https://www.youtube.com/watch?

v=pEZhGZVMglg

out Drug
 Vasopressin is used to manage anti-diuretic hormone deficiency. It has off-label uses
and is used in the treatment of gastrointestinal bleeding, ventricular tachycardia and
ventricular defibrillation. Vasopressin is used to treat diabetes insipidus related to low
levels of antidiuretic hormone

rug Usage
 1 ampoule: 20 units / 1ml
 Usual Dose: 0.01 to 0.03 units/minutes
 Preparation: 20 units in 50 ml NSS
 Drug Concentration: 20 units / 50 ml = 0.4 units / ml
 Rate of Infusion: ( Desired Dose * 60 ) / Drug Concentration
o Example: (0.01 units/min * 60 ) / 0.4 units / ml = 1.5 ml/hr

 Dopamine is a prescription medicine used to treat the symptoms of low blood

pressure, low cardiac output and improves blood flow to the kidneys. Dopamine may
be used alone or with other medications.
 Dopamine belongs to a class of drugs called Inotropic Agents.

 1 ampoule= 200mg/5ml
 Amount of drug needed per 50ml infusion solution :
 Amount of drug to dilute = Body weight * 3
o Example: 70 kg * 3 = 210 mg
 Amount of drug = (210 mg * 5 ml)/200 mg = 5.25 ml
 Preparation: 44.75 ml NSS + 5.25 ml drug = 50 ml 1 ml = (210 mg * 1000) / 50 ml =
4200 mcg
 Rate of Infusion: (mcg * body weight * 60 min ) / drug concentration
o Example: (5 mcg * 70 * 60 ) / 4200 mcg = 5 ml / hr

   
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Common Emergency Drugs &

Dose Calculations
March 9, 2021 Admin 0 Comments
DOPAMINE

About Drug

 Dopamine is a prescription medicine used to treat the symptoms of low blood pressure, low
cardiac output and improves blood flow to the kidneys. Dopamine may be used alone or
with other medications.
 Dopamine belongs to a class of drugs called Inotropic Agents.
Drug Usage

 1 ampoule= 200mg/5ml
 Amount of drug needed per 50ml infusion solution :
 Amount of drug to dilute = Body weight * 3
o Example: 70 kg * 3 = 210 mg
 Amount of drug = (210 mg * 5 ml)/200 mg = 5.25 ml
 Preparation: 44.75 ml NSS + 5.25 ml drug = 50 ml 1 ml = (210 mg * 1000) / 50 ml = 4200
mcg
 Rate of Infusion: (mcg * body weight * 60 min ) / drug concentration
o Example: (5 mcg * 70 * 60 ) / 4200 mcg = 5 ml / hr



DORMICUM (MIDAZOLAM)

About Drug

 Midazolam injection is used before medical procedures and surgery to cause drowsiness,
relieve anxiety, and prevent any memory of the event. It is also sometimes given as part of
the anesthesia during surgery to produce a loss of consciousness. It is also used to cause
a state of decreased consciousness in seriously ill people in intensive care units (ICU) who
are breathing with the help of a machine. It is in a class of medications called
benzodiazepines. It works by slowing activity in the brain to allow relaxation and decreased
consciousness.
Drug Usage

 1 ampoule= 15mg/3ml
 Preparation: 45 mg ampoule (9 ml) + 36 ml NSS
o Drug Concentration : 45 mg / 45 ml = 1 mg / 1 ml
 Rate of Infusion:
 (Desired Dose * Quantity ) / Drug Concentration
o Example: (2 mg * 45 ml ) / 45 mg = 2 ml / hr
 FENTANYL

About Drug

 Fentanyl is used to treat breakthrough pain (sudden episodes of pain that occur despite
round the clock treatment with pain medication) in cancer patients at least 18 years of age
(or at least 16 years of age if using Actiq brand lozenges) who are taking regularly
scheduled doses of another narcotic (opiate) pain medication, and who are tolerant (used
to the effects of the medication) to narcotic pain medications. It is in a class of
medications called narcotic (opiate) analgesics. It works by changing the way the brain and
nervous system respond to pain.
Drug Usage

 Infusion: 1 ampoule= 500 mcg/10 ml

 Preparation: 10 ml Fentanyl + 40 ml NSS
o Drug Concentration : 50 ml = 500 mcg
 1 ml = 10 mcg
 Rate of Infusion:
 (Desired Dose * Quantity ) / Drug Concentration
o Example: (25 mcg * 50 ml ) = 2.5 ml 500 mcg
 DOBUTAMINE

About Drug

 Dobutamine is indicated for patients who require positive inotropic support in the treatment
of cardiac decompensation due to depressed contractility resulting either from organic
heart disease or from cardiac surgical procedures, especially when a low cardiac output is
associated with raised pulmonary capillary pressure.
Drug Usage

 1 ampoule= 250mg/5ml
 Amount of drug needed per 50ml solution :
o Amount of drug to dilute = Body weight * 3
o Example: 70 kg * 3 = 210 mg
 Amount of drug = (210 mg * 5 ml)/250 mg = 4.2 ml
 Preparation: 45.8 ml NSS + 4.2 ml drug = 50 ml
 Rate of Infusion:
 (mcg * body weight * 60 min ) / drug concentration
o Example: (4 mcg * 70 * 60 ) / 4200 mcg = 4 ml / hr

ATRACURIUM
 About Drug

 Atracurium Besylate Injection is a skeletal muscle relaxant used in addition to general

anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation
during surgery or mechanical ventilation. Atracurium besylate injection is available in
generic form.
Drug Usage

 1 ampoule= 25 mg (2.5 ml)

 Preparation: 4 ampoule (100 mg) + 40 ml NSS
 Drug Concentration: 100 mg / 50 ml
 Rate of Infusion: (Desired Dose * 50 ml) / Drug Concentration
o Example: (5 mg * 50 ml ) / 100 mg = 5 ml / hr

AMIODARONE

About Drug

 Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat
(such as persistent ventricular fibrillation/tachycardia). It is used to restore normal heart
rhythm and maintain a regular, steady heartbeat.
 Amiodarone is known as an anti-arrhythmic drug. It works by blocking certain electrical
signals in the heart that can cause an irregular heartbeat.
Drug Usage
 1 ampoule= 150 mg (3 ml)
 Loading Dose: 1 ampoule (150 mg / 3 ml) + 12 mlD5W
 A.MAINTANENCE DOSE: 360 mg in 6 hours
o ( 360 mg * 3 ml ) 150 mg = 7.2 ml
o 7.2 ml ( amiodarone ) + 42.8 ml D5%W = 50 ml = 8.3 ml/hr
o B. 540 mg in 18 hours
o ( 540 mg * 3 ml ) / 150 mg = 10.8 ml
o 10.8 ml ( amiodarone ) + 39.2 ml D5%W = 2.7 ml / hr

ADRENALINE

About Drug

 Adrenaline, also known as Epinephrine, is a medication and hormone. As a medication, it is

used to treat a number of conditions, including anaphylaxis, cardiac arrest, asthma, and
superficial bleeding. Inhaled epinephrine may be used to improve the symptoms of croup. It
may also be used for asthma when other treatments are not effective. It is given
intravenously, by injection into a muscle, by inhalation, or by injection just under the skin.
Drug Usage

 1 ampoule= 1 ml / 1mg
 Preparation: 12 ml of Adrenaline + 38 ml D5W = 50 ml
 Drug Concentration = 12 mg / 50 ml = 0.24 mg
o 0.24 mg * 1000 = 240 mcg / ml
 Rate of Infusion: ( Desired Dose * 60 ) / 240 mcg = ml / hr
o Example (2mcg * 60 min) / 240 mcg = 0.5 ml / hr
 HEPARIN

About Drug

 Heparin is used to prevent blood clots from forming in people who have certain medical
conditions or who are undergoing certain medical procedures that increase the chance that
clots will form. Heparin is also used to stop the growth of clots that have already formed in
the blood vessels, but it cannot be used to decrease the size of clots that have already
formed
Drug Usage

 1 ampoule= 25,000 IU / 5 ml
 Preparation: 45 ml NSS + 25,000 ( 5 ml ) Heparin
 Rate of Infusion: ( Desired Dose * Quantity ) / Drug Concentration
o Example 100 units * 50 / 25,000 units = 0.2 ml / hr

HYDRALAZINE
 About Drug

 Hydralazine is used to treat high blood pressure. Hydralazine is in a class of medications

called vasodilators. It works by relaxing the blood vessels so that blood can flow more
easily through the body
Drug Usage

 1 ampoule= 20 mg
 Preparation: 20 mg dilute in 1 ml water of inj
 Loading Dose: 10-20 mg over 3-5 minutes, further dilute with 10 ml NS over 3-5 mins, then
repeat after 20-30 minutes
 Infusion: Reconstitute 3 ampoules ( 60 mg ) Hydralazine with 1 ml water of injection each.
o Make upto 60 ml with NSS
o Drug Concentration: 1 ml : 1mg
 Note: Give rate between 2 and 15 mg / hr depending on BP and Pulse

INSULIN

About Drug

 Human insulin is used to control blood sugar in people who have type 1 diabetes (condition
in which the body does not make insulin and therefore cannot control the amount of sugar
in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is
too high because the body does not produce or use insulin normally) that cannot be
controlled with oral medications alone
 Drug Usage

 Preparation: 49.5 ml NSS + 50 units (0.5 ml R.I)

 Rate of Infusion: (Desired Dose * Quantity) / 50 units
o Example: (3 Units * 50 ml ) / 50 units = 3 ml / hr

LABETALOL

About Drug

 Labetalol belongs to a group of medicines called beta blockers. It’s used to treat high blood
pressure, including high blood pressure in pregnancy. It can also be used to prevent chest
pain caused by angina
Drug Usage

 1 ampule ( 20 ml ) = 100 mg
 Preparation: 20 ml Labetalol + 30 ml NSS
 Drug Concentration: 1 ml = 2 mg
 Rate of Infusion: (Desired Dose * Quantity) / Drug Concentration
o Example: (5 mg * 50 ) / 100 mg = 2.5 ml / hr
 LASIX

About Drug

 Lasix is used to reduce extra fluid in the body (edema) caused by conditions such as heart
failure, liver disease, and kidney disease. This can lessen symptoms such as shortness of
breath and swelling in your arms, legs, and abdomen. This drug is also used to treat high
blood pressure
Drug Usage

 1 ampule = 20 mg ( 2ml )
 Drug Concentration: 10 ampule = 200 mg (20 ml)
 Preparation: 20 ml Lasix + 20 ml NSS
o 40 ml = 200 mg
o 1 ml = 5 mg
 Rate of Infusion: (Desired Dose * Quantity) / Drug Concentration
o Example: (10 mg/hr * 40 ml ) / 200 mg = 2 ml / hr

LEVOPHED

About Drug
 Levophed (norepinephrine bitartrate) is a vasoconstrictor, similar to adrenaline, used to
treat life-threatening low blood pressure (hypotension) that can occur with certain medical
conditions or surgical procedures. Levophed is often used during or after CPR (cardio-
pulmonary resuscitation)
Drug Usage

 1 ampule = 3 mg / 3 ml
 Drug Concentration: 3 mg / 50 ml = 0.06 mg /1 ml
o 0.06 mg * 1000 mcg = 60 mcg / ml
 Preparation: 3 mg + 47 ml D5W = 50 ml
 Rate of Infusion: (Desired Dose * 60 min) / 60 mcg
o Example: ( 2 mcg * 60 min ) / 60 mcg = 2 ml / hr

NITROGLYCERINE

About Drug

 Nitroglycerin sublingual tablets are used to treat episodes of angina (chest pain) in people
who have coronary artery disease (narrowing of the blood vessels that supply blood to the
heart). It is also used just before activities that may cause episodes of angina in order to
prevent the angina from occurring
Drug Usage

 1 ampule = 50 mg ( 10 ml )
 Drug Concentration: 50 mg / 50 ml = 1 mg /1 ml
o 1 mg * 1000 mcg = 1000 mcg / ml
 Preparation: 40 ml NSS + 10 ml NTG
 Rate of Infusion: (Desired Dose * 60 min) / Drug Concentration
o Example: ( 5 mcg * 60 min ) / 1000 mcg = 0.3 ml / hr
 OMEPRAZOLE

About Drug

 Omeprazole reduces the amount of acid your stomach makes. It’s a widely used treatment
for indigestion and heartburn and acid reflux. It’s also taken to prevent and treat stomach
ulcers.
 Sometimes omeprazole is taken for a rare illness caused by a tumour in the pancreas or gut
called Zollinger-Ellison syndrome.
Drug Usage

 1 vial = 40 mg
 Preparation: 5 vial (200 mg) Omeprazole + 50 ml NS
o 50 ml = 200 mg
o 1 ml = 4 mg
 Rate of Infusion: (Desired Dose * Quantity) / Drug Concentration
o Example: ( 8 mg * 50 ml ) / 200 mcg = 2 ml / hr
 PHENYLEPHRINE

About Drug

 Phenylephrine is used to relieve nasal discomfort caused by colds, allergies, and hay fever.
It is also used to relieve sinus congestion and pressure. Phenylephrine will relieve
symptoms but will not treat the cause of the symptoms or speed recovery. Phenylephrine is
in a class of medications called nasal decongestants. It works by reducing swelling of the
blood vessels in the nasal passages
Drug Usage

 1 ampoule: 10 mg / 1 ml
 Preparation: 10 mg in 250 ml NS
o 1 ml = 40 mcg/min
 Rate of Infusion: (Desired Dose * 60) / 40 mcg/ml
o Example: ( 1 mcg/min * 60 ) / 40 mcg/ml = 40 mcg / min

PHENYTOIN

About Drug
 Phenytoin is used to control certain type of seizures, and to treat and prevent seizures that
may begin during or after surgery to the brain or nervous system. Phenytoin is in a class of
medications called anticonvulsants. It works by decreasing abnormal electrical activity in
the brain
Drug Usage

 1 ampoule: 250 mg / 5 ml
 Loading Dose: 15 mg/kg at a rate not greater than 50 mg/min for 20-30 mins.
 Maintenance Dose: Followed by 100 mg every 6-8 hours
 Prophylaxis: 200-600 mg/day PO/IV
 Antiarrythmic: 10 mg IV every 15 minutes until arrhythmia stops

PROPOFOL

About Drug

 Propofol is an intravenous (IV) sedative-hypnotic agent that can be used for initiation and
maintenance of Monitored Anesthesia Care (MAC) sedation, combined sedation and
regional anesthesia, induction of general anesthesia, maintenance of general anesthesia,
and intensive care unit (ICU) sedation of intubated, mechanically ventilated patients
Drug Usage

 Infusion: 1 ampoule: 200 mg = 20 ml

 Preparation: 500 mg = 50 ml without dilution
 Drug Concentration: 1 ml = 10 mg
 Rate of Infusion: ( Desired Dose * Quantity ) / Drug Concentration
o Example: (10 mg * 50 ml ) / 500 mg = 1 ml / hr
 SANDOSTATIN

About Drug

 Sandostatin LAR Depot (octreotide acetate) is an octapeptide used to treat acromegaly.

Sandostatin LAR Depot is also used to reduce flushing episodes and watery diarrhea
caused by cancerous tumors (carcinoid syndrome) or tumors called vasoactive intestinal
peptide tumors (VIP adenomas)
Drug Usage

 1 ampoule: 100 mcg / ml

 3 ampoules (300 mcg / 3 ml) + 27 ml NSS = 30 ml
 Drug Concentration: 30 ml = 300 mcg
o 1ml = 10 mcg
 Note: 25 mcg bolus followed by 25-50 mcg / hr

VASOPRESSIN
 About Drug

 Vasopressin is used to manage anti-diuretic hormone deficiency. It has off-label uses and is
used in the treatment of gastrointestinal bleeding, ventricular tachycardia and ventricular
defibrillation. Vasopressin is used to treat diabetes insipidus related to low levels of
antidiuretic hormone
Drug Usage

 1 ampoule: 20 units / 1ml

 Usual Dose: 0.01 to 0.03 units/minutes
 Preparation: 20 units in 50 ml NSS
 Drug Concentration: 20 units / 50 ml = 0.4 units / ml
 Rate of Infusion: ( Desired Dose * 60 ) / Drug Concentration
o Example: (0.01 units/min * 60 ) / 0.4 units / ml = 1.5 ml/hr

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sandostatin LAR Depot (octreotide acetate) is an octapeptide used to

treat acromegaly. Sandostatin LAR Depot is also used to reduce
flushing episodes and watery diarrhea caused by cancerous tumors
(carcinoid syndrome) or tumors called vasoactive intestinal peptide
tumors (VIP adenomas)
 1 ampoule: 100 mcg / ml
 3 ampoules (300 mcg / 3 ml) + 27 ml NSS = 30 ml
 Drug Concentration: 30 ml = 300 mcg
o 1ml = 10 mcg
 Note: 25 mcg bolus followed by 25-50 mcg / hr

Ro
 tiatioropofol is an intravenous (IV) sedative-hypnotic agent that can be used for
ropofol is an intravenous (IV) sedative-hypnotic agent that can be used for inDopamine
is a prescription medicine used to treat the symptoms of low blood pressure, low
cardiac output and improves blood flow to the kidneys. Dopamine may be used alone
or with other medications.
 Dopamine belongs to a class of drugs called Inotropic Agents.
itiation and maintenance of Monitored Anesthesia Care (MAC) sedation, combined
sedation and regional anesthesia, induction of general anesthesia, maintenance of
general anesthesia, and intensive care unit (ICU) sedation of intubated, mechanically
ventilated patientsinitiation and maintenance of Monitored Anesthesia Care (MAC)
sedation, combined sedation and regional anesthesia, induction of general anesthesia,
maintenance of general anesthesia, and intensive care unit (ICU) sedation of intubated,
mechanically ventilated patientsn and maintenance of Monitored Anesthesia Care (MAC)
sedation, combined sedation and regional anesthesia, induction of general anesthesia,
maintenance of general anesthesia, and intensive care unit (ICU) sedation of intubated,
mechanically ventilated patients

INOTROPIC INFUSION DRUG CALCULATIONS Inotropic drugs are dosed in

mcg/kg/min and converted into mL/hr for infusion. Although this
calculation is done by the infusion pharmacist, the administering
nurse should verify the dosage and infusion rates.

DOBUTAMINE 
Synthetic catecholamine (beta-1 agonist). Increases contractility and to a lesser extent he
Little direct effect on BP. Uses: refractory CHF or hypotensive patients in whom vasodilat
used because of effects on BP.
Onset of action: 1-10 minutes. Peak effect: 10-20 minutes. Half-life: 2 minutes. Excretion: Urine (as metabolite

Adult (usual): 2.5 to 20 mcg/kg/minute. Maximum: 40 mcg/kg/min. Titrate to desired response. Administer into
doses to increase cardiac output are 2.5 to 15 mcg/kg/minute IV.
Drip rate (500mg/250 ml) ml/hr = wt(kg) x (mcg/min) x 0.03.
Supplied: 12.5 mg/ml (20 ml, 40 ml, 100 ml)

DOPAMINE 
Used to support BP, CO and renal perfusion in shock.
Dosing (Adult):
Refractory CHF: initial dose: 0.5 to 2 mcg/kg/min.
Renal: 1 to 5 mcg/kg/min.
Severely ill patient: initially 5 mcg/kg/min, increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg
Cardiac life support (initial): 2 to 5 mcg/kg/min - titrated to effect. Infusion may be increased by 1-4 mcg/kg/mi
minute intervals until optimal response is obtained. If dosages >20-30 mcg/kg/minute are needed, a more direct-a
be more beneficial (ie, epinephrine, norepinephrine). [0.5 to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily a

Used to support BP, CO and renal perfusion in shock. IMPORTANT NOTE: Renal shutdown may occur at doses
micrograms/kilogram/minute. The infusion rate should be reduced if urine flow decreases without adequate periph
Administer into large vein to prevent the possibility of extravasation (central line administration).

Calculation of drip rate (ml/hr) 400mg/250 ml: wt(kg) x mcg/min x 0.0375.

The predominant effects of dopamine are dose-related

At low rates of infusion (0.5-2 mcg/kg/min) dopamine causes vasodilation that is

presumed to be due to a specific agonist action on dopamine receptors in the
renal, mesenteric, coronary, and intracerebral vascular beds. The vasodilation in
these vascular beds is accompanied by increased glomerular filtration rate, renal
blood flow, sodium excretion, and urine flow. Hypotension sometimes occurs. An
increase in urinary output produced by dopamine is usually not associated with a
decrease in osmolality of the urine.
At intermediate rates of infusion (2-10 mcg/kg/min) dopamine acts to stimulate
the beta1-adrenoceptors, resulting in improved myocardial contractility,
increased SA rate and enhanced impulse conduction in the heart. There is little,
if any, stimulation of the b2-adrenoceptors (peripheral vasodilation). Dopamine
causes less increase in myocardial oxygen consumption than isoproterenol, and its
use is not usually associated with a tachyarrhythmia. Clinical studies indicate
that it usually increases systolic and pulse pressure with either no effect or a
slight increase in diastolic pressure. Blood flow to the peripheral vascular beds
may decrease while mesenteric flow increases due to increased cardiac output. At
low and intermediate doses, total peripheral resistance (which would be raised by
alpha activity) is usually unchanged.
At higher rates of infusion (10-20 mcg/kg/min) there is some effect on alpha-
adrenoceptors, with consequent vasoconstrictor effects and a rise in blood
pressure. The vasoconstrictor effects are first seen in the skeletal muscle
vascular beds, but with increasing doses, they are also evident in the renal and
mesenteric vessels. At very high rates of infusion (above 20 mcg/kg/min),
stimulation of alpha-adrenoceptors predominates and vasoconstriction may
compromise the circulation of the limbs and override the dopaminergic effects of
dopamine, reversing renal dilation and naturesis.

EPINEPHRINE  
Dosing (Adult): Refractory hypotension (refractory to dopamine/dobutamine): Continuous IV
mcg/min (range: 1-10 mcg/minute) - titrate dosage to desired effect. Usual rate: 1 to 4 mcg
cardiac dysfunction may require doses >10 mcg/minute (up to max of 20 mcg/min in a 70kg pat
Administration: Central line administration only.

Endotracheal: Doses (2-2.5 x IV dose) should be diluted to 10 ml with NS or distilled water prior to administrati

Anaphylaxis (adult): 0.3 mg IM (0.3 ml of a 1:1000 solution). May be repeated if severe anaphylaxis persists - re
minutes prn or give 0.1 to 0.25 mg IV (1:10,000) over 5-10min repeat q5 to 15 minutes as needed or start continu
4 mcg/min.

Asthma: inhalational form: start with 1 inhalation, then wait at least 1 min. If not relieved, use once more. Do not
least 3 hr. Asthma: subcutaneous (SC) form: 0.2-0.5 mg (0.2-0.5 ml of a 1:1000 solution) SC every 2 hr as require
attacks, may repeat dose every 20 min for a maximum of 3 doses.

Cardiac arrest: 1 mg IV initially; may be repeated as necessary q 3-5 min.

INAMRINONE - INOCOR ®  

Phosphodiesterase inhibitor with positive inotropic and vasodilator activity.
FDA labeled indications: CHF, acute (short-term treatment). Non-FDA labeled indications: Cardiac surgery/low
states. Inotropic support (Advance cardiac life support).
Dosing (Adult): CHF (short term): initial: 0.75 mg/kg IV bolus over 2-3 min, may repeat in 30 minutes. Maint: 5
IV infusion. Recommended total daily dose, not to exceed 10 mg/kg.

Renal Dosing
Renal failure: Crcl<10 ml/min: Administer 50% to 75% of dose.

MIDODRINE - PROAMATINE ®  

 Mechanism of Action: ProAmatine® forms an active metabolite, desglymidodrine, that is an
agonist, and exerts its actions via activation of the alpha-adrenergic receptors of the art
venous vasculature, producing an increase in vascular tone and elevation of blood pressure.
Desglymidodrine does not stimulate cardiac beta-adrenergic receptors. Desglymidodrine diffu
across the blood-brain barrier, and is therefore not associated with effects on the central
system.
Administration of ProAmatine® results in a rise in standing, sitting, and supine systolic and diastolic blood pressu
with orthostatic hypotension of various etiologies. Standing systolic blood pressure is elevated by approximately 1
1 hour after a 10-mg dose of midodrine, with some effect persisting for 2 to 3 hours. ProAmatine® has no clinical
effect on standing or supine pulse rates in patients with autonomic failure.

INDICATIONS AND USAGE

ProAmatine® is indicated for the treatment of symptomatic orthostatic hypotension (OH). Because ProAmatine®
marked elevation of supine blood pressure (BP>200 mmHg systolic), it should be used in patients whose lives are
impaired despite standard clinical care, including non-pharmacologic treatment (such as support stockings), fluid
lifestyle alterations. The indication is based on ProAmatine®'s effect on increases in 1-minute standing systolic bl
surrogate marker considered likely to correspond to a clinical benefit. At present, however, clinical benefits of Pro
principally improved ability to perform life activities, have not been established. Further clinical trials are underw
describe the clinical benefits of ProAmatine®.
After initiation of treatment, ProAmatine® should be continued only for patients who report significant symptom

CONTRAINDICATIONS
ProAmatine® is contraindicated in patients with severe organic heart disease, acute renal disease, urinary retentio
pheochromocytoma or thyrotoxicosis. ProAmatine® should not be used in patients with persistent and excessive s
hypertension.

WARNINGS
Supine Hypertension: The most potentially serious adverse reaction associated with ProAmatine® therapy is mark
supine arterial blood pressure (supine hypertension). Systolic pressure of about 200 mmHg were seen overall in a
patients given 10 mg of ProAmatine®. Systolic elevations of this degree were most likely to be observed in patien
elevated pre-treatment systolic blood pressures (mean 170 mmHg). There is no experience in patients with initial
pressure above 180 mmHg, as those patients were excluded from the clinical trials. Use of ProAmatine® in such p
recommended. Sitting blood pressures were also elevated by ProAmatine® therapy. It is essential to monitor supi
blood pressures in patients maintained on ProAmatine®.

--------------------------------------------------------
DOSAGE AND ADMINISTRATION
--------------------------------------------------------
The recommended dose of ProAmatine® is 10 mg, 3 times daily. Dosing should take place during the daytime ho
patient needs to be upright, pursuing the activities of daily living. A suggested dosing schedule of approximately 4
as follows: shortly before, or upon arising in the morning, midday and late afternoon (not later than 6 P.M.). Dose
3-hour intervals, if required, to control symptoms, but not more frequently. Single doses as high as 20 mg have be
patients, but severe and persistent systolic supine hypertension occurs at a high rate (about 45%) at this dose. In o
potential for supine hypertension during sleep, ProAmatine® should not be given after the evening meal or less th
bedtime. Total daily doses greater than 30 mg have been tolerated by some patients, but their safety and usefulnes
studied systematically or established. Because of the risk of supine hypertension, ProAmatine® should be continu
patients who appear to attain symptomatic improvement during initial treatment.

The supine and standing blood pressure should be monitored regularly, and the administration of ProAmatine® sh
if supine blood pressure increases excessively.

Because desglymidodrine is excreted renally, dosing in patients with abnormal renal function should be cautious;
not been systematically studied, it is recommended that treatment of these patients be initiated using 2.5-mg doses

Dosing in children has not been adequately studied.

Blood levels of midodrine and desglymidodrine were similar when comparing levels in patients 65 or older vs. yo
and when comparing males vs. females, suggesting dose modifications for these groups are not necessary.

Renal Dosing
Renal impairment: 2.5 mg tid - gradually increasing as tolerated.

[Supplied 2.5, 5 mg, 10mg tablet]

MILRINONE - PRIMACOR ®  

Phosphodiesterase inhibitor with positive inotropic and vasodilator activity.
Venodilator: 0 Arterial dilator: ++ Inotropic effect: +++
Calculation of drip rate: 50 mg/250ml (ml/hr) = wt (kg) x 0.3 x mcg/kg/min.
Dosing (Adult):
CHF: initial loading dose, 50 mcg/kg IV over 10min, then 0.375 to 0.75 mcg/kg/min IV (Usual: 0.5 mcg/kg/min)
surgery: 15min before separation from cardiopulmonary bypass, 50 mcg/kg IV over 20 minutes followed by a co
of 0.5 mcg/kg/min IV for a minimum of 4hr.

Recommended infusion rates: renal insufficiency

   Creatinine Clearance Infusion Rate
   (mL/min/1.73 m 2 ) (mcg/kg/min)
 5 0.20
10 0.23
20 0.28
30 0.33
40 0.38
50 0.43
Supplied: Injection (soln): 1 mg/ml (10 ml, 20 ml, 50 ml)

NOREPINEPHRINE - LEVOPHED ®   

Alpha receptor & Beta-1 agonist. Used to maintain BP in hypotensive states. Most potent vas
(Norepi >>> phenylephrine).
Dosage (initial): 8 to 12 mcg/min -titrate to BP (Usual target: SB:80-100 or MAP=80). Usual maintenance: 2 to 4
doses as high as 0.5 to 1.5 mcg/kg/min for 1-10days have been used in septic shock.

Note: Norepinephrine dosage is stated in terms of norepinephrine base and intravenous formulation is norepineph
Norepinephrine bitartrate 2 mg = Norepinephrine base 1 mg.

Usual range: 8-30 mcg/minute. Range used in clinical trials: 0.01-3 mcg/kg/minute.
ACLS dosage range: 0.1 - 0.5 mcg/kg/minute.
Administer into large vein to avoid the potential for extravasation.

Calculation of drip rate 8 mg/ 250 ml (ml/hr) = mcg/min x 1.875.

Supplied: Injection (soln): 1 mg/ml - 4 ml

PHENYLEPHRINE - NEOSYNEPHRINE ®  

Alpha agonist. May be given IM,SC, IV push, or by continuous infusion.
Treat mild/moderate hypotension, also PSVT.

IV infusion: usual initial rate: 0.1 to 0.18 mg/min (100 to 180mcg/min) (titrate).

Usual maintenance rate: 40-60 mcg/min.
Maximum rate (range): infusion rates as high as 8 to10 mcg/kg/min may be required in shock.
[Usual maximum dosing range reported: 0.4 to 9.1 mcg/kg/minute ].

IV bolus therapy:  0.1 to 0.5 mg/dose every 10-15 minutes as needed (initial dose should not exceed 0.5 mg)  PS
 IV push, subsequent doses may be increased in increments of 0.1 to 0.2mg.

Calculation of drip rate (40 mg/250) (ml/hr) = (mg/min) x 375.

VASOPRESSIN - PITRESSIN ®   

ADH analog (Posterior pituitary hormone).
Dosing (Adults): 
Diabetes insipidus: Note: Dosage is highly variable - titrated based on serum and urine sod
osmolality in addition to fluid balance and urine output. 5-10 units IM/SQ 2-4 times daily
(dosage range 5-60 units/day). Abdominal distention: 5 units IM stat, then 10 units every 3
GI hemorrhage: Continuous IV infusion: 0.5 milliunits/kg/hour (0.0005 unit/kg/hour). Double dosage as needed
to a maximum of 10 milliunits/kg/hour.
IV: Initial: 0.2-0.4 unit/minute, then titrate dose as needed. If bleeding stops, continue at same dose for 12 hours,
48 hours.
Out-of-hospital asystole (unlabeled use): Adults: 40 units IV. If spontaneous circulation is not restored in 3 minu
dose.
Pulseless VT/VF: 40 units IV (as a single dose only). If no IV access - administer 40 units diluted with NS (to a t
ml) endotracheally.

Vasodilatory shock/septic shock: Vasopressin may be used in patients with refractory shock despite adequate flu
and the use of high-dose conventional catecholamines such as norepinephrine and dopamine, however, further stu
to determine its exact place in therapy. Current evidence does not support the use of vasopressin as a replacement
norepinephrine or dopamine as a first-line agent.

The recommended infusion rate for vasopressin in the treatment of shock in adults
is 0.01- 0.03 units/min. This dosage range is reported to be effective in about
85% of patients with norepinephrine resistant hypotension. Doses greater than
0.04 units/min may lead to cardiac arrest.
 O'Brien A et al reported rapid rebound hypotension as a common problem after treatment with
vasopressin is stopped. Potential side effects of vasopressin infusion range from ischemic skin
lesions to possible intestinal ischemia. Vasopressin therapy may also result in decreased cardiac
output and hepatosplanchnic flow.

Supplied: Injection: 20 units/ml (0.5 ml, 1 ml, 10 ml)

REFERENCE(S) 
National Institutes of Health, U.S. National Library of Medicine, DailyMed
Database.
Provides access to the latest drug monographs submitted to the Food and Drug
Administration (FDA). Please review the latest applicable package insert for
additional information and possible updates.  A local search option of this data
can be found here.
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 may cause serious side effects including:

 lightheadedness,

 chest pain,

 fast, slow, or pounding heartbeats,

 shortness of breath,

 cold feeling,

 numbness,

 blue-colored appearance in your hands or feet, and

 darkening or skin changes in your hands or feet

Get medical help right away, if you have any of the symptoms listed above.

The most common side effects of Dopamine include:

 headache,

 anxiety,

 nausea,

 vomiting,

 chills and

 goosebumps
Tell the doctor if you have any side effect that bothers you or that does not go away.

These are not all the possible side effects of Dopamine. For more information, ask
your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to
FDA at 1-800-FDA-1088.

DESCRIPTION

Dopamine, a sympathomimetic amine vasopressor, is the naturally occurring

immediate precursor of norepinephrine. Dopamine hydrochloride is a white to off-
white crystalline powder, which may have a slight odor of hydrochloric acid. It is
freely soluble in water and soluble in alcohol. Dopamine HCl is sensitive to alkalies,
iron salts, and oxidizing agents. Chemically it is designated as 4-(2-aminoethyl)
pyrocatechol hydrochloride, and the structural formula is:

Dopamine Hydrochloride Injection is a clear, practically colorless, sterile, pyrogen-

free, aqueous solution of dopamine HCl for intravenous infusion after dilution. Each
mL contains either 40 mg, 80 mg, or 160 mg of dopamine hydrochloride (equivalent
to 32.3 mg, 64.6 mg, and 129.2 mg of dopamine base respectively) in water for
injection, q.s. Each mL of all preparations contains the following: sodium
metabisulfite 9 mg added as an antioxidant; citric acid, anhydrous 10 mg, and sodium
citrate, dihydrate 5 mg added as a buffer. The pH range (2.5 to 5.0) may be adjusted
with additional citric acid and/or sodium citrate.
Dopamine must be diluted in an appropriate sterile parenteral solution (see DOSAGE
AND ADMINISTRATION section).

Indications

INDICATIONS

Dopamine HCl is indicated for the correction of hemodynamic imbalances present in

the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia,
open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive
failure.

Patients most likely to respond adequately to dodpamine HCl are those in whom
physiological parameters, such as urine flow, myocardial function, and blood
pressure, have not undergone profound deterioration. Multiclinic trials indicate that
the shorter the time interval between onset of signs and symptoms and initiation of
therapy with volume correction and dopamine HCl, the better the prognosis. Where
appropriate, blood volume restoration with a suitable plasma expander or whole blood
should be accomplished or completed prior to administration of dopamine HCl.

Poor Perfusion Of Vital Organs

Urine flow appears to be one of the better diagnostic signs by which adequacy of vital
organ perfusion can be monitored. Nevertheless, the physician should also observe the
patient for signs of reversal of confusion or reversal of comatose condition. Loss of
pallor, increase in toe temperature, and/or adequacy of nail bed capillary filling may
also be used as indices of adequate dosage. Clinical studies have shown that when
dopamine HCl is administered before urine flow has diminished to levels
approximating 0.3 mL/minute, prognosis is more favorable. Nevertheless, in a number
of oliguric or anuric patients, administration of dopamine HCl has resulted in an
increase in urine flow which in some cases reached normal levels. Dopamine HCl
may also increase urine flow in patients whose output is within normal limits and thus
may be of value in reducing the degree of pre-existing fluid accumulation. It should
be noted that at doses above those optimal for the individual patient, urine flow may
decrease, necessitating reduction of dosage.

Low Cardiac Output

Increased cardiac output is related to dopamine's direct inotropic effect on

the myocardium. Increased cardiac output at low or moderate doses appears to be
related to a favorable prognosis. Increase in cardiac output has been associated with
either static or decreased systemic vascular resistance (SVR). Static or decreased SVR
associated with low or moderate movements in cardiac output is believed to be a
reflection of differential effects on specific vascular beds with increased resistance in
peripheral beds (e.g., femoral) and concomitant decreases in mesenteric and renal
vascular beds.

Redistribution of blood flow parallels these changes so that an increase in cardiac

output is accompanied by an increase in mesenteric and renal blood flow. In many
instances the renal fraction of the total cardiac output has been found to increase.
Increase in cardiac output produced by dopamine is not associated with substantial
decreases in systemic vascular resistance as may occur with isoproterenol.

Hypotension

Hypotension due to inadequate cardiac output can be managed by administration of

low to moderate doses of dopamine HCl, which have little effect on SVR. At high
therapeutic doses, the alphaadrenergic activity of dopamine becomes more prominent
and thus may correct hypotension due to diminished SVR. As in the case of
other circulatory decompensation states, prognosis is better in patients whose blood
pressure and urine flow have not undergone profound deterioration. Therefore, it is
suggested that the physician administer dopamine HCl as soon as a definite trend
toward decreased systolic and diastolic pressure becomes evident.
 SLIDESHOW

Heart Disease: Symptoms, Signs, and CausesSee Slideshow

Dosage

DOSAGE AND ADMINISTRATION

WARNING: This is a potent drug: It must be diluted before administration to

the patient.

Dopamine Hydrochloride Injection, USP is administered (only after dilution) by

intravenous infusion.

Suggested Dilution: Transfer contents of one or more ampuls or vials

by aseptic technique to either 250 mL or 500 mL of one of the following sterile
intravenous solutions:

1. Sodium Chloride Injection, USP

2. Dextrose (5%) Injection, USP
3. Dextrose (5%) and Sodium Chloride (0.9%) Injection, USP
4. 5% Dextrose in 0.45% Sodium Chloride Solution Injection, USP
5. Dextrose (5%) and Lactated Ringer'™s Solution Injection
 6. Sodium Lactate Injection, USP (1/6 Molar)
7. Lactated Ringer'™s Injection, USP

Dopamine Hydrochloride Injection, USP has been found to be stable for a minimum
of 24 hours after dilution in the sterile intravenous solutions listed above. However, as
with all intravenous admixtures, dilution should be made just prior to administration.

Do NOT add Dopamine Hydrochloride to Sodium Bicarbonate Injection, USP or

other alkaline intravenous solutions, since the drug is inactivated in alkaline solution.

Rate of Administration: Dopamine Hydrochloride Injection, USP, after dilution, is

administered intravenously by infusion through a suitable intravenous catheter or
needle. When administering Dopamine Hydrochloride (or any potent medication) by
continuous intravenous infusion, it is advisable to use a precision volume control
intravenous set. Each patient must be individually titrated to the desired hemodynamic
or renal response to dopamine.

Administration rates greater than 50 mcg/kg/minute have safely been used in

advanced circulatory decompensation states. If unnecessary fluid expansion is of
concern, adjustment of drug concentration may be preferred over increasing the flow
rate of a less concentrated dilution.

Suggested Regimen

1. When appropriate, increase blood volume with whole blood or plasma until central venous
pressure is 10 to 15 cm H2O or pulmonary wedge pressure is 14 to 18 mm Hg.

2. Begin infusion of diluted solution at doses of 2 to 5 mcg/kg/minute of Dopamine

Hydrochloride in patients who are likely to respond to modest increments of heart force and

renal perfusion.

In more seriously ill patients, begin infusion of diluted solution at doses of 5 mcg/kg/minute

of Dopamine Hydrochloride and increase gradually using 5 to 10 mcg/kg/minute increments

up to 20 to 50 mcg/kg/minute as needed. If doses in excess of 50 mcg/kg/minute are

required, it is advisable to check urine output frequently. Should urinary flow begin to

decrease in the absence of hypotension, reduction of dopamine dosage should be

 considered. Multiclinic trials have shown that more than 50% of the patients have been

satisfactorily maintained on doses of dopamine less than 20 mcg/kg/minute. In patients who

do not respond to these doses with adequate arterial pressures or urine flow, additional

increments of dopamine may be given in an effort to produce an appropriate arterial

pressure and central perfusion.

3. Treatment of all patients requires constant evaluation of therapy in terms of the blood
volume, augmentation of cardiac contractility, and distribution of peripheral perfusion.

Dosage of dopamine should be adjusted according to the patient's response, with particular

attention to diminution of established urine flow rate, increasing tachycardia or development

of new dysrhythmias as indices for decreasing or temporarily suspending the dosage.

4. As with all potent intravenously administered drugs, care should be taken to control the rate
of administration to avoid inadvertent administration of a bolus of drug.

Parenteral drug products should be inspected visually for particulate matter and

discoloration prior to administration, whenever solution and container permit.

HOW SUPPLIED

Dopamine HCl Injection, USP is available as follows:

Product No. Dopamine HCl mg per volume fill How Packaged

NDC 0517-1805-25 200 mg/5 mL Vial (40 mg/mL) Packages of 25 vials (color-coded WHITE)

NDC 0517-1905-25 400 mg/5 mL Vial (80 mg/mL) Packages of 25 vials (color-coded GREEN)

NDC 0517-1305-25 800 mg/5 mL Vial (160 mg/mL) Packages of 25 vials (color-coded YELLOW)

Avoid contact with alkalies (including sodium bicarbonate), oxidizing agents or iron
salts.

Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F)
(See USP Controlled Room Temperature).

NOTE - Do not use the injection if it is darker than slightly yellow or discolored in
any other way.
WARNING: NOT FOR DIRECT INTRAVENOUS INJECTION, MUST BE
DILUTED BEFORE USE.

INTRAVENOUS INFUSION ONLY.

The vial stopper is not made with natural rubber latex.

American Regent, Inc., Shirley, NY 11967. Revised: Dec 2014

Side Effects

SIDE EFFECTS

The following adverse reactions have been observed, but there are not enough data to
support an estimate of their frequency.

Cardiovascular System

ventricular arrhythmia (at very high

doses), atrial fibrillation, ectopic beats, tachycardia, anginal pain, palpitation, cardiac
conduction abnormalities, widened QRS
complex, bradycardia, hypotension, hypertension, vasoconstriction

Respiratory System

dyspnea

Gastrointestinal System

nausea, vomiting

Metabolic/Nutritional System

azotemia

Central Nervous System

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