Anemia of Prematurity - Portal Neonatal

Adult Dose
Pediatric Dose
Contraindications
Interactions
0.5 mcg/kg/min IV initially, titrate until desired therapeutic effect attained,
typically up to 20 mcg/kg/min
Administer as in adults; premature infants may respond to very small
doses
Documented hypersensitivity; idiopathic hypertrophic subaortic stenosis
and atrial fibrillation or flutter
Beta-adrenergic blockers antagonize effects of dobutamine; general
anesthetics may increase toxicity
Incompatible with acyclovir, aminophylline, bumetanide, diazepam,
digoxin, furosemide, indomethacin, phenytoin, and sodium bicarbonate
Pregnancy B - Usually safe but benefits must outweigh the risks.
Precautions
Drug Name
Continuous heart rate and intraarterial blood pressure monitoring
preferred; watch for extravasation associated with infiltration; correct
hypovolemia before infusion; caution if evidence of hypertrophic
cardiomyopathy exists in infant due to increased risk of decreased left
ventricular output resulting from inotropic use
Digoxin (Lanoxin) -- Cardiac glycoside with direct inotropic effects in
addition to indirect effects on the cardiovascular system.
Acts directly on cardiac muscle, increasing myocardial systolic
contractions. Its indirect actions result in increased carotid sinus nerve
activity and enhanced sympathetic withdrawal for any given increase in
mean arterial pressure.
Adult Dose 0.125-0.375 mg PO qd
Pediatric Dose
Contraindications
Interactions
Total digitalizing dose:
5-10 years: 20-35 mcg/kg PO divided in 3 doses q6h
>10 years: 10-15 mcg/kg PO divided in 3 doses q6h
Maintenance dose: Use 25-35% of PO loading dose
Documented hypersensitivity; beriberi heart disease, idiopathic
hypertrophic subaortic stenosis, constrictive pericarditis, and carotid
sinus syndrome
Medications that may increase digoxin levels include alprazolam,
benzodiazepines, bepridil, captopril, cyclosporine, propafenone,
propantheline, erythromycin, hydroxychloroquine, itraconazole,
nifedipine, omeprazole, ibuprofen, indomethacin, tetracycline, verapamil
Medications that may decrease serum digoxin levels include
aminoglutethimide, antihistamines, cholestyramine, neomycin,
penicillamine, aminoglycosides, antineoplastic treatment combinations
(eg, carmustine, bleomycin, methotrexate, cytarabine, doxorubicin,
cyclophosphamide, vincristine, procarbazine), aluminum or magnesium
antacids, rifampin, sulfasalazine, barbiturates, and aminosalicylic acid
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Hypokalemia may reduce positive inotropic effect of digitalis; IV calcium
may produce arrhythmias in digitalized patients; hypercalcemia
predisposes patient to digitalis toxicity, and hypocalcemia can make
digoxin ineffective until serum calcium levels are normal; magnesium
replacement therapy must be instituted in patients with
hypomagnesemia to prevent digitalis toxicity; patients diagnosed with
incomplete AV block may progress to complete block when treated with
digoxin; exercise caution in hypothyroidism, hypoxia, and acute
myocarditis; in the infant of a diabetic mother, caution must be used with
these agents if evidence of hypertrophic cardiomyopathy exists; these
infants are at increased risk of decreased left ventricular output resulting
from the use of these agents