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DRUG DOSE
CARDIOLOGY
1
A-Z Cardiovascular Drug Doses
Contents
ACS 1
Table 1 Doses Of Fibrinolytic Agents 1
Table 2 Comparison Of Approved Fibrinolytic Agents* 1
Table 3 Contraindications And Cautions For Fibrinolytic
Use In Stemi* 3
Table 4 Doses Of Antiplatelet And Antithrombin Co-
Therapies 4
Table 5 Dosages Of Inhibitors Of The Renin–Angiotensin–
Aldosterone System
In Trials After Myocardial Infarction 6
Table 6 -- Recommended Dosing Regimens For Long-
Term Nitrate Therapy 7
Normogram Heparine 8
Table A.1 -- Intravenous Unfractionated Heparin
“Raschke Nomogram” 8
Table A.2 -- Recommended Dose Adjustment Of
Conventional Antithrombotics Used For Acute Coronary
Syndromes* 9
Table B -- Biomarkers For Evaluation Of Patients With
St-Segment Elevation Myocardial Infarction 12
AF - ATRIAL FIBRILASI
A-Z Cardiovascular Drug Doses
2
HEART FAILURE
Table 9 -- Diuretics For Treating Fluid Retention In
Chronic Heart Failure 16
Table 10 Drugs For The Prevention And Treatment Of
Chronic Heart Failure 18
Table 11 Intravenous Vasodilators Used To Treat Acute
Heart Failure 19
Table 12 Drugs Used To Treat Acute Heart Failure That
Are Positive Inotropes Or Vasopressors Or Both 20
HIPERTENSI
Table 13 -- Representative Diuretics And Potassium-
Sparing Agents 21
Table 14 -- Parenteral Drugs For Treatment Of
Hypertensive Emergency 22
DYSLIPIDEMIA
Table 15 -- Current Lipid-Lowering Medications 24
ANTIARRHYTHMIA
Table 16. Clinical Usage Information For Antiarrhythmic
Agents 26
A-Z Cardiovascular Drug Doses
3
Table 18-- Fondaparinux Dosing For Patients With Acute
Pulmonary Embolism Or Dvt 31
Table 19 Use Of Heparin Before And
After Thrombolysis 31
Table 20 Approved Thrombolytic Regimens For Pulmonary
Embolism 32
Table 21 Adjustment Of Intravenous Unfractionated
Heparin Dosage Based On The Activated Partial
Thromboplastin Time 32
Table 22 Subcutaneous Regimens Of Low
Molecularweight Heparins And Fondaparinux Approved
For The Treatment Of Pulmonary Embolism 33
RHEUMATIC FEVER
Table 23 Antibiotic Therapy For Acute Rheumatic Fever
And Long-Term Prophylaxis 34
ENDOCARDITIS
Table 25 Treatment Of Native Valve Endocarditis Caused
By Penicillin-Susceptible Viridans Streptococci And
Streptococcus Gallolyticus (Bovis) (Mic <0.1 ?G/Ml)* 37
Table 26 Treatment Of Native Valve Endocarditis Caused
By Strains Of Viridans Streptococci And Streptococcus
Gallolyticus (Bovis) Relatively Resistant To Penicillin G
(Mic >0.1 ?G/Ml And <0.5 ?G/Ml)* 38
A-Z Cardiovascular Drug Doses
4
5
A-Z Cardiovascular Drug Doses
6
A-Z Cardiovascular Drug Doses
ACS
Table 1 Doses of Fibrinolytic agents
Initial treatment Spesific contra-
indications
Streptokinase (SK) 1.5 million units over 30- Prior SK or anis-
60 min i.v treptase
Alteplase (tPA) 15 mg i.v bolus 0,75 mg/
kg over 30 min ( up to 50
mg) then 0,5 mg/kg over
60 min i.v. ( up to 35 mg)
Reteplase (r-PA) 10 units + 10 units i.v.
bolus given 30 min apart
Tenecteplase ( TNK- Single i.v bolus :
tPA) 30 mg if < 60 kg
35 mg if 60-<70 kg
40 mg if 70-<80 kg
45 mg if 80-<90 kg
50 mg if > 90 kg
30-
10 U ? 2
Up to 100 mg in 50 mg
1.5 MU in (30 min
Dose 90 min (based based
30-60 min apart) each
on weight) on
over 2 min
weight
1
PARAME- STREPTO- ALTEPLASE RE- TNK
TER KINASE TEPLASE t-PA
Bolus
administra- No No Yes Yes
tion
Antigenic
Allergic
reactions
(hypoten- Yes No No No
sion most
common)
Systemic
Mini-
fibrinogen Marked Mild Moderate
mal
depletion
90-min
patency ≈50 ≈75 ≈75 ≈75[†]
rates (%)
TIMI grade
32 54 60 63
3 flow (%)
Cost per 2750
dose (U.S. 568 2750 2750 for
$)[‡] 50 mg
From Antman EM, Anbe DT, Armstrong PW, et al: ACC/AHA guidelines for the management of patients
with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Manage-
ment of Patients with Acute Myocardial Infarction). Circulation 110:e82, 2004.
TIMI = Thrombolysis in Myocardial Infarction; TNK = tenecteplase.
* Data from Armstrong PW, Collen D: Fibrinolysis for acute myocardial infarction: Current status
A-Z Cardiovascular Drug Doses
and new horizons for pharmacological reperfusion, part 1. Circulation 103:2862, 2001.
† Data from Cannon CP, Gibson CM, McCabe CH, et al: TNK-tissue plasminogen activator com-
pared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial.
Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation 98:2805, 1998.
‡ Data from Medical Economics Staff: 2001 Drug Topics Red Book. 105th ed. Montvale, NJ, Medi-
cal Economics Company, 2001.
2
TABLE 3 -- Contraindications and Cautions for
Fibrinolytic Use in STEMI*
Absolute Contraindications
Any prior intracranial hemorrhage
Known structural cerebral vascular lesion (e.g., arteriovenous
malformation)
Known malignant intracranial neoplasm (primary or metastatic)
Ischemic stroke within 3 mo except acute ischemic stroke within
3 hr
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed head or facial trauma within 3 mo
Relative Contraindications
History of chronic severe poorly controlled hypertension
Severe uncontrolled hypertension on presentation (SBP
>180 mm Hg or DBP >110 mm Hg)[†]
History of prior ischemic stroke > 3 mo, dementia, or known
intracranial pathology not covered in contraindications
Traumatic or prolonged (>10 min) CPR or major surgery (<3 wk)
Recent (within 2-4 wk) internal bleeding
Noncompressible vascular punctures
A-Z Cardiovascular Drug Doses
4
Without reperfusion therapy
Aspirin Starting dose 150–500 mg orally.
Clopidogrel 75 mg/day orally.
Doses of antithrombin co-therapies
With primary PCI
Unfractionated 70–100 U/kg i.v. bolus when no GP IIb/IIIa inhibi-
heparin tor is planned.
50–60 U/kg i.v. bolus with GP IIb/IIIa inhibitors.
Enoxaparin 0.5 mg/kg i.v. bolus.
Bivalirudin 0.75 mg/kg i.v. bolus followed by i.v infusion of
1.75 mg/kg/h for up to 4 h after the procedure as
clinically warranted. After cessation
of the 1.75 mg/kg/h infusion, a reduced infusion
dose of 0.25 mg/kg/h may be continued for 4–12
h as clinically necessary.
With fibrinolytic therapy
Unfractionated 60 U/kg i.v. bolus with a maximum of 4000 U
heparin followed by an i.v. infusion of 12 U/kg with a max-
imum of 1000 U/h for 24–48 h.Target
aPTT: 50–70 s or 1.5 to 2.0 times that of control
to be monitored at 3, 6, 12 and 24 h.
Enoxaparin In patients <75 years of age:
30 mg i.v. bolus followed 15 min later by 1 mg/kg
s.c. every 12 h until hospital discharge for a maxi-
mum of 8 days The first two
doses should not exceed 100 mg.
In patients >75 years of age:
A-Z Cardiovascular Drug Doses
5
Fondaparinux 2.5 mg i.v. bolus followed by a s.c. dose of 2.5 mg
once daily up to 8 days or hospital discharge.
Without reperfusion therapy
Unfractionated Same dose as with fibrinolytic therapy.
heparin
Enoxaparin Same dose as with fibrinolytic therapy.
Fondaparinux Same dose as with fibrinolytic therapy.
aPTT ¼ activated partial thromboplastin time; b.i.d.¼ twice a day; GP ¼ glycoprotein; i.v. ¼ intravenous;
PCI ¼ percutaneous coronary intervention; s.c. ¼ subcutaneous; UFH ¼ unfractionated heparin
20 mg initially uptitrated in
OPTIMAAL losar- four steps Up to 50 mg daily
tan 12.5 mg
EPHESUS eplerone 25 mg intially Up to 50 mg daily
7
Normogram heparine
TABLE A.1 -- Intravenous Unfractionated Heparin
“Raschke Nomogram”
VARIABLE ACTION
Initial heparin bolus 80 units/kg bolus, then 18 units/kg/hr
aPTT <35 seconds (<1.2 80 units/kg bolus, then increase by 4
times control) units/kg/hr
aPTT 35 to 45 seconds
40 units/kg bolus, then increase by 2
(1.2 to 1.5 times con-
units/kg/hr
trol)
aPTT 46 to 70 seconds
(1.5 to 2.3 times con- No change
trol)
aPTT 71 to 90 seconds
Decrease infusion rate by 2 units/kg/hr
(2.3 to 3 times control)
aPTT >90 seconds (>3 Hold infusion 1 hr, then decrease infusion
times control) rate by 3 units/kg/hr
From Raschke RA, Reilly BM, Guidry JR, et al: The weight-based heparin dosing nomogram compared with
a “standard care” nomogram: A randomized controlled trial. Ann Intern Med 119:874, 1993.
A-Z Cardiovascular Drug Doses
8
TABLE A.2 -- Recommended Dose Adjustment of
Conventional Antithrombotics Used for Acute Coronary
Syndromes*
eGFR (mL/min/1.73 m2) (CrCl in mL/min)
ANTI-
THROM- DIALY-
BOTIC SIS-DE-
60-90 30-60 <30
AGENT PEN-
DENT
No ad- No adjust- No ad-
No adjustment
Aspirin justment ment need- justment
needed
needed ed needed
No ad- No adjust- No ad-
No adjustment
Clopidogrel justment ment need- justment
needed
needed ed needed
No ad- No adjust- No ad-
No adjustment
Ticlopidine justment ment need- justment
needed
needed ed needed
No
No guide- No guide-
Heparin guide- No guidelines
lines lines
lines
Reduce dose
No
No guide- by 30%; factor No guide-
LMWH guide-
lines Xa monitoring lines
lines
advocated A-Z Cardiovascular Drug Doses
9
eGFR (mL/min/1.73 m2) (CrCl in mL/min)
ANTI-
THROM- DIALY-
BOTIC SIS-DE-
60-90 30-60 <30
AGENT PEN-
DENT
CrCl = 45-
60 mL/min
or SrCr =
1.6-2 mg/
dL—reduce CrCl = 15-
bolus to 29 mL/min
0.2 mg/kg IV or SrCr = 3.1-
+ decrease 6 mg/dL—re-
infusion duce bolus
rate by 50% to 0.2 mg/
(0.075 mg/ kg IV + de- Reduce
No kg/hr IV) crease infusion bolus dose
Lepirudin guide- CrCl = 30- rate by 85% to 0.2 mg/
lines 44 mL/min (0.0225 mg/ kg IV; no
or SrCr = kg/hr IV) infusion
2.1-3 mg/ CrCl < 15 mL/
dL—reduce min or SrCr >
bolus to 6 mg/dL—re-
0.2 mg/kg IV duce bolus to
+ decrease 0.2 mg/kg IV;
standard ini- no infusion
tial infusion
rate by 70%
(0.045 mg/
kg/hr IV)
A-Z Cardiovascular Drug Doses
10
eGFR (mL/min/1.73 m2) (CrCl in mL/min)
ANTI-
THROM- DIALY-
BOTIC SIS-DE-
60-90 30-60 <30
AGENT PEN-
DENT
No
guide- No guide- No guide-
No guidelines
lines lines lines;
Abciximab Monitoring
Monitor- Monitoring monitoring
advocated
ing advo- advocated advocated
cated
SrCr =
No clinical
2-4 mg/
data; in
No dL—135 mg/ SrCr > 4.0 mg/
vitro data
Eptifibatide guide- kg IV bolus + dL; contraindi-
demon-
lines 0.5 mg/kg/ cated
strate
min IV infu-
clearance
sion
No clinical
0.2 mg/kg/min
data; in
No dose IV for 30 min,
No dose ad- vitro data
Tirofiban adjust- followed by
justment demon-
ment 0.05 mg/kg/
strate
min IV
clearance
Modified from Sica D: The implications of renal impairment among patients undergoing percutaneous
coronary intervention. J Invasive Cardiol 14(Suppl B):30B, 2002.
11
TABLE B -- Biomarkers for Evaluation of Patients with
ST-Segment Elevation Myocardial Infarction
BIOMARK- MOLEC- RANGE MEAN TIME TO
ER ULAR OF TIME TIME RETURN TO
WEIGHT TO INI- TO PEAK NORMAL
(DA) TIAL EL- ELEVA- RANGE
EVATION TIONS
(HR) (NON-
REPER-
FUSED)
Frequently Used in Clinical Practice
MB-CK[*] 86,000 3-12 24 hr 48-72 hr
cTnI[†] 23,500 3-12 24 hr 5-10 days
12 hr-2
cTnT 33,000 3-12 5-14 days
days
Infrequently Used in Clinical Practice
Myoglobin 17,800 1-4 6-7 hr 24 hr
MB-CK tis-
86,000 2-6 18 hr Unknown
sue isoform
MM-CK tis-
86,000 1-6 12 hr 38 hr
sue isoform
Modified from Antman EM, Anbe DT, Armstrong PW, et al: ACC/AHA guidelines for the management of
patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the
Management of Patients with Acute Myocardial Infarction). Circulation 110:e82, 2004.
† Multiple assays available for clinical use; clinicians should be familiar with the cutoff value used
in their institution.
12
AF - Atrial Fibrilasi
Table 7 Drugs and doses for pharmacological conversion of
(recent-onset) AF
Drug Dose Follow up Risk
dose
Amiodarone 5 mg/kg i.v. over 50 mg/h Phlebitis, hypotension.
1h Will slow the ventricu-
lar rate. Delayed
AF conversion to sinus
rhythm.
Flecainide 2 mg/kg i.v. over N/A Not suitable for pa-
10 min, tients with marked
or structural heart
200–300 mg p.o. disease; may prolong
QRS duration, and
hence the QT
interval; and may inad-
vertently increase the
ventricular rate
due to conversion to
atrial flutter and 1:1
conduction to the
ventricles.
Ibutilide 1 mg i.v. over 1 mg i.v. Can cause prolongation
10 min over 10 of the QT interval and
min after torsades de
waiting for pointes; watch for
A-Z Cardiovascular Drug Doses
13
Propafenone 2 mg/kg i.v. over Not suitable for pa-
10 min, tients with marked
or structural heart
450–600 mg p.o. disease; may prolong
QRS duration; will
slightly slow
the ventricular rate,
but may inadvertently
increase the
ventricular rate due
to conversion to atrial
flutter and 1:1
conduction to the ven-
tricles.
Vernakalant 3 mg/kg i.v. over Second So far only evaluated in
10 min infusion clinical trials; recently
of 2 mg/ approved.
kg i.v.
over 10
min af-
ter15 min
rest
A-Z Cardiovascular Drug Doses
14
Table 8 Drugs for rate control
Intravenous Usual oral maintenance dose
administration
Beta-Blockers
Metoprolol
2.5–5 mg 100–200 mg o.d. (ER)
CR/XL
Bisoprolol N/A 2.5–10 mg o.d.
Esmolol 10 mg N/A
Others
5 mg/kg in 1
h, and
Amiodarone 100 mg–200 mg o.d.
A-Z Cardiovascular Drug Doses
50 mg/h main-
tenance
Dronedaronea N/A 400 mg b.i.d.
ER : extended release formulations; N/A : not applicable.
aOnly in patients with non-permanent atrial fibrillation.
15
Heart Failure
TABLE 9 -- Diuretics for Treating Fluid Retention in
Chronic Heart Failure
DRUG INITIAL DAILY MAX- DURA-
DOSAGE IMUM TION OF
TOTAL ACTION
DAILY (hr)
DOSAGE
Loop diuretics*
Bumetanide 0.5-1.0 mg qd or bid 10 mg 4-6
Furosemide 20-40 mg qd or bid 600 mg 6-8
Torsemide 10-20 mg qd 200 mg 12-16
Ethacrynic acid 25-50 mg qd or bid 200 mg 6
Thiazide diuretics[†]
250-500 mg qd or
Chlorothiazide 1000 mg 6-12
bid
Chlorthalidone 12.5-25 mg qd 100 mg 24-72
Hydrochlorothi-
25 mg qd or bid 200 mg 6-12
azide
Indapamide 2.5 mg qd 5 mg 36
Metolazone 2.5-5 mg qd 20 mg 12-24
A-Z Cardiovascular Drug Doses
Potassium-sparing diuretics
Amiloride 12.5-25 mg qd 20 mg 24
Triamterene 50-75 mg bid 200 mg 7-9
16
DRUG INITIAL DAILY MAX- DURA-
DOSAGE IMUM TION OF
TOTAL ACTION
DAILY (hr)
DOSAGE
AVP antagonists
Satavaptan 25 mg qd 50 mg qd NS
Tolvaptan 15 mg qd 60 mg qd NS
Lixivaptan 125 mg qd 250 mg bid NS
20-mg IV loading
40-mg IV
dose, followed by
Conivaptan (IV) infusion/ 7-9
20-mg continuous IV
day
infusion/day
Sequential nephron blockade
2.5 to 10 mg qd plus
Metolazone
loop diuretic
Hydrochlorothi- 25 to 100 mg qd or
azide bid plus loop diuretic
Chlorothiazide 500 to 1000 mg qd
(IV) plus loop diuretic
Modified from Hunt SA, Abraham WT, Chin MH, et al: ACC/AHA 2005 Guideline Update for the Diagnosis and
Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines. Circulation 112:e154, 2005.
Note: Unless indicated, all doses are for oral diuretics.
NS = not specified.
17
TABLE 10 -- Drugs for the Prevention and Treatment of
Chronic Heart Failure
AGENTS INITIATING MAXIMAL DOS-
DOSAGE AGE
Angiotensin-Converting Enzyme Inhibitors
Captopril 6.25 mg tid 50 mg tid
Enalapril 2.5 mg bid 10 mg bid
Lisinopril 2.5-5.0 mg qd 20 mg qd
Ramipril 1.25-2.5 mg qd 10 mg qd
Fosinopril 5-10 mg qd 40 mg qd
Quinapril 5 bid 40 mg bid
Trandolapril 0.5 mg qd 4 mg qd
Angiotensin Receptor Blockers
Valsartan 40 mg bid 160 mg bid
Candesartan 4-8 mg qd 32 mg qd
Losartan 12.5-25 mg qd 50 mg qd
Beta Receptor Blockers
25 mg bid (50 mg
Carvedilol 3.125 mg bid bid if body weight >
85 kg)
Carvedilol-CR 10 mg qd 80 mg qd
Bisoprolol 1.25 mg bid 10 mg qd
A-Z Cardiovascular Drug Doses
18
AGENTS INITIATING MAXIMAL DOS-
DOSAGE AGE
Other Agents
Combination of hydrala- 10-25 mg/10 mg
75 mg/40 mg tid
zine/isosorbide dinitrate tid
Fixed dose of hydrala- 37.5 mg/20 mg 75 mg/40 mg (two
zine/isosorbide dinitrate (one tablet) tid tablets) tid
Digoxin* 0.125 mg qd ≤0.375 mg/day[†]
Modified from Mann DL: Heart failure and cor pulmonale. In Kasper DL, Braunwald E, Fauci AS, Hauser SL,
et al (eds): Harrison›s Principles of Internal Medicine. 17th ed. New York, McGraw-Hill, 2007, p 1449.
* Dosing should be based on ideal body weight, age and renal function
† Trough level should be 0.5-1 ng/mL, although absolute levels have not been established
aAlso a vasodilator.
bBolus not recommended in hypotensive patients (systolic blood pressure
,90 mmHg).
a ¼ alpha adrenoceptor; b ¼ beta adrenoceptor; d ¼ dopamine receptor.
20
Hipertensi
TABLE 13 -- Representative Diuretics and Potassium-
Sparing Agents
AGENT DAILY DOSE DURATION OF
(MG) ACTION (HR)
Thiazides
Bendroflumethiazide 1.25-5.0 >18
Hydrochlorothiazide 6.25-50 12-18
Methyclothiazide 2.5-5.0 >24
Trichlormethiazide 1-4 >34
Related Sulfonamide Compounds
Chlorthalidone 12.5-50 24-72
Indapamide 1.25-2.5 24
Metolazone 0.5-10 24
Loop Diuretics
Bumetanide 0.5-5 4-6
Ethacrynic acid 25-100 12
Furosemide 40-480 4-6
Torsemide 5-40 12
Potassium-Sparing Agents
Amiloride 5-10 24
A-Z Cardiovascular Drug Doses
Eplerenone 50-200 24
Spironolactone 25-100 8-12
Triamterene 50-100 12
21
TABLE 14 -- Parenteral Drugs for Treatment of
Hypertensive Emergency
DRUG* DOSE ONSET DUR- ADVERSE SPECIAL
OF AC- ATION EFFECTS INDICA-
TION OF AC- TIONS
TION
Vasodilators
Nausea, vom-
Not pre-
iting, muscle
0.25- ferred for
Nitroprus- Immedi- twitching,
10.00 ?g/ 1-2 min most hy-
side ate thiocyanate
kg/min IV pertensive
and cyanide
emergencies
toxicity
Headache,
vomiting, Not pre-
methe- ferred but
Nitroglyc- 5-100 ?g/ moglobin- may be
2-5 min 5-10 min
erin min emia, toler- useful for
ance with coronary
prolonged ischemia
use
Tachycardia, May be in-
Fenoldo-
0.1-0.6 ?g/ 10- increased dicated for
pam (Cor- 4-5 min
kg/min IV 15 min intraocular renal insuffi-
lopam)
pressure ciency
Nicardipine Most hy-
(Cardene 5-15 mg/h 5-10 min 1-4 hr pertensive
IV) Headache, emergencies
1-2 mg nausea, flush-
IV, rapidly ing, tachycar- Most hy-
Clevidipine
increasing 2-4 min 5-15 min dia pertensive
(Cleviprex)
dose to emergencies
A-Z Cardiovascular Drug Doses
16 mg max
10- Tachycardia,
5-20 mg IV 1-4 hr
20 min flushing,
Eclampsia;
Hydrala- headache,
not for aortic
zine 10-40 mg 20- vomiting,
4-6 hr dissection
IM 30 min aggravation
of angina
22
DRUG* DOSE ONSET DUR- ADVERSE SPECIAL
OF AC- ATION EFFECTS INDICA-
TION OF AC- TIONS
TION
Adrenergic Inhibitors
Tachycardia,
Phentol- Catechol-
5-15 mg IV 1-2 min 3-10 min flushing,
amine amine excess
headache
250-
500 ?g/
Aortic dis-
Esmolol kg/min for Hypotension,
1-2 min 1-20 min section after
(Brevibloc) 4 min, then nausea
surgery
50-300 ?g/
kg/min IV
Vomiting,
20-80 mg scalp tingling,
Most hy-
Labetalol IV bolus burning in
pertensive
(Normo- every throat, dizzi-
5-10 min 3-6 hr emergencies,
dyne, Tran- 10 min, ness, nausea,
except acute
date) 2-mg/min heart block,
heart failure
IV infusion orthostatic
hypotension
* In order of rapidity of action.
† Hypotension may occur with any of these.
‡ Intravenous formulations of other calcium channel
blockers are also available
23
Dyslipidemia
TABLE 15 -- Current Lipid-Lowering Medications
GENERIC NAME BRAND NAME RECOMMEND-
ED DOSAGE
RANGE
Statins
Atorvastatin Lipitor 10-80 mg
Fluvastatin Lescol 20-80 mg
Lovastatin Mevacor 20-80 mg
Pravastatin Pravachol 10-40 mg
Rosuvastatin Crestor 15-40 mg
Simvastatin Zocor 10-80 mg
Pitavastatin Levacol 2-4 mg
Bile Acid Absorption Inhibitors
Cholestyramine Questran 2-24 g
Colestipol Colestid 5-30 g
Colesevelam WelChol 3.8-4.5 g
Cholesterol Absorption Inhibitor
Ezetimibe Zetia (Ezetrol) 10 mg
Fibrates*
A-Z Cardiovascular Drug Doses
24
GENERIC NAME BRAND NAME RECOMMEND-
ED DOSAGE
RANGE
Bezafibrate Bezalip 400 mg
Tricor, Trilipix, Lipi-
Fenofibrate 40-200 mg
dil Micro, Lipidil EZ
Gemfibrozil[†] Lopid 600-1200 mg
Niacin‡ Niacin 1-3 g
Nicotinic acid Niaspan 1-2 g
25
26
A-Z Cardiovascular Drug Doses
Antiarrhythmia
Table 16. Clinical Usage information for antiarrhythmic agents
USUAL DOSAGE RANGES TIME TO PEAK MAJOR
PREG-
INTRAVENOUS (MG) ORAL (MG) PLASMA CON ROUTE
DRUG NANCY
CENTRATION OF ELIMI-
MAINTE- LOAD- MAINTE- CLASS
LOADING (ORAL) (hr) NATION
NANCE ING NANCE
6 to 10 mg/ 300 to
800 to
Quinidine kg at 0.3 to — 600 q 1.5 to 3.0 Liver C
1000
0.5 mg/kg/min 6 hr
6 to 13 mg/ 2 to 250 to
Procain- 500 to
kg at 0.2 to 6 mg/ 1000 q 1 Kidneys C
amide 1000
0.5 mg/kg/min min 4-6 hr
1 to 2 mg/ 100 to
Disopyra- 1 mg/kg/
kg over 15 to 300 q 1 to 2 Kidneys C
mide hr
45 min* 6-8 hr
1 to 3 mg/kg at 1 to
Lidocaine 20 to 50 mg/ 4 mg/ N/A N/A N/A Liver B
min min
0.5 to 150 to
400 to
Mexiletine 500 mg* 1.0 g / 300 q 2 to 4 Liver C
600
24 hr 8 -12 hr
100 to
100 mg q 5 min
Phenytoin 1000 400 q12- 8 to 12 Liver D
for ≤1000 mg
24 hr
100 to 50 to
Flecainide 2 mg/kg* 200 q 200 q 3 to 4 Kidneys C
12 hr 12 hr
150 to
600 to
Propafenone 1 to 2 mg/kg 300 q 1 to 3 Liver C
900
8-12 hr
0.25 to 0.5 mg 10 to
Propranolol q 5 min to 200 q 4 Liver C
≤0.20 mg/kg 6-8 hr
15 mg/min for
10 min
800 to
1 mg/min for
1600 qd 200 to
Amiodarone 3 hr 1 mg/min Kidneys D
for 7-14 600 qd
5 mg/min
days
thereafter
400 mg
Dronedarone N/A N/A N/A 3 to 4 Liver X
q 12hr
80 to
10 mg over 1 to
Sotalol 320 q 2.5 to 4 Kidneys B
2 min*
12 hr
27
A-Z Cardiovascular Drug Doses
28
A-Z Cardiovascular Drug Doses
1 mg over
Ibutilide N/A N/A N/A N/A Kidneys C
10 min
0.125
2 to 5 ?g/kg
Dofetilide N/A N/A to 0.5 q Kidneys C
infusion*
12 hr
80 to
5 to 10 mg over 0.005 mg
Verapamil 120 q 1 to 2 Liver C
1 to 2 min /kg /min
6-8 hr
6 to 18 mg (rap-
Adenosine N/A N/A N/A N/A C
idly)
0.125 to 0.5 to 0.125 to
Digoxin 0.5 to 1.0 mg 2 to 6 Kidneys C
0.25 qd 1.0 0.25 qd
N/A: not applicable.
Results presented may vary according to doses, disease state, and intravenous or oral administration.
Pregnancy class: A—controlled studies show no fetal risk; B—no controlled studies, but no evidence of fetal
risk; fetal harm unlikely; C—fetal risk cannot be excluded; drug should be used only if potential benefits
outweigh potential risk; D—definite fetal risk; drug should be avoided unless in a life-threatening situation
or safer alternatives do not exist ; X—contraindicated in pregnancy.
* Intravenous use investigational.
Pulmonary Embolism or
DVT
TABLE 17 -- Low-Molecular-Weight Heparins
NAME STATUS MOLEC- AN- TREATMENT
ULAR TI-Xa/ DOSE
WEIGHT ANTI-IIa
RATIO
1 mg/kg twice
daily (approved
FDA ap-
as an inpatient or
Enoxapa- proved for
4800 3.9 outpatient dose),
rin DVT treat-
or 1.5 mg/kg once
ment
daily (inpatient
dose only)
FDA ap-
proved for 100 units/kg twice
Dalteparin cancer-as- 5000 2.2 daily, or 200 units/
sociated kg once daily
DVT
4100 units twice
daily for patients
Not avail- weighing <50 kg,
Nadropa- able in the 6150 units twice
4500 3.5
rin United daily for 50-70 kg,
States and 9200 units
A-Z Cardiovascular Drug Doses
29
NAME STATUS MOLEC- AN- TREATMENT
ULAR TI-Xa/ DOSE
WEIGHT AN-
TI-IIa
RATIO
3500 units twice
daily for patients
weighing 35-45 kg,
Not available
4200 units twice
Reviparin in the United 3900 3.3
daily for 46-60 kg,
States
and 6300 units
twice daily for
>60 kg
FDA approved
175 units/kg once
Tinzaparin for DVT treat- 4500 1.5
daily
ment
In 2007, the Food and Drug Administration (FDA) approved the LMWH dalteparin as
monotherapy without warfarin in cancer patients with acute VTE. In a trial of 672 pa-
tients with VTE and cancer, those randomized to dalteparin monotherapy had a much
lower VTE recurrence rate than did patients receiving dalteparin as a “bridge” to warfa-
rin: 8.8% versus 17.4%.[86] At times, LMWH is used off label as monotherapy without
warfarin to treat VTE patients without cancer who cannot tolerate warfarin or who suffer
recurrent VTE despite warfarin.[87]
A-Z Cardiovascular Drug Doses
30
TABLE 18-- Fondaparinux Dosing for Patients with
Acute Pulmonary Embolism or DVT
Patient weight <50 kg 50-100 kg >100 kg
Daily dose of 5 mg 7.5 mg 10 mg
fondaparinux*
* Assumes normal renal function.
31
Table 20 Approved thrombolytic regimens for pulmonary
embolism
Streptokinase 250 000 IU as a loading dose over 30 min, fol-
lowed by 100 000 IU/h over 12–24 h
Accelerated regimen: 1.5 million IU over 2 h
Urokinase 4400 IU/kg as a loading dose over 10 min, fol-
lowed by 4400 IU/kg/h over 12–24 h
Accelerated regimen: 3 million IU over 2 h
rtPA 100 mg over 2 h or 0.6 mg/kg over 15 min (max-
imum dose 50 mg)
rtPA = recombinant tissue plasminogen activator.
32
Table 22 Subcutaneous regimens of low molecularweight
heparins and fondaparinux approved for the treatment of
pulmonary embolism
Dose Interval
Enoxaparin 1.0 mg/kg Every 12 h
or 1.5 mg/kg (a) Once daily (a)
Tinzaparin 175 U/kg Once daily
Fondaparinux 5 mg (body weight < 50 kg) Once daily
7.5 mg (body weight 50–
100 kg)
10 mg (body weight .100
kg)
In patients with cancer, Dalteparin is approved for extended treatment of symptomatic VTE (proximal DVT
and/or PE), at an initial dose of 200 U/kg s.c. once daily (see drug labelling for details).
Once-daily injection of enoxaparin at the dose of 1.5 mg/kg is approved for inpatient (hospital) treatment
of PE in the United States and in some, but not all, European countries.
33
Rheumatic Fever
TABLE 23 -- Antibiotic Therapy for Acute Rheumatic
Fever and Long-Term Prophylaxis
Initial Treatment of Group A Beta-Hemolytic Streptococcal Pharyngitis
(Adult Dosages)
ANTI- DOSE FRE- DURA- COM- CLASS
BIOTIC QUENCY TION MENTS
↓ Compli-
Benzathine 1.2 million Acutely
One time ance issues I
penicillin G units IM only
↑ Pain
Penicillin V 500 mg PO Twice daily 10 days I
1000 mg
Amoxicillin Daily 10 days I
PO
Penicillin
Allergic
Avoid if
Nar- history of
row-spec- Varies by Varies by anaphy-
10 days I
trum ceph- drug drug laxis sec-
alosporins* ondary to
penicillin
Clindamy-
300 mg PO Twice daily 10 days IIa
cin*,[†]
500 mg PO
A-Z Cardiovascular Drug Doses
Azithromy- day 1
Daily 5 days IIa
cin*,[‡] 250 mg PO
days 2-5
Clarithro-
250 mg PO Twice daily 10 days IIa
mycin*,[‡]
34
Secondary Prophylaxis Regimen for Patients with Documented RF
(Adult Dosages)[?]
FRE- COM-
ANTIBIOTIC DOSE CLASS
QUENCY MENTS
↓ Com-
Benzathine peni- 1.2 million Every 3 to pliance
I
cillin G units IM 4 weeks[?] issues
↑ Pain
Penicillin V 250 mg PO Twice daily I
Erythromycin*,[‡] 250 mg PO Twice daily I
Sulfadiazine* 1 g PO Daily I
Sulfisoxazole* 1 g PO Daily IIa
Modified from Gerber MA, Baltimore RS, Eaton CB, et al: Prevention of rheumatic fever and diagnosis and
treatment of acute streptococcal pharyngitis. A scientific statement from the American Heart Association
Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. Circulation 119:1541, 2009; and Rheu-
matic fever and rheumatic heart disease. World Health Organ Tech Rep Ser 923:1, 2004.
† Dosage is empiric. For severe pharyngitis, doses up to 1.2 g daily in two to four divided doses.
‡ Some areas have a high rate of macrolide-resistant group A streptococci. In addition, erythro-
mycin toxicity, including gastrointestinal intolerance and long-QT syndrome, limits its use.
? Duration of therapy ranges from 5 years to life-long (see text). For patients with poststrepto-
coccal reactive arthritis, recommended duration is 1 year in nonendemic areas, 5 years where
RF is prevalent if no evidence of carditis appears.
? In endemic areas, benzathine penicillin every 3 weeks should be considered to maintain opti-
mal drug levels (Class I indication). In nonendemic areas, benzathine penicillin is given every 3
weeks if RF recurs on the regimen of every 4 weeks (Class I).
A-Z Cardiovascular Drug Doses
35
36
A-Z Cardiovascular Drug Doses
Endocarditis
TABLE 25 -- Treatment of Native Valve Endocarditis
Caused by Penicillin-Susceptible Viridans Streptococci
and Streptococcus gallolyticus (bovis) (MIC <0.1 ?g/mL)*
ANTIBIOT- DOSAGE AND ROUTE[†] DURATION
IC
12-18 million units/24 hr IV either
Aqueous peni-
continuously or every 4 hr in six 4 weeks
cillin G
equally divided doses
or
Ceftriaxone 2 g once daily IV or IM 4 weeks
12-18 million units/24 hr IV either
Aqueous peni-
continuously or every 4 hr in six 2 weeks
cillin G
equally divided doses
or
Ceftriaxone 2 g once daily IV or IM 2 weeks
plus
3 mg/kg/day IM or IV as a single
Gentamicin daily dose or divided in equal doses 2 weeks
every 8 hr
30 mg/kg/24 hr IV in two equal-
ly divided doses, not to exceed
Vancomycin 4 weeks
2 g/24 hr unless serum levels are
monitored
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial
therapy, and management of complications. Circulation 111:3167, 2005.
A-Z Cardiovascular Drug Doses
† Dosages given are for patients with normal renal function. Vancomycin and gentamicin doses
must be reduced for treatment of patients with renal dysfunction. Gentamicin doses are
calculated by ideal body weight (men = 50 kg + 2.3 kg per inch over 5 feet; women = 45.5 kg +
2.3 kg per inch over 5 feet). Vancomycin doses are based on actual body weight. Vancomycin
doses are adjusted to yield 1-hour postinfusion serum concentration of 30 to 45 ?g/mL and
trough of 15 ?g/mL. Gentamicin administered every 8 hours should be adjusted to achieve
a 1-hour peak concentration of 3 to 3.5 ?g/mL and a trough of <1.0 ?g/mL. Lengthening of
the dose-to-dose interval may be required to achieve these parameters in patients with renal
dysfunction.
37
TABLE 26 -- Treatment of Native Valve Endocarditis
Caused by Strains of Viridans Streptococci and
Streptococcus gallolyticus (bovis) Relatively Resistant to
Penicillin G (MIC >0.1 ?g/mL and <0.5 ?g/mL)*
ANTIBIOT- DOSAGE AND ROUTE[†] DURATION
IC
24 million units/24 hr IV either
Aqueous peni-
continuously or every 4 hr in six 4 weeks
cillin G
equally divided doses
or
Ceftriaxone 2 g once daily IV or IM
plus
3 mg/kg/day IM or IV as a single
Gentamicin daily dose or divided in equal 2 weeks
doses every 8 hr
30 mg/kg/24 hr IV in two equal-
ly divided doses, not to exceed
Vancomycin 4 weeks
2 g/24 hr unless serum levels
are monitored
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial
therapy, and management of complications. Circulation 111:3167, 2005.
* For streptococci with penicillin MIC > 0.5 ?g/mL, see text and Table 67-8.
† Dosages are for patients with normal renal function; see Table 67-6 footnote.
A-Z Cardiovascular Drug Doses
38
TABLE 27 -- Treatment of Staphylococcal Endocarditis
in the Absence of Prosthetic Material
DURA-
ANTIBIOTIC DOSAGE AND ROUTE* TION
Methicillin-susceptible staphylococci†
Nafcillin or oxacillin 2 g IV every 4 hr 4-6 weeks
or
Cefazolin 2 g IV every 8 hr 4-6 weeks
or
15 to 20 mg/kg actual body
Vancomycin 4-6 weeks
weight, IV every 8 to 12 hr
Methicillin-resistant staphylococci‡
15 to 20 mg/kg actual body
Vancomycin[?] 4-6 weeks
weight, IV every 8 to 12 hr
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial t
herapy, and management of complications. Circulation 111:3167, 2005.
* Dosages are for patients with normal renal function; see Table 67-6 footnote.
39
TABLE 28 -- Treatment of Staphylococcal Endocarditis
in the Presence of a Prosthetic Valve or Other Prosthetic
Material
ANTIBIOTIC DOSAGE AND ROUTE* DURATION
Regimen for methicillin-resistant staphylococci†
15 to 20 mg/kg actual body
Vancomycin[‡] ≥6 weeks
weight, IV every 8 to 12 hr
plus
Rifampin 300 mg PO every 8 hr ≥6 weeks
and
Gentamicin[?] 1.0 mg/kg IM or IV every 8 hr 2 weeks
Regimen for methicillin-susceptible staphylococci
Nafcillin or oxacil-
2 g IV every 4 hr ≥6 weeks
lin[?]
plus
Rifampin 300 mg PO every 8 hr ≥6 6weeks
and
Gentamicin[?] 1.0 mg/kg IM or IV every 8 hr 2 weeks
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial
therapy, and management of complications. Circulation 111:3167, 2005.
* Dosages are for patients with normal renal function. See Table 67-6 footnote for gentamicin
dosing.
A-Z Cardiovascular Drug Doses
40
TABLE 29 -- Treatment of Endocarditis Caused by
HACEK Microorganisms*
ANTIBIOT- DOSAGE AND ROUTE[†] DURATION
IC
Ceftriaxone[‡] 2 g once daily IV or IM 4 weeks
or
Ampicillin-sul- 12 g/24 hr IV given every 4 hr in
4 weeks
bactam six equally divided doses
Modified from Baddour LM, Wilson WR, Bayer AS, et al: Infective endocarditis: Diagnosis, antimicrobial
therapy, and management of complications. Circulation 111:3167, 2005.
† Dosages are for those with normal renal function; see Table 67-6 footnote.
41
Hyperthyroidism
TABLE 30 -- Beta-Adrenergic Receptor Blockade in the
Treatment of Hyperthyroidism*
DRUG DOSAGE FREQUENCY CONSIDER-
ATIONS
Nonselective β-AR
Propranolol 10-40 mg tid or qid blockade; longest
experience
Relative beta1
selectivity; in-
Atenolol 25-100 mg bid
creased patient
compliance
Relative beta1
Metoprolol 25-50 mg qid
selectivity
Nonselective β-AR
blockade; once
Nadolol 40-160 mg qd
daily; least experi-
ence to date
IV pump, In ICU setting of
Esmolol 50-100 ?g/ severe hyperthy-
kg/min roidism or storm
* Each of these drugs has been approved for the treatment of cardiovascular diseases, but to
A-Z Cardiovascular Drug Doses
42
Dosis PIAT
43
A-Z Cardiovascular Drug Doses
44
A-Z Cardiovascular Drug Doses
45
A-Z Cardiovascular Drug Doses
46
A-Z Cardiovascular Drug Doses
47
A-Z Cardiovascular Drug Doses
48
A-Z Cardiovascular Drug Doses
49
A-Z Cardiovascular Drug Doses
50
A-Z Cardiovascular Drug Doses