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Iowa Neonatology Handbook: Pharmacology
Antiarrhythmic Drugs1
Jeffrey L. Segar, MD
Peer Review Status: Internally Peer Reviewed
Dosage Recommendations and Pharmacokinetics of the antiarrhythmic
drugs1
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Drug
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Initial Dose
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Maintenance
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Effective Plasma Conc
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T 1/2
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GI Absorption
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Protein Binding
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Metabolism
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Renal Excretion (% unchanged)
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Adverse Effects
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Adenosine
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50 mcg/kg IV push increasing by 50 mcg/kg q2 min
until sinus rhythm. Max: 250 mcg/kg
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10 sec
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Flushing, dyspnea
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Digoxin
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See page 135
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1-2 ng/ml
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15-72 hrs (range of means)
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70%
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20%
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Liver, GI tract
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60%
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Heart block, arythmia
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Lidocaine
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1-5 mg/kgIV
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10-50 mcg/kg/min IV
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1-5 mcg/ml
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15-30 min
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<35%
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10-50%
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Liver
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<10%
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CNS, decreased myocardial contractility,
arrhythmia
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Phenytoin
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2-5 mg/kg IV over 5-10 min, repeat up to 20
mg/kg
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2-8 mg/kg q 8-12 hrs P.O.
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5-18 mcg/ml
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8-197 hrs (range of means)
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>80%
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>70%
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Liver
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<10%
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lethargy
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Procainamide
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3-10 mg/kg IV over 10 min
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20-80 mcg/kg/min IV 3-9 mg/kg q4 hrs P.O.
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3-10 mcg/ml
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2-4 hrs
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>75%
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15%
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Liver
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50-60%
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arrhythmia, p ercarditis, pneumonitis
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Propranolol
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10-20 mcg/kg IV over 10 min
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0.05-2 mg/kg q 6 hrs P.O.
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20-100 ng/ml
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3-6 hrs
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>90% (<30% bioavailable)
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90%
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Liver
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5%
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bradycardia, hypotension
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Quinidine
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Not recommended
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5-15 mg/kg q 6 hrs P.O.
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2-6 mcg/ml
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6-7 hrs
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>90%
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70-80%
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Liver
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20-50%
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arrhythmia, hypotension
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1 Portions of this information were derived
from adult patients
References: Gelband and Rosen, 1975; Guntheroth, 1978;
Somogyi et al, 1981; Schreeweiss, 1990; Roberts, 1984
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