Scheduled |
Chlordiazepoxide | - PO/NGT: 25-100 mg q6hr
(Increase each dose by 25 mg every 24 hrs to a max daily dose of 400 mg) - NPO: None
| |
Clonidine | - PO/NGT: 0.2-0.3 mg q6hr
(Titrate up every 24 hrs to a max daily dose of 2.4 mg) - NPO: consider SL administration
| Hold if SBP < 90 Wean over 3-5 days to avoid rebound sympathetic hyperactivity SL = PO bioavailability Ideal agent for alcohol or opioid withdrawal symptoms/agiation |
Gabapentin | - PO/NGT: Load 800 mg x 1, followed by 300-900 mg q8hr
(Titrate up every 24 hrs to a max daily dose of 3200 mg) - NPO: None
| Utilize liquid only for patients receiving medications via feeding tube Adjust frequency to q12h or q24h for patients with an AKI or CKD No weaning required Ideal agent for alcohol or opioid withdrawal symptoms/agitation. If using for withdrawal, minimum starting dose 600 mg q8H |
Olanzapine | - PO/NGT: 5-10 mg q12-24hr
- NPO: 5-10 mg IM q12-24hr
- (Titrate up every 24 hrs to a max daily dose of 20 mg combined PO/IM)
| - Black Box warning: IM olanzapine + IM lorazepam
Start with 2.5 mg PO/IM in patients with history of dementia ODT tablets need to be dissolved and swallowed for optimal effect |
Phenobarbital | - *Load all patients with 5-10 mg/kg IBW IVPB over 30 mins*
(May repeat 30 minutes after completion of previous infusion up to two times) - PO/NGT: 64.8-97.2 mg PO/NGT q8h (max daily dose 20mg/kg IBW*)
- NPO: No recommendation for scheduled, utilize PRN’s: 130 mg IV over 3 mins or 260 mg IV over 5 mins q4hr (max daily dose 20mg/kg IBW*)
| - ADE: respiratory depression with rapid administration, dermatologic reactions, hypotension
- Drug-drug interactions: CYP 3A4 inducer
Contains propylene glycol May check serum trough levels if needed (goal < 20). *Max dose may be higher as directed by TDM Ideal agent for agitation or symptoms related to alcohol withdrawal |
Quetiapine | - PO/NGT: 25-100 mg q8-12hr
(Titrate up every 12-24 hrs to a max daily dose of 300 mg) - NPO: None
| Ideal agent for agitation and to promote sleep |
Valproate/divalproex | - PO/NGT: 500-1000 mg q8hr
(Titrate up to a max daily dose of 3000 mg*) - NPO: 500-1000 mg IV q8hr
(Titrate up to a max daily dose of 3000 mg*)
| - ADE: hyperammonemia, thrombocytopenia, hepatotoxicity
- Drug-drug interactions: (Meropenem decreases VPA concentration, phenobarbital increases VPA concentration)
Not recommended in liver insufficiency No weaning necessary Contraindicated in pregnancy May check serum levels if needed (goal < 100) *Max dose may be higher as directed by TDM or ADE PO/NGT formulation should be divalproex sprinkle capsules Ideal agent for agitation related to traumatic brain injury |
PRN |
Chlorpromazine | 25-50 mg IV/IM q6-8H PRN (If IV min infusion rate 1 mg/min due to hypotension) | - ADE: QTc prolongation, EPS
- Hypotension: IV >> IM
|
Haloperidol | 5-10 mg IV q4hr PRN | - ADE: QTc prolongation, EPS
|
Ketamine | 4-5 mg/kg IM | - ADE: emergence reaction, hypersalavation, tachycardia
If emergence reactions develop treat with lorazepam 2 mg IV |
Olanzapine | 5-10 mg IM PRN q8hr | |
Phenobarbital | 130 mg IV over 3 mins or 260 mg IV over 5 mins q4hr max daily dose 20mg/kg IBW) | Preferred agent for agitation related to alcohol withdrawal |
Ziprasidone | 10-20 mg IV PRN q4hr | |
- EPS = extrapyramidal symptoms
- If HR < 60 bpm use QT and not QTc for medication monitoring
- *all PO meds are 90-100% bioavailable
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