Dosage Titration

Edward Nichols, EdD, MSN, RN

 Titrated Medications
• The process of adjusting the dosage of a medication based on patient response is called
Titration.

• Orders for titrated medications are often prescribed for critical-care patients. Such orders
require that therapeutic effects, such as pain reduction, blood pressure, sedation, be
monitored.

• The dose of the medication must be adjusted accordingly until the desired effect is achieved.
 Titrated Medications (cont.)
• An order for a titrated medication generally includes a purpose for titrating
and a maximum dose. If either the initial dose or directions for subsequent
adjustments of the initial dose are not included in the order, the medication
cannot be given, and you must contact the prescriber.
 Titrated Medications (cont.)
• Dosage errors with titrated medications can quickly result in catastrophic
consequences. Therefore, a thorough knowledge of the particular
medication and its proper dosage adjustments is crucial.

• Dosage increment choices are medication-specific and depend on many

factors that go beyond the scope of this presentation.
 Titrated Medications (cont.)
• Most titrated medications are weight-based. We always round to the 10th
place when converting pounds (lbs) to kilograms (kg).

• Example: If a patient weighs 183 lbs, how many kg does the patient weight?

183 lbs ÷ 2.2 = 83.2 kg

 Titrated Medications (cont.)
• Most titrated medications require the RN to calculate a concentration.

• Example: If the pharmacy sends you Dopamine 400 mg in 500 mL NS, what is the concentration
of medication in the IV bag?

400 ÷ 500 = 0.8 mg/mL

• This means that there is 0.8 mg of Dopamine in every 1 mL of NS.

 Titrated Medications (cont.)
• Next, most titrated medication dosages must be converted from mg to mcg.
But be careful…always read the order…NEVER ASSUME!

• Example: 0.8 mg/mL of Dopamine would need to be converted to mcg.

0.8 mg x 1000 = 800 mcg/mL

 Titrated Medications (cont.)
• Next, you set-up your problem and round your answer to the 10th place…
• To find the mcg/kg/min you will divide across then multiply the concentration at the
end.
mL ÷ kg ÷ min x concentration = mcg/kg/min

• To find the mL/hr you will multiple across then divide the concentration at the end.
mcg x kg x min ÷ concentration = mL/hr
 Titration Practice
• Physician order – Dopamine 400 mg in 500 mL NS to infuse at 8 mL/hr and
titrate to keep the SBP > 90 mmHg.
• Patient weight – 174 lbs

• Question: Calculate the mcg/kg/min

(answer next slide)

 Titration Practice
• Concentration – 400 mg ÷ 500 x 1000 = 800 mcg/mL
• Weight - 174 ÷ 2.2 = 79.1 kg

• Answer – 8 ÷ 79.1 ÷ 60 x 800 = 1.3 mcg/kg/min

 Titration Practice
• Physician order – Dobutamine 800 mg in 500 mL NS to infuse at 27 mL/hr
and titrate to keep the MAP > 80.
• Patient weight – 239 lbs

• Question: Calculate the mcg/kg/min

(answer next slide)

 Titration Practice
• Concentration – 800 mg ÷ 500 x 1000 = 1600 mcg/mL
• Weight - 239 ÷ 2.2 = 108.6 kg

• Answer – 27 ÷ 108.6 ÷ 60 x 1600 = 6.6 mcg/kg/min

 Titration Practice
• Physician order – Propofol 1000 mg in 100 mL NS to infuse at 13
mcg/kg/min and titrate to sedation and SBP > 90 mmHg.
• Patient weight – 132 lbs

• Question: Calculate the mL/hr

(answer next slide)

 Titration Practice
• Concentration – 1000 mg ÷ 100 x 1000 = 10000 mcg/mL
• Weight - 132 ÷ 2.2 = 60 kg

• Answer – 13 x 60 x 60 ÷ 10000 = 4.7 mL/hr

 Titration Practice
• Physician order – Dopamine 400 mg in 250 mL NS to infuse at 3 mcg/kg/min
and titrate to SBP > 90 mmHg.
• Patient weight – 153 lbs

• Question: Calculate the mL/hr

(answer next slide)

 Titration Practice
• Concentration – 400 mg ÷ 250 x 1000 = 1600 mcg/mL
• Weight - 153 ÷ 2.2 = 69.5 kg

• Answer – 3 x 69.5 x 60 ÷ 1600 = 7.8 mL/hr