1. Dysautonomia Formulary

2. Please take note of the following prior to using this formulary:
Most of these medications are not FDA approved for the treatment of dysautonomia, particularly in the pediatric population.
The dosage information provider here is a combination of recommendations from the Pediatric Dosing Handbook Formulary and expert opinion.
It is important for this dosing information to be used with caution and only after full review of the entire dysautonomia module.
We highly encourage you to discuss medication dosing with a pharmacist and/or pediatric physiatrist if you have any questions or concerns.

3. BROMOCRIPTINE Starting Dose How to Titrate Maximum Dose Onset
Age<2 years: mg PO BID
Age>2 years: 1.25mg PO BID
Can start with daily dosing if conservative
How to Titrate
Double the dose 1-2 times/week until you have reached the desired effect
Maximum Dose
Children: 12.5mg BID
Adults: 25mg BID
Onset
1-2 hours
Half-life
15 hours
BROMOCRIPTINE
Propanalol
Labetalol
Diazepam
Clonidine
Clonazepam
Bromocriptine

4. CLONAZEPAM Starting Dose How to Titrate Maximum Dose Onset Half-life
mg/kg/day divided BID
Maximum STARTING dose: 1.5mg/day
How to Titrate
Increase dose by up to 0.5mg q3 days
Maximum Dose
0.2mg/kg/day OR 20mg/day
Onset
20-60 minutes
Half-life
22-33 hours
Other
Clonazepam should generally be used twice daily however it can be given up to 4 times a day. If a patient requires more frequent dosing then consider adding other medications as increased frequency will “snow” the patient. If you are titrating the dose upward, start with nighttime dose due to the cognitive suppressive effects.
CLONAZEPAM
Propanalol
Labetalol
Diazepam
Clonidine
Clonazepam
Bromocriptine

5. CLONIDINE Starting Dose How to Titrate Maximum Dose Onset Half-life
5-10 MICROGRAMS/kg/day divided q8-12 hours
How to Titrate
Gradually to 5-25 MICROGRAMS/kg/day divided every 6 hours. Monitor blood pressures closely.
Maximum Dose
0.9mg/day
Onset
Oral: minutes
Half-life
8-12 hours
Other
Some transdermal patches can be cut in half however, half of a 0.1mg patch cannot be considered 0.05mg, it must be considered a ½ patch because exact dosing cannot be guaranteed. The patch may take up to 2-3days to reach therapeutic levels. Once removed, therapeutic levels may persist for 8-12 hours and will then slowly decline over 24-48hours.
CLONIDINE
Propanalol
Labetalol
Diazepam
Clonidine
Clonazepam
Bromocriptine

6. DIAZEPAM Starting Dose How to Titrate Maximum Dose Onset Half-life
PO or IV/IM: mg/kg/dose q6-8hrs
How to Titrate
If no effect after 1st dose then repeat in 30 min
Re-eval frequently to assess efficacy and increase dose or frequency as needed
Maximum Dose
0.6mg/kg in 8hrs
May consider higher doses in consultation with PM&R and/or the ICU due to risk of respiratory depression
Onset
IV: 1-3minutes
Rectal: 2-10 minutes
Half-life
Age 1mo-2yrs: hours
Age 2-16yrs: hours
Other
Monitor for respiratory depression
The half-life of the active metabolite that causes respiratory depression is hours
DIAZEPAM
Propanalol
Labetalol
Diazepam
Clonidine
Clonazepam
Bromocriptine

7. LABETALOL Starting Dose How to Titrate Maximum Dose Onset Half-life
mg/kg/dose with range of 0.2-1mg/kg/dose
How to Titrate
Discuss with physiatrist and pharmacist
Maximum Dose
20mg/dose
Onset
(IV): 2-5 minutes
Half-life
(IV) 5-8 hours
Labetolol
Propanalol
Labetalol
Diazepam
Clonidine
Clonazepam
Bromocriptine

8. PROPRANALOL Starting Dose How to Titrate Maximum Dose Onset Half-life
mg/kg/day divided BID
How to Titrate
Increase dose by 2.5-5mg/dose
Maximum Dose
30mg q6 hours
Onset
1-2 hours
Half-life
4-6 hours
Other
Can initiate at an interval of every other day if conservative. At greater than maximal doses, will cause bronchospasm that is unresponsive to beta agonists. When titrating, if no response in heart rate, increase the next dose or increase q1-2 days by the increment noted above—usual dose is 1-5mg/kg/day. Look at heart rate to gauge how well it is working
PROPRANOLOL
Propanalol
Labetalol
Diazepam
Clonidine
Clonazepam
Bromocriptine