Harriet Lane Handbook
Drug Dosages
I. Note to Reader
The author has made every attempt to check dosages and medical content for accuracy. Because of the incomplete data on pediatric dosing, many drug dosages will be modified after the publication of this text. We recommend that the readers check product information and published literature for changes in dosing, especially for newer medicines. The US Food and Drug Administration (FDA) provides the following pediatric drug information data sources:
- New Pediatric Labeling Information: https://www.fda.gov/science-research/pediatrics/pediatric-labeling-changes
- Drug Safety Report Updates: https://www.fda.gov/advisory-committees/pediatric-advisory-committee/pedia...
- Ongoing and completed clinical research study information of pediatric medicines in development is located in https://www.clinicaltrials.gov/
To prevent prescribing errors, the use of abbreviations has been greatly discouraged. The following is a list of abbreviations that The Joint Commission considers prohibited for use.The Joint Commission
| Official “Do Not Use” Lista | ||
| Do Not Use | Potential Problem | Use Instead |
| U (unit) | Mistaken for “0” (zero), the number “4” (four) or “cc” | Write “unit” |
| IU (International Unit) | Mistaken for IV (intravenous) or the number 10 (ten) | Write “International Unit” |
| Q.D., QD, q.d., qd (daily) | Mistaken for each other | Write “daily” |
| Q.O.D., QOD, q.o.d, qod (every other day) | Period after the Q mistaken for “I” and the “O” mistaken for “I” | Write “every other day” |
| Trailing zero (X.0 mg)b | Decimal point is missed | Write X mg |
| Lack of leading zero (.X mg) | Decimal point is missed | Write 0.X mg |
| MS | Can mean morphine sulfate or magnesium sulfate | Write “morphine sulfate” Write “magnesium sulfate” |
| MSO4 and MgSO4 | Confused for one another | |
a Applies to all orders and all medication-related documentation that is handwritten (including free-text computer entry) or on preprinted forms.
b Exception: A “trailing zero” may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes. It may not be used in medication orders or other medication-related documentation.
Additional Abbreviations, Acronyms, and Symbols (For Possible Future Inclusion in the Official “Do Not Use” List)
| Do Not Use | Potential Problem | Use Instead |
| > (greater than) < (less than) | Misinterpreted as the number “7” (seven) or the letter “L” Confused for one another | Write “greater than” Write “less than” |
| Abbreviations for drug names | Misinterpreted due to similar abbreviations for multiple drugs | Write drug names in full |
| Apothecary units | Unfamiliar to many practitioners Confused with metric units | Use metric units |
| @ | Mistaken for the number “2” (two) | Write “at” |
| cc | Mistaken for U (units) when poorly written | Write “mL” or “ml” or “milliliters” (“mL” is preferred) |
| μg | Mistaken for mg (milligrams), resulting in one thousand-fold overdose | Write “mCg” or “micrograms” |
II. Sample Entry
III. Explanation of Breastfeeding Categories
See sample entry on previous page.
- 1 Compatible
- 2 Use with caution
- 3 Unknown with concerns
- X Contraindicated
- ? Safety not established
IV. Explanation of Pregnancy Categories
- A Adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters.
- B Animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women; or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy, and there is no evidence of risk in later trimesters.
- C Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans; or there are no animal reproduction studies and no adequate studies in humans.
- D There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks.
- X Studies in animals or humans demonstrate fetal abnormalities or adverse reaction; reports indicate evidence of fetal risk. The risk of use in pregnant women clearly outweighs any possible benefit.
- ? Pregnancy category not established
V. Nomogram and Equation for Body Surface Area
FIGURE 30.1
Nomogram and equation for body surface area.
From Kliegman RM, Stanton BF, Schor NF, et al., eds. Nelson Textbook of Pediatrics. 20th ed. Elsevier; 2016.
VI. Drug Index
Acetaminophen
Acetazolamide
Acetylcysteine
Acth
Acyclovir
Adapalene ± Benzoyl Peroxide
Adderall
Adenosine
Albumin, Human
Albuterol
Allopurinol
Almotriptan Malate
Alprostadil
Alteplase
Aluminum Hydroxide
Aluminum Hydroxide with Magnesium Hydroxide
Amantadine Hydrochloride
Amikacin Sulfate
Aminocaproic Acid
Aminophylline
Amiodarone HCL
Amitriptyline
Amlodipine
Ammonul
Amoxicillin
Amoxicillin-Clavulanic Acid
Amphetamine
Amphotericin B Deoxycholate (Conventional)
Amphotericin B Lipid Complex
Amphotericin B, Liposomal
Ampicillin
Ampicillin/Sulbactam
Antipyrine and Benzocaine (Otic)
Arginine Hydrochloride—Injectable Preparation
Aripiprazole
Arnuity Ellipta
Ascorbic Acid
Aspirin
Atenolol
Atomoxetine
Atovaquone
Atropine Sulfate
Auralgan
Azathioprine
Azelastine
Azelastine and Fluticasone
Azithromycin
Aztreonam
Bacitracin ± Polymyxin B
Baclofen
Baloxavir Marboxil
Beclomethasone Dipropionate
Benzoyl Peroxide
Benztropine Mesylate
Beractant
Betamethasone
Bicitra
Bisacodyl
Bismuth Subsalicylate
Bosentan
Breo Ellipta
Brompheniramine with Phenylephrine
Budesonide
Budesonide and Formoterol
Bumetanide
Butorphanol
Caffeine Citrate
Calcitonin—Salmon
Calcitriol
Calcium Acetate
Calcium Carbonate
Calcium Chloride
Calcium Citrate
Calcium Gluconate
Calcium Lactate
Calfactant
Cannabidiol
Captopril
Carbamazepine
Carbamide Peroxide
Carbinoxamine
Carnitine
Carvedilol
Caspofungin
Cefaclor
Cefadroxil
Cefazolin
Cefdinir
Cefepime
Cefiderocol
Cefixime
Cefotaxime
Cefotetan
Cefoxitin
Cefpodoxime Proxetil
Cefprozil
Ceftaroline Fosamil
Ceftazidime
Ceftazidime with Avibactam
Ceftolozane with Tazobactam
Ceftriaxone
Cefuroxime (Iv, Im)/Cefuroxime Axetil (Po)
Celecoxib
Cephalexin
Cetirizine ± Pseudoephedrine
Charcoal, Activated
Chloramphenicol
Chloroquine Phosphate
Chlorothiazide
Chlorpheniramine Maleate
Chlorpromazine
Cholecalciferol
Cholestyramine
Ciclesonide
Cidofovir
Ciprofloxacin
Citrate Mixtures
Clarithromycin
Clindamycin
Clobazam
Clonazepam
Clonidine
Clotrimazole
Corticotropin
Cortisone Acetate
Co-Trimoxazole
Cromolyn
Cyanocobalamin/Vitamin B12
Cyclopentolate
Cyclopentolate with Phenylephrine
Cyclosporine, Cyclosporine Microemulsion, Cyclosporine Modified
Cyproheptadine
Dabigatran etexilate mesylate
Dantrolene
Dapsone
Darbepoetin Alfa
Deferoxamine Mesylate
Desmopressin Acetate
Dexamethasone
Dexmedetomidine
Dexmethylphenidate
Dextroamphetamine ± Amphetamine
Diazepam
Diazoxide
Digoxin
Digoxin Immune Fab (Ovine)
Diltiazem
Dimenhydrinate
Diphenhydramine
Divalproex Sodium
Dobutamine
Docusate
Dolasetron
Dopamine
Dornase Alfa/Dnase
Doxycycline
Dronabinol
Droperidol
Dymista
Elexacaftor/Tezacaftor/Ivacaftor
Emla
Enalapril Maleate (PO), Enalaprilat (IV)
Enoxaparin
Epinephrine HCL
Epinephrine, Racemic
Epoetin Alfa
Epoprostenol
Ergocalciferol
Ergotamine Tartrate ± Caffeine
Ertapenem
Erythromycin Preparations
Erythropoietin
Escitalopram
Esmolol HCL
Esomeprazole
Etanercept
Ethambutol HCL
Ethosuximide
Etomidate
Famciclovir
Famotidine
Felbamate
Fentanyl
Ferric Gluconate
Ferrous Sulfate
Fexofenadine ± Pseudoephedrine
Fidaxomicin
Filgrastim
Flecainide Acetate
Fluconazole
Flucytosine
Fludrocortisone Acetate
Flumazenil
Flunisolide
Fluoride
Fluoxetine Hydrochloride
Fluticasone Furoate + Vilanterol
Fluticasone Preparations
Fluticasone Propionate and Salmeterol
Fluvoxamine
Folic Acid
Fomepizole
Foscarnet
Fosphenytoin
Furosemide
Gabapentin
Ganciclovir
Gatifloxacin
GCSF
Gentamicin
Glucagon HCL
Glycerin
Glycopyrrolate
Granisetron
Griseofulvin
Guanfacine
Haloperidol
Heparin Sodium
Hyaluronidase
Hydralazine Hydrochloride
Hydrochlorothiazide
Hydrocortisone
Hydromorphone Hcl
Hydroxychloroquine sulfate
Hydroxyzine
Ibuprofen
Iloprost
Imipenem and Cilastatin
Imipramine
Immune Globulin
Indomethacin
Insulin Preparations
Iodide
Iodixanol
Iohexol
Ipratropium Bromide ± Albuterol
Iron Dextran
Iron—INJECTABLE Preparations
Iron—Oral Preparations
Iron Sucrose
Isoniazid
Isoproterenol
Isotretinoin
Itraconazole
Ivacaftor
Ivermectin
Kalydeco
Ketamine
Ketoconazole
Ketorolac
Lacosamide
Labetalol
Lactulose
Lamivudine
Lamotrigine
Lansoprazole
Levalbuterol
Levetiracetam
Levocarnitine
Levofloxacin
Levothyroxine (T4)
Lidocaine
Lidocaine and Prilocaine
Lindane
Linezolid
Liraglutide
Lisdexamfetamine
Lisinopril
Lithium
Lodoxamide
Loperamide
Loratadine – Pseudoephedrine
Lorazepam
Losartan
Low-Molecular-Weight Heparin
Lucinactant
Lumacaftor and Ivacaftor
Magnesium Citrate
Magnesium Hydroxide
Magnesium Oxide
Magnesium Sulfate
Mannitol
Mebendazole
Medroxyprogesterone
Mefloquine Hcl
Meropenem
Mesalamine
Metformin
Methadone Hcl
Methimazole
Methylene Blue
Methylphenidate Hcl
Methylprednisolone
Metoclopramide
Metolazone
Metoprolol
Metronidazole
Micafungin Sodium
Miconazole
Midazolam
Milrinone
Mineral Oil
Minocycline
Minoxidil
Mometasone Furoate ± Fomoterol Fumarate
Montelukast
Morphine Sulfate
Mupirocin
Mycophenolate
Nafcillin
Naloxone
Naproxen/Naproxen Sodium
Neo-Polymycin Ophthalmic Ointment
Neosporin Ophthalmic Solution
Neo-Polycin Hc
Neomycin Sulfate
Neomycin/Polymyxin B Ophthalmic Products
Neomycin/Polymyxin B/Bacitracin
Neostigmine
Nevirapine
Niacin/Vitamin B3
Nicardipine
Nifedipine
Nitrofurantoin
Nitroglycerin
Nitroprusside
Norepinephrine Bitartrate
Nortriptyline Hydrochloride
Nystatin
Octreotide Acetate
Ofloxacin (Otic and Ophthalmic)
Olanzapine
Olopatadine
Omeprazole
Omnipaque
Ondansetron
Orkambi
Oseltamivir Phosphate
Oxacillin
Oxcarbazepine
Oxybutynin Chloride
Oxycodone
Oxycodone and Acetaminophen
Palivizumab
Pancrelipase/Pancreatic Enzymes
Pancuronium Bromide
Pantoprazole
Paromomycin Sulfate
Paroxetine
Penicillin G Preparations—Aqueous Potassium and Sodium
Penicillin G Preparations—Benzathine
Penicillin G Preparations—Penicillin G Benzathine and Penicillin G Procaine
Penicillin G Preparations—Procaine
Penicillin V Potassium
Pentamidine Isethionate
Pentobarbital
Permethrin
Phenazopyridine Hcl
Phenobarbital
Phentolamine Mesylate
Phenylephrine Hcl
Phenytoin
Phosphorus Supplements
Physostigmine Salicylate
Phytonadione/Vitamin K1
Pilocarpine Hcl
Pimecrolimus
Piperacillin with Tazobactam
Polycitra
Polyethylene Glycol—Electrolyte Solution
Polymyxin B Sulfate and Bacitracin
Polymyxin B Sulfate and Trimethoprim Sulfate
Polymyxin B Sulfate, Neomycin Sulfate, Hydrocortisone Otic
Polysporin
Polytrim Ophthalmic Solution
Poractant Alfa
Posaconazole
Potassium Iodide
Potassium Supplements
Pralidoxime Chloride + Atropine
Prednisolone
Prednisone
Primaquine Phosphate
Primidone
Probenecid
Prochlorperazine
Promethazine
Propranolol
Propylthiouracil
Prostaglandin E1
Protamine Sulfate
Pseudoephedrine
Psyllium
Pyrantel Pamoate
Pyrazinamide
Pyrethrins with Piperonyl Butoxide
Pyridostigmine Bromide
Pyridoxine
Pyrimethamine
Quetiapine
Quinidine
Quinupristin And Dalfopristin
Raltegravir
Rasburicase
Rho (D) Immune Globulin Intravenous (Human)
Ribavirin
Riboflavin
Rifabutin
Rifampin
Rifaximin
Rimantadine
Risperidone
Rivaroxaban
Rizatriptan Benzoate
Rocuronium
Rufinamide
Salmeterol
Scopolamine Hydrobromide
Selenium Sulfide
Senna/Sennosides
Sertraline HCL
Sildenafil
Silver Sulfadiazine
Simethicone
Sirolimus
Sodium Bicarbonate
Sodium Chloride—Inhaled Preparations
Sodium Phenylacetate and Sodium Benzoate
Sodium Phosphate
Sodium Polystyrene Sulfonate
Spironolactone
Streptomycin Sulfate
Succimer
Succinylcholine
Sucralfate
Sugammadex
Sulfacetamide Sodium Ophthalmic
Sulfadiazine
Sulfamethoxazole and Trimethoprim
Sulfasalazine
Sumatriptan Succinate
Surfactant, Pulmonary/Beractant
Surfactant, Pulmonary/Calfactant
Surfactant, Pulmonary/Poractant Alfa
Symdeko
Tacrolimus
Tazarotene
Terbinafine
Terbutaline
Tetracycline HCL
Tezacaftor and Ivacaftor
Theophylline
Thiamine
Thioridazine
Tiagabine
Tiotropium
Tobramycin
Tolnaftate
Topiramate
Trazodone
Treprostinil
Tretinoin—Topical Preparations
Triamcinolone
Triamterene
Trifluridine
Trikafta
Trimethobenzamide HCL
Trimethoprim and Sulfamethoxazole
Ursodiol
Valacyclovir
Valganciclovir
Valproic Acid/Valproate sodium
Valsartan
Vancomycin
Varicella-Zoster Immune Globulin (Human)
Vasopressin
Vecuronium Bromide
Verapamil
Vigabatrin
Vitamin A
Vitamin B1
Vitamin B2
Vitamin B3
Vitamin B6
Vitamin B12
Vitamin C
Vitamin D2
Vitamin D3
Vitamin E/α-Tocopherol
Vitamin K
Voriconazole
Warfarin
Zidovudine
Zinc Salts, Systemic
Zolmitriptan
Zonisamide
