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HITUNG DROP IV DRIP

http://www.unc.edu/~bangel/quiz/testivh.htm
http://emsstaff.buncombecounty.org/inhousetraining/ivdriprates/ivdriprates_overview2.htm
http://atitesting.com/ati_next_gen/skillsmodules/content/iv-therapy/equipment/calculating-iv.html

http://www.ugapharmd.com/
Chemotherapy Drugs Reconstitution and Stability
Information

Drug

Add
Final
listed
Concentration
volume

Stability at Stability
Other Information
Room
Under
Temp
Refrigeration

Aldesleukin 22 million unit


1.2ml
Amifostine 500mg
9.7ml
Asparaginase 10,000 unis (for IV use) 5ml
Asparaginase 10,000 unis (for IM use) 2ml
Bleomycin 15 units (for IM or Subq) 1ml
Bleomycin 15 units (for IV)
5ml
Bleomycin 30 units (for IM or Subq) 2ml
Bleomycin 30 units (for IV)
10ml
Busulfan 6mg/ml
--Carboplatin 50mg
5ml
Carboplatin 150mg
15ml
Carboplatin 450mg
45ml
Carmustine 100mg
30ml

1.1mg/ml
50mg/ml
2,000 units/ml
5,000 units/ml
15 units/ml
3 units/ml
15 units/ml
3 units/ml
6mg/ml
10mg/ml
10mg/ml
10mg/ml
3.3mg/ml

48 hours
5 hours
8 hours
8 hours
14 days
14 days
14 days
14 days
8 hours
24 hours
24 hours
24 hours
8 hours

Cisplatin
Cladribine 1mg/ml
Cyclophosphamide 100mg

1mg/ml
1mg/ml
20mg/ml

24 hours 24 hours
n/a 14 days
24 hours 6 days

----5ml

48 hours
24 hours
8 hours
8 hours
28 days
28 days
28 days
28 days
12 hours
5 days
5 days
5 days
24 hours

1.1mg = 18 million units

Mix only in 0.9% NaCl. 1 unit = 1mg


Mix only in 0.9% NaCl. 1 unit = 1mg
Mix only in 0.9% NaCl. 1 unit = 1mg
Mix only in 0.9% NaCl. 1 unit = 1mg

First dilute with 3ml alcohol then 27ml of


sterile water. Mix only in 0.9% NaCl.
Dilute only in 0.9% NaCl

Cyclophosphamide 200mg
Cyclophosphamide 500mg
Cyclophosphamide 1000mg
Cyclophosphamide 2000mg
Cytarabine 100mg
Cytarabine 500mg
Cytarabine 1000mg
Cytarabine 2000mg
Dacarbazine 100mg
Dacarbazine 200mg
Dactinomycin 0.5mg
Daunorubicin 20mg
Dexrazoxane 250mg
Dexrazoxane 500mg
Docetaxel 20mg
Docetaxel 80mg
Doxorubicin liposomal (Doxil) 2mg/ml
Doxorubicin 10mg
Doxorubicin 20mg
Doxorubicin 50mg
Doxorubicin 150mg
Doxorubicin 2mg/ml
Epirubicin 2mg/ml
Etoposide 20mg/ml
Etoposide Phosphate 10mg
Floxuridine 500mg
Fludarabine 50mg
Gemcitabine 200mg
Gemcitabine 1000mg
Idarubicin 1mg/ml
Ifosfamide 1gm
Ifosfamide 3gm
Interferon alpha 2b 3 million I.U.
Interferon alpha 2b 5 million I.U.
Interferon alpha 2b 10 million I.U.

10ml 20mg/ml
24 hours
25ml 20mg/ml
24 hours
50ml 20mg/ml
24 hours
100ml 20mg/ml
24 hours
5ml
20mg/ml
48 hours
10ml 50mg/ml
48 hours
10ml 100mg/ml
48 hours
20ml 100mg/ml
48 hours
9.9ml 10mg/ml
24 hours
19.7ml 10mg/ml
24 hours
1.1ml 0.5mg/ml
24 hours
4ml
5mg/ml
24 hours
25ml 10mg/ml
24 hours
50ml 10mg/ml
24 hours
1.8ml 10mg/ml
8 hours
???
10mg/ml
8 hours
--- 2mg/ml
n/a
5ml
2mg/ml
7 days
10ml 2mg/ml
7 days
25ml 2mg/ml
7 days
75ml 2mg/ml
7 days
--- 2mg/ml
7 days
--- 2mg/ml
14 days
--- 20mg/ml
24 hours
10ml 10mg/ml
24 hours
5ml 100mg/ml
n/a
2ml 25mg/ml
16 days
5ml 38mg/ml
24 hours
25ml 38mg/ml
24 hours
--- 1mg/ml
72 hours
20ml 50mg/ml
7 days
60ml 50mg/ml
7 days
1ml
3 million IU/ml 28 days
1ml
5 million IU/ml 28 days
1ml
10 million IU/ml 28 days

6 days
6 days
6 days
6 days
n/a
n/a
n/a
n/a
96 hours
96 hours
24 hours
48 hours
n/a
n/a
8 hours
8 hours
24 hours
15 days
15 days
15 days
15 days
15 days
14 days
n/a
7 days
14 days
16 days
n/a
n/a
n/a
6 weeks
6 weeks
n/a
n/a
n/a

***Protect from light***


***Protect from light***
Don't mix with a diluent w/ a preservative
Do NOT refrigerate
Do NOT refrigerate
Mix in a glass bottle; stability may be
longer (i.e. several weeks; see Trissels)
Dilute only in D5W **Protect from light**
***Protect from light***
***Protect from light***
***Protect from light***
***Protect from light***
***Protect from light***

Do NOT refrigerate
Do NOT refrigerate
***Protect from light***

Interferon alpha 2b 18 million I.U.


Interferon alpha 2b 25 million I.U.
Interferon alpha 2b 50 million I.U.
Irinotecan 20mg/ml
Leucovorin 100mg
Leucovorin 350mg
Leucovorin 350mg/ml
Mechlorethamine 10mg
Melphalan 50mg
Mesna 100mg/ml
Methotrexate 20mg
Methotrexate 1000mg
Methotrexate 25mg/ml
Mitomycin 5mg
Mitomycin 20mg
Mitomycin 40mg
Mitoxantrone 2mg/ml
Paclitaxel 6mg/ml
Pentostatin 10mg
Streptozocin 1gm
Teniposide 10mg/ml
Thiotepa 15mg
Topotecan 4mg
Vinblastine 10mg
Vincristine 1mg/ml
Vinorelbine 10mg/ml

1ml
18 million IU/ml 28 days n/a
5ml
5 million IU/ml 28 days n/a
1ml
50 million IU/ml 28 days n/a
--- 20mg/ml
28 days 28 days
10ml 10mg/ml
n/a
7 days
34.5ml 10mg/ml
n/a
7 days
17ml 20mg/ml
n/a
7 days
10ml 1mg/ml
Use Immediately
10ml 5mg/ml
Use Immediately
--- 100mg/ml
24 hours n/a
1ml
20mg/ml
7 days n/a
19.4ml 50mg/ml
7 days n/a
--- 25mg/ml
7 days n/a
10ml 500mcg/ml
7 days 14 days
40ml 500mcg/ml
7 days 14 days
80ml 500mcg/ml
7 days 14 days
--- 2mg/ml
48 hours 48 hours
--- 6mg/ml
48 hours n/a
5ml
2mg/ml
48 hours 96 hours
9.5ml 100mg/ml
48 hours 96 hours
--- 10mg/ml
24 hours n/a
1.6ml 15mg/ml
24 hours 48 hours
4ml
1mg/ml
24 hours n/a
10ml 1mg/ml
24 hours 21 days
--- 1mg/ml
24 hours 7 days
--- 10mg/ml
24 hours 24 hours

***Protect from light***


***Protect from light***
***Protect from light***
***Protect from light***

***Protect from light***


***Protect from light***
***Protect from light***

Do NOT refrigerate
Stability in 0.9% NaCl
Do NOT refrigerate
***Protect from light***
***Protect from light***

*** Stability is that of an IV solution, not that diluted drug in the vial unless otherwise noted

DILUTION CHEMO DRUG IV


Aldesleukin (Proleukin)
Dilute dose in 50ml Dextrose 5% and infuse over 15 minutes
Acceptable concentration range: 30-70mcg/ml (1.5-3.5mg in 50ml) (24.5-57 million i.u. in 50ml)
Stable for 48 hours
Amifostine (Ethyol)
Infuse over 15 minutes (for chemo) or 3 minutes (for radiation) 30 minutes before treatment
Stable in NaCl ***DO NOT DILUTE IN DEXTROSE***
Stable for 24 hours under refrigeration or 5 hours at room temperature
Dilute to 5-40mg/ml
Asparaginase (Elspar)
Compatible with dextrose and NaCl
Infuse over at least 30 minutes
No specific dilution information available
Use infusion within 8 hours
May be given IM or IV
Bleomycin
Use infusion within 24 hours (Solution stability may be much longer than this)
Mix in 0.9% NaCl. Bleomycin is unstable in dextrose.
Infuse over 10 minutes
May be given IM,IV, or SubQ
For IM injection: dilute to 3-15mg/ml
For IV injection: dilute to less than 3mg/ml
For Intrapleural injection: dilute in 50-100ml of saline
Busulfan (Busulfex)
Available in 6mg/ml solution
Dilute 10 fold for infusion (i.e. 10ml of busulfan in 100ml of fluid)
Compatible with dextrose and NaCl
Give through a central line
Infuse over 2 hours every 6 hours for 4 consecutive days (16 total doses)

Stable for 12 hours under refrigeration or 8 hours at room temperature


Carboplatin (Paraplatin)
Use infusion within 8 hours (Solution stability may be much longer than this)
Dilute to a concentration no LOWER than 0.5mg/ml
Compatible with dextrose and NaCl
Infuse over at least 15 minutes
Carmustine (Bicnu)
Mix ONLY in 0.9% NaCl
Stable for 24 hours under refrigeration or 8 hours at room temperature
Infuse over 1-2 hours (longer infusion decreases incidence of pain/burning at injection site and flushing
No specific dilution information available
Cisplatin (Platinol)
Patient should be hydrated with 1-2 liters of fluid over 8-12 hours prior to giving cisplatin
Total cisplatin dose should be diluted into 2 liters of fluid (it may vary, this is not an absolute amount)
Infuse over 6-8 hours
Usually given IV, may be given intra-arterial and intraperitoneal instillation.
Must be diluted in 0.9% NaCl or D5NS, but NOT D5W (There must be NaCl in the infusion)
Minimum NaCl concentration in infusion is 0.2% (Cisplatin becomes unstable if it is lower)
Stable for 24 hours
Cladribine (Leustatin)
Dilute only in 0.9% NaCl, dextrose increases degredation of cladribine
Stable for at least 14 days under refrigeration
If precipitate forms in vial due to refrigeration, allow vial to come to room temp but do not heat vial
Dilute 500ml 0.9% NaCl for infusion for repeated once daily doses
Infuse 500ml bag over 24 hours for 7 consecutive days
Cyclophosphamide (Cytoxan)
Compatible with dextrose and NaCl
Stable for 6 days under refrigeration or 24 hours at room temperature
No specific dilution information available
May be given intraperitoneally, intrapleurally, IM, IV push, or continuous/intermittent IV infusion

Cytarabine (Cytosar U)
Compatible with dextrose and NaCl
Stable for at least 48 hours at room temperature
May be given intrathecally, SubQ, IM, IV push, or continuous/intermittent IV infusion
No specific dilution information available
Usually infused over 1-3 hours
Dacarbazine (DTIC-Dome)
***Protect from light***
Compatible with dextrose and NaCl
Stable for 24 hours at room temperature and 96 hours under refrigeration if protected from light
Dilute in 250ml of fluid and infuse over 15-30 minutes
Dactinomycin (Cosmegen)
Stable for 24 hours
***Do NOT give IM or subq; IV only***
May be given IV push or IV infusion
Compatible with dextrose and NaCl
Do not dilute with a preservative containing solution, it may cause precipitation
May be pushed without further dilution over a few minutes in the vein with a free flowing fluid,
and be sure to flush the line when you're done; you can also dilute it in a minibag
Daunorubicin (Cerubidine) (Daunoxome is liposomal formulation)
Compatible with dextrose and NaCl
Stable for 24 hours at room temperature or 48 hours under refrigeration
Give IV only
Administration option 1: Dilute with 10-15ml and give IV push over 2-3 minutes in a line with a rapidly flowing large volue fluid
Administration option 2: Dilute in 100ml and infuse over 30-45 minutes
Dexrazoxane (Zinecard)
***Do not refrigerate*** may cause precipitation
Stable for 24 hours at room temperature
Give by slow IV push or rapid IV infusion
Compatible with dextrose and NaCl, but slightly more stable in dextrose than NaCl (5% vs. 9% loss in 24 hours)

Docetaxel (Taxotere)
Compatible with dextrose and NaCl
Stable for at least 8 hours under refrigeration or at room temperature; may be much longer (see Trissels)
Infusion should be between 0.3 and 0.74mg/ml
Mix in a glass bottle
Infuse over 1 hour
Doxorubicin liposomal (Doxil)
Do NOT mix in 0.9% NaCl
Dilute in 250ml of dextrose 5% in water
Stable for 24 hours under refrigeration
For AIDS related Kaposi's sarcoma: infuse over 30 minutes
For Ovarian cancer: initiate at 1mg/minute and if it's tolerated give the full dose over 1 hour
Doxorubicin NON-liposomal (Adriamycin)
Compatible with dextrose and NaCl
Stable for 7 days at room temperature and 15 days under refrigeration
Infuse no faster than over 5 minutes
No specific dilution information available
Epirubicin (Ellence)
Compatible with dextrose and NaCl
Stable for 14 days at room temp and under refrigeration
Dilute to 50-100mcg/ml for infusion
Infuse over 3-5 minutes
Do NOT give IV push due to extravasation
Etoposide
Compatible with dextrose and NaCl
Stable for 24 hours at room temperature
Dilute to 0.2-0.4mg/ml for infusion
Infuse over 30-60 minutes
Etoposide Phosphate (Etopophos)

Compatible with dextrose and NaCl


Stable for 24 hours at room temperature and 7 days under refrigeration
Milligram dose is in Etoposide equivalents and has nothing to do with the phosphate
Reconstitute vial to 10mg/ml. Dose may be given without any further dilution or as low as 0.1mg/ml
Infuse over 5 minutes to 3 hours
Floxuridine (Fudr)
Compatible with dextrose and NaCl
Stable for 14 days under refrigeration
Dilute to 5-10mg/ml for infusion
Do not exceed a rate of 200mg/hr
Fludarabine (Fludara)
Compatible with dextrose and NaCl
Mix in 100ml of fluid and infuse over 30 minutes
Manufacturer suggests using solution within 8 hours of mixing, but it is stable much longer (See Trissels)

Gemcitabine (Gemzar)
Compatible with dextrose and NaCl
Do NOT refrigerate; may cause crystallization
Stable for 24 hours at room temperature
Dilute to 0.1-38mg/ml for infusion
Administered once weekly by IV infusion over 30 minutes
Idarubicin (Idamycin)
Compatible with dextrose and NaCl
***Protect from light***
Stable for at least 72 hours at room temperature if protected from light
Infuse over 10-15 minutes
No specific dilution information available
Ifosfamide (Ifex)
Compatible with dextrose and NaCl
Stable for 7 days at room temperature or 6 weeks under refrigeration

Infuse over at least 30 minutes


Dilute to 0.6-20mg/ml
Interferon alpha 2b (Intron A/Rebetol)
Dilute only in NaCl solutions
May be given IM, SubQ, IV infusion, or intralesionally
50 million I.U. only for use in malignant melanoma and AIDS related Kaposi's sarcoma
Stable for up to 28 days at room temperature
For IV infusions, dilute to no less than 0.1 million I.U. per ml and infuse over 20 minutes
Irinotecan (Camptosar)
Compatible with dextrose and NaCl
***Protect from light***
Stable for 28 days at room temp or under refrigeration if protected from light
Dilute to 0.12-2.8mg/ml for infusions
Infuse over 90 minutes

IV DRUG INFORMATION
1/4 Normal Saline Water 1000ml + 23.4% NaCl (4meq/ml) 38.8meq (9.7ml)
D12W 500ml

D10W 500ml + 26.32ml of D50

Abelcet (Amphotericin B Lipid Complex)


***Protect from Light***
Mix in D5W
***Do not mix in any electrolyte solutions***
Adult Dose: 5mg/kg q24
Adult Concentration:
Neonatal Dose:

0.16-0.83mg/ml
1-5mg/kg, Start at 1mg/kg
May increase in daily 1mg/kg increments
1-2mg/ml

Neonate Conc.:
Rate = 2.5mg/kg/hr i.e. run over 2 hours
Stable for 48 hours under refrigeration plus an additional 6 hours at room temp.
Dosing Calculator
Acetadote (Acetylcysteine for Tylenol overdose)
150mg/kg in 200ml D5W over 15 minutes
50mg/kg in 500ml D5W over 4 hours
100mg/kg in 1000ml D5W over 16 hours
Dosing Calculator
Dosing Protocol

Activase (Alteplase)
Dilute 50mg vial with 50ml or 100mg vial with 100ml of sterile water to make 1mg/ml
Must be used within 8 hours of mixing
Dosing:
(TIA) - 0.09mg/kg over 1 minute, then 0.81mg/kg over 1 hour (maximum total of 90mg)
(Arterial thrombosis) 0.05-0.1mg/kg/hr over 1-8 hours
(PE) 100mg IV over 2 hours or 30-50mg via pulmonary artery over 1.5-2 hours
(MI: 3 hr infusion) 0.75mg/kg over 1 hour, then 0.25mg/kg/hr x 2 hours (If BW < 65kg)
(MI: 3 hr infusion) 60mg over 1 hour, then 20mg/hr x 2 hours (If BW > 65kg)

(MI: accelerated infusion) 15mg over 1-2 minutes, then 0.75mg/kg (max 50mg) over 30 minutes,
then 0.5mg/kg (max 35mg) over 1 hour
(Prevention for reocclusion Post-MI) 3.3mcg/kg/minute x 4 hours
Dosing Calculator
Aminocaproic acid
Stable in dextrose and NaCl
Stable for at least 7 days
10-100mg/ml concentrations have been used
Manufacturer recommends diluting to approximately 20mg/ml or 50ml of diluent for each gram of drug
For acute bleeding syndromes manufacturer recommends 4-5gm over 1 hour
followed by 1gm per hour for about 8 hours or until bleeding is controlled.
Maximum daily dosage: 30 grams
Ambisome (Amphotericin B Liposome)
***Protect from Light***
Mix in D5W
***Do not mix in any electrolyte solutions***
4mg/ml concentration made by adding 12ml sterile water to 50mg vial (stable for 24 hours),
then further dilute for infusion (stable for 6 hours)
Must be refrigerated
Adult Dose: 3-5mg/kg q24
Adult Concentration:
1-2mg/ml
Neonatal Dose:
1-5mg/kg, Start at 1mg/kg
May increase in daily 1mg/kg increments
Neonate Conc.:
Less than 2mg/ml
Rate = Run over 2 hours
Dosing Calculator
Amphotec (Amphotericin B Cholesteryl Sulfate Complex)
***Protect from Light***
Mix in D5W
***Do not mix in any electrolyte solutions***
Adult Dose: 3-4mg/kg q24
Adult Concentration: 0.16-0.83mg/ml

Neonatal Dose: 3-4mg/kg


Neonate Conc.: 0.16-0.83mg/ml
Rate = 1mg/kg/hr i.e. if dose is 3mg/kg, run over 3 hours and 4mg/kg over 4 hours, etc
Rate may be shortened to 2 hours if well tolerated
Test dose of 10ml to be pulled from infusion bag should be given over 15-30 mintes,
then monitor patient for 30 minutes for any reaction
Stable for 24 hours under refrigeration
Dosing Calculator
Amphotericin B (Conventional Formulation)
***Protect from Light***
Mix in D5W
***Do not mix in any electrolyte solutions***
Adult Dose: 0.25-1mg/kg q24 may be increased to 1.5mg/kg q48
Total Daily dose should NEVER NEVER NEVER exceed 1.5mg/kg
Adult Concentration: 0.1mg/ml
Neonatal Dose: 0.5-1MG/KG
Neonate Conc.: 0.1mg/ml
Run over 2-6 hours
Stable for 24 hours at room temperature, 7 days under refrigeration
Dosing Calculator
Antizol
(Fomepizole)
Compatible with dextrose and NaCl
Stable for 24 hours
If drug becomes solid in vial, hold under warm water to get drug to go back into solution
Mix in 100ml of fluid
Run over 30 minutes
Dose: 15mg/kg, then 10mg/kg q12 x 4 doses, then 15mg/kg until ethylene glycol or methanol level is less than 20mg/dl
Dosing Protocol
Aredia (Pamidronate disodium)
Compatible with dextrose and NaCl
Stable under refrigeration for 24 hours

Dilute 30mg doses in 500ml of fluid


Dilute 60-90mg doses in 1000ml of fluid
30-90mg to give over 2-24 hours
Argatroban
Compatible with dextrose and NaCl
Treatment of HIT: Start with 2mcg/kg/min
Obtain a baseline aPTT level,then Monitor aPTT levels until the
aPTT is 1.5-3 times baseline value (obtain level every 2 hours)
Patients with moderate hepatic impairment initiate with 0.5mcg/kg/min
Stable for 24 hours at room temperature, 48 hours under refrigeration
Dosing Calculator
Dosing Protocol
Azactam
(Aztreonam)
Compatible with dextrose and NaCl
Should be given over 20-60 minutes per gram
Maximum concentration 1gm/50ml
Stable for 48 hours at room temp or 7 days under refrigeration
Bactrim (Sulfamethoxazole/TMP)
Mix in D5W
Stable for 4-6 hours
Dilute each 5ml of Bactrim in 125ml of Dextrose (75ml if fluid restriction)
Dose: 8-10mg/kg of TMP (0.5-0.625ml/kg) split q6, 8, or 12
Available as Sulfamethoxazole 80mg/ml & TMP 16mg/ml (dosing based on TMP)
Run over 60 - 90 minutes
Bananna Bag
Compatible with dextrose and NaCl
Thiamine and folic acid can be put in a piggy back
Multivitamins may be put in as little as 500ml, but 1000ml is recommended.
Stable for 24 hours

Brevibloc (Esmolol)
Compatible in dextrose and NaCl
Mix in D5W
Available as 10mg/ml premix
Stable when mixed for 7 days at room temperature or under refrigeration
Dosing Protocol
Calcium Gluconate
Stable for at least 24 hours
Compatible with dextrose and NaCl
May push undiluted or give as an infusion
Do not exceed 1.8meq/min (2-3 minutes per 10ml amp)
Cancidas (caspofungin):
70mg load followed by 50mg/day
Mix in 250ml of 0.9% NaCl
***Unstable in dextrose***
May be mixed in 100ml if patient requires fluid restriction
In patients with moderate hepatic insufficiency, dose may be 35mg
Run over 1 hour
Stable 24 hours out of fridge
Stable 24 hours out of fridge
Cardene IV (Nicardipine HCl)
Compatible in dextrose and NaCl
Dilute 25mg/10ml vial with 240ml to make 0.1mg/ml infusion
Stable for 24 hours at room temperature
NOT compatible with Lactated Ringers or Sodium Bicarbonate
Dosing Protocol
Cardizem
(Diltiazem)
Compatible in dextrose and NaCl
Put 125mg (25ml) in 100ml of fluid to make 1mg/ml
Stable for at least 48 hours under refrigeration

Dosing Protocol
Cerebyx (Fosphenytoin)
Compatible in dextrose and NaCl
75mg = 50mg PE (phenytoin equivalents)
Mix in concentration of 1.5-25mg/ml of PE
Run no faster than 150mg/min PE
Stable for 30 days under refrigeration, 2 days at room temperature
Cordarone (Amiodarone)
Mix only in dextrose, it can precipitate in NaCl
Must be mixed in glass if infusion exceeds 2 hours (i.e. a bolus can be put in a bag
Mix in concentrations of 1-6mg/ml
Concentrations greater than 2mg/ml must be given via a central line
Stable for at least 5 days at room temperature
Must be administered by a volumetric infusion pump *** NOT drop counter infusion sets
Dosing Calculator
Dosing Protocol
Corlopram (Fenoldopam)
Compatible with dextrose and NaCl
Mix 10mg in 250ml to make a final concentration of 40mcg/ml
Stable for 24 hours at room temperature
DO NOT USE A BOLUS
Dosing Calculator
Dosing Protocol
Cortrosyn (Cosyntropin)
May be given IM, IV push, or by IV infusion
If given IV push, silute 0.25mg vial with 1ml of 0.9% NaCl and push over 2 minutes.
For IV infusion, dilute in dextrose or saline and give 0.25mg dose over 6 hours
Normal patients will have a baseline cortisol level of greater than 5mcg/dL
and a level of 18mcg/dL with an increase of at least 7mcg/dL 30 minutes
after recieving Cortrosyn. If the level is taken 60 minutes after recieving
Cortrosyn, there should be an increase of at least 11mcg/dL.

Do not give Cortrosyn with blood or plasma infusions due to enzyme degredation
Dosing Protocol
Corvert (Ibutilide)
Compatible with dextrose and NaCl
Add drug to 50ml of fluid and infuse over 10 minutes
Dose for Patients 60+kg: 1mg = 10ml (whole vial)
Dose for Patients < 60kg: 0.01mg/kg = 0.1ml/kg of vial
Stable for 24 hours at room temperature or 48 hours under refrigeration
Dosing Calculator
Dosing Protocol
Demadex (Torsemide)
Compatible in dextrose and NaCl
Mix in dextrose at concentration of 0.1-0.8mg/ml
Mix in NaCl at concentration of 0.1-0.4mg/ml
Stable for 24 hours at room temperature

OR

Digibind (Digoxin Immune Fab)


Dilute in 50-100ml of 0.9% NaCl and infuse over at least 30 minutes; if infusion reactions occur, infuse slower
Infusion may be given wide open if cardiac arrest is imminent
Infusion must be used within 4 hours of reconstitution
Hypokalemia, rapid ventricular response, CHF exacerbation, or low cardiac output may result from digoxin withdrawal
Dilute vials with 4ml (each vial contains 38mg)
Dosing Calculators
Digifab (Digoxin Immune Fab)
Dilute in 0.9% NaCl to a concentration of approximately 10mg/ml and infuse over at least 30 minutes
If infusion reactions occur, infuse slower
Infusion may be given wide open if cardiac arrest is imminent
Infusion must be used within 4 hours of reconstitution
Hypokalemia, rapid ventricular response, CHF exacerbation, or low cardiac output may result from digoxin withdrawal
Dilute vials with 4ml (each vial contains 40mg)
Dosing Calculators

Depacon (Valproate Sodium)


Compatible in dextrose and NaCl
Stable for at least 6 days at room temperature
Dilute with at least 50ml of fluid
Run over 1 hour not to exceed 20mg/min (1.2gm/hour)
Dilantin (phenytoin)
Should be given into a large vein through large gauge needle or large catheter.
Rate should not exceed 50mg/min
May be given IV push (preferred because it is not very stable in solution)
Can be mixed in NaCl approximately 10mg/ml
Dobutamine
Dobutamine is available in 250ml bag of D5W at a concentration of 1mg/ml
Compatible in dextrose and NaCl
Stable for 24 hours at room temperature
Dilute to a concentration of no greater than 5mg/ml
Dosing Protocol
Dopamine
Dopamine is available in 250ml bag of D5W at a concentration of 1.6mg/ml
Dosing Protocol
Epinephrine
***Protect from light***
Compatible in dextrose and NaCl
Standard infusion is 4mg/liter, but much higher concentrations may be used (i.e. 87mg/liter).
Stable for at least 24 hours if protected from light.
Do not use if solution appears pink (epinephrine is oxidized)
Dosing Protocol
Ferrlecit (solium ferric gluconate complex):
Dose: 125mg in 100ml 0.9% NS
Run over 1 hour
NO test dose (that's with Iron Dextran)

Infed (Iron
Dextran)
0.9% NaCl is the suggested diluent for iron dextran
Using Dextrose had a greater incidence of phlebitis
Stable for at least 3 months under refrigeration
First, give a test dose of 25mg, wait one hour, then give the remainder of the dose over one to six hours
Dose in adults: 50*[0.0442*(Desired Hemoglobin - Actual Hemoglobin) * IBW + (0.26*IBW)]
Inocor (Inamrinone)
Discard after 24 hours
Compatible with NaCl (Do NOT mix in dextrose)
Dilute to 1.25-2.5mg/ml
Dosing Protocol
Integrilin Drip (eptifibatide):
Bolus: 180mcg/kg
Drip Rate: 2 mcg/kg/min
Drip Concentration: 2mg/ml
If CrCl < 50ml/min, the rate is half with same bolus
Available in 100ml premixed vial
Dosing Calculator
Dosing Protocol
Isuprel
(Isoproterenol)
***Protect from light***
Concentration 0.4-4mcg/ml (1-10ml of 0.2ml/ml injection in 500ml of fluid.
Compatible in dextrose and NaCl
Stable for at least 24 hours if protected from light.
Dosing Protocol
Levophed (Norepinephrine)
***Protect from light***
Compatible in dextrose and NaCl

Must be given in a large vein


May be mixed at 4-40mcg/ml concentrations
4mcg/ml: 1 amp (4ml in 1000ml of fluid)
16mcg/ml: 1 amp (4ml in 250ml of fluid)
32mcg/ml: 2 amps (8ml in 250ml of fluid)
Dosing Protocol
Lidocaine
Available in a 2 gm in 500ml of D5W as a premix
Compatible in dextrose and NaCl
Magnesium:
Compatible in dextrose and NaCl
May be diluted to concentration of 200mg/ml or less
Stable for at least 60 days under refrigeration
Maximum rate of infusion is 150mg/min (i.e. 2 gm over 15 minutes)
Merrem (Meropenem)
More stable in NaCl than dextrose (see below)
Dilute to concentration of 2.5-50mg/ml
Infuse over 15-30 minutes
In saline, 50mg/ml stable 2hours at room temp or 12hours under refrigeration
In saline, 2.5-20mg/ml stable 4 hours at room temp or 24 hours under refrigeration
In dextrose, 2.5-20mg/ml stable 1 hour at room temp or 6 hours under refrigeration
Mesnex (Mesna)
Compatible in dextrose and NaCl
May be given by injection or infusion
Usually given over 15-30 minutes but may be given by continuous infusion
Dilute infusion to 20mg/ml
Multidose vials stable for 8 days in fridge
Natrecor (6mcg/ml) (Nesiritide)
Bolus: weight (kg)/3 = ml of bolus
Infusion: weight (kg)*0.1 = ml/hr

Mix 1.5mg in 250ml of fluid to make final concentration of 6mcg/ml


Compatible in dextrose and NaCl
Stable for 24 hours at room temp or in fridge
Dosing Calculator
Dosing Protocol
Neosynephrine (Phenylephrine)
***Protect from light***
Compatible in dextrose and NaCl
May be mixed in concentrations of 0.02-1mg/ml (0.02mg/ml is 10mg in 500ml)
Stable for at least 48 hours at room temperature
Dosing Protocol
Nipride (Nitroprusside)
***Protect from light***
Compatible with dextrose
DO NOT mix in NaCl; it will break down into cyanide (That's Bad!!!)
Mix 50mg in 250-1000ml of D5W
Stable for 24 hours at room temperature
Dosing Calculator
Dosing Protocol
Nitroglycerin
Compatible in dextrose and NaCl
Stable for 48 hours at room temp or 7 days under refrigeration
Mix 50mg in 250ml (200mcg/ml)
Do not exceed 400mcg/ml
Must be mixed in glass
Dosing Calculator
Dosing Protocol
Norcuron (Vecuronium)
Compatible in dextrose and NaCl
Mix in a concentration of 0.1-0.2mg/ml
Stable for 24 hours

Should be refrigeration after reconstitution if not being used


Pentamidine (Pentam)
Compatible in dextrose and NaCl
Mix in 50 to 250ml of fluid
Run over 60 to 120 minutes
Stable for 48 hours at room temperature
Dose: 4mg/kg once daily for 14-21 days
Precedex (Dexmedetomidine)
Compatible in dextrose and NaCl
Dilute 2ml (200mcg) in 48ml of 0.9% NaCl (4mcg/ml)
Stable for 48 hours at room temperature
Dosing Protocol
Primacor (Milrinone)
Available as 200mcg/ml premix
Compatible with dextrose and NaCl
Stable for at least 14 days
Dosing Protocol
Primaxin (Imipenem-Cilastatin)
Compatible in NaCl
Do not exceed concentration of 5mg/ml
Infuse each 500mg over at least 30 minutes
Stable for 4 hours at room temp or 24 hours under refrigeration
Pronestyl (Procainamide)
Compatible with NaCl
Mix in a concentration of 2-4mg/ml
Stable for 24 hours at room temp or 7 days under refrigeration
Do not exceed 50mg/min
Protamine
Compatible with NaCl and Dextrose

Stable for at least 10 days at room temperature


May be given undiluted or as an infusion
Do not give any faster than 50mg per 10 minutes
May cause severe hypotension and bradycardia. Patients who are having cardiovascular
symptoms already may need the drug to be administered slower (i.e. 50mg per hour)
Dosing Protocol
Refludan
(Lepirudin)
Compatible in dextrose and NaCl
For bolus, dilute one 50mg vial with 10ml to make 5mg/ml and push over 15-20 seconds
For drip, dilute to a concentration of 0.2-0.4mg/ml (50-100mg in 250ml bag)
Stable for 24 hours
aPTT ratio (aPTT/midpoint of lab normal range) target is 1.5-2.5
aPTT should be checked every 4 hours until aPTT ratio 1.5-2.5, then every 24 hours
Dosing Calculator
Dosing Protocol
Regitine (Phentolamine)
10mg diluted with 10ml 0.9% NaCl and inject into the affected area for extravasation of catecholamines
such as norepinephrine, epinephrine, and dopamine
Retavase (Reteplase)
Dilute 10.4 unit vial with 10ml of water to make 1 unit/ml (DO NOT SHAKE)
Must be used within 4 hours of mixing
Dose (MI): 10 units over 2 minutes x 2 doses 30 minutes apart
Dosing Calculator
Sandostatin (Octreotide)
***Protect from light***
Stored under refrigeration but may be stored for up to 14 days at room temperature
Compatible in dextrose and NaCl
May be mixed in 50-200ml and infused over 15-30 minutes
Dose: (Esophageal Varices) 50mcg bolus followed by 25-50mcg/hr
Dosing Protocol

Synagis (Palivizumab)
Dose: 15mg/kg once monthly during RSV season (roughly November through April)
50mg vial - add 0.6ml of sterile water, 50mg = 0.5ml
100mg vial - add 1.0ml of sterile water, 100mg = 1.0ml
Use within 6 hours of reconstitution
Theophylline Drip (Aminophylline)
Max rate 20mg/min
Loading dose 6mg/kg over 20-30 minutes
(Only load if patient is not taking Theophylline)
Theophylline available as premix as 400mg (equivalent to 500mg aminophylline) in 500ml D5W
Also stable in 0.9% NaCl for at least 24 hours
Mix with 500mg in 500ml to make a 1mg/ml (aminophylline)(Theophylline premix is of equivalent concentration)
Dosing Calculator
Dosing Protocol
Loading dose (Only load if patient is not taking Theophylline): 6mg/kg over 20-30 minutes

Maintenance Dose:
For 12 Hours following bolus
6 months - 9 years
1.2mg/kg/hr
9-16 years
1mg/kg/hr
Young adult smoker
1mg/kg/hr
Nonsmoking adult
0.7mg/kg/hr
Elderly
0.6mg/kg/hr
Cor Pulmonale Pt.
0.6mg/kg/hr
CHF or Liver Failure
0.5mg/kg/hr
***Doses are based on Aminophylline, NOT Theophylline
TNKase (Tenecteplase)
Dilute 50mg vial with 10ml to make 5mg/ml
Must be used within 8 hours of mixing
Give IV push over 5 seconds
Dosing:

Maintenance dose following 12


hours
1mg/kg/hr
0.8mg/kg/hr
0.8mg/kg/hr
0.5mg/kg/hr
0.3mg/kg/hr
0.3mg/kg/hr
0.1-0.2mg/kg/hr

< 60kg: dose - 30mg


60-69kg: dose - 35mg
70-79kg: dose - 40mg
80-89kg: dose - 45mg
> 89kg: dose - 50mg
Dosing Calculator
Trandate
(Labetalol)
***Protect from light***
Compatible in dextrose and NaCl
Stable for at least 72 hours
Mix to a concentration of 0.667-1mg/ml for continuous infusion
Initiate infusion at 2mg/minute
Vasopressin
Compatible in dextrose and NaCl
May be diluted to concentration of 0.1-1 unit/ml
Versed
(Midazolam)
Compatible in dextrose and NaCl
Stable in 0.9% NaCl for 10 days
Mix to a concentration of 1mg/ml
Dosing Protocol
Vfend(Voriconazol
e)
Stable 14 days at room temperature
Dose: 6mg/kg q12 x 2 doses then 4mg/kg q12
Compatible with dextrose and NaCl
Dilute to concentration of 0.5-5mg/ml
Infuse over 1-2 hours max rate 3mg/kg/hr
Dosing Calculator

Vibramycin (Doxycycline)
***Protect from light***
Compatible in dextrose and NaCl
Stable for 72 hours under refrigeration
Mix in 0.1-1mg/ml
Infuse over 1-4 hours
Vitamin K
***Protect from light***
Compatible in dextrose and NaCl
May be given IV push or by infusion
Use immediately after mixing
Do not exceed 1mg/min
Xigris (Drotrecogin alfa (activated))
Compatible with dextrose and NaCl
Dilute to concentration of 0.1-0.2mg/ml
Infusion Rate: 24mcg/kg/hour X 96 hours
Dose based on actual body weight at the start of the infusion
Stable 14 hours at room temperature
If refrigerated then hung, discard after 24 hours
Dosing Calculator
Dosing Protocol
Zantac (Ranitidine)
***Protect from light***
Compatible in dextrose and NaCl
Put 150mg in 250ml (0.6mg/ml)
Infuse at a rate of 6.25mg/hr or 10.4ml/hr
Stable for at least 24 hours if protected from light.
Zovirax (Acyclovir)
Compatible in dextrose and NaCl
Mix in concentrations of no greater than 7mg/ml
Infuse over 1 hour

DO NOT REFRIGERATE
Do not use bacteriostatic water to dissolve powder
Dosage 5-20mg/kg every 8 hours
Do not exceed 20mg/kg every 8 hours in any patient
Sources:
American Hospital Formulary Service. Drug Information. Bethesda, MD: ASHP, 2005
Trissel LA. Handbook on Injectable Drugs. 13th ed. Bethesda, MD: ASHP, 2005
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