• Dose adjustment
  • Neonatal Intensive Care Drug Manual




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    Route

    Dose 1-6

    IV

    Loading dose: 20 mg/kg
    Maintenance dose: Start 12 hours after loading dose.

    First 7 days of life:

    Term infants: 2.5 mg/kg/dose every 12 hours (range 4–8 mg/kg/day)

    Preterm infants: 2.5 mg/kg/dose every 24 hours. Titrate as per serum concentrations.


    8–30 days:

    Term infants: 2.5 mg/kg/dose every 8 hours (range 4–8 mg/kg/day)

    Preterm infants: 2.5 mg/kg/dose every 12 hours. Titrate as per serum concentrations.
    Beyond 30 days:

    Term infants: 2.5 mg/kg/dose every 6 hours

    Preterm infants: 2.5 mg/kg/dose every 8 hours. Titrate as per serum concentrations.


    Oral

    Maintenance: start same as for IV maintenance. Average oral bioavailability 75%. Monitor concentrations and adjust dose accordingly.



    Dose adjustment
    Therapeutic hypothermia: Check serum concentration at 24 hours after loading and on day 4 and 7 if therapy continued.7

    ECMO: Larger doses may be needed to achieve comparable serum concentration.8

    Renal impairment: Insufficient information to recommend any specific dose adjustment.

    Hepatic impairment: Dosage escalation should be gradual.




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    Neonatal Intensive Care Drug Manual

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