Commonly Used Medications in ACLS


Type of Drug


Recommended Dosage

Side Effects

Other Notes

Adenosine Antiarrhythmic Supraventricular Tachycardia 1st dose = 6 mg rapid IV push followed by saline bolus


2nd dose = 12 mg rapid IV push in 1-2 minutes

Headache, dizziness, metallic taste, dyspnea, hypotension, bradycardia or  palpitations, nausea, flushing, sweating Cardiac monitoring during administration; administer through central line if available; flush with saline following administration: give very rapidly. 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 blood pressure


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: 0.5 mg IV every 3-5 minutes with 3 mg max dose; May be given by ETT


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 < 100mm Hg with signs of shock 2 to 20 mcg/kg per 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 ETT every 3 to 5 minutes; follow with 0.1-0.5 mcg/kg/min 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 – 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 Ventricular Fibrillation (VF) or Ventricular TachycardiaWide complex tachycardia Cardiac Arrest: 1-1.5 mg/kg IV bolus; may repeat twice at half dose in 5-10 minutes to total of 3mg/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 3mg/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 acute MI


Magnesium Sulfate Electrolyte; bronchodilator Torsades de pointes; Hypo- magnesemia; 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 response to maintain oxygen saturation > 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 Ventricular Fibrillation (VF) /asystole/Pulseless Electrical Activity (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


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