BASIC MEDICATION OPTIONS

Drug  (Class) Dose Range Comment
Local Anesthesia and Additives
Lidocaine (Xylocaine)
(0.5% – 1%)
Up to 200 mg (20 mL 1% or 40 mL 0.5%) Most common in U.S.  Lower concentration as effective but more expensive
Bacteriostatic Saline 20 mL Somewhat less effective than lidocaine
Bicarbonate Buffer 5 mL / 50 mL anesthetic Less injection pain
Vasopressin (Vasostrict) 5-10 u / 50 mL anesthetic Decreases bleeding and systemic absorption; can be expensive
Oral and IV Pain Medications
Ibuprofen (Motrin; Advil) 600 – 800 mg PO More effective at least 30 minutes before procedure
Naproxen (Naprosyn; Aleve) 220 – 500 mg PO More effective at least 30 minutes before procedure
Hydrocodone/Acetaminophen (Norco) or Acetaminophen with Codeine  (Tylenol w/ Codeine) 1-2 tablets of 5/325 mg
or 300/30 mg PO
Equivalent medications can also be used
Lorazepam (Ativan) 0.5 – 1 mg SL
or 1-2 mg PO
Shorter acting benzodiazepine. Antidote is flumazenil
Diazepam (Valium) 5-10 mg PO Longer acting benzodiazepine. Antidote is flumazenil
Fentanyl (Sublimaze) 50 – 100 μg IV Give over 30-60 seconds. Antidote is naloxone
Midazolam (Versed) 1 – 2 mg IV Give over 2 minutes. Antidote is flumazenil
Uterotonics for Post-Aspiration Hemorrhage
Methylergonovine (Methergine) 0.2 mg PO/IM or intracervical Use with caution in hypertensive patients
Misoprostol (Cytotec) 800mcg SL or
800-1000mcg PR
Given a rapid time to peak concentration, SL or buccal may be preferable to PR if possible (Kerns 2013)
Carboprost (Hemabate)* 0.25 mg IM, may repeat at 15-90 minute intervals to max of 2mg Use with caution in asthmatic patients
* Not available for use outside inpatient medical facilities
Oxytocin (Pitocin) 10 u IM, or 10-40 u IV in crystalloid, or 10 u IVP More uterine oxytocin receptors > 20 weeks
Emergency Medications
Atropine Sulfate (Atropen) 0.2 mg (0.5 mL) IV push or 0.4 mg (1 mL) IM, each 3-5 min to max dose of 2 mg For prolonged symptomatic bradycardia with vasovagal
Some use in paracervical block to prevent vasovagal
Diphenhydramine (Benadryl) 25 – 50 mg IM/IV/PO For allergic reaction
Use PO for mild symptoms and IM/IV for anaphylaxis
Epinephrine 1:1000 (Adrenalin) 0.3 – 0.5 mg (1 mg/mL) SQ/IM
Repeat doses at 5-15 min intervals as necessary
For anaphylaxis.  Preferable to inject in mid-anterolateral thigh
Naloxone (Narcan) 0.1 mg – 0.2 mg (0.25-0.50 mL) IV / IM each 2-3 min
Max dose 0.4 mg
Opiate antidote
Flumazenil (Romazicon) 0.2 mg (2 mL) IV each min
Max dose of 1 mg
Benzodiazepine antidote