| Drug | Onset (min) | Log P | Protein Binding (%) | Metabolism / Elimination | Dose Adjustment on ECMO^ | Dose Range* |
|---|
| Brivaracetam | 5 | 0.86 | <20 | Hepatic / enzymatic hydrolysis | - | Adult: 2 mg/kg or 100–200 mg IV x 1, followed by 50–200 mg IV twice daily Pediatric: 2 mg/kg (max 200 mg) IV x 1, followed by 0.5–1.25 mg/kg/dose twice daily Neonatal: 3 mg/kg IV x 1, followed by 0.75–1.5 mg/kg/dose twice daily |
| Fosphenytoin | 30 | 1.08 | 90 | Hepatic | ++ | Adult: 15-20 mg PE/kg (max 2000 mg PE) IV, followed by 4–7 mg PE/kg/day IV in 2–4 divided doses Pediatric: 15–20 mg PE/kg (max 1,500 mg PE) IV x 1, followed by 2–4 mg PE/kg/dose twice daily Neonatal: 20 mg PE/kg IV x 1, followed by 2–4 mg PE/kg/dose twice daily |
| Ketamine | 1–2 | 2.9 | 10-30 | Hepatic | - | Adult: 1–10 mg/kg/hr Pediatric: 1–7 mg/kg/hr Neonatal: 1–7 mg/kg/hr |
| Lacosamide | 60 | 0.75 | <15 | Renal / Hepatic | - | Adult: 200–600 mg IV x 1, followed by 100–400 mg IV in 2 divided doses Pediatric: 5–10 mg/kg/dose (max 400 mg) IV x 1, followed by 5–7 mg/kg/dose IV every 12 hours Neonatal: 5–10 mg/kg/dose IV x 1, followed by 2.5–5 mg/kg/dose IV every 12 hours |
| Levetiracetam | 5 | -0.6 | <10 | Renal / Enzymatic hydrolysis | - | Adult: 1000–4500 mg IV x 1, followed by 500–1500 mg IV twice daily Pediatric: 60 mg/kg (max 4,500 mg) IV x 1, followed by 10–30 mg/kg/dose IV every 12 hours Neonatal: 60 mg/kg IV x 1, followed by 10–30 mg/kg/dose IV every 12 hours |
| Lorazepam | 5–20 | 2.5–3.0 | 91 | Hepatic | - | Adult: 4 mg IV or 0.1 mg/kg IV x 1 (max 4 mg), may repeat, consider midazolam infusion if refractory seizures occur Pediatric: 0.1 mg/kg/dose (max 4 mg) IV x 1, may repeat, consider midazolam infusion if refractory seizures occur Neonatal: 0.05–0.1 mg/kg/dose IV x 1, may repeat, consider midazolam infusion if refractory seizures occur |
| Midazolam | 2–5 | 2.7–3.9 | 97 | Hepatic; active metabolite renally eliminated | +++ | Adult: 0.2 mg/kg IV over 2–5 min, repeat 0.2 mg/kg IV boluses every 5 min until seizures stop, up to a maximum loading dose of 2 mg/kg, followed by 0.2–2.9 mg/kg/hr Pediatric: 0.2 mg/kg (max 10 mg) IV x 1, followed by 0.1–1 mg/kg/hr Neonatal: 0.2 mg/kg IV x 1, followed by 0.15–1 mg/kg/hr |
| Phenobarbital | 5 | 1.47 | 48 | Hepatic | ++ | Adult: 5–15 mg/kg IV x 1, may repeat in 10 min with 5–10 mg/kg IV x 1, followed by 1–2 mg/kg/day IV in 2–3 divided doses Pediatric: 15–20 mg/kg IV x 1 (max 1,000 mg/dose); may repeat in 10 min with 5–10 mg/kg IV x 1, followed by 1–2.5 mg/kg/dose every 12 hours Neonatal: 15–20 mg/kg IV x 1, may repeat up to a total of 40 mg/kg, followed by 3.5 mg/kg/dose IV every 12 hours |
| Phenytoin | 30 | 2.47 | 90 | Hepatic | ++ | Adult: 15–20 mg/kg (max 30 mg/kg) IV, followed by 4–7 mg/kg/day IV in 2–4 divided doses Pediatric: 15–20 mg/kg (max 1,000 mg) IV x 1, followed by 2–4 mg/kg/dose every 12 hours Neonatal: 20 mg/kg IV x 1, followed by 2–4 mg/kg/dose every 12 hours |
| Valproate | 20 | 2.8 | 90 | Renal / Hepatic | - | Adult: 20–40 mg/kg (max 3000 mg) IV x 1, followed by 10–15 mg/kg/day IV in 2–3 divided doses Pediatric: Not recommended in children <2 years of age; 40 mg/kg (max 3000 mg) IV x 1, followed by 10–15 mg/kg/day IV in 3–4 divided doses. Neonatal: Not recommended in children <2 years of age |