Pediatric Cardiac Drug Dosing
Quick reference for commonly used cardiac medications in pediatrics.
Note: Always verify doses with current formulary and adjust for renal/hepatic function.
Heart Failure / Cardiomyopathy
ACE Inhibitors
| Drug |
Starting Dose |
Target Dose |
Max Dose |
Notes |
| Captopril |
0.1-0.3 mg/kg/dose TID |
0.5-1 mg/kg/dose TID |
6 mg/kg/day |
Short-acting; good for titration |
| Enalapril |
0.05-0.1 mg/kg/day ÷ BID |
0.1-0.5 mg/kg/day ÷ BID |
0.5 mg/kg/day |
|
| Lisinopril |
0.05-0.1 mg/kg/day |
0.1-0.5 mg/kg/day |
0.6 mg/kg/day |
Once daily dosing |
ARBs
| Drug |
Dose |
Max |
Notes |
| Losartan |
0.5-1 mg/kg/day |
1.4 mg/kg/day (max 100 mg) |
Alternative to ACEi |
| Valsartan |
1-2 mg/kg/day |
40-160 mg/day |
|
Beta-Blockers
| Drug |
Starting Dose |
Target Dose |
Notes |
| Carvedilol |
0.05-0.1 mg/kg/dose BID |
0.2-0.4 mg/kg/dose BID |
Titrate slowly |
| Metoprolol |
0.5-1 mg/kg/day ÷ BID |
2-4 mg/kg/day |
Succinate (ER) preferred |
| Propranolol |
0.5-1 mg/kg/day ÷ TID-QID |
2-4 mg/kg/day |
LQTS preferred agent |
| Nadolol |
0.5-1 mg/kg/day |
2-2.5 mg/kg/day |
LQTS preferred; once daily |
Diuretics
| Drug |
Dose |
Max |
Notes |
| Furosemide |
0.5-2 mg/kg/dose |
6 mg/kg/dose |
IV or PO |
| Chlorothiazide |
10-20 mg/kg/day ÷ BID |
40 mg/kg/day |
|
| Spironolactone |
1-3 mg/kg/day ÷ BID |
3 mg/kg/day |
K+ sparing; MRA benefit in HF |
| Metolazone |
0.1-0.2 mg/kg/dose |
0.4 mg/kg/dose |
Thiazide-like; synergy with loop |
Inotropes
| Drug |
Dose Range |
Notes |
| Milrinone |
0.25-1 mcg/kg/min |
First-line; inodilatator |
| Dobutamine |
2-20 mcg/kg/min |
Catecholamine |
| Dopamine |
2-20 mcg/kg/min |
Dose-dependent effects |
| Epinephrine |
0.01-1 mcg/kg/min |
Strong inotropy |
Arrhythmia Medications
Antiarrhythmics
| Drug |
Dose |
Notes |
| Adenosine |
0.1 mg/kg (max 6 mg), then 0.2 mg/kg (max 12 mg) |
Rapid IV push; SVT |
| Amiodarone |
Load: 5 mg/kg IV; Maint: 5-15 mg/kg/day PO |
Many interactions; LFTs/TFTs/PFTs |
| Flecainide |
2-6 mg/kg/day ÷ BID-TID |
CPVT add-on; structurally normal hearts |
| Sotalol |
2-4 mg/kg/day ÷ BID-TID |
Beta-blocker + Class III |
| Propafenone |
8-15 mg/kg/day ÷ TID |
|
| Digoxin |
Load: 10-15 mcg/kg ÷ doses; Maint: 5-10 mcg/kg/day |
Narrow therapeutic window |
Pulmonary Hypertension
PDE5 Inhibitors
| Drug |
Dose |
Notes |
| Sildenafil |
0.25-1 mg/kg/dose TID |
FDA approved in children |
| Tadalafil |
0.5-1 mg/kg/day |
Once daily; fewer pediatric data |
Endothelin Receptor Antagonists
| Drug |
Dose |
Notes |
| Bosentan |
2 mg/kg/dose BID (10-20 kg: 31.25 mg BID) |
Monitor LFTs monthly |
| Ambrisentan |
2.5-5 mg daily (>35 kg) |
Less hepatotoxicity |
Prostacyclins
| Drug |
Route |
Notes |
| Epoprostenol |
IV (continuous) |
Most potent; complex admin |
| Treprostinil |
SC, IV, inhaled, oral |
Multiple formulations |
| Iloprost |
Inhaled |
6-9 times daily |
Kawasaki Disease
| Agent |
Dose |
Notes |
| IVIG |
2 g/kg single infusion |
Over 10-12 hours |
| Aspirin (high-dose) |
80-100 mg/kg/day ÷ QID |
Until afebrile 48-72 hours |
| Aspirin (low-dose) |
3-5 mg/kg/day |
Continue 6-8 weeks minimum |
| Infliximab |
5 mg/kg IV |
IVIG-refractory |
| Methylprednisolone |
2 mg/kg/day or 30 mg/kg pulse |
High-risk intensification |
Anticoagulation
Heparin
| Type |
Dose |
Target |
| UFH |
28 U/kg/hr (no bolus) or 75 U/kg bolus + 20 U/kg/hr |
Anti-Xa 0.35-0.7 or aPTT 60-85 |
| LMWH (Enoxaparin) |
<2 months: 1.5 mg/kg/dose q12h; >2 months: 1 mg/kg/dose q12h |
Anti-Xa 0.5-1.0 |
Warfarin
| Indication |
Target INR |
| Mechanical valve |
2.5-3.5 |
| Fontan |
2.0-3.0 |
| DVT/PE |
2.0-3.0 |
Antiplatelet
| Drug |
Dose |
Notes |
| Aspirin |
3-5 mg/kg/day (max 81-325 mg) |
Kawasaki, Fontan |
| Clopidogrel |
0.2-1 mg/kg/day (max 75 mg) |
Post-stent, shunt |
Pericarditis
| Agent |
Pediatric Dose |
Duration |
| Ibuprofen |
30-50 mg/kg/day ÷ TID (max 2400 mg/day) |
1-2 weeks, then taper |
| Colchicine |
<5 years: 0.5 mg daily; ≥5 years: 0.5-1 mg daily |
3 months (first); 6 months (recurrent) |
| Indomethacin |
1-2 mg/kg/day ÷ TID |
Alternative NSAID |
Avoid aspirin in children <12 years (Reye syndrome)
IE Prophylaxis
| Agent |
Dose |
Timing |
| Amoxicillin |
50 mg/kg (max 2 g) |
30-60 min before procedure |
| Ampicillin |
50 mg/kg IM/IV (max 2 g) |
If unable to take PO |
| Cephalexin |
50 mg/kg (max 2 g) |
PCN allergy (non-anaphylactic) |
| Azithromycin |
15 mg/kg (max 500 mg) |
Severe PCN allergy |
| Clindamycin |
20 mg/kg (max 600 mg) |
Severe PCN allergy |
Resuscitation Medications
| Drug |
Dose |
Route |
Notes |
| Epinephrine |
0.01 mg/kg (0.1 mL/kg of 1:10,000) |
IV/IO |
Every 3-5 min |
| Amiodarone |
5 mg/kg |
IV/IO |
VF/pVT after 3rd shock |
| Lidocaine |
1 mg/kg |
IV/IO |
Alternative to amiodarone |
| Calcium chloride |
20 mg/kg |
IV |
Hyperkalemia, hypocalcemia |
| Sodium bicarbonate |
1 mEq/kg |
IV |
Prolonged arrest, hyperkalemia |
| Atropine |
0.02 mg/kg (min 0.1 mg) |
IV |
Symptomatic bradycardia |
Key Interactions & Monitoring
| Drug |
Key Interactions |
Monitoring |
| Amiodarone |
Warfarin, digoxin, QT-prolonging drugs |
LFTs, TFTs, PFTs, ECG |
| Digoxin |
Amiodarone, quinidine |
Drug level, K+, renal function |
| Flecainide |
Avoid with structural heart disease |
ECG (QRS widening) |
| Warfarin |
Many (check interactions) |
INR, vitamin K intake |
| Bosentan |
Cyclosporine, hormonal contraceptives |
LFTs monthly |
| Sildenafil |
Nitrates contraindicated |
BP |
Always verify doses with current references and adjust for patient-specific factors
This is a quick reference, not a comprehensive formulary