| Drug | Mechanism | Dose | Clinical effect | Side effects |
| Morphine sulfate | Opioid agonist* | | - Abortive
- Improves most features
| - Respiratory depression
- Sedation
- Hypotension
- Ileus
- Emesis
- Histamine release
- Development of tolerance (requiring dose escalation)
|
| Propofol | GABA-A agonist | - 10 to 20 mg IV bolus or continuous infusion (up to 80 mcg/kg/minute)
| - Abortive (bolus) or preventive (infusion)
- Improves most features
| - Deep sedation (only permissible in patients who are intubated and ventilated)
- Propofol infusion syndrome (in sustained high doses)
|
| Benzodiazepines | GABA-A agonists | - Diazepam 5 to 10 mg IV bolus
- Lorazepam 1 to 4 mg IV bolus
- Midazolam 2 to 5 mg IV bolus
- Clonazepam 0.5 to 2 mg every 8 hours by enteral route
| - Abortive (diazepam, lorazepam, midazolam) or preventive (clonazepam)
- Can improve most features but less effectively than morphine
- Diazepam is most useful for hypertonicity
| - Sedation
- Respiratory depression
- Development of tolerance (requiring dose escalation)
|
| Dexmedetomidine | Central alpha-2 adrenergic receptor agonist | - 0.2 to 1.5 mcg/kg/hour by IV infusion
| - Abortive and preventive
- Improves mostly tachycardia and hypertension but may improve other features as well
| - Bradycardia
- Hypotension
- Sedation
|
| Clonidine | Central alpha-2 adrenergic receptor agonist | - 0.1 to 0.3 mg every 6 to 8 hours by enteral route (subcutaneous option also available)
| - Abortive and preventive
- Improves mostly tachycardia and hypertension but may improve other features as well
| - Bradycardia
- Hypotension
- Sedation
|
| Propranolol¶ | Noncardioselective beta blocker | - 20 to 80 mg every 4 to 6 hours by enteral route
| - Preventive
- Improves tachycardia, hypertension, and diaphoresis and might improve dystonia
- Less effective for fever
| - Bradycardia
- Hypotension
- Sleep disturbances
|
| Gabapentin | Interacts with alpha-2-delta subunit of voltage-gated calcium channels in brain and spinal cord | - 100 to 300 mg every 8 hours by enteral route
- Can rapidly titrate up to 3600 or 4800 mg total daily dose
| - Preventive
- Improves most features
| |
| Bromocriptine | Dopamine D2 receptor agonist | - 1.25 mg every 12 hours by enteral route
- Can titrate up 20 to 40 mg total daily dose
| - Preventive
- Effect tends to be modest and delayed
| - Confusion
- Agitation
- Dyskinesia
- Nausea/emesis
- Orthostatic hypotension
- Could reduce seizure threshold
|
| Baclofen | GABA-B agonist | - 5 mg every 8 hours by enteral route
- Can titrate up to 80 mg total daily dose (intrathecal option available through implanted pump)
| - Preventive
- Improves hypertonicity and dystonia
| - Sedation
- Muscle weakness
- Risk of withdrawal (mostly with intrathecal administration)
|
| Dantrolene | Ryanodine receptors in myocytes | - 0.5 to 2 mg/kg IV every 6 to 12 hours, up to 10 mg/kg total daily dose
| - Abortive
- Improves hypertonicity and dystonia
| - Hepatotoxicity (can be severe)
- Respiratory depression
- Muscle weakness
|
