Commonly Used Medications in ACLS
Types, uses and dosages of drugs change very quickly. For this reason, it is critical that a qualified medical person with up-to-date knowledge of medications be primarily responsible for ordering medications during resuscitation. All members of a resuscitation team should be familiar with the most commonly used drugs, which are listed in the “ACLS Resuscitation Medications” (Table 11, below). NOTE: Doses and uses are based on AHA recommendations. Anyone that administers these drugs should be aware of and competent in the use of these medications. These drugs should only be administered by licensed medical professionals.
| Drug | Type of Drug | Uses | Recommended Dosage | Side Effects | Other Notes |
| Adenosine | Antiarrhythmic | Supraventricular tachycardia (SVT) | 1st dose = 6 mg rapid IV push followed by saline bolus
2nd dose = 12 mg rapid IV push in |
Headache, dizziness, metallic taste, dyspnea, hypotension, bradycardia or palpitations, nausea, flushing, sweating | Cardiac monitoring during administration;
Administer through central line if available; Do not use in 2nd or 3rd degree heart block |
| Amiodarone | Antiarrhythmic | Unstable ventricular tachycardia (VT) with pulses; ventricular fibrillation (VF); VT without pulse and unresponsive to shock | 300 mg rapid bolus with 2nd dose of 150 mg if necessary to a maximum of 2.2 grams over 24 hours | Headache, dizziness, tremors, ataxia, syncope, significant hypotension, bradycardia, CHF, torsades de pointes, nausea, vomiting, diarrhea, rash, skin discoloration, hair loss, flushing, coagulation abnormalities | Monitor ECG and BP;
Use with caution in patients with a perfusing rhythm, hepatic failure; Do not use in 2nd or 3rd degree heart block |
| Atropine | Anticholinergic | Symptomatic bradycardia; toxic poisonings and overdoses | Bradycardia: 1.0 mg IV every 3-5 minutes with 3 mg max dose; may be given by ET tube
Toxins/overdose: 2-4 mg may be needed until symptoms reverse |
Headache, dizziness, confusion, anxiety, flushing, blurred vision, photophobia, pupil dilation, dry mouth, tachycardia, hypotension, hypertension, nausea, vomiting, constipation, urinary retention, painful urination, rash, dry skin | Monitor ECG, oxygen, and BP;
Administer before intubation if bradycardia is present; Contraindicated in glaucoma and tachyarrhythmias; Doses lower than 0.5mg should not be given since this may result in worsening of bradycardia |
| Dopamine | Catecholamine vasopressor, inotrope | Can be given in bradycardia after atropine; can be given for systolic BP <100 mm Hg with signs of shock | 2 to 20 mcg/kg/minute infusion titrated to response | Headache, dyspnea, palpitations, PVCs, SVT, VT, nausea/ vomiting, acute renal failure | Monitor ECG and BP;
If hypovolemic, give fluid boluses first; Avoid high infusion rates; Do not mix in alkaline solutions or with sodium bicarbonate |
| Epinephrine | Catecholamine vasopressor, Inotrope | Cardiac arrest; anaphylaxis; symptomatic bradycardia after atropine; shock when pacing and atropine are not effective | Cardiac arrest: 1.0 mg (1:10000) IV or 2-2.5 mg (1:1000) per ET tube every 3-5 minutes; follow with 0.1-0.5 mcg/kg/minute infusion titrated to response Symptomatic bradycardia or shock: 2-10 mcg/minute infusion titrated to response |
Tremors, anxiety, headaches, dizziness, confusion, SVT, VT, hallucinations, dyspnea, palpitations, chest pain, hypertension, nausea, vomiting, hyperglycemia, hypokalemia, vasoconstriction | Available in 1:1000 and 1:10000 concentrations so be aware of which concentration is being used;
Monitor BP, oxygen, and ECG; Administer via central line if possible to avoid the danger of tissue necrosis; Do not give in cocaine induced VT |
| Lidocaine | Antiarrhythmic | Cardiac arrest from VF or VT Wide complex tachycardia |
Cardiac Arrest: 1-1.5 mg/kg IV bolus; may repeat twice at half dose in 5-10 minutes to total of 3 mg/kg; followed with infusion of 1-4 mg per minute infusion
Wide complex tachycardia with pulse: 0.5-1.5 mg/kg IV; may repeat twice at half dose in 5-10 minutes to total of 3 mg/kg; followed with infusion of 1-4 mg per minute infusion |
Seizures, heart block, bradycardia, dyspnea, respiratory depression, nausea, vomiting, headache, dizziness, tremor, drowsiness, tinnitus, blurred vision, hypotension, rash | Monitor ECG and BP;
May cause seizures; Do not give for wide complex bradycardia; Do not use prophylactically in AMI |
| Magnesium sulfate | Electrolyte; bronchodilator | Torsades de pointes; hypomagnesemia; digitalis toxicity | Cardiac arrest due to hypomagnesemia or torsades: 1-2 gram IV bolus
Torsades with a pulse: 1-2 gram IV over 5-60 minutes followed by infusion at 0.5-1 gram per hour IV |
Confusion, sedation, weakness, respiratory depression, hypotension, heart block, bradycardia, cardiac arrest, nausea, vomiting, muscle cramping, flushing, sweating | Monitor ECG, oxygen and BP;
Rapid bolus may cause hypotension and bradycardia; Calcium chloride is the antidote to reverse hypermagnesemia |
| Oxygen | Elemental gas | Hypoxia, respiratory distress or failure, shock, trauma, cardiac arrest | In resuscitation, administer at 100% via high flow system and titrate to maintain O2 sat >94% | Headache, dry nose, mouth, possible airway obstruction if secretions become dry | Monitor oxygen saturation;
Insufficient flow rates may cause carbon dioxide retention |
| Vasopressin | Antidiuretic hormone analogue | As alternative to epinephrine for VF, asystole/PEA
Shock |
Cardiac arrest: 40 units IV as replacement for 2nd or 3rd dose of epinephrine
Shock: IV infusion of 0.02-0.04 units/ minute |
Fever; dizziness; arrhythmia; chest pain; hypertension; nausea; vomiting; abdominal cramping and pain; hives | Monitor BP and distal pulses; Watch for signs of water intoxication; Deliver through central line if possible to avoid tissue necrosis from IV extravasation |
