Indications And Dose
Status epilepticus | Febrile convulsions ▶BY BUCCAL ADMINISTRATION ▶Child 1–2 months: 300 micrograms/kg (max. per dose 2.5 mg), then 300 micrograms/kg after 10 minutes (max. per dose 2.5 mg) if required ▶Child 3–11 months: 2.5 mg, then 2.5 mg after 10 minutes if required ▶Child 1–4 years: 5 mg, then 5 mg after 10 minutes if required ▶Child 5–9 years: 7.5 mg, then 7.5 mg after 10 minutes if required ▶Child 10–17 years: 10 mg, then 10 mg after 10 minutes if required ▶Adult: 10 mg, then 10 mg after 10 minutes if required Conscious sedation for procedures ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: Initially 2–2.5 mg, to be administered 5–10 minutes before procedure at a rate of approximately 2 mg/minute, increased in steps of 1 mg if required, usual total dose is 3.5–5 mg; maximum 7.5 mg per course ▶Elderly: Initially 0.5–1 mg, to be administered 5–10 minutes before procedure at a rate of approximately 2 mg/minute, increased in steps of 0.5–1 mg if required; maximum 3.5 mg per course Sedative in combined anaesthesia ▶INITIALLY BY INTRAVENOUS INJECTION ▶Adult: 30–100 micrograms/kg, repeated if necessary, alternatively (by continuous intravenous infusion) 30–100 micrograms/kg/hour ▶Elderly: Lower doses needed Premedication ▶BY DEEP INTRAMUSCULAR INJECTION ▶Adult: 70–100 micrograms/kg, to be administered 20–60 minutes before induction, for debilitated patients, use elderly dose ▶Elderly: 25–50 micrograms/kg, to be administered 20–60 minutes before induction ▶BY INTRAVENOUS INJECTION ▶Adult: 1–2 mg, repeated if necessary, to be administered 5–30 minutes before procedure, for debilitated patients, use elderly dose ▶Elderly: 0.5 mg, repeated if necessary, initial dose to be administered 5–30 minutes before procedure, repeat dose slowly as required Induction of anaesthesia (but rarely used) ▶BY SLOW INTRAVENOUS INJECTION ▶Adult: 150–200 micrograms/kg daily in divided doses (max. per dose 5 mg), dose to be given at intervals of 2 minutes, maximum total dose 600 micrograms/kg, for debilitated patients, use elderly dose ▶Elderly: 50–150 micrograms/kg daily in divided doses (max. per dose 5 mg), dose to be given at intervals of 2 minutes, maximum total dose 600 micrograms/kg Sedation of patient receiving intensive care ▶INITIALLY BY SLOW INTRAVENOUS INJECTION ▶Adult: Initially 30–300 micrograms/kg, dose to be given in steps of 1–2.5 mg every 2 minutes, then (by slow intravenous injection or by continuous intravenous infusion) 30–200 micrograms/kg/hour, reduce dose (or reduce or omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia, lower doses may be adequate if opioid analgesic also used Adjunct to antipsychotic for confusion and restlessness in palliative care ▶BY SUBCUTANEOUS INFUSION ▶Adult: Initially 10–20 mg/24 hours, adjusted according to response; usual dose 20–60 mg/24 hours Convulsions in palliative care ▶BY CONTINUOUS SUBCUTANEOUS INFUSION ▶Adult: Initially 20–40 mg/24 hours l UNLICENSED USE Unlicensed oromucosal formulations are also available and may have different doses—refer to product literature. ▶In adults Oromucosal solution not licensed for use in adults over 18 years. ▶In children Oromucosal solution not licensed for use in children under 3 months. Injection not licensed for use in status epilepticus or febrile convulsions. Not licensed for use in children under 6 months for premedication and conscious sedation. Not licensed for use by mouth. Not licensed for use by buccal administration for conscious sedation.
Source pages 378, 379