Medications that can cause bradycardia in children

Acetylcholinesterase inhibitors (indirect-acting parasympathomimetic)

Donepezil

Echothiophate*

Edrophonium

Galantamine

Neostigmine

Physostigmine

Pyridostigmine

Rivastigmine

Analgesic, anesthetic, sedative-hypnotic

Barbiturates (eg, phenobarbital, pentobarbital)

Benzodiazepines (eg, lorazepam, diazepam)^¶

Dexmedetomidine

Local anesthetics (eg, lidocaine, mepivacaine, prilocaine)

Opioids (morphine > fentanyl)

Propofol

Antimigraine

Ergots (eg, ergotamine)

Cholinergic (direct-acting parasympathomimetic)

Acetylcholine*

Carbachol*

Cevimeline*

Cardiovascular

Alpha₂-adrenergic agonists (eg, clonidine, guanfacine, methyldopa)

Antiarrhythmics (eg, amiodarone, adenosine, lidocaine)

Beta-blockers

Calcium channel blockers (dihydropyridine > nondihydropyridine)

Digoxin

Nitrates (eg, nitroglycerin, nitroprusside)

Corticosteroids

Glucocorticoids (eg, methylprednisolone, prednisone)

Mineralocorticoids (eg, fludrocortisone)

Psychotropic

Lithium

Vasoactive (including topical decongestants and vasoconstrictors)*

Alpha-adrenergic agonists (phenylephrine*, midodrine, naphazoline*, oxymetazoline*, tetrahydrozoline*)

Octreotide

Medications associated with bradycardia in children. Effect may be related to dose, method, and rate of administration or exposure.

* Includes decongestant nasal sprays (imidazoline derivatives), eye drops (miotics, vasoconstrictors), and other topical vasoactive agents that may cause severe bradycardia upon oral ingestion of relatively small amounts.
¶ Bradycardia may be seen with rapid intravenous administration or overdose, or in combined use with opioid analgesics.

Graphic 102555 Version 2.0

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Medications that can cause bradycardia in children