CONTINUOUS INFUSION TITRATION GUIDELINES (Critical Care)
THESE ARE DOSING GUIDELINES ONLY.
An order is required for each medication with the following parameters:
1. Name of medication
2. Initial rate
3. Goal/titration end point
4. Maximum dose
Standard concentrations are used per WMC policy.
Drug Name
Units of Admin
CISatracurium
Initial Rate of Infusion
(unless order specifies a rate)
LD = loading dose
Initial dose = initial infusion
rate
INITIAL DOSE: 3mcg/kg/min
Titration
Maximum Dose
By end point with
documentation
(unless order
specifies a max)
0.5 mcg/kg/min every 60 min
[mcg/kg/min]
dexmedetomidine
[mcg/kg/hr]
10mcg/kg/min
LD: 1 mcg/kg over 10 min
0.1 mcg/kg/hr every 30 min
1.4 mcg/kg/hr
INITIAL DOSE: 0.3 mcg/kg/hr
Comments
Monitor with BIS for
sedation and train of 4 for
neuromuscular blockade
Call MD if RASS not
achieved with dose of 1
mcg/kg/hr.
48 hours or less.
Automatically dc’d in 36
hours from initial order.
diltiazem
LD: 20 mg over 2 minutes
2.5 to 5 mg/hr every 15 min
15 mg/hr
[mg/hr]
INITIAL DOSE: 5 mg/hr
HYDROmorphone
INITIAL DOSE: 0.4 mg
0.2 mg bolus every 10
minutes, max dose 3.2 mg/2
hours, then increase by
0.2mg/hr every 20 min
per Sedation Protocol
3mg/hr
Rebolus x 2 before
increasing infusion.
Per End of Life orders
1.5mg/hr
If continuous infusion not
required, use bolus
dosing.
INITIAL DOSE: as ordered
2.5- 10 mcg/kg/min every 10
min
20 mcg/kg/min
Central line preferred.
INITIAL DOSE: as ordered
1-10 mcg/kg/min every 5
min
20 mcg/kg/min
Central line preferred.
INITIAL DOSE: Sepsis 2
mcg/min
1-10 mcg/min every 3 min
CT Surgery 8mg/min
Central line preferred.
mcg/hr
DOBUamine
[mcg/kg/min]
DOPamine
[mcg/kg/min]
EPINEPHrine
[mcg/min]
10 mcg/min
INITIAL DOSE: CT Surgery 1
mcg/min
SEPSIS: If rate
exceeds 10 mcg/min,
notify MD.
esmolol
LD: 500 mcg/min over 1 min
INITIAL DOSE: 50 mcg/kg/min
50 mcg/kg/min every 5
minutes
300 mcg/kg/min
[mcg/kg/min]
fenoldopam
0.05-0.1 mcg/kg/min every
15 minutes
1.6 mcg/min
[mcg/kg/min]
INITIAL DOSE: 0.03-0.05
mcg/kg/min
fentanyl
LD: 50 mcg
INITIAL DOSE: 50 mcg every 5
minutes
50 mcg/hr, if 200 mcg
reached in 2 hours
Sedation Protocol
mcg/hr
isoproterenol
LD: 1-2mcg
[mcg/min]
INITIAL DOSE: 1mcg/min
200 mcg/hr
Rebolus x 2 before
increasing infusion.
If continuous infusion not
required, use bolus
dosing.
1mcg/min every 15min
10mcg/min
Central line preferred.
labetalol
INITIAL DOSE: 2mg/min
2mg/min, titrate every 5 min
6mg/min
LD: 1 to 2 mg (RASS
dependent)
1 to 2 mg/hr every 15
minutes
8 mg/hr
[mg/min]
LORazepam
[mg/hour]
INITIAL DOSE: 1 mg/hr
midazolam
[mg/hr]
LD: 2 to 5 mg (RASS
dependent)
If continuous infusion not
required, use bolus
dosing.
2 to 5 mg/hr every 10
minutes
10 mg/hr
INITIAL DOSE: 1 mg/hr
milrinone
LD 25mcg/kg/min
[mcg/kg/min]
INITIAL DOSE: 0.25
mcg/kg/min
morphine
Rebolus x 2 before
increasing infusion.
Rebolus x 2 before
increasing infusion.
If continuous infusion not
required, use bolus
dosing.
0.025mcg/min every 5 min
0.75 mcg/kg/min
Initial dose: 1mg/hr
1mg/hr every 15 min
10mg/hr
INITIAL DOSE: 5 mg/hr
2.5 mg/hr every 5 minutes
15 mg/hr
INITIAL DOSE: 10 mcg/min
5 mcg/min every 5 min; until
20 mcg/min, then by 10
mcg/min ever 5 min
200 mcg/min
INITIAL DOSE: 0.1
mcg/kg/min
0.5 mcg/kg/min every 5
minutes
10 mcg/kg/min;
[mcg/kg/min]
norepinephrine
INITIAL DOSE: as ordered
20 mcg/min
[mcg/min]
SEPSIS: 2 mcg/min
2.5-10 mcg/min every 3
minutes
pancuronium
INITIAL DOSE: as ordered
0.1-0.2mcg/kg/kg every 60
min
1mcg/kg/min
INITIAL DOSE: as ordered
0.5-1mg/kg/hr every 60min
4mg/kg/hr
INITIAL DOSE: as ordered
20 mcg/min every 3 minutes
200 mcg/min
Central line preferred.
INITIAL DOSE: 10 mcg/kr/min
5 mcg/kg/min every 5
minutes
60 mcg/kg/min
Check orders for
supplemental sedative is
max rate reached.
rocuronium
LOADING DOSE: 0.6-1mg/kg
15mcg/kg/min
[mcg/kg/min]
INITIAL DOSE: 8mcg/kg/min
increase dose by 10% every 2
hours based on Train of Four
results
Monitor with BIS for
sedation and train of 4 for
NMB
vasopressin
INITIAL DOSE: 0.03 units/min
Nontitrating dose for shock.
0.03 units/min
Central line preferred.
CT Surgery 0.01 units/min
every 30 min
CT Surgery 0.08
units/min
[mg/hr]
niCARdipine
[mg/hour]
nitroGLYCERIN
[mcg/min]
nitroPRUSSIDE
[mcg/kg/min]
PENTobarbital
Central line preferred.
5 mcg/kg/min if SrCr
above 1.5 mg/dL
Central line preferred.
SEPSIS: If rate
exceeds 30 mcg/min,
notify MD.
Monitor with BIS for
sedation and train of 4 for
NMB
[mg/kg/hr]
phenylephrine
[mcg/min]
propofol
[mcg/kg/min]
Replacement/shock
dose
[units/min]
vecuronium
[mcg/kg/min]
Reviewed at P&T May 9, 2013
0.05 mcg/kg every 60 min
based on train of four results
1mcg/kg/min
Monitor with BIS for
sedation and train of 4 for
NMB