Drug dosage calculations
From WikiAnesthesia
The drug dosage calculations provide specific dose information based upon patient statistics provided in the fields above and the indications and routes selected for the drug.
- IMPORTANT: This calculator is designed to be a quick reference, and many important considerations and contraindications are not listed here. As with all clinical decision support tools, ultimately use clinical judgement when selecting the dose to be administered for a specific patient.
- If the dose is weight-based and weight is provided, the mass and volume of drug will also be calculated
- Doses are calculated using total body weight unless otherwise specified
- For volume, verify the correct preparation of the drug is selected
- If the drug has different dosing based upon age (e.g. pediatric, elderly) and age is provided, an adjusted dose will be provided if the data is available
- Some doses may have important additional information which will be shown as a link below the dose
Contributing to this calculator
Use the discussion page to leave feedback about the calculator. To contribute more substantially, see the calculators guide to learn about the process to get developer access.
The drug dosage calculations are powered by the patients, bodyComposition, drugs, and drugDosages modules. The dosage data is defined in the drugs data module.Search drugs
Sedatives and hypnotics
Load
- 1 mcg/kg IV over 10 min
- 0.2-1 mcg/kg/hr IV
- 0.2-0.6 mg/kg IV (Lean body weight)
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
- If sedation recurs, repeat reversal q20m
- Max 0.2 mg/min or 3 mg/hr
- Adjust dosing in hepatic impairment
- Seizures may occur in chronic benzodiazepine users and patients with epilepsy
- 1-2 mg/kg IV (Lean body weight)
- Syed Q, Kohli A. Methohexital. 2021 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31335011.
- 0.01-0.03 mg/kg IV
Adult dosing
Induction
- 1-2.5 mg/kg IV (Lean body weight)
- 100-200 mcg/kg/min IV
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
Adult dosing
- 2.5-5 mg IV q2m
- 2.5-5 mL of 1 mg/mL
- Russo H, Bressolle F. Pharmacodynamics and pharmacokinetics of thiopental. Clin Pharmacokinet. 1998 Aug;35(2):95-134. doi: 10.2165/00003088-199835020-00002. PMID: 9739479.
Opioids
Load
- 8-20 mcg/kg IV
- 0.5-3 mcg/kg/min IV
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
Higher doses may be required in opioid-tolerant patients
Higher doses may be required in opioid-tolerant patients
- 0.1-0.3 mg/kg IV/IM/PO/SQ (Ideal body weight)
Higher doses may be required in opioid-tolerant patients
- Murphy GS, Szokol JW. Intraoperative Methadone in Surgical Patients: A Review of Clinical Investigations. Anesthesiology. 2019 Sep;131(3):678-692. doi: 10.1097/ALN.0000000000002755. PMID: 31094758.
Adult dosing
- 2.5-10 mg IV/IM
- 0.25-1 mL of 10 mg/mL
Adult dosing
- 20-200 mcg IV q2-3m
- 0.05-0.5 mL of 0.4 mg/mL
Higher doses may be required in opioid-tolerant patients
Load
- 1-2 mcg/kg IV (Lean body weight)
- 0.1-1 mcg/kg/min IV (Lean body weight)
- Egan TD, Huizinga B, Gupta SK, Jaarsma RL, Sperry RJ, Yee JB, Muir KT. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998 Sep;89(3):562-73. doi: 10.1097/00000542-199809000-00004. PMID: 9743391.
Load
- 0.25-2 mcg/kg IV (Lean body weight)
- 0.3-1.5 mcg/kg/hr IV
Neuromuscular blockade
Load
- 0.4-0.5 mg/kg IV (Ideal body weight)
- 5-10 mcg/kg/min IV (Ideal body weight)
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
Adult dosing
Load
- 0.15-0.2 mg/kg IV (Ideal body weight)
- 0.03 mg/kg IV (Ideal body weight)
- 1-2 mcg/kg/min IV (Ideal body weight)
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
- 0.03-0.07 mg/kg IV (Max: 5 mg)
For each 1 mg of neostigmine, give 0.2 mg of glycopyrrolate to avoid bradycardia
Standard
- 0.04-0.1 mg/kg IV (Ideal body weight)
- 0.1-0.15 mg/kg IV (Ideal body weight)
- 0.015-0.1 mg/kg IV q30-60m (Ideal body weight)
- 0.1 mg/kg/hr IV (Ideal body weight)
Reduce dose or avoid in renal impairment
- Holmgreen WC, Nishioka G, Smith RB. Pancuronium rapid induction sequence. Anesth Prog. 1987 Sep-Oct;34(5):171-6. PMID: 3479916; PMCID: PMC2148540.
Standard
- 0.6 mg/kg IV (Ideal body weight)
- 1.2 mg/kg IV (Ideal body weight)
- 0.04 mg/kg IV (Ideal body weight)
- 0.1-0.2 mg/kg IV (Ideal body weight)
- 0.01-0.012 mg/kg/min IV (Ideal body weight)
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
- Gaszynski TM, Szewczyk T. Rocuronium for rapid sequence induction in morbidly obese patients: a prospective study for evaluation of intubation conditions after administration 1.2 mg kg⁻¹ ideal body weight of rocuronium. Eur J Anaesthesiol. 2011 Aug;28(8):609-10. doi: 10.1097/EJA.0b013e32834753d0. PMID: 21562423.
- Kim KN, Kim KS, Choi HI, Jeong JS, Lee HJ. Optimal precurarizing dose of rocuronium to decrease fasciculation and myalgia following succinylcholine administration. Korean J Anesthesiol. 2014 Jun;66(6):451-6. doi: 10.4097/kjae.2014.66.6.451. Epub 2014 Jun 26. PMID: 25006369; PMCID: PMC4085266.
Standard
- 0.1 mg/kg IV (Ideal body weight)
- 0.15-0.2 mg/kg IV (Ideal body weight)
- 0.01-0.015 mg/kg IV q20-40m (Ideal body weight)
- 0.05-0.07 mg/kg/hr IV (Ideal body weight)
For rapid sequence, can give priming dose of 0.01 mg/kg three minutes before induction to reduce onset of paralysis to 75 to 90 seconds.
- Ramzy M, McAllister RK. Vecuronium. [Updated 2021 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493143/
- Smith CE, Kovach B, Polk JD, Hagen JF, Fallon WF Jr. Prehospital tracheal intubating conditions during rapid sequence intubation: rocuronium versus vecuronium. Air Med J. 2002 Jan-Feb;21(1):26-32. doi: 10.1067/mmj.2002.121713. PMID: 11805764.
- Baumgarten RK, Carter CE, Reynolds WJ, Brown JL, DeVera HV. Priming with nondepolarizing relaxants for rapid tracheal intubation: a double-blind evaluation. Can J Anaesth. 1988 Jan;35(1):5-11. doi: 10.1007/BF03010536. PMID: 2894903.
- Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23. doi: 10.1093/bja/aeq312. PMID: 21148651.
- 1-1.5 mg/kg IV
≥2 twitches on TOF:
- 2 mg/kg IV
- 4 mg/kg IV
- 16 mg/kg IV
Cardiovascular agonists
Repeat as needed to a maximum total dose of 3 mgLow doses may cause paradoxical bradycardia
- 0.5-20 mcg/kg/min IV
First line vasopressor for cardiogenic shock with low cardiac output and maintained blood pressure
- Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011 Apr 1;183(7):847-55. doi: 10.1164/rccm.201006-0972CI. Epub 2010 Nov 19. PMID: 21097695.
- Predominant receptor activation is dose-dependent:
- <5 mcg/kg/min: Dopaminergic
- 5-10 mcg/kg/min: β-1 adrenergic
- >10 mcg/kg/min: α-1 adrenergic
- Low-dose dopamine should not be used for renal protective effect
- Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011 Apr 1;183(7):847-55. doi: 10.1164/rccm.201006-0972CI. Epub 2010 Nov 19. PMID: 21097695.
- Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet. 2000 Dec 23-30;356(9248):2139-43. doi: 10.1016/s0140-6736(00)03495-4. PMID: 11191541.
Adult dosing
- 2.5-25 mg IV
- 0.5-5 mL of 5 mg/mL
Adult dosing
Bolus
- 5-20 mcg IV q1-5m
- 0.05-0.2 mL of 100 mcg/mL
- 0.01-2 mcg/kg/min IV
First line vasopressor for anaphylactic shock
- Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011 Apr 1;183(7):847-55. doi: 10.1164/rccm.201006-0972CI. Epub 2010 Nov 19. PMID: 21097695.
- Gallanosa A, Stevens JB, Quick J. Glycopyrrolate. 2020 Oct 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 30252291.
Load (optional)
- 50 mcg/kg IV over 10 min
- 0.13-0.75 mcg/kg/min IV
- Used in cardiogenic shock
- Dose adjustment needed in renal impairment
- Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011 Apr 1;183(7):847-55. doi: 10.1164/rccm.201006-0972CI. Epub 2010 Nov 19. PMID: 21097695.
Adult dosing
Bolus
- 5-20 mcg IV
- 0.5-2 mL of 10 mcg/mL
- 0.05-3.3 mcg/kg/min IV
First line vasopressor for septic and hypovolemic shock
- Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011 Apr 1;183(7):847-55. doi: 10.1164/rccm.201006-0972CI. Epub 2010 Nov 19. PMID: 21097695.
Adult dosing
Bolus
- 50-200 mcg IV
- 0.5-2 mL of 100 mcg/mL
- 0.25-1 mcg/kg/min IV
Adult dosing
Bolus
- 0.5-1 units IV
- 0.5-1 mL of 1 unit/mL
- 0.01-0.07 units/min IV
- 0.01-0.07 mL/min of 1 unit/mL
Use caution with sustained infusions >0.04 units/min which can cause cardiac and splanchnic ischemia
- Hollenberg SM. Vasoactive drugs in circulatory shock. Am J Respir Crit Care Med. 2011 Apr 1;183(7):847-55. doi: 10.1164/rccm.201006-0972CI. Epub 2010 Nov 19. PMID: 21097695.
Cardiovascular antagonists
Initial dose:
- 0.3-0.4 mg/kg IV rapid push
- 2 mg/kg IV
Administer as a rapid push via central line or most proximal peripheral IV available
- Desai VR, Rosas AL, Britz GW. Adenosine to facilitate the clipping of cerebral aneurysms: literature review. Stroke Vasc Neurol. 2017 Jun 23;2(4):204-209. doi: 10.1136/svn-2017-000082. PMID: 29507781; PMCID: PMC5829927.
Load
- 150 mg IV over 10 min
- 100 mL of 1.5 mg/mL
- 1 mg/min IV over 6 hours
- 0.67 mL/min of 1.5 mg/mL
Repeated boluses may be given over 10 to 30 minutes, max of 6-8 boluses in 24 hour period. Boluses given more rapidly than 10 minutes increase risk of hypotension.For treatment of unstable atrial fibrillation with or without rapid ventricular response (RVR)
Adult dosing
Bolus
- 125-500 mcg IV
- 0.25-1 mL of 0.5 mg/mL
- 1-2 mg/hr IV
- 2-4 mL/hr of 0.5 mg/mL
- Double dose every 90 seconds initially
- When near goal
- Increase dose by less than double
- Lengthen titration interval to 5-10 min
- Clevipine drug label. Accessible at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022156s003lbl.pdf
- Cheung, AT, Avery, IV EG. Clevidipine Bolus Administration in the Treatment of Hypertensive Patients Undergoing Cardiac Surgery (SPRINT). Identifier NCT00799604. https://clinicaltrials.gov/ct2/show/NCT00799604
Load
- 0.5-1 mg/kg IV
- 50-300 mcg/kg/min IV
Titrate infusion by 50 mcg/kg/min q4m until desired effect achieved.
- Pevtsov A, Kerndt CC, Fredlund KL. Esmolol. [Updated 2021 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518965/
Double dose q5-10m until desired effect achieved.
- Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag. 2008;4(3):615-27. doi: 10.2147/vhrm.s2471. PMID: 18827911; PMCID: PMC2515421.
Adult dosing
- 1-5 mg IV q5m (15 mg max)
- 1-5 mL of 1 mg/mL
Adult dosing
Bolus
- 10-40 mcg IV
- 1-4 mL of 10 mcg/mL
- 0.1-3 mcg/kg/min IV
- Titrate by 0.1-0.2 mcg/kg/min q3-5m until desired effect achieved
Adult dosing
Bolus
- 12.5-25 mcg IV
- 0.025-0.05 mL of 500 mcg/mL
- 0.3-2 mcg/kg/min IV
- Titrate by 0.5 mcg/kg/min q3-5m until desired effect achieved
- High doses (8-10 mcg/kg/min) should not be used for more than 10 minutes
- Schulz V. Clinical pharmacokinetics of nitroprusside, cyanide, thiosulphate and thiocyanate. Clin Pharmacokinet. 1984 May-Jun;9(3):239-51. doi: 10.2165/00003088-198409030-00005. PMID: 6375932.
Postoperative nausea and vomiting
- 40 mg PO
- 1 pill of 40 mg/pill
- Singh PM, Borle A, Rewari V, Makkar JK, Trikha A, Sinha AC, Goudra B. Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis. Postgrad Med J. 2016 Feb;92(1084):87-98. doi: 10.1136/postgradmedj-2015-133515. Epub 2015 Dec 1. PMID: 26627976.
Adult dosing
- 4-8 mg IV
- 2-4 mL of 2 mg/mL
- 150 mg IV
- 1 vial of 150 mg/vial
- Murakami C, Kakuta N, Kume K, Sakai Y, Kasai A, Oyama T, Tanaka K, Tsutsumi YM. A Comparison of Fosaprepitant and Ondansetron for Preventing Postoperative Nausea and Vomiting in Moderate to High Risk Patients: A Retrospective Database Analysis. Biomed Res Int. 2017;2017:5703528. doi: 10.1155/2017/5703528. Epub 2017 Dec 19. PMID: 29410964; PMCID: PMC5749222.
Adult dosing
- 1 mg IV
- 1 mL of 1 mg/mL
- De Oliveira GS Jr, Castro-Alves LJ, Chang R, Yaghmour E, McCarthy RJ. Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii's studies. Br J Anaesth. 2012 Nov;109(5):688-97. doi: 10.1093/bja/aes325. Epub 2012 Sep 25. PMID: 23015617.
- Maximum recommended daily dose 16 mg due to QT prolongation risk
- Reduced to 8 mg in patients with severe hepatic impairment
- Griddine A, Bush JS. Ondansetron. [Updated 2022 Sep 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499839/
- Kovac AL, Eberhart L, Kotarski J, Clerici G, Apfel C; Palonosetron 04-07 Study Group. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing postoperative nausea and vomiting over a 72-hour period. Anesth Analg. 2008 Aug;107(2):439-44. doi: 10.1213/ane.0b013e31817abcd3. PMID: 18633021.
Max 40 mg/dayContraindicated in children <2 years old
Max 40 mg/day
- IM is preferred over IV due to risk of tissue necrosis if extravasation occurs.
- Contraindicated in children <2 years old
- 1.5 mg TD q72h
- 1 patch of 1.5 mg/patch
1 transdermal patch delivers scopolamine 1.5 mg over 72 hours
Non-opioid analgesics
Max 4 g/day. Use caution in hepatic impairment.
A 10 mg dose of ketorolac is as effective for acute pain control as a 15 or 30 mg dose1
- Motov S, Yasavolian M, Likourezos A, Pushkar I, Hossain R, Drapkin J, Cohen V, Filk N, Smith A, Huang F, Rockoff B, Homel P, Fromm C. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2017 Aug;70(2):177-184. doi: 10.1016/j.annemergmed.2016.10.014. Epub 2016 Dec 16. PMID: 27993418.
Load
- 1-2 mg/kg IV
- 1.5-3 mg/kg/hr IV
Maximum total dose 4.5 mg/kg
- Lauren K. Dunn, Marcel E. Durieux; Perioperative Use of Intravenous Lidocaine. Anesthesiology 2017; 126:729–737 doi: https://doi.org/10.1097/ALN.0000000000001527
Obstetric anesthesia
- 0.25 mg IM q15-90m, max 2 mg/day
- 1 mL of 0.25 mg/mL
- Relatively contraindicated in asthma
- 0.2 mg IM q5-10m, max 2 doses
- 1 mL of 0.2 mg/mL
- After 2 doses q5-10m, repeat q2-4h
- Relatively contraindicated in preeclampsia and (gestational) hypertension
- 400-800 mcg SL
- 2-4 pill of 200 mcg/pill
- Hofmeyr GJ, Gülmezoglu AM, Novikova N, Linder V, Ferreira S, Piaggio G. Misoprostol to prevent and treat postpartum haemorrhage: a systematic review and meta-analysis of maternal deaths and dose-related effects. Bull World Health Organ. 2009 Sep;87(9):666-77. doi: 10.2471/blt.08.055715. PMID: 19784446; PMCID: PMC2739911.
- WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. Geneva: World Health Organization; 2012. PMID: 23586122.
- 2.5-25 mcg/min IV
- 0.0025-0.025 mL/min of 1 mg/mL
- Initiate infusion at 2.5-5 mcg/min
- Increase by 2.5 to 5 mcg/min q20-30m until desired effect achieved (max 25 mcg/min)
- Avoid prolonged treatment (48-72 hr)
- Use caution in patients with tachycardia-sensitive cardiac disease or poorly controlled hypothyroidism or diabetes mellitus
Electrolytes
- Administer via central line
- A 10 mL ampule of calcium chloride 100 mg/mL contains 272 mg of elemental calcium
- French S, Subauste J, Geraci S. Calcium abnormalities in hospitalized patients. South Med J. 2012 Apr;105(4):231-7. doi: 10.1097/SMJ.0b013e31824e1737. PMID: 22475676.
- Can administer peripherally
- A 10 mL ampule of calcium gluconate 100 mg/mL contains 93 mg of elemental calcium
- French S, Subauste J, Geraci S. Calcium abnormalities in hospitalized patients. South Med J. 2012 Apr;105(4):231-7. doi: 10.1097/SMJ.0b013e31824e1737. PMID: 22475676.
- Rapid administration can cause hypotension and bradycardia
- 1-2 mEq/kg IV
Diuretics
- 0.25-1 g/kg IV
Antibiotics
Ampicillin
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Gentamicin dosing is based on total body weight (TBW)
- If the total body weight is more than 20% above ideal body weight (IBW), use the dosing weight (DW) below
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
- 15 mg/kg IV (no redose)
- Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. doi: 10.2146/ajhp120568. PMID: 23327981.
Malignant hyperthermia
Other
- Max 400 mg/day
- Rapid IV administration may cause hypotension
- Ellis BC, Brown SG. Parenteral antihistamines cause hypotension in anaphylaxis. Emerg Med Australas. 2013 Feb;25(1):92-3. doi: 10.1111/1742-6723.12028. PMID: 23379461.
Load
- 180 mcg/kg IV
- 2 mcg/kg IV
Infusion should be continued until discharge or up to 18-24 hr after procedure (whichever comes first), providing up to 96 hr of therapy.
- Minor procedures
- Take usual AM steroid dose, no supplementation required
- Moderate surgical stress
- Take usual AM steroid dose
- 50 mg before incision
- 25 mg q8h for 24h
- Major surgical stress
- Take usual AM steroid dose
- 100 mg before incision
- 50 mg q8h for 24h
- Taper dose by 50% per day until at usual dose
- HPA axis suppression is unlikely in patients taking less than 5 mg/day of prednisone or equivalent
- Methylprednisolone 4 mg/day, dexamethasone 0.5 mg/day, hydrocortisone 20 mg/day
- HPA axis suppression is likely in patients taking more than 20 mg/day of prednisone or equivalent
- Methylprednisolone 16 mg/day, dexamethasone 2 mg/day, hydrocortisone 80 mg/day
- Patients taking intermediate doses or who have discontinued higher doses in the previous year should undergo preoperative evaluation of their HPA axis
- Liu MM, Reidy AB, Saatee S, Collard CD. Perioperative Steroid Management: Approaches Based on Current Evidence. Anesthesiology. 2017 Jul;127(1):166-172. doi: 10.1097/ALN.0000000000001659. PMID: 28452806.
General (<70 kg) dosing
Bolus
- 1.5 mL/kg IV over 2-3 min (Max: 100 mL, Ideal body weight)
- 0.25 mL/kg/min IV (Max: 17 mL/min, Ideal body weight)
- If patient remains unstable:
- Repeat bolus
- Double infusion rate
- Neal JM, Neal EJ, Weinberg GL. American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version. Reg Anesth Pain Med. 2021 Jan;46(1):81-82. doi: 10.1136/rapm-2020-101986. Epub 2020 Nov 4. PMID: 33148630.
Adult dosing
- 15-30 mL PO
Top contributors: Chris Rishel