- Management of delayed gastric emptying/reflux if oral therapy not feasible
- Adjunct to facilitate small bowel intubations; in diagnostic radiology to facilitate gastroduodenal evacuation of barium meal
- Prevention of nausea and vomiting during chemotherapy or postoperatively
- Migraine
- Available as a 5 mg/mL colourless injection. Store at room temperature
- Diluted solutions stable 48 hours at room temperature when protected from light
- Solutions Compatible: D5W, 0.9% NaCl, D5W/0.45%NaCl, ringer's solution, ringer's lactate
- Additive/Above Cassette Compatible: aminophylline, atropine, benztropine, dexamethasone, dimenhydrinate, diphenhydramine, fentanyl, heparin, hydromorphone, hydroxyzine, meperidine, methylprednisolone sodium succinate, morphine, midazolam, KCL (up to 30 mmol/L), ranitidine
- Y-site Compatible: ciprofloxacin, cisatracurium, fluconazole, meropenem, TPN (amino acids/dextrose)
Incompatible: ampicillin, chloramphenicol, furosemide, penicilin G, propofol, sodium bicarbonate
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES Usual dilution: 5 mg/mL |
| IV Direct |
NO |
| IV Intermittent Infusion |
YES Usual dilution Hem/Onc only: 1 mg/mL Usual dilution other wards/ER: 0.5 mg/mL Infusion time: 15-30 minutes |
| IV Continuous Infusion | YES Usual dilution: 1 mg/mL |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- Gastroesophageal reflux: 0.4 -0.8 mg/kg/day IM/IV QID, 30 minutes before meals and at bedtime (maximum 15 mg QID)
- Chemotherapy-Induced Nausea/Vomiting: 0.5-1 mg/kg/dose IV given 30 minutes before chemotherapy Q 2-4 hours PRN (maximum 25 mg/dose)
** Administer diphenhydramine 1 mg/kg/dose (max 50 mg) concurrently to prevent dystonic reactions
- Postoperative Nausea/Vomiting: 0.1-0.2 mg/kg/dose IV Q6-8 hours PRN (maximum 10 mg/dose)
- Migraine: Pediatric dose guidelines for migraines do not exist in the literature.If required, a reasonable approach would be to use dosing similar to that used for postop nausea and vomiting: 0.1-0.2 mg/kg/dose IV (maximum dose: 10 mg/dose) x 1
- Small Bowel Intubation:
< 6 yrs: 0.1 mg/kg IV x 1 dose 5 minutes prior to intubation
6-14 yrs: 2.5-5 mg IV x 1 dose 5 minutes prior to intubation
> 14 yrs: 10 mg IV x 1 dose 5 minutes prior to intubation
Adult:
- Gastroesophageal reflux: 10-15 mg IM/IV QID, 30 minutes before meals and at bedtime
- Chemotherapy-Induced Nausea/Vomiting: 1-2 mg/kg/dose IV given 30 minutes before chemotherapy Q 2-4 hours PRN (maximum 10 mg/kg/day)
** Administer diphenhydramine 1 mg/kg/dose (max 50 mg) concurrently to prevent dystonic reactions
- Postoperative Nausea/Vomiting: 10 mg IV Q 6-8 hours PRN
DOSE ADJUSTMENT IN RENAL FAILURE:
CrCl: 40-50 mL/minute: Administer 75% of recommended dose
CrCl: 10-40 mL/minute: Administer 50% of recommended dose
CrCl: < 10 mL/minute: Administer 25-50% of recommended dose
- Migraine - 10 mg IV x 1 dose
- IV Direct may cause transient feelings of anxiety and restlessness, followed by drowsiness
- Extrapyramidal reactions within 24-48 hours: Treatment: diphenhydramine 1 mg/kg IV stat
- Diarrhea, Fluid retention, urinary frequency
- Insomnia, headache, visual disturbances- less common
- Transient flushing after large dose
- May increase seizure frequency in epileptics
- Monitor renal function, BP, HR
- Contraindicated in pheochromocytoma, GI obstruction, history of seizure disorder or patients receiving drugs likely to cause extrapyramidal symptoms
- May alter the absorption of oral medications (e.g: decrease digoxin absorption, increases cyclosporine and tacrolimus absorption)
- Concomitant use with MAO inhibitors increases hypertensive episodes