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Intrathecal Injections

Colleen Barthol; Conrado Gamboa

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    AMA Citation
    Barthol C, Gamboa C. Barthol C, Gamboa C Barthol, Colleen, and Conrado Gamboa.Intrathecal Injections. In: Attridge RL, Miller ML, Moote R, Ryan L. Attridge R.L., Miller M.L., Moote R, Ryan L Eds. Rebecca L. Attridge, et al.eds. Internal Medicine: A Guide to Clinical Therapeutics New York, NY: McGraw-Hill; 2013. http://accesspharmacy.mhmedical.com/content.aspx?bookid=565&sectionid=42003769. Accessed May 21, 2018.
    MLA Citation
    Barthol C, Gamboa C. Barthol C, Gamboa C Barthol, Colleen, and Conrado Gamboa.. "Intrathecal Injections." Internal Medicine: A Guide to Clinical Therapeutics Attridge RL, Miller ML, Moote R, Ryan L. Attridge R.L., Miller M.L., Moote R, Ryan L Eds. Rebecca L. Attridge, et al. New York, NY: McGraw-Hill, 2013, http://accesspharmacy.mhmedical.com/content.aspx?bookid=565&sectionid=42003769.

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Table Graphic Jump Location
Table C-1 Adult Intrathecal Analgesic Injections*
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Table C-1 Adult Intrathecal Analgesic Injections*

Class

Medication

Usual Dose

Onset

Duration

Concentration

Side Effects

Opioid Analgesics

Fentanyl

5–25mcg/dose

5–10min

1–4h

0.05mg/mL PF

Sedation, N/V, urinary retention, respiratory depression, constipation

Hydromorphone

50–100mcg/dose

†

†

10mg/mL PF

Sedation, N/V, pruritus, urinary retention, respiratory depression, constipation

Morphine

0.2–1mg/dose (APS recommends 0.1–0.3mg/dose)

45–75min

18–24h

0.5, 1, 10, 25mg/mL PF

Sedation, N/V, pruritus, urinary retention, respiratory depression, constipation

Sedatives

Midazolam

1–2mg/dose

5–10min

2–4h

1, 5mg/mL PF (diluted to max conc 1mg/mL)

Sedation, motor weakness, respiratory depression

Nonopioid Adjuvants

Baclofen

25–75mcg/dose

30–60min

4–8h

0.05, 0.5, 2mg/mL PF

Sedation, cognitive impairment, weakness, hypotension, constipation, urinary retention

Clonidine

25–75mcg

30–60min

6–8h

100, 500mcg/mL PF

Orthostatic hypotension, bradycardia, sedation

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Table Graphic Jump Location
Table C-2 Adult Intrathecal Antimicrobial Injections*
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Table C-2 Adult Intrathecal Antimicrobial Injections*

Medication

Usual Dose

Concentration

Route

Side Effects

Amikacin

5–20mg/d

4mg/mL PFNS

IT‡

Minor hearing loss

Amphotericin B

0.01–0.5mg/d

0.1mg/mL D5W

IT/IVT‡

Tinnitus, fever, chills, parkinsonism

Gentamicin

4–8mg/d

2mg/mL PFNS

IT/IVT‡

Transient hearing loss, seizures, aseptic meningitis

Tobramycin

4–8mg/d

2mg/mL PFNS

IT/IVT‡

Transient hearing loss, seizures, aseptic meningitis

Vancomycin

5–20mg/d

5mg/mL PFNS

IT/IVT‡

Sensorineural hearing loss

APS, American Pain Society; IT, intrathecal; IVT, intraventricular; N/V, nausea & vomiting; PFNS, preservative-free normal saline.

*Information provided as a medical resource but not intended to replace physician's judgment.

†Information not available.

‡Not FDA approved by this route.

References: Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesth Analg 2005;101: S30; Tunkel AR, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267; Ziai W, Lewin III JJ. Improving the role of intraventricular antimicrobial agents in the management of meningitis. Curr Opin Neurol 22:277.

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