Drug Infusion Doses
OVERVIEW
This page lists common and important drug infusion doses, preparation, and rates used in critical care.
DISCLAIMER:
- Always refer to local guidelines when prescribing and administering these agents in clinical practice.
- It is the clinician’s responsibility to check that the right medication and the right dose for the right patient is given at the right time.
- Please double-check these dosing suggestions in the paediatric population, and adjust doses for elderly, comorbid, or obese patients as required according to local guidelines.
SUMMARY DRUG INFUSION TABLE
DISCLAIMER: These are examples from an unnamed adult intensive care unit Institution 1, please check your local infusion protocols and double-check doses — especially with regards to the paediatric patient population.
Route of administration is either via peripheral intravenous access [P] or central intravenous access [C] as indicated below.
Drug | Preparation | Dosing / Infusion Rate | Route |
Actrapid (neutral insulin) | 50 units in 50 mL 0.9% saline (1 unit/mL) | Inf.: 0.1 units/kg/h for DKA initial Titrate to BSL. | [P&C] |
Adrenaline (epinephrine) | 4 mg in 100 mL 0.9% saline (40 microgs/mL) | Inf.: 0.01-1 microgs/kg/min E.g. 1-20 mL/h, ultimately, titrate to effect | [P&C, C preferred] |
Amiodarone | 900 mg in 500 mL 5% dextrose (1.8 mg/mL) | Inf.: Run over 24 hours E.g. 21 mL/h | [P&C, C preferred] |
Cisatracurium | Neat: 50mg in 25mL (2 mg/mL) | Bolus: 0.15-0.2 mg/kg Maint.: 0.5-5 microgs/kg/min titrate to TOF (Train of four) | [P&C] |
Clevidipine | Neat: 50 mg in 100 mL or 25 mg in 50 mL (0.5 mg/mL) | Maint.: 4-6 mg/h Start: 1-2 mg/h, doubling every 90seconds until BP target achieved, then smaller adjustments Max: 16 mg/h (no more than 500 mg/day) | [P&C] |
Dexmedetomidine | 200 microgs in 50 mL 0.9% saline (4 microgs/mL) | Load: 0.5-1 microgs/kg over 10-20mins Start: 0.2-0.4 microgs/kg/h Maint.: 0.2-1 microgs/kg/h E.g. 1-15 mL/h | [P&C] |
Dobutamine | 250 mg in 100 mL 0.9% saline (2.5 mg/mL) | Inf.: 2.5-10 microgs/kg/min E.g. 4.2-16.8 mL/h | [P&C, C preferred] |
Esmolol | Neat: 600 mg in 60 mL (10 mg/mL) There is a mythical 2.5 g vial, reconstitute in 250 mL of 0.9% saline (10 mg/mL) | Load: 500 microgs/kg in 1min, then Start: 50 microgs/kg/min Adjust every 3-4 mins by repeat load and increase infusion by 50 microgs/kg/min etc. Maint.: 50-200 microgs/kg/min E.g. 3.5 mL bolus, then 21 mL/h | [P&C] |
Fentanyl | 500 microgs in 50 mL 0.9% saline (10 microgs/mL) | Bolus: 0.5-1 microgs/kg or aliquots of 25-50 microgs (pain) RSI: 2-5 microgs/kg Infusion: 10-100 microgs/h E.g. 1-5 mL/h (after boluses) | [P&C] |
Furosemide | Neat: 250 mg in 25 mL 0.9% saline (10 mg/mL) | Inf.: 5-20 mg/h (dose should not exceed 1000 mg/day) E.g. 0.5-2 mL/h | [P&C] |
Glyceryl Trinitrate (GTN) | 50 mg in 100 mL 5% dextrose (500 microgs/mL) | Inf.: 0.6-12 mg/h Start: 1.5 mg/h (3 mL/h) Adjust by 0.5-1 mL/h every 2-3 mins Titrate to effect. | [P&C] |
Isoprenaline | 1 mg in 100 mL 5% dextrose (10 microgs/mL) | Inf.: 0.5-10 microgs/min Start: 0.5-5 microgs/min E.g. 3-60 mL/h adjust by 3 mL/h every 1-2 mins. Titrate to effect. | [P&C] |
Ketamine | 600 mg in 60 mL 0.9% saline (10 mg/mL) | Bolus: 0.1-0.3 mg/kg for sedation RSI: 0.25-2 mg/kg Inf.: 0.05-0.1 mg/kg/h for analgesia Inf.: 0.2 mg/kg/h for sedation | [P&C] |
Labetalol | 100 mg in 100 mL 5% dextrose (1 mg/mL) Neat: 300 mg in 60 mL (5 mg/mL) | Bolus: 0.25-0.5 mg/kg (adult up to 20mg) over 2 min repeat every 10 min Inf.: 0.25 – 3 mg/kg/h (up to 300 mg/h) | [P&C] |
Levosimendan | 12.5 mg in 250 mL 5% dextrose (50 microgs/mL) | Load: 6-24 microgs/kg over 10mins Maint.: 1-14 microgs/min for 24 hours | [C] |
Lidocaine (lignocaine) | Neat: 1 or 2% drawn up into 60 mL syringe (10 mg/mL 1% or 20 mg/mL 2%) | Bolus: 1 mg/kg (Pain / ALS) Inf.: 1-4 mg/min for 24 hours (VT) E.g. 6-24 mL/h for 1% solution | [P&C] |
Metaraminol | 30 mg in 60 mL 0.9% saline (0.5 mg/mL) | Bolus: 0.5-1 mg every 2-5 mins Inf.: 0.5-10 mg/h adjusting every 5-10 mins Titrate to effect. Consider norad. if >10 mL/h | [P&C] |
Midazolam | 50 mg in 50 mL 0.9% saline (1 mg/mL) | Bolus: 0.1 mg/kg (up to 5 mg) for sedation Inf.: 0.03-0.2 mg/kg/h for sedation E.g. 0.5-10 mg/h | [P&C] |
Milrinone | 20 mg in 100 mL 0.9% saline (200 microgs/mL) | Load: 50 microgs/kg (rarely administered) Inf.: 0.375-0.75 microgs/kg/min E.g. 5-15mL/h | [C] |
Morphine | 60 mg in 60 mL 0.9% saline (1 mg/mL) | Bolus: 0.1 mg/kg or aliquots of 2.5-5 mg (pain) Inf.: 1-10 mg/h | [P&C] |
Nimodipine | Neat: 10 mg in 50 mL (200 microgs/mL) | Inf.: 20 microgs/kg/h or 1mL/h/10kg (of body weight) for aSAH E.g. 7ml/h | [C] |
Noradrenaline (norepinephrine) | 4 mg in 100 mL 5% dextrose (40 microgs/mL) | Inf.: 0.01-1 microgs/kg/min E.g. 1-20 mL/h, ultimately, titrate to effect | [C] |
Oxycodone | 60 mg in 60 mL 0.9% saline (1 mg/mL) | Bolus: 0.1-0.2 mg/kg or aliquots of 0.5-2 mg (pain) Inf.: 1-10 mg/h | [P&C] |
Phenylephrine* | 10 mg in 500 mL 5% dextrose (20 microgs/mL) | Bolus: 40-100 microgs Inf.: 0.1-2 microgs/kg/min | [P&C] |
Propofol | Neat: 1% 1000 mg in 100 mL (10 mg/mL) | Bolus: 0.5-1 mg/kg as required every 3-5 mins for sedation Induction: 0.5-2 mg/kg Maint.: 1-4 mg/kg/h E.g. 1-25 mL/h | [P&C] |
Remifentanil* | 5 mg in 100 mL 0.9% saline (50 microgs/mL) Consider higher concentration in ICU use. | Induction: 1 microg/kg bolus, then, Maint.: 0.05-2 microgs/kg/min (anaesthesia) Inf.: 0.1-0.4 microgs/kg/min (ICU/analgesia) | [P&C] |
Salbutamol | 5 mg in 50 mL 0.9% saline (100 microgs/mL) | Load: 4-5 microgs/kg over 10mins Maint.: 5-20 microgs/min E.g. 3-12mL/h | [P&C] |
Sodium Nitroprusside (SNiP) | [C] 50 mg in 100 mL 5% dextrose (500 microgs/mL) [P] 50-100 mg in 500 mL 5% dextrose (100-200 microgs/mL) | Inf.: 0.5-10 microgs/kg/min Start: 1500 microgs/h (3mL/h) adjust every 2-3 mins by 1 mL E.g. 1-15 mL/h | [P&C] |
Thiopentone | 2.5 g in 50 mL 0.9% sterile water (50 mg/mL) | RSI: 3-4 mg/kg can give in divided doses Elevated ICP boluses: 100 mg Thio coma load: 10 mg/kg over 1 hour Maint.: 1-4 mg/kg/h adjust to BIS/cEEG burst suppression. | [C] |
Vasopressin (argipressin) | 20 units in 50 mL 0.9% saline (0.4 units/mL) | Inf.: 0.01-0.1 units/min E.g. 0-6 mL/h | [C] |
NOTES
- Examples are for your mythical 70kg man and otherwise typical rates seen at Institution 1 with drug dilutions from the table.
- Induction ranges are wide, smaller doses are often appropriate in critically ill and/or elderly patients.
- * Not used frequently in institution 1 in ICU
- Abbreviations: BIS (Bispectral Index), cEEG (Continuous EEG)
- For noradrenaline / adrenaline infusion concentration with 4mg in 100 mL
- 1 mL = 40 microgs
- microg/kg/min calculation:
- 40 microgs / 70 kg (mythical man) = 0.57 microgs
- 0.57 microgs / 60 minutes = 0.009 microgs/kg/min
- microg / min calculation:
- 40 microg / 60 min = 0.667 microg / min
- microg/kg/min calculation:
- 1 mL/h = ~0.01 microgs/kg/min (for the mythical 70kg man)
- 10 mL/h = 0.1 microg/kg/min
- 100 mL/h = 1 microg/kg/min
- 3 mL/h = 2 microgs/min
- 1 mL = 40 microgs
ANAESTHESIA
Doses:
- Adrenaline – 0.1-1 microgs/kg/min
- Dexmedetomidine – 0.2-0.7 microgs/kg/h
- Dobutamine – 1-20 microgs/kg/min
- Dopamine – 1-20 microgs/kg/min
- GTN – 0.1-0.8 microgs/kg/min
- Ketamine – analgesia: 0.05-0.1 mg/kg/h, sedation: 0.2 mg/kg/h
- Lignocaine – 1.5 mg/kg/h
- Noradrenaline – 0.1-1 microgs/kg/min
- Phenylephrine – 0.1-2 microgs/kg/min
- Propofol – 4-12 mg/kg/h or 75-175 microgs/kg/min
- Remifentanil – 0.1-1 microgs/kg/min
Total intravenous anaesthesia (TIVA):
- Propofol
- Sedation:
- Initiation: 100-150 microgs/kg/min (6 to 9 mg/kg/h) IV infusion or 0.5 mg/kg slow IV injection for 3-5 min followed by,
- Maintenance: 25-75 microgs/kg/min (1.5-4.5 mg/kg/h) IV infusion or 10-20 mg incremental IV bolus doses
- General anaesthetic:
- Induction: 40 mg IV every 10 seconds until induction onset (2-2.5 mg/kg)
- Maintenance: 100-200 microgs/kg/min IV infusion (6-12 mg/kg/h) (GA)
- Target-controlled infusion (TCI):
- Schnider model: Propofol 1% targeting effect site (Ce)
- Sedation: 0.1-2 microgs/mL
- Rapid induction: 4-6 microgs/mL
- Slower induction: 1-3 microgs/mL
- Maintenance anaesthesia: 3-6 microgs/mL
- Maintenance w/ concurrent opioids: 2.5-4 microgs/mL
- Concentration on waking: 1-2 microgs/mL
- Marsh model: Propofol 1% targeting plasma concentration (Cp)
- Schnider model: Propofol 1% targeting effect site (Ce)
- Sedation:
- Remifentanil
- General anaesthetic:
- Induction: 0.5-1 microgs/kg
- Maintenance: 0.25-2 microgs/kg/min
- TCI:
- Minto model: Remifentanil targeting effect site (Ce)
- Induction: 4-8 ng/mL
- Maintenance: 3-8 ng/mL, very stimulating procedures may require higher
- Maintenance w/ propofol: 2-6 ng/mL
- Marsh model: Remifentanil targeting plasma concentration (Cp)
- Minto model: Remifentanil targeting effect site (Ce)
- General anaesthetic:
Tips:
- 170 microgs/kg/min = patients weight in mL/h
- Number of mg in 50 mL @ 3 mL/h = microgs/min
References and Links
Introduction to ICU Series
Introduction to ICU Series Landing Page
DAY TO DAY ICU: FASTHUG, ICU Ward Round, Clinical Examination, Communication in a Crisis, Documenting the ward round in ICU, Human Factors
AIRWAY: Bag Valve Mask Ventilation, Oropharyngeal Airway, Nasopharyngeal Airway, Endotracheal Tube (ETT), Tracheostomy Tubes
BREATHING: Positive End Expiratory Pressure (PEEP), High Flow Nasal Prongs (HFNP), Intubation and Mechanical Ventilation, Mechanical Ventilation Overview, Non-invasive Ventilation (NIV)
CIRCULATION: Arrhythmias, Atrial Fibrillation, ICU after Cardiac Surgery, Pacing Modes, ECMO, Shock
CNS: Brain Death, Delirium in the ICU, Examination of the Unconscious Patient, External-ventricular Drain (EVD), Sedation in the ICU
GASTROINTESTINAL: Enteral Nutrition vs Parenteral Nutrition, Intolerance to EN, Prokinetics, Stress Ulcer Prophylaxis (SUP), Ileus
GENITOURINARY: Acute Kidney Injury (AKI), CRRT Indications
HAEMATOLOGICAL: Anaemia, Blood Products, Massive Transfusion Protocol (MTP)
INFECTIOUS DISEASE: Antimicrobial Stewardship, Antimicrobial Quick Reference, Central Line Associated Bacterial Infection (CLABSI), Handwashing in ICU, Neutropenic Sepsis, Nosocomial Infections, Sepsis Overview
SPECIAL GROUPS IN ICU: Early Management of the Critically Ill Child, Paediatric Formulas, Paediatric Vital Signs, Pregnancy and ICU, Obesity, Elderly
FLUIDS AND ELECTROLYTES: Albumin vs 0.9% Saline, Assessing Fluid Status, Electrolyte Abnormalities, Hypertonic Saline
PHARMACOLOGY: Drug Infusion Doses, Summary of Vasopressors, Prokinetics, Steroid Conversion, GI Drug Absorption in Critical Illness
PROCEDURES: Arterial line, CVC, Intercostal Catheter (ICC), Intraosseous Needle, Underwater seal drain, Naso- and Orogastric Tubes (NGT/OGT), Rapid Infusion Catheter (RIC)
INVESTIGATIONS: ABG Interpretation, Echo in ICU, CXR in ICU, Routine daily CXR, FBC, TEG/ROTEM, US in Critical Care
ICU MONITORING: NIBP vs Arterial line, Arterial Line Pressure Transduction, Cardiac Output, Central Venous Pressure (CVP), CO2 / Capnography, Pulmonary Artery Catheter (PAC / Swan-Ganz), Pulse Oximeter
CCC Pharmacology Series
Respiratory: Bosentan, Delivery of B2 Agonists in Intubated Patients, Nitric Oxide, Oxygen, Prostacyclin, Sildenafil
Cardiovascular: Adenosine, Adrenaline (Epinephrine), Amiodarone, Classification of Vasoactive drugs, Clevidipine, Digoxin, Dobutamine, Dopamine, Levosimendan, Levosimendan vs Dobutamine, Milrinone, Noradrenaline, Phenylephrine, Sodium Nitroprusside (SNiP), Sotalol, Vasopressin
Neurological: Dexmedetomidine, Ketamine, Levetiracetam, Lignocaine, Lithium, Midazolam, Physostigmine, Propofol, Sodium Valproate, Sugammadex, Thiopentone
Endocrine: Desmopressin, Glucagon Therapy, Medications and Thyroid Function
Gastrointestinal: Octreotide, Omeprazole, Ranitidine, Sucralfate, Terlipressin
Genitourinary: Furosemide, Mannitol, Spironolactone
Haematological: Activated Protein C, Alteplase, Aprotinin, Aspirin, Clopidogrel, Dipyridamole, DOACs, Factor VIIa, Heparin, LMW Heparin, Protamine, Prothrombinex, Tenecteplase, Tirofiban, Tranexamic Acid (TXA), Warfarin
Antimicrobial: Antimicrobial Dosing and Kill Characteristics, Benzylpenicillin, Ceftriaxone, Ciprofloxacin, Co-trimoxazole / Bactrim, Fluconazole, Gentamicin, Imipenem, Linezolid, Meropenem, Piperacillin-Tazobactam, Rifampicin, Vancomycin
Analgesic: Alfentanil, Celecoxib, COX II Inhibitors, Ketamine, Lignocaine, Morphine, NSAIDs, Opioids, Paracetamol (Acetaminophen), Paracetamol in Critical Illness, Tramadol
Miscellaneous: Activated Charcoal, Adverse Drug Reactions, Alkali Therapies, Drug Absorption in Critical Illness, Drug Infusion Doses, Epidural Complications, Epidural vs Opioids in Rib Fractures, Magnesium, Methylene Blue, Pharmacology and Critical Illness, PK and Obesity, PK and ECMO, Sodium Bicarbonate Use, Statins in Critical Illness, Therapeutic Drug Monitoring, Weights in Pharmacology
Toxicology: Digibind, Flumazenil, Glucagon Therapy, Intralipid, N-Acetylcysteine, Naloxone, Propofol Infusion Syndrome
- Australian Injectable Drugs Handbook, 8th Edition. (2022). Retrieved 13 August 2022, from https://aidh.hcn.com.au/
- Australian Medicines Handbook. (2022). Retrieved 13 August 2022, from https://amhonline.amh.net.au/
- IBM Micromedex. (2022). Retrieved 13 August 2022, from https://www.micromedexsolutions.com
- MIMS. (2022). Retrieved 13 August 2022, from https://www.mimsonline.com.au
- Nimmo, A., Absalom, A., Bagshaw, O., Biswas, A., Cook, T., & Costello, A. et al. (2018). Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia, 74(2), 211-224. doi: 10.1111/anae.14428 [Free Full Text]
- TIVA Guide. (2022). Retrieved 13 August 2022, from https://clinicaltoolkit.scot.nhs.uk/sjh-theatres-and-anaesthetics/clinical-resources/tiva-guide/
Critical Care
Compendium
ICU Advanced Trainee BMedSci [UoN], BMed [UoN], MMed(CritCare) [USyd] from a broadacre farm who found himself in a quaternary metropolitan ICU. Always trying to make medical education more interesting and appropriately targeted; pre-hospital and retrieval curious; passionate about equitable access to healthcare; looking forward to a future life in regional Australia. Student of LITFL.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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