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1/26/26 Updates to ADULT Titration Guidelines beginning Tuesday, January 27
January 26, 2026
Beginning tomorrow - the following changes will be made in 1Chart between 0800 and 0900. Please see attached flyer that has been distributed to nursing
Designated pharmacists will be modifying the comments on any of these titratable infusion orders that were active prior to the change
1.dexmediTOMIDine - add a range to the titration parameters
Titrate by 0.1 – 0.2 mcg/kg/hr at 15 minute intervals to achieve a RASS score of -1 to 0; if neurologically impaired prior to sedation (unable to follow commands), keep RASS -3 to 0.
- norepinephrine- add a range to the titration parameters AND change clinical goal to MAP 65 - 75
Titrate by 0.01 – 0.04 mcg/kg/min at 1 minute intervals, up to a rate of 0.5 mcg/kg/min. For rates exceeding 0.5 mcg/kg/min, titrate by 0.2 mcg/kg/min at 1 minute intervals to keep MAP 65 - 75.
Notify provider if HR exceeds provider specified parameters or if patient develops a new arrhythmia. Infusion may be decreased rapidly or paused for patient emergencies.
- phenylephrine- add a range to the titration parameters AND change clinical goal to MAP 65 - 75
Titrate by 0.1 – 0.5 mcg/kg/min at 1 minute intervals to keep MAP 65 - 75. Notify provider if HR exceeds provider specified parameters or if patient develops a new arrhythmia. Infusion may be decreased rapidly or paused for patient emergencies.
- DOPamine- change clinical goal to MAP 65 -75
Titrate by 2.5 mcg/kg/min every 5 minutes to keep MAP 65 - 75. In an emergency situation, may increase dose every 2 minutes
Notify provider if HR exceeds provider specified parameters or if patient develops a new arrhythmia. Infusion may be decreased rapidly or paused for patient emergencies.
- epinephrine- change clinical goal to MAP 65 -75
Titrate by 0.02 mcg/kg/min every 3 minutes to keep MAP 65 - 75.
Notify provider if HR exceeds provider specified parameters or if patient develops a new arrhythmia. Infusion may be decreased rapidly or paused for patient emergencies.
- dilTIAZem- only applies to fixed rate use outside of the ICU; updates usual max dose for non-ICU patients to 15 mg/hr; Doses exceeding 15 mg/hr require approval from cardiology
25 mg/hr. Usual maximum dose outside of the ICU is 15 mg/hr. However, rates above 15 mg/hr may be used with approval from cardiology
Please let me know if you have any questions
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Michele Durda, Pharm.D.
Medication Safety/Drug Utilization Pharmacist
Huntsville Hospital
101 Sivley Road
Huntsville, AL 35801
256-265-8229 (office)
256-520-6721 (personal cell)
Information included in this document is prepared and maintained for use by Hospital Quality Assurance pursuant to Section 22-21-8 of the Code of Alabama, 1975