Pediatric palliative care: Medications used to treat common

symptoms in
children________________________________________
Symptoms
Dyspnea

Respiratory
secretions
("death rattle")

Drug

Oral dose
and
frequency

Intravenous
dose and
frequency

Other routes

Morphine

0.1 mg/kg every

three to four
hours as needed

0.05 mg/kg every

three to four hours
as needed

0.1 mg/kg
sublingual
(concentrated oral
solution) every
three to four hours
as needed; 0.05
mg/kg
subcutaneous
every three to four
hours as needed

Lorazepam

0.025 to 0.05
mg/kg every six
hours as needed
(maximum initial
dose 2 mg)

0.025 to 0.05 mg/kg

every six hours as
needed (maximum
initial dose 2 mg)

0.025 to 0.05
mg/kg
subcutaneous
every six hours as
needed (maximum
initial dose 2 mg)

Glycopyrrolate

0.04 to 0.1
mg/kg every four
to eight hours
(maximum initial
dose 1 to 2 mg)

4 mcg/kg every four

hours as needed
(maximum initial
dose 0.1 mg)

Hyoscyamine

Age <2 years:

0.03 mg/dose
every four hours
as needed

Age <2 years: 0.03

mg/dose
sublingual every
four hours as
needed

Age 2 to 12
years: 0.06 to
0.125 mg/dose
every four hours
as needed

Age 2 to 12 years:
0.06 to 0.125
mg/dose
sublingual every
four hours as
needed

Age >12 years:

0.125 to 0.25
mg/dose every
four hours as
needed

Age >12 years:

0.125 to 0.25
mg/dose
sublingual every
six hours as
needed

Scopolamine
hydrobromide

Adolescents: 0.4
mg/dose every
eight hours as
needed

6 mcg/kg
every eight hours as
needed (maximum
initial dose 0.3 mg)

6 mcg/kg
subcutaneous
every eight hours
as needed

(maximum initial
dose 0.3 mg)
Adolescents: 1.5
mg transdermal
patch behind ear
every 72 hours
Fatigue

Methylphenidate
(immediate release)

Age 6 years:
0.05 to 0.1
mg/kg per dose
given in the
morning and at
noon (maximum
2.5 mg per dose
initially)

Anorexia/weight
loss

Megestrol acetate

Use only in
children >10
years old
Initial dose: 3.75
mg/kg twice a
day (maximum
initial dose 100
mg)
If no effect in two
weeks: increase
to 5 mg/kg twice
a day (maximum
200 mg per
dose)

Constipation

Dexamethasone

0.15 mg/kg per

dose twice a day
(maximum initial
dose 8 mg)

Dronabinol

Age 6 years:
2.5 mg/m2 per
dose every six
hours

Cyproheptadine

Age 8 years: 2
mg every eight
hours

Polyethylene glycol
3350

0.7 gram/kg (up

to 8.5 grams
initially) once
daily
Increase to 1.5
gram/kg
(maximum 17
grams) once
daily as needed

0.15 mg/kg per

dose twice a day
(maximum initial
dose 8 mg)

Senna (Syrup [8.8

mg sennosides per
5 mL strength syrup]
or tablet [8.6 mg
sennosides])

Six months
to two years: 2.2
mg (1.25 mL) to
4.4 mg (2.5 mL)
at bedtime
Two to six years:
4.4 mg (2.5 mL)
to 6.6 mg (3.75
mL) at bedtime,
or half tablet at
bedtime
6 to 12 years:
8.8 mg (5 mL) to
13.2 mg (7.5 mL)
at bedtime,
or one tablet at
bedtime

Lactulose (10 gram

per 15 mL strength
solution)

7.5 mL once
daily as needed
or 5 to 10 mL
every two hours
until bowel
movement
(maximum 60
mL per 24 hours)

Bisacodyl

3 to 12 years:
0.3 mg/kg/24
hours (10 mg
maximum) once
daily as needed
(onset six hours)

Glycerin

Six months to two

years: 5 mg per
rectum once daily
as needed
2 to 11 years: 5 to
10 mg per rectum
once daily as
needed
Six months to six
years: 2 to 5 mL
rectal solution or
one infant
suppository per
rectum once daily
as needed
>6 years: 5 to 15
mL rectal solution
or one adult
suppository per
rectum once daily
as needed

Docusate

Six months
to three years:
10 mg once to
twice daily

Three to six
years: 20 mg
once to twice
daily
6 to 12 years: 40
mg once to twice
daily
Mineral oil enema
(Fleet)

Nausea/vomiting

2 to 11 years: 30
to 60 mL per
rectum once daily
as needed

Metoclopramide

0.1 to 0.2 mg/kg

per dose three
times daily
before meals as
needed
(maximum initial
dose 10 mg)

0.1 to 0.2 mg/kg per

dose three times
daily before meals
as needed
(maximum initial
dose 10 mg)

Prochlorperazine

>10 years: 0.1

mg/kg per dose
every eight
hours as needed
(maximum initial
dose 5)

>10 years: 0.1 to

0.15 mg/kg per
dose every eight
hours as needed
(maximum initial
dose 5)

>10 years: 0.1

mg/kg per dose as
a suppository per
rectum every eight
hours as needed
(maximum initial
dose 5)

Promethazine

2 years: 0.25 to
0.5 mg/kg per
dose every four
to six hours as
needed
(maximum initial
dose 12.5 mg)

Not recommended
due to risk of tissue
injury depending on
IV line placement
and condition

2 years: 0.25 to
0.5 mg/kg per
dose as a
suppository per
rectum every four
to six hours as
needed (maximum
initial dose 12.5
mg)

Ondansetron

<0.3 m2: 1 mg
every eight
hours as needed

0.15 mg/kg every

eight hours as
needed (maximum
initial dose 8 mg)

0.3 to 0.6 m2: 2

mg every eight
hours as needed
0.6 to 1 m2: 3 mg
every eight
hours as needed
>1 m2: 4 to 8 mg
every eight
hours as needed
>11 years: 8 mg
every eight

hours as needed
Haloperidol

0.01 mg/kg per

dose three times
daily as needed
(maximum initial
dose 0.5 mg)

Diphenhydramine

1 mg/kg per
dose every six
hours as needed

1 mg/kg per dose

every six hours as
needed

Lorazepam

0.025 to 0.05
mg/kg every six
hours as need
(maximum initial
dose 2 mg)

0.02 to 0.05 mg/kg

every six hours as
need (maximum
initial dose 2 mg)

Dexamethasone

0.1 mg/kg three

times a day
(maximum initial
dose 5 mg)

0.1 mg/kg three

times a day
(maximum initial
dose 5 mg)

0.02 to 0.05 mg/kg

sublingual every
six hours as need
(maximum initial
dose 2 mg)

Dosing to prevent
nausea/vomiting
due to emetogenic
chemotherapy or
radiotherapy:
Initial dose 10
mg/m2 (maximum
initial dose 20 mg);
then 5 mg/m2
(maximum initial
dose 5 mg)
every six hours
Fever

Insomnia

Anxiety

Acetaminophen

15 mg/kg per
dose every four
to six hours as
needed

Ibuprofen

10 mg/kg every
six to eight hours
as needed

Melatonin

2 to 3 mg at
bedtime

Trazodone

6 years: 0.75 to
1 mg/kg at
bedtime (12.5 to
50 mg)

Lorazepam

0.025 to 0.05
mg/kg every six
hours as needed
(maximum initial

15 mg/kg per
rectum every four
to six hours as
needed
Adolescent 17
years: 100 to 200
mg every four to six
hours as needed

0.02 to 0.05 mg/kg

every six hours as
needed (maximum
initial dose 2 mg)

0.02 to 0.05 mg/kg

sublingual every
six hours as
needed (maximum

dose 2 mg)
Agitation/delirium

Muscle spasm

Seizures

Haloperidol

initial dose 2 mg)

0.01 mg/kg three

times a day as
needed
(maximum initial
dose 0.5 mg)

0.01 mg/kg three

times a day as
needed (maximum
initial dose 0.5 mg)

For acute
agitation: 0.02 to
0.05 mg/kg, may
repeat with a
dose of 0.025
mg/kg in one
hour as needed

For acute agitation:

0.02 to 0.05 mg/kg,
may repeat with a
dose of 0.025 mg/kg
in one hour as
needed

Clonazepam

0.005 to 0.01
mg/kg every 8 to
12 hours
(maximum initial
dose 0.5 mg)

Olanzapine

Adolescents: 2.5
to 5 mg once
daily

Diazepam

0.04 to 0.2
mg/kg per dose
every six to eight
hours as needed
(up to 2.5 mg per
dose initially)

Baclofen

2 years: 5 mg
three times a
day, may
increase every
three days by 5
to 15 mg/day to
a maximum dose
of 40 mg/day

0.04 to 0.2 mg/kg

per dose every six
to eight hours as
needed (up to 2.5
mg per dose
initially)

Lorazepam

0.05 to 0.1 mg/kg

per dose; may
repeat in 10 to 15
minutes (maximum
cumulative dose 10
mg over 20
minutes)

Midazolam

Second line
(refractory
seizures): 0.15
mg/kg loading dose
followed by
continuous infusion
of 1 mcg/kg/minute
gradually titrated to
effect

0.2 mg/kg
intranasal may
repeat in 10
minutes OR
0.3 mg/kg buccal
may repeat in 10
minutes

Diazepam

Adjunct for
prevention of
seizures: 0.04 to
0.2 mg/kg per
dose every six
hours (up to 2.5
mg per dose
initially)

Rectal gel
formulation
(Diastat)
Two to five years:
0.5 mg/kg per
rectum
6 to 11 years: 0.3
mg/kg per rectum
>12 years: 0.2
mg/kg per rectum

Doses should be
rounded to 2.5, 5,
7.5, 10, 12.5, 15,
17.5 or 20
mg/dose. Dose
may be repeated
in 4 to 12 hours if
needed
Neuropathic pain

Gabapentin**

3 years of age:
Day one to
three: 5 mg/kg
at bedtime
Day four to six:
5 mg/kg twice a
day
Day seven to
nine: 5
mg/kg/dose
three times a
day
Day 10 to 12: 5
mg/kg/dose in
the morning
and midday,
and 10 mg/kg
at bedtime

Nortriptyline

6 years of age:
Day one to
four: 0.2 mg/kg
at bedtime
Day four to
eight: 0.4
mg/kg at
bedtime

______________________________________________________________________________________
* Doses are for individuals over six months of age (except where shown otherwise) with a maximum weight
of 50 kg.
Dosing shown is for scopolamine hydrobromide (oral, parenteral). Scopolamine butylbromide, widely
available outside US, is not equivalent to and is dosed differently than dosing shown.
Dosing shown is for nausea-vomiting related to gastrointestinal dysmotility. Higher doses