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.

INTENSIVE CARE

Doses:

  • Adrenaline – 1-70 microgs/min
  • Dexmedetomidine – 0.2-0.7 microgs/kg/h
  • Dobutamine – 70-1400 microgs/min
  • Dopamine – 70-1400 microgs/min
  • Fentanyl – 10-50 microgs/h
  • GTN – 1-70 microgs/min
  • Ketamine – 0.2 mg/kg/h
  • Levosimendan – loading dose: 6-24 microgs/kg over 10 min, infusion for 24 hours of 1- 14 microgs/min
  • Midazolam – 1-20 mg/h
  • Milrinone – loading dose 50 microgs/kg, infusion 25-50 microgs/min
  • Morphine – 1-10 mg/h
  • Noradrenaline – 1-70 microgs/min
  • Phenylephrine – 1-140 microgs/min
  • Propofol – 10-200 mg/h (adult), must be less than 4 mg/kg/h (paediatrics)
  • Sodium Nitroprusside – 1-4 microgs/kg/min
  • Vasopressin – 0.01-0.1 units/min

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)
  • 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)

Tips:

  • 170 microgs/kg/min = patients weight in mL/h
  • Number of mg in 50 mL @ 3 mL/h = microgs/min

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 is either via peripheral intravenous access [P] or central intravenous access [C] as indicated below.

DrugPreparationDosing / Infusion RateRoute
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]
Amiodarone900 mg in 500 mL 5% dextrose (1.8 mg/mL)Inf.: Run over 24 hours
E.g. 21 mL/h
[P&C, C preferred]
CisatracuriumNeat: 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]
ClevidipineNeat: 50 mg in 100 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]
Dexmedetomidine200 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]
Dobutamine250 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]
EsmololNeat: 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]
Fentanyl500 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]
FurosemideNeat: 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]
Isoprenaline1 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]
Ketamine600 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]
Levosimendan12.5 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]
Metaraminol30 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]
Midazolam50 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]
Milrinone20 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]
Morphine60 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]
NimodipineNeat: 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]
Oxycodone60 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]
PropofolNeat: 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]
Salbutamol5 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]
Thiopentone2.5 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),


Cite this article as: James Pearlman and Chris Nickson, "Drug Infusion Doses," In: LITFL - Life in the FastLane, Accessed on December 6, 2022, https://litfl.com/drug-infusion-doses/.

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.

| INTENSIVE | RAGE | Resuscitology | SMACC

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