- Jacquelyn McClary
Adapted from Thomson Reuters Clinical Editorial Staff: NeoFax , Ann Arbor, Mich, 2011, Thomson Reuters; and Taketomo CK, Hodding JH, Kraus DM: Pediatric dosage handbook, ed 17, Hudson, Ohio, 2010-2011, Lexi-Comp.
| Medication (Trade Name)/Route of Administration | Mechanism of Action/Dosing | Important Adverse Events | Special Considerations |
|---|---|---|---|
| Acetaminophen (Tylenol) PO/PR | Inhibits prostaglandin synthesis in central nervous system. Peripherally blocks pain impulse generation. Inhibits hypothalamic thermal regulating center. PO: 10-15 mg/kg q4-6h PR: 15-20 mg/kg q6-8h | Liver toxicity in overdose (acute or chronic) | Rectal administration results in prolonged, variable absorption. Elimination prolonged in patients with liver dysfunction. |
| Acyclovir (Zovirax) IV | Inhibits DNA synthesis and viral replication by incorporation into viral DNA. IV: 20 mg/kg q8h | Renal dysfunction, neutropenia | Maintain proper hydration, monitor renal function. Consider prolonging dosing interval in infants of <34 wk PMA or with significant renal or hepatic impairment. |
| Adenosine (Adenocard) IV | Slows AV conduction, thereby interrupting reentry pathway and restoring normal sinus rhythm. IV: 50 μg/kg initially; increase in 50-μg/kg increments and repeat every 2 min to max dose of 250 μg/kg | Momentary complete heart block after administration Bronchoconstriction in patients with reactive airway disease | Administer over 1-2 sec and as close to IV insertion site as possible; follow immediately with NS flush. Contraindicated in patients with second- or third-degree heart block. Methylxanthines diminish effect of adenosine and therefore larger doses may be needed. |
| Albuterol (Proventil, Ventolin) PO/Neb/MDI | β 2 -agonist that relaxes bronchial smooth muscle. Neb: 0.1-0.5 mg/kg q2-6h MDI: 1 actuation q2-6h PO: 0.1-0.3 mg/kg/dose q6-8h | Tachycardia, hypokalemia with continuous administration | Oral administration may be associated with more systemic adverse events. |
| Alprostadil (prostaglandin E 1 ) (Prostin VR) IV | Prostaglandin E 1 analog that produces direct vasodilation of vascular and ductus arteriosus smooth muscle. IV: 0.05-0.1 μg/kg/min via continuous infusion; maintenance doses may be as low as 0.01 μg/kg/min | Hypotension, flushing, bradycardia, fever, apnea | Apnea occurs in ~10%-12% of neonates within first hour of infusion. |
| Amikacin (Amikin) IM/IV | Inhibits bacterial protein synthesis by inhibiting 50S ribosomal subunit. PMA ≤29 wk: 0-7 days old: 18 mg/kg q48h 8-28 days old: 15 mg/kg q36h ≥29 days old: 15 mg/kg q24h PMA 30-34 wk: 0-7 days old: 18 mg/kg q36h ≥8 days old: 15 mg/kg q24h PMA ≥35 wk: 15 mg/kg q24h | Nephrotoxic, ototoxic, additive neuromuscular blockade with neuromuscular blocking agents | Monitor serum concentrations.Therapeutic peak serum concentration is 20 to 30 μg/mL. Therapeutic trough serum concentration is <10 μg/mL. Should not be concurrently administered in same IV line with extended-spectrum penicillins (possible inactivation). Synergistic antibacterial actions with penicillins and other antibiotics. |
| Amiodarone (Cordarone, Pacerone) IV/PO | Inhibits adrenergic stimulation, prolongs action potential and refractory period in myocardial tissue, decreases AV conduction and sinus node function. IV: 5 mg/kg loading dose followed by maintenance infusion of 7-15 μg/kg/min PO: 5-10 mg/kg q12h after 24-48 hr of IV therapy | Hypotension, bradycardia, AV block, pneumonitis, pulmonary fibrosis, liver injury | Hyperthyroidism or hypothyroidism may occur with long-term use. |
| Ammonium chloride IV/PO | Increases acidity by increasing concentration of free hydrogen ions, which combine with bicarbonate ion to form CO 2 and water; net result is replacement of bicarbonate ions with chloride ions. IV/PO: 75-150 mg/kg/day divided q6-8h | Metabolic acidosis, hyperchloremia | Use only as alternative supplement after sodium and potassium supplementation have been optimized. |
| Amphotericin B (Amphocin, Fungizone) Amphotericin B lipid complex (Abelcet) Amphotericin B liposome (AmBisome) IV | Binds to fungal ergosterol, compromising fungal cell wall integrity. Amphotericin B: 1-1.5 mg/kg q24h over 2-6 hr Amphotericin B lipid complex: 5 mg/kg q24h over 2 hr Amphotericin B liposome: 5-7 mg/kg q24h over 2 hr | Hypomagnesemia, hypokalemia nephrotoxicity, fever, chills, thrombocytopenia | Monitor renal function, electrolytes. Adjust dosing interval if serum creatinine increases >0.4 mg/dL from baseline. Less nephrotoxicity with lipid and liposome formulations. |
| Ampicillin (Omnipen, Polycillin, Principen) IM/IV | Inhibits bacterial cell wall synthesis by binding to specific penicillin-binding proteins. Causes cell wall death resulting in bacteriocidal activity. PMA ≤29 wk: 0-28 days old: 25-50 mg/kg q12h >28 days old: 25-50 mg/kg q8h PMA 30-36 wk: 0-14 days old: 25-50 mg/kg q12h >14 days old: 25-50 mg/kg q8h PMA 37-44 wk: 0-7 days old: 25-50 mg/kg q12h >7 days old: 25-50 mg/kg q8h PMA ≥45 wk: 25-50 mg/kg q6h | CNS excitation or seizure activity with very large doses | For GBS bacteremia dosages may be increased to 200 mg/kg/day. For GBS meningitis dosages may be increased to 300-400 mg/kg/day and doses given at more frequent intervals. |
| Atropine PO/IV/IM/ET | Competitively inhibits actions of acetylcholine in secretory glands, smooth muscle, and CNS. PO: 0.02 mg/kg q4-6h; increase gradually to max 0.09 mg/kg/dose IV/IM: 0.01-0.03 mg/kg over 1 min; may repeat every 10-15 min (max dose 0.04 mg/kg) ET: 0.01-0.03 mg/kg followed by 1 mL NS | Tachycardia, arrhythmias, urinary retention, decreased GI motility | Administer rapidly and undiluted. Small doses may result in paradoxical bradycardia. |
| Azithromycin (Zithromax) PO/IV | Inhibits bacterial protein synthesis by binding to 50S ribosomal subunit. PO: 10 mg/kg q24h × 5 days IV: 5-10 mg/kg q24h | Diarrhea, rash, blood in stool | Recommended PO dosing is for treatment of pertussis.IV dosing not well studied in pediatric patients. |
| Aztreonam (Azactam) IM/IV | Inhibits bacterial cell wall synthesis and causes cell wall destruction by binding to penicillin-binding proteins. PMA ≤29 wk: 0-28 days old: 30 mg/kg q12h >28 days old: 30 mg/kg q8h PMA 30-36 wk: 0-14 days old: 30 mg/kg q12h >14 days old: 30 mg/kg q8h PMA 37-44 wk: 0-7 days old: 30 mg/kg q12h >7 days old: 30 mg/kg q8h PMA ≥45 wk: 30 mg/kg q6h | Hypoglycemia, eosinophilia, elevated transaminases | Contains L-arginine—provide adequate glucose to avoid hypoglycemia. |
| Beractant (Survanta) IT | Modified bovine pulmonary surfactant analog. Replaces deficient or ineffective endogenous lung surfactant. IT: 4 mL/kg divided into 4 aliquots administered as soon as possible after birth; repeat up to 3 doses within 48 hr of life if needed, no more frequently than q6h | Reflux of surfactant up ET, decreased oxygenation, bradycardia | For IT administration only. Suspension should be at room temperature before administering. Do not artificially warm. Swirl suspension; do not shake or filter suspension. Continuously monitor heart rate and oxygen saturation during administration. |
| Bumetanide (Bumex) PO/IM/IV | Inhibits chloride and sodium reabsorption in ascending loop of Henle and proximal renal tubule, causing increased excretion of water and electrolytes. PO/IM/IV: 0.005-0.1 mg/kg <34 wk, 0-2 mo old: q24h <34 wk, >2 mo old: q12h ≥34 wk, 0-1 mo old: q24h ≥34 wk, >1 mo old: q12h | Hypomagnesemia, hyponatremia, hypokalemia, metabolic hypochloremic alkalosis | Higher dosages required with abnormal renal function or congestive heart failure. May displace bilirubin at high dosages or with long duration of therapy. |
| Caffeine citrate (Cafcit) PO/IV | Stimulates central inspiratory drive and improves skeletal muscle contraction. Loading dose: 20-25 mg/kg Maintenance dose: 5-10 mg/kg q24h | Tachycardia, cardiac dysrhythmias, insomnia, GI disturbances, gastroesophageal reflux | Therapeutic trough serum concentration range is 5-25 μg/mL; toxicity is associated with serum concentrations of >40-50 μg/mL. Monitoring serum concentrations not typically necessary at recommended dosages. |
| Calfactant (Infasurf) IT | Natural surfactant extracted from calf lung. Replaces deficient or ineffective endogenous lung surfactant. IT: 3 mL/kg divided into 2 aliquots administered as soon as possible after birth; repeat up to 3 doses if needed, no more frequently than q12h | Reflux of surfactant up ET, decreased oxygenation, bradycardia | For IT administration only. Suspension should be at room temperature before administering. Do not artificially warm. Swirl suspension; do not shake or filter suspension. Continuously monitor heart rate and oxygen saturation during administration. |
| Captopril (Capoten) PO | Competitively inhibits angiotensin-converting enzyme. Initial dose: 0.01-0.05 mg/kg q8-12h; adjust dose based on response Max dose: 0.5 mg/kg q6-24h | Decreased cerebral or renal blood flow, hyperkalemia | Monitor renal function. Onset of action is 15 min and peak effect is 30-90 min after dosing. |
| Caspofungin (Cancidas) IV | Inhibits synthesis of essential cell wall component in susceptible fungi. IV: 25 mg/m 2 q24h | Thrombophlebitis, hypercalcemia, hypokalemia, increased liver enzymes | Monitor electrolytes and hepatic transaminases. |
| Cefazolin (Ancef, Kefzol) IM/IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. PMA ≤29 wk: 0-28 days old: 25 mg/kg q12h >28 days old: 25 mg/kg q8h PMA 30-36 wk: 0-14 days old: 25 mg/kg q12h >14 days old: 25 mg/kg q8h PMA 37-44 wk: 0-7 days old: 25 mg/kg q12h >7 days old: 25 mg/kg q8h PMA ≥45 wk: 25 mg/kg q6h | Phlebitis, eosinophilia | Poor CNS penetration. Often used for perioperative infection prophylaxis. |
| Cefepime (Maxipime) IM/IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Mild to moderate infections: ≤28 days old: 30 mg/kg q12h >28 days old: 50 mg/kg q12h Meningitis and severe infections: 50 mg/kg q12h | Eosinophilia, elevated hepatic transaminases | Widely distributed in body tissues and fluids, including CNS. |
| Cefotaxime (Claforan) IM/IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. PMA ≤29 wk: 0-28 days old: 50 mg/kg q12h >28 days old: 50 mg/kg q8h PMA 30-36 wk: 0-14 days old: 50 mg/kg q12h >14 days old: 50 mg/kg q8h PMA 37-44 wk: 0-7 days old: 50 mg/kg q12h >7 days old: 50 mg/kg q8h PMA ≥45 wk: 50 mg/kg q6h | Leukopenia, granulocytopenia, eosinophilia | Widely distributed in CSF and other tissues. |
| Cefoxitin (Mefoxin) IM/IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. PMA ≤29 wk: 0-28 days old: 25-33 mg/kg q12h >28 days old: 25-33 mg/kg q8h PMA 30-36 wk: 0-14 days old: 25-33 mg/kg q12h >14 days old: 25-33 mg/kg q8h PMA 37-44 wk: 0-7 days old: 25-33 mg/kg q12h >7 days old: 25-33 mg/kg q8h PMA ≥45 wk: 25-33 mg/kg q6h | Eosinophilia, elevated hepatic transaminases | Use often limited to skin, intraabdominal, and urinary tract infections. |
| Ceftazidime (Fortaz) IM/IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. PMA ≤29 wk: 0-28 days old: 30 mg/kg q12h >28 days old: 30 mg/kg q8h PMA 30-36 wk: 0-14 days old: 30 mg/kg q12h >14 days old: 30 mg/kg q8h PMA 37-44 wk: 0-7 days old: 30 mg/kg q12h >7 days old: 30 mg/kg q8h PMA ≥45 wk: 30 mg/kg q8h | Eosinophilia, elevated hepatic transaminases | Widely distributed in body tissues and fluids. Synergistic with aminoglycosides. |
| Ceftriaxone (Rocephin) IM/IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Sepsis: 50 mg/kg q24h Meningitis: 100 mg/kg loading dose, then 80 mg/kg q24h | Increased bleeding time, leukopenia, eosinophilia, transient gall bladder precipitations | Displaces bilirubin from albumin binding sites—not recommended for use in neonates with hyperbilirubinemia. Contraindicated with concurrent administration of calcium-containing solutions. |
| Chlorothiazide (Diuril) PO/IV | Inhibits Na reabsorption in distal renal tubules causing increased excretion of sodium, chloride, potassium, bicarbonate, magnesium, phosphate, calcium, and water. PO: 10-20 mg/kg q12h IV: 2-10 mg/kg q12h | Hypochloremic metabolic alkalosis, fluid and electrolyte disorders, hyperglycemia | Synergistic effect with loop diuretics (e.g., furosemide) or spironolactone. Monitor serum electrolytes closely. |
| Cholecalciferol (vitamin D 3 , D-Vi-Sol) PO | Vitamin D supplementation is used to stimulate or support skeletal growth. Supplementation: 400 U q24h Vitamin D deficiency: 400-1000 U q24h | Signs of toxicity due to hypercalcemia (vomiting, nephrocalcinosis, arrhythmia) | Monitor 25-hydroxyvitamin D concentrations, particularly in neonates receiving higher dosages. Monitor calcium and phosphorous levels. |
| Clindamycin (Cleocin) PO/IM/IV | Inhibits bacterial protein synthesis by reversibly binding to 50S ribosome subunit. PMA ≤29 wk: 0-28 days old: 5-7.5 mg/kg q12h >28 days old: 5-7.5 mg/kg q8h PMA 30-36 wk: 0-14 days old: 5-7.5 mg/kg q12h >14 days old: 5-7.5 mg/kg q8h PMA 37-44 wk: 0-7 days old: 5-7.5 mg/kg q12h >7 days old: 5-7.5 mg/kg q8h PMA ≥45 wk: 5-7.5 mg/kg q6h | Clostridium difficile -associated diarrhea, pseudomembranous colitis, phlebitis at site of injection | Increase dosing interval in the presence of significant liver dysfunction. |
| Dexamethasone (Decadron) PO/IV/IM | Decreases inflammation by suppressing proinflammatory mediators. Facilitation of ventilator weaning: 0.01-0.075 mg/kg q12h Airway edema: 0.25-0.5 mg/kg q8h; max dose 1 mg/kg/day | Hypertension, hyperglycemia, GI bleeding or perforation, growth inhibition | For ventilator weaning, 10-day DART trial protocol is commonly used. Typically airway edema treatment limited to 3 doses. |
| Diazoxide (Proglycem) PO | Inhibits insulin release from pancreas. PO: 2-5 mg/kg q8h | Sodium and fluid retention, pulmonary hypertension, cardiac failure | Alcohol content of oral suspension is 7.25%; GI upset and abdominal distension are common. |
| Digoxin (Lanoxin) PO/IV | Reversibly binds to Na-K-Ca pump and increases calcium influx within myocardial cells, which results in increase in force of myocardial contraction. See Appendix A-1 for dosing. | Atrial and ventricular arrhythmias | Hypokalemia, hypomagnesemia, hypermagnesemia, and hypercalcemia predispose patients to digoxin toxicity. Follow serum drug concentrations with target range of 1-2 ng/mL. |
| Dobutamine IV | Reversibly binds to and stimulates β 1 -adrenergic receptor, causing increased contractility and heart rate. Continuous IV infusion: 2-25 μg/kg/min | Hypotension in setting of hypovolemia, tachycardia, arrhythmias, phlebitis | Correct hypovolemia before initiation of therapy if possible. Use phentolamine for treatment of extravasation. |
| Dopamine IV | Stimulates α- and β-adrenergic and dopaminergic receptors, which results in cardiac stimulation, increased renal blood flow, and vasoconstriction. Continuous IV infusion: 2-20 μg/kg/min | Hypertension, tachycardia, phlebitis | Pharmacologic effect is dose dependent. Use phentolamine for treatment of extravasation. |
| Dornase alfa (Pulmozyme) Neb | Selectively cleaves DNA, which reduces mucous viscosity in pulmonary secretions. Neb: 1.25-2.5 mL q12-24h | Desaturation, airway obstruction | Each single-dose ampule contains 2.5 mg/2.5 mL dornase alfa. |
| Enalapril (PO) (Vasotec) Enalaprilat (IV) | Exerts blood pressure and cardiac effects through competitive inhibition of angiotensin-converting enzyme. PO: 0.04-0.15 mg/kg q6-24h IV: 0.005-0.01 mg/kg q8-24h | Reflex tachycardia, renal dysfunction, hyperkalemia | Monitor renal function. Begin at low doses q24h and titrate up based on response. |
| Enoxaparin (Lovenox) SC | Potentiates antithrombin III activity and inactivates anticoagulation factor Xa. Throm basis treatment: Term: 1.7 mg/kg q12h Preterm: 2 mg/kg q12h Prophylaxis: <3 months: 0.75 mg/kg q12h ≥3 months: 0.5 mg/kg q12h | Intracranial hemorrhage, GI bleeding, hematoma at injection site | Monitor Xa levels 4 hr after a dose; target range is 0.5-1 U/ml for treatment and 0.1-0.4 U/mL for prophylaxis. Therapeutic dosages in preterm neonates are widely variable. Renally cleared; reduced dosages required in renal dysfunction. Call 1-800-NOCLOTS for dosing assistance. |
| Epinephrine (Adrenalin) IV/ET | Stimulates α- and β-adrenergic receptors, which results in cardiac stimulation and dilation of skeletal muscle vasculature. IV: 0.01-0.03 mg/kg/dose q3-5min Continuous IV infusion: 0.02-1 μg/kg/min ET: 0.1 mg/kg followed by 1 mL NS | Hypertension, tachycardia, arrhythmias, phlebitis, renal vascular ischemia | Correct acidosis before administration if possible. Use phentolamine for treatment of extravasation. |
| Epoetin alfa (Epogen, Procrit) IV/SC | Synthetic analog of erythropoietin that stimulates erythropoiesis. IV/SC: 400-500 U/kg 3 times per week | Neutropenia | Subcutaneous route preferred. Continue therapy until hematocrit is ≥35% (usually 2-4 wk). Consider administration of iron if iron stores are not adequate. |
| Erythromycin (Eryped, E.E.S.) PO/IV | Inhibits bacterial protein synthesis by reversibly binding to 50S ribosome subunit. PO erythromycin ethylsuccinate: Infection: 10-12.5 mg/kg q6h Gastric motility: 10 mg/kg q6h × 48 hr, then 4 mg/kg q6h IV erythromycin lactobionate: 5-10 mg/kg q6h | Bradycardia and hypotension during IV administration, phlebitis, diarrhea, abdominal pain | Administer PO with feeds to reduce GI side effects and increase absorption. |
| Esmolol (Brevibloc) IV | Competitively blocks response to β 1 -adrenergic stimulation with minimal effect on β 2 -adrenergic receptors. Supraventricular tachycardia: 100 μg/kg/min continuous IV infusion; increase by 50-100 μg/kg/min every 5 min to usual max 200 μg/kg/min Postoperative hypertension: 50 μg/kg/min continuous IV infusion; increase by 25-50 μg/kg/min every 5 min to usual max 200 μg/kg/min | Hypotension, tissue necrosis | Use phentolamine for treatment of extravasation. |
| Famotidine (Pepcid) PO/IV | Competitively inhibits histamine receptors in gastric parietal cells, which results in inhibition of gastric acid secretion. PO: 0.5-1 mg/kg q24h IV: 0.25-0.5 mg/kg q24h | Late-onset bacterial or fungal sepsis | Oral suspension contains sodium benzoate. |
| Fentanyl (Sublimaze) IV | Binds with opioid μ receptors in CNS to decrease pain. IV push: 1-4 μg/kg q2-4h Continuous IV infusion: 0.5-5 μg/kg/hr | Respiratory depression, chest wall rigidity, urinary retention | Dependence may occur with long-term administration. Effects reversed by naloxone. Approximately 100 times more potent than morphine. |
| Ferrous sulfate (Fer-In-Sol) PO | Repletes diminished iron stores and is incorporated into hemoglobin. Routine supplementation: 2-4 mg/kg/day divided q12-24h Patients receiving erythropoietin: 6 mg/kg/day divided q12-24h | Constipation, discolored stool | Infants who have received multiple recent blood transfusions are at risk of iron overload—typically no supplementation is required. |
| Fluconazole (Diflucan) PO/IV | Reversibly binds to fungal cytochrome P-450, inhibiting sterol C-14 α-demethylation and decreasing ergosterol synthesis, which ultimately inhibits cell membrane formation. Invasive candidiasis Loading dose (IV/PO): 12-25 mg/kg Maintenance dose (IV/PO): PMA ≤29 wk: 0-14 days old: 6-12 mg/kg q48h >14 days old: 6-12 mg/kg q24h PMA >30 wk: 0-7 days old: 6-12 mg/kg q48h >7 days old: 6-12 mg/kg q24h Thrush 6 mg/kg PO × 1 dose, then 3 mg/kg PO q24h | Increased liver enzymes | Limited data for higher dosages—consider using in severe infection or if fungal strain has high minimum inhibitory concentration. Extend dosing interval in setting of renal dysfunction. |
| Flumazenil (Romazicon) IV/IN/PR | Antagonizes effect of benzodiazepines on GABA/benzodiazepine receptors. IV: 5-10 μg/kg over 15 sec; repeat q45sec to max cumulative dose of 50 μg/kg or 1 mg (whichever is smaller) IN: 20 μg/kg per nostril PR: 15-30 μg/kg; repeat q15-20min | Hypotension, seizures | Seizures most common in patients receiving benzodiazepines for long-term sedation. |
| Fosphenytoin (Cerebyx) IV/IM | Phenytoin prodrug. Increases efflux or decreases influx of sodium ions across cell membranes in motor cortex, which results in neuronal membrane stabilization. Dosing expressed in phenytoin equivalents (PE): Fosphenytoin 1 mg PE = phenytoin 1 mg Loading dose: 15-20 mg PE/kg Maintenance dose: 4-8 mg PE/kg q24h | Hypotension, venous irritation | May administer much more rapidly than phenytoin, up to 1.5 mg/kg/min. Term infants >1 wk of age may need higher dosages at more frequent intervals (8 mg PE/kg q8h). Displaces bilirubin from protein binding sites. Target serum phenytoin levels are 6-20 μg/mL. |
| Furosemide (Lasix) PO/IV/IM | Inhibits chloride and sodium reabsorption in ascending loop of Henle and proximal renal tubule, which causes increased excretion of water and electrolytes. IV: 1-2 mg/kg/dose q6-48h PO: 1-4 mg/kg/dose q6-48h | Hypochloremic alkalosis, hyponatremia, hypokalemia, hypercalciuria and renal calculi, ototoxicity | Has synergistic effect with proximal and distal tubule inhibitors (e.g., thiazides). Monitor electrolytes closely. Risk of ototoxicity increased in neonates also receiving aminoglycosides. |
| Ganciclovir (Cytovene-IV) | Competes for incorporation into viral DNA and interferes with viral DNA chain elongation, which results in inhibition of viral replication. Acute infection: 6 mg/kg IV q12h Chronic suppression: 30-40 mg/kg PO q8h | Thrombocytopenia, anemia, neutropenia | Treat acute infections for minimum of 6 wk. Monitor complete blood count results 2-3 times per week for first 3 wk, then weekly if infant’s condition is stable. Cut dose in half for neutropenia (<500 cells/mm 3 ). Discontinue if neutropenia does not resolve. |
| Gentamicin IV/IM | Inhibits bacterial protein synthesis by inhibiting 30S and 50S ribosomal subunits, which results in defective bacterial cell membrane. PMA <35 wk: 4 mg/kg q24h PMA ≥35 wk: 5 mg/kg q24h | Nephrotoxicity, ototoxicity (increased risk with concurrent use of other nephrotoxic or ototoxic drugs) | Monitor serum trough concentration before third dose if treating for >48 hr. Target trough concentration is <1 μg/mL. Extend dosing interval if trough is >1 μg/mL. Should not be concurrently administered in same IV line with extended-spectrum penicillin. |
| Glucagon IV/IM/SC | Increases hepatic glycogenolysis and gluconeogenesis, which causes increase in blood glucose. 0.2 mg/kg up to max dose of 1 mg; repeat q20min prn | Tachycardia, GI disturbances, rebound hypoglycemia | Rise in blood glucose lasts about 2 hr. |
| Heparin IV | Potentiates action of antithrombin III, inactivates thrombin, inhibits conversion of fibrinogen to fibrin. Loading dose: 75 U/kg IV push Maintenance dose: 28 U/kg/hr Continuous IV infusion—adjust based on APTT; target range dependent on indication | Hemorrhage, thrombocytopenia | Effects reversible with protamine. Monitor platelet levels closely. Nontherapeutic doses added to TPN or IV fluids to maintain patency of lines (0.5-1 U/mL). |
| Hyaluronidase (Amphadase, Vitrase) SC | Modifies permeability of connective tissue and increases distribution and absorption of locally injected substances. SC: 150 U as 5 separate injections around extravasation site | Erythema | Administer as soon as possible after extravasation. Not for use with extravasation of vasoactive agents. |
| Hydralazine (Apresoline) PO/IV | Produces direct vasodilation of arterioles causing decreased systemic resistance. PO: 0.25-1 mg/kg q6-8h IV: 0.1-0.5 mg/kg q6-8h gradually increased to max of 2 mg/kg q6h | Agranulocytosis, hypotension, tachycardia | If used with β-blocker expect reduction in hydralazine dose required. |
| Hydrochlorothiazide (Microzide) PO | Inhibits Na reabsorption in distal renal tubules, which causes increased excretion of water and electrolytes. PO: 1-2 mg/kg q12h | Hypochloremic metabolic alkalosis, hypokalemia, hypouricemia, hyperglycemia | Has synergistic effect with loop diuretics (e.g., furosemide). Administer with food to improve absorption. |
| Hydrocortisone (Solu-Cortef) PO/IV | Corticosteroid that decreases inflammation by suppressing migration and decreasing capillary permeability of proinflammatory mediators. Stress dose: 20-30 mg/m 2 /day divided q8-12h Physiologic dose: 7-9 mg/m 2 /day divided q8-12h Facilitation of ventilator weaning: 0.2-2 mg/kg q12h | Possible aggravation of fluid retention, pituitary-adrenal axis suppression, hyperglycemia, hypertension, GI perforation (increased risk if given with indomethacin) | For ventilator weaning start at high dosages and wean over 10 days. Taper stress dose and physiologic dose based on patient response and condition. |
| Ibuprofen lysine (NeoProfen) IV | Inhibits prostaglandin synthesis by decreasing cyclooxygenase activity. Dose 1: 10 mg/kg Doses 2 and 3 starting 24 hr after dose 1: 5 mg/kg q24h | GI perforation, renal impairment, impaired platelet function | Monitor urine output, BUN, and serum creatinine. Verify adequate platelet count before administration. Monitor for signs of bleeding. |
| Imipenem/cilastatin (Primaxin) IV/IM | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. IV/IM: 20-25 mg/kg q12h | Seizures in patients with meningitis or renal dysfunction, increased platelet count, eosinophilia, elevated liver enzymes | Cilastatin prevents renal metabolism of imipenem, but has no antibacterial activity. IM route limited to mild to moderate infections. Restricted to treatment of non-CNS infections. Clearance is directly related to renal function. |
| Indomethacin (Indocin) IV | Inhibits prostaglandin synthesis by decreasing cyclooxygenase activity. Dose 1: 0.2 mg/kg followed by: Postnatal age <48 hr at time of dose 1: 0.1 mg/kg q12-24h for 2 doses Postnatal age 2-7 days at time of dose 1: 0.2 mg/kg q12-24h for 2 doses Postnatal age >7 days at time of dose 1: 0.25 mg/kg q12-24h for 2 doses | Oliguria, anuria, GI perforation, impaired platelet function | Monitor urine output, BUN, and serum creatinine—extend dosing interval if severe oliguria occurs. Verify adequate platelet count before administration. Monitor for signs of bleeding. |
| Insulin (Humulin R) IV/SC | Regulates metabolism of macronutrients and facilitates glucose transport into muscle, adipose, and other tissues. SC: 0.1-0.2 U/kg q6-12h Continuous IV infusion: 0.01-0.1 U/kg/hr | Hypoglycemia and associated signs and symptoms | Assess blood glucose every15-30 min after starting infusion and after any changes. To avoid binding of insulin to tubing, fill IV tubing with insulin solution and wait 20 min before starting infusion. |
| Intravenous immune globulin (IVIG) (Gamunex, Flebogamma, Carimune NF) IV | Concentrated form of immunoglobulin G antibodies for replacement therapy. Standard dose: 500-750 mg/kg Neonatal alloimmune thrombocytopenia: 400-1000 mg/kg | Hypotension, renal dysfunction, phlebitis | Monitor heart rate and blood pressure during infusion. If infusion not well tolerated, decrease in rate may be warranted. In most cases a single dose is sufficient, but doses may be repeated every 24 hr. |
| Ipratropium (Atrovent) Neb/MDI | Bronchodilator that blocks acetylcholine action in bronchial smooth muscle. MDI: 2-4 puffs q6-8h Neb: 75-175 μg (0.4-0.9 mL) q6-8h | Neonatal lung models suggest better drug delivery with spacer and MDI than with nebulizer. | |
| Iron dextran IV (IN Fed) | Replaces iron and allows for transportation of oxygen via hemoglobin. IV: 0.4-1 mg/kg q24h | Hypotension, respiratory distress, delayed fever or agitation (24-48 hr after administration), phlebitis | Add to TPN solution and infuse continuously if possible. If intermittent infusion necessary, dilute each dose (1-10 mg/mL) and administer over 1 hr. Longer infusion times can be used if intolerance occurs. |
| Lamivudine (3TC, Epivir) PO | Antiretroviral agent that inhibits reverse transcription via viral DNA chain termination. PO: 2 mg/kg q12h | Lactic acidosis, elevated hepatic enzymes | Used in combination with zidovudine for prevention of mother-to-child HIV transmission. Consider consulting infectious disease specialist for specific antiretroviral regimen recommendations. Monitor liver enzymes regularly if long-term treatment required. |
| Lansoprazole (Prevacid) PO | Inhibits proton pump and leads to decreased gastric acid secretion. PO: 1 mg/kg q24h | Increased transaminases with prolonged therapy | Dosages up to 2 mg/kg/day have been used in refractory cases. Monitor liver function with prolonged therapy. |
| Levetiracetam (Keppra) IV/PO | Exact mechanism unknown, but activity may include blocking GABA-ergic inhibitory transmission and inhibiting voltage-dependent calcium channels. IV/PO: 10 mg/kg q12-24h titrated up every 1-2 wk to max of 30 mg/kg q12h Administer q24h in neonates and q12h in infants | Sedation, irritability, GI disturbances, phlebitis | Second-line therapy for seizures refractory to phenobarbital or other antiepileptics. |
| Levothyroxine (Synthroid) PO/IV | Replacement therapy for thyroid hormone involved in normal metabolism, growth, and synthesis. PO: 10-14 μg/kg q24h IV: 5-8 μg/kg q24h | Tachycardia, fever, GI disturbances | Adjust PO dose in 12.5-μg increments and always round up. For oral doses crush tablet and suspend in small amount of sterile water, breast milk, or formula and use immediately. Do not use IV formulation for PO administration. |
| Linezolid (Zyvox) PO/IV | Inhibits initiation of bacterial protein synthesis by binding to 50S ribosome subunit. Preterm ≤1 wk of age: PO/IV: 10 mg/kg q12h Full term or preterm >1 wk of age: PO/IV: 10 mg/kg q8h | Elevated transaminases, diarrhea, anemia, thrombocytopenia | Limit use to infections caused by gram-positive organisms that are refractory to treatment with vancomycin. |
| Lorazepam (Ativan) PO/IV/IM | Binds to GABA receptor, enhancing effects of GABA, which is the major inhibitory neurotransmitter. PO/IV/IM: 0.05-0.01 mg/kg repeated based on clinical response | Hypotension, respiratory depression, rhythmic myoclonic jerking, phlebitis | Injectable form contains benzyl alcohol, polyethylene glycol, and propylene glycol. Use limited to acute management of seizures refractory to conventional therapy. |
| Meropenem (Merrem) IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.GA <32 wk: 0-14 days old: 20 mg/kg q12h >14 days old: 20 mg/kg q8h GA ≥32 wk: 0-7 days old: 20 mg/kg q12h >7 days old: 20 mg/kg q8h | Thrombocytosis, eosinophilia, phlebitis | Limit use to treatment of severe infections resistant to other antibiotics; use of broad-spectrum antibiotics increases risk of fungal infection and pseudomembranous colitis. |
| Methadone (Dolophine) IV/PO | Binds to opiate receptors in CNS, altering perception of and response to pain. IV/PO: 0.05-0.2 mg/kg q6-24h | Respiratory depression, abdominal distension, delayed gastric emptying | Start with lower doses at more frequent intervals and titrate up as needed based on NAS scores. Wean doses 10%-20% per week, adjusted based on withdrawal symptoms. Extend dosing interval first until administration is every 12 hr, then wean dose. Long elimination half-life requires slow weaning. |
| Metoclopramide (Reglan) PO/IV | Dopamine receptor antagonist that promotes gastric emptying and accelerates intestinal transit time. PO/IV: 0.033-0.1 mg/kg q8h | Extrapyramidal symptoms, dystonic reactions | Extrapyramidal symptoms more likely at higher dosages or with prolonged use. |
| Metronidazole (Flagyl) PO/IV | Breaks helical structure of DNA, which results in inhibition of protein synthesis and cell death. Loading dose: 15 mg/kg Maintenance dose: PMA ≤29 wk: 0-28 days old: 7.5 mg/kg q48h >28 days old: 7.5 mg/kg q24h PMA 30-36 wk: 0-14 days old: 7.5 mg/kg q24h >14 days old: 7.5 mg/kg q12h PMA 37-44 wk: 0-7 days old: 7.5 mg/kg q24h >7 days old: 7.5 mg/kg q12h PMA ≥45 wk: 7.5 mg/kg q8h | GI disturbances, neutropenia, thrombocytopenia | |
| Micafungin (Mycamine) IV | Inhibits synthesis of essential cell wall components of susceptible fungi, which results in osmotic stress and lysis of the fungal cell. IV: 7-10 mg/kg q24h | Hypokalemia, hypernatremia, thrombocytopenia, elevated liver enzymes | Use higher dose (10 mg/kg) for meningitis and neonates of <27 wk GA and <14 days of age. |
| Midazolam (Versed) PO/IV/IM/IN/SL | Binds to receptors for GABA, the major inhibitory neurotransmitter, which enhances effects of GABA. IV push/IM: 0.05-0.15 mg/kg q2-4h prn Continuous IV infusion: 0.01-0.06 mg/kg/hr, titrated as needed IN/SL: 0.2 mg/kg PO: 0.25 mg/kg | Hypotension, respiratory depression, myoclonus | Used most often for sedation, but can also be used for refractory seizures. Prolonged or repeated use may have detrimental effects on neurodevelopmental outcomes. Respiratory depression more common when administered with narcotics. Preservative-free injection available. |
| Milrinone (Primacor) IV | Inhibits phosphodiesterase III, which potentiates delivery of calcium to the myocardium and results in a positive inotropic effect. Also causes relaxation of vascular muscle and vasodilatation. Loading dose: 50-75 μg/kg/min Continuous IV infusion: 0.25-0.75 μg/kg/min | Thrombocytopenia, arrhythmias, tachycardia, hypotension | Loading dose optional based on status of patient. Correct hypovolemia before initiation. Blood pressure may decrease 5%-9% after loading dose and heart rate may increase 5%-10%. |
| Morphine (Astramorph, Duramorph) PO/IV/IM/SC | Binds to opiate receptors in the CNS, altering perception of and response to pain. Analgesia IV/IM/SC: 0.05-0.2 mg/kg q4h prn Continuous IV infusion: 10-20 μg/kg/hr, titrated as needed PO: 0.15-0.3 mg/kg q4h prn (or 3 times IV dose) NAS PO: 0.03-0.1 mg/kg q3h, increase as needed to control withdrawal | Hypotension, vasodilation, flushing, pruritus, respiratory depression, Gl disturbances | Closely monitor respiratory rate, blood pressure, heart rate, oxygen saturation, and bowel sounds. Metabolized to an active metabolite that is renally excreted. Effects reversed by naloxone. When used for NAS, wean 10%-20% daily as tolerated. |
| Nafcillin IV/IM | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Sepsis: 25 mg/kg Meningitis: 50 mg/kg PMA ≤29 wk: 0-28 days old: q12h >28 days old: q8h PMA 30-36 wk: 0-14 days old: q12h >14 days old: q8h PMA 37-44 wk: 0-7 days old: q12h >7 days old: q8h PMA ≥45 wk: q6h | Extravasation, GI disturbances, acute interstitial nephritis | Increase dosing interval in the presence of hepatic dysfunction. |
| Naloxone (Narcan) IV/IM/SC | Competes and displaces narcotics at narcotic receptor sites. IV/IM: 0.1 mg/kg q2-3min prn | Half-life of naloxone may be shorter than that of opioids; therefore, repeating doses every 1-2 hr may be necessary. May precipitate withdrawal symptoms in neonates receiving long-term opioid therapy. | |
| Neostigmine (Prostigmin) IV/IM/SC | Inhibits hydrolysis of acetylcholine, which facilitates cholinergic activity. IV: 0.04-0.08 mg/kg | Bradycardia, hypotension | Use for reversal of nondepolarizing neuromuscular blockade. Administer with 0.02 mg/kg atropine to minimize bradycardia. |
| Nevirapine (Viramune) PO | Antiretroviral agent that inhibits reverse transcriptase and disrupts life cycle of the virus. PO: 2 mg/kg × 1 dose as soon as possible after birth | GI disturbances, eosinophilia, neutropenia, hepatoxicity, granulocytopenia | Used in combination with zidovudine for prevention of mother-to-child HIV transmission. Consider consulting infectious disease specialist for specific recommendations on antiretroviral regimen and treatment beyond 1 dose. |
| Nystatin (Nystop) PO, topical | Binds to sterols in fungal cell membranes and increases permeability, which allows leakage of cellular contents. Topical: q6h PO: Preterm: 0.5 mL (50,000 U) to each side of mouth q6h Term: 1 mL (100,000 U) to each side of mouth q6h | Rash due to inactive ingredients in topical product | Continue treatment for 3 days after symptoms resolve. |
| Omeprazole (Prilosec) PO | Inhibits proton pump, which results in decreased gastric acid secretion. PO: 0.5-1.5 mg/kg q24h | Mild increase in transaminases with prolonged therapy | Monitor liver function with prolonged therapy. |
| Oxacillin IV/IM | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Sepsis: 25 mg/kg Meningitis: 50 mg/kg PMA ≤29 wk: 0-28 days old: q12h >28 days old: q8h PMA 30-36 wk: 0-14 days old: q12h >14 days old: q8h PMA 37-44 wk: 0-7 days old: q12h >7 days old: q8h PMA ≥45 wk: q6h | Thrombocytopenia, leukopenia, eosinophilia, neutropenia, acute interstitial nephritis, extravasation, elevated liver enzymes | Poor CSF penetration. Consider extending dosing interval in the presence of poor renal function. |
| Palivizumab (Synagis) IM | Monoclonal antibody that neutralizes and inhibits respiratory syncytial virus (RSV). IM: 15 mg/kg every month during RSV season | Swelling at injection site, fever, upper respiratory tract infection | Immunoprophylaxis against RSV infection in high-risk infants; not effective for treatment of RSV disease. |
| Pancuronium (Pavulon) IV | Blocks acetylcholine from binding to motor end plate receptors, which inhibits depolarization and causes neuromuscular blockade. IV push: 0.04-0.15 mg/kg q1-2h | Tachycardia, changes in blood pressure | Use with sedatives and analgesics. Provide eye lubrication. Contains benzyl alcohol. |
| Papaverine IV | Smooth muscle spasmolytic that produces generalized smooth muscle relaxation and vasodilation. Continuous IV infusion: 30 mg per 250 mL arterial catheter solution; infuse at 1 mL/hr | Chronic hepatitis with long-term therapy | Prolongs patency of peripheral arterial catheter. Use with caution in first days of life in infants at risk of developing intracranial hemorrhage. |
| Penicillin G IV/IM | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Meningitis: 75,000-100,000 U/kg Bacteremia: 25,000-50,000 U/kg PMA ≤29 wk: 0-28 days old: q12h >28 days old: q8h PMA 30-36 wk: 0-14 days old: q12h >14 days old: q8h PMA 37-44 wk: 0-7 days old: q12h >7 days old: q8h PMA ≥45 wk: q6h GBS or gonococcal bacteremia: 200,000 U/kg/day divided q6-8h GBS or gonococcal meningitis: 500,000 U/kg/day divided q6-8h Congenital syphilis: 50,000 U/kg IV q12h for first 7 days, then q8h or 50,000 U/kg IM q24h | Extravasation, cardiorespiratory arrest and death if IM form given IV | Use only aqueous penicillin for IV administration. Use procaine or benzathine penicillin for IM administration. Treat congenital syphilis for 10 days. |
| Phenobarbital (Luminal) PO/IV/IM | Binds to GABA receptor and enhances GABA activity, which results in depressed CNS activity. Loading dose: 20 mg/kg IV; repeat 5-10 mg/kg prn to total 40 mg/kg Maintenance dose: 3-5 mg/kg q24h IV, IM, or PO | Extravasation, respiratory depression, sedation, elevated liver enzymes | Begin maintenance dose 12-24 hr after loading dose. Avoid IM administration for loading dose due to erratic absorption and slower onset of action. Target serum concentration is 15-40 μg/mL; increased sedation at concentrations of >40 μg/mL and increased respiratory depression at concentrations of >60 μg/mL. |
| Phentolamine SC | Blocks α-adrenergic receptors and reverses vasoconstriction caused by extravasation. SC: 1-5 mL of 0.5 mg/mL solution | Amount injected into extravasation site depends on size of infiltrate. Use for extravasation of vasoconstrictive agents (dopamine, epinephrine, etc.). | |
| Phenytoin (Dilantin) PO/IV | Stabilizes neuronal membranes and decreases seizure activity by altering sodium ion transport across cell membranes in the motor cortex. Loading dose: 15-20 mg/kg IV Maintenance dose: 4-8 mg/kg IV or PO q24h | Bradycardia, arrhythmia, and hypotension during infusion; extravasation; rickets; nystagmus; gingivitis | Infuse slowly at maximum rate of 0.5 mg/kg/min. Do not administer IM. Higher dosages (up to 8 mg/kg q8h) may be needed after 1 wk of age. Target total serum concentration is 6-15 μg/mL in first few weeks of life, then 10-20 μg/mL. Target free serum concentration is 1-2 μg/mL. Administer oral doses at same time daily with regard to meals. Injectable form contains alcohol and propylene glycol. |
| Piperacillin/tazobactam (Zosyn) IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Tazobactam binds to β-lactamases and prevents degradation of piperacillin. IV: 50-100 mg/kg PMA ≤29 wk: 0-28 days old: q12h >28 days old: q8h PMA 30-36 wk: 0-14 days old: q12h >14 days old: q8h PMA 37-44 wk: 0-7 days old: q12h >7 days old: q8h PMA ≥45 wk: q8h | Eosinophilia, hyperbilirubinemia, elevated liver enzymes | Limited CNS penetration; avoid use if meningitis suspected. |
| Poractant alfa (Curosurf) IT | Natural surfactant extracted from porcine lung. Replaces deficient or ineffective endogenous lung surfactant. Initial dose: 2.5 mL/kg administered as soon as possible after birth Repeat doses: 1.25 mL/kg q12h prn × 2 doses | Reflux of surfactant up ET, decreased oxygenation, bradycardia | For IT administration only. Suspension should be at room temperature before administering. Do not artificially warm. Swirl suspension; do not shake or filter suspension. Continuously monitor heart rate and oxygen saturation during administration. |
| Propranolol (Inderal) PO/IV | Blocks stimulation of β 1 – and β 2 -adrenergic receptors, which results in decreased heart rate, myocardial contractility, and blood pressure. IV: 0.01 mg/kg q6h; increase prn to max 0.15 mg/kg q6h PO: 0.25 mg/kg q6h; increase prn to max 3.5 mg/kg q6h | Bradycardia, bronchospasm, hypoglycemia, hypotension | Rebound tachycardia occurs with abrupt discontinuation. Hypotension increased with underlying myocardial dysfunction. |
| Protamine IV | Combines with heparin to form complex with no anticoagulant activity. Dose based on time since last heparin dose: <30 min: 1 mg per 100 U heparin received 30-60 min: 0.5-0.75 mg per 100 U heparin received 60-120 min: 0.375-0.5 mg per 100 U heparin received >120 min: 0.25-0.375 mg per 100 U heparin received Max dose: 50 mg | Hypotension, bradycardia, bleeding problems | Infusion rate should not exceed 5 mg/min. Increased risk of bleeding and severe adverse reactions with high dose, rapid administration, or repeated doses. |
| Ranitidine (Zantac) PO/IV | Competitively inhibits histamine receptors in gastric parietal cells, which results in inhibition of gastric acid secretion. IV, term: 1.5 mg/kg q8h IV, preterm: 0.5 mg/kg q12h Continuous IV infusion: 0.04-0.1 mg/kg/hr PO: 2 mg/kg q8h | Thrombocytopenia, bradycardia, late-onset bacterial or fungal sepsis | Oral solution contains 7.5% alcohol. |
| Rifampin (Rifadin) PO/IV | Inhibits bacterial RNA synthesis by binding to β subunit of DNA-dependent RNA polymerase, thereby inhibiting RNA transcription. Treatment IV: 5-10 mg/kg q12h PO: 10-20 mg/kg q24h Prophylaxis Meningococcus: 5 mg/kg PO q12h × 2 days Haemophilus influenzae type B: 10 mg/kg PO q24h × 4 days | Extravasation, elevated hepatic transaminases, thrombocytopenia | Causes orange-red discoloration of urine, sputum, tears, and other bodily fluids. Do not use as monotherapy due to quick development of resistance. |
| Rocuronium (Zemuron) IV | Binds to cholinergic receptor sites and blocks neural transmission at myoneural junction. IV: 0.3-0.6 mg/kg over 5-10 sec | Increased pulmonary vascular resistance | Must be given with adequate analgesia and sedation. Primarily used before intubation due to rapid onset and short duration of action. |
| Sildenafil (Revatio) PO/IV | Phosphodiesterase type-5 inhibitor that causes vasodilation in the pulmonary vasculature. IV: 0.25-1 mg/kg q6-12h PO: 0.5-2 mg/kg q6-12h | Worsening oxygenation, hypotension | Start therapy with lower dosages and titrate slowly based on oxygenation and blood pressure. Pharmacokinetics in neonates is not well defined. Data for neonates are limited and use is considered experimental. |
| Sodium bicarbonate IV | Dissociates to provide bicarbonate ion, which neutralizes hydrogen ion and raises blood and urinary pH. Usual dosage: 1-2 mEq/kg Based on base deficit: HCO 3 needed (mEq) = HCO 3 deficit (mEq/L) × (0.3 × weight in kg) Administer ½ calculated dose then reassess | Tissue necrosis, hypocalcemia, hypokalemia, hypernatremia | Administer 1-2 mEq/kg over at least 30 min. Maximum concentration used in neonates is 0.5 mEq/mL (4.2%). Do not administer with calcium- or phosphate-containing solutions. Not recommended for use in neonatal resuscitation. |
| Sotalol (Betapace) PO | Blocks stimulation of β 1 – and β 2 -adrenergic receptors, which results in decreased heart rate and AV node conduction. Prolongs refractory period of atrial muscle, ventricular muscle, and AV accessory pathways. PO: 1 mg/kg q12h; increase every 3 days until stable rhythm maintained to max dose of 4 mg/kg q12h | Arrhythmias (sinoatrial block, AV block, torsade de pointes, ventricular ectopic activity), hypotension, dyspnea | Continuous cardiac monitoring required for at least 3 days at maintenance dose. High dosages increase risk of torsade de pointes. |
| Spironolactone (Aldactone) PO | Competes for aldosterone receptors in distal renal tubules, increasing sodium, chloride, and water excretion while conserving potassium and hydrogen ions. PO: 1-3 mg/kg q24h | Hyperkalemia, GI upset | Significantly less diuretic effect than thiazide and loop diuretics; use only in combination with other diuretics. May help to decrease potassium losses secondary to use of other diuretics. |
| Ticarcillin/clavulanate (Timentin) IV | Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Clavulanic acid binds to β-lactamases and prevents degradation of ticarcillin. IV: 75-100 mg/kg PMA ≤29 wk: 0-28 days old: q12h >28 days old: q8h PMA 30-36 wk: 0-14 days old: q12h >14 days old: q8h PMA 37-44 wk: 0-7 days old: q12h >7 days old: q8h PMA ≥45 wk: q6h | Eosinophilia, hyperbilirubinemia, hypernatremia, elevated liver enzymes | Limited CNS penetration; avoid use if meningitis suspected. |
| Tobramycin IV/IM | Inhibits bacterial protein synthesis by inhibiting 30S and 50S ribosomal subunits, which results in defective bacterial cell membrane. PMA <35 wk: 4 mg/kg q24h PMA ≥35 wk: 5 mg/kg q24h | Nephrotoxicity, ototoxicity (increased risk with concurrent use of other nephrotoxic or ototoxic drugs) | Monitor serum trough concentration before third dose if treating for >48 hr. Target trough concentration is <1 μg/mL. Extend dosing interval if trough is >1 μg/mL. Should not be concurrently administered in same IV line with extended-spectrum penicillin. |
| Ursodiol (Actigall) PO | Reduces secretion of cholesterol from liver and reabsorption of cholesterol by intestines, which results in decreased cholesterol in bile and bile stones. PO: 10-15 mg/kg q12h | Abdominal pain, constipation, flatulence, nausea and vomiting | Administer with food. |
| Valganciclovir (Valcyte) PO | Rapidly metabolized to the active component ganciclovir, which competes for incorporation into viral DNA, interferes with viral DNA chain elongation, and thus inhibits viral replication. PO: 16 mg/kg q12h | Thrombocytopenia, neutropenia, anemia | Treat acute infections for minimum of 6 wk. Hold dose for ANC of <500 cells/mm 3 until ANC is >750 cells/mm 3 . If ANC falls again to <750 cells/mm 3 reduce dose by 50%. If ANC falls to <500 cells/mm 3 discontinue drug. |
| Vancomycin (Vancocin) IV | Inhibits bacterial cell wall synthesis and alters bacterial cell membrane permeability. Meningitis: 15 mg/kg Bacteremia: 10 mg/kg PMA ≤29 wk: 0-14 days old: q18h >14 days old: q12h PMA 30-36 wk: 0-14 days old: q12h >14 days old: q8h PMA 37-44 wk: 0-7 days old: q12h >7 days old: q8h PMA ≥45 wk: q6h | Nephrotoxicity and ototoxicity (increased with aminoglycoside therapy), phlebitis, neutropenia | Serum trough concentrations correlate best with both efficacy and toxicity. Target serum trough concentration is 5-15 μg/mL. Concentrations up to 20 μg/mL have been targeted in severe infections. |
| Vecuronium (Norcuron) IV | Inhibits depolarization by blocking acetylcholine from binding to motor end plate receptors. IV push: 0.03-0.15 mg/kg q1-2h Continuous IV infusion: 0.06-0.1 mg/kg/hr | Bradycardia and hypotension when used with narcotics | Must be given with adequate sedation and analgesia. Provide eye lubrication. |
| Vitamin A (Aquasol A) IM | Retinol metabolites exhibit potent effects on gene expression and on lung growth and development. IM: 5000 U 3 times per week × 4 wk | Signs and symptoms of toxicity include lethargy, hepatomegaly, edema, bony tenderness, mucocutaneous lesions | Use in premature infants at highest risk of developing chronic lung disease. |
| Vitamin K (Mephyton, phytonadione) IM/IV | Promotes formation of clotting factors II, VII, IX, and X in the liver. Prophylaxis of hemorrhagic disease Term: 0.5-1 mg IM Preterm (<32 wk): <1000 g: 0.3 mg/kg IM ≥1000 g: 0.5 mg IM Treatment of hemorrhagic disease: 1-10 mg slow IV push Treatment of clotting deficiency: 1-10 mg IM or IV push | Pain and swelling at IM injection site | Administer IV doses very slowly, not to exceed 1 mg/min. Severe reactions have been reported very rarely in adults. |
| Zidovudine (AZT) (Retrovir) IV/PO | Phosphorylated to its active metabolite, which is incorporated into HIV by reverse transcriptase; inhibits HIV viral polymerases and DNA synthesis. IV: 1.5 mg/kg PO: 2 mg/kg PMA ≤29 wk: 0-28 days old: q12h >28 days old: q8h PMA 30-34 wk: 0-14 days old: q12h >14 days old: q8h PMA ≥35 wk: q6h | Anemia, neutropenia, thrombocytopenia | Begin within 6-12 hr of birth and continue for at least 6 wk. Consider consulting infectious disease specialist for specific antiretroviral regimen recommendations. |
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