Drug Summary

Acceptable Alternative Medications

Approval Process:

In the setting of drug shortages, the Office of the Medical Director will approve of alternative medications for temporary use until the original medications are available. These alternative medications are not meant to be interchangeable with the authorized pharmaceuticals unless officially approved by the Medical Director when deemed appropriate by system needs.

Alternative for Ziprasidone (Geodon®):

Haloperidol (Haldol®):

  • Pharmacologic properties:Antipsychotic agent or major tranquilizer
  • Indications:Behavioral emergencies for patients with severe agitation or aggressive behavior resulting in interference with patient care or patient/crew safety.
  • Dosage and administration:
    • Adult: 5 mg if < 60 kg IM/IV, 10 mg if > 60 kg IM/IV
    • Pediatric: Safety and effectiveness in children has not been conducted for IM/IV route.

Alternative for Midazolam (Versed®):

Lorazepam (Ativan ®):

  • Pharmacologic properties:Benzodiazepine, anticonvulsant, sedative hypnotic
  • Indications:Status epilepticus, cocaine (sympathomimetic) toxicity, premedication prior to cardioversion or transcutaneous pacing, behavioral emergencies - may be adjunctive treatment, with haloperidol
  • Dosage and administration:
    • Adult: 1-2 mg, IV/IM, may be repeated once
    • Pediatric - For active seizures only:
      • 0.05 mg/kg slow IV or IM (Max. individual dose 2 mg)
        • If seizures continue or re-occur after 5 minutes repeat Lorazepam (Ativan) 0.05 mg kg IV (Max. individual dose 2 mg)

Alternative for Fentanyl (Sublimaze®):

Morphine Sulfate:

  • Pharmacologic properties:narcotic analgesic
  • Indications:Chest pain associated with suspected myocardial ischemia or pulmonary edema, thermal burns, frostbite, isolated extremity injury, premedication for cardioversion, or transcutaneous pacing
  • Dosage and administration:
    • Adult:2 mg slow IVP every 2 minutes until pain relief (can also be given IM or SC)
      • Maximum total dose 10 mg
    • Pediatric: 0.1 mg/kg slow IVP every 2 minutes until pain relief (can also be given IM or SC)
      • Maximum individual dose 2 mg, maximum total dose 10 mg