FENTANYL

The authors make no claims of the accuracy of the information contained

herein; and these suggested doses and/or guidelines are not a substitute for
clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the
preparation of this document shall be liable for any special, consequential, or
exemplary damages resulting in whole or part from any user's use of or
reliance upon this material. PLEASE READ
THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS
SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND
BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents

NS, D5W
Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate]

[0 - 5000 mcg] [50-250ml] [Titrate]

[1250 mcg] [250 ml] [Titrate]
[2500 mcg] [250 ml] [Titrate]
[5000 mcg] [250 ml] [Titrate]
(May concentrate further)
[2500 mcg] [ 50 ml] (50 mcg/ml)
Stability / Miscellaneous
EXP: 2 Days (RT / REF).
Some studies indicate stability up to 30 days.
Minimum dilution: 2500 to 5000 mcg/ 50 ml.
-------------------------------------------------------------------------------Adults:
Premedication: I.M., slow I.V.: 50-100 mcg/dose 30-60 minutes
prior to surgery
Adjunct to regional anesthesia: I.M., slow I.V.: 50-100 mcg/dose; if
I.V. used, give over 1-2 minutes
Severe pain: I.M.: 50-100 mcg/dose every 1-2 hours as needed;
patients with prior opiate exposure may tolerate higher initial doses

Adjunct to general anesthesia: Slow I.V.:

Low dose: Initial: 2 mcg/kg/dose; Maintenance: Additional doses
infrequently needed
Moderate dose: Initial: 2-20 mcg/kg/dose; Maintenance: 25-100
mcg/dose may be given slow I.V. or I.M. as needed
High dose: Initial: 20-50 mcg/kg/dose; Maintenance: 25 mcg to onehalf the initial loading dose may be given as needed
General anesthesia without additional anesthetic agents: Slow
I.V.: 50-100 mcg/kg with O2 and skeletal muscle relaxant
Mechanically-ventilated patients (based on 70 kg patient): Slow
I.V.: 0.35-1.5 mcg/kg every 30-60 minutes as needed; infusion: 0.7 10 mcg/kg/hour
Patient-controlled analgesia (PCA): I.V.: Usual concentration: 50
mcg/mL
Demand dose: Usual: 10 mcg; range: 10-50 mcg
Lockout interval: 5-8 minutes
-------------------------------------------------------------------------------DOSAGE AND ADMINISTRATION
50 mcg = 0.05 mg = 1 mL
Dosage should be individualized. Some of the factors to be
considered in determining the dose are age, body weight, physical
status, underlying pathological condition, use of other drugs, type of
anesthesia to be used and the surgical procedure involved. Dosage
should be reduced in elderly or debilitated patients.
Vital signs should be monitored routinely.
I.Premedication Premedication (to be appropriately modified in
the elderly, debilitated, and those who have received other
depressant drugs)50 mcg to 100 mcg (0.05 mg to 0.1 mg) (1 mL
to 2 mL) may be administered intramuscularly 30 to 60 minutes prior
to surgery.
II.Adjunct to General Anesthesia See Dosage Range Chart

III.Adjunct to Regional Anesthesia 50 mcg to 100 mcg (0.05 mg

to 0.1 mg) (1 mL to 2 mL) may be administered intramuscularly or
slowly intravenously, over one to two minutes, when additional
analgesia is required.
IV.Postoperatively (recovery room) 50 mcg to 100 mcg (0.05 mg
to 0.1 mg) (1 mL to 2 mL) may be administered intramuscularly for
the control of pain, tachypnea, and emergence delirium. The dose
may be repeated in one to two hours as needed.
Usage in Children: For induction and maintenance in children 2 to
12 years of age, a reduced dose as low as 2 mcg/kg to 3 mcg/kg is
recommended.
DOSAGE RANGE CHART
TOTAL DOSAGE (expressed as fentanyl base)

Low Dose -

Moderate Dose -

High Dose -

2 mcg/kg (0.002 mg/kg)

(0.04 mL/kg) Fentanyl, in
small doses is most
useful for minor, but
painful, surgical
procedures. In addition
to the analgesia during
surgery, Fentanyl may
also provide some pain
relief in the immediate
postoperative period.

2-20 mcg/kg (0.002-0.02

mg/kg) (0.04-0.4 mL/kg) Where
surgery becomes more major,
a larger dose is required. With
this dose, in addition to
adequate analgesia, one would
expect to see some abolition of
the stress response. However,
respiratory depression will be
such that artificial ventilation
during anesthesia is necessary
and careful observation of
ventilation postoperatively is
essential.

20-50 mcg/kg (0.02-0.05 mg/kg)

(0.4-1 mL/kg) During open heart
surgery and certain more
complicated neurosurgical and
orthopedic procedures where
surgery is more prolonged, and
in the opinion of the
anesthesiologist, the stress
response to surgery would be
detrimental to the well being of
the patient, dosages of 20-50
mcg/kg (0.02-0.05 mg/kg) (0.4-1
mL/kg) of fentanyl with nitrous
oxide/oxygen have been shown
to attenuate the stress response
as defined by increased levels of
circulating growth hormone,
catecholamine, ADH, and
prolactin. When dosages in this
range have been used during
surgery, postoperative ventilation
and observation are essential
due to extended postoperative
respiratory depression. The main
objective of this technique would
be to producestress-free

TOTAL DOSAGE (expressed as fentanyl base)

Low Dose -

Moderate Dose -

High Dose -

anesthesia.
DOSAGE RANGE CHART
MAINTENANCE DOSAGE (expressed as fentanyl base)

Low Dose -

Moderate Dose -

High Dose -

2 mcg/kg (0.002
mg/kg) (0.04 mL/kg)
Additional dosages
of fentanyl are
infrequently needed
in these minor
procedures.

2-20 mcg/kg (0.002-0.02

mg/kg) (0.04-0.4 mL/kg) 25100 mcg (0.025 to 0.1 mg) (0.5
to 2 mL) may be administered
intravenously or
intramuscularly when
movement and/or changes in
vital signs indicate surgical
stress or lightening of
analgesia.

20-50 mcg/kg (0.02-0.05 mg/kg) (0.41.0 mL/kg) Maintenance dosage

(ranging from 25 mcg (0.025 mg) (0.5
mL) to one half the initial loading
dose) will be dictated by the changes
in vital signs which indicate stress
and lightening of analgesia. However,
the additional dosage selected must
be individualized especially if the
anticipated remaining operative time
is short.

As a General Anesthetic:
When attenuation of the responses to surgical stress is especially
important, doses of 50 mcg/kg to 100 mcg/kg (0.05 mg/kg to 0.1
mg/kg) (1 mL/kg to 2 mL/kg) may be administered with oxygen and
a muscle relaxant. This technique has been reported to provide
anesthesia without the use of additional anesthetic agents. In certain
cases, doses up to 150 mcg/kg (0.15 mg/kg) (3 mL/kg) may be
necessary to produce this anesthetic effect. It has been used for
open heart surgery and certain other major surgical procedures in
patients for whom protection of the myocardium from excess oxygen
demand is particularly indicated, and for certain complicated
neurological and orthopedic procedures.
As noted above, it is essential that qualified personnel and adequate
facilities be available for the management of respiratory depression.

See package insert for WARNINGS and PRECAUTIONS for use of

fentanyl with other CNS depressants, and in patients with altered
response.
Parenteral drug products should be inspected visually for particulate
matter and discoloration prior to administration, whenever solution
and container permit.
HOW SUPPLIED
Fentanyl Citrate Injection, USP equivalent to 50 mcg (0.05 mg)
fentanyl/mL, is supplied in single-dose glass containers as follows:
Size

Container Package

Package Size

List No.

2 mL

Ampul

tens

9093

2 mL

Fliptop Vial

twenty fives

9094

5 mL

Ampul

tens

9093

5 mL

Fliptop Vial

twenty fives

9094

10 mL

Ampul

fives

9093

10 mL

Fliptop Vial

ones

9094

20 mL

Ampul

fives

9093

20 mL

Fliptop Vial

ones

9094

50 mL

Fliptop Vial

ones

9094

PROTECT FROM LIGHT. Store at 20 to 25C (68 to 77F). [See

USP Controlled Room Temperature.]
Revised: April, 2007
Printed in USA EN-1504
Hospira, Inc., Lake Forest, IL 60045 USA
Source: [package insert]
Disclaimer

The authors make no claims of the accuracy of the information contained

herein; and these suggested doses are not a substitute for clinical judgment.
Neither GlobalRPh Inc. nor any other party involved in the preparation of this
program shall be liable for any special, consequential, or exemplary
damages resulting in whole or part from any user's use of or reliance upon
this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE
ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS
SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS
SET FORTH IN THE DISCLAIMER

:: Komposisi ::
Tiap MYOTONIC tablet salut selaput mengandung:
Methylergometrine maleate ........................... 0,125 mg
Tiap ml MYOTONIC injeksi mengandung:
Methylergometrine maleate ............................. 0,2 mg
:: Farmakologi ::
MYOTONIC mengandung methylergometrine maleate suatu senyawa turunan alkaloid
ergometrine. Methylergometrine maleate pada dosis rendah mempunyai efek tetanik
uterotonik yang menimbulkan kontraksi uterus dengan meningkatkan frekuensi dan
kekuatan (amplitudo) kontraksi. Pada dosis tinggi dapat meningkatkan tonus uterus
basal. Methylergometrine bekerja langsung pada otot polos uterus, dengan cepat dan
poten melalui reseptor -adrenergik sehingga dengan segera memperpendek persalinan
kala tiga dan menghentikan pendarahan uterus.
:: Indikasi ::
MYOTONIC diindikasikan untuk:

Mencegah dan mengobati pendarahan pasca persalinan dan pasca abortus,

termasuk pendarahan uterus karena sectio caesaria.
Melancarkan persalinan kala 3 (tiga).
Pendarahan uterus setelah plasenta lepas, atoni uterus, subinvolusi uterus pada
puerperium, lokhiometra.

:: Kontraindikasi ::
- Hipersensitif terhadap Methylergometrine dan komponen obat lainnya.
- Kehamilan kala satu dan kala dua pada partus sebelum corona kepala terlihat.
- Hipertensi, termasuk hipertensi karena kehamilan (pre-eklampsia, eklampsia).
- Inersia uterus primer dan sekunder.
- Tidak boleh digunakan untuk induksi atau mempercepat kelahiran.
:: Efek Samping ::
Efek samping yang telah dilaporkan adalah mual, muntah dan sakit perut dapat terjadi
setelah pemberian dosis yang besar.
Hipertensi dapat terjadi terutama setelah penyuntikan intravena yang cepat.
Pernah dilaporkan adanya kelainan-kelainan pada kulit, nyeri kepala atau reaksi-reaksi

kardiovaskular seperti vertigo, takikardia atau bradikardia.

:: Peringatan Dan Perhatian ::

Pada suntikan intravena penyuntikan harus diberikan secara lambat.

Penyuntikan intravena jangan digunakan secara rutin karena adanya kemungkinan
meningkatnya tekanan darah dan serangan serebrovaskuler. Bila penggunaan
intravena sangat diperlukan sebagai life saving berikan perlahan-lahan minimum 60
detik dengan pengawasan tekanan darah.

Pada kasus letak bayi sungsang, MYOTONIC baru diberikan setelah bayi lahir,
pada partus kembar, setelah bayi terakhir dilahirkan.

Pada keadaan sepsis berat atau menetap.

Penderita penyakit vaskuler perifer.

Penderita penyakit jantung iskemik.

Penderita gangguan fungsi hati dan ginjal.

:: Interaksi Obat ::
Pemberian vasokonstriktor dan alkaloid ergot lainnya.
:: Dosis Dan Cara Penggunaan ::

Pendarahan karena sectio caesaria: setelah bayi dikeluarkan secara ekstraksi i.m.
1 ml atau i.v. 0,5 sampai 1 ml.

Melancarkan persalinan kala tiga: i.m. 0,5 sampai 1 ml (0,1 - 0,2 mg) setelah
kepala atau bahu anterior keluar atau selambat-lambatnya segera setelah bayi
dilahirkan.

Penanganan kala tiga pada partus dengan anastesi umum: i.v. 1 ml (0,2 mg).

Pada atoni uterus: i.m. 1 ml atau i.v. 0,5 ml sampai 1 ml.

Penanganan involusi uterus: 1 tablet 3 kali sehari umumnya 3 - 4 hari.

Pada pendarahan puerperal, subinvolusi, lokhiometra: 1 atau 2 tablet 3 kali

sehari, atau i.m. 0,5 sampai 1 ml sehari.

:: Kemasan ::
MYOTONIC tablet salut selaput
Dus isi 10 strip @ 10 tablet
No. Reg. : DKL 0515618617 A1
Simpan pada suhu (25 - 30) C, kering dan terlindung dari cahaya
MYOTONIC injeksi
Dus isi 10 Ampul @ 1 ml
No. Reg. : DKL 0515618843 A1
Simpan pada suhu (2 - 8) C dan terlindung dari cahaya
:: Cara Penyimpanan ::
MYOTONIC tablet salut selaput: simpan pada suhu (25-30) oC, kering dan terlindung
dari cahaya.
MYOTONIC injeksi: simpan pada suhu (2-8) oC, dan terlindung dari cahaya.

Clonidine merupakan obat jenis alpha agonist. Clonidine menurunkan

tekanan darah dengan cara mengurangi kadar kimia tertentu dalam darah. Hal ini
membuat pembuluh darah mengendur dan jantung berdetak dengan lebih lambat
dan mudah. Obat ini dapat digunakan bersamaan dengan obat tekanan darah
lainnya.
Indikasi:
Untuk mengobati tekanan darah tinggi (hipertensi).
Dosis:

Dosis awal: 50-100 mcg melalui mulut (per oral), 3 kali sehari, atau 75-150

mcg melalui mulut (per oral), 2 kali sehari.

Dosis rumatan: 300-1200 mcg/hari melalui mulut, dalam dosis yang dibagi.
Dosis maksimum: 2.4 mg/hari

Efek Samping:
Efek CNS (keadaan mengantuk, kepeningan, sakit kepala, depresi,

kecemasan, kelelahan, gangguan tidur, impotensi); Efek GI (mulut kering,

konstipasi, mabuk, anoreksia); Efek GU (sulit buang air kecil, incontinece);
Efek CV (hipotensi ortostatik, penyimpanan cairan).
Efek lainnya yang tidak umum: Bradycardia, gangguan ECG, gagal
jantung, halusinasi, dan lain-lain.

Instruksi Khusus:
Gunakan dengan hati-hati pada pasien dengan penyakit cerebrovaskuler,
kerusakan ginjal, penyakit jantung isemik, MI (myocardial infarction),

penyakit vaskular perifer oklusif atau pada mereka yang memiliki riwayat
depresi.
Pasien yang menjalani pengobatan jangka panjang tidak boleh berhenti
secara tiba-tiba.

PETIDIN HIDROKLORIDA
Indikasi:

nyeri sedang sampai berat; analgesia obstetrik; analgesia perioperatif.

Peringatan:

lihat pada Garam Morfin dan keterangan di atas; tidak cocok untuk nyeri
berat yang berkepanjangan.
Interaksi:

Lampiran 1 (analgesik opioid)

Kontraindikasi:

lihat pada Garam Morfin dan keterangan di atas; gangguan fungsi ginjal
berat.
Efek Samping:

lihat pada Garam Morfin dan keterangan di atas; konvulsi dilaporkan pada
overdosis.
Dosis:

nyeri akut, oral 50-150 mg tiap 4 jam; anak: 0,5-2 mg/kg bb; anak-anak
0,5-2 mg/kg bb.
Injeksi subkutan atau intramuskuler, 25-100 mg, diulang setelah 4 jam;
ANAK, injeksi intramuskuler, 0,5-2 mg/kg bb.
Injeksi intravena perlahan, 25-50 mg, diulang setelah 4 jam.
Analgesia obstetrik, injeksi subkutan atau intramuskuler, 50-100 mg,
diulang 1-3 jam kemudian bila perlu; maksimum 400 mg dalam 24 jam.
Pramedikasi, injeksi intramuskular, 25-100 mg 1 jam sebelum

pembedahan; anak 0,5-2 mg/kg bb.

Nyeri pasca bedah, injeksi subkutan atau intramuskuler, 25-100 mg setiap
2-3 jam jika diperlukan; anak, injeksi intramuskuler, 0,5-2 mg/kg bb.
Catatan: selama pasca bedah, pasien sebaiknya dimonitor secara
saksama pada penghilangan rasa nyerinya juga efek samping yang
mungkin timbul, terutama penekanan pernapasan.