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
  • 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

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 (C_e)
      • 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 (C_p)
• Remifentanil
  • General anaesthetic:
    • Induction: 0.5-1 microgs/kg
    • Maintenance: 0.25-2 microgs/kg/min
  • TCI:
    • Minto model: Remifentanil targeting effect site (C_e)
      • 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 (C_p)

Tips:

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

References and links

• 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/

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