Table 2.
Medication reference.
| Medication | Dose | Peak effect | Max daily dose | Notes/monitoring |
|---|---|---|---|---|
| Diphenhydramine (antihistaminic) | PO/IM: 12.5–50mg 1 mg/kg/dose |
PO: 2 hours | Child: 50–100 mg Adolescent: 100–200 mg |
Avoid in delirium. Can be combined with haloperidol or chlorpromazine if concerns for EPS. Can cause disinhibition or delirium in younger or DD youth. |
| Lorazepam (benzodiazepine) | PO/IM/IV/NGT: 0.5 mg–2 mg 0.05 mg–0.1 mg/kg/dose |
IV: 10 minutes PO/IM: 1–2 hours |
Child: 4 mg Adolescent: 6–8 mg Depending on weight/proir medication exposure |
Can cause disinhibition or delirium in younger or DD youth. Can be given with haloperidol, chlorpromazine or risperidone. Do not give with olanzapine (especially IM due to risk of respiratory suppression. |
| Clonidine (alpha2 agonist) | PO: 0.05 mg–0.1 mg | PO: 30–60 minutes | 27–40.5 kg: 0.2 mg/day 40.5–45 kg: 0.3 mg/day >45 kg: 0.4mg/day |
Monitor for hypotension and bradycardia. Avaoid giving with BZD or atypicals due to hypotension risk. |
| Chlorpromazine (antipsychotic) | PO/IM: 12.5–60 mg (IM should be half PO dose) 0.55 mg/kg/dose |
PO: 30–60 minutes IM: 15 minutes |
Child <5 years: 40mg/day Child >5 years: 75mg/day |
Monitor hypotension. Monitor for QT prolongation. |
| Haloperidol (antipsychotic) | PO/IM: 0.5 mg–5 mg (IM should be half a dose of PO) 0.05–0.1 mg/kg/dose |
PO: 2 hours IM: 20 minutes |
15–40 kg: 6mg >40 kg: 15 mg Depending on prior antipsychotic exposure |
Monitor hypotension. Consider EKG or cardiac monitoring for QT prolongation, especially for IV administration. Note EPS risk with MDD > 3mg/day, with IV dosing having very high EPS risk. Consider AIMS testing. |
| Olanzapine (antipsychotic) | PO/ODT or IM: 2.5–10 mg (IM should be half or 1/4 dose of PO) | PO: 5 hours (range 1–8 hours) IM: 15–45 minutes |
10–20 mg Depending on antipsychotic exposure | Do not give with or within 1 hour of any BZD given risk for respiratory suppresion |
| Risperidone (antipsychotic) | PO/ODT: 0.25–1mg 0.005–0.01mg/kg/dose |
PO: 1 hour | Child: 1–2 mg Adolescent: 2–3 mg Depending on antipsychotic exposure |
Can cause akathisia (restlessness/agitaion) in higher doses. |
| Quetiapine (antipsychotic) | PO: 25–50 mg 1–1.5 mg/kg/dose (or divided) |
PO: 30 minutes-2 hours | >10 years: 600 mg Depending on prior antipsychotic exposure |
More sedating at lower doses Monitor hypotension. |
PO, by mouth; IM, intramuscular; IV, intravenous; NGT, nasogastric tube; mg, milligram; EPS, extrapyramidal symptoms; DD, developmental disability; mg/kg, milligrams per kilogram; BZD, benzodiazepines; EKG, electrocardiogram; AIMS, Abnormal Involuntary Movement Scale; MDD, major depressive disorder; ODT, orally dissolving tablet.