Neonatologist's Pocket Drug Reference

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Acetylcistein®
Acetylcysteine 200 mg effervescent sachets
Dose: 200 - 400 mg PO up to 3 times daily if necessary. BNFC2010-11
تعا
ض ٢٢ م
/ فلاب

مض
...
ز
)
 طقم ءام
مض

٤ /مجم ٢٠ ظ
٠ ِك (راوف نيياتضص ليتصا
Solution concentration 50 mg/mL.

USES
Meconium ileus.
Mucolytic; lowers the viscosity of the mucous and facilitates its
removal by the mucociliary action.
It improves the phagocytic capacity of alveolar macrophages.

ADVERSE EFFECTS / PRECAUTIONS
Hypersensitivity-like reactions including rashes and anaphylaxis.
Avoid with peptic ulceration.

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Acyclovir (Zovirax®)
250 mg / 5 mL Vial or 200 mg / 5 mL Susp.
Dose: 20 mg/kg/dose Q8h IVI over 1h, for 14 days (in localized
HSV infections) or 21 days (in disseminated or CNS infections).
Prolong dosing interval to Q12h in PT <34 wk PMA, in RF or LCF.
Dose: 75 mg/kg/dose Q12hrs PO for chronic suppression.
تــعاض ىدـم ىلع ديرو ثاعا
ض

مض
/
۸
. . )
مض

+
٩

مض (
٢ )
مض
/
٥

مجم ٢٥ (
٠ طكاريفوز
Infusion solution concentration 5 mg/mL.
Maximum Infusion solution concentration 7 mg/mL.
Dilution should be used within 24h. Don’t refrigerate.
Compatible with D5W and NS.
مفلاب

تعاض /
٢٢

مض
)


...
مض
/
٥

مجم
ب
(
٢٠٠ ارش طكاريفوز
Store oral suspension at room temperature.

RENAL IMPAIRMENT
Cr Cl 25-50 mL/min/1.73m2  IV dose Q12h.
Cr Cl 10-25 mL/min/1.73m2  IV dose Q24h.
Cr Cl 10-25 mL/min/1.73m2  For HZV PO Q8h.
Cr Cl <10 mL/min/1.73m2  For HZV or HSV PO Q12h.

USES
Neonatal HSV, VZV with CNS and pulmonary involvement.

MONITOR
Periodic CBC.
Serum concentration 2h after dose is ~ 2 μg/mL.
Renal and hepatic function.
IV site for phlebitis  use more diluted infusion.

ADVERSE EFFECTS / PRECAUTIONS
Neutropenia (20%)   dose or use Neupogen® if ANC remains <
500/mm3.
Phlebitis at IV site (due to alkaline pH of 10).
Transient renal dysfunction and crystalluria  slow infusion rate,
good hydration.

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Adenocor®
Adenosine 3 mg / mL vial
Starting Dose: 50 µg/kg rapid IV push (1-2 sec)
Increase dose in 50 µg/kg increments Q2min until return of sinus
rhythm. Usual maximum dose: 250 µg/kg.
Flush IV with saline immediately.

Neofax2010
150 μg/kg; if necessary repeat injection Q1-2min increasing dose
by 50–100 μg/kg until tachycardia terminated or max. single dose
of 300 μg/kg given


BNFC2010-11
د
يرو ٢٠ ني
٠ لوطوا تجهزطب تطزغ
...
 م
)
م مض ٤ ٥.
+ مض (
½
م
/
مض
)
جم ٣ (روكوىيدا
ت
) باجخضالا بطح نيخقُق دلك اهرازكجو تعزجلا ةداٍس مخٍو ن
( الآ
Solution concentration 300 µg/mL.
Don’t refrigerate; crystallization will occur.
Compatible with: D5W and NS

USES
Acute treatment of sustained paroxysmal SVT (adenosine  sinus
node automaticity and AV node conduction with no negative
inotropic effects).

ADVERSE EFFECTS / PRECAUTIONS
Flushing, dyspnea and irritability (frequent but resolve within 1
min).
Transient (duration < 1 min) arrhythmias may occur between
termination of SVT and onset of normal sinus rhythm.
Apnea (in preterms)
Recurrence in 30% of treated patients.
Aminophylline/Theophylline and caffeine  adenosine’s effect by
competitive antagonism.

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Adrenaline 1 mg / mL
1
Severe bradycardia, hypotension: 0.1 - 0.3 mL/kg of 1:10.000
concentration (equal to 0.01-0.03 mg/kg), IV push or IC.

Given via ETT in high doses up to 0.1 mg/kg, followed by 1 mL NS.
مجك
/ ٢٠
٠ نيلوطوأ تجهزطب تطزغ –
٣٠ ٢٠ )


مض

+
٩ مض (
٢ )
مض
/
٢

مجم (
٢ ًـيلاـىيردا
بلقلا عاعوا ءاىثأ دٍرو
تبوبهالأ يف مجك
/

٢٠٠ نيلوطوأ تجهزطب تطزغ
٢٠ نقح مخً  )
مض
/
٢

مجم (
٢ ًـيلاـىيردا
ب
) لقلا عاعوا ءاىثأ( ٪ ٩.
٠ حلم م مض ٢مث تٍزجىحلا
IVI: Start 0.1 μg/kg/min, max. of 1 μg/kg/min.
Adjust to desired response.
/

مجك مض
/ .٠
٣ لدعمب تعاض
٢٤ ىدم ىلع دٍرو  )
+
٤٩
مض
مض (
٢ ) ٢
مض م
/ جم (
٢ ًـيلاـىيردا
تعاطلا
/ مجك
/

مض
٣ ىلا تباجخضالا بطح دٍشجو تًادبلا يف عا
ت طلا
Infusion solution concentration 0.02 mg/mL.
Incompatible with NaHCO3. Protect from light.
Compatible with dobutamine, dopamine, Lasix®, fentanyl,
heparin, midazolam and KCl.
Maximum infusion concentration 0.064 mg/mL.
Aerosol Therapy: 0.05-0.15 mL of 1:1000 concentration diluted
with NS to 3 mL, Q½h, maximum 4 doses.
Gomella2009
رسـ يلاوـ يبه م م مض )
+
٣
٢
مض مج
/ م (
٢ ًـيلاــــىيرد ٢
ا ٠
٠ نيلوطوأ تجهزطب تطزغ -
٢٥ ٥

a 1:100 (1%) solution contains 10 mg in 1 ml
a 1:1000 (1‰) solution contains 1 mg in 1 ml
a 1:10,000 solution contains 0.1 mg in 1 ml

USES
Acute cardiovascular collapse; when adequate ventilation and
chest compression have failed to increase the HR > 60 bpm.
Short-term use for systemic hypotension.
In older infants, may be used SC to relief of bronchospasm.

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Adrenaline 1 mg / mL
2

MONITOR
Heart rate, blood pressure and IV site for signs of infiltration.

ADVERSE EFFECTS / PRECAUTIONS
If possible correct acidosis before administration of epinephrine
to enhance the effectiveness of the drug.
Hypokalemia and  serum lactate.
Hyperglycemia.
Cardiac arrhythmias (premature ventricular complexes and VT).
Renal vascular ischemia (add low dose of dopamine with IVI).
Bolus  Severe hypertension with intracranial hemorrhage.
 Myocardial oxygen requirement.
IV infiltration causes tissue ischemia and necrosis.

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Amikin®
1
Amikacin 500 mg / 2 mL
Dose: as table IVI over 30 min.
ىدم ىلع ديــرو مض
٢٠ ىتح لمكً مض . .  ) ٢٤
مض ٥.
+ مض (
½ )
/
٢
مض مجم٥٠ (
٠ ًـيكيمأ
تـ

ـعاض . .
/ تعاض فصه
تــعا
ض
/
٢٤ لضـع٢٠
٠ نيلوطوا تجهزطب تطزغ . . )
مض
/
٢ مجم ٥٠ (
٠ ًـيكيمأ
Infusion solution concentration 5 mg/mL.
Also available in 100 mg per 2 mL vials
IM injection is associated with variable absorption especially in
the very small infants.
Compatible with: D5W, D10W, D20W and NS.

PMA (wk)
Postnatal (d)
Dose (mg/kg)
Interval (h)
≤ 29 *
0-7
18 (3.6 mL)
48
8-28
15 (3 mL)
36
≥ 29
15
24
30-34
0-7
18
36
≥ 8
15
24
≥ 35
All
15
24
* or significant asphyxia, PDA or ttt with indomethacin.

USES
G-ve Bacilli - resistant to other aminoglycosides - usually
combined with a β-lactam antibiotic (in separate infusion).

ADVERSE EFFECTS
Patients with impaired renal function, dehydration and those who
receive high dosage or prolonged therapy are at an  risk of
toxicity.
Transient and reversible renal tubular dysfunction   urinary
loss of Na, Ca, and Mg.
Vestibular and auditory ototoxicity (irreversible).
 Neuromuscular blockade when used with pancuronium and in
patients with hypermagnesemia.
DC or adjust dose when there’s an evidence of oto- or
nephrotoxicity.

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Amikin®
2
Amikacin 500 mg / 2 mL

PRECAUTIONS
The use of other oto- and nephrotoxic drugs (lasix / vancomycin)
may  these side effects.

SERUM LEVEL
Measure when treating for > 48h.
Obtain peak concentration 30 minutes after end of infusion or 1
hour after IM injection and trough level just prior to the next
dose, refrigerate blood sample soon.
Peak: 20-30 µg/mL
Trough: 2-5 µg/mL

INTERACTIONS WITH
Analgesics: plasma concentration of amikacin and gentamicin
possibly  by indometacin.
Antibacterials:  risk of nephrotoxicity and ototoxicity when given
with teicoplanin or vancomycin; possible  risk of nephrotoxicity
when given with cephalosporins.
Amphotericin:  risk of nephrotoxicity.
Digoxin: gentamicin possibly  plasma concentration of digoxin.
Loop Diuretics:  risk of otoxicity.

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Amiodarone
1
Cordarone® 150 mg / 3 mL amp.
LD: 5 mg/kg IVI over 30-60 min, preferably in a central vein.
MD: 7-15 µg/kg/min (10-20 mg/kg/day). Begin at 7 µg/kg/min
and titrate by monitoring effects.
Consider switching to oral therapy within 24-48h.
PO: 5-10 mg/kg Q12h.


Neofax2010
PO: initially 5-10 mg/kg Q12h for 7-10 days, then reduced to MD
of 5–10 mg/kg Q24h.


BNFC2010-11
م
ض ٢٤ ىتح لمكخطح و٢٠ ني
٠ لوطوا تجهزطب تطزغ
...


مض
) ٣ م
/ ج م٢٥٠ (نورادروك
تعاطلا يف مض ٢
لدعمب ت

عاض
٢٤ ىدم ىل
ع ديرو ٪ ٥ ج
Infusion Solution concentration should be < 2 mg/mL.
Compatible with D5W, NS at concentrations of 1-6 mg/mL,
heparin and NaHCO3.
Protect from light.
Avoid benzyl alcohol containing injections in neonates.
ت

عاض ٢٢ / ليا
رلاب

مض . .
م
)


م

مض
٢٠
+ صزق
½ ( م
) ج م٢٠٠ صزق (نورادروك

USES
Class III antiarrhythmic used for life-threatening or drug-resistant
refractory SVT, VT and postoperative junctional ectopic
tachycardia (JET).

ADVERSE EFFECTS / PRECAUTIONS
Short term toxicity:
1. Bradycardia and hypotension (possibly associated with rapid
rates of infusion).
2. AV block.
3. Polymorphic ventricular tachycardia.
4. Irritation to peripheral vessels (concentrations > 2 mg/mL).
5. May exacerbate an exciting arrhythmia.

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Amiodarone
2
Cordarone® 150 mg / 3 mL amp.



ADVERSE EFFECTS / PRECAUTIONS
Long term toxicity:
1. Hyperthyroidism (due to inhibition of T4 and T3).
2. Hypothyroidism (due to high concentrations of inorganic
iodine).
Amiodarone contains iodine and can cause both hypothyroidism or
hyperthyroidism can. Laboratory tests (T3, T4, and TSH) should be
performed before treatment and every 6 months.
The thyrotoxicosis may be very refractory, and amiodarone should
usually be withdrawn at least temporarily to help achieve control;
treatment with carbimazole may be required.
Hypothyroidism can be treated with replacement therapy without
withdrawing amiodarone if it is essential.
BNFC2010-11
3. Hepatitis and cholestatic jaundice (rare).
4. Photosensitivity (10%), nausea and vomiting (10%), optic
neuritis (4-9%) and pulmonary fibrosis (4-9%) have been
reported with prolonged oral use in adults.


MONITOR
HR and blood pressure.
ECG monitor and resuscitation facilities must be available during
IVI.
Liver-function and thyroid-function tests required before
treatment and then every 6 months.
Measure serum K+ concentration before treatment.
Pulmonary function tests and CXR required before treatment
Acute porphyria.

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