| Drug dose or action | Comments |
Constipation |
Docusate (solution, 4 or 10 mg/mL or tablet, 50 or 100 mg/tab) | - Infants >6 months but <2 years: 12.5 mg orally three times daily
- Children >2 and adolescents: 40 to 150 mg/day in 1 to 4 divided doses
| For prophylaxis of OIC we usually administer 25 to 50 mg twice daily. Not for use in neonates because of benzyl alcohol content. |
Senna (syrup, 8.8 mg sennoside/5 mL or tablets, 8.6 mg sennosides/tab) | - 1 to 2 years: 1.25 to 2.5 mL orally once or twice daily
- 2 to 6 years: 2.5 to 3.75 mL orally once or twice daily
- 6 to 12 years: 5 to 7.5 mL (or 1 to 2 tabs) orally once or twice daily
- ≥12 years: 5 to 15 mL (or 1 to 3 tabs) orally once or twice daily
| Usually given once daily at bedtime. Given routinely with docusate for OIC unless contraindicated. |
Glycerin suppository | - 2 to 5 years: 1 pediatric suppository daily
- ≥6 years: 1 adult suppository daily
| Usually used as a stimulant in infants. Do not administer suppository if patient is neutropenic. |
Polyethylene glycol 3350 | - 0.2 to 0.8 g/kg/day, to a maximum of 17 g orally per day
| For constipation unresponsive to above measures |
Nausea/vomiting* |
Ondansetron | - 0.15 mg/kg IV every 8 hours, usual maximum 4 mg per dose
| If this dose inadequate, consider adding another antiemetic |
Metoclopramide | - 0.1 mg/kg IV every 6 to 8 hours as needed, usual maximum 10 mg per dose
| Occasionally used as second line drug |
Pruritus* |
Nalbuphine | - 0.1 mg/kg to a maximum of 5 mg by slow infusion over 20 minutes every 6 hours as needed
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Naloxone | - Infusion: 0.25 mcg/kg/hour IV
| Usually restricted to patients who are on PCA or continuous infusions of opioid |
Urinary retention |
Nalbuphine | - 0.1 mg/kg to a maximum of 5 mg IV over 20 minutes every 6 hours as needed
| Nalbuphine may be helpful in some patients. Bladder catheterization may be necessary for opioid induced urinary retention. |
Excessive sedation | - Reduce opioid dose and/or rotate to a different opioid
- Check for other sedatives concomitantly prescribed
- Utilize opioid sparing analgesics such as NSAIDs, acetaminophen, regional anesthesia, topical lidocaine
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Respiratory depression/respiratory arrest | - Stop infusion or reduce dose immediately depending on severity
- Apply physiologic monitors including pulse oximeter
- If spontaneously breathing, provide oxygen, ensure adequate chest movement/air entry
- Administer partial reversal: Naloxone 5 mcg/kg IV every 2 minutes until respiratory rate is age appropriate and patient is responsive
- If apneic or breathing inadequately, support ventilation with bag, mask and oxygen
- Administer full reversal: Naloxone 10 mcg/kg IV every 2 mins (may administer 0.4 to 2 mg every 2 minutes) until awake and breathing
- Observe closely for re-narcotization over an extended time period
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