Selecting a Treatment Regimen
Table 6. Drug Table Drug
Dose
Epinephrine 1:1000 Adult: 0.2-0.5 mL (mg) Child: 0.01 mL (mg)/kg
(EpiPen® (EpiPen Jr® ) )
0.3 mg 0.15 mg
Glucocorticosteroids Slow IV Adult: 100-300 mg (hydrocortisone equivalent) Child: ≤ 1 year; 25 mg 1-5 years; 50 mg 6-12 years; 100 mg OR Dexamethasone Adult: 0.5-20 mg Child: 0.2-0.5 mg/kg
Vasopressors Dobutamine
Dopamine
Norepinephrine (Levophed®
)
Phenylephrine (NeoSynephrine®
Albuterol (Proventil®
)
Nebulized therapy )
(Ventolin Nebules® )
Levalbuterol (Xopenex®
Aminophylline Antihistamines
H1
Diphenhydramine (Benadryl®
)
Hydroxyzine (Vistaril®
)
IM or slow IV Adult: 25-50 mg Child: 1 mg/kg up to 50 mg
Adult: 25-100 mg IM Child: 0.25 mg/kg IM
Chlorpheniramine 10-20 mg IV H2
Ranitidine (Zantac®
)
An H2 antagonist added to the H1 antagonist may be helpful in the management of anaphylaxis.
IM or IV Adult: 50 mg or 6.25 mg/h Child: 2-4 mg/kg
16
Adult: IV – 2.5-20 mcg/kg/min
Adult: IV – 0.5-2 mcg/kg/min
Adult: IV – 8-12 mcg/min
Adult: IV – 0.1-0.5 mg OR 0.1-0.18 mg/min
)
2.5 mg q6-8h 1.25-5 mg q6-8h
0.63-1.25 mg q6-8h
5 mg/kg by intravenous injection over at least 20 min
Antihistamines are considered supportive therapy and do not replace epinephrine. Antihistamines are second line drugs that can be given after epinephrine administration since they may be useful for control of cutaneous and cardiovascular manifestations.
For asthma-like symptoms
Titrate to BP; most potent vasoconstrictor
For mild/moderate hypotension Comments
Epinephrine and oxygen are the most important therapeutic agents administered in anaphylaxis.
For patient use in an emergency; not a substitute for emergency medical treatment
Glucocorticosteroids are second line drugs, requiring 4-6 hours before onset of action. They should never be administered in lieu of epinephrine. Efficacy for the treatment of anaphylaxis has not been established.
(Br
and)
