-24h (max 200 mg/day)
Extemporaneously prepared suspension can be made with 60-day stability under refrigeration.
Stavudine (Zerit); Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Cap: 15, 20, 30, 40 mg
Soln: 1 mg/mL; 7 mos-15 yrs: 1-2 mg/kg/day PO bid (max 80 mg/day)
>15 yrs or if >40 kg: 40 mg PO bid
Peripheral neuropathy, pancreatitis, increased liver function tests.
Streptomycin; Antibacterial, Aminoglycoside

Tuberculostatic; Inj: 400 mg/mL [2.5 mL]; Newborns: 10-20 mg/kg/day IM qd
Infants: 20-30 mg/kg/day IM q12h
Children: 20-40 mg/kg/day IM qd (max 1 gm/day) or 20-40 mg/kg/dose IM biweekly under direct observation (max 1 gm/dose)
Available only on a compassionate use basis from Pfizer (800-254-4445). May not be given IV.
Succimer (Chemet); Antidote - Lead; Cap: 100 mg; 10 mg/kg/dose PO q8h x 5 days, then 10 mg/kg/dose PO bid x 14 days
Patients must drink ample fluids. The capsule may be opened and sprinkled on food.
Succinylcholine (Anectine); Neuromuscular Blocker, Depolarizing; Inj per mL: 20, 50, 100 mg; IV: Initial dose 1-2 mg/kg (max 150 mg), maintenance
dose 0.3-0.6 mg/kg IV prn
IM: 2.5-4 mg/kg (max 150 mg)
Pretreatment with atropine reduces occurrence of bradycardia.
Sucralfate (Carafate); Antacid; Susp: 100 mg/mL

Tab: 1 gm; 40-80 mg/kg/day PO q6h (max 4 gm/day)
Must be taken on an empty stomach.
Sulfacetamide (Bleph-10, Cetamide, Sulamyd); Antibacterial; Ophth oint: 10% [3.5 gm]
Ophth soln: 10% [1, 2.5, 5, 15 mL]; Ophth oint: Apply to lower conjunctival sac qd-qid
Ophth soln: Instill 1-2 drops into eye(s) q2-3h during the day
Avoid use in patients <2 months of age.
Sulconazole (Exelderm); Antifungal ; Cream: 1% [15, 30, 60 gm]

Soln, topical: 1% [30 mL]; Apply topically qd-bid.
Sulfadiazine; Antibacterial; Tab: 500 mg; Congenital Toxoplasmosis: 100 mg/kg/day PO bid for 12 months with pyrimethamine, 1 mg/kg/day qd, and
folinic acid, 5 mg q3d x 6 mos, followed by pyrimethamine, 1 mg/kg/day 3 times/week, and folinic acid,10 mg 3 times/week, for 6 months.
Toxoplasmosis: 120-200 mg/kg/day PO q6h (max 8 gm/day) with pyrimethamine 2 mg/kg/day bid for 3 days, followed by 1 mg/kg/day (max 25 mg/day)
qd, with folinic acid 5-10 mg PO q 3 days.
Extemporaneous suspension can be made with 7 day stability under refrigeration.
Sulfasalazine (Azulfidine); Bowel Anti-Inflammatory Agent; Tab: 500 mg

Tab DR: 500 mg; >2 yrs: 30-75 mg/kg/day PO q4-8h (max 6 gm/day)
Use lower dosage range for mild colitis and higher range for severe disease. May cause orange-yellow discoloration of urine and skin.
Sulfisoxazole (Gantrisin); Antibacterial, Sulfa; Ophth soln: 4% [15 mL]

Susp: 500 mg/5 mL
Syr: 500 mg/5 mL
Tab: 500 mg; >2 mos: Initially 75 mg/kg (max 4 gm) PO x 1, then 120-150 mg/kg/day PO q4-6h (max 6 gm/day)
UTI Prophylaxis: 10-20 mg/kg/day PO q12h
Otitis Media Prophylaxis: 35-75 mg/kg/day PO qhs
Ophth: Instill 1-2 drops in eye q2-3h
Terbinafine (Lamisil); Antifungal; Cream: 1% [15, 30 gm]

Gel: 1.12% [5, 15, 30 gm]; Apply topically bid.
Terbutaline (Brethine); Bronchodilator; Inj: 1 mg/mL

Tab: 2.5, 5 mg; PO: <12 yrs: 0.05 mg/kg PO q8h, increase gradually up to 0.15 mg/kg PO q8h, max daily dose 5mg; >12 yrs: 2.5 mg PO tid, may
increase to max 7.5 mg/dose
SC: <12 yrs: 0.005-0.01 mg/kg to max 0.4 mg/dose q15-20 min for 3 doses, may repeat q2-6h prn
>12 yrs: 0.25 mg, may repeat q20 minutes x 2 doses
IV: loading dose 2-10 mcg/kg over 10 minutes (max 500 mcg) , followed by continuous infusion 0.08-4 mcg/kg/min. Titrate by 0.1-0.2 mcg/kg/min q30
min.
Monitor heart rate and blood pressure. Discontinue if HR >200 beats per minute in children <6 yrs or >180 in children >6 yrs.
Tetanus immune globulin (Hyper-Tet); Immune Globulin; Syringe: 250 units

Vial: 250 units; Children: 4 units/kg IM
Adults: 250 units IM
Indicated in tetanus-prone injuries in a non-immunized person, or in a person immunized >10 years ago. May be advisable to give a child the entire 250
unit adult dose since the same number of organisms will be present in a child as in an adult.
Tetanus Toxoid, Adsorbed; Toxoid; Inj: 5 Lf units tetanus/0.5 mL; >7 yrs: 0.5 mL IM
For children <7 yrs, use DtaP.
Tetracycline (Achromycin); Antibacterial, Tetracycline; Cap: 100, 250, 500 mg

Susp: 125 mg/5mL
Tab: 250, 500 mg
Oint: 3% [14.2, 30 gm]
Soln, topical: 2.2 mg/mL [70 mL]; PO: > 8 yrs: 25-50 mg/kg/day q6h (max 3 gm/day)
Use of tetracyclines <8 yrs of age may cause permanent dental discoloration, enamel hypoplasia. Take on an empty stomach (1 hour before or 2 hours
after meals); do not give with dairy products or antacids.
Topical: Apply twice daily.
Tetrahydrozoline (Visine); Vasoconstrictor; Ophth soln: 0.05% [15, 22.5, 30 mL]; Adolescents: Instill 1-2 drop(s) into eye(s) up to four times daily.
For temporary relief of eye redness due to minor irritation.
Theophylline (Slophyllin Gyrocaps, Sustaire, Theobid Jr, Duracaps, Theo Dur Sprinkle); Bronchodilator; Cap: 100, 200 mg
Cap SR: 50, 60, 75, 100, 125, 130, 200, 250, 260, 300
Elixir: 80 mg/15 mL
Soln: 80 mg/15mL
Syr: 10 mg/mL
Tab: 100, 125, 200, 250, 300 mg
Tab, ER: 100, 200, 300, 450, 600 mg
Tab SR: 50, 75, 100, 125, 130, 200, 250, 260, 300, 400, 450, 500, 600 mg
Tab, TR: 100, 200, 250, 300, 400, 500 mg; 1-9 yrs: 20-24 mg/kg/day PO bid-qid
9-12 yrs: 16 mg/kg/day PO bid-qid
12-16 yrs: 13 mg/kg/day PO bid-qid
>16 yrs: 10 mg/kg/day PO bid-qid
Therapeutic serum levels 10-20 mcg/mL. Immediate-release products are dosed tid-qid. Sustained-release products can be dosed bid.
Thiabendazole (Mintezol); Anthelmintic; Susp: 500 mg/5 mL

Tab, chew: 500 mg; Strongyloidiasis, Cutaneous Larva Migrans: 50 mg/kg/day PO bid (max 3 gm/day). Treat for 2 days for strongyloidiasis (>5 days
for disseminated disease) and for 2-5 days for cutaneous larva migrans.
Dracunculosis: 50-75 mg/kg/day PO q12h x 3 days.
Trichinosis: 50 mg/kg/day PO bid (max 3 gm/day) for 2-4 days
Visceral Larva Migrans: 50 mg/kg/day PO bid (max 3 gm/day) for 5-7 days.
Administer after meals. Chew tablet thoroughly.
Thiamine (Betalin); Vitamin B1; Inj: 100 mg/mL

Tab: 50, 100, 250, 500 mg
Tab EC: 20 mg; Thiamine Deficiency (beriberi): 10-25 mg/dose IM/IV qd or 10-50 mg/day PO qd x 2 wk, then 5-10 mg/day PO qd x 1 month.
Thiethylperazine (Torecan); Phenothiazine; Inj: 5 mg/mL

Tab: 10 mg; >12 yrs: 10 mg PO/IM tid prn
IV administration is not recommended.
Thiopental (Pentothal) (C-III); Barbiturate; Inj: 250, 400, 500 mg; 1, 2.5, 5 gm; Increased Intracranial Pressure: 1.5-5 mg/kg/dose IV prn
Seizures: 2-3 mg/kg/dose IV prn
Sedation: 5-10 mg/kg/dose PR (max 4 gm)
Thioridazine (Mellaril); Phenothiazine; Liq: 30 mg/mL, 100 mg/mL

Tab: 10, 15, 25, 50, 100, 150, 200 mg; 2-12 yrs: 0.5-1 mg/kg/day PO bid-tid; increase as needed to max 3 mg/kg/day
>12 yrs: 25-100 mg/dose PO tid; increase as needed to max 800 mg/day
May cause dose-related prolongation of the QTc interval
Tiagabine (Gabitril); Anticonvulsant; Tab: 2, 4, 12, 16 mg; 12-18 yrs: initially 4 mg PO qd; may increase by 4-8 mg/day at weekly intervals until clinical
response is achieved or max of 32 mg/day
Divide dose bid-qid.
Ticarcillin (Ticar); Antibacterial, Penicillin; Inj: 3 gm; 200-300 mg/kg/day IV/IM q4-6h. Doses as high as 400 mg/kg/day IV/IM q4-6h prn have been used
in cystic fibrosis. Maximum daily dose 24 gm.
Adjust dosage in renal impairment. Contains 5.2-6.5 mEq sodium per gram.
Tobramycin (Tobrex, Tobi); Antibacterial, Aminoglycoside; Inj: 10 mg/mL, 40 mg/mL

Ophth soln: 0.3% [5 mL]
Soln for nebulizer: 300 mg/5 mL; IV/IM:
<5 yrs: 7.5 mg/kg/day q8h
5-10 yrs: 6.0 mg/kg/day q8h.
>10 yrs: 5.0 mg/kg/day q8h
Infuse IV dose over 30 minutes. Therapeutic peak serum levels: 4-10 mcg/mL, trough serum levels: <2 mcg/mL.
Ophth: Instill 1-2 drops into eye(s) q4h, or apply ointment to conjunctival sac bid-tid
The ophthalmic solution can be used in the ears.
Nebulizer (cystic fibrosis patients): >6 yrs: 300 mg nebulized bid in repeating cycles of 28 days on drug, 28 days off of drug.
Tolnaftate (Absorbine, Aftate, Desenex, Tinactin); Antifungal; Cream: 1% [15, 21.3, 30 gm]
Gel: 1% [15 gm]
Liq, topical: 1% [59.2, 118.3, 120 mL]
Powder: 1% [45, 90, 100, 105, 150 gm]
Soln, topical: 1% [10 mL]; Apply topically bid.
Topiramate (Topamax); Anticonvulsant; Cap, sprinkle: 15, 25 mg

Tab: 25, 100, 200 mg; 2-16 yrs: 1-3 mg/kg/day (max 25 mg/day) PO qhs x 1 week, then increase q1-2 wks by 1-3 mg/kg/day bid; usual maintenance
dose 5-9 mg/kg/day bid
>16yrs: Initially 25-50 mg PO qhs x 1 wk, then increase by 25-50 mg/day bid x 1 wk, then increase by 50 mg/day until effective dose (usual
maintenance 200 mg bid, max 1600 mg/day)
Adequate fluid intake is necessary to prevent kidney stone formation. May cause drowsiness.
Torsemide (Demadex); Diuretic, Loop; Inj: 10 mg/mL

Tab: 5, 10, 20, 100 mg; Adolescents:
Hypertension: 5 mg PO/IV qd, may increase to 10 mg PO/IV qd
Edema: 10-20 mg PO/IV qd, titrate as needed to max 200 mg/day
Tretinoin (Retin A); Anti-acne; Cream: 0.02% [40 gm], 0.025% [20, 45 gm], 0.05% [20, 45, 60 gm], 0.1% [20, 45 gm]
Gel: 0.01% [15, 45 mL], 0.025% [15, 20, 45 mL], 0.04% [20, 45 mL], 0.1% [20, 45 mL]
Liq: 0.05% [28 mL]; Wash and dry face, then apply to affected area qhs
Side effects include local redness and photosensitivity.
Triamcinolone (Aristocort, Azmacort, Kenacort, Kenalog, Nasacort, Nasacort AQ); Corticosteroid; Cream: 0.025, 0.1, 0.5% [15, 30, 60, 80, 120, 240 gm]
Oint: 0.025, 0.1, 0.5% [15, 28, 30, 57, 60, 80, 113, 240 gm]
Metered Dose Inhaler: 100 mcg/puff [> 240 doses/20 gm]
Spray, Nasal (Nasacort): 55 mcg/puff, 100 sprays/bottle [10 gm]
Spray, Nasal (Nasacort AQ): 55 mcg/spray, 30 sprays/bottle [6.5 gm] or 120 sprays/bottle [16.5 gm]
Syr: 4 mg/5 mL
Tab: 4, 8 mg; Topical: Apply a thin film bid-tid
High-potency corticosteroid: 0.5%
Medium-potency corticosteroid: 0.1%, 0.25%
MDI:
6-12 yrs: 1-2 puffs tid-qid or 2-4 puffs bid
>12 yrs: 2 puffs tid-qid or 4 puffs bid (max 16 puffs/day)
Intranasal (Nasacort):
6-11 yrs: 2 sprays in each nostril qd
>12 yrs: 2 sprays in each nostril qd, may increase to two sprays bid or 1 spray qid
Intranasal (Nasacort AQ):
6-11 yrs: 1 spray in each nostril qd, may increase to 2 sprays qd
>12 yrs: 2 sprays in each nostril qd
Oral: >12 yrs: 4-100 mg/day po qd-qid
Triazolam (Halcion)
(C-IV); Benzodiazepine; Tab: 0.125, 0.25 mg; Adolescents and Adults: 0.125-0.25 mg PO qhs prn
Triethanolamine (Cerumenex); Ceruminolytic; Soln, otic: 10% [6, 12 mL] ; Fill ear canal, insert cotton plug, wait 15-30 min, then flush with lukewarm
water using bulb syringe
Tromethamine (THAM); Alkalinizing Agent, Parenteral; Inj: 0.3 molar [500 mL]; Metabolic acidosis with cardiac arrest: 3.5-6 mL/kg IV.
To replace base deficit: mL of 0.3 molar solution = body weight in kg x base deficit in mEq/L.
1mM = 120 mg = 3.3 mL = 1 mEq
Trifluridine (Viroptic); Antiviral, Ophthalmic; Ophth soln: 1% [7.5 mL]; Instill 1 drop into each eye q2h while awake (max 9 drops/day/eye) for 2 days,
then use 1 drop q4h for 7 days.
Trimethobenzamide (Tigan); Antiemetic; Cap: 100, 250 mg

Inj: 100 mg/mL
Supp: 100, 200 mg ; 15-20 mg/kg/day IM/PO/PR q6-8h prn nausea (max 200 mg/dose IM/PR, 250 mg/dose PO).
Not for IV administration.
Trimethoprim (Proloprim); Antibacterial; Soln: 50 mg/5 mL

Tab: 100, 200 mg; Otitis Media:
10 mg/kg/day PO q12h (max 200 mg/day)
UTI:
<12 yrs: 4-6 mg/kg/day PO bid
>12 yrs: 100 mg PO bid or 200 mg PO qd
Urokinase (Abbokinase); Thrombolytic Agent; Inj: 250,000 units; Arterial or Venous Thrombosis or Pulmonary Emboli: IV loading dose 4400
units/kg over 10 min, then 4400 units/kg/hr continuous IV infusion for 12-72h. Individualize dose based on response; reassess clot q12-24h.
Partially occluded catheter: Continuous IV infusion of 150-200 units/kg/hr in each lumen for 8-48h
Ursodiol (Actigall, Urso); Gallstone Dissolution Agent; Cap: 300 mg

Tab: 250 mg
Biliary Atresia: 10-15 mg/kg/day PO qd
Cystic Fibrosis: 30 mg/kg/day PO qd-bid
Cholestasis: 30 mg/kg/day PO bid-tid
An extemporaneously prepared suspension can be made with 60-day stability at room temperature or under refrigeration.
Valacyclovir (Valtrex); Antiviral; Tab: 500, 1000 mg; Adolescents:

Herpes Zoster: 1 gm PO tid for 7 days
Herplex labialis (cold sores): 2 gm PO bid x 1 day
First episode genital herpes: 1 gm PO bid x 10 days
Recurrent genital herpes: 500 mg PO bid for 3 days
Chronic Suppressive Therapy:
500-1000 mg/day PO qd
Valproic acid (Depacon, Depakene, Depakote); Anticonvulsant; Cap (Depakene): 250 mg

Cap, sprinkles (Depakote Sprinkles): 125 mg
Inj (Depakene): 100 mg/mL [5 mL]
Syr: 250 mg/5 mL
Tab, DR (Depakote): 125, 250, 500 mg
Tab, ER (Depakote-ER): 500 mg
Seizures:
PO: Initially 10-15 mg/kg/day qd-tid; increase 5-10 mg/kg/day q1wk to maintenance (usual range 30-60 mg/kg/day bid-tid, may require up to 100
mg/kg/day in combination with other anticonvulsants)
PR: May use oral syrup rectally (dilute 1:1 with water): loading dose 17-20 mg/kg, maintenance dose 10-15 mg/kg/dose q8h
IV: 10-60 mg/kg/day IV q6h; if already stable on oral regimen but now NPO, use same mg/kg/day as oral but divide q6h.
Therapeutic Serum Levels: 50-100 mcg/mL
Prophylaxis of migraine headaches:
Depakote-ER only approved dosage form: adults 500 mg PO qd x 7 days, may increase to 1000 mg PO qd if needed
Life-threatening pancreatitis may occur. Monitor liver enzymes and CBC.
Vancomycin (Vancocin); Antibacterial; Cap: 125, 250 mg

Inj: 500 mg, 1 gm
Soln: 1, 10 gm; Gram-positive infection: 40-60 mg/kg/day IV q6-8h (max 2 gm/day)
Clostridium difficile colitis: 40 mg/kg/day PO q6-8h (max 2 gm/day)
Not absorbed enterally. Oral formulation is not effective for systemic infection.
Vasopressin (Pitressin); Antidiuretic Hormone; Inj: 20 units/mL [0.5, 1, 10 mL]; Diabetes Insipidus:
Continuous infusion: 0.5 milliunit/kg/hr (0.0005 U/kg/hr), then double dosage as needed every 30 minutes to a max of 10 milliunit/kg/hr (0.01 u/kg/hr);
titrate based on serum and urine sodium, osmolality, fluid balance and urine output.
Intermittent IM/SC: 2.5-10 units bid-qid prn
GI Hemorrhage: Initially 0.002-0.005 U/kg/min, titrate dose as needed to maximum of 0.01 U/kg/min
Varicella zoster immune globulin (VZIG); Immune Globulin; Vial: 125 U/2.5 mL; Administer by deep IM injection (may not be given IV)
0-10 kg = 125 units
10-20 kg; = 250 units
20-30 kg; = 375 units
30-40 kg; = 500 units
>40 kg = 625 units
Administer within 72 hours after exposure.
Varicella virus vaccine (Varivax); Vaccine; Single dose vials: 0.5 mL; 0.5 mL SC
1-12 y: Single dose
>12 y: 2 doses; second dose 4-8 weeks after first dose. Longer interval between first and second dose does not necessitate third dose but may leave
the person unprotected in the intervening months.
Vecuronium bromide (Norcuron); Neuromuscular Blocker Nondepolarizing; Inj: 10, 20 mg; IV: 0.1 mg/kg/dose prn
Continuous IV infusion: 0.05-0.1 mg/kg/hr, titrate as necessary to maintain paralysis.
Monitor patient using peripheral nerve stimulator, measuring twitch response.
Vigabatrin (Sabril); Anticonvulsant; Tab: 500 mg; Epilepsy:

10-15 kg: 500-1000 mg/day PO qd-bid
16-30 kg: 1000-1500 mg/day PO qd-bid
31-50 kg: 1500-3000 mg/day PO bid
>50 kg: 2000-4000 mg/day PO bid
Usual adult dose: 2000-3000 mg/day PO bid, max 4000 mg/day
Infantile spasms:
50-150 mg/kg/day PO bid
Maximum daily dose 4000 mg. Most common side effects are drowsiness and fatigue. Visual field defects may occur, which may persist upon
discontinuation of drug.
Vitamin A (Aquasol A); Vitamin; Cap: 10,000; 15,000; 25,000; 50,000 U

Drops, oral: 5000 U/0.1 mL [30 mL]
Inj: 50,000 U/mL
Tab: 5000, 15000 U; Severe Deficiency with Xerophthalmia:
1-8 yrs: 5,000 units/kg/day PO qd for 5 days or until recovery; or 5,000-15,000 units/day IM qd for 10 days.
>8 yrs: 500,000 units/day PO qd x 3 days, then 50,000 units/day PO for 14 days; then 10,000-20,000 units/day PO for 2 mos; or 50,000-100,000
units/day IM for 3 days; then 50,000 units/day IM for 14 days.
Supplementation in measles (recommended by WHO):
6 mos-1 yr: 100,000 U PO qd x 2, then q4 wks if ophthalmologic evidence of Vitamin A deficiency
>1 yr: 200,000 U PO qd x 2, then q4 wks if ophthalmologic evidence of Vitamin A deficiency
Daily dietary supplement (PO):
<1 yr: 1250 U
1-3 yrs: 13300 U
4-6 yrs: 1670 U
7-10 yrs: 2330 U
>10 yrs: female - 2670 U, male - 3330 U
0.3 mcg retinol = 1 U vitamin A
Vitamin E (Aquasol E, D-Alpha Tocopherol); Vitamin; Cap: 100, 200, 400, 600, 1000 U
Drops, oral: 15 U/0.3 mL [12, 30 mL]
Tab: 100, 200, 400, 500, 800 U; Malabsorption syndrome: 1 U/kg/day PO qd (max 75 units/day).
Children with cystic fibrosis, sickle cell anemia, or beta-thalassemia may require higher maintenance doses.
Vitamin E deficiency in neonates: 25-50 units/day PO qd x 1 week
Voriconazole (Vfend); Antifungal; Tab: 50, 200 mg

Inj: 200 mg; >12 yrs: loading dose 6 mg/kg IV q12h x 2 doses, then maintenance dose 4 mg/kg IV q12h or 200 mg PO q12h (use 100 mg PO q12h if
<40 kg
Warfarin (Coumadin); Anticoagulant; Inj: 5 mg

Tab: 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg; 0.1 mg/kg/day PO/IV qd (range 0.05-0.34 mg/kg/day).
Titrate to international normalized ratio (INR) of 2-3. Monitor for signs and symptoms of bleeding.
Zafirlukast (Accolate); Leukotriene Receptor Antagonist; Tab: 10, 20 mg; 5 - 11 yrs: 10 mg PO bid
Take on an empty stomach.
Zalcitabine (Hivid, ddC); Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Tab: 0.375, 0.75 mg; <13 yrs: 0.005-0.01 mg/kg/dose PO
q8h
>13 yrs: 0.75 mg PO q8h
Peripheral neuropathy, fatigue, oral ulcers. Take on an empty stomach.
Zanamivir (Relenza); Antiviral, Neuraminidase Inhibitor; Diskhaler: 5 mg/inhalation; >7 yrs: 2 inhalations (total dose 10 mg) bid x 5 days
Approved for treatment of uncomplicated influenza type A or B in patients who have had symptoms for <48 hours. Risk of bronchospasm in patients
with asthma or chronic obstructive pulmonary disease.
Zidovudine (AZT, Retrovir, ZDV); Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Cap: 100 mg
Inj: 10 mg/mL
Syr: 10 mg/mL
Tab: 300 mg; <2 wks: 2 mg/kg/dose PO q6h, or 1.5 mg/kg/dose IV q6h
2-4 wks: 3 mg/kg/dose PO q6h, or 2.25 mg/kg/dose IV q6h
4 wks - 12 yrs: 90-180 mg/m2/dose PO q6h (max 200 mg/dose), or 0.5-1.8 mg/kg/hr continuous IV infusion, or 100-120 mg/m2/dose IV q6h
>12 yrs:
Monotherapy and symptomatic: 100 mg PO q4h or 200 mg PO q8h
Monotherapy and asymptomatic: 100 mg PO q4h while awake (500 mg/day)
Combination therapy: 200 mg PO q8h or 1 mg/kg/dose IV q4h
Most common side effects include anemia, agranulocytopenia, and increased liver function tests.
Zileuton (Zyflo); Leukotriene Receptor Inhibitor; Tab: 600 mg; >12 yrs: 600 mg PO qid
Take with meals and at bedtime. Not effective for acute episodes of asthma.
Zinc sulfate (Orazinc); Trace Metal; Cap: 220 mg zinc sulfate (50 mg elemental zinc)
Inj: 1 mg elemental zinc/mL, 5 mg elemental zinc/mL
Tab: 110 mg zinc sulfate (25 mg elemental zinc); Dose expressed as mg elemental zinc
Zinc Deficiency: 0.5-1 mg/kg/day PO qd-tid
Supplement to Parenteral Nutrition (IV):
Premature infant: 400 mcg/kg/day
Term infant <3 months: 300 mcg/kg/day
3 mos -5 yrs: 100 mcg/kg/day
>5 yrs: 2-5 mg/day
Zinc sulfate contains 23% elemental zinc. Normal serum level 70-130 mcg/dL.
Combination Drugs
Actifed; Decongestant, Antihistamine; Syr per 5 mL: Pseudoephedrine 30 mg, triprolidine 1.25 mg
Tab: Pseudoephedrine 60 mg, triprolidine 5 mg; 4 m-2 yr: 1.25 mL PO tid-qid
2-4 yr: 2.5 mL PO tid-qid
4-6 yr: 3.75 mL tid-qid
6-12 yr: 5 mL or 1/2 tab/cap tid-qid
>12 yr: 10 mL or 1 tab/cap tid-qid
Adderall
CNS Stimulant; Tab (mixed amphetamine salts): 5, 7.5, 10, 12.5, 15, 20, 30 mg
Cap, XR (mixed amphetamine salts): 10, 20, 30 mg; 3-5 yrs: Initially 2.5 to 5 mg PO in AM. Increase by 2.5 to 5 mg weekly until 2.5 to 40 mg/d in 1-3
doses/day
>6 yrs: Initially 5 mg PO qd or bid (in the morning and at noon). Increase daily dose by 5 mg at weekly intervals until optimum response is achieved.
Max 40 mg/day qd-tid.
If converting from immediate-release tablets to extended-release capsules, use same daily mg dose.
Advair; Bronchodilator, Corticosteroid; MDI:

100/50: fluticasone 100 mcg and salmeterol 50 mcg per puff
250/50: fluticasone 250 mcg and salmeterol 50 mcg per puff
500/50: fluticasone 500 mcg and salmeterol 50 mcg per puff; Patients not currently using inhaled corticosteroids:
4-11 yrs: one inhalation bid using 100/50 MDI
>12 yrs: one inhalation bid using 100/50 MDI
Patients currently using inhaled corticosteroids:
Higher doses may be needed
Aldactazide; Diuretic, Thiazide and Potassium Sparing; Tab: Spironolactone 25 mg, hydrochlorothiazide 25 mg;
Spironolactone 50 mg, hydrochlorothiazide 50 mg; 1.5-3 mg/kg/day of spironolactone PO q6-12h (max 200 mg/day)
Allerest Maximum Strength; Decongestant
Antihistamine; Tab: Pseudoephedrine 30 mg, chlorpheniramine 2 mg; 6-12 yrs: 1 tablet PO q6h prn
>12 yrs: 2 tabs PO q6h prn
Augmentin; Antibacterial, Penicillin; TID Formulations

Susp per 5 mL: Amoxicillin 125 mg, clavulanic acid 31.25 mg; 250 mg/62.5 mg;
Tab: Amoxicillin 250 mg, clavulanic acid 125 mg; 500 mg/125 mg
Tab, chew: Amoxicillin 125 mg, clavulanic acid 31.25 mg; 250 mg/62.5 mg
BID Formulations
Susp per 5 mL: Amoxicillin 200 mg, clavulanic acid 28.5 mg; 400 mg/57 mg; Augmentin-ES-600: amoxicillin 600 mg, clavulanic acid 42.9 mg
Tab: Amoxicillin 875 mg, clavulanic acid 125 mg; 125 mg/5 mL or 250 mg/5 mL suspension or 125 mg or 250 mg chewable tablets: 20-40 mg of
amoxicillin component/kg/day PO tid (max 500 mg/dose)
200 mg/5 mL or 400 mg/5 mL suspension or tablets or 200 mg or 400 mg chewable tablets: 25-45 mg of amoxicillin component/kg/day PO bid
Augmentin ES-600: indicated only for persistent or recurrent otitis media: 45 mg/kg/day PO bid
Adolescents and adults using tablets (non-chewable):
Mild-to-moderate infections: 250 mg PO tid or 500 mg PO bid
; Severe infections: 500 mg PO tid or 875 mg PO bid
Treating resistant Streptococcus pneumoniae: 80-90 mg/kg/day PO bid
The bid regimen causes less diarrhea. Clavulanic acid is a beta-lactamase inhibitor.
Allergan; Otic Analgesic Agent; Soln, otic: Antipyrine 5.4%, benzocaine 1.4% [15 mL]; Ear Wax Removal: instill 2-4 drops 3-4 times daily for 2-3 days
Analgesia: Fill ear canal with 2-4 drops q1-2h until pain and congestion are relieved
Auralgan; Otic Analgesic Agent; Soln, otic: Antipyrine 5.4%, benzocaine 1.4% [10 mL]; Ear Wax Removal: instill 2-4 drops 3-4 times daily for 2-3 days
Analgesia: Fill ear canal with 2-4 drops q1-2h until pain and congestion are relieved
Bactrim (Cotrimoxazole, Septra); Antibacterial, Sulfa; Susp per 5 mL: Trimethoprim 40 mg, sulfamethoxazole 200 mg
Tab (single strength or SS): Trimethoprim 80 mg, sulfamethoxazole 400 mg;
Tab (double strength or DS): Trimethoprim 160 mg, sulfamethoxazole 800 mg
Inj per mL: Trimethoprim 16 mg, sulfamethoxazole 80 mg; Children >2 mos:
Mild-Moderate Infections: 6-12 mg of trimethoprim/kg/day PO bid
Serious Infections (Pneumocystis): 15-20 mg of trimethoprim/kg/day PO/IV q6h
UTI Prophylaxis: 2 mg of trimethoprim/kg/day PO qd (max 160 mg/day trimethoprim)
Pneumocystis Prophylaxis: 5-10 mg of trimethoprim/kg/day PO bid three days per week (max 320 mg/day)
Caladryl for Kids; Antihistamine; Cream: Calamine 8%, pramoxine 1% [45 gm]; >1 yrs: Apply to the affected area tid-qid
Cheracol Cough Syrup

C-V; Antitussive, Expectorant; Liquid per 5 mL: Codeine 10 mg, guaifenesin 100 mg; Dose based on codeine:
0.5 mg/kg/dose PO q4-6h prn
Cheracol-D; Antitussive, Expectorant; Liquid per 5 mL: Dextromethorphan 10 mg, guaifenesin 100 mg; Dose based on dextromethorphan
1-2 mg/kg/day PO q6-8h (max 120 mg./day)
Drink ample fluids
Cipro HC Otic; Antibacterial, Quinolone; Corticosteroid; Otic susp per mL: ciprofloxacin 2 mg, hydrocortisone 10 mg; >1 yr: Instill 3 drops into the
affected ear(s) bid x 7 days
Combivent; Bronchodilator, Anticholinergic Agent; MDI: 90 mcg albuterol/puff and 18 mcg ipratropium/puff [200 puffs/14.7 gm]; >12 yrs: 2 puffs qid.
May increase to max 12 puffs/day.
Contraindicated in patients with allergies to soybeans or peanuts.
Combivir ; Antiretroviral, Nucleoside Analog Reverse Transcriptase Inhibitor; Tab: zidovudine 300 mg, lamivudine 150 mg; >12 yrs: 1 tablet PO bid
Coricidin HBP Cold & Flu Tablets; Analgesic, Antihistamine; Tab: Acetaminophen 325 mg, chlorpheniramine 2 mg; 6-12 yrs: 1 tablet PO q4-6h prn
>12 yrs: 2 tabs PO q4-6h prn
Coricidin D Cold, Flu, & Sinus Tablets; Analgesic, Antihistamine, Decongestant; Tab: Acetaminophen 325 mg, chlorpheniramine 2 mg,
pseudoephedrine 30 mg; 6-12 yrs: 1 tablet PO q6h prn
Coricidin HBP Cough & Cold Tablets; Antitussive, Antihistamine; Tab: Dextromethorphan 30 mg, chlorpheniramine 4 mg; >12 yrs: 1 tab PO q6h prn
Coricidin HBP Maximum Strength Flu Tablets; Analgesic, Antihistamine, Antitussive; Tab: Acetaminophen 500 mg, chlorpheniramine 2 mg,
dextromethorphan 15 mg; >12 yrs: 2 tabs PO q6h prn
Cortisporin; Corticosteroid, Antibacterial
; Cream per gm: Hydrocortisone 0.5%, neomycin 0.5%, polymixin 10,000 U [7.5 gm]
Oint per gm: Hydrocortisone 1%, neomycin 0.5%, bacitracin 400 U, polymixin B 5,000 U [15 gm]
Ophth oint per gm: Hydrocortisone 1%, neomycin 0.35%, bacitracin 400 U, polymixin10,000 U [3.5 gm]
Ophth susp: Hydrocortisone 1%, neomycin 0.35%, polymixin10,000 U/mL [7.5 mL]; Topical: Apply topically to affected area bid-qid
Ophth: Instill 1-2 drops in affected eye(s) q3-4h or apply ointment to affected eye(s) q3-4h
Otic: Instill 3 drops in affected ear q6-8h; do not use solution if ear drum has been punctured
Cyclomydril; Mydriatic; Ophth soln: Cyclopentolate 0.2%, phenylephrine 1% [2, 5 mL]; Instill 1 drop in each eye q5-10 min up to 3 doses approximately
40-50 minutes prior to examination
Darvocet-N 50
Darvocet-N 100; Opioid Narcotic; Tab: Propoxyphene 50 mg, acetaminophen 325 mg

Tab: Propoxyphene 100 mg, acetaminophen 650 mg; Adolescents:
Darvocet-N 50: 1-2 tabs PO q4h prn or
Darvocet-N 100: 1 tab PO q4h prn
Max 600 mg propoxyphene/day
Dimetane DX; Antitussive, Decongestant, Antihistamine; Syrup per 5 mL: Dextromethorphan 10 mg, pseudoephedrine 30 mg, brompheniramine 2 mg;
Dose per pseudoepherine componenet:
4-5 mg/kg/day PO q6h prn
DuoNeb; Anticholinergic Agent, Beta-2 Adrenergic Agonist; Neb Soln: albuterol 2.5 mg, ipratroprium 0.5 mg [3 mL unit dose]; Nebulize 3 mL qid.
Diphtheria and Tetanus Toxoids; Vaccines; Inj: DT: 2 Lf units diphtheria and 5 Lf units tetanus [0.5 mL], Td: 2 Lf units diphtheria and 2 Lf units tetanus
[0.5 mL]; <6 yrs: 0.5 mL IM using DT
>7 yrs: 0.5 mL IM using Td
EMLA; Eutectic Mixture of Local Anesthetics; Cream: Lidocaine 2.5%, prilocaine 2.5% [5, 30 gm]
Band-Aid impregnated with EMLA cream; Apply thick layer to intact skin and cover with an occlusive dressing, such as Tegaderm. Leave on 1-4h.
Haleys MO; Laxative; Liquid per 5 mL: Mineral oil 1.25 mL, magnesium hydroxide 300 mg; 6-12 yrs: 5-15 mL PO qhs prn
>12 yrs: 15-30 mL PO qhs prn
Lomotil
C-V; Antidiarrheal; Liquid per 5 mL: Diphenoxylate 2.5 mg, atropine 0.025 mg
Tablet: Diphenoxylate 2.5 mg, atropine 0.025 mg; <2 yrs: not recommended
2-12 yrs: 0.3-0.4 mg/kg/day diphenoxylate component PO qid
>13 yrs: 5 mg diphenoxylate PO x 1, then 2.5 mg PO bid-tid
Kaletra; Antiretroviral, Protease Inhibitor; Cap: 133.3 mg lopinavir, 33.3 mg ritonavir

Soln per mL: 80 mg lopinavir, 20 mg ritonavir; 7-14.9 kg: 24 mg lopinavir/kg/day PO bid
15-40 kg: 20 mg lopinavir/kg/day PO bid
>40 kg: 400 mg lopinavir PO bid
Take with food to increase absorption. Solution contains alcohol.
Lortab (C-III); Opioid Narcotic, Analgesic; Elix per 5 mL: Hydrocodone 2.5 mg, acetaminophen 167 mg
Tab: Hydrocodone 2.5 mg, acetaminophen 500 mg
Tab: Hydrocodone 5 mg, acetaminophen 500 mg
Tab: Hydrocodone 7.5 mg, acetaminophen 500 mg
Tab: Hydrocodone 10 mg, acetaminophen 500 mg [Lortab Plus]; Children: 0.6 mg/kg/day PO of hydrocodone component q6-8h prn pain
<2 yrs: Max 1.25 mg/dose
2-12 yrs: Max 5 mg/dose
>12 yrs: Max 10 mg/dose
Adults: 1-2 tabs PO q4-6h prn
Maximum acetaminophen dosage: 80 mg/kg/day or 4 gm/day (whichever is smaller)
Neosporin; Antibacterial; Oint, topical per gm: Polymyxin B 5,000 U, neomycin 3.5 mg, bacitracin 400 U [0.9 gm unit dose; 15, 30 gm]
Ophth oint per gm: Polymyxin B 10,000 U, neomycin 3.5 mg, bacitracin 400 U [3.5 gm]
Ophth soln per mL: Polymyxin B 10,000 Units, neomycin 1.75 mg, gramicidin 0.025 mg [10 mL]; Topical: Apply topically 1-3 times daily
Ophth oint: Apply ointment to lower conjunctival sac of affected eye(s) bid-qid
Ophth soln: Instill 1-2 drops in the affected eye(s) bid-qid for 7-10 days
Neosporin Plus; Antibacterial, Topical Anesthetic; Cream per gm: Polymyxin B 10,000 U, neomycin 3.5 mg, pramoxine 10 mg [15 gm]
Oint per gm: Polymyxin B 10,000 U, neomycin 3.5 mg, bacitracin 500 U, pramoxine 10 mg [15, 30 gm]; Apply topically 1-3 times daily
Otobiotic; Antibacterial,
Corticosteroid; Soln, otic per mL: Polymyxin B 10,000 Units, hydrocortisone 0.5% [15 mL]; Instill 3 drops in each ear tid-qid
Pediacare Cough-Cold; Decongestant, Antihistamine, Antitussive; Liquid per 5 mL: Pseudoephedrine 15 mg, chlorpheniramine 1 mg, dextromethor-
phan 5 mg; 3-5 yrs: 5 mL or 1 tab PO q4-6h prn
6-12 yrs: 10 mL or 2 tabs PO q4-6h prn
>12 yrs: 15 mL or 4 tabs PO q4-6h prn
Max 4 doses daily.
Pediacare Night Rest Cough Cold; Decongestant, Antihistamine, Antitussive; Liquid per 5 mL: Pseudoephedrine 15 mg, chlorpheniramine 1 mg,
dextromethorphan 7.5 mg; 3-5 yrs: 5 mL PO q6-8h prn
6-12 yrs: 10 mL PO q6-8h prn
>12 yrs: 20 mL PO q6-8h prn
Pediarix; Vaccine, Combination; Inj: 0.5 mL

Contains: diphtheria, tetanus, acellular pertussis, hepatitis B, inactivated polio vaccine; 0.5 mL IM
See appendix for vaccination schedule. May be used when all five of these immunizations are due to be given.
Pediazole; Macrolide and Sulfa; Liquid per 5 mL: Erythromycin 200 mg, sulfisoxazole 600 mg [100, 150, 200 mL]; 1-1.25 mL/kg/day PO q6h or 40-50
mg/kg/day of erythromycin PO q6h (max 2 gm erythromycin/day)
Pediotic; Antibacterial, Corticosteroid; Susp, otic per mL: Polymyxin B 10,000 U; neomycin 5 mg; hydrocortisone 1% [7.5 mL]; Instill 3 drops into the
affected ear(s) tid-qid
Percocet (C-II); Opioid Narcotic, Analgesic; Cap: Oxycodone 5 mg, acetaminophen 500 mg
Cplt: Oxycodone 5 mg, acetaminophen 500 mg
Soln per 5 mL: Oxycodone 5 mg, acetaminophen 325 mg
Tab: Oxycodone 5 mg, Acetaminophen 325 mg; 0.05-0.15 mg/kg/dose oxycodone component PO q4-6h prn (max 5 mg/dose)
Phenaphen/Codeine, No. 3, No. 4 (C-III); Analgesic, Opioid Narcotic; Tab [No.3]: Acetaminophen 325 mg, codeine 30 mg
Tab [No. 4]: Acetaminophen 325 mg, codeine 60 mg; 0.5-1 mg/kg/dose of codeine component PO q4h prn (max dose 60 mg)
Phenergan with Dextromethorphan; Antihistamine, Antitussive; Syr per 5 mL: Promethazine 6.25 mg, dextromethorphan 15 mg; 2-5 yrs: 1.25 mL PO
q4-6h prn
6-12 yrs: 2.5 mL PO q4-6h prn
Phenergan VC; Antihistamine, Decongestant; Syr per 5 mL: Promethazine 6.25 mg, phenylephrine 5 mg; 2-5 yrs: 1.25 mL PO q4-6h prn
6-12 yrs: 2.5 mL PO q4-6h prn
Phenergan w/Codeine (C-V); Antihistamine, Antitussive; Syr per 5 mL: Promethazine 6.25 mg, codeine 10 mg; 2-5 yrs: 1.25-2.5 mL PO q4-6h prn
6-12 yrs: 2.5-5 mL PO q4-6h prn
>12 yrs: 5-10 mL PO q4-6h prn
Promethazine VC w/Codeine (C-V); Antihistamine, Antitussive, Decongestant; Syr per 5 mL: Promethazine 6.25 mg, codeine 10 mg, phenylephrine 5
mg; 2-5 yrs: 1.25 mL PO q4-6h prn
6-12 yrs: 2.5-5 mL PO q4-6h prn
Polycitra; Alkalinizing Agent; Liq per 5 mL: Sodium citrate 500 mg, citric acid 334 mg, potassium citrate 550 mg; 2-3 mEq/kg/day PO tid-qid.
Contains 1 mEq sodium, 1 mEq potassium, and 2 mEq bicarbonate per mL.
Polycitra K; Alkalinizing Agent; Liq per 5 mL: Potassium citrate 1100 mg, citric acid 334 mg
Packet: Potassium citrate 1100 mg, citric acid 334 mg; 2-3 mEq/kg/day PO tid-qid.
Contains 2 mEq potassium and 2 mEq bicarbonate per mL.
Polysporin; Antibacterial; Oint per gm: Polymyxin B 10,000 units; bacitracin 500 units [15, 30 gm]
Oint, ophth per gm: polymyxin B 10,000 units, bacitracin 500 units [3.5 gm]
Powder per gm: Polymyxin B 10,000 units, bacitracin 500 units [10 gm]; Topical: Apply topically tid
Ophth: Apply ointment to conjunctival sac of eye(s) q3-4h prn
Primaxin; Antibacterial, Carbacephem; Inj (IV): Imipenem 250 mg, cilastatin 250 mg; 500 mg/500 mg
Inj (IM): Imipenem 500 mg, cilastatin 500 mg; Dosage is based on imipenem component
60-100 mg/kg/day IV/IM q6-8h (max 4 gm/day)
IM formulation is limited to mild/moderate infections.
Seizures may occur, especially if renal function is impaired.
Robitussin A-C (C-V); Antitussive, Expectorant; Syr per 5 mL: Codeine 10 mg, guaifenesin 100 mg; 6 mos-2 yrs: 1.25-2.5mL PO q4h prn
2-6 yrs: 2.5-5 mL PO q4-6h prn (max 30 mg/day)
6-12 yrs: 5-10 mL PO q4h prn
>12 yrs: 10 mL PO q4h prn
Robitussin-DM; Expectorant, Antitussive; Syr per 5 mL: Guaifenesin 100 mg, dextromethorphan 10 mg ; 1-2 mg/kg/day of dextromethorphan PO q6-8h
prn or
2-5 yrs: 2.5 mL PO q4h prn
6-12 yrs: 5 mL PO q4h prn
>12 yrs: 10 mL PO q4h prn; ; ;
Robitussin Allergy & Cold Liquid; Antihistamine, Antitussive, Decongestant; Syr per 5 mL: brompheniramine 2 mg, dextromethorphan 10 mg,
pseudoephedrine 30 mg; Dose per pseudoephrine component:
4-5 mg/kg/day PO q6h (max 10 ml/dose)
Robitussin Pediatric Night Relief Couth & Cold Liquid; Antihistamine, Antitussive, Decongestant; Syr per 5 mL: chlorpheniramine 1 mg,
dextromethorphan 7.5 mg, pseudoephrine 15 mg; 6-11 yrs: 10 mL PO q6 prn
Robitussin Pediatric Cough and Cold; Decongestant, Antitussive; Syr per 5 mL: Pseudoephedrine 15 mg, dextromethorphan 7.5 mg; 2-5 yrs: 5 mL PO
q4-6h prn
6-12 yrs: 10 mL PO q4-6h prn
Maximum four doses daily
Rondec; Decongestant, Antihistamine; Syr per 5 mL: Pseudoephedrine 45 mg, brompheniramine 4 mg

Tab: Pseudoephedrine 60 mg, carbinoxamine 4 mg; 4-5 mg/kg/day of pseudoephedrine PO q6h prn (max 60 mg/dose)
Rondec-DM; Decongestant, Antihistamine, Antitussive; Drops per mL: Pseudoephedrine 15 mg, carbinoxamine 1 mg, dextromethorphan 4 mg
Syr per 5 mL: Pseudoephedrine 45 mg, brompheniramine 4 mg, dextromethorphan 15 mg; 4-5 mg/kg/day of pseudoephedrine PO q6h prn (max 60
mg/dose)
Rondec Drops; Decongestant, Antihistamine; Drops per mL: Pseudoephedrine 15 mg, carbinoxamine 1 mg; 4-5 mg/kg/day of pseudoephedrine PO
q6h prn (max 60 mg/dose)
Rondec TR; Decongestant, Antihistamine; Tab TR: Pseudoephedrine 120 mg, carbinoxamine 8 mg; Adolescent: 1 tab PO bid
Ryna Liquid; Decongestant, Antihistamine; Liquid per 5 mL: Pseudoephedrine 30 mg, chlorpheniramine 2 mg; 4-5 mg/kg/day of pseudoephedrine PO
q6h prn (max 60 mg/dose)
Ryna-C
(C-V); Antitussive, Decongestant, Antihistamine; Liquid per 5 mL: Codeine 10 mg, pseudoephedrine 30 mg, chlorpheniramine 2 mg; 4-5 mg/kg/day of
pseudoephedrine component PO q6h prn
Rynatan Pediatric Suspension; Decongestant, Antihistamine; Susp per 5 mL: Phenylephrine 5 mg, chlorpheniramine 4.5 mg; 2-6 yrs: 2.5-5 mL PO bid
prn
7-12 yrs: 5-10 mL PO bid prn
>12 yrs: 10 mL PO bid prn
Septra; Antibacterial, Sulfa; Susp per 5 mL: Trimethoprim 40 mg, sulfamethoxazole 200 mg
Tab (single strength or SS): Trimethoprim 80 mg, sulfamethoxazole 400 mg;
Tab (double strength or DS): Trimethoprim 160 mg, sulfamethoxazole 800 mg
Inj (per mL): Trimethoprim 16 mg, sulfamethoxazole 80 mg; Children >2 mos:
Mild-Moderate Infections: 6-12 mg of trimethoprim/kg/day PO bid
Serious Infections (Pneumocystis): 15-20 mg of trimethoprim/kg/day PO/IV q6h
UTI Prophylaxis: 2 mg of trimethoprim/kg/day PO qd (max 160 mg/day trimethoprim)
Pneumocystis Prophylaxis: 5-10 mg of trimethoprim/kg/day PO bid three days per week (max 320 mg/day)
Sodium citrate and citric acid (Bicitra); Electrolyte Supplement; Liq per 5 mL: sodium citrate 500 mg, citric acid 334 mg ; 2-3 mEq/kg/day PO tid-qid
Equivalent to 1 mEq sodium and 1 mEq bicarbonate per mL.
Sodium phosphate and potassium phosphate (Neutra-Phos); Electrolyte Supplement; Powd Packet: phosphorus 250 mg [8 mM], potassium 278 mg
[7.125 mEq], sodium 164 mg [7.125 mEq]
Tab:
K-Phos MF: phosphorus 125.6 mg [4 mM], potassium 44.5 mg [1.1 mEq], sodium 67 mg [2.9 mEq]
K-Phos Neutral: phosphorus 250 mg [8 mM], potassium 45 mg [1.1 mEq], sodium 298 mg [13 mEq]
K-Phos No. 2: phosphorus 250 mg [8 mM], potassium 88 mg [2.3 mEq], sodium 134 mg [5.8 mEq]
Uro-KP-Neutral: phosphorus 250 mg [8 mM], potassium 49.4 mg [1.27 mEq], sodium 250.5 mg [10.9 mEq]; Prevention and treatment of
hypophosphatemia:
2-3 mM/kg/day PO bid-qid
Usual adult dose: 50-150 mM/day PO bid-qid
Synercid; Antibacterial, Streptogramin; Inj: 500 mg (quinupristin 150 mg, dalfopristin 350 mg); 7.5 mg/kg/dose IV q8-12h (frequency depends on the
severity of the infection)
Infuse each dose over one hour. Used to treat vancomycin-resistant enterococcus faecium (VREF). Cutaneous reactions and infusion site reactions
may occur.
Timentin; Antibacterial, Penicillin; Inj: Ticarcillin 3 gm, clavulanate 0.1 gm; 200-300 mg/kg/day of ticarcillin IV/IM q4-6h (max 24gm/day)
1 gram ticarcillin contains 4.75 mEq Na and 0.15 mEq K. Adjust dose in renal impairment.
Triaminic AM Non-Drowsy Cough & Cold Decongestant Liquid; Antitussive, Decongestant; Susp per 5 mL: dextromethorphan 7.5 mg, pseudoephrine
15 mg; 2-5 yrs: 5 mL PO q6h prn
>12 yrs: 10 mL po q6h prn
Triaminic Chest Congestion Liquid; Expectorant, Decongestant; Susp per 5 mL: guaifenesin 50 mg, pseudoephrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Triaminic Cold & Allergy Liquid; Antihistamine, Decongestant; Susp per 5 mL: chlorpheniramine 1 mg, pseudoephrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Triaminic Cold, Allergy, Sinus Medicine Tablets; Analgesic, Antihistamine, Decongestant; Tab: acetaminophen 650 mg, chlorpheniramine 4 mg,
pseudoephedrine 60 mg; >12 yrs: one tablet PO q6h prn
Triaminic Throat Pain & Cough Softchew Tablets; Analgesic, Antitussive, Decongestant; Tab: acetaminophen 160 mg, dextromethorphan 5 mg,
pseudoephedrine 15 mg; 2-5 yrs: one tablet PO q6h prn
6-11 yrs: 12 tablets PO q6h prn
>12 yrs: 4 tablets PO q6h prn
Triaminic Cough & Congestion Liquid; Antitussive, Decongestant; Susp per 5 mL: dextromethorphan 7.5 mg, pseudoephrine 15 mg; 2-5 yrs: 5 mL PO
q6h prn
Triaminic Softchews Allergy Sinus & Headache Tablets; Analgesic, Decongestant; Tab: acetaminophen 160 mg, pseudoephedrine 15 mg; 2-5 yrs: one
tablet PO q4-6h prn (max 4 tablets/day)
6-11 yrs: 2 tablets PO q4-6h prn (max 8 tablets/day)
Triaminic Cough & Sore Throat Liquid; Analgesic, Antitussive, Decongestant; Susp per 5 mL: acetaminophen 160 mg, dextromethorphan 7.5 mg,
pseudoephrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Triaminic Cold & Cough Liquid; Antihistamine, Antitussive, Decongestant; Susp per 5 mL: chlorpheniramine 1 mg, dextromethorphan 5 mg,
pseudoephrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Triaminic Cold & Cough Softchews; Antihistamine, Antitussive, Decongestant; Tab, chew: chlorpheniramine 1 mg, dextromethorphan 5 mg,
pseudoephedrine 15 mg; 2-5 yrs: 1 tab PO q6h prn
6-11 yrs: 2 tabs PO q6h prn
Triaminic Cold & Night Time Cough Liquid; Antihistamine, Antitussive, Decongestant; Susp per 5 mL: chlorpheniramine 1 mg, dextromethorphan 7.5
mg, pseudoephrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Triaminic Cold, Cough, and Fever Liquid; Analgesic, Antihistamine, Antitussive, Decongestant; Susp per 5 mL: acetaminophen 160 mg,
chlorpheniramine 1 mg, dextromethorphan 7.5 mg, pseudoephrine 15 mg; 2 -5 yrs: 5 mL PO q6h prn
Tobradex; Corticosteroid, Antibacterial; Ophth susp: dexamethasone 0.1%, tobramycin 0.3% [2.5, 5, 10 mL]
Ophth oint: dexamethasone 0.1%, tobramycin 0.3% [3.5 gm]; Ophth susp: Instill 1-2 drops into affected eye(s) q4-6h.
Ophth oint: Apply into conjunctival sac of affected eye(s) q6-8h.
Trizivir; Nucleoside Analog Reverse Transcriptase Inhibitors; Tab: abacivir 300 mg, lamivudine 150 mg, zidovudine 300 mg; >40 kg: one tablet PO bid
Tylenol Childrens Cold Plus Cough Suspension; Analgesic, Antihistamine, Antitussive, Decongestant; Liq per 5 mL: Acetaminophen 160 mg,
chlorpheniramine 1 mg, dextromethorphan 5 mg, pseudoephedrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Maximum 4 doses per day
Tylenol Childrens Flu Suspension; Analgesic, Antihistamine, Antitussive, Decongestant; Susp per 5 mL: Acetaminophen 160 mg, chlorpheniramine 1
mg, dextromethorphan 7.5 mg, pseudoephedrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
12 yrs: 20 mL PO q6h prn
Tylenol Infants Cold Concentrated Drops; Analgesic, Decongestant; Drops per 1 mL: Acetaminophen 100 mg, pseudoephedrine 9.375 mg; Dose per
pseudoephedrine component:
4 mg/kg/day PO q6h prn
Tylenol Childrens Sinus Suspension; Analgesic, Antihistamine, Decongestant; Susp per 5 mL: Acetaminophen 160 mg, pseudoephedrine 15 mg; 2-5
yrs: 5 mL PO q6h prn
Tylenol Childrens Cold Liquid; Analgesic, Antihistamine, Decongestant; Liq per 5 mL: Acetaminophen 160 mg, chlorpheniramine 1 mg,
pseudoephedrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Tylenol Cold Childrens Cold Chewable Tablets; Analgesic, Antihistamine, Decongestant; Tab: Acetaminophen 80 mg, chlorpheniramine 0.5 mg,
pseudoephedrine 7.5 mg; 2-5 yrs: 2 tablets PO q4h prn
Tylenol Infants Cold Decongestant & Fever Reducer Plus Cough Concentrated Drops; Analgesic, Antitussive Decongestant; Drops per 1 mL:
acetaminophen 100 mg, dextromethorphan 3.125 mg, pseudoephedrine 9.375 mg; 2-3 yrs: 1.6 mL PO q4-6h prn (max 6.4 mL/day)
Tylenol Childrens Cold Plus Cough Chewable Tablets; Analgesic, Antihistamine, Antitussive, Decongestant; Tab: Acetaminophen 80 mg,
chlorpheniramine 0.5 mg, dextromethorphan 2.5 mg, pseudoephedrine 7.5 mg; 2-5 yrs: 2 tablets PO q6h prn
Tylenol w/Codeine
(C-III); Analgesic, Opioid Narcotic; Elix per 5 mL: Acetaminophen 120 mg, codeine 12 mg
No. 2 Tab: Acetaminophen 300 mg, codeine 15 mg
No. 3 Tab: Acetaminophen 300 mg, codeine 30 mg
No. 4 Tab: Acetaminophen 300 mg, codeine 60 mg; 0.5-1 mg/kg/dose of codeine PO q4-6h
Maximum 60 mg/dose
Unasyn; Antibacterial, Penicillin; Inj: Ampicillin 1 gm/sulbactam 0.5 gm; ampicillin 2 gm / sulbactam 1 gm; 100-200 mg of ampicillin component/kg/day
IM/IV q6h; in meningitis, may use 200-400 mg/kg/day IV q6h (max 8 gm ampicillin/day)
Vasocon-A; Ophth Decongestant, Antihistamine; Ophth soln: Naphazoline 0.05%, antazoline 0.5% [5, 15 mL]; Instill 1-2 drops in each eye q4-6h prn
Do not use for more than 3-4 days.
Vicks Pediatric 44M Cough & Cold Relief Liquid; Antihistamine, Antitussive, Decongestant; Liq per 5 mL: chlorpheniramine 0.67 mg, dextromethorphan
5 mg, pseudoephedrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
Vicks 44M Cough, Cold & Flu Relief Liquid; Analgesic, Antihistamine, Antitussive, Decongestant; Liq per 5 mL: Acetaminophen 162.5 mg, chlorphenir-
amine 1 mg, dextromethorphan 7.5 mg, pseudoephedrine 15 mg; 2-5 yrs: 5 mL PO q6h prn
12 yrs: 30 mL PO q6h prn
Vicks Childrens NyQuil Cold/Cough Relief Liquid; Antihistamine, Antitussive, Decongestant; Liq per 5 mL: chlorpheniramine 0.67 mg,
dextromethorphan 5 mg, pseudoephedrine 10 mg; 2-5 yrs: 7.5 mL PO q6h prn
Vicks Pediatric 44E Cough & Chest Congestion Relief Liquid; Antitussive, Expectorant; Syrup per 5 mL: Dextromethorphan 3.3 mg, guaifenesin 33.3
mg; 2-6 yrs: 7. 5 mL PO q4h prn (max 45 mL/day)
6-11 yrs: 15 mL PO q4h prn (max 90 mL/day)
Vicks 44E Cough & Chest Congestion Relief Liquid; Antitussive, Expectorant; Liq per 5 mL: dextromethorphan 6.67 mg, guaifenesin 66.7 mg; 2-5 yrs:
5 mL PO q6h prn
Vicodin
Vicodin ES
Vicodin HP
(C-III); Opioid Narcotic, Analgesic; Vicodin Tab: Hydrocodone 5 mg, acetaminophen 500 mg
Vicodin ES Tab: Hydrocodone 7.5 mg, acetaminophen 750 mg
Vicodin HP Tab: Hydrocodone 10 mg, acetaminophen 660 mg; 0.6 mg/kg/day hydrocodone component PO q6-8h prn
<2 yrs: Max 1.25 mg/dose
2-12 yrs: Max 5 mg/dose
>12 yrs: Max 10 mg/dose
Adults: 1-2 Vicodin tabs PO q4-6h prn (max 8 tablets/day) or 1 Vicodin ES tab PO q4-6h prn (max 5 ES tablets/day) or 1 Vicodin HP tab PO q6h prn
(max 4 HP tablets/day)
Zosyn; Antibacterial, Penicillin; Inj: Piperacillin 2 gm, tazobactam 0.25 gm; 3 gm/0.375 gm; 4 gm/0.5 gm; 240 mg/kg/day of piperacillin IV q8h, may use
up to 300-400 mg/kg/day IV q6h for serious pseudomonal infections (max 12 gm/day)
1 gm piperacillin contains 2.35 mEq Na
Appendix
Immunization Schedule for Infants and Children
Age Immunizations Comments
Birth-2mo HBV Infants born to HbsAg-positive or unknown status
mothers should be immunized within 12 hours of
birth.
1-4 mo HBV Second dose should be given at least one month
after first dose
2 mo DTaP, HIB, IPV DTaP and IPV can be initiated as early as 4 wk in
high endemicity areas
4 mo DTaP, HIB, IPV 2-mo interval (minimum 6 wk) for IPV
6 mo DTaP, (HIB) Dose 3 of HIB is not indicated if the product for
doses 1 and 2 was Pedvax HIB.
6-18 mo HBV, IPV Third dose of HBV should be given at least 2 months
after second dose
12-15 mo HIB, MMR, VAR Tuberculin testing may be done at the same visit
15-18 mo DTaP The fourth dose of DTaP should be given 6-12 mo
after third dose and may be given as early as 12 mo,
provided that the interval between doses 3 and 4 is
at least 6 mo
4-6 y DTaP, IPV, MMR DTaP and IPV should be given at or before school
entry. DTaP should not be given at or after the
seventh birthday
11-12 y MMR The second dose of MMR should be given at entry to
middle school or junior high school if it was not given
at ages 4-6 y.
14-16 y Td Repeat every 10 yrs throughout life
DTaP = diphtheria and tetanus toxoids and acellular pertussis vaccine; HBV = Hepatitis B virus vaccine; HIB = Haemophilus
influenzae type b conjugate vaccine; IPV = Inactivated polio vaccine; MMR = live measles, mumps, and rubella viruses
vaccine; Td = adult tetanus toxoid (full dose) and diphtheria toxoid (reduced dose), for children >7 y and adults; VAR =
varicella vaccine
Immunization Schedule for Children Not Immunized in the First Year of Life
Age <7 Yrs Immunization(s) Comments
First visit DTaP, HIB, HBV, MMR, If indicated, tuberculin testing may be done at same visit.
IPV, VAR If child is 5 yrs of age or older, HIB is not indicated.
Consider varicella vaccine if the child has not had varicella
disease.
Interval after first DTaP, HBV

visit:
1 mos
2 mos DTaP, HIB, IPV Second dose of HIB is indicated only in children whose first
dose was received when younger than 15 mos
49
>8 mos DTaP, HBV, IPV
4-6 yrs (at or DTaP, IPV DTaP is not necessary if the fourth dose was given after
before school the fourth birthday. IPV is not necessary if the third dose
entry) was given after the fourth birthday.
11-12 yrs MMR At entry to middle school or junior high school.
10 yrs later Td Repeat every 10 yrs throughout life
7 Years and Older

First visit HBV, IPV, MMR, Td, IPV may also be given 1 month after the first visit if
VAR accelerated poliomyelitis vaccination is necessary.
Consider varicella vaccine if the child has not had varicella
disease.
Interval after first
visit:
2 mos HBV, IPV, Td, VAR Second varicella vaccine dose needed 4-8 weeks after first
dose if older than 12 years.
8-14 mos HBV, IPV, Td
11-12 yrs MMR At entry to middle or junior high school
10 yrs later Td Repeat every 10 yrs throughout life.
DTaP diphtheria and tetanus toxoids and acellular pertussis; HBV=Hepatitis B vaccine; HIB=Haemophilus
influenzae type b conjugate; IPV=inactivated poliovirus vaccine; MMR = live measles, mumps, and rubella;
Td=adult tetanus toxoid (full dose) and diphtheria toxoid (reduced dose), for children >7 y and adults;
VAR=varicella vaccine
Hemophilus B Conjugate Vaccines

Product Age at First Dose Subsequent Doses Dosage
Hibtiter 2-6 mos 3 doses, 2 mos apart* 0.5 mL IM
7-11 mos 2 doses, 2 mos apart*
12-14 mos 1 dose*
15-71 mos 1 dose
*plus booster dose at 15 mos, which
must be at least 2 mos after previous
dose
Pedvax HIB 2-6 mos 2 doses, 2 mos apart** 0.5 mL IM
7-11 mos 2 doses, 2 mos apart**
12-14 mos 1 dose*
15-71 mos 1 dose
**plus booster at 12 mos, which must
be at least 2mos after previous dose
*plus booster dose at 15 months,
which must be least 2 mos after
previous dose
50
Product Age at First Dose Subsequent Doses Dosage
ActHIB 2-6 mos 3 doses, 2 mos apart* 0.5 mL IM
7-11 mos 2 doses, 2 mos apart^
12-14 mos 1 dose**
15-59 mos 1 dose
Plus booster dose at *12-18 mos
^12-15 mos
**15 mos,
which must be at least 2 mos after
previous dose
(1) Administer IM mid-thigh or deltoid. (2) Try to use same product for complete vaccination course as not
therapeutically equivalent. (3) ActHIB may be reconstituted with Tripedia (Aventis-Pasteur brand of whole-cell
DTP).
Varicella vaccine
The AAP recommends varicella vaccination as a routine immunization of childhood. If adolescents
11-12 years old have not been vaccinated or do not have a reliable history of chickenpox disease,
they should be vaccinated. When administered to children <12 years, a single dose of vaccine
is sufficient. For children >12 years, two doses, separated by 4-8 weeks, are recommended.
Meningococcal vaccine
Primary immunization is a single dose. Protective antibody levels are achieved within 7-10 days.
Revaccination may be indicated for individuals at high risk of infection who were first vaccinated
at age <4 years or more than three years ago. High-risk groups include: (1) deficiencies in late
complement components, (2) functional or actual asplenia, (3) travelers to or residents of hyperendemic
areas. The CDC also recommends that college students consider vaccination to reduce the risk
for potentially fatal meningococcal disease.
Pneumococcal vaccine, polyvalent

Indicated in children >2 years with increased risk of pneumococcal disease or its complications
(asplenia, nephrotic syndrome, immunosuppression).
Pneumococcal vaccine, conjugate

May be given in children as young as six weeks old. Routine immunization schedule consists
of 3 doses at 2 month intervals starting at age 2 months followed by a fourth dose at 12-15 months
of age. For previously unvaccinated children, three doses at least two months apart are necessary
for children 7-11 months of age at first immunization. If the unvaccinated child is 12-23 months
of age, then two doses at least two months apart are necessary; if the unvaccinated child is 2
years to 9 years of age, then a single dose is sufficient.
Measles vaccine (single entity)

While the MMR (measles/mumps/rubella) is the preferred product for most immunizations, vaccination
for measles is recommended for high-risk groups (eg, college students, health-care workers).
Influenza Vaccine (annually)

Age Product Type Dosage Number of Doses
51
6-35 mos subvirion 0.25 mL 1 or 2*
3-8 yrs subvirion 0.5 mL 1 or 2*
9-12 yrs subvirion 0.5 mL 1
> 12 yrs whole-virion or subvirion 0.5 mL 1
*Two doses are recommended for children <9 years of age who are receiving influenza
vaccine for the first time. Wait at least one month in between doses.
Polio vaccination
To eliminate the risk of vaccine-associated paralytic polio, an all-IPV (inactivated polio vaccine)
schedule is now recommended for routine childhood polio vaccination in the US. OPV (oral polio
vaccine) may be used only for the following special circumstances:
-mass vaccination campaigns to control outbreaks of paralytic polio
-unvaccinated children who will be traveling in <4 weeks to areas where polio is endemic or epidemic
-children of parents who do not accept the recommended number of vaccine injections
Hepatitis A Vaccine
Immunization with hepatitis A vaccine is indicated for >2 year olds who are or will be at increased
risk of infection by hepatitis A: travelers to endemic areas, populations with high incidence of
disease such as native Alaskans, chronic liver disease.
Endocarditis Prophylaxis
For Dental and Upper Respiratory Procedures:
Oral: Amoxicillin 50 mg/kg (max 2 gm) one hour prior to procedure.
Oral, if penicillin allergic: Clindamycin 20 mg/kg (max 600 mg) or cephalexin 50 mg/kg (max
2 gm) or azithromycin/clarithromycin 15 mg/kg (max 500 mg) one hour before procedure.
IV/IM: Ampicillin 50 mg/kg (max 2 gm) 30 minutes before procedure
IV/IM, if penicillin allergic: Clindamycin 20 mg/kg (max 600 mg) or cefazolin 25 mg/kg (max
1 gm) 30 minutes before procedure.
For Gastrointestinal and Genitourinary Procedures:
High-Risk Patients: Ampicillin 50 mg/kg (max 2 gm) IV/IM plus gentamicin 1.5 mg/kg (max
120 mg) IV/IM within 30 minutes before starting procedure; then ampicillin 25 mg/kg (max
1 gm) IV or amoxicillin 25 mg/kg (max 1 gm) PO six hours later.
High-Risk Patients Allergic to Penicillins: Vancomycin 20 mg/kg (max 1 gm) IV over 1-2
hours plus gentamicin 1.5 mg/kg (max 120 mg) IV/IM - complete injections/infusion within
30 minutes before starting procedure.
Moderate-Risk Patients: Amoxicillin 50 mg/kg (max 2 gm) PO one hour before procedure
or ampicillin 50 mg/kg (max 2 gm) IV/IM within 30 minutes before starting procedure.
Moderate-Risk Patients Allergic to Penicillins: Vancomycin 20 mg/kg (max 1 gm) IV over
1 hour; complete infusion within 30 minutes of starting procedure.
52
High-risk patients include those with prosthetic cardiac valves, previous bacterial endocarditis,
complex cyanotic congenital heart disease, or surgically constructed systemic pulmonary shunts
or conduits. Moderate-risk patients include those with other congenital cardiac malformations,
acquired valvar dysfunction, hypertrophic cardiomyopathy, or mitral valve prolapse with valvar
regurgitation and/or thickened leaflets. Streptococci viridans are the most common cause of endocarditis
after dental or upper respiratory procedures; enterococci are the most common cause of endocarditis
after gastrointestinal or genitourinary procedures.
Parenteral Nutrition
Total Parenteral Nutrition Requirements
Infants-25 kg 25-45 kg >45 kg
Calories 90-120 kcal/kg/day 60-105 kcal/kg/day 40-75 kcal/kg/day
Fluid 120-180 mL/kg/day 120-150 mL/kg/day 50-75 mL/kg/day
Dextrose 4-6 mg/kg/min 7-8 mg/kg/min 7-8 mg/kg/min
Protein 2.5-3 gm/kg/day 1.5-2.5 gm/kg/day 0.8-2.0 gm/kg/day
Sodium 2-5 mEq/kg/day 2-5 60-150 mEq/day

mEq/kg/day
Potassium 2-4 mEq/kg/day 2-4 70-150 mEq/day

mEq/kg/day
Chloride 2-3 mEq/kg/day 2-3 2-3 mEq/kg/day

mEq/kg/day
Calcium 1-2 mEq/kg/day 0.5-1.5 mEq/kg/day 0.2-0.3 mEq/kg/day
Phosphate 0.5-1.5 mMol/kg/day 0.5-1.0 mMol/kg/day 7-10

mMol/1000 cal
Magnesium 1 0.5-1 mEq/kg/day 0.35-0.45 mEq/kg/day

mEq/kg/day
Multi-Trace 1 mL/day 1 mL/day 1 mL/day

Element
Formula
Insulin and Acetate, if indicated.
53
Dextrose Infusion:
Dextrose in mg/kg/min = % Dextrose x rate (mL/hr) x 0.167 divided by weight in kilograms
Dextrose% = kcal desired x 2.89 divided by mL volume of TPN solution
Amino Acids (Protein):

% of amino acids = (amino acid requirement in gm x 100 ) divided by volume of fluid of TPN in
mL
Neonates and Infants: Start with 0.5 gm/kg/day and increase by 0.5-1 gm/kg/day as tolerated
Children and Young Adults: Start with 1 gm/kg/day and increase by 0.5-1 gm/kg/day as tolerated.
Lipid solution:
10% soln = 1 gm/10 mL = 1.1 kcal/mL; 20% soln = 2 gm/10 mL = 2.0 kcal/mL. For infants, children,
and young adults: Begin with 1 gm/kg/day, and advance as tolerated by 0.5-1 gm/kg/day. Usual
maximum is 3 gm/kg/day or 40% of calories per day. Monitor serum triglyceride 6h after infusion
(maintain <200 mg/dL)
Parenteral Multivitamin - Dosage:

Neonates Peds MVI 2mL/kg/day (max 5 mL/day)
Children <11 yrs Peds MVI 5mL/day
>11 yrs MVC 9+3 10 mL/day
54
Diphtheria
Diphtheria
Diphtheria is an acute, toxin-mediated disease caused by the
bacterium Corynebacterium diphtheriae. The name of the
disease is derived from the Greek diphthera, meaning leather
hide. The disease was described in the 5th century BCE by
Hippocrates, and epidemics were described in the 6th century
AD by Aetius. The bacterium was first observed in
diphtheritic membranes by Klebs in 1883 and cultivated by 5
Lffler in 1884. Antitoxin was invented in the late 19th
century, and toxoid was developed in the 1920s.
Corynebacterium diphtheriae
C. diphtheriae is an aerobic gram-positive bacillus. Toxin
production (toxigenicity) occurs only when the bacillus is
itself infected (lysogenized) by a specific virus (bacteriophage)
carrying the genetic information for the toxin (tox gene).
Only toxigenic strains can cause severe disease.
Culture of the organism requires selective media containing

tellurite. If isolated, the organism must be distinguished in
the laboratory from other Corynebacterium species that nor-
mally inhabit the nasopharynx and skin (e.g., diphtheroids).
C. diphtheriae has three biotypesgravis, intermedius, and

mitis. The most severe disease is associated with the gravis
biotype, but any strain may produce toxin. All isolates of
C. diphtheriae should be tested by the laboratory for toxigenicity.
Pathogenesis
Susceptible persons may acquire toxigenic diphtheria bacilli
in the nasopharynx. The organism produces a toxin that
inhibits cellular protein synthesis and is responsible for local
tissue destruction and membrane formation. The toxin pro-
duced at the site of the membrane is absorbed into the
bloodstream and then distributed to the tissues of the body.
The toxin is responsible for the major complications of
myocarditis and neuritis and can also cause low platelet
counts (thrombocytopenia) and protein in the urine (proteinuria).
Clinical disease associated with nontoxin-producing strains

is generally milder. While rare severe cases have been reported,
these may actually have been caused by toxigenic strains
that were not detected because of inadequate culture sampling.
Clinical Features
The incubation period of diphtheria is 25 days
(range, 110 days).
Disease can involve almost any mucous membrane. For clinical

purposes, it is convenient to classify diphtheria into a
number of manifestations, depending on the site of disease.
57
Diphtheria
Anterior Nasal Diphtheria
The onset of anterior nasal diphtheria is indistinguishable
from that of the common cold and is usually characterized
by a mucopurulent nasal discharge (containing both mucus
and pus) which may become blood-tinged. A white membrane
usually forms on the nasal septum. The disease is usually
fairly mild because of apparent poor systemic absorption of
5 toxin in this location, and it can be terminated rapidly by
antitoxin and antibiotic therapy.
Pharyngeal and Tonsillar Diphtheria

The most common sites of diphtheria infection are the
pharynx and the tonsils. Infection at these sites is usually
associated with substantial systemic absorption of toxin.
The onset of pharyngitis is insidious. Early symptoms
include malaise, sore throat, anorexia, and low-grade fever.
Within 23 days, a bluish-white membrane forms and
extends, varying in size from covering a small patch on the
tonsils to covering most of the soft palate. Often by the time
a physician is contacted, the membrane is greyish-green, or
black if bleeding has occurred. There is a minimal amount
of mucosal erythema surrounding the membrane. The
membrane is adherent to the tissue, and forcible attempts to
remove it cause bleeding. Extensive membrane formation
may result in respiratory obstruction.
The patient may recover at this point; or if enough toxin is

absorbed, develop severe prostration, striking pallor, rapid
pulse, stupor, and coma, and may even die within 6 to 10
days. Fever is usually not high, even though the patient may
appear quite toxic. Patients with severe disease may develop
marked edema of the submandibular areas and the anterior
neck along with lymphadenopathy, giving a characteristic
bullneck appearance.
Laryngeal Diphtheria
Laryngeal diphtheria can be either an extension of the
pharyngeal form or can only involve this site. Symptoms
include fever, hoarseness, and a barking cough. The membrane
can lead to airway obstruction, coma, and death.
Cutaneous (Skin) Diphtheria

In the United States, cutaneous diphtheria has been most
often associated with homeless persons. Skin infections are
quite common in the tropics and are probably responsible
for the high levels of natural immunity found in these popu-
lations. Skin infections may be manifested by a scaling rash
or by ulcers with clearly demarcated edges and membrane,
but any chronic skin lesion may harbor C. diphtheriae along
with other organisms. Generally, the organisms isolated from
58
Diphtheria
recent cases in the United States were nontoxigenic. The
severity of the skin disease with toxigenic strains appears to
be less than in other forms of infection with toxigenic
strains. Skin diseases associated with nontoxigenic strains
are no longer reported to the National Notifiable Diseases
Surveillance System in the United States.
Other sites of involvement include the mucous membranes 5

of the conjunctiva and vulvovaginal area, as well as the
external auditory canal.
Complications
Most complications of diphtheria, including death, are
attributable to effects of the toxin. The severity of the disease
and complications are generally related to the extent of
local disease. The toxin, when absorbed, affects organs and
tissues distant from the site of invasion. The most frequent
complications of diphtheria are myocarditis and neuritis:
Myocarditis may present as abnormal cardiac rhythms
and can occur early in the course of the illness or weeks
later, and can lead to heart failure. If myocarditis occurs
early, it is often fatal.
Neuritis most often affects motor nerves and usually

resolves completely. Paralysis of the soft palate is most
frequent during the third week of illness. Paralysis of eye
muscles, limbs, and diaphragm can occur after the fifth
week. Secondary pneumonia and respiratory failure may
result from diaphragmatic paralysis.
Other complications include otitis media and respiratory

insufficiency due to airway obstruction, especially in
infants.
Death
The overall case-fatality rate for diphtheria is 5%10%,
with higher death rates (up to 20%) among persons younger
than 5 and older than 40 years of age. The case-fatality rate
for diphtheria has changed very little during the last 50 years.
Laboratory Diagnosis
Diagnosis of diphtheria is usually made on the basis of
clinical presentation since it is imperative to begin
presumptive therapy quickly.
Culture of the lesion is done to confirm the diagnosis. It is

critical to take a swab of the pharyngeal area, especially any
discolored areas, ulcerations, and tonsillar crypts. Culture
medium containing tellurite is preferred because it provides
a selective advantage for the growth of this organism.
59
Diphtheria
A blood agar plate is also inoculated for detection of
hemolytic streptococcus. If diphtheria bacilli are isolated,
they must be tested for toxin production.
Gram stain and Kenyon stain of material from the

membrane itself can be helpful when trying to confirm the
clinical diagnosis. The Gram stain may show multiple
5 club-shaped forms that look like Chinese characters. Other
Corynebacterium species (diphtheroids) that can normally
inhabit the throat may confuse the interpretation of direct
stain. However, treatment should be started if clinical
diphtheria is suggested, even in the absence of a diagnostic
Gram stain.
In the event that prior antibiotic therapy may have impeded

a positive culture in a suspect diphtheria case, two sources of
evidence can aid in presumptive diagnosis: 1) isolation of
C. diphtheriae from cultures of specimens from close contacts,
or 2) a low nonprotective diphtheria antibody titer
(less than 0.1 IU) in serum obtained prior to antitoxin
administration. This is done by commercial laboratories and
requires several days. To isolate C. diphtheriae from carriers, it
is best to inoculate a Lffler or Pai slant with the throat
swab. After an incubation period of 1824 hours, growth from
the slant is used to inoculate a medium containing tellurite.
Medical Management
Diphtheria Antitoxin
Diphtheria antitoxin, produced in horses, was first used in
the United States in 1891. It is no longer indicated for
prophylaxis of contacts of diphtheria patients, only for the
treatment of diphtheria. Since 1997, diphtheria antitoxin
has been available only from CDC, and only through an
Investigational New Drug (IND) protocol.
Antitoxin will not neutralize toxin that is already fixed to

tissues, but it will neutralize circulating (unbound) toxin
and will prevent progression of disease. The patient must be
tested for sensitivity before antitoxin is given. Consultation
on the use of diphtheria antitoxin is available through the
duty officer at the National Immunization Program during
office hours (8:00 a.m.4:30 p.m. ET) at 404-639-8257, or
at all other times through CDC's Directors Emergency
Operations Center at 770-488-7100.
Persons with suspected diphtheria should be given antibiotics

and antitoxin in adequate dosage and placed in isolation
after the provisional clinical diagnosis is made and appropriate
cultures are obtained. Respiratory support and airway
maintenance should also be administered as needed.
60
Diphtheria
Antibiotics
Treatment with erythromycin orally or by injection
(40 mg/kg/day; maximum, 2 gm/day) for 14 days, or procaine
penicillin G daily, intramuscularly (300,000 U/day for those
weighing 10 kg or less, and 600,000 U/day for those weighing
more than 10 kg) for 14 days. The disease is usually not
contagious 48 hours after antibiotics are instituted.
Elimination of the organism should be documented by two 5
consecutive negative cultures after therapy is completed.
Preventive Measures
For close contacts, especially household contacts, a
diphtheria booster, appropriate for age, should be given.
Contacts should also receive antibioticsbenzathine
penicillin G (600,000 units for persons younger than 6 years
old and l,200,000 units for those 6 years old and older) or a
7- to 10-day course of oral erythromycin, (40 mg/kg/day for
children and 1 g/day for adults). For compliance reasons, if
surveillance of contacts cannot be maintained, they should
receive benzathine penicillin G. Identified carriers in the
community should also receive antibiotics. Maintain close
surveillance and begin antitoxin at the first signs of illness.
Contacts of cutaneous diphtheria should be treated as

described above; however, if the strain is shown to be non-
toxigenic, investigation of contacts can be discontinued.
Epidemiology
Occurrence
Diphtheria occurs worldwide, but clinical cases are more
prevalent in temperate zones. In the United States during
the pretoxoid era, the highest incidence was in the
Southeast during the winter. More recently, highest incidence
rates have been in states with significant populations of
Native Americans. No geographic concentration of cases is
currently observed in the United States.
Reservoir
Human carriers are the reservoir for C. diphtheriae and are
usually asymptomatic. In outbreaks, high percentages of
children are found to be transient carriers.
Transmission
Transmission is most often person-to-person spread from the
respiratory tract. Rarely, transmission may occur from skin
lesions or articles soiled with discharges from lesions of
infected persons (fomites).
61
Diphtheria
Temporal Pattern
In temperate areas, diphtheria most frequently occurs during
winter and spring.
Communicability
Transmission may occur as long as virulent bacilli are pres-
5 ent in discharges and lesions. The time is variable, but
organisms usually persist 2 weeks or less, and seldom more
than 4 weeks, without antibiotics. Chronic carriers may
shed organisms for 6 months or more. Effective antibiotic
therapy promptly terminates shedding.
Secular Trends in the United States

Diphtheria was once a major cause of morbidity and mortality
among children. In England and Wales during the 1930s,
diphtheria was among the top three causes of death for
children younger than 15 years of age.
In the 1920s in the United States, 100,000200,000 cases

of diphtheria (140150 cases per 100,000 population) and
13,00015,000 deaths were reported each year. In 1921, a
total of 206,000 cases and 15,520 deaths were reported. The
number of cases gradually declined to about 19,000 cases in
1945 (15 per 100,000 population). A more rapid decrease
began with the widespread use of toxoid in the late 1940s.
From 1970 to 1979, an average of 196 cases per year were

reported. This included a high proportion of cutaneous cases
from an outbreak in Washington State. Beginning in 1980,
all cases with nontoxigenic cutaneous isolates were excluded
from reporting. Diphtheria was seen most frequently in
Native Americans and persons in lower socioeconomic strata.
From 1980 through 2004, 57 cases of diphtheria were

reported in the United States, an average of 23 per year
(range, 05 cases per year). Only 5 cases have been reported
since 2000.
Of 53 reported cases with known patient age since 1980, 31

(58%) were in persons 20 years of age or older; 44% of cases
were among persons 40 years of age or older. Most cases
have occurred in unimmunized or inadequately immunized
persons. The current age distribution of cases corroborates
the finding of inadequate levels of circulating antitoxin in
many adults (up to 60% with less than protective levels).
Although diphtheria disease is rare in the United States, it

appears that Corynebacterium diphtheriae continues to
circulate in areas of the country with previously endemic
diphtheria. In 1996, 10 isolates of C. diphtheriae were
obtained from persons in an Native American community
in South Dakota. Eight of these isolates were toxigenic.
62
Diphtheria
None of the infected persons had classic diphtheria disease,
although five had either pharyngitis or tonsillitis. The
presence of toxigenic C. diphtheriae in this community is a
good reminder for providers not to let down their guard
against this organism.
Diphtheria continues to occur in other parts of the world.

A major epidemic of diphtheria occurred in countries of the 5
former Soviet Union beginning in 1990. By 1994, the epidemic
had affected all 15 Newly Independent States (NIS). More
than 157,000 cases and more than 5,000 deaths were reported.
In the 6 years from 1990 through 1995, the NIS accounted
for more than 90% of all diphtheria cases reported to the
World Health Organization from the entire world. In some
NIS countries, up to 80% of the epidemic diphtheria cases
have been among adults. The outbreak and the age distribution
of cases are believed to be due to several factors, including a
lack of routine immunization of adults in these countries.
Diphtheria Toxoid
Characteristics
Beginning in the early 1900s, prophylaxis was attempted
with toxinantitoxin mixtures. Toxoid was developed
around 1921 but was not widely used until the early 1930s.
It was incorporated with tetanus toxoid and pertussis
vaccine and became routinely used in the 1940s.
Diphtheria toxoid is produced by growing toxigenic

C. diphtheriae in liquid medium. The filtrate is incubated with
formaldehyde to convert toxin to toxoid and is then
adsorbed onto an aluminum salt.
Single-antigen diphtheria toxoid is not available.

Diphtheria toxoid is available combined with tetanus toxoid
as pediatric DT or adult Td, and with both tetanus toxoid
and acellular pertussis vaccine as DTaP and Tdap.
Diphtheria toxoid is also available as a combined
DTaP-inactivated poliovirus (IPV)-hepatitis B combination
(Pediarixsee the pertussis chapter for more information).
Pediatric formulations (DT and DTaP) contain a similar
amount of tetanus toxoid as adult Td, but contain 34 times
as much diphtheria toxoid. Children younger than 7 years of
age should receive either DTaP or pediatric DT. Persons 7
years of age or older should receive the adult formulation
(adult Td), even if they have not completed a series of
DTaP or pediatric DT. Two brands of Tdap are available
Boostrix (approved for children 1018 years of age) and
Adacel (approved for persons 1164 years of age). DTaP and
Tdap vaccines do not contain thimerosal as a preservative.
63
Diphtheria
Immunogenicity and Vaccine Efficacy
After a primary series of three properly spaced diphtheria
toxoid doses in adults or four doses in infants, a protective
level of antitoxin (defined as greater than 0.1 IU of
antitoxin/mL) is reached in more than 95%. Diphtheria
toxoid has been estimated to have a clinical efficacy of 97%.
5
Vaccination Schedule and Use
DTaP (diphtheria and tetanus toxoids and acellular pertussis
vaccine) is the vaccine of choice for children 6 weeks
through 6 years of age. The usual schedule is a primary series
of 4 doses at 2,4,6, and 1518 months of age. The first,
second, and third doses of DTaP should be separated by a
minimum of 4 weeks. The fourth dose should follow the
third dose by no less than 6 months, and should not be
administered before 12 months of age.
If a child has a valid contraindication to pertussis vaccine,

pediatric DT should be used to complete the vaccination
series. If the child was younger than 12 months old when
the first dose of DT was administered (as DTP, DTaP, or
DT), the child should receive a total of four primary DT
doses. If the child was 12 months of age or older at the time
the first dose of DT was administered, three doses (third
dose 612 months after the second) completes the primary
DT series.
If the fourth dose of DT, DTP or DTaP is administered

before the fourth birthday, a booster (fifth) dose is recom-
mended at 46 years of age. The fifth dose is not required if
the fourth dose was given on or after the fourth birthday.
Because of waning antitoxin titers, most persons have antitoxin

levels below the optimal level 10 years after the last dose.
Tetanus toxoid should be given with diphtheria toxoid as
Td every 10 years. The first booster dose may be given at
1112 years of age if at least 5 years have elapsed since the
last dose of DTP, DTaP, or DT. ACIP recommends this dose
be administered as Tdap. If a dose is given sooner as part of
wound management, the next booster is not needed for 10
years thereafter. More frequent boosters are not indicated
and have been reported to result in an increased incidence
and severity of local adverse reactions.
Td is the vaccine of choice for children 7 years and older

and for adults. A primary series is three or four doses,
depending on whether the person has received prior doses of
diphtheria-containing vaccine and the age these doses were
administered. The number of doses recommended for
children who received one or more doses of DTP, DTaP, or
DT before age 7 years is discussed above. For unvaccinated
persons 7 years and older (including persons who cannot
64
Diphtheria
document prior vaccination), the primary series is three
doses. The first two doses should be separated by at least 4
weeks, and the third dose given 612 months after the second.
ACIP recommends that one of these doses (preferably the
first) be administered as Tdap. A booster dose of Td should
be given every 10 years. Tdap is approved for a single dose
at this time (i.e., it should not be used for all the doses of
Td in a previously unvaccinated person 7 years or older). 5
Refer to the pertussis chapter for more information about Tdap.
Interruption of the recommended schedule or delay of

subsequent doses does not reduce the response to the vaccine
when the series is finally completed. There is no need to
restart a series regardless of the time elapsed between doses.
Diphtheria disease might not confer immunity. Persons

recovering from diphtheria should begin or complete active
immunization with diphtheria toxoid during convalescence.
Adverse Reactions Following

Vaccination
Local reactions, generally erythema and induration with or
without tenderness, are common after the administration of
vaccines containing diphtheria toxoid. Local reactions are
usually self-limited and require no therapy. A nodule may be
palpable at the injection site for several weeks. Abscess at
the site of injection has been reported. Fever and other
systemic symptoms are not common.
Exaggerated local (Arthus-type) reactions are occasionally

reported following receipt of a diphtheria- or tetanus-containing
vaccine. These reactions present as extensive painful
swelling, often from shoulder to elbow. They generally begin
28 hours after injections and are reported most often in
adults, particularly those who have received frequent doses
of diphtheria or tetanus toxoid. Persons experiencing these
severe reactions usually have very high serum antitoxin levels;
they should not be given further routine or emergency
booster doses of Td more frequently than every 10 years.
Less severe local reactions may occur in persons who have
multiple prior boosters.
Rarely, severe systemic reactions such as generalized

urticaria, anaphylaxis, or neurologic complications have
been reported following administration of diphtheria toxoid.
Contraindications and Precautions

to Vaccination
Persons with a history of a severe allergic reaction following
a prior dose should not receive additional doses of diphtheria
toxoid. Diphtheria toxoid should be deferred for those
65
Diphtheria
persons who have moderate to severe acute illness, but
persons with minor illness may be vaccinated.
Immunosuppression and pregnancy are not contraindications
to receiving diphtheria toxoid. See pertussis chapter for
additional information on contraindications and precautions
to Tdap.
5 Vaccine Storage and Handling

DTaP, DT (pediatric), Td, DTP/Hib, Tdap, and tetanus
toxoid should be stored continuously at 3546F (28C).
The vaccine may be out of refrigeration for as long as
4 days, but it should be refrigerated immediately when
received. Freezing reduces the potency of the tetanus
component. Vaccine exposed to freezing temperature
should never be administered.
Suspect Case Investigation

and Control
Immediate action on all highly suspect cases (including
cutaneous) is warranted until they are shown not to be
caused by toxigenic C. diphtheriae. The following action
should also be taken for any toxigenic C. diphtheriae carriers
who are detected.
1. Contact state health department or CDC.
2. Obtain appropriate cultures and preliminary clinical and

epidemiologic information (including vaccine history).
3. Begin early presumptive treatment with antibiotics and

antitoxin. Impose strict isolation until at least two
cultures are negative 24 hours after antibiotics were
discontinued.
4. Identify close contacts, especially household members

and other persons directly exposed to oral secretions of
the patient. Culture all close contacts, regardless of their
immunization status. Ideally, culture should be from both
throat and nasal swabs. After culture, all contacts should
receive antibiotic prophylaxis. Inadequately immunized
contacts should receive DTaP/DT/Td/Tdap boosters. If
fewer than three doses of diphtheria toxoid have been
given, or vaccination history is unknown, an immediate
dose of diphtheria toxoid should be given and the pri-
mary series completed according to the current schedule.
If more than 5 years have elapsed since administration of
diphtheria toxoid-containing vaccine, a booster dose
should be given. If the most recent dose was within 5
years, no booster is required (see the ACIP's 1991
Diphtheria, Tetanus, and Pertussis: Recommendations for
Vaccine Use and Other Preventive Measures for schedule for
66
Diphtheria
children younger than 7 years of age.) Unimmunized
contacts should start a course of DTaP/DT/Td vaccine
and be monitored closely for symptoms of diphtheria
for 7 days.
5. Treat any confirmed carrier with an adequate course of

antibiotic, and repeat cultures at a minimum of 2 weeks
to ensure eradication of the organism. Persons who 5
continue to harbor the organism after treatment with
either penicillin or erythromycin should receive an
additional 10-day course of erythromycin and should
submit samples for follow-up cultures.
6. Treat any contact with antitoxin at the first sign

of illness.
Selected References
CDC. Diphtheria, tetanus, and pertussis: Recommendations
for vaccine use and other preventive measures. MMWR
1991;40 (No. RR-10):128.
CDC. Pertussis vaccination: use of acellular pertussis

vaccines among infants and young children.
Recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR 1997;46
(No. RR-7):125.
CDC. Provisional recommendations for the use of Tdap are

available at
http://www.cdc.gov/nip/recs/provisional_recs/default.htm
CDC. Update: Diphtheria epidemicNewly Independent

States of the Former Soviet Union, January 1995March
1996. MMWR 1996;45:6937.
CDC. Toxigenic Corynebacterium diphtheriaeNorthern

Plains Indian community, AugustOctober 1996. MMWR
1993;42:8401, 847.
Farizo KM, Strebel PM, Chen RT, Kimbler A, Cleary TJ,

Cochi SL. Fatal respiratory disease due to Corynebacterium
diphtheriae: case report and review of guidelines for
management, investigation, and control. Clin Infect Dis
1993;16:5968.
Hardy IRB. Diphtheria. In: Evans AS, Brachman PS, eds.

Bacterial Infections of Humans. Epidemiology and Control.
3rd ed. New York, NY: Plenum Medical Book Company;
1998:25368.
67
Diphtheria
Orenstein WA, Hadler S, Wharton M. Trends in vaccine-
preventable diseases. Semin Pediatr Infect Dis 1997;8:2333.
Vitek CR, Wharton M. Diphtheria in the former Soviet

Union: reemergence of a pandemic disease. Emerg Infect Dis
1998;4:53950.
5 Wharton M, Vitek CR. Diphtheria. In Plotkin SA,

Orenstein WA, eds. Vaccines. 4th ed. Philadelphia, PA:
Saunders, 2003:21128.
68
General Recommendations on Immunization
General Recommendations
on Immunization 2
This chapter discusses issues that are commonly encountered
in vaccination practices. A more thorough discussion of
issues common to more than one vaccine can be found in
the General Recommendations on Immunization:
Recommendations of the Advisory Committee on
Immunization Practices and the American Academy of
Family Physicians. These recommendations are revised
every 35 years as needed; the most current edition was
published in February 2002 (MMWR 2002;51(RR2):136).
A revised document is expected to be published in 2006.
All providers who administer vaccine should have a copy of
this report and be familiar with its contents. It can be
downloaded from the MMWR website or ordered in print
version from the Centers for Disease Control and Prevention.
Timing and Spacing of Vaccines

The timing and spacing of vaccine doses are two of the
most important issues in the appropriate use of vaccines.
Specific circumstances that are commonly encountered in
immunization practice are the timing of antibody-containing
blood products and live vaccines (particularly measles
vaccine), simultaneous and nonsimultaneous administration
of different vaccines, and the interval between subsequent
doses of the same vaccine.
General Rule
Inactivated vaccines generally are not affected by circulating
antibody to the antigen.
Live attenuated vaccines may be affected by circulating
antibody to the antigen.
AntibodyVaccine Interactions
The presence of circulating antibody to a vaccine antigen
may reduce or completely eliminate the immune response to
the vaccine. The amount of interference produced by
circulating antibody generally depends on the type of
vaccine administered and the amount of antibody.
Inactivated antigens are generally not substantially affected by

circulating antibody, so they can be administered before, after,
or at the same time as the antibody. Simultaneous
administration of antibody (in the form of immune globulin)
and vaccine is recommended for postexposure prophylaxis of
certain diseases, such as hepatitis B, rabies, and tetanus.
9
Live vaccines must replicate in order to cause an immune
response. Antibody against parenteral (injected) live vaccine
2 antigen may interfere with replication. If a live parenteral
vaccine (measles-mumps-rubella [MMR] or varicella) must
be given around the time that antibody is given, the two
must be separated by enough time so that the antibody does
not interfere with viral replication. If the live vaccine is
given first, it is necessary to wait at least 2 weeks (i.e., an
incubation period) before giving the antibody. If the interval
between the vaccine and antibody is less than 2 weeks, the
recipient should be tested for immunity or the vaccine dose
should be repeated.
If the antibody is given before a dose of MMR or varicella

vaccine, it is necessary to wait until the antibody has waned
(degraded) before giving the vaccine to reduce the chance
of interference by the antibody. The necessary interval
between an antibody-containing product and MMR or varicella
vaccine depends on the concentration of antibody in the
product. A table listing the recommended intervals between
administration of antibody products and live vaccines
(MMR and varicella) is included in Appendix A and in the
General Recommendations on Immunization. The interval
between administration of an antibody product and MMR
or varicella vaccination can be as long as 11 months.
Although passively acquired antibodies can interfere with

the response to rubella vaccine, the low dose of anti-Rho(D)
globulin administered to postpartum women has not been
demonstrated to reduce the response to the RA27/3 strain
rubella vaccine. Because of the importance of rubella
immunity among childbearing age women, postpartum
vaccination of rubella-susceptible women with rubella or
MMR vaccine should not be delayed because of receipt of
anti-Rho(D) globulin or any other blood product during the
last trimester of pregnancy or at delivery. These women
should be vaccinated immediately after delivery and, if
possible, tested 3 months later to ensure immunity to rubella
and, if necessary, to measles.
Oral typhoid, and yellow fever vaccines are not affected by

the administration of immune globulin or blood products.
They may be given simultaneously with blood products, or
separated by any interval. These vaccines are not affected
because few North Americans are immune to yellow fever or
typhoid. Consequently, donated blood products in the
United States do not contain a significant amount of
antibody to these organisms. The effect of circulating
antibody on live attenuated influenza vaccine is not known.
Two antibody products are available for the prevention of

respiratory syncytial virus (RSV) infection in infants and
young children. RSV-IG (RespiGam) is an intravenous
10
human immune globulin product. RSV-IG contains other
human antibodies in addition to antibody to RSV, and
may interfere with live parenteral vaccines for as long as
2
9 months. Palivizumab (Synagis) contains only monoclonal
antibody to respiratory syncytial virus (RSV). It does not
interfere with the response to live virus vaccines.
General Rule
There is no contraindication to the simultaneous
administration of any vaccines.
Simultaneous and Nonsimultaneous

Administration
Simultaneous administration of the most widely used live
and inactivated vaccines does not result in decreased
antibody responses or increased rates of adverse reactions.
Simultaneous administration of all vaccines for which a child

is eligible can be very important in childhood vaccination
programs because it increases the probability that a child
will be fully immunized at the appropriate age. A study
during a measles outbreak in the early 1990s showed that
about one-third of measles cases in unvaccinated but
vaccine-eligible preschool children could have been
prevented if MMR had been administered at the same visit
when another vaccine was given.
Individual vaccines should not be mixed in the same syringe

unless they are licensed for mixing by the Food and Drug
Administration. Only the sanofi-pasteur Hib/DTaP (TriHIBit)
vaccine is licensed for mixing in the same syringe.
Nonsimultaneous Administration
of Different Vaccines
In some situations, vaccines that could be given simultaneously
are not (e.g., if the child is receiving vaccines from two
different providers). Live parenteral (injected) vaccines
(MMR, varicella, and yellow fever) and live attenuated
influenza vaccine (LAIV) that are not administered
simultaneously should be separated by at least 4 weeks.
This precaution is intended to reduce or eliminate interference
from the vaccine given first on the vaccine given later. If
two live parenteral vaccines or LAIV are not administered
simultaneously but are separated by less than 4 weeks, the
vaccine given second should be repeated in 4 weeks or
confirmed to be effective by serologic testing of the recipient
(serologic testing is not recommended for LAIV). An
exception to this recommendation is yellow fever vaccine
11
administered less than 4 weeks after single-antigen measles
vaccine. A 1999 study demonstrated that yellow fever vaccine
2 is not affected by measles vaccine given 127 days earlier.
The effect of nonsimultaneously administered rubella,
mumps, varicella, and yellow fever vaccines is not known.
Live vaccines administered by the oral route (oral polio

vaccine [OPV], oral typhoid) are not believed to interfere
with each other if not given simultaneously. These vaccines
may be given at any time before or after each other. Oral
typhoid is not licensed for children younger than 6 years of
age, and OPV is no longer available in the United States, so
these vaccines are not likely to be given to the same child.
Parenteral live vaccines (MMR, varicella, and yellow fever)

and LAIV are not believed to have an effect on live vaccines
given by the oral route (OPV, oral typhoid). Live oral
vaccines may be given at any time before or after live
parenteral vaccines or LAIV.
All other combinations of two inactivated vaccines, or live

and inactivated vaccines, may be given at any time before
or after each other.
General Rule
Increasing the interval between doses of a multidose
vaccine does not diminish the effectiveness of the vaccine.
Decreasing the interval between doses of a multidose
vaccine may interfere with antibody response and protection.
Interval Between Doses

of the Same Vaccine
Immunizations are recommended for members of the
youngest age group at risk for a disease for whom efficacy,
immunogenicity, and safety of a vaccine have been
demonstrated. Most vaccines in the childhood immunization
schedule require two or more doses for stimulation of an
adequate and persisting antibody response. Studies have
demonstrated that recommended ages and intervals between
doses of the same antigen(s) provide optimal protection or
have the best evidence of efficacy. Table 1 of the General
Recommendations on Immunization (included in Appendix A)
shows the recommended minimal ages and minimal inter-
vals between immunizations for vaccines in the
recommended childhood immunization schedule.
12
Administering doses of a multidose vaccine at shorter than

the recommended intervals might be necessary when an
2
infant or child is behind schedule and needs to be brought
up-to-date quickly or when international travel is pending.
In these cases, an accelerated schedule using the minimum
age or minimum interval criteria can be used. Accelerated
schedules should not be used routinely.
Vaccine doses should not be administered at intervals less

than the recommended minimal intervals or earlier than
the minimal ages. Two exceptions to this may occur. The
first is for measles vaccine during a measles outbreak, when
the vaccine may be administered at an age younger than
12 months (this dose would not be counted, and would be
repeated at 12 months of age or older). The second consid-
eration involves administering a dose a few days earlier than
the minimum interval or age, which is unlikely to have a
substantially negative effect on the immune response to that
dose. Although vaccinations should not be scheduled at an
interval or age less than the recommended minimums, a
child may have erroneously been brought to the office early,
or may have come for an appointment not specifically for
vaccination (for example, for an ear recheck). In these
situations, the clinician can consider administering the
vaccine earlier than the minimum interval or age. If the
parent/child is known to the clinician and is reliable, it is
preferable to reschedule the child for vaccination closer to
the recommended interval. If the parent/child is not known
to the clinician or is not reliable (e.g., habitually misses
appointments), it may be preferable to administer the
vaccine at that visit than to reschedule a later appointment
that may not be kept.
Vaccine doses administered up to 4 days before the minimum

interval or age can be counted as valid. This 4-day
recommendation does not apply to rabies vaccine because
of the unique schedule for this vaccine. Doses administered
5 days or earlier than the minimum interval or age should
not be counted as valid doses and should be repeated as age
appropriate. The repeat dose should be spaced after the
invalid dose by a time greater than the recommended
minimum interval shown in Table 1 of the General
Recommendations. In certain situations, local or state
requirements might mandate that doses of selected vaccines
be administered on or after specific ages, superseding these
4-day recommendations.
In some cases, a scheduled dose of vaccine may not be given

on time. If this occurs, the dose should be given at the next
visit. Not all permutations of all schedules for all vaccines
have been studied. However, available data indicate that
intervals between doses longer than those routinely recom-
13
mended do not affect seroconversion rate or titer when the
schedule was completed. Consequently, it is not necessary
2 to restart the series or add doses of any vaccine because of
an extended interval between doses. The only exception to
this rule is oral typhoid vaccine in some circumstances. In
the case of oral typhoid, some experts recommend repeating
the series if the four-dose series is extended to more than
3 weeks.
General Rule
Live attenuated vaccines generally produce
long-lasting immunity with a single dose.
Inactivated vaccines require multiple doses and
may require periodic boosting to maintain immunity.
Number of Doses
For live injected vaccines, the first dose administered at the
recommended age usually provides protection. An additional
dose is given to ensure seroconversion. For instance, 95%
to 98% of recipients will respond to a single dose of measles
vaccine. The second dose is given to ensure that nearly 100%
of persons are immune (i.e., the second dose is
insurance). Immunity following live vaccines is
long-lasting, and booster doses are not necessary.
For inactivated vaccines, the first dose administered at the

recommended age usually does not provide protection
(hepatitis A vaccine is an exception). A protective immune
response may not develop until the second or third dose.
For inactivated vaccines, antibody titers may decrease
(wane) below protective levels after a few years. This
phenomenon is most notable for tetanus and diphtheria.
For these vaccines, periodic boosting is required.
An additional dose is given to raise antibody back to
protective levels.
Not all inactivated vaccines require boosting throughout life.

For example, Haemophilus influenzae type b (Hib) vaccine does
not require boosting because Hib disease is very rare in
children older than 5 years of age. Hepatitis B vaccine does
not require boosting because of immunologic memory to the
vaccine and the long incubation period of hepatitis B
(which can produce an autoboost).
14
Adverse Reactions Following
Vaccination 2
Vaccines are intended to produce active immunity to specific
antigens. An adverse reaction is an untoward effect caused
by a vaccine that is extraneous to the vaccines primary
purpose of production of immunity. Adverse reactions are
also called vaccine side effect. A vaccine adverse event
refers to any adverse event that occurs following vaccination.
An adverse event could be a true vaccine reaction or just a
coincidental event, with further research needed to
distinguish between them.
Vaccine adverse reactions fall into three general categories:

local, systemic, and allergic. Local reactions are generally
the least severe and most frequent. Allergic reactions are
the most severe and least frequent.
The most common type of adverse reactions are local

reactions, such as pain, swelling, and redness at the site of
injection. Local reactions may occur with up to 50% of
vaccine doses, depending on the type of vaccine. Local
reactions are most common with inactivated vaccines,
particularly those, such as DTaP, that contain adjuvants.
Local adverse reactions generally occur within a few hours
of the injection and are usually mild and self-limited. On
rare occasions, local reactions may be very exaggerated or
severe. These are often referred to as hypersensitivity reactions,
although they are not allergic, as the term implies. These
reactions are also known as Arthus reactions, and are most
commonly seen with tetanus and diphtheria toxoids. Arthus
reactions are believed to be due to very high titers of
antibody, usually because of too many doses of toxoid.
Systemic adverse reactions are more generalized events and

include fever, malaise, myalgias (muscle pain), headache,
loss of appetite, and others. These symptoms are common
and nonspecific; they may occur in a vaccinated persons
because of the vaccine or may be caused by something
unrelated to the vaccine, like a concomitant viral infection.
Systemic adverse reactions were relatively frequent with

DTP vaccine, which contained a whole-cell pertussis com-
ponent. However, comparison of the frequency of systemic
adverse events among vaccine and placebo recipients shows
they are not common with inactivated vaccines currently in
use, including acellular pertussis vaccine.
Systemic adverse reactions may occur following receipt of

live attenuated vaccines. Live attenuated vaccines must
replicate in order to produce immunity. The adverse
reactions that follow live attenuated vaccines, such as fever
or rash, represent symptoms produced from that replication
and are similar to a mild form of the natural disease.
15
Systemic adverse reactions following live vaccines are usually
mild, and occur a week or two after the vaccine was given
2 (i.e., after an incubation period of the vaccine virus). LAIV
replicates in the mucous membranes of the nose and throat,
not in the lung. As a result, LAIV may cause upper respiratory
symptoms (like a cold) but not influenza-like symptoms.
A third type of vaccine adverse reaction is a severe

(anaphylactic) allergic reaction. The allergic reaction may
be caused by the vaccine antigen itself or some other
component of the vaccine, such as cell culture material,
stabilizer, preservatives, or antibiotic used to inhibit bacterial
growth. Severe allergic reactions to vaccines may be life-
threatening. Fortunately, they are very rare, occurring at a
rate of less than one in half a million doses. The risk of an
allergic reaction can be minimized by good screening prior
to vaccination. All providers who administer vaccines must
have an emergency protocol and supplies to treat anaphylaxis.
Reporting Vaccine Adverse Events

From 1978 to 1990, CDC conducted the Monitoring System
for Adverse Events Following Immunization (MSAEFI) in
the public sector. In 1990, MSAEFI was replaced by the
Vaccine Adverse Events Reporting System (VAERS), which
includes reporting from both public and private sectors.
Providers should report any clinically significant adverse
event that occurs after the administration of any vaccine
licensed in the United States.
Providers should report a clinically significant adverse event

even if they are unsure whether a vaccine caused the event.
The telephone number to call for answers to questions and
to obtain VAERS forms is 8008227967, or visit the
VAERS website at http://vaers.hhs.gov. VAERS now accepts
reports of adverse events through their online system.
(See Chapter 4, Vaccine Safety.)
Contraindications and Precautions

to Vaccination
Contraindications and precautions to vaccination generally
dictate circumstances when vaccines will not be given. Most
contraindications and precautions are temporary, and the
vaccine can be given at a later time.
A contraindication is a condition in a recipient that

increases the chance of a serious adverse reaction. It is a
condition in the recipient of the vaccine, not with the vaccine
per se. If the vaccine were given in the presence of that
condition, the resulting adverse reaction could seriously
16
harm the recipient. For instance, administering influenza
vaccine to a person with a true anaphylactic allergy to egg 2
could cause serious illness or death in the recipient. In general,
vaccines should not be administered when a contraindication
condition is present.
A precaution is similar to a contraindication. A precaution

is a condition in a recipient that might increase the chance
or severity of a serious adverse reaction, or compromise the
ability of the vaccine to produce immunity (such as
administering measles vaccine to a person with passive
immunity to measles from a blood transfusion). Injury could
result, but the chance of this happening is less than with a
contraindication. In general, vaccines are deferred when a
precaution condition is present. However, situations may
arise when the benefit of protection from the vaccine
outweighs the risk of an adverse reaction, and a provider
may decide to give the vaccine. For example, prolonged
crying or a high fever after a dose of whole-cell or acellular
pertussis vaccine is considered a precaution to subsequent
doses of pediatric pertussis vaccine. But if the child were at
high risk of pertussis exposure (e.g., during a pertussis
outbreak in the community), a provider may choose to
vaccinate the child and treat the adverse reaction if it
occurs. In this example, the benefit of protection from the
vaccine outweighs the harm potentially caused by the vaccine.
There are very few true contraindication and precaution

conditions. Only two of these conditions are generally
considered to be permanent: severe (anaphylactic) allergic
reaction to a vaccine component or following a prior dose
of a vaccine, and encephalopathy not due to another
identifiable cause occurring within 7 days of vaccination.
Four conditions are considered permanent precautions to

further doses of pediatric pertussis-containing vaccine:
o
temperature greater than 105 F, collapse or shock-like state
(hypotonic hyporesponsive episode), persistent inconsolable
crying lasting 3 or more hours occurring within 48 hours of
a dose, or a seizure, with or without fever, occurring within
3 days of a dose. The occurrence of one of these events
following DTaP vaccine is not a precaution to pertussis
vaccination of an adolescent or adult.
Two conditions are temporary contraindications to vaccination

with live vaccines: pregnancy and immunosuppression.
Two conditions are temporary precautions to vaccination:
moderate or severe acute illness (all vaccines), and recent
receipt of an antibody-containing blood product (MMR
and varicella only).
17
Allergy
2 A severe (anaphylactic) allergic reaction following a dose of
vaccine will almost always contraindicate a subsequent dose
of that vaccine. Severe allergies are those that are mediated
by IgE, occur within minutes or hours of receiving the
vaccine, and require medical attention. Examples of severe
allergic reactions are generalized urticaria (hives), swelling
of the mouth and throat, difficulty breathing, wheezing,
hypotension, or shock. With appropriate screening these
reactions are very rare following vaccination.
A table listing vaccine contents is included in Appendix B.

Persons may be allergic to the vaccine antigen, animal
protein, antibiotics, preservatives, or stabilizers. The most
common animal protein allergen is egg protein found in
vaccines prepared using embryonated chicken eggs (e.g.,
yellow fever and influenza vaccines). Ordinarily, persons
who are able to eat eggs or egg products can receive
vaccines that contain egg; persons with histories of
anaphylactic or anaphylactic-like allergy to eggs or egg
proteins should not. Asking persons whether they can eat
eggs without adverse effects is a reasonable way to screen
for those who might be at risk from receiving yellow fever
and influenza vaccines.
Several studies have shown that children who have a

history of severe allergy to eggs rarely have reactions to
MMR vaccine. This is probably because measles and mumps
vaccine viruses are both grown in chick embryo fibroblasts,
not actually in eggs. It appears that gelatin, not egg, might
be the cause of allergic reactions to MMR. As a result, in
1998, the Advisory Committee on Immunization Practices
removed severe egg allergy as a contraindication to measles
and mumps vaccines. Egg-allergic children may be vaccinated
with MMR without prior skin testing.
Certain vaccines contain trace amounts of neomycin.

Persons who have experienced anaphylactic reactions to
neomycin should not receive these vaccines. Most often,
a neomycin allergy reaction is a contact dermatitis, a
manifestation of a delayed-type (cell-mediated) immune
response, rather than anaphylaxis. A history of delayed-type
reactions to neomycin is not a contraindication for
administration of these vaccines.
Latex is liquid sap from the commercial rubber tree. Latex

contains naturally occurring impurities (e.g., plant proteins
and peptides), which are believed to be responsible for allergic
reactions. Latex is processed to form natural rubber latex
and dry natural rubber. Dry natural rubber and natural
rubber latex might contain the same plant impurities as
latex but in a lesser amounts. Natural rubber latex is used to
produce medical gloves, catheters, and other products. Dry
18
natural rubber is used in syringe plungers, vial stoppers, and
injection ports on intravascular tubing. Synthetic rubber
and synthetic latex also are used in medical gloves, syringe
2
plungers, and vial stoppers. Synthetic rubber and synthetic
latex do not contain natural rubber or natural latex, and
therefore, do not contain the impurities linked to allergic
reactions.
The most common type of latex sensitivity is contact-type

(type 4) allergy, usually as a result of prolonged contact with
latex-containing gloves. However, injection-procedureassociated
latex allergies among diabetic patients have been described.
Allergic reactions (including anaphylaxis) after vaccination
procedures are rare. Only one report of an allergic reaction
after administration of hepatitis B vaccine in a patient with
known severe allergy (anaphylaxis) to latex has been published.
If a person reports a severe (anaphylactic) allergy to latex,

vaccines supplied in vials or syringes that contain natural
rubber should not be administered unless the benefit of
vaccination clearly outweighs the risk of an allergic reaction
to the vaccine. For latex allergies other than anaphylactic
allergies (e.g., a history of contact allergy to latex gloves),
vaccines supplied in vials or syringes that contain dry
natural rubber or natural rubber latex can be administered.
Pregnancy
The concern about vaccinating pregnant women is with
infection of the fetus and is theoretical. Only smallpox
(vaccinia) vaccine has been shown to cause fetal injury.
However, since the theoretical possibility exists, live vaccines
should not be given to women known to be pregnant.
Since inactivated vaccines cannot replicate, they cannot

cause fetal infection. Inactivated vaccines should be
administered to pregnant women for whom they are
indicated. Susceptible household contacts of pregnant
women should receive MMR and varicella vaccines and
may receive LAIV, if eligible.
Immunosuppression
Live vaccines can cause severe or fatal reactions in
immunosuppressed persons due to uncontrolled replication
of the vaccine virus, particularly vaccinia and oral polio
vaccine virus (and rarely measles and varicella vaccine
virus). Severely immunosuppressed persons should not be
given live vaccines for this reason. Persons with isolated
B-cell deficiency may receive varicella vaccine. Inactivated
vaccines cannot replicate, so they are safe to use in
immunosuppressed persons. However, response to the
vaccine may be decreased.
19
Both diseases and drugs can cause significant immunosup-
pression. Persons with congenital immunodeficiency,
2 leukemia, lymphoma, or generalized malignancy should not
receive live vaccines. OPV should not be given if an
immunosuppressed person is in the household. However,
MMR, varicella vaccines, and LAIV may be given when an
immunosuppressed person lives in the same house.
Certain drugs may cause immunosuppression. For instance,

persons receiving cancer treatment with alkylating agents or
antimetabolites, or radiation therapy should not be given
live vaccines. Live vaccines can be given after chemotherapy
has been discontinued for at least 3 months. Persons receiving
large doses of corticosteroids should not receive live vaccines.
For example, this would include persons receiving
20 milligrams or more of prednisone daily or 2 or more
milligrams of prednisone per kilogram of body weight per
day for 14 days or longer.
Aerosolized steroids, such as inhalers for asthma, are not

contraindications to vaccination, nor are alternate-day,
rapidly tapering, and short (less than 14 days) high-dose
schedules, topical formulations, and physiologic replacement
schedules.
The safety and efficacy of live attenuated vaccines

administered concurrently with recombinant human
immune mediators and immune modulators is not known.
There is evidence that use of therapeutic monoclonal
antibodies, especially the anti-tumor necrosis factor agents
adalimumab, infliximab, and etanercept, may lead to
reactivation of latent tuberculosis infection and tuberculosis
disease and predispose to other opportunistic infections.
Because the safety of live attenuated vaccines for persons
receiving these drugs is not known, it is prudent to avoid
administration of live attenuated vaccines for at least a
month following treatment with these drugs.
Inactivated vaccines are not contraindicated for immuno-

suppressed persons. However, response to the vaccine may
be poor. Because a relatively functional immune system is
required to develop an immune response to a vaccine, an
immunosuppressed person may not be protected even if the
vaccine has been given. Additional recommendations for
vaccination of immunosuppressed persons are detailed in
the General Recommendations on Immunization.
HIV Infection
Persons infected with human immunodeficiency virus
(HIV) may have no symptoms, or may be severely immuno-
suppressed. In general, the same vaccination recommendations
apply as with other types of immunosuppression. Live-virus
vaccines are usually contraindicated, but inactivated vaccines
are not contraindicated.
20
Measles and varicella can be very severe illnesses in persons
with HIV infection and are often associated with complications.
Therefore, measles vaccine (as combination MMR vaccine)
2
and varicella vaccine are recommended for persons with
HIV infection who are asymptomatic or mildly immunosup-
pressed. However, persons with severe immunosuppression
due to HIV infection should not receive measles vaccine,
MMR, or varicella vaccine. Susceptible household contacts
of persons with HIV infection should receive MMR and
varicella vaccines. Persons with HIV infection should not
receive LAIV; they should receive inactivated influenza vaccine.
Vaccination of Hematopoietic Stem Cell

Transplant Recipients
Hematopoietic stem cell transplant (HSCT) is the infusion
of hematopoietic stem cells from a donor into a patient who
has received chemotherapy and often radiation, both of
which are usually bone marrow ablative. HSCT is used to
treat a variety of neoplastic diseases, hematologic disorders,
immunodeficiency syndromes, congenital enzyme deficiencies,
and autoimmune disorders. HSCT recipients can receive
either their own cells (i.e., autologous HSCT) or cells from
a donor other than the transplant recipient (i.e., allogeneic
HSCT).
Antibody titers to vaccine-preventable diseases (e.g.,

tetanus, poliovirus, measles, mumps, rubella, and encapsulated
bacteria [i.e., Streptococcus pneumoniae and Haemophilus
influenzae type b]) decline during the 14 years after allogeneic
or autologous HSCT if the recipient is not revaccinated.
HSCT recipients are at increased risk for certain vaccine-
preventable diseases. As a result, HSCT recipients should be
routinely revaccinated after HSCT, regardless of the source
of the transplanted stem cells. Revaccination with inactivated
vaccines should begin 12 months after HSCT. An exception
to this recommendation is for influenza vaccine, which
should be administered 6 months after HSCT and annually
thereafter for the life of the recipient. MMR vaccine should
be administered 24 months after transplantation if the
HSCT recipient is presumed to be immunocompetent.
Varicella, meningococcal, and pneumococcal conjugate
vaccines are not currently recommended for HSCT recipients
because of insufficient experience using these vaccines
among HSCT recipients.
Household and other close contacts of HSCT recipients and

healthcare workers who care for HSCT recipients should be
appropriately vaccinated, particularly against influenza,
measles, and varicella. Additional details of vaccination of
HSCT recipients and their contacts can be found in a CDC
report on this topic available at
http://www.cdc.gov/nip/publications/hsct-recs.pdf.
21
Moderate or Severe Acute Illness
2 There is no evidence that a concurrent acute illness reduces
vaccine efficacy or increases vaccine adverse events. The
concern is that an adverse reaction (particularly fever)
following vaccination could complicate the management of
a severely ill person. If a person has a moderate or severe
acute illness, vaccination with both live and inactivated
vaccines should be delayed until the illness has improved.
Minor, common illnesses (such as otitis media, upper

respiratory infections, colds, and diarrhea) are NOT
contraindications to vaccination.
Invalid Contraindications
to Vaccination
Some healthcare providers inappropriately consider certain
conditions or circumstances to be true contraindications or
precautions to vaccinations. Such conditions or circumstances
are known as invalid contraindications; they result in missed
opportunities to administer needed vaccines. Some of the
most common invalid contraindications are minor illnesses,
conditions related to pregnancy and breastfeeding, allergies
that are not anaphylactic in nature, and certain aspects of
the patients family history.
Minor Illness
Children with mild acute illnesses, such as low-grade fever,
upper respiratory infection (URI), colds, otitis media, and
mild diarrhea, can and should be vaccinated.
Several large studies have shown that young children with

URI, otitis media, diarrhea, and/or fever respond to measles
vaccine as well as those without these conditions. These
large studies refute the results of an earlier small study
(Krober, JAMA 1991) which suggested that minor infections
such as URIs might impair the response to measles vaccine.
Further, there is no evidence that mild diarrhea reduces the
success of immunization of infants in this country.
Low-grade fever is not a contraindication to immunization.

Temperature measurement is not necessary before
immunization if the infant or child does not appear ill and
the parent does not say the child is currently ill.
Antimicrobial Therapy
Antimicrobial agents do not have an effect on the immune
response to a vaccine. No commonly used antibiotic or
antiviral agent will inactivate a live-virus vaccine.
22
Disease Exposure or Convalescence
If a child is not moderately or severely ill, he or she should
be vaccinated. There is no evidence that either disease
2
exposure or convalescence will affect the response to a
vaccine or increase the likelihood of an adverse event.
Pregnancy or Immunosuppression in the

Household or Breastfeeding
It is critical that healthy household contacts of pregnant
women and immunosuppressed persons be vaccinated.
Vaccination of healthy contacts reduces the chance of
exposure of pregnant women and immunosuppressed persons.
Most vaccines, including live vaccines (MMR, varicella,
and yellow fever), can be given to infants or children who
are household contacts of pregnant or immunosuppressed
persons, as well as to breastfeeding infants. Vaccinia (smallpox)
vaccine is not recommended for household contacts of a
pregnant or immunosuppressed person in nonemergency
situations. Live attenuated influenza vaccine should not be
administered to persons who have contact with severely
immunosuppressed persons who are hospitalized and require
care in a protected environment (i.e., who are in isolation
because of immunosuppression). LAIV may be administered
to contacts of persons with lesser degrees of immunosuppression.
Measles and mumps vaccine viruses produce a noncommu-

nicable infection and are not transmitted to household
contacts. Rubella vaccine virus has been shown to be shed
in human milk, but transmission to an infant has rarely
been documented. Transmission of varicella vaccine virus is
not common, and most women and older immunosuppressed
persons are immune from having had chickenpox. LAIV
may be administered to a woman who is breastfeeding if she
is otherwise eligible. The risk of transmission of vaccine
virus is not known but is probably low. Breastfeeding does
not decrease the response to routine childhood vaccines.
Breastfeeding also does not extend or improve the passive
immunity to vaccine-preventable disease that is provided by
maternal antibody.
Premature Birth
Vaccines should be started on schedule based on the childs
chronological age. Premature infants have been shown to
respond adequately to vaccines used in infancy.
Studies demonstrate that decreased seroconversion rates

might occur among certain premature infants with low
birth weights (less than 2,000 grams) after administration
of hepatitis B vaccine at birth. However, by 1 month
chronological age, all premature infants, regardless of
initial birthweight or gestational age are as likely to
respond as adequately as older and larger infants.
23
All premature infants born to hepatitis B surface antigen
(HBsAg)positive mothers and mothers with unknown
2 HBsAg status must receive immunoprophylaxis with hepati-
tis B vaccine and hepatitis B immunoglobulin (HBIG) with-
in 12 hours after birth. If these infants weigh less than 2,000
grams at birth, the initial vaccine dose should not be count-
ed toward completion of the hepatitis B vaccine series, and
three additional doses of hepatitis B vaccine should be
administered beginning when the infant is 1 month of age.
The optimal timing of the first dose of hepatitis B vaccine

for premature infants of HBsAg-negative mothers with a
birth weight of less than 2,000 grams has not been determined.
These infants can begin the first dose of the hepatitis B vaccine
series at 1 month of chronological age. Premature infants
discharged from the hospital prior to 1 month chronological
age may also be given hepatitis B vaccine at discharge if
they are medically stable and showing consistent weight gain.
NonVaccine-Related Allergies
Infants and children with nonspecific allergies, duck or
feather allergy, or allergy to penicillin, children who have
relatives with allergies, and children taking allergy shots can
and should be immunized. No vaccine available in the
United States contains duck antigen or penicillin.
Nonanaphylactic Allergy to
Vaccine Component
Anaphylactic allergy to a vaccine component (such as egg
or neomycin) is a true contraindication to vaccination.
Nonanaphylactic allergy to a vaccine constituent is not a
contraindication to that vaccine.
Family History of Adverse Events

The only family history that is relevant in the decision to
vaccinate a child is immunosuppression. A family history of
adverse reactions unrelated to immunosupression or family
history of seizures or sudden infant death syndrome is not a
contraindication to vaccination. Varicella virus vaccine
should not be administered to persons who have a family
history of congenital or hereditary immunodeficiency in
first-degree relatives (e.g., parents and siblings) unless the
immune competence of the potential vaccine recipient has
been clinically substantiated or verified by a laboratory.
Tuberculosis Skin Test (PPD)

Infants and children who need TB skin tests can and should
be immunized. All vaccines, including MMR, can be given
on the same day as a TB skin test, or any time after a TB
skin test is applied. For most vaccines, there are no TB skin
test timing restrictions at all.
24
MMR vaccine may decrease the response to a TB skin test,
causing a false-negative response in someone who actually
has an infection with tuberculosis. MMR can be given the
2
same day as a TB skin test, but if MMR has been given and
1 or more days have elapsed, in most situations a wait of 46
weeks is recommended before giving a routine TB skin test.
No information on the effect of varicella vaccine or LAIV
on a TB skin test is available. Until such information is
available, it is prudent to apply rules for spacing measles
vaccine and TB skin testing to varicella vaccine and LAIV.
Screening for Contraindications and

Precautions to Vaccination
The key to preventing serious adverse reactions is screening.
Every person who administers vaccines should screen
every patient for contraindications and precautions before
giving the vaccine dose. Effective screening is not difficult
or complicated and can be accomplished with just a few
questions.
How is your child (or how are you) today?

This question screens for concurrent moderate or acute illness.
If the child has been examined, this question may not be
necessary or may have already been asked.
Does your child have any allergies

to any food or medication?
A severe allergic reaction to a vaccine component is a
contraindication to vaccination, so this question must
always be asked. It may be more time-efficient to inquire
about allergies in a generic way (i.e., any food or medication)
rather than to inquire about specific vaccine components.
Most parents will not be familiar with minor components of
vaccine, but they should know if the child has had an allergic
reaction to a food or medication that was severe enough to
require medical attention.
Did the child have any problems after

his or her last shots?
This open-ended question explores for allergic reactions to
previous doses and for conditions following pertussis vaccine
that may be precautions to additional doses, such as high
fever or a hypotonic episode.
Does the child have any problems with

his or her immune system?
This question will help identify children with immunodefi-
ciency who generally should not receive live attenuated
vaccines, particularly oral polio vaccine.
continues
25
2 Does anyone in your household have a problem

with their immune system?
Oral polio vaccine should not be given to a healthy person
who has household contact with someone who is immunod-
eficient. LAIV should not be given to household contacts of
severely immunosuppressed persons.
Has the child received any blood products in the last year,
like a transfusion, or immune globulin?
This question helps identify precautions for live attenuated
MMR and varicella vaccines, which should not be given to
persons who have received passive antibody in the last few
months. The question may also expose unreported illnesses
that might not have been revealed in earlier questions.
Are you pregnant, or trying to become pregnant?

This question should be asked of all adolescent and adult
women. MMR, varicella, smallpox (vaccinia), and LAIV
vaccines should not be given to women known to be pregnant
or for 4 weeks prior to pregnancy. Persons with a pregnant
household contact should not receive smallpox (vaccinia)
vaccine in nonemergency situations. ACIP does not
recommend pregnancy testing prior to administration of
any vaccine.
Every person should be screened for contraindications and

precautions before vaccination. Standardized screening
forms for both children and adults, developed by the
Immunization Action Coalition, are included in Appendix A.
Selected References
American Academy of Pediatrics. Active and passive
immunization. In: Pickering LK, ed. Red Book: 2003 Report
of the Committee on Infectious Diseases. Elk Grove Village, IL:
American Academy of Pediatrics;2003:198
Atkinson W, Pickering LK, Watson JC, Peter G. General

immunization practices. In: Plotkin SA, OrentseinWA, eds.
Vaccines. 4th ed., Philadelphia, PA: Saunders;2003:91122.
CDC. General recommendations on immunization: recom-

mendations of the Advisory Committee on Immunization
Practices and the American Academy of Family Physicians.
MMWR 2002;51(RR-2):136.
CDC. Recommendations of the Advisory Committee on

Immunization Practices: use of vaccines and immune globulins
in persons with altered immunocompetence. MMWR
1993;42(RR-4):118.
26
CDC. Guidelines for preventing opportunistic infections
among hematopoietic stem cell transplant recipients:
recommendations of CDC, the Infectious Disease Society of
2
America, and the American Society of Blood and Marrow
Transplantation. MMWR 2000;49(RR-10):1128.
Dietz VJ, Stevenson J, Zell ER, et al. Potential impact on

vaccination coverage levels by administering vaccines
simultaneously and reducing dropout rates. Arch Pediatr
Adolesc Med 1994;148:9439.
James JM, Burks AW, Roberson RK, Sampson HA. Safe

administration of the measles vaccine to children allergic
to eggs. N Engl J Med 1995;332:12629.
King GE, Hadler SC. Simultaneous administration of

childhood vaccines: an important public health policy that
is safe and efficacious. Pediatr Infect Dis J 1994;13:394407.
Plotkin SA. Vaccines, vaccination and vaccinology. J. Infect

Dis 2003;187:134959.
27

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Pediatric Drug Reference

Dosages, Side Effects, and Drug Interactions

Jane L. Gennrich, PharmD

Current Clinical Strategies Publishing

Digital Book and Updates

Current Clinical Strategies Publishing

Printed in USA ISBN 1-929622-43-0

Acetaminophen (Tylenol); Analgesic, Antipyretic; Cap: 325, 500 mg

Acetylcysteine (Mucomyst); Antidote to Acetaminophen; Soln, 10%: 4, 10, 30 mL

Acyclovir (Zovirax); Antiviral; Cap: 200 mg

Allopurinol (Zyloprim); Hypouricemic; Tab: 100, 300 mg

Amantadine (Symmetrel); Antiviral; Cap: 100 mg

Amcinonide (Cyclocort); Corticosteroid; Cream: 0.1% [15, 30, 60 gm]

Aminocaproic Acid (Amicar); Hemostatic Agent; Syr: 250 mg/mL

Aminophylline (Somophyllin, Truphylline); Bronchodilator; Inj: 25 mg/mL

Amoxicillin (Amoxil); Antibacterial, Penicillin ; Cap: 250, 500 mg

Ampicillin (Omnipen, Principen); Antibacterial, Penicillin ; Cap: 250, 500 mg

Amprenavir (Agenerase); Antiretroviral, Protease Inhibitor; Cap: 50, 150 mg

Attapulgite (Kaopectate); Antidiarrheal Agent; Caplet: 750 mg

Atovaquone (Mepron); Antiprotozoal Agent; Susp: 750 mg/5 mL

Azathioprine (Imuran); Immunosuppressant Agent; Inj: 100 mg

Azithromycin (Zithromax); Antibacterial, Macrolide ; Packet, oral: 1 gm

Benzoyl peroxide (Benzac, Desquam X, Persa-gel); Anti-acne; Bar: 5, 10%

Betamethasone dipropionate (Alphatrex, Diprosone); Corticosteroid; Aerosol, topical: 0. 1% [85 gm]

Bisacodyl (Dulcolax); Laxative, Stimulant ; Enema, susp: 10 mg/30 mL

Bismuth subsalicylate (Pepto-Bismol); Antidiarrheal; Cplt: 262 mg

Bitolterol (Tornalate); Bronchodilator; MDI: 370 mcg/puff [300 puffs/15 mL]

Brompheniramine (Dimetapp); Antihistamine; Elix: 2 mg/5 mL

Bumetanide (Bumex); Diuretic, Loop; Inj: 0.25 mg/mL

Calcitriol (Rocaltrol, Calcijex); Vitamin D Analog; Cap: 0.25, 0.5 mcg

Carbamazepine (Tegretol); Anticonvulsant; Cap ER: 200, 300 mg

Carnitine (Carnitor, Vitacarn); Nutritional Supplement; Cap: 250 mg

Cefaclor (Ceclor); Cephalosporin, 2nd generation; Cap: 250, 500 mg

Cefadroxil (Duricef); Cephalosporin, 1st generation; Cap: 500 mg

Cefdinir (Omnicef); Cephalosporin, 3rd generation; Cap: 300 mg

Cefixime (Suprax); Cephalosporin, 3rd generation; Susp: 100 mg/5 mL

Cefpodoxime (Vantin); Cephalosporin, 3rd generation; Susp per 5 mL: 50 , 100 mg

Ceftibuten (Cedax); Cephalosporin, 3rd generation; Cap: 400 mg

Cephalexin (Keflex, Keftab); Cephalosporin, 1st generation; Cap: 250, 500 mg

Cephradine (Velosef); Cephalosporin, 1st generation; Cap: 250, 500 mg

Cetirizine (Zyrtec); Antihistamine; Tab: 5, 10 mg

Charcoal, activated (Actidose, CharcoAid); Adsorbent; With sorbitol

Chloral hydrate (C-IV) (Noctec); Sedative/hypnotic; Cap: 500 mg

Chloramphenicol (Chloromycetin); Antibacterial; Cap: 250 mg

Chlorothiazide (Diuril); Diuretic, Thiazide; Inj: 500 mg

Chlorpheniramine (Chlor-Trimeton); Antihistamine; Cap, SR: 8, 12 mg

Chlorpromazine (Thorazine); Phenothiazine; Cap SR: 30, 75, 150 mg

Cimetidine (Tagamet); Histamine-2 Antagonist; Inj: 150 mg/mL

Cimetidine (Tagamet); Histamine-2 Antagonist; Inj: 150 mg/mL

Cisapride (Propulsid); Prokinetic agent; Susp: 1 mg/mL

Clindamycin (Cleocin); Antibacterial; Cap: 75, 150, 300 mg

Clonidine (Catapres); Alpha-adrenergic Agonist; Tab: 0.1, 0.2, 0.3 mg

Clorazepate (C-IV) (Tranxene); Benzodiazepine; Tab: 3.75, 7.5, 15 mg

Codeine phosphate (C-II); Opioid Narcotic; Inj: 15, 30 mg/mL

Crotamiton (Eurax); Scabicide; Cream: 10% [60 gm]

Cyclosporine (Sandimmune, Neoral, SangCya); Immunosuppressant Agent; Sandimmune

Cyproheptadine (Periactin); Antihistamine; Syr: 2 mg/5 mL

Dantrolene sodium (Dantrium); Muscle Relaxant; Cap: 25, 50, 100 mg

Desloratidine (Clarinex); Antihistamine ; Tab: 5 mg

Desmopressin (DDAVP, Stimate); Pituitary Hormone; Inj: 4 mcg/mL

Desonide (Desowen, Tridesilon); Corticosteroid; Cream, oint: 0.05% [15, 60 gm]

Desoximetasone (Topicort); Corticosteroid; Cream: 0.05% [15, 60 gm]

Dexmethylphenidate (Focalin); Stimulant Agent ; Tabs: 2.5, 5, 10 mg; ADDH: