Dengue Drug Summary

Drug	Dosage	Remarks
Paracetamol (Acetaminophen)	Children: <3 months: 10 mg/kg/dose PO 3 months-1 year: 60-120 mg/dose PO 1-5 years: 120-250 mg/dose PO 6-12 years: 250-500 mg/dose PO To be administered 4-6 hourly Max dose: 4 doses/day Adults: 0.5-1 g PO 6-8 hourly Max dose: 4 g/day	Adverse Reactions Occasional hypersensitivity reactions (urticaria, dyspnea, hypotension in adults and angioedema in children); Rare and usually mild hematologic reactions (thrombocytopenia, leukopenia, pancytopenia, neutropenia and agranulocytosis)

Drug	Dosage1	Remarks
5% Albumin	Individualized dosage	Adverse Reactions Circulatory overload, urticaria, fever, chills, changes in respiration, pulse and BP Special Instructions Contraindicated in CHF, renal insufficiency, chronic anemia Use with caution in low cardiac reserve and marked dehydration
Dextran	As dextran 40 (10% solution): 10 mL/kg/day IV infusion for up to 5 days As dextran 70 (6% solution): Initial dose: 500-1000 mL as an IV infusion Maintenance dose: 10 mL/kg/day x 3 days	Adverse Reactions GI disturbances; CNS effects (headache, dizziness); Dermatologic effects (allergic reactions, alopecia); Other effects (raised liver enzyme values, bone marrow suppression) Special Instructions Contraindicated in marked cardiac decompensation, severe renal disease with oliguria or anuria
Gelatin 4%	Individualized dosage IV dose may be given rapidly (500 mL in 5-10 minutes) in severe acute blood loss until signs of hypovolemia are relieved	Adverse Reactions Hypersensitivity reactions (severe anaphylactic reactions have occurred) Special Instructions Contraindicated in patients with severe heart failure, bleeding disorders, renal failure May cause acute hypotension when used with ACE inhibitors
Hetastarch (Hydroxyethyl starch)	500-1000 mL/day IV, up to 20 mL/kg body wt/day	Adverse Reactions Dorsalgia, allergic skin reactions, difficulty of breathing, tachycardia, hypotension Special Instructions Contraindicated in hemorrhagic defects, severe CHF, renal failure with oliguria and anuria, allergies against starch, hyperhydration states

¹Initial infusion rates should be modified according to the patient’s requirements. Subsequent IV fluids and infusion rates should be adjusted according to the patient’s clinical condition, hematocrit levels and vital signs.

Drug	Dosage1	Remarks
5% Glucose solution	Start at 10-20 mL/kg body wt/hr	Adverse Reactions Electrolyte imbalance eg hyperkalemia, hypernatremia, hyperchloremia Pulmonary edema, circulatory overload Special Instructions Hypertonic lactate solution: Use with caution in patients with cardiac disease particularly digitalized patients, patients with hyperkalemia, severe renal failure Avoid in patients with severe hypernatremia, metabolic alkalosis and renal failure with anuria
Hypertonic lactate solution	Loading dose: 3-5 mL/kg body wt over 15 minutes depending on severity of hemodynamic imbalances and clinical condition
Physiological saline or NSS	Start at 10-20 mL/kg body wt/hr
Ringer’s acetate	Start at 10-20 mL/kg body wt/hr
Ringer’s lactate	Start at 10-20 mL/kg body wt/hr

¹1Initial infusion rates should be modified according to the patient’s requirements. Subsequent IV fluids and infusion rates should be adjusted according to the patient’s clinical condition, hematocrit levels and vital signs.

Drug	Dosage	Remarks
Dengue tetravalent vaccine (live, attenuated)	Children >9 years & Adult <45 years: 3 injections of 0.5 mL SC, each at 6-month interval	Adverse Reactions Serious allergic reactions (difficulty of breathing, blueness of the tongue or lips, rash, swelling of the face or throat); CNS effects (decreased BP causing dizziness or collapse, headache); Injection site reactions (pain, hematoma, erythema, swelling, pruritus); Other effects (malaise, muscle pain, asthenia, fever) Special Instructions Postpone administration until 4 weeks after immunosuppressive treatment Contraindicated in patients with mild to high fever or acute disease, weakened immune system due to genetic defect, HIV infection or therapies affecting the immune system (high-dose corticosteroids) and those who had allergic reactions prior to administration

All dosage recommendations are for non-pregnant and non-breastfeeding women and non-elderly adults 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.