II. Indications
- Other Narcotic Analgesics are preferred
- See disadvantages below (e.g. accumulation)
- Consider when only 1-2 doses required
- Suppresses rigors and shivering
- Amphotericin
- Therapeutic Hypothermia
III. Pharmacokinetics
- Onset: 10 to 15 minutes
- Peak: 30 to 50 minutes
- Duration: 2 to 4 hours
IV. Dosing: Child
- Dose: 0.25-1.0 mg/kg (up to 1.8 mg/kg has been used max: 100 mg) IM q3-4 hours
V. Dosing: Adult
- Dose: 50 to 100 mg (or 1-1.5 mg/kg) IM q3-4 hours
- Dose per weight (default dosing often too low)
- Intravenous dosing preferred over intramuscular
- No dosing adjustment needed for IV versus IM
- Dosing frequency is often dosed too infrequently
- Duration of action is only 3 hours
- Avoid more than 2-3 doses due to accumulation
- Often administered with Hydroxyzine (Vistaril)
- Vistaril 25 to 50 mg (0.5 mg/kg) IM q4-6 hours
- Vistaril no longer routinely recommended
- Consider alternative intravenous Antiemetic
VI. Disadvantages
- Toxic metabolites
- Neurotoxic metabolites (e.g. Seizure risk)
- Clark (1995) J Emerg Med 13(6):797 [PubMed]
- Weak Analgesic compared with other Narcotics
- Accumulates in Renal Failure (avoid in the elderly)
- Psychomimetic effects (Dysphoria or Euphoria)
- Poor oral absorption
VII. Advantages
- Serotonin reuptake inhibitor
- Suppresses rigors and shivering
- Amphotericin
- Therapeutic Hypothermia