Inotropic agents |
Digoxin (C) | Loading dose 0.5 mg IV over 5 min, then 0.25 mg IV q6h × 2. Maintenance 0.125-0.375 mg IV/PO qd | No change | Placental transfer Higher maternal maintenance dose required for fetal effect Not teratogenic |
Dopamine (C) | Initiate with 5 μg/kg/min and titrate by 5-10 μg/kg/min to max 50 μg/kg/min | Directly ↓ UBF May ↑ UBF with improved maternal hemodynamics | No known adverse fetal effects |
Dobutamine (B) | Initiate with 1.0 μg/kg/min and titrate up to 20 μg/kg/min | | No known adverse fetal effects |
Epinephrine (C) | Endotracheal, 0.5-1.0 mg q5min; IV 0.5 mg bolus and follow with 2-10 μg/kg/min infusion | | Not teratogenic |
Vasodilators |
Nitroprusside (C) | Initiate with 0.3 μg/kg/min and titrate to 10 μg/kg/min | ↑ UBF unless significant ↓ in maternal BP | No known adverse fetal effects Potential for fetal cyanide toxicity Avoid prolonged use |
Hydralazine (C) | 5-10 mg IV q15-30min; total dose 30 mg | | Not teratogenic |
Nitroglycerin (B) | 0.4-0.8 mg sublingual 1-2 in of dermal paste, IV infusion 10 μg/min, titrate up by 10-20 μg/min prn | | Not teratogenic |
β-Blockers |
Propranolol (C) | 1 mg IV q2min as needed | May ↓ by ↑ uterine tone and/or ↓ maternal BP | Not teratogenic Readily crosses placenta Fetal bradycardia IUGR |
Labetalol (C) | 10-20 mg IV followed by 20-80 mg IV q 10 min to total dose of 150 mg | | Category D if used in 2nd or 3rd trimester |
Atenolol (D) | 5 mg IV over 5 min, repeat in 5 min to a total dose of 15 mg | | |
Metoprolol (C)z | 5 mg IV over 5 min; repeat in 10 min | | |
Esmolol (C) | 500 ug/kg IV over 1 min with infusion rate of 50-200 μg/kg/min | | No known adverse fetal effects Rapid metabolism (1/2 life 11 min) also occurs in the fetus |
Calcium channel blockers |
Verapamil (C) | 2.5-5 mg IV bolus over 2 min, repeat in 5 min and then q30 min prn to a max dose 20 mg | Mild ↓ UBF | Not teratogenic |
Nifedipine (C) | 10 mg PO, repeat every 6 h | | |
Diltiazem (C) | 20 mg IV bolus over 2 min, repeat in 15 min | | |
Vasoconstrictors |
Ephedrine sulphate (C) | 10-25 mg slow IV bolus, repeat q 15 min prn × 3 | No effect | Not teratogenic 70% of maternal blood level in the fetus |
Metaraminol (C) | Initiate with 0.1 mg/min and titrate to 2 mg/min | Mild ↓ UBF | No data available |
Antidysrhythmic agents |
Lidocaine (B) | 1 mg/kg bolus; repeat 1/2 bolus at 10 min as needed × 4; infusion at 1-4 mg/min; total dose 3 mg/kg | No effect | Not teratogenic Rapidly crosses placenta |
Procainamide (C) | 100 mg over 30 min, then 2-6 mg/min infusion; total dose 17 mg/kg | | |
Quinidine (C) | 15 mg/kg over 60 min, then 0.02 mg/kg/min infusion | | |
Bretylium (C) | 5 mg/kg IV bolus, then 1-2 mg/min infusion | ↓ UBF | Unknown |
Phenytoin (D) | 300 mg IV, then 100 mg every 5 min to a total of 1000 mg | No effect | Teratogenic Fetal Hydantoin syndrome Teratogenic |
Amiodarone (D) | 5 mg/kg IV over 3 min, then 10 mg/kg/day | | Transient bradycardia Prolonged QT |
AV node blocking agents |
Adenosine | 6 mg IV bolus over 1-3 s, followed by 20 mL saline bolus; may repeat at 12 mg in 1-2 min × 2 | ↑ or ↓ UBF | No known adverse fetal effects |
Verapamil | As stated above | | |
β-Blockers | As stated above | | |
Digoxin | As stated above | | |