Antihistamines & Antiallergics

Drug	Dosage	Remarks
First Generation
Azatadine	6-12 years old: 0.5-1 mg PO 12 hourly	Adverse Reactions Most common: CNS effects (drowsiness, lassitude, dizziness, incoordination, paradoxical stimulation) Other common: CNS effects (headache, psychomotor impairment); Antimuscarinic effects (dry mouth, viscous secretions, urinary retention, blurred vision) Occasionally can cause GI effects (nausea/vomiting, diarrhea, epigastric pain, anorexia or increased appetite); CV effects (palpitations, arrhythmias, rarely hazardous ventricular arrhythmias, hypotension); Hypersensitivity reactions (rashes, angioedema, anaphylaxis); Other effects (convulsion, sweating, myalgia, tremor) Promethazine may sometimes cause photosensitivity or jaundice Special Instructions Contraindicated in newborns and premature infants, concomitant use with monoamine oxidase inhibitors (MAOIs) Use with caution in patients with angle-closure glaucoma, urinary retention, epilepsy, renal or hepatic impairment Reduction of dosage may be needed
Brompheniramine	2-6 years old: 1 mg PO 4-6 hourly >6-12 years old: 2 mg PO 4-6 hourly >12 years old: 4 mg PO 4-6 hourly
Carbinoxamine	2-5 years old: 1-2 mg PO 6-8 hourly 6-11 years old: 2-4 mg PO 6-8 hourly ≥12 years old: 4-8 mg PO 6-8 hourly
Chlorpheniramine	1-2 years old: 1-2 mg PO 12 hourly 2-5 years old: 1 mg PO 4-6 hourly Max dose: 6 mg/day 6-12 years old: 2 mg PO 4-6 hourly Max dose: 12 mg/day ≥12 years old: 4 mg PO 4-6 hourly Max dose: 24 mg/day or <6 months old: 250 mcg/kg IM/IV Max dose: 2.5 mg 6 months-6 years old: 2.5 mg IM/IV 6-12 years old: 5 mg IM/IV May be repeated up to 4x/24 hours Given by slow IV injection in a period of 1 minute
Clemastine	<1 year old: 0.1-0.25 mg PO 12 hourly 1-3 years old: 0.25-0.5 mg PO 12 hourly 3-6 years old: 0.5 mg PO 12 hourly 6-12 years old: 0.5-1 mg PO 12 hourly
Cyproheptadine	2-6 years old: 2 mg PO 8-12 hourly Max dose: 12 mg/day 7-14 years old: 4 mg PO 8-12 hourly Max dose: 16 mg/day
Dexchlorpheniramine	2-5 years old: 0.5 mg PO 4-6 hourly Max dose: 3 mg/day 6-12 years old: 1 mg PO 4-6 hourly Max dose: 6 mg/day >12 years old: 2 mg PO 4-6 hourly Max dose: 12 mg/day
Diphenhydramine	2-6 years old: 6.25 mg PO 4-6 hourly 6-11 years old: 12.5-25 mg PO 4-6 hourly ≥12 years old: 25-50 mg PO 6-8 hourly Max dose: 300 mg/day or 5 mg/kg/day (or 150 mg/m²) deep IM or IV injection divided 6 hourly Max dose: 300 mg/day
Hydroxyzine	<6 years old: 30-50 mg/day PO in divided doses ≥6 years old: 50-100 mg/day PO in divided doses
Ketotifen	6 months-3 years old: 0.5 mg PO 12 hourly >3 years old: 1 mg PO 12 hourly
Mebhydrolin napadisylate	<2 years old: 50-100 mg/day PO in divided doses 2-5 years old: 50-150 mg/day PO in divided doses 5-10 years old: 100-200 mg/day PO in divided doses >10 years old: 100-300 mg/day PO in divided doses
Mequitazine	<12 years old: 0.25 mg/kg body wt/day PO in 2 divided doses >12 years old: 2.5-5 mg PO 12 hourly
Oxatomide	0.5 mg/kg PO 12 hourly
Pheniramine	5-10 years old: 22.5 mg PO 8 hourly >10 years old: 15-45 mg PO 8-12 hourly Max dose: 3 mg/kg/day
Piprinhydrinate	1.5 mg PO 8 hourly
Promethazine	2-5 years old: 5-15 mg/day PO in 1 or 2 divided doses Max dose: 15 mg/day 5-10 years old: 10-25 mg/day PO in 1 or 2 divided doses Max dose: 25 mg/day or 5-10 years old: 6.25-12.5 mg deep IM injection
Triprolidine (Triprolidine hydrochloride)	4 months-<2 years old: 0.313 mg PO 4-6 hourly Max dose: 1.252 mg/day 2-<4 years old: 0.625 mg PO 4-6 hourly Max dose: 2.5 mg/day 4-<6 years old: 0.938 mg PO 4-6 hourly Max dose: 3.744 mg/day 6-<12 years old: 1.25 mg PO 4-6 hourly Max dose: 5 mg/day ≥12 years old: 2.5 mg PO 4-6 hourly Max dose: 10 mg/day
Second Generation
Acrivastine	≥12 years old: 8 mg PO 8 hourly	Adverse Reactions Cause little or no drowsiness and antimuscarinic effect as compared to first generation antihistamines Cetirizine may cause higher incidence of drowsiness as compared with other second generation antihistamines Special Instructions Contraindicated in severe renal impairment Use with caution in children <6 months old, in patients with hepatic or renal impairment, epilepsy
Astemizole	6-12 years old: 5 mg PO 24 hourly >12 years old: 10 mg PO 24 hourly
Cetirizine	6 months-1 year old: 2.5 mg PO 24 hourly 1-2 years old: 2.5 mg PO 12 hourly 2-6 years old: 2.5 mg PO 24 hourly Max dose: 5 mg/day PO or 2.5 mg PO 12 hourly ≥6 years old: 5-10 mg PO 24 hourly
Desloratadine	6-11 months: 1 mg PO 24 hourly 1-5 years old: 1.25 mg PO 24 hourly 6-11 years old: 2.5 mg PO 24 hourly ≥12 years old: 5 mg PO 24 hourly
Ebastine	6-12 years old: 5-10 mg PO 24 hourly >12 years old: 10-20 mg PO 24 hourly
Fexofenadine	6-23 months old <10.5 kg: 15 mg PO 12 hourly ≥10.5 kg: 30 mg PO 12 hourly 2-11 years old: 30 mg PO 12 hourly ≥12 years old: 60 mg PO 12 hourly
Levocetirizine	6 months-5 years old: 1.25 mg PO 24 hourly 6-11 years old: 2.5 mg PO 24 hourly ≥12 years old: 5 mg PO 24 hourly
Loratadine	2-5 years old: 5 mg PO 24 hourly ≥6 years old: 5 mg PO 12 hourly or 10 mg PO 24 hourly
Mizolastine	≥12 years old: 10 mg PO 24 hourly

Cardiac Drugs

Drug

Dosage

Remarks

Dopamine

2-20 mcg/kg/min continuous IV infusion
Titrate dose based on desired effect

Adverse Reactions

CV effects (ectopic beats, tachycardia, vasoconstriction, cardiac conduction abnormalities, palpitations, chest pain); CNS effects (anxiety, headache); GI effects (nausea/vomiting); Other effects (decreased urine output in high doses, dyspnea)

Special Instructions

Hypovolemia should be corrected prior to dopamine infusion
Patient’s hemodynamic status should be monitored
Avoid in patients with pheochromocytoma
Use with caution in patients with occlusive vascular disease, hyperthyroidism, angle-closure glaucoma

Epinephrine
(Adrenaline)

Anaphylactic reactions:
0.1-0.5 mL of the 1:1,000 solution IM
Max dose: 1 mL (=1 mg) may be repeated after 10-15 minutes
Anaphylactic shock
10 mcg/kg IM
Self-administration with autoinjector:
Children 7.5-<15 kg: 100 mcg IM/SC
Children 15-<30 kg: 150 mcg IM/SC
Children ≥30 kg: 300 mcg IM/SC
Hypotension/shock, fluid-resistant: 0.1-1 mcg/kg/min continuous IV infusion
Doses up to 5 mcg/kg/min may rarely be necessary
Inotropic support: 0.1-1 mcg/kg/min continuous IV infusion
Titrate dosage to desired effect
Nebulization: 0.25-0.5 mL of 2.25% racemic Epinephrine solution diluted in 3 mL normal saline, or L-epinephrine at an equivalent dose

Administration

IM injection in the anterolateral aspect of the thigh is preferred during anaphylaxis
Central line administration is preferred when given as a continuous infusion
IV infusions require an infusion pump

Adverse Reactions

CV effects (palpitation, tachycardia, cardiac arrhythmia, hypertension, pallor); CNS effects (anxiety, apprehension, nervousness, dizziness, headache); GI effects (nausea/vomiting); Other effects (diaphoresis, dyspnea, pulmonary edema, weakness, tremor, decreased renal and splanchnic blood flow)

Special Instructions

Cardiac and BP monitoring are required during continuous or IV infusion
Assess intravascular volume and support when used to treat hypotension
Use with caution in patients with thyroid disease

Corticosteroid Hormones

Drug	Dosage	Remarks
Dexamethasone	6-40 mcg/kg IV or 0.235-1.25 mg/m² IM/IV 12-24 hourly	Adverse Reactions CV effects (cardiomyopathy, hypertension, edema); CNS effects (headache, insomnia, psychiatric disturbances); GI effects (increased appetite, peptic ulcer, nausea, indigestion); Dermatologic effects (bruising, urticaria, skin test reaction suppression, impaired wound healing); Other effects (diabetes mellitus, hypokalemia, pituitary adrenal axis suppression, growth suppression, weakness, osteoporosis) Special Instructions Contraindicated in patients with systemic fungal infections, varicella and concomitant administration of live or attenuated vaccines Use with caution in patients with tuberculosis, heart failure, recent myocardial infarction, diabetes mellitus, GI disease (eg diverticulitis, peptic ulcer, ulcerative colitis), hepatic/renal impairment, myasthenia gravis, osteoporosis, history of seizure disorder, thyroid dysfunction
Hydrocortisone	0.56-8 mg/kg IV 24 hourly or >25 mg IV 24 hourly or ≤1 year old: 25 mg IV 6-8 hourly 1-5 years old: 50 mg IV 6-8 hourly 6-12 years old: 100 mg IV 6-8 hourly
Methylprednisolone	1-2 mg/kg IV single dose Max dose: 125 mg/dose
Prednisolone	1-2 mg/kg/day PO divided 6-24 hourly x 1-3 weeks Max dose: 60 mg/day

Selective Beta2-Adrenoceptor Agonist

Drug	Available Strength	Dosage	Remarks
Salbutamol (Albuterol)¹	1 mg/1 mL, 2 mg/1 mL, 2.5 mg/2.5 mL inhalation solution unit dose	2.5-5 mg via nebulizer 6-8 hourly as required Severe bronchospasm Max dose: 40 mg/day	Adverse Reactions Dependent on patient’s age, dose and route of administration CV effects (tachycardia, chest pain, chest discomfort, palpitation, flushing, arrhythmias); CNS effects (headache, insomnia, dizziness, drowsiness, irritability); GI effects (nausea/vomiting, mouth dryness, diarrhea, unusual taste); Endocrine effects (hyperglycemia, hypokalemia, lactic acidosis); Other effects (muscle tremor, cramping, cough, epistaxis, hypersensitivity reactions) Special Instructions Use with caution in patients with cardiovascular disease (ie hypertension, arrhythmia), diabetes mellitus, glaucoma, hyperthyroidism, hypokalemia, seizure disorders Use of face mask is advised in children <4 years old
	100 mcg/dose MDI	Acute bronchospasm ≥4 years old: 1-2 inhalations as necessary Max dose: 400 mcg/day
	200 mcg/dose inhalation powder capsule	200 mcg inhaled 4-6 hourly as needed
	2 mg, 4 mg tab; 2 mg/5 mL syrup	2-5 years old: 1-2 mg PO 6-8 hourly 6-12 years old: 2 mg PO 6-8 hourly
	5 mg/5 mL infusion	Initial dose: 5 mcg/min IV infusion Usual dose: 3-20 mcg/min IV infusion May increase dose in respiratory failure

¹Salbutamol combination with Ipratropium bromide is available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for children with normal renal and hepatic function unless otherwise stated.
Not all products are available or approved for above use in all countries.
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.

Anaphylaxis (Pediatric) Drug Summary

Antihistamines & Antiallergics

Cardiac Drugs

Corticosteroid Hormones

Selective Beta2-Adrenoceptor Agonist

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