Pressor dosing

FYI for those in ICU: Weight Based dosing for Pressors won't be instituted yet until new pumps arrive. Please use Pressor dosing as indicated in our current ICU admit orders.

Weight Based dosing for Pressors

Weight Based dosing for Vasopressors

See twitter link on right for quick link to table

Kaiser Oakland and Richmond hospitals will be implementing Baxter pumps programmed with a clinical library intended to provide additional safety features for medications delivered by continuous infusion.with weight based dosing to deliver medications. With the implementation of this clinical library, the dosing parameters for three vasopressor drugs will change. Three vasopressors in particular have significant importance and thus require attention. Significant changes are summarized below:

• Medications affected: epinephrine (Adrenalin), phenylephrine (Neo-Synephrine), and norepinephrine (Levophed).
• All three medications will need to be ordered as Dosing for all three medications will now be weight based in Mmicrogram/kg/min (mcg/kg/min). Previous dosing was mcg/min.
• Orders should read according to the following guideline: “Start norepinephrine at 0.05 mcg/kg/min IV, titrate to maintain MAP greater than ____.”
• Maximum infusion doses will now be weight specific, according to dosing charts which are readily available in ICU, PACU, ED and the Inpatient Pharmacy.
• Shaded areas on the dosing chart are reserved for high doses and are considered unusual and atypical.
• If a patient requires dosing of one of these pressors that is in the shaded area of the chart, a critical care physician should be consulted.

Specific Dosing charts are available in the ICU, PACU, ED. Please ask the nurse in charge.

Physicians who will order these medications are generally critical care specialists

Medication	Usual Starting Dose	Standard Concentration
Epinephrine (Adrenalin)	0.04 to 0.08 mcg/kg/min Titrate by 0.01 to 0.02 mcg/kg/min Max dose: See dosing chart	8 mcg/ml (2 mg/250 ml D5W)
Phenylephrine (Neo-Synephrine)	0.5 to 1 mcg/kg/min Titrate by 0.4 mcg/kg/min to SBP or MAP per MD order Max dose: See dosing chart	160 mcg/ml (40 mg/250 ml D5W or NS)
Norepinephrine (Levophed, Levarterenl)	0.2 mcg/kg/min Titrate by 0.05 mcg/kg/min increments to meet MAP or BP goals Max dose: See dosing chart	16 mcg/ml (4 mg/250ml D5W)

10/28/2009

Inpatient Pharmacy

KM/AH