Medication Administration Policy

Section II Parenteral Medication Administration Guidelines
This section can be copied and kept for reference at bedside.

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Medication How IV Push SVP or LVP Standard Diluent Precautions / Comments Stability / Storage Limitations /
Generic - (Brand) Supplied Conc / Rate Max/Min Concentrations Restrictions
Recommended Infusion Time
ABCIXimab 2mg/ml 5 Yes Percutaneous Coronary Intervention: Preprinted order set available Do not shake solution or
(Reopro) ml vial 2 mg/ml 0.25 mg/Kg bolus followed by 0.125 transport via tube system.
Give bolus over 1 mcg/Kg/min infusion (up to max Monitor Hgb/Hct, platelets, PT, PTT
Antiplatelet IIb/IIIa minute 10mcg/min = 7.2 mg) x 12 hours 6 hours after admin and 24 hrs after Administer in separate IV line
administration
System Standard Concentration: 7.2 0.22 micron filter must be used
mg/ 250 ml NS (28.8 mcg/ml) in preparation!!
AcetaZOLAMIDE 500 mg Yes IV Push Preferred ** Verify dose to be given. Discard

(Diamox) Vial 100 mg/ml at max vial after drawing up correct dose. ** Reconstitute vial with sterile
rate of 250 water only.
Diuretic mg/min. May cause thrombophlebitis
Acetylcysteine, N- 200 mg/ml NO Acetaminophen overdose: (Prescott Caution with use in patients with
acetylcysteine 30 ml vial Trial Protocol) Loading dose: 150 asthma and/or history of Administer in separate IV line
(Acetadote) mg/kg IV over 60 minutes bronchospasm
Maintenance dose: 50 mg/kg IV over 4 Solution may turn
hours x 1 then 100 mg/kg IV over 16 Common adverse effects: rash, pink/lavender in color – still ok
Antidote – hours urticaria and pruritus to use
acetaminophen overdose Traditional dosing protocol may be
used to dose IV rescue – Loading Urticaria and pruritus may be treated
Dose: 140mg/kg IV over 60minutes; with antihistamine (i.e.
Maintenance dose: 70mg/kg IV Q4h x diphenhydramine) with physician
17 doses. order.
N-acetylcysteine should continue until

liver function improves!!
Pediatric patients: recommended conc
is 40 mg/ml to avoid hyponatremia and
seizures.
Acyclovir 5 mg/ml NO Up to 350 mg in 50 ml NS or D5W Renal tubular damage with infusions Do NOT refrigerate –
(Zovirax) 10ml and 351-700 mg in 100ml NS or D5W <60min. precipitate may form.
20 ml vials Infuse doses over at least 60 min. Phlebitis if conc.>7mg/ml
Antiviral Max conc: 7 mg/ml
Dose reduction recommended for
CrCl < 50 ml/min
• Units with cardiac monitoring and nurses who have demonstrated competency to manage this medication. 1
Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Final 07-2009
Adenosine 3 mg/ml 2 Yes, IV Push Preferred Dyspnea, flushing and heart-block Follow rapid IV push dose with * See footnote
(Adenocard) ml vial, 3 6 mg rapidly over (asystole) not uncommon with rapid 20 ml NS flush
mg/ml 2 ml 2 seconds followed resolution as half-life is only 10 Continuous ECG,
and 4 ml with saline flush. seconds If given into IV line, use BP monitoring
Anti-arrhythmic syringe May then give closest port to insertion site and recommended
12mg 1-2 min Reflex tachycardia may occur if follow with NS flush. Elevate during
later, followed by given too slowly extremity administration
another 12 mg 1-2
min later if needed.
Albumin, Human 5% - 250ml NO Dose and rate of administration based Administer with IV tubing provided If diluting 25% albumin, NS is
Serum 25% - 50ml upon patient condition. by pharmacy. preferred. D5W may be used
bottles Recommended max rate of infusion: for limited volumes.
Plasma Expander 5% at 10 ml/min DO NOT dilute with sterile
25% at 3 ml/min water!
Allopurinol 500mg/30 NO Intermittent Infusion – Do not mix with other solutions Stable only 10 hours after
(Aloprim) ml Vial 200-400mg/M²/day dilution at room temp
(Max of 600mg) diluted in 100ml Limited Indication: Hyperuricemia
Xanthine oxidase NS/D5W associated with chemotherapy Do NOT refrigerate
inhibitor Give over 30 minutes Dose reduction recommended for Reconstitute vial with sterile
CrCl < 20 ml/min water only! Further dilute with
NS or D5W
Alprostadil (PGE1) 500 mcg/ml NO Usual dose range for treatment of Very short half-life necessitating Stable x 24 hours at room * See footnote
1 ml vial pulmonary hypertension: 1-150 continuous infusion administration temperature
nanograms/kg/min
Vasodilator/ Common side effects in adults
Prostaglandin System Standard Concentration: 1000 include: flushing, nausea, abd
mcg/100 ml NS (10 mcg/ml) cramps, tachycardia, hypotension,
and edema.
System “Concentrated” Concentration:
2000 mcg/100 ml NS (20 mcg/ml) Monitor respiratory and cardiac status
Max conc: 20 mcg/ml
May cause thrombophlebitis –
recommend central line
administration
Alteplase 100 mg/ Yes, MI – Greater than 67kg: 15 mg over 2 Thrombolytic medication: Monitor Reconstitution must be with *See footnote for
(Activase, TPA, Cathflo) 100 ml (1 Up to 15 mg over min, 50 mg over 30min, 35 mg over for bleeding. sterile water. cardiopulmonary
mg/ml) vial 2 min. (7.5 next 60min. indications (i.e.:
& mg/min) MI - 67kg or Less: 15mg over 2min, Minimize potential risks for bleeding: Conc 0.01-1 mg/ml stable 24 AMI, PE).
*HIGH ALERT 2mg followed by 0.75mg/kg over 30min, Establish all IV’s prior to therapy. hours (if diluent is NS after
MEDICATION* Cathflo then 0.5mg/kg over 60min. Total dose (Minimum of 2 peripheral IVs reconstitution) Monitoring is at
Do not confuse with vials not to exceed 100mg. recommended in addition to physician
other thrombolytic Ischemic stroke: 0.9 mg/Kg up to max thrombolytic infusion site.) Avoid shaking reconstituted discretion for
medicines 90Kg - Give 10% as bolus over 1min, solution. Do not transport via peripheral
then remainder over 60min Avoid unnecessary arterial/venous tube system. vascular
Thrombolytic Pulmonary Embolism: 100 mg over 2 punctures, excessive blood sampling, indications.
hours or IM injections for at least 24 hr Administer via separate IV
after d/c’d (malnourished patients 48 line. No restrictions
Peripheral Vascular Thrombolysis: hr). for alteplase use
Per Interventional for catheter
Radiology/Interventional Cardiology. Apply pressure dressings to all clearance or
Preprinted order sets available. puncture sites. administration of
Catheter Clearing: low doses per
Metro: Give 0.5 ml of 1 mg/ml chest tube.
alteplase and dwell x 60 min. If still
occluded, aspirate alteplase, instill 1 ml
of 1 mg/ml alteplase and dwell 60 min.
If still occluded, aspirate alteplase,
instill 2 ml of 1 mg/ml alteplase and
dwell 60 min. When patency is
restored, withdraw 5-10 ml and discard
then flush with 10 ml NS.
If catheter capacity is greater than
volume of alteplase, then follow dose
with NS to fill catheter volume. If
patency is not restored after 2 ml dose,
contact physician for further orders.
(Metro Nursing Clinical Policy MN-11)
*Use 2 mg dose initially for
hemodialysis catheters and fistulas *
Amikacin 250 mg/ml NO Dilute in 100 ml D5W or NS Aminoglycoside dosing and
(Amikin) 2 ml & 4 Max conc: 5mg/ml monitoring service available from
ml vials pharmacy upon physician order.
Antibiotic/ Infuse over 60 minutes
Aminoglycoside Monitor renal function.
Aminocaproic Acid 250 mg/ml NO Intermittent infusion: Hypotension, bradycardia, arrhythmia Expiration dating: 7 days
(Amicar) 20 ml Vial Typically 1 Gm in 50 ml NS/D5W with too rapid infusion refrigerated.
Infuse over 60 minutes.
Hemostatic / Recommended max dose: 30 Gm/24
Antifibrinolytic Continuous infusion: hr
System Standard Concentration: 5
gm/250 ml NS (20 mg/ml)
Usual dose range: 1 – 1.25 Gm/hr
Cardiac Surgery:
Loading dose: 10 gm/40 mL drawn up
in a syringe & administered IV over 20
minutes.
Maintenance Drip: 2 gm/hr (40mL/hr)
during surgery.
(10 gram/40 mL added to 150mL NS;
total volume 200 mL).
Aminophylline – See
Theophylline
Amiodarone 50 mg/ml Yes, Bolus: 150 mg / 100ml D5W (PVC) Central Line Required if Two-hour stability if mixed * See footnote
(Cordarone) 3 ml vial, V. fib or Pulseless concentration exceeds 2 mg/ml in Poly Vinyl Chloride (PVC)
ampule V-tach: Give 300 System Standard Conc: 450 mg / 250 plastic container.
mg undiluted over ml D5W (Excel Bag) (1.8 mg/ml) Monitoring: Infusions running longer than 2
Anti-arrhythmic 30 seconds. Follow System “Concentrated” conc: 600 Continuous EKG Monitoring hrs require Excel or glass
with 20ml NS mg/88 ml D5W (total volume 100 ml) BP - Monitor during loading containers. Stable 24 hours
flush. May give (Excel Bag) (6 mg/ml) Central line dose: Continuous or q15min x after dilution with D5W in
150 mg after 3 –5 only! 3; then q4-6hr while stable on Excel or glass.
min if infusion.
V.fib/pulseless V- Usual starting dose: Use of in-line 0.22 micron
tach persists Bolus 150 mg in 100ml D5W over 10 filter required for infusions.
Decreasing rate or stopping infusion
min. then 60 mg/hr x 6 hours then 30 may alleviate hypotension and/or Check with pharmacist for
mg/hr x 18 hours via infusion. bradycardia compatibility information.
Preprinted order set available for new
onset A.Fib
Amphotericin B 50 mg and NO Optional Test dose: 0.1 mg/kg up to 1 Test Dose no longer considered Use D5W only
(Fungizone) 100 mg mg in 50 ml D5W. Infuse over 10-30 necessary & no longer recommended.
vials min Protect from light.
Monitoring: VS q15 min x 1 hr then Do NOT filter
Anti-fungal Doses < 25 mg/250 ml D5W q 1 hr for at least 1 hr post-infusion.
26-50 mg/500 ml D5W
Infuse over 3 hours Administer any pre-medications 30 Amphotericin may cause renal
minutes prior to starting daily wasting of K+, Mg+2, HCO3-
infusion – Premeds must be per and Na+ Daily monitoring
physician order. recommended.
Recommended pre-medications: Supplementation may be
Acetaminophen 500-1000 mg PO or required.
650 mg PR ; Diphenhydramine 25-50
mg PO/IV ; Hydrocortisone 25-50 mg
IV (use only in pt history of severe
rigors)
Sodium loading recommended to
prevent nephrotoxicity. 500 ml NS
before and after infusion. Lower
volume (i.e. 250 ml) may be consider
in pt with cardiac compromise or
develop HTN during NS infusion.
Amphotericin B Lipid 100 mg vial NO 3 - 5mg / Kg / Day typical dose Monitor VS q15 min x 1 hr then q 1 Use D5W only
Complex (Abelcet) Dilute with D5W to final hr for at least 1 hr post-infusion.
concentration of 2 mg / ml. Gently agitate solution prior to
Anti-fungal Infuse over 2 hours Administer any pre-medications 30 beginning infusion and every 2
minutes prior to starting daily hours.
infusion
See Amphotericin B for Stable 6 hr at room temp –
recommended pre-meds.
Amphotericin B 50 mg Vial 3 – 5 mg/Kg/Day typical dose Monitor VS q15 min x 1 hr then q 1 Use D5W only
NO
Liposomal Dilute with D5W to final hr for at least 1 hr post-infusion.
(AmBisome) concentration of 1-2 mg/ml Gently agitate solution prior to
Infuse over 2 hours Administer any pre-medications 30 beginning infusion and every 2
Anti-fungal minutes prior to starting daily hours.
infusion Stable 6 hrs after dilution at
See Amphotericin B for room temp
recommended pre-meds.
Ampicillin 0.5, 1 & 2 Up to 1 Gm 50ml NS Penicillin derivative – check
NO
Gm Vial 2Gm 100ml NS allergies
Antibiotic/ Beta-lactam Infuse dose over 30 min
Ampicillin / Sulbactam 1.5 & 3 Gm Not advised <1.5 Gm/50 ml NS Penicillin derivative – check
(Unasyn) Vial 1.6 to 3 Gm/100 ml NS allergies
(2/3 amp, Infuse dose over 30 minutes
Antibiotic/ Beta-lactam 1/3 Dose reduction recommended for
sulbactam) CrCl < 30 ml/min
Anidulafungin 50 mg vial Not advised Intermittent infusion: Histamine-mediated symptoms Reconstitute vials with
(Eraxis) 50 mg in 100 ml NS or D5W (rash, urticaria, flushing, pruritus, accompanying diluent only
100 mg in 250 ml NS or D5W dyspnea, and hypotension) possible
Antifungal 200 mg in 500 ml NS or D5W – infrequent when infusion rate <
1.1 mg/min
MAX infusion rate 1.1 mg/minute
Anticoagulant Citrate 500 ml NO May cause hypocalcemia
Dextrose – A bags Not for intravenous
(ACD-A) administration. Do NOT infuse
directly into patient.
*HIGH ALERT
MEDICATION* Continuous infusion with Continuous
Renal Replacement Therapy (CRRT)
Anticoagulant and Plasmapheresis
Used as anticoagulant for the machines

– not effective as anticoagulant for
patient.
Anti-thymocyte 50mg/ml – NO Intermittent Infusion – Metro: Preprinted order set use is
globulin- Equine 5ml Vial Prevention/treatment transplant mandatory per P&T!!
(Atgam, Lymphocyte rejection: 5-15 mg/kg daily for 7-14 Use NS – Do NOT use D5W
Immune Globulin) days. Frequency and duration may be Test dose recommended prior to first due to possible precipitate
modified in response to peripheral CD3 dose of each cycle. formation
targets. Pre-medication with a corticosteroid,
Immunosuppressant Treatment of aplastic anemia: antihistamine and acetaminophen is Do not shake or transport via
15 - 20mg/kg daily for 5-8 days recommended tube system
See preprinted physician orders for
Dilute into 250-1000ml NS and infuse monitoring parameters.
Use 0.22 micron filter
over at least 4 hours Moderate fever and chills common
(Use concentrations of 4mg/ml or less) during infusion
Do not mix with other solutions
Central line administration

preferred.
Anti-thymocyte 5 mg/ml – NO Treatment acute rejection Monitor BP, HR, respiratory status *See footnote
globulin- Rabbit 5ml Vial Dose: 0.75mg/kg - 1.5 mg/kg daily x continuously. Stop infusion and call
(RATG, Lymphocyte 7-14 days PHYSICIAN stat if SBP < 70, HR > Do not shake or transport via
Immune Globulin, Infuse initial infusion over 6 hours, 150 or dyspnea, bronchospasm, tube system
Thymoglobulin) subsequent infusions over 4-6 hr cyanosis or febrile reaction occurs.
Anaphylaxis may occur. Do not mix with other solutions
Dose will be rounded to the nearest Diphenhydramine 50mg IV and
Immunosuppressant vial size! epinephrine 1 mg (1 ml) required at Central line administration
bedside. preferred. Addition of
hydrocortisone and heparin
Pre-medication with a corticosteroid, recommended if infusing
antihistamine and acetaminophen 1 hr peripherally. Use 0.22micron
prior to infusion is recommended in-line filter
Moderate fever and chills common
during infusion – decreasing rate may Metro: preprinted order set
relieve available
Argatroban 100 mg/ml NO System Standard Conc: 250mg/ 250ml Monitor for signs of bleeding
2.5 ml Vial NS (1mg/ml) Check PTT 3 hrs after dose changes
*HIGH ALERT Do not mix with other
MEDICATION* Treatment of Heparin Induced Argatroban increases INR medications/solutions. Check
Thrombocytopenia: measurement falsely. with pharmacist for
Start at 0.5-2 mcg/kg/min and titrate to Dose reduction recommended for pt compatibility information.
Anticoagulant achieve PTT of 50-80 seconds w/ hepatic insufficiency, azole
Argatroban preprinted order set antifungals, amiodarone or
available. hypotension.
Monitor platelets, Hgb/Hct daily
Platelets < 150,000 – notify physician
Aripiprazole 7.5mg/mL NO NO Do not administer IV or SQ.
(Abilify) vial For deep IM injection only.
IM ONLY
Anti-psychotic
Ascorbic Acid 500 mg/ml Yes, Daily dose may be added to 1000ml May cause dizziness/faintness w/ Stability of opened vial
50ml Vial admin slowly over volume D5W or NS and administered rapid injection questionable after 24 hours due
Antioxidant/ 3-5 minutes slowly over a few hours to oxidation
Nutritional supplement
Protect from light
Also, may be given
IM or SQ
Atracurium 10 mg/ml 5 Yes, Initial bolus: 0.4-0.5 mg/Kg, Metro Nursing Clinical Policy – Refrigerate vials Controlled airway
(Tracrium) and 10 ml administer bolus Usual dose range: 2 – 20 mcg/kg/min Neuromuscular blockade (MN-13) Vials stable x 14 days at room and ventilation
vials doses rapidly temp but then must be required;
discarded Critical Care
*HIGH ALERT Metro: preprinted order set available only:
MEDICATION* System Standard Conc: 500 mg/50 ml for ICU neuromuscular blockade ED, ICU, Surgery
NS (total vol=100 ml) (5 mg/ml) May give undiluted if
necessary Sedation
Neuromuscular -
must be
blocker
administered
prior to and
during
paralytic use!
Atropine 0.1 mg/ ml Yes, NO Bradycardia: 0.5 mg - may repeat Follow dose with 20 ml NS * See footnote
10 ml give rapidly IV for every 3-5 min up to max dose of 0.04 flush – elevate extremity x 10-
Anticholinergic vial/syringe bradycardia mg/kg 20 seconds Pre-procedure use
(Antimuscarinic) 1 mg/ml 1 PEA/asystole: 1 mg every 3-5 min up does not require
ml Slow IV injection to max of 3 mg total Extremely large doses may be cardiac
vial/syringe may cause Pre-procedure medication: Usual needed for treatment of monitoring.
paroxysmal dose is 0.4 – 0.6 mg IV/IM/SC x 1, organophosphate (nerve agent)
bradycardia 30-60 min prior to procedure poisoning.
AzaTHIOprine 100 mg Yes, Dilute in 50 - 100 ml NS Avoid extravasation
(Imuran) Vial 100 mg over 5 min Protect from light
(20 mg/min). Infuse over 30 min
Immunosuppressant
Azithromycin 500 mg NO Infuse over 60 minutes
(Zithromax) Vial (2mg/ml Max Conc)
Antibiotic/ Macrolide
Aztreonam 1 Gm Vial, NO < 1Gm/50 ml D5W over 30 min Dose reduction recommended for
(Azactam) Premix: 1 > 1 Gm /100 ml D5W over 60 min CrCl < 30 ml/min
Gm/50 ml
Antibiotic/ Monobactam
B1 – Vitamin
See Thiamine
B6 - Vitamin
See Pyridoxine
BASILIXimab 20mg Vial NO Intermittent Infusion – Typical dosing: Do not mix with other solutions
(Simulect) 40 mg in 100 ml NS given over 30 Do not shake solution or transport via Stable only 4 hours at room
minutes pre-op 1 hr prior to incision. tube system temp.
Immunosuppressant Then 20mg in 50ml NS – infuse over
30 minutes given POD#4.
BeneFIX
See Factor 9 -
Recombinant
Betamethasone 5mL vial IM only NO Betamethasone 12 mg IM q24h x 2
(Celestone) (6mg/mL) Do NOT doses recommended for all
administer IV pregnancies 24-34 weeks at risk for
Corticosteroid pre-term delivery.
Bivalrudin 250mg Vial Yes, Continuous infusion, weight-based and Dose reduction recommended for
(Angiomax) May bolus 0.75 - indication specific. CRCL < 30 ml/min
1mg/kg depending Dose Range for Therapeutic
*HIGH ALERT on indication Anticoagulation: 0.1 – 0.25 mg/kg/hr Bleeding risk
MEDICATION* and titrated to target PTT. PTT & ACT affected by bivalrudin
Anticoagulant Dose for PCI: Refer to orderset. Pre-printed order sets for Cath Lab
Standard conc: 250 mg/50 ml NS PCI & Therapeutic Anticoagulation
(5 mg/ml) in Heparin Allergic Patients
Bumetanide 2, 4, & 10 Yes, Doses may be diluted in 25-50 ml High doses have been associated with
(Bumex) ml Vial Give at max rate D5W/NS and infused at max rate of muscle stiffness and tenderness
(0.25 mg / of 0.5 mg/min 0.5 mg/min
ml) Monitor BP/ fluid status
Diuretic Continuous infusion –
System Standard Conc: 10 mg/ 60 ml
NS (total volume 100 ml) (0.1 mg/ml)
Buprenorphine 0.3 mg / ml Yes, IV Push or IM preferred Monitor for excess sedation,
(Buprenex) Amp Give 0.3 mg dose cardiovascular and respiratory status
over 2 min.
** NOTE: Reversal may require
Narcotic Analgesic
higher doses of naloxone**
**After naloxone administration -
monitor for risk of recurrent
respiratory depression. **
May cause withdrawal in opioid /
methadone dependent patients.
Butorphanol 1, 2 & 10 Yes, IV Push or IM preferred Monitor for excess sedation,
(Stadol) ml Vial Admin at 0.5 cardiovascular and respiratory status
(2 mg / ml) mg/min
Narcotic Analgesic May cause withdrawal in opioid /
methadone dependent patients.
Caffeine/Sodium 250 mg/ml NO Postdural Puncture Headache: Do NOT refrigerate * See footnote
Monitor BP/HR – may cause
Benzoate 2 ml vial 500 mg x 1 –2 doses hypertension/tachycardia
(Common dilution: 500 mg/L. Given
Stimulant/analgesic over 60-90 min)
Calcitriol 1 mcg/ml 1 Yes, Not advised Discard ampule after use.

Used in the treatment of
(Calcijex) ml ampule 2-3 mcg/min hypocalcemia/secondary
Stable 8 hr in syringe
Vitamin D Analog hyperparathyroidism in chronic renal
failure patients.
Calcium Chloride 100 mg/ml Yes, Incompatible with phosphate * See footnote
IV push should be used ONLY in
(10%) Admin at Intermittent infusion: solutions
emergency situations!
*HIGH ALERT 10 ml 50mg/min (0.5 1 Gm in 25 ml D5W – infuse over
MEDICATION* vial/syringe ml/min) in 30min Avoid extravasation- See PPO 5046 Central line
emergency only. 2 Gm in 50 ml D5W – infuse over for general guidelines / administration preferred
For treatment of 60min management. Never give IM or
severe SQ-Irritant and may cause tissue 1 ml = 27.3 mg = 1.36 mEq
Electrolyte hyperkalemia, may necrosis elemental calcium
give 5-10 ml over Calcium chloride is 3 times as
2-5 min. Adverse reactions that may occur potent as calcium gluconate.
with too rapid administration:
If on digoxin do bradycardia, sense of oppression,
NOT give calcium burning sensation at IV site
IV push!
Calcium Gluconate 100 mg/ml Yes, Intermittent infusion: Avoid extravasation Incompatible with phosphate
(10%) Administer into 1 Gm in 25 ml D5W – infuse over 15 Central line administration solutions
*HIGH ALERT 10 ml Vial large vein at max min preferred.
MEDICATION* rate of 1.5 ml/min 2 Gm in 50 ml D5W – infuse over 30 1 ml = 9.3 mg = 0.46 mEq
min SQ/IM administration not elemental calcium
Infusion preferred! recommended
Electrolyte
If on digoxin do Avoid Extravasation – see PPO 5046
NOT give calcium for general guidelines / management
IV push!
Adverse reactions: same as calcium
chloride
Caspofungin 50 mg, 70 NO Indicated for treatment of invasive Phlebitis common.
(Cancidas) mg vials candidiasis & aspergillosis NS only!!
Intermittent Infusion:
Antifungal Infuse over 60 min Do not mix with any other
50 mg/250 ml NS or medications/solutions!
70 mg/250 ml NS
CeFAZolin 1 & 2 Gm May be given IV Up to 1 Gm /50 ml D5W -- Infuse over Contraindicated in patients with prior
(Kefzol/Ancef) Vials push over 3-5 min 15 min hypersensitivity to cephalosporins
1 Gm/ 50 (i.e. hemodialysis > 1 Gm/100 ml D5W -- Infuse over 30 Check allergies
Antibiotic/ ml D5W patients) min
Cephalosporin premix Routine use of IV Dose reduction recommended
push is not with CrCl < 30 ml/min.
recommended
May be given IM
Cefepime 0.5, 1 & 2 Not advised Infuse doses over 30 minutes Contraindicated in patients with prior
(Maxipime) Gm Vials hypersensitivity to cephalosporins
Check allergies
Antibiotic/
Cephalosporin Dose reduction recommended with
CrCl < 60 ml/min
Cefotaxime 1 & 2 Gm May be given IV Up to 1 Gm/50 ml NS Contraindicated in patients with prior
(Claforan) Vials push over 3-5 min Infuse over 15 minutes hypersensitivity to cephalosporins
(i.e. hemodialysis > 1 Gm/100ml NS Check allergies
Antibiotic/ patients) Infuse over 30 minutes
Cephalosporin Routine use of IV Dose reduction recommended
push is not with CrCl < 50ml/min.
recommended
Cefoxitin 1g & 2 g May be given IV Infuse over 15-30 minutes Contraindicated in patients with prior
(Mefoxin) vials, push over 3-5 min hypersensitivity to cephalosporins
Premix: (i.e. hemodialysis Check allergies
Antibiotic/ 1g /50 ml patients) Max rate:
Cephalosporin 1 gm/3 min Dose reduction recommended
Routine use of IV with CrCl < 50 ml/min.
push is not
recommended
Ceftazidime 1 g & 2g May be given IV Infuse over 30 minutes Contraindicated in patients with prior
(Fortaz) vials push over 3-5 min hypersensitivity to cephalosporins
(i.e. hemodialysis Check allergies
patients)
Antibiotic/ Routine use of IV Dose reduction recommended
Cephalosporin push is not with CrCl < 50 ml/min.
recommended
CefTRIAXone 250 mg, NO Infuse over 30 minutes Contraindicated in patients with prior
(Rocephin) 500 mg, 1 hypersensitivity to cephalosporins
& 2 g vials. Check allergies
Antibiotic/ Premix: Do NOT co-administer with IV
Cephalosporin 1g/50 ml calcium products.
Cefuroxime 0.75 & 1.5 May be given IV Infuse over 15 to30 minutes Contraindicated in patients with prior
(Zinacef) Gm Vials, push over 3-5 min hypersensitivity to cephalosporins
Premix: (i.e. hemodialysis Check allergies
Antibiotic/ 1.5 g/50 ml patients) Max rate:
Cephalosporin 750 mg/3 min Dose reduction recommended
Routine use of IV with CrCl < 20 ml/min.
push is not
recommended
Chloramphenicol 1 g vial Yes over at least Usual dose is 50 mg/kg/day divided Q May cause idiosyncratic aplastic Stable in NS and D5W Do NOT
1min (100mg/mL) 6 hr - infuse over 15-30 min anemia. administer IM.
Antibiotic May cause dose related bone marrow
Maximum concentration for infusion: suppression. Monitor CBC.
<20mg/mL
Chlorothiazide 500 mg vial Yes, May be diluted with D5W or NS and May cause hypokalemia, Do NOT give SC/IM – avoid
(Diuril) Slowly give given as infusion over 10 min hyponatremia, and hypochloremic extravasation!!
500mg over 10 alkalosis – monitor electrolytes
minutes Reconstitute each 500mg vial
Thiazide Diuretic (50mg/min) Monitor BP, fluid status with 18 ml sterile water – use
immediately
Usual dose: 0.25 –
1 gm daily to twice
daily
ChlorproMAZINE 25mg/ml Yes, Up to 50 mg/25 ml D5W infused Slow rate of administration if extra- Avoid mixing with alkaline SQ
(Thorazine) vial Dilute with NS to slowly over at a rate of 0.5-1mg/min pyramidal symptoms develop solutions administration
(1 & 2mLs) conc of 1 mg/ml (dystonia, motor restlessness, not
(Dilute 1 ml with Parkinson-like symptoms) – may be recommended.
Antipsychotic 24 ml NS) treated with diphenhydramine 50mg
IV per physician order
Max rate of
admin is 1 May cause hypotension (esp. in
mg/min elderly or given IV)
BP, HR monitoring recommended w/
May be given IM IV administration
Cidofovir 375 mg NO 5 mg/Kg dose in 100ml NS. Give 2gm probenecid 3 hours prior to Pharmacy to prepare dose using
(Vistide) Vial Infuse over 60 minutes – Administered cidofovir dose and 1gm at 2 and 8 chemotherapy precautions
(75 mg/ml) every 1-2 weeks. hours after infusion
Antiviral Administer and discard using
Maximum recommended concentration Infuse 1 L NS over 1-2 hours chemotherapy
is 5 mg/ml immediately before each cidofovir precautions.
dose. Patients who can tolerate
additional fluid should receive a
second liter either at the start of the
To minimize potential cidofovir infusion or immediately
nephrotoxicity, probenecid and IV afterwards and infused over a 1-3 hour
saline pre-hydration must be period
ordered with each infusion
Monitor renal function.
Contraindicated with
CrCl<55mL/min or SrCr>1.5
Ciprofloxacin Premix: NO 400mg/200ml in D5W premixed Dose reduction recommended
(Cipro) 400 mg/200 Infuse over 60 minutes with CrCl < 50 ml/min.
ml D5W (2
mg/ml) Max conc: 2 mg/ml
Antibiotic/ 20ml Vial
Fluoroquinolone (10 mg/ml)
CISatracurium 2 mg/ml 5, Yes, Continuous infusion: Metro Nursing Clinical Policy on Refrigerate vials Controlled airway
(Nimbex) 10 ml vials Admin bolus doses Usual dose range: 0.5 – 10 Neuromuscular Blockade (MN-13) Vials stable x 21 days at room and ventilation
rapidly – 0.2 mcg/kg/min temp but then must be required;
*HIGH ALERT 10 mg/ml mg/Kg discarded. Critical Care
MEDICATION* 20 ml vial System Standard Conc: 200 mg/ 80 ml only:
NS (total volume 100 ml) (2 mg/ml) May give undiluted if ED, ICU, Surgery
necessary
Neuromuscular-
blocker Sedation must
be
administered
prior to and
during
paralytic use!
Clindamycin 6 ml Vials NO Doses < 300 mg, infuse over 15 min Contraindicated for patients with
(Cleocin) (150mg/ml) Doses > 300 mg, infuse over 30 min allergy to lincomycin (Lincocin)
Premix:
Antibiotic 300 mg/50
ml, Max conc: 18mg/ml
600 mg/50
ml, 900
mg/50 ml
Codeine 15 mg/ml, NO NO IV administration may lead to severe
30 mg/ml hypotension. Do not give IV.
and 60 IM or SQ
Narcotic Analgesic mg/ml administration
Monitor respiratory status – may
syringes preferred
cause respiratory depression or
distress
Reverse effects with naloxone
(Narcan)
Colistimethate/colistin 150 mg vial Yes, Intermittent infusion preferred: Monitor renal function – may
(Coly-Mycin M) Slowly over 3-5 Dilute in 50 ml NS and infuse over 30 cause/exacerbate acute renal failure
min minutes Dose reductions recommended with
Antibiotic decrease renal function
Monitor neuro status – may cause

neurotoxicity.
Conivaptan 20 mg/ 4 NO
(Vaprisol) ml ampule Loading dose: 20 mg in 100 ml D5W Indicated for the treatment of
infused over 30 minutes euvolemic symptomatic
hyponatremia Dilute with D5W only!
Continuous infusion over 24hours:
Vasopressin antagonist 10mg/250mL D5W or Overly rapid correction of sodium Infuse via separate line.
20 mg in 250 ml D5W or (>8-12 mEq/L/24 hrs) may result in
40 mg in 250 ml D5W serious sequelae. Protect ampule from light.
Total duration of therapy not to exceed VASCULAR IRRITANT!

4 days. Peripheral infusion site must be
rotated every 24 hours – infuse via
large vein only!
Serial serum sodium levels

(recommended every 6 hours)
required with physician call back
parameters (minimum: Call physician
if increase in serum sodium > 8 mEq
in 24 hours or >0.5mEq/L/hr). If
levels and call back parameters not
included in original order,
physician must be contacted for
order per Metro P&T
Cosyntropin 250 mcg Yes, Intermittent infusion: 250mcg/250 ml 250 mcg = 25mg corticotropin
(Cortrosyn) Vial 250 mcg/ml in NS NS or D5W (ACTH) Infusion stable 12 hr
over 2 min. (125 Infuse over 6 hours
Diagnostic – Adrenal mcg/min)
function
CycloSPORINE 50 mg Amp NO Due to the risk of anaphylaxis, patients
(Sandimmune) (10 mg/ ml) Intermittent Infusion – typically q 12 receiving cyclosporine IV should be
hr Use admin set provided by
under continuous observation for at
For doses < 12.5 mg, give over 60 min pharmacy (Non PVC tubing)
least the first 30 minutes following
For doses > 12.5 mg, Infuse over start of the infusion and at frequent
minimum of 2 hours. Protect ampule from light
intervals during. Epinephrine should
Concentration must be 0.4 – 2 mg/ml
be available (UBC) during 1st 30
minutes
Continuous infusion – Change bag
daily at 1800 IV dose = 0.33 x PO dose
System Standard Conc: 250 mg/250 ml
NS (Excel) (1 mg/ml)
System “Concentrated” Conc: 250 mg/
Monitor cyclosporine trough
Immunosuppressant 100 ml NS (Excel) (2.5 mg/ml)
concentrations.
Cytomegalovirus 1 Gm and NO Usual Dose: 50-150mg/kg – doses up Start infusion within 6 hr of
Monitor vital signs before, midway
(CMV) Immune 2.5 Gm to 400mg/kg for severe CMV infection entering vial. Complete
through, after infusion and before any
Globulin (CytoGam) Vials infusion within 12 hr of
change in rate.
Initial Dose: 15 mg/kg/hr entering vial.
- May increase to 30 mg/kg/hr if no Potential adverse reactions: flushing,
adverse reactions after 30 min. Administer through IV line
chills, muscle cramps, back pain,
- May increase to max rate of 60 with in-line 15micron filter.
fever, nausea, vomiting, wheezing, and
mg/kg/hr if no adverse reactions after a decreased blood pressure.
subsequent 30 min. Do NOT exceed 60 Administer using a separate IV
mg/Kg/hr!! Max volume = 75 ml/hr line. May be "piggybacked"
If patient develops minor side effects
Subsequent Doses: 15 mg/kg/hr for 15 into pre-existing line of NS or
(nausea, back pain, flushing), slow the
min, then 30 mg/kg/hr for 15 min, then D5W, however CMV-IG should
IV rate or temporarily interrupt the
60 mg/kg/hr if no adverse reactions not be diluted more than 50%.
infusion.
Do NOT exceed 60 mg/kg/hr!!
CMVIG/ IgG antibody to Max volume = 75 ml/hr. If anaphylaxis or hypotension
CMV occurs, discontinue the infusion and
contact the physician.
Daclizumab 5mg/ml – NO Intermittent Infusion – 5 doses define standard course of Stable 24 hours after dilution
(Zenapax) 5ml vial 1mg/Kg diluted into 50ml NS. therapy. First dose before transplant refrigerated
Infuse over 15 minutes via peripheral and subsequent doses 14 days apart Stable 4 hr at room temp
or central line.
Do not mix with other solutions
Immunosuppressant Do not shake solution or
transport via tube system
Dalfopristin / 500mg Vial NO Usual dose: Flush IV lines before and after
Quinupristin 7.5mg/Kg (in 250 ml D5W) q 8-12 hr admin with D5W only, avoid Do not shake
(Synercid) NS
Infuse over 60 minutes
Infusion site reactions common –
Concentrated solution in 100ml D5W – pain, burning, itch – further dilute
Antibiotic central line administration only doses (500-750mL) if these occur
Arthralgia & myalgia common
Dalteparin Pre-filled NO Not advised. SC administration only! Do NOT See syringe for manufacturer
(Fragmin) syringes, give IM expiration date
multi-dose SC
Anticoagulant/ Low vial administration
molecular weight heparin only! Do NOT
give IM
Dantrolene 20 mg Vial Yes, Malignant Hyperthermia (MH): Staff in areas where stored to Dilute with STERILE
(Dantrium) Rapid admin Prevention: 2.5 mg/Kg infused over periodically check expiration WATER only – 60 ml per 20
advised for 60 minutes 1.25 hours prior to date on vials to insure use of in mg = 0.33 mg/ml.
Malignant treatment of anesthesia. Prepare immediately before
date medication when needed.
Hyperthermia Hotline Malignant administration. Six-hour
(for contact with MH Treatment: 2.5 mg/Kg infusion stability at room temp.
Hyperthermia Avoid extravasation – central line
expert) (MH) given rapidly. Repeat dose every 5 administration preferred. Do not
1-800-MH-HYPER min until symptoms subside or withhold care if no central access ** Powder in vials may take
(1-800-644-9737) 10mg/Kg (recommended upper available!! several minutes to dissolve
limit) has been reached (subsequent **
doses may be given as needed!) Monitor urine output
Then continue 1 mg/kg every 4-8 hr
for 24 – 48 hrs. Call Code 4 and/or pharmacy
for assistance if treating MH
Muscle relaxant
DAPTOmycin 250 mg, NO Dilute in 100 ml NS – Dose reduction recommended for CrCl **Not compatible in
(Cubicin) 500 mg vial Infuse over 30 min < 30: q48 hr dextrose!!
Usual dose: 4-6 mg/kg IV q24h May cause elevated CPK levels – Stable 12 hr at room temp/48
monitor for myopathy hrs refrigerated
Antibiotic Max concentration: 20mg/mL
Check with pharmacist for
compatibilities
Darbepoetin alfa Vials: Yes, Not necessary Monitor for injection site pain, Do not shake product or Restricted to
(Arenesp) 25 mcg/ml SQ or IV bolus headache, arthralgias, and myalgias. transport via tube system Outpatient
40 mcg/ml Hemoglobin <10 in chemotherapy- administration
Red cell stimulating 60 mcg/ml induced anemia. Refrigerate only.
hormone 100 mcg/ml Hemoglobin < 12 mg/dl in chronic Check
200 mcg/ml kidney disease / other indications. hemoglobin prior
to administration.
Notify physician
prn for dose
reduction or
interruption based
on most recent
hemoglobin.
Deferoxamine 500 mg, NO Dose varies with indication. Flushing, hypotension and shock have Reconstitute with STERILE
(Desferal) 2000 mg Acute Iron Overload: IM route preferred been reported with IV administration – WATER then dilute with NS
Vials IM administration unless pt in shock. Recommended dose slow infusion rate if this occurs.
preferred is 1000 mg then 500 mg Q 4 hr x 2 Chronic Iron Overload: 500 – 1000 mg
doses. Subsequent doses may follow. daily IM
May be given SC Max dose = 6 Gm/24 hr. 2000 mg IV with each unit of Protect from light
If given via IV infusion: Max rate = 15 transfused blood – administered
mg/kg/hr for first 1000 mg then max separately. Max rate = 15 mg/kg/hr. Do NOT Refrigerate
rate of 125 mg/hr for subsequent doses. Max dose = 6 Gm/24 hr no matter
amount of blood transfused.
Iron Chelating agent Dilute in 500 ml or 1000 ml NS
Desmopressin 1 ml Vial Yes, Usual Dose: 0.3 mcg/kg in 50 ml NS Monitor HR and BP during infusion Refrigerate vial
(DDAVP) (4 mcg/ml) for treatment of given over 15-30 min and for 60 minutes after.
diabetes insipidus To stabilize hemostasis before surgery Stable 12 hr after diluted
Hormone – Vasopressin – may give 2-4 administer 30min prior to procedure. When used to manage diabetes refrigerated
analog mcg/d Give at max Children < 10 kg, -dilute in 10 ml NS insipidus, monitoring of urine output
rate of 4 mcg/min every 8 hr recommended
May be given May cause hyponatremia – monitor
subcutaneously Na+
Dexamethasone 4 mg/ml 1, Yes, IV Push preferred. Doses > 10 mg may be ordered as
(Decadron) 5, 25 and IV Push preferred intermittent IV infusion
30 ml vials – all doses over 2 Doses may be diluted in NS or D5W Pt may complain about perianal
Corticosteroid 24 mg/ml 5 min. IM injection used in OB – 6 mg IM itching/tingling with doses > 10 mg
ml vial q12h x 4 doses recommended as
alternative to betamethasone for all
pregnancies 24-34 weeks at risk for
pre-term delivery.
Dexmedetomidine 200mcg/2m After bolus, start at 0.4 mcg/kg/hr Hypotension in 30% of patients; Critical Care only
(Precedex) l vial Loading dose of Increase 0.1 mcg/kg/hr q 10 minutes up Bradycardia may occur
1mcg/kg given to maximum of 0.7 mcg/kg/hr Monitor cardiovascular and respiratory
Sedative over 10 min status
Usual dose range: 0.2 – 0.7 mcg/kg/hr Potentiates effects of opioids &
benzodiazepines. Anticipate dose
System Standard Conc: 200 mcg/50 ml reductions / titrate to effect.
NS (4 mcg/ml) Agent lacks amnestic properties.
Usual duration of infusion < 24 hr
Preprinted order set available
Dextran-40 Solution 10% in NS Not advised For plasma volume expansion Do not administered unless
or D5W – Total dose during first 24 hours should Observe for signs of allergic reaction. solution is clear
Plasma volume expander 500ml not exceed 20ml/Kg (2 Gm/kg)
Check bag for expiration
Therapy should not exceed 5 days
Dextrose 50% Solution 25 Gm / Yes, Reversal of severe hypoglycemia Highly osmotic solution! Irritating to
50ml Administer at when oral intervention is not possible. peripheral veins - give via central
(500mg/ml) rate not > line whenever possible
Hypertonic glucose vial/syringe 5Gm/min or Avoid Extravasation – see PPO
10ml/min 5046 for general guidelines /
management
Preprinted inpatient hypoglycemic
order set available.
DIAZepam 5 mg/ml – Yes, Do not dilute – precipitation Avoid extravasation. Incompatible with many
(Valium) 1 & 2 ml Admin at rate not Thrombophlebitis is common – give medications and solutions –
syringes, > 5mg/min preferably into Y-site of running IV. contact pharmacist
Sedative/ Vials
Benzodiazepine IM absorption Monitor cardiovascular and respiratory
erratic. status. May cause respiratory
depression.
Reverse with flumazenil

(Romazicon)
Diazoxide 300mg/20m Yes, Dilution not advised Avoid extravasation Use Central Line Do not mix with other IV * See footnote
(Hyperstat) l Give rapidly over if available. medications.
(15mg/ml) 30 seconds If infused – give 15-30 mg/min Protect from light.
Diuretic Do not administer IM/SQ Darkened solutions should not
be used.
Digoxin 0.25mg/ml Yes, undiluted & Slow IV Push recommended Check apical pulse prior to
(Lanoxin) – 2ml Amp give slowly over administration. If heart rate is less
at least 3-5min or than 50 BPM or otherwise specified –
Cardiovascular/ Positive diluted to 10ml HOLD dose & call physician
inotrope NS & give slowly
over at least 3-5
min
Digoxin Immune FAB 38 mg Vial Yes, Diluted in 50ml NS. Monitor vital signs & ECG *See footnote
(Digibind, Digifab) (Digibind) 10mg/ml -ONLY Infuse over 30 min. Monitor for hypokalemia – obtain Use reconstituted product
40 mg vial if Cardiac Arrest is serial potassium levels especially immediately.
Digoxin antidote (Digifab) imminent. Give Metro: ** Dose rounded to nearest during the hours after administration
over 5 min. vial per P&T ** Use administration set provided
Preprinted order set available Digoxin serum level assay not by pharmacy which includes
accurate after digibind. Pharmacy 0.22 micron filter
will notify lab pt has received digoxin
immune FAB
Dihydroergotamine 1mg/ml – Yes, Continuous infusion may be used in Total IV dose should not exceed 2 Protect ampule from light
(DHE) 1ml amp Give at max rate status migranosis mg/day (3mg/day if continuous
of 1mg/min infusion). Total weekly dose should
Antimigraine/ Ergot not exceed 6 mg (20mg over 7 days if
alkaloid May be given IM continuous infusion).
Monitor HR and BP.

Contact physician immediately (and
stop infusion if continuous infusion)
if chest pain develops. Contact
physician immediately if
numbness/tingling of extremeties,
nausea/vomiting unrelieved by
antiemetics, leg cramping,
or coldness of skin develops.
Contraindicated in patients with

hypersensitivity to ergot alkaloids –
ergotamine.
Contraindicated if ergotamine or
triptan used within past 24 hours
Contraindicated with multiple drug
classes (i.e. MAO-Inhibitors, potent
inhibitors of 3A4).
Contraindicated in patients with
ischemic heart disease.
Diltiazem 5mg/ml – 5 Yes, System Standard Conc: 125 mg/100 ml Increase infusion rate by 5 mg/hr Solution (vial) should be stored * See footnote
(Cardizem) & 10 ml Initial dose: 0.25 NS (total vol=125 ml) (1 mg/ml) every 60 min if HR remains > 100 in refrigerator.
Vial, 5 ml mg/kg over 2 min beats per minute.
syringe Second dose: 0.35 System “Concentrated” Conc: 125 Maximum Dose: 20mg/hr
mg/kg over 2 min, mg/25 ml NS (total volume 50 ml) Check with pharmacist
give after 20 (2.5 mg/ml) D/C infusion if HR < 60 BPM, 2nd or regarding compatibility
minutes if response 3rd degree AV block, junctional information.
to first dose is poor Usual dose range: 5 – 15 mg/hr rhythm or asystole.
Or
15-20mg IV push Onset: 2-5 min Monitoring:
over 5-10min; may Half-life: 3-9 hr
Cardiovascular/ Calcium Continuous EKG Monitoring
Channel Blocker repeat in 30min x 1 BP - Following initiation or
dose titration: Continuous
Administration
through running IV
BP or q15min x 3, then q4h x
line preferred 4 then q4-6hrs while stable.
Pre-printed order set available for

new onset A.Fib
DiphenhydrAMINE 50mg/ml Yes, Usual dose: 25-50mg Max single dose: 100 mg Dilute to concentration of 25
(Benadryl) 1 & 10 ml Max rate of 25 IV Push Preferred Max dose/day: 400 mg mg/ml with NS or D5W
Vial mg/min
Antihistamine 1 ml
Syringe May be given IM
DOBUTamine 500mg in NO System Standard Conc: 500 mg/250 ml Continuous EKG Monitoring * See footnote if
(Dobutrex) 250ml D5W Premix (2 mg/ml) May have slight pink titrating dose.
D5W Pre- Monitoring: Following initiation or coloration which is normal
mix Bag System “Concentrated” conc: 500 dose titration - Continuous BP or Not necessary for
mg/60 ml NS (total volume 100 ml) (5 q15min x 3, then q4-6hrs while maintenance
Cardiovascular/ Positive
12.5 mg/ml mg/ml) stable. infusion for CHF
inotrope
20ml Vial
Usual dose range: 2 – 20 mcg/Kg/min Monitor for ectopy, increase in heart
rate
Onset: 2 min
Half-life: 2 min Irritant to tissues –administer via
large vein. Central line preferred.
Avoid Extravasation – see PPO 5046
for general guidelines / management.
Dolansetron 20 mg/ml Yes, Dose may be diluted in 50 ml May cause QT prolongation Do not mix with other Non-formulary.
(Anzemet) 0.625 ml Give 12.5 – 25 mg D5W/NS. Infuse over 15 min medications. Autosubstitution
ampule, over 30 seconds to ondansetron
Antiemetic/ 5HT3 20mg/ml
receptor antagonist 5 & 25ml
vials
DOPamine 400 mg/250 NO System Standard Conc: 400 mg/250 Monitoring - Following initiation * See footnote
(Inotrope) ml D5W ml D5W Premix (1.6 mg/ml) or dose titration: Continuous BP Consult pharmacist for
Premix Bag or q15min x 3, then q4x 4 then compatibility information.
System “Concentrated” Conc: 800 Central Line
mg/250 ml NS (3.2 mg/ml) q4-6h while stable. Avoid infiltration –
Vasopressor 40 mg/ml- Administration
5 & 10 ml Phentolamine (Regitine) Required unless
Usual dose range is 2 – 20 mcg/kg/min intradermally
Vial order obtained
Onset: 5 min Dopaminergic effects: /subcutaneously from physician
80 mg/ml – Duration of action: 10 min < 5 mcg/kg/min recommended for for peripheral
5 ml vial Half-life: 2 min Beta effects (Improved Cardiac management administration!!
Output): 2-10 mcg/Kg/min Midline access is
Alpha > Beta Effects Avoid Extravasation – see not = to a
(Vasoconstriction): PPO 5046 for general central line.
> 10-15 mcg/Kg/min guidelines / management Check IV site
every 30
Central Line Administration minutes while
Required unless order obtained dopamine is
from physician for peripheral administered
administration!! peripherally.
Check IV site every 30 minutes
while dopamine is administered
peripherally.
Doxercalciferol 2 mcg/ml 1 Yes, Not advised Used in the treatment of secondary Protect from light
(Hectorol) ml and 2 ml 2-4 mcg/min hyperparathyroidism in chronic renal
ampules failure patients. Discard ampule after use.
Vitamin D Analog
Doxycycline 100 & 200 NO Max conc = 1 mg/ml Avoid extravasation -Irritant to Stable 12 hr at room temp or
(Vibramycin) mg Vial tissues 72 hr refrigerated
Infuse over minimum of 60 min Protect from light
Antibiotic/ Tetracycline
Droperidol 2.5mg/ml – Yes, May dilute dose to 50 ml in D5W or Use with caution if cardiovascular
(Inapsine) 2, 5ml vials Give at max rate NS - administer over 15 min disease is present.
of 2.5 mg/min
Antiemetic May cause QT prolongation. Avoid in
May be given IM patients with prolonged baseline QT.
Normalization of potassium and
magnesium levels recommended.
Monitor for hypotension & tachycardia
– monitor BP and HR.
Monitor for extrapyramidal effects
Contraindicated in Parkinson’s
patients.
Drotrecogin alfa 5mg & NO Weight based dose rounding – Significant risk of bleeding Stable for 12 hr only. Critical Care
(recombinant activated 20mg vials 24mcg/kg/hr X 96 hours
Protein C, Xigris) Standard Bags: (100mcg/ml) Mandatory pre-printed physician
5mg/50ml NS order set to review indications,
10mg/100 ml NS warnings and contraindications!
Adjunctive treatment for 15mg/150 ml NS
severe sepsis 20mg/200 ml NS Patient must meet criteria to be
25mg/250 ml NS eligible to receive drug!
Hold infusion x 2 hr prior to invasive

procedure (procedure with inherent
risk of bleeding).
Restart infusion immediately for
uncomplicated less invasive
procedure.
Hold for at least 12 hr after major
invasive procedure/surgery.
Edetate CALCIUM 200mg/mL NO Dose varies with indication. If given IM, add lidocaine 1% 1 ml Telemetry
Disodium (CaEDTA) – 5 ml vial Usual Dose: 500-1000 mg/m2/day in for each 1 ml of CaEDTA monitoring
(Calcium Disodium IM route preferred 500 ml D5W/NS Establish urine flow with adequate IV advised
Versentate) for patients with Infuse over at least 4 hrs – 8-12 hrs fluids prior to administration
cerebral edema or recommended Dose reduction recommended for SCr
*HIGH ALERT lead > 2 mg/dl
MEDICATION* encephalopathy ***Caution: Do not confuse with
Edetate Disodium (Endrate) – verify
Heavy metal chelator product & indication. Confusion of
products has resulted in fatalities.***
Enalaprilat 1.25 mg/ml Yes, May dilute in 50 ml NS – give over 10 Peak Blood Pressure reduction may
(Vasotec IV) 1 & 2 ml Max rate: 1.25 min be anticipated within 15 minutes of
vial mg/ml over 5 min administration – Monitor BP
Antihypertensive/ ACE
inhibitor
Enoxaparin Pre-filled Yes, NO Contraindicated in patients receiving See syringe for manufacturer
(Lovenox) syringes 30 mg for cardiac heparin (increased bleeding risk) and expiration date.
and multi- indications over 1 heparin-induced thrombocytopenia.
Anticoagulant/ Low dose vial minute x 1 only Do not expel air bubble in
molecular weight heparin Usually given SQ Preprinted order set available for syringe before administering
DVT/PE Treatment dose.
Doses rounded to nearest 10mg Dose reduction recommended

for patients with CrCl < 30
ml/min
EPHEDrine 50 mg/ml, Yes, NO Monitor HR, BP every15 min and Critical Care
1 ml amp. Slowly at max Usual Intermittent IV dose: 5-25mg urine output every 1-2 h –
Vasopressor rate of 25 mg/min repeated q5-10min as needed
Consider continuous ECG
May be given IM/SQ Recommended max of 150 mg/24 hr
EPINEPHrine 1 mg/ml, Yes, System Standard Conc: 4 mg/250 ml Monitor BP, HR and rhythm every 15 Critical Care
1 ml amp & Usual dose is 1 mg NS (16 mcg/ml) min. Preferred measurement of BP
30 ml vial Give rapidly & per arterial line if possible. Do not use discolored solutions
Vasopressor
follow with NS System “Concentration” Conc: 8
mg/100 ml NS (80 mcg/ml) Monitor urine output every 1-2 hr Protect from light
flush
Avoid Extravasation – see PPO 5046 Incompatible with many meds
May be given Usual dose range: 1 – 10 mcg/min and solutions – contact
IM/SQ in for general guidelines / management
Phentolamine intradermally pharmacist
treatment of
hypersensitivity Dose may be given via ET tube if no /subcutaneously recommended for **Check label as not all
reactions/ IV access at 2 to 2 ½ x IV dose, diluted management epinephrine can be given IV
anaphylaxis/asthm in 10 ml NS **
a Central line administration
advised!
Epoprostenol 0.5 and 1.5 NO Continuous infusion required. Avoid interruptions of infusion Dilute only with * See footnote
(Flolan) mg vials Upon admission, patients are ( half-life = 6 min) – loss of disease manufacturer-supplied
for converted from home infusion device control could lead to death diluent!
Vasodilator/ reconstituti to hospital IV infusion pump.
Prostaglandin on Monitor for hypotension, flushing,
Usual starting dose is 2 nanogram/ headache, N/V, anxiety & chest pain. Protect from light
Kg/min. Titrate per physician orders.
A “Flolan Dosing Weight” is ** Metro: Bag must be
**Metro: preprinted order set established and used throughout the changed every 8 hr even if
available – use advised! ** patient’s therapy. The “Flolan Dosing bag not empty **
Weight” should be used when
calculating infusion rate.
Eptifibatide 2mg/ml – Yes, Continuous Infusion – Pre-printed order set available for
(Integrelin) 10ml Vial 180mcg/Kg bolus Acute Coronary Syndrome/PTCA: ACS/PTCA Compatible with heparin
for loading over 1-2 minutes. 0.5 - 2 mcg/Kg/min (max 15 mg/hr)
Antiplatelet IIb/IIIa doses & ACS – x 1 Monitor for bleeding. Use vented set to administer
0.75mg/ml PTCA - Repeat System Standard Conc: 75 mg/ 100 ml Recommended to decrease infusion undiluted eptifibatide
100ml Vial bolus in 10 min Premix (0.75 mg/ml) rate to 1 mcg/kg/min for pt with SrCr
for 2 –4 mg/dl
maintenanc
e infusions
Ertapenem 1 Gm vial NO 1 Gm/50 ml NS Caution with PCN allergy – check Stable 6 hr at room temp or 24 Restricted
(INVanz) Infuse over 30 min allergies hr refrigerated – use within 4 hr indications per
May be given IM after removal from refrigerator P&T
Antibiotic/ Carbapenem Dose reduction recommended for
CrCl < 30 ml/min Stable in NS only!
Erythromycin 500 & NO Up to 500 mg in 100ml NS Slow infusion rate if vein irritation Stable 24 hours refrigerated, 8
1000mg 501 - 1000 mg in 250ml NS occurs hours at room temp after
Antibiotic/ Macrolide vials (Max Concentration = 500mg/100ml dilution
NS) Avoid Extravasation – see PPO 5046
Infuse all doses over 60 min. for general guidelines / management
Erythropoietin, 2,3,4,10, 20 Yes Dilution not advised Monitor for hypertension, fever, Do not shake product or Check
epoetin alfa & 40 Give SQ or IV headache, arthralgias & nausea transport via tube system hemoglobin prior
(Epogen, Procrit) thousand Push over 30-60 Chronic Renal Failure: Recommended to administration.
units/ml seconds initial dose: 50 – 100 units/kg SQ or IV Goal: Refrigerate vials See EMAR for
vials 3 times per week. SQ may be Hemoglobin <10 in chemotherapy- Hold parameters.
Red cell stimulating 20,000 administered weekly induced anemia. Notify physician
hormone unit/2 ml Hemoglobin < 12 mg/dl in chronic prn for dose
Multi-dose kidney disease / other indications. reduction or
vial interruption based
on most recent
hemoglobin.
Esmolol 10mg/ml Yes, System Standard Conc: 2.5 gm/250 ml Monitor BP and Heart Rate/Rhythm Telemetry /
(Brevibloc) 10 ml Vial IV push loading NS Premix (10mg/ml) every 5-15 min during dose initiation Critical Care
doses (500 and titration. Advised
Premix: 2.5 mcg/Kg) over 60 System “Concentrated” Conc: * See footnote
Cardiovascular/ Beta-
Gm/250 ml seconds 2000mg/100 ml NS (20 mg/ml)
Blocker
Central Line Only Doses > 200 mcg/kg/min do not have
Dose range: 50 – 200 mcg/Kg/min increased benefits
(Titrate in 50 mcg/Kg/min increments
every 5 min to desired response) Contraindications: 2nd/3rd degree AV
block, sinus bradycardia, cardiogenic
Onset: immediate shock
Peak response: 5 min
Duration: 10-30 min
Half-life: 9 min
Esomeprazole 20 mg, 40 Yes, System Standard Concentration: 80 Continuous infusion duration should Reconstitute vial with 5 ml NS.
(Nexium IV) mg vials 5 ml over 3 mg/ 250 ml NS (0.32 mg/ml) not exceed 72 hr Use within 1 hour of
minutes reconstitution.
Usual dose for GI bleeds: 80 mg (in
Proton Pump Inhibitor Reconstitute vial 100ml NS) bolus over 30 minutes then Diluted solution stable for 12
with 5 ml NS 8 mg/hr continuous infusion hours (NS)
Do not administer with other

medications/fluids – check with
pharmacist for compatibility
information
Estrogens, Conjugated 25 mg vial Yes, Not advised Slow rate of administration if Refrigerate before and
(Premarin IV) 5mg/min at body/facial flushing occurs following reconstitution.
5 mg/ml conc. Usual intermittent dose -slow IV push Do not use darkened solution.
Hormone - Estrogen Abnormal uterine bleeding: 25mg Used for treatment of abnormal
Uremic bleeding: 0.6mg/kg/day uterine bleeding. Also used for Do not shake vial!!
uremic bleeding. Do not mix with other
solutions/medications
** Verify dose to be given. Discard
vial after drawing up correct dose. **
Ethacrynic acid 50 mg Vial Yes, Slow IV push recommended Slow rate of administration if vein
(Edecrin) Give over > 3 min irritation occurs and/or consider
Max of 100 mg different IV site
Diuretic per single dose
No IM/SC administration!
Etidronate Disodium 50mg/ml – NO Usual dose for treatment of Temporary taste loss not uncommon
(Didronel IV) 6ml Amp hypercalcemia: 7.5 mg/Kg/day x 3 following IV etididronate
(300mg) days
Inhibitor of bone Diluted in 250ml NS – infuse over Adequate hydration recommended
metabolism minimum of 2 hours prior to administration
(3 mg/ml max concentration) Too rapid administration may lead to
renal insufficiency
Dose decrease recommended in pt
with SrCr 2.5 – 4.9 mg/dl. Not
recommended in pt with SrCr > 5
mg/dl
Etomidate 2 mg/ml Yes NO Monitor BP, HR and RR Critical Care

10 ml vial, 0.3 mg/Kg over
**HIGH ALERT 20 ml 15-60 seconds Pain at injection site common
MEDICATION** vial/syringe Transient myoclonic
movement/seizure-like activity may
occur.
Sedative
Nausea/vomiting common
Etomidate has no analgesic
properties.
Exenatide Pre-filled No NO Not for use in Type 1 diabetics or for Non-formulary.
(Byetta) syringes the treatment of diabetic ketoacidosis Refrigerate Patient may use
SC Do NOT mix with insulin!! own supply if
**HIGH ALERT administration Common side effect: nausea deemed necessary
MEDICATION** ONLY & appropriate by
prescriber.
Incretin
mimetic/adjunctive
therapy for diabetes
Factor VIIa - 1mg, 2mg Yes, give over 2-5 Usual single dose: 15 - 100 mcg/kg Monitor Coagulation profile, PTT/PT Vial stable at room temperature
Recombinant & 5 mg min Hgb/Hct, platelets for 2 years prior to
(Novoseven) vials Continuous infusion may be done –do reconstitution.
Reconstitute with NOT further dilute Factor VIIa or run May increase risk of thrombotic
Blood factor diluent provided to into running IV line events Once reconstituted -
final concentration administer within 3 hours.
of 1mg/mL Non-emergent indications: Confirm
final coagulation results and Factor
VIIa order with prescriber prior to
administration.
Factor 8 – Human Vials – size Yes – Slow IV ***Caution: Product is labeled in Use diluent provided
VonWillebrand Disease (VWD) –
(Humate-P) varies push at rate not to Factor 8 units and von Willebrand
Usual Dose: 40-80 IU/kg** initial
based on exceed 4mL/min factor:Ristocetin Cofactor (VWF:RCo) Stability: 24hrs room temp or
dose; for major bleeds or invasive units. In VWD disease dose is based on
pooled refrigerated
procedures, continue with repeated VWF:RCo content. ***
plasma doses of 25-30 IU/kg Q8- 12h
source Product is NOT typically used for
Infusions: Use diluent & filter Hemophilia A
provided with product. No additional
**Use higher dose for patients with
(inline) filtration or dilution
type 2 and 3 VWD
recommended.
Factor 8 – 250, 500, Yes - Slow IV Use diluent provided
Hemophilia A – Usual Dose: 50 Multiple products in Hemophilia A
Recombinant 1000,2000 push over 5-10min Stability: 3hrs –
IU/kg initial dose; for major bleeds or available – this may be used as a
(Helixate) units/vial Stability may be extended on a
invasive procedures, continue with 25 “universal product” for urgent
case-by-case basis –
IU/kg repeated Q12h reconstitution. Life-threatening
concentrations / dilutions must
bleeds/ Major surgery: Target Factor
be considered.
8 levels of 80-100%.
Factor 9 – 250, 500, Yes - Slow IV Decreased Factor 9 recovery requires Use diluent provided
Hemophilia B – Usual Dose: 95
Recombinant 1000,2000 push over 5min higher relative dose to achieve target Stability: 3hrs
IU/kg to achieve a target Factor 9 level
(BeneFIX) units/vial Factor 9 levels. Stability may be extended on a
of 70-80%; Repeat doses at 12-24hr
Dose = Target level x Pt wt x 1.3 case-by-case basis. –
intervals at a dose of 40 IU/kg
concentrations / dilutions must
be considered.
Factor 9 Complex – Vial sizes Yes – 5-10mL/min Warfarin reversal in life threatening Product FDA approved for Use diluent provided (SW)
Human vary based Do not exceed bleeds – Usual dose: Hemophilia B.
(Profilnine SD) on pooled 10mL/min – rates 50 units/kg or 4,000 units Contains Factors II, VII, IX, X –
plasma in excess of this Doses may be repeated based on INR In life-threatening bleeds:
source may result in response (total dose range 25- coadministration with vitamin K &
vasomotor 100units/kg) additional source of factor 7 (FFP or
reactions. NovoSeven) is recommended.
Famotidine 10mg/ml – Yes, IV Push preferred Dose reduction recommended for pt

(Pepcid) 2 & 4 ml 10mg/ml – give Intermittent infusion: with CrCl < 50 ml/min
Vial over 1 min 20mg/50 ml NS – infuse over 15 min
H2 Receptor Antagonist
Dilute with 5-10
ml NS or D5W
Fat Emulsion 20% Yes Start continuous intravenous drip Do not use propofol as lipid Stored at room temperature. None
(Intralipid, Liposyn) 500 ml 1.5 mL/kg IV at 0.25 mL/kg/min upon initiation source.
bag bolus over 1 of first IV bolus. Recommended storage in
Local anesthetic minute (for ACLS must be continued L&D, OR, and other areas
toxicity suspected local Increase infusion to 0.5 mL/kg/min throughout fat emulsion with high volume use of
anesthetic if adequate circulation not administration! local anesthetics.
toxicity); restored/BP declines after second
consider bolus. Achieving continuous infusion
repeating bolus rate > 1200 ml/hr (0.25 mL/kg/hr
up to two more Continue lipid infusion until for a 80 kg patient) may require
times q 3-5 hemodynamic stability restored – infusion via multiple lines.
minutes if recovery may take longer than an
adequate hour. ** No standard dosing has been
circulation not established – contact Poison
restored A total cumulative dose of 8 Control and/or see
mL/kg has been recommended. www.lipidrescue.org for further
information **
Fenoldopam 10 mg/ml – NO Continuous infusion recommended; Monitor BP (preferably via arterial Critical Care
(Corlopam) 5ml Amp Begin at 0.05 mcg/Kg/min and titrate line if possible), HR q 15 min during Incompatible with many
up by 0.05mcg/Kg/min every 15 dose initiation and titration. medications/solutions – contact
Antihypertensive minutes to desired effect pharmacist
Usual dose range: 0.05 – 1.6 Half-life = 5 min. Effects quickly
mcg/Kg/min reversed with D/C of drip
Doses > 1.5 mcg/kg/min rarely
System Standard Conc: 10 mg/ 250 ml required
NS (40 mcg/ml)
System “Concentrated” Conc: 10 Tachycardia may occur if drug
mg/100 ml NS (100 mcg/ml) started at rate > 0.1 mcg/kg/min or if
titrated too quickly
FentaNYL 50 mcg/ml Yes, Continuous infusion or PCA Monitor BP, RR
(Sublimaze) – various Slowly over 3 – 5 recommended
sized minutes Too rapid administration
**HIGH ALERT amps/vials Bolus dose range: 10–30 mcg may cause respiratory Metro: If PCA
MEDICATION** Continuous IV dose range: 20 – 60 depression/distress ordered,
mcg/hr mandatory order
Narcotic analgesic Reverse effect with naloxone set must be used
System Standard Conc for continuous (Narcan)
infusion: 1250 mcg/250 ml NS Premix
Optimal dose determined by patient
(5 mcg/ml)
response
System “Concentrated “ Conc: 1000
mcg/ 100 ml NS (10 mcg/ml)
Ferrous Gluconate Amps Yes, Intermittent infusion: Test dose not necessary
Complex 62.5mg/5 Max 12.5mg/min 62.5 mg – 125 mg/100 ml NS Unopened ampules good until
(Ferrlecit) ml Infuse over 30 - 60 min Monitor vital signs (BP) including expiration dating from
Give 62.5 mg over orthostatic BP – manufacturer Metro: max dose
Iron Supplement 5 min Doses greater than 125 mg require per infusion is
Give 125 mg over dilution Metro: For Outpatient Admin - 250 mg per P&T
10 min Doses < 250 mg – monitor patient
Max dose per Metro P&T = 250 mg for 1 hour post-infusion per P&T
IV push not Doses of 250 mg – monitor patient
recommended for for 2 hours post- infusion per P&T
doses > 125 mg
May cause hypotension or
hypertension, chest, back or groin
pain. Symptoms typically resolve 1-2
hours after infusion completed.
Filgrastim 300mcg/ 1 SQ preferred Intermittent infusion: Refrigerate

(Neupogen) ml 300mcg/18ml D5W
480mcg/1.6 480mcg/25ml D5W Do not shake product or
White cell stimulating ml Vials Infuse over 30 min transport via tube system
hormone Dilute in D5W only!!
Fluconazole Premix NO Intermittent administration

(Diflucan) 200mg/200 recommended Dose reduction recommended for
ml & Infuse at max rate of 200 mg/hour CrCl < 50 ml/min
Antifungal 400mg/400
ml
Flumazenil 5 & 10 ml Yes, To reverse benzodiazepine Irritant, avoid infiltration
(Romazicon) vial 0.1 Give rapidly over (BZD) effects – intermittent
mg/ml 15-30 seconds administration recommended: 0.2 mg Elim half-life = 60 min – much less Monitor BP, HR, RR
preferably into IV repeated every 60 seconds to a total than typical BZD’s and re-sedation
**HIGH ALERT
large vein with of 3mg/hr. following initial response is possible
MEDICATION**
running IV & not unusual
**Reversal Agent** Titrate to response using small IV
May unmask BZD controlled seizures
Benzodiazepine doses. Most patients respond to total
or precipitate BZD withdrawal in
(BZD) antagonist doses between 1 & 3 mg
chronic BZD users.
Folic Acid 5mg/ml – Yes, Common component in “banana” bag. Dilution recommended for > 5 mg Protect from light
10 ml vial Give over 1-2 min
Vitamin/Nutritional May dilute with NS or D5W and Methanol Poisoning: Cofactor in
supplement May be given SQ, administered continuously via elimination - Higher dose folic acid
IM peripheral or central line (50-75mg) administered q4h x 24h or
until resolution of acidosis.
Fomepizole 1Gm/ml – NO Intermittent Infusion – Solution may solidify at temps Monitor ethylene
(Antizol) 1.5 ml vials 15mg/Kg load then 10mg/Kg every < 77°F, run under warm water or hold glycol or
12h x 4 then 15mg/Kg every 12h until in hands to liquify methanol serum
Ethylene glycol and serum ethylene glycol <20mg/dL and / Dialyzable – dosing interval concentrations
Methanol Antidote or resolution of acidosis Monitor for signs of allergic reaction – should be increased to every 4
shortness of breath, rash, hives, and hr during hemodialysis
Dilute with 100ml NS and infuse over pruritus.
30 minutes Do not wait for results of
methanol/ethylene glycol blood levels
to initiate therapy.
Fondaparinux Pre-filled NO Administer SC only! Do NOT give See syringe for manufacturer
(Arixtra) syringes IM! expiration date.
Administer SC
Anticoagulant only! Do NOT Contraindicated per manufacturer in Do not expel air bubble in
give IM! patients w/ CrCl < 30 ml/min or body syringe before administering
weight < 50 kg dose.
Foscarnet 24 mg/ml NO Peripheral Line: Must be diluted to 12 Adequate hydration is recommended May administer
(Foscavir) in 250 and mg/ml with NS or D5W prior to and during treatment to Do NOT refrigerate undiluted undiluted through
500ml minimize renal toxicity solution central line only!
Antiviral bottles Central line: May be given undiluted.
Induction Dose: rate not to exceed Dose reduction recommended in pt Incompatible with many
1 mg/kg/min (minimum of 1 hour) with decrease CrCl medications and solutions,
every 8 hours. check with pharmacist
Maintenance Dose: 90-120 mg/kg/day May cause thrombophlebitis
given over 2 hours
Fosphenytoin 50 mg/ml Yes May dilute to 50 or 100ml with NS. Prodrug of phenytoin - preferred
(Cerebyx) 2 & 10 ml Dilute to total of Infuse not rate not faster than product for IV/ IM administration. Refrigerate vials
vial 10mL (or max 150mg/min
Anticonvulsant concentration of Automatically substituted for
25mg/mL) and Rate reduction to 75 mg/min phenytoin.
administer at max recommended in elderly and pt with
rate of 150mg /min coronary heart disease. Monitor BP/HR/RR during infusion
and 30-60 min after.
May be given IM
undiluted Flushed feeling with IV admin. not
uncommon - pruritus – commonly
near groin area
Furosemide 10mg/ml Yes, Dilute doses 100-200 mg with Do not use furosemide solutions that
(Lasix) vial and Doses < 100 mg NS/D5W and administered no faster are yellow in color
pre-filled may be given IV than 10 mg/min. Doses > 200 mg must Do NOT refrigerate - may
Diuretic syringes push at max rate be diluted and given no faster than 4 IV furosemide = 50% PO dose crystallize with refrigeration
of mg/min.
10 mg/min Monitor urine output/fluid status, BP
Continuous infusion usual dose range
1 – 20 mg/hr. Higher doses may be
been used in kidney failure.
System Standard Conc: 250mg/250ml
NS (1 mg/ml)
System “Concentrated” Conc: 250
mg/100ml NS (total volume 125 ml) (2
mg/ml)
Ganciclovir 500mg vial NO Dilute dose to 100ml D5W. Irritant - monitor for phlebitis and
(Cytovene) Reconstitut Infuse over 60 minutes infusion site pain Use chemotherapy
e with 10ml precautions for preparation,
Antiviral NS to Final concentrations greater than administration & disposal
10mg/ml not recommended for Dose reduction recommended for Cr
50mg/ml Cl < 70 ml/min
peripheral administration
Gentamicin 10mg/ml NO Dilute all doses in 50 -100ml NS or Aminoglycoside dosing and

and D5w monitoring service available from
Antibiotic/ 40mg/ml in ** May be given Infuse over 30-60 minutes pharmacy upon physician order.
Aminoglycoside 2 & 20ml undiluted
vials & intrathecally – Extended interval (7mg/kg) dosing Monitor renal function.
premixed using preservative infuse over 60min
minibags in free product **
various
doses
Glucagon 1 mg Vial Yes, Use immediately after
Continuous infusions may be used in Forms precipitate when mixed with
1mg/ml over 60 reconstitution.
treatment of calcium channel blocker or chloride solutions, NO NS – Dilute
Hormone, seconds beta-blocker overdoses. Usual dose with sterile water or D5W
Antihypoglycemic Agent range: 1 – 5 mg/hr
May also be given Tx of hypoglycemia: usually awakens
IM or SQ pt within 15 min
Granisetron 1mg/ml Yes, IV Push preferred. Give dose 30 minutes prior to
(Kytril) Vial Undiluted over 30 chemotherapy to prevent
seconds Intermittent infusion: Dilute in 25 to 50
nausea/vomiting.
Antiemetic/ 5HT3 ml NS or D5W - Infuse over 5 minutes
receptor antagonist
Haloperidol 5mg/ml Yes, Recommended to flush line

Prefer intermittent IV Push Use with caution if cardiovascular
(Haldol) Vial and Give at max rate with at least 2 ml NS before
disease is present.
syringe of 5mg/min Titrate dose to desired effect and after med admin
Antipsychotic/ Use only the May cause QT prolongation.
Anxiolytic lactate salt of Normalization of potassium and
haloperidol for IV magnesium levels recommended.
Push – NOT Monitor for hypotension and/or
Decanoate salt symptoms of angina. Also, monitor for
extrapyramidal effects
May be given IM
Will NOT cause respiratory
depression.
Contraindicated in Parkinson’s patients
Helixate
See Factor 8 -
Recombinant
Heparin Various Yes, Per manufacturer on vials and Recheck
Continuous infusion – Monitor platelets – may cause
concentra- All doses syringes concentration
thrombocytopenia with any dose (even
**HIGH ALERT tions vials administered over Standard conc: 25000 units/500 ml
catheter flushing!) of vial/bag
MEDICATION** and 10-20 seconds, D5W premix (50 units/ml) Multi-dose vials expire 28 days
Monitor for signs of bleeding before
syringes undiluted from initial opening.
administering
Recheck concentration Monitor PTT 6 hours after any dose
Premix See specific weight-based dosing dose!
of vial/bag before change or per orders
bag: Do NOT give IM!! protocols (PPOs) for Cardiac
administering dose!
50 units/ml Indications and for Treatment of
500 ml DVT/PE
Anticoagulant
Hetastarch 6% solution NO Intravenous infusion preferred. Not to Rare allergic reactions to hetastarch
(Hespan) in 500ml exceed 1500ml/24 hours have been reported. Monitor for
NS hypersensitivity reactions.
Plasma expander
Monitor for plasma volume overload –
(dyspnea, fluid in lungs, rapid increase
in blood pressure)
severe renal insufficiency
Humate-P
See Factor 8 - Human
HydrALAZINE 20mg/ml Yes, Incompatible with many

Intermittent or continuous infusion NOT Monitor for reflex tachycardia after
(Apresoline) Vials Give undiluted at a medications and solutions,
recommended each dose. Monitor BP every 5 min
max rate of check with pharmacist
until stabile.
Antihypertensive 5mg/min Exception – OB uses continuous
infusions Maximal reduction in blood pressure
seen 15-80 min after doses given
50 mg/500 ml D5W or fluid per
physician
Metro: See MWH-19-MAT: Women’s
Health Policy & Procedures –
Hydralazine: Continuous Infusion
Hydrocortisone Various Yes, Check vial/syringe for
IV Push preferred. May dilute dose to Local infusion related adverse effects
vial sizes Give undiluted expiration date.
50ml in NS or D5W and give over are rare.
Corticosteroid 100mg/2ml doses over 30 –60 several minutes.
250mg/2ml seconds
500mg/4ml Intrathecal administration: use
1000mg/8m preservative-free ONLY!!
l
HYDROmorphone 2, 4, or Yes, Continuous infusion: Reverse effects with naloxone
(Dilaudid) 10mg/ml Give dose slowly Very Potent opioid analgesic.
System Standard Conc: 50 mg/250 ml (Narcan)
Vials and over 2-3 min or High doses (IV >1mg or IM >
*HIGH ALERT syringes max rate of 0.5 NS (0.2 mg/ml) Monitor RR, HR, BP 2mg) in opioid naïve patients Metro: If PCA
MEDICATION* mg/min System “Concentrated” Conc: 50 mg/ Give lower doses to elderly, debilitated must be verified with ordered,
100 ml NS (0.5 mg/ml) or patients on additional CNS prescriber. mandatory PCA
Narcotic analgesic depressants order set must be
IV dose = 1/3 to 1/5 PO dose. used
Hydromorphone 1.5 mg IV =
Morphine 10 mg IV
Hydroxocobalamin 1 kit = 2 x NO 2.5 gm reconstituted with 100 ml NS – Urine and skin will turn red
(Cyanokit) 2.5 gm Stable 6 hours
infuse over 7.5 minutes – repeat x 1 for
vials May cause hypertension
total of 5 gm
Antidote – cyanide Allergic reactions including
poisoning 2nd 5 gm dose may be given over 15 anaphylaxis, pruritus, rash may occur
minutes to 2 hours depending on
severity/clinical response for total dose
of 10 gm May interfere with various lab tests
HydrOXYzine 25 & NO Intermittent Infusion – Not advised; IM Hypotension, phlebitis and hemolysis
(Vistaril) 50mg/ml Preferred! reported following IV administration
Vials & IM preferred Intra-arterial administration has
Antihistamine Syringes resulted in endarteritis, thrombosis and
gangrene.
Do NOT give IV-push
Ibutilide 1mg/10ml NO 1 mg/50 ml NS Continuous cardiac monitoring * See footnote
(Corvert) Infused over 10 min recommended for at least 4 hours bedside monitor
Stop infusion when afib/aflutter after completion of infusion. & defibrillator
Anti-arrhythmic terminated recommended
If < 60kg dose @ 0.01mg/Kg Monitor for increased QT interval
May repeat same dose 10 minutes after prolongation and ventricular
completion of initial dose if rhythm not arrhythmia potential
converted
Check potassium and magnesium
Preprinted order set available levels: should be within normal limits
at time of infusion
Imipenem/Cilastatin 500mg Vial NO
< 500mg/100ml NS. Infuse over Reduce rate of infusion if
(Primaxin)
30 minutes nausea/vomiting occur
Antibiotic/ Carbapenem > 500 mg/250ml NS. Infuse over 60 Caution with penicillin allergy
minutes Check allergies
CrCl < 70 ml/min
Immune Globulin Various Not advised Monitoring
Standard IVIG (Carimune) - Unless clinically
Intravenous (IVIG) strengths & - Monitor BP every 15 minutes for first Filter not required for:
contains sucrose indicated (i.e. IgA
brands hour of every infusion, then every 30- Carimune, Privigen or deficiency) -
Initial Dose -Carimune: 60 min. for duration of the initial Gammagard. requests for
Immune modulator 3% solution recommended for infusion. Monitor Blood Pressure specific brands
previously untreated patients. every 30-60 min. during subsequent Gammagard S/D requires filter cannot be
First dose dispensed as partial dose ( 3% infusions if the patient has a history of – use provided administration accommodated.
solution – usually 6g dose). If tolerated intolerance to IVIG. set that includes 15 micron
– after first bag – remainder of dose is Decrease rate or stop infusion if filter. If administration set not Indication
provided as 6% solution. Solution patient experiences adverse provided, contact pharmacy for required with all
may be further concentrated to 12% as reactions. filter! orders.
needed. Consider premedication with Pharmacists will
Initial Rate -Carimune 3% Solution: acetaminophen +/- diphenhydramine Reconstitute Carimune vials provide ordered
Initiate at 30-60mL/hr x 15-30min. If with sterile water
Refer to IVIG PPO dose as 3%, 6% or
tolerated may increase rate every 15-
- Monitor patient for signs and 12% solution
30minutes to a maximum of 150mL/hr.
symptoms of anaphylaxis and have (Carimune) or a
epinephrine available to treat. 10% solution
Subsequent Doses – (Carimune 6% and (Gammagard,
12% Solutions): - Monitor renal function Privigen).
After 1st dose of 3% solution,
subsequent infusions (6% or 12%) may Adverse reactions include Pharmacist will
be administered at a higher hypotension, headache, fatigue, change round dose down
concentration and higher rate (i.e. in pulse, flushing, tightness in chest, to nearest vial (3,
increasing q15-30 min). Infuse at a chills, fever, dizziness, 5, 6 or 10g)
maximum rate of 2 mg/kg/min nausea/vomiting, backache, leg depending on
cramps, uticaria, and diaphoresis availability within
Sucrose-free IVIG 10% Solutions 90% of calculated
Standard (Sucrose-containing) IVIG
dose.
is appropriate for most patients;
Initial Dose-Gammagard & Privigen however, IVIG has been associated
Initiate at 15-30mL/hr and increase as with renal dysfunction, ARF, osmotic
tolerated every 30min to maximum of nephrosis, and death. Patients
5mL/kg/hr (Gammagard) and predisposed to ARF include patients
2.4mL/kg/hr (Privigen), respectively. with: 1) any degree of pre-existing
renal insufficiency, 2) diabetes
Subsequent Doses: Higher rates may mellitus, 3) age > 65, 4) volume
be possible for Privigen based on depletion, 5) sepsis, 6)
indication & tolerability (check with paraproteinemia, 7) pts receiving
pharmacist). known nephrotoxic drugs
In these patients, IVIG should be
administered at the minimum
concentration and the minimum
infusion rate that is practical.
• Units with cardiac monitoring and nurses who have demonstrated competency to manage
Sucrose-free thismay
IVIG medication.
also be
40
Formerly Metro Nursing Policy MN-18-B Med Admin. Guidelines - Revised Finalconsidered.
07-2009
Inamrinone 20 ml amp Yes Loading dose 0.75 mg/Kg Dose-related thrombocytopenia Dilute with NS only * See footnote
(Inocor) (5 mg/ml) May give occurs in 2-3% within 48-72 hr after
undiluted via Usual dose range: 5-10 mcg/Kg/min initiation. Reverses within one week Incompatible with many
formerly – amrinone
central line or Standard conc: 400 mg/250 ml NS upon d/c of med. medications/solutions – check
running IV. Give (total vol=330 ml) (1.2 mg/ml) with pharmacist
over 2-3 min. Monitor BP, HR every 15 min
Cardiovascular/ Positive “Concentrated” conc: 500 mg/100 ml
inotrope NS (total vol=200 ml) (2.5 mg/ml) Total cumulative dose should not
exceed 10 mg/kg
Maximum Concentration = undiluted
(5 mg/ml)
Indomethacin 1mg Vial Yes, Prepare solution just prior to Neonatal
Not advised For closure of Patent Ductus Arteriosis
(Indocin) Give 0.1 – 0.25 administration Intensive Care
in premature infants between 500 &
mg/Kg dose over 1750 Gram Weight.
Anti-inflammatory/ 5-10 seconds Do not dilute with agents
NSAID See labeling for age specific dosing containing benzyl alcohol. Use
Course of therapy involves 3 doses 12- preservative-free sterile water
24 hours apart or NS only!
InFLIXimab 100 mg NO Infuse slowly over 2 hours Monitor for allergic symptoms – Administer within 3 hrs of
(Remicade) Vial shortness of breath, rash, hives, and preparation
Recommended Doses: pruritus.
Monoclonal antibody Crohn’s: 5 mg/Kg Do NOT shake or transport
Rheumatoid Arthritis: 3 mg/Kg Premedication with acetaminophen solution through pneumatic
and diphenhydramine recommended tube system
Concentration should be 0.4 - 4mg/ml
Preprinted order sets available Use administration set provided
by pharmacy (contains 1.2
micron filter)
Insulin- Human 100 Regular Insulin System Standard Concentration: Waste 10-20 ml of diluted solution Recheck
Regular units/ml 10 used for IV route. 150 Units/150ml NS (1 unit/ml) through the administration set to Vials are stable x 28 days after insulin name
Also see Section III ml vial Give all doses over saturate binding sites in IV tubing first use refrigerated or at room and dose
15-30 seconds before connection to infusion pump. temp
before
*HIGH ALERT administering!
MEDICATION* Preprinted order sets available for
insulin infusions in ICU patients,
Recheck insulin name Also administered Adult Surgical/Medical Patients, and
and dose before SQ – see section DKA/Hyperosmolar Nonketotic
administering! IV of guidelines Coma Patients
Antidiabetic Monitor blood glucose
Iron Dextran 50 mg/ml- Yes, Dose > 200mg = Total Dose Infusion 25 mg test dose IV-Push over 30 Use NS – D5W has increased
(INFed) 2ml Vial Doses up to 200mg (TDI) - dilute into 250-500 ml NS Max seconds to 5 min recommended incidence of phlebitis/pain at
at max rate of 50 conc = 50 mg/ml before each total dose infusion injection site
Iron supplement mg/min Observe and monitor BP and HR
Infuse over 2-6 hours every 15 min for 60 minutes after test Lean body weight (or ideal
dose before implementing infusion body weight) not actual body
weight should be used in
May be given IM – IV infusion Have the following readily available calculating dose
preferred over IM due to local during infusion: diphenhydramine 50
complications and unpredictable mg IV, epinephrine 1:1000 (1 mg/ml) Incompatible with many
absorption with IM admin and hydrocortisone 100mg/2ml medications/solutions, check
Anaphylactoid/Hypotensive reactions with pharmacist
possible.
Iron Sucrose Complex 20mg/ml – Yes, Hypotensive reactions may be

(Venofer) 5ml Undiluted up to 50 mg IV in 50 ml NS over 15 min possible
vial 200mg at max 100 mg IV in 50 ml NS over 30 min
rate of 20mg/min 200 mg IV in 50 ml NS over 60 min Test dose not necessary.
Iron supplement 300 mg IV in 100 ml over 2 hours
Monitor vital signs (BP) including
orthostatic BP –
Maximum Dose per P&T: 300 mg – no
more frequently than once weekly Metro: For Outpatients -
Doses < 100 mg – monitor patient
for 1 hour post-infusion per P&T
Doses 200-300 mg – monitor patient
for 2 hours post- infusion per P&T
May cause hypotension or

hypertension, chest, back or groin
pain. Symptoms typically resolve 1-2
hours after infusion completed.
Isoniazid 100 mg / Yes, Dilution not advised. Solution may cause local irritation Solution may crystallize at low
(Nydrazid®) ml Vial – Administer room temperature.
Slow rate if tingling sensation
10ml undiluted & slowly
reported in extremities
Antimicrobial over 5 minutes Warm slowly to re-dissolve
Oral administration preferred. May
be given IM via ventrogluteal site due
to volume per dose.
Isoproterenol 0.2 mg / ml NO System Standard Conc: 1 mg/250 ml Monitor ECG continuously; BP and Incompatible with many * See footnote
(Isuprel®) 5 ml amp NS (4 mcg/ml) HR every 15 min meds/solutions – check with
System “Concentrated” Conc: 2 Monitor urine output every 1-2 hr pharmacist
Cardiovascular/ mg/250 ml NS (8 mcg/ml)
May cause PVC’s
Chronotrope
Usual dose range: 1-10mcg/min Cardiac transplant patients have
Decrease/temporarily stop infusion if little or no response to Atropine.
HR > 110. Doses sufficient to increase Isoproterenol is considered first
HR > 130, may induce ventricular line drug for treatment of severe
arrhythmias or angina. bradycardia in heart transplant
patients
K – Vitamin K – See
Phytonadione
Ketamine 10 mg/ml Yes, Usual dose for sedation: 0.2 – 1 mg/kg Monitor RR, BP, HR and mental Protect from light Critical Care &
20 ml vial; Slowly over 2-3 IV status. prescriber
50 mg/ml min (conc max Continuous infusions may be used May cause – experienced
Analgesic- 10 ml vial; 50mg/ml) during surgery as general anesthetic. * respiratory depression with high w/administratio
sedative/anesthetic Infusion may be used as sedative / doses or too rapid injection n
analgesic for refractory pain *cardiovascular stimulation (HTN,
May also be given syndromes tachycardia)
IM *hypersalivation / excessive
Infusion: Dilute dose in D5W or NS to secretions - may be managed with
final concentration of 1-2mg/mL atropine/glycopyrolate.
(max: 2 mg/mL) *Emergence phenomenon (vivid
dreams, hallucinations, delirium,
confusion)
** Oxygen via nasal cannula at
minimum w/continuous pulse Benzodiazepines (eg. midazolam)
oximetry/ECG monitoring may decrease/alleviate CV
recommended while sedated stimulation and emergence
phenomenon
Ketorolac 15 mg & 30 Yes, Give IV - push Recommended max dose is 120
(Toradol) mg per ml Give over 15-30 Pain with injection common-slow mg/day
syringe & seconds infusion if this occurs Recommended max dose for
Analgesic/ Anti- vial CrCl < 50 ml/min or age > 65
inflammatory/ NSAID NSAID – check allergies y.o. is 60 mg/day
Max recommended length of

therapy is 5 days
Labetalol 5 mg/ml 4 Yes, Continuous infusion: Initial rate: 0.5 – Maximum anti-hypertensive effect * Continuous
(Trandate, Normodyne) ml syringe, Give 10 mg over 2 2 mg/min titrate to desired effect apparent approximately 5 min after infusion - see
20 ml vial minutes System Standard Conc: each dose NOT compatible with alkaline footnote
Antihypertensive 250 mg/150 ml NS (total vol 200 ml) solutions such as furosemide
(1.25 mg/ml) Titrate to desired BP parameters (Lasix) – check with Intermittent doses
pharmacist for compatibilities - monitor VS.
System “Concentrated” Conc: May cause orthostatic hypotension. May cause
300 mg/40 ml NS (total vol 100ml) Administer to pt while in supine hypotension and
(3mg/ml) position if possible. bradycardia
Undiluted 5mg/ml = max conc
Lacosamide 10mg/mL NO Dilute all doses in 100mL NS and IV dose = PO dose IV doses mixed in 0.9% NaCl
(Vimpat) single dose administer over 30min are stable for 24 hours at room
20mL vial temperature.
Anti-seizure
Lansoprazole 30 mg vial NO 30 mg in 50 ml NS IV dose = PO dose Vial must be reconstituted with
(Prevacid) Infuse over 30 min Sterile Water and further
diluted within 1 hr
Proton Pump Inhibitor
In-line filter must be used!
Do not administer with other
medications/fluids – check with
information
Lepirudin 5 mg/ml 10 Yes, Maintenance infusion: 0.1 mg/Kg/Hr, Anticoagulant for use in patients with
(Refludan) ml vial Loading dose (0.4 titrate to target aPTT heparin associated thrombocytopenia
mg/kg – max 44
mg)*: IV Push System Standard Conc: 50mg/ 100 ml Monitor for signs of bleeding!
*HIGH ALERT
MEDICATION* over 30 seconds NS (0.5 mg/ml) Monitor therapy with aPTT (1.5-2.5
x baseline) 4 hours after beginning
Anticoagulant Preprinted order set available drip or change in the rate of a
continuous infusion
*Adjust dose if CrCl < 60 ml/min,
SrCr > 1.5, or if pt has received
thrombolytic
Levetiracetam 500 mg/5 NO Dilute in 100 ml NS and infuse over 15 Double check drug name
(Keppra) ml vial minutes Store at room temperature
IV Dose = PO Dose
Anticonvulsant Dose reduction for patients with CrCl Compatible with NS, D5W,
< 50 ml/min recommended. LR, lorazepam, diazepam and
valproate
Levofloxacin 25mg/ml NO Infuse 250 and 500 mg doses over 60 Dose reduction for patients with CrCl
(Levaquin) Vial. min < 50 ml/min recommended
Premix:
Antibiotic/ 500mg/100 Infuse 750 mg dose over 90 min
Fluoroquinolone ml
Levocarnitine 200 mg/ml Yes, May be given as intermittent infusion May cause HTN – monitor VS Discard ampule immediately
(Carnitor) 2.5 ml Give over 2-3 min – diluted to conc of 0.5 to 8 mg/ml in after use
ampule NS or LR May cause N/V – slow rate of
Nutritional infusion Use NS or LR – NOT D5W
supplement/Amino acid
May cause hypercalcemia
Levothyroxine 200 mcg/5 Yes, Slow IV push recommended ** Verify dose to be given. Discard Use immediately after
(Levothroid, Synthroid) ml Give over 2 min vial after drawing up correct dose. ** reconstitution
vial Use NS only to reconstitute
Hormone - thyroid IV dose = 50% of PO dose
Do not combine with other
solutions
Lidocaine 100mg Yes, Continuous infusion required to Continuous EKG Monitoring * See footnote
Syringes, 50-100mg over 2 maintain anti-arrhythmic effect
Anti-arrhythmic 2Gm/500ml minutes at max Do NOT exceed 300 mg/hour or 4 Continuous ECG monitoring.
Premix rate of 50mg/min Usual dose range: 1 – 4 mg / min mg/min
System Standard Conc: 2000 mg/ 500 Cardiac signs of toxicity: Widening Therapeutic serum lidocaine
ml D5W Premix (4 mg/ml) of QRS, bradycardia, increasing levels: 1.5 to 5
** Do not use in PVCs, hypotension, heart block Toxic levels: > 5
WPW syndrome System “Concentrated” Conc: 2000
mg/ 100 ml NS (total volume 200ml) Non-cardiac signs of toxicity:
** numbness of lips, tongue and face;
(10 mg/ml)
tremors; paresthesias; diploplia;
Can be given via ET tube: 2 – 2 ½ x mental status changes,
IV dose nausea/vomiting; confusion; slurred
speech
Linezolid Premix: NO Max conc: 2 mg/ml Weak MAO inhibitor – verify patient Compatible with NS, D5W and Low tyramine
(Zyvox) 400mg/ on low tyramine diet (in addition to LR restriction (in
200ml NS, Administer dose over 60 minutes ordered diet) addition to
Antimicrobial 600mg/ Low tyramine diet to continue x 3 Incompatible with ceftriaxone ordered diet)
300ml NS days after d/c of medication.
Premix Avoid co-administration with meds Normally may exhibit a yellow
bags that may increase risk of serotonin color
syndrome (i.e. SSRIs, SNRIs, TCAs)
LORazepam 2&4 Yes, Continuous infusion Monitor respiratory and Critical Care for
(Ativan) mg/ml Dilute with equal System Standard Conc: 100 mg/ 50 ml cardiovascular status Vials stable 60 days at room continuous
syringe / volume NS-Give D5W Excel or glass bottle (total May cause respiratory depression temp infusion
Sedative/ Vial at max rate of 2 volume 100 ml) (1 mg/ml)
Benzodiazepine mg/min Observe for crystals (may use 5 Continuous
Reverse with flumazenil micron in-line filter). infusion may be
(Romazicon) given
unmonitored if
used for comfort
care/hospice pt
Magnesium Vials: 4 Yes, Intermittent infusion: Magnesium 1 Gm = 8.12 mEq Mg. **Metro OB:
mEq/ml – Bolus dose only supplementation - 1 – 2 Gm over 30 Mandatory use of
*HIGH ALERT multiple for Torsades de min Metro OB: Assess DTR, respirations, order set for IV
MEDICATION* vial sizes Pointes signs and symptoms of Mg toxicity infusion
Premix Dilute with 10 ml Pre-eclampsia/eclampsia: Usual bolus (muscle weakness, ECG changes,
Electrolyte bags: NS/D5W for 1 gm dose is 4 grams given over 20-30 hypotension, sedation, confusion),
1 Gm/100 dose; 20 ml minutes I&Os. Obtain Mg levels as order by
ml, 2 NS/D5W for 2 gm Pre-term labor: Usual bolus dose is 6 physician
Gm/50 ml, dose. Give at max grams given over 20-30 minutes May cause respiratory/cardiovascular
4Gm/100 rate of 1Gm/min collapse
ml, 6 Gm/ Continuous Infusion: 1- 4 Gm/hr
50 ml & 20 Antidote for Mg toxicity: calcium
gm/50 ml System Standard Conc: 20 grams/ 500 gluconate
Premix ml Sterile Water Premix (40 mg/ml)
Mannitol Vial 25%- Yes, Intermittent Infusion: Use 0.22 micron in-line filter Do not refrigerate!!
(Osmitrol) (12.5Gm/5 12.5 Gm/50 ml Infuse over 30-60 min
0ml) over 5 min or Inspect vials/bags for crystals
Osmotic diuretic Premix: 1g/kg over no less prior to administration
20% (100 than 10 min 12.5 gm = 62.5 ml of 20%, 50 ml 25%
Hypertonic solutions – monitor
Gm/500 25 gm = 125 ml of 20%, 100 ml 25%
venous site for irritation.
ml) 50 gm = 250 ml 20%, 200 ml 25%
10% (50
for general guidelines / management
Gm/ 500 Metro: Infusion bags from pharmacy
ml) contain extra volume for priming of Common hold parameters: Na+ > 145
tubing and filter. or Serum Osmolarity > 310
Meperidine 25,50,75 & Yes, Continuous infusion NOT advised Not recommended for patients 65 PCA: Check syringe for
(Demerol) 100 mg/ml Dilute dose to years or older nor patients with expiration date Metro: If PCA
syringe, 10ml with NS and PCA administration recommended poor renal function. ordered,
*HIGH ALERT 50 mg/ml give at max rate mandatory order
MEDICATION* vial of 10 mg per Monitor for delirium, or other CNS set must be used
minute System Standard Conc: 250 mg/ 250 toxicity
ml NS (1 mg/ml) Monitor respiratory status – may
Narcotic analgesic cause respiratory depression or
System “Concentrated” Conc: 250
mg/ 100 ml NS (2.5 mg/ml) distress
Reverse respiratory depression
with naloxone (Narcan)
Meropenem 500 mg & 1 May be given IV Intermittent Infusion – Usual Dose: Monitor for allergic reaction-rash, Stable 24 hr after dilution with
(Merrem) Gm vials push over 3-5 min 500mg/50mL –1g/100mL NS IV over hives, and shortness of breath, NS refrigerated
(i.e. hemodialysis 30min pruritus.
Antibiotic/ Carbapenem patients) Stable only 4 hr after dilution
Routine use of IV Extended infusions over 3 hours may Caution with penicillin allergy with D5W refrigerated
push is not be used for treatment of resistant Check allergies!
recommended pathogens.
Dose reduction recommended in
pts w/ CrCl < 50 ml/min
Methyldopate 50mg/ml – NO Intermittent Infusion Monitor BP / Orthostasis

(Aldomet IV) 5 & 10ml Up to 250mg in 50ml D5W over Uncommon anecdotal reports of
Vial 30min paradoxical pressor response with IV
Antihypertensive 251-500mg in 100ml D5W over methyldopate-blood pressure may
60min increase
Methylene Blue 1% Yes, Continuous infusion: Urine and feces may turn blue-green. Incompatible with many * See footnote
Solution 1-2 mg/kg Methemoglobinemia: (converts Skin discoloration may also occur. medications/solutions – contact
(10mg/mL) SLOWLY over 3- methemoglobin to hemoglobin) pharmacist
Avoid extravasation – may cause
1 ml 5 min 0.1 – 0.15 mg/kg/hr necrotic abscesses
amp/vial Use only NS for dilution
10 ml Metro: Preprinted order set
amp/vial available for treatment of septic Total doses > 7 mg/kg may cause
shock/refractory hypotension dyspnea, cyanosis, dysrhythmias,
Loading dose 2mg/kg in 50mL NS hypotension, CNS depression
over 30min followed by infusion of
0.5-2mg/kg/hr Use with caution in pts w/ severe renal
insufficiency or G-6-PD deficiency
System Standard Conc: 500 mg/ 50 ml
NS (total volume 100 ml) (5 mg/ml) Administer via Central Line only!
Pulse Ox reading may be artificially
Thiazone dye low during IV administration
Methylergonovine 0.2 mg/ml NO Usual dose: 0.2 mg IM q4 hr Monitor BP – do not administer if BP Discard discolored solutions
(Methergine) 1 ml amp Give IM only > 140/90
0.2 mg over 1 min
Uterine Stimulant Do NOT give via IV administration
due to increased risk of HTN and
CVA.
Intravenous administration in severe,
life-threatening situations ONLY.
Methylnatrexone 12mg / NO Not recommended. Usual dose q48h – SQ in upper arm, Store at room temperature.
(Relistor) 0.6ml vial abdomen or thigh only.
SQ Intermittent SQ administration ONLY. Once drawn up in a syringe
Opioid Antagonist administration Frequency not to exceed Q24h dose is stable at room
ONLY temperature for 24hours
MethylPREDNISolone 40, 125 & Yes – IV Push preferred method of Acute Spinal Cord Injury: Critical Care
(Solu-Medrol) 500mg at max rate of 50 administration Continuous Infusion -- Usual dose: Reconstitute vials with sterile recommended for
Vial, 1&2 mg/min Intermittent Infusion 30 mg/kg bolus over 15 min then 5.4 water only. May further dilute continuous
Gm Vial 100-250mg in 50ml NS – give over 15 mg/kg/hr x 23 (or 48) hours with NS. infusion
Corticosteroid min
> 250mg in at least 50ml NS – give ** Depo-Medrol must be given IM –
over 60 min not IV **
MetoCLOPramide 5mg/ml in Yes, Intermittent Infusion Contraindicated
Slow rate if extra-pyramidal symptoms
(Reglan) 2,10, 20 & Give at 5 mg/min Doses > 10mg, dilute in 50 ml. Infuse in patients with
(dystonia, motor restlessness,
30 ml Vial over 15 min Parkinson’s
parkinson-like symptoms) occur
Prokinetic/antiemetic disease.
Reverse EPS with diphenhydramine
(Benadryl) 50mg IV per physician
order
Contraindicated in Parkinson’s
patients.
MetoPROLOL 1mg/ml – Yes, IV-push preferred Monitor HR and BP Administer undiluted * See footnote
(Lopressor) 5ml Give at max rate
Syringe & of 5mg/min Acute myocardial infarction:
Cardiovascular/Beta Amp 5 mg IVP every 5 minutes x 3
Blocker
MetroNIDAZOLE 500 mg NO Infuse over 60min Incompatible with many meds and May form crystals if
(Flagyl) Vial, solutions – check with pharmacist refrigerated, warm to room
Premix: temperature to re-dissolve
500 mg/100
Antibiotic ml Avoid ETOH use during treatment
and 72 hours post due to possible
disulfiram like reaction
Micafungin 50 mg, 100 NO For treatment of candidemia, invasive No dose adjustments required in Dilute vials prior to
(Mycamine) mg vials candidiasis, aspergillus infections renal/hepatic dysfunction reconstitution with NS (without
bacteriostatic agent)
Intermittent infusion: 50-150 mg in
Antifungal 100 ml NS or D5W infused over 60
minutes
MIDAZolam 1&5 Yes, Continuous infusion: Titrate doses slowly especially in the *See footnote
(Versed) mg/ml 1 – 2.5 mg doses Usual dose range: 0.5 – 10 mg/hr elderly
Vial & over 2 – 3 Monitor respiratory and Critical Care for
Syringes minutes. Titrate System Standard Conc: 50 mg/ 100 ml cardiovascular status continuous
Sedative/ SLOWLY NS (0.5 mg/ml) infusion
Benzodiazepine Rapid and/or frequent
administration may cause
respiratory depression
Reverse effects with flumazenil
(Romazecon)
Milrinone 200 Yes, Continuous Infusion: Dose reduction recommended for * See footnote
(Primacor) mcg/ml- Loading dose of 50 Usual dose range: 0.25 – 1 decreased renal function Incompatible with many meds
100ml mcg/Kg over 10 mcg/kg/min – titrate to response – check with pharmacist
Premix, minutes Monitoring:
10 & 20 ml System Standard Conc: 20mg/100 ml
Cardiovascular/ Positive
D5W Premix (200 mcg/ml)
Continuous EKG Monitoring
inotrope vial 1 Following initiation or dose
mg/ml System “Concentrated” Conc: 20 titration: Continuous BP or
mg/30 ml NS (total volume 50 ml) q15min x 3, then q1h x 4
(400 mcg/ml) then q4h x 2 then q4-6 hours
Half-life: 1-3 hr while stable.
Morphine Various Yes, Continuous Infusion – Hierarchy of effects analgesia PCA: Check syringe for
concentra- at max rate of 1 sedation respiratory depression expiration date
*HIGH ALERT tions, vials mg/min System Standard Conc: 50mg/250ml Metro: If PCA
MEDICATION* & syringes. NS (0.2 mg/ml) Monitor respiratory and ordered,
System “Concentrated” conc: cardiovascular status – may cause mandatory order
50mg/100ml NS (0.5 mg/ml) respiratory depression/distress set must be used
Narcotic analgesic
Titrate to dose that relieves pain
without excessive sedation – avoid
Chronic pain management- maximum abrupt dose changes
dose is effective dose Lower doses advised in elderly,
debilitated or in patients receiving
other CNS depressants
Reverse effects with naloxone

(Narcan)
Moxifloxacin 400 mg/250 NO Infuse over 60 min

(Avelox) ml
Premix
Antibiotic/
Fluoroquinolone
Multivitamin MVI-12 NO Common component of banana bag.
(adult) 10
Vitamin/ Nutritional ml vial Manufacturer recommends Common component of TPN.
supplement minimum volume for infusions of
500 ml.
Muromonab CD3 1 mg/ml – Yes, NO Pre-dose corticosteroid, antihistamine * See footnote
(Orthoclone OKT3) 5 ml Amp 5 mg over 60 and acetaminophen recommended
seconds Do not mix with other
Be aware of potential for cytokine solutions/medications
Immunosuppressant release syndrome (CRS) & acute
hypersensitivity (allergy) reactions
with initial doses
Dose is 5 mg IV daily x 10-14 days
in adults
Mycophenolate mofetil 500mg Vial NO Infuse over 2 hours Each 500mg vial reconstituted with Do not mix with other
(CellCept) 14ml D5W solutions/medications
Final concentration of solution should
Immunosuppressant be 6 mg/ml
Avoid direct contact with solution.

If this occurs, thoroughly wash
exposed area with soap and water –
teratogen.
Nafcillin 1 & 2 Gm NO Intermittent Infusion Penicillin derivative - check
(Nafcil) Vials < 2 Gm give over 30min allergies
2 Gm/100 > 2 Gm give over 60min
ml Premix Avoid Extravasation – see PPO 5046
Antibiotic/ Penicillin for general guidelines / management
Tissue damage reported with
infiltration – prefer central line
administration if available
Slow rate or further dilute if phlebitis
occurs
Nalbuphine 10mg/ml – Yes, Not Advised – Give IV Push 10 mg Nalbuphine = 10 mg IV
(Nubain) 10ml Vial at max rate of 1 Morphine
20mg/ml – mg/min
10ml Vial Monitor respiratory status –
Narcotic Analgesic may cause respiratory
depression
Reverse with naloxone (Narcan)
May cause withdrawal in opioid

dependent patients.
NaLOXone 0.4 & Yes, Not advised – Give IV Push Used for reversal of narcotic agents
(Narcan) 1 mg/ml, 0.1 – 0.4 mg over
various size 1 minute Continuous infusion for epidural Onset of action within 2 min
REVERSAL AGENT syringes & May repeat IV associated pruritis If no response after 10 mg given,
vials doses at 2-3 min System Standard Conc: 1 mg/250ml question narcotic overdose
intervals or per NS (4mcg/mL)
Narcotic Antagonist/
order System “Concentrated” Conc: 2 Reversal of opiod depression may
Reversal agent for mg/100 ml NS (20mcg/mL) cause nausea/vomiting, sweating,
Narcotics tremulous, tachycardia, and HTN.
NATALizumab 300mg/15 NO Intermittent infusion: 300 mg in 100 Restrictions in administration apply – Vials: Refrigerate and protect Must be only
(Tysabri) ml vial ml NS. Infuse over 1 hour. patient, physician, in fusion center from light administered in
and pharmacy must be registered with FDA registered
FDA. USE NS ONLY! outpatient
Monoclonal antibody for infusion areas –
Multiple Sclerosis & Preprinted order set available for Stable 8 hours after dilution check with site
Crohns Disease administration in ASLMC refrigerated. Warm to room (i.e. ASLMC –
CND and ASLMC ATC. temp prior to infusion. CND/ATC only;
no inpatient
May cause infusion-related/ Do NOT shake. Do NOT areas)
hypersensitivity reactions. Monitor transport via tube system.
patient during and x 1 hour post-
infusion. Emergency preprinted order
set available.
Neostigmine 1 mg/ml = Yes, NO Antidote for non-depolarizing *See footnote

(Prostigmin) 1:1000 – 10 0.5 – 2 mg. Give neuromuscular blockade (see Precautions/
ml vial SLOWLY Comments)
0.5 mg/ml Metro: For Acute Colonic Pseudo-
Anticholinesterase = May give IM Obstruction (Ogilvie’s Syndrome):
1:2000 – 1 Per P&T --Bedside telemetry/RN
ml amp/vial presence required during
0.25 mg/ml Usual max/total administration. Give over 10 min.
= 1:4000 – dose is 5 mg Patients must remain in monitored
1 ml amp bed 4-6 hours after administration.
Use with caution in renal
dysfunction. Decrease dose for CrCl
< 50mL/min
Nesiritide 1.5 mg vial Bolus dose: 2 Continuous infusion: Usual dose = Monitoring parameters and IV Flush tubing with approx. 25 * See footnote
(Natrecor) mcg/kg IV push 0.01 mcg/kg/min. Drip may be incompatibilities available on pre- ml prior to connecting to
over 1 minute. increased by 0.01 mcg/kg/min q3h if printed order set patient and prior to bolus if
Bolus not always needed to maximum dose of 0.03 ordered.
Cardiovascular/ given. mcg/kg/min. For initiation or dose titration,
monitor BP every 15 min x 4, every Incompatible with heparin,
Vasodilator
System Standard Conc: 1.5mg/250ml 30 min x 2, every 1hr x 2 hr then insulin, furosemide,
NS (6 mcg/ml) every 4 hr. Hold for BP < 90. bumetanide, enalaprilat, and
hydralazine. Consult
information.
NiCARdipine 2.5mg/ml – NO Continuous Infusion Rate >3mg/hr: Continuous BP & Critical Care –
(Cardene) 10ml Amp System Standard Conc: 25 mg/250 ml EKG Monitoring See footnote*
NS (0.1mg/ml) Central line access advised!
Cardiovascular/ Calcium Rate 1-3mg/hr: Continuous BP &
Channel Blocker System “Concentrated” conc: 50 HR or vitals q15min x 3, q30 x 2 then
mg/80 ml NS (total vol 100 ml) (0.5
Manufacturer recommends
q4-6h while stable. changing IV site every 12
mg/ml)
hours if run peripherally
Normally solution light yellow in
Usual dose range: 2.5 – 15 mg/hr color
Recommended titration: Initiate at 2.5-
5mg/hr & increase infusion by 2.5 Incompatible with Lactated
mg/hr Q15min until at BP goal (max of Ringers or bicarbonate solutions –
15 mg/hr). Once desired effect contact pharmacist for
reached, reduce to maintenance of 3 compatibility information
mg/hr.
NitroGLYcerin Vial NO Continuous Infusion – Initial dose: 10 Monitoring - For initiation or dose Glass container only * See footnote
(Tridil) 50mg/10ml mcg/min then titrate by 10mcg titration: Continuous BP &HR or Use vented set
Premix increments q5min to desired BP goal q5min x 3, then q15min x 3, then Q4-
Cardiovascular/ 50mg/500m 6hr while stable. Check with pharmacist
l& Usual dose: 10-200 mcg/min regarding compatibility
Vasodilator
50mg/250m System Standard Conc: 50 mg/250 ml Side effects include: hypotension, information.
l D5W Premix (glass bottle) (200 HA (common), tachycardia
mcg/ml) ** If IV tubing changes are needed,
System “Concentrated” conc: 100 monitor pt every 15 min x 1 hr for
mg/250 ml NS (glass bottle) (400 possible NTG-retitration. IV tubing
mcg/ml) sets must be changed every 72 hr. **
NitroPRUSSide 50mg/2 ml NO Continuous Infusion: Monitor BP (via arterial line if Protect from light Critical Care
(Nipride) vial possible) and HR every 15 min
Usual dose range: 0.5 – 10 Sodium thiosulfate 500mg
mcg/Kg/min Monitor urine output every 1-2 hr may be added to each
Cardiovascular/ System Standard = 50 mg/250 ml NS Excessive infusion may produce nitroprusside infusion bag to
Vasodilator (200mcg/ml) cyanide toxicity. Monitor for signs decrease cyanide formation.
System “Concentrated” conc: 50 and symptoms of cyanide toxicity: Addition is recommended
mg/100 ml NS (500mcg/ml) mental status changes, dyspnea, HA, when nitroprusside dose is
N/V, ataxia, absent reflexes, distant > 2 mcg/kg/min for more than
Onset: 30-60 sec heart sounds, widely dilated pupils, one hour or for infusion
Peak effect: 1-2 min shallow breathing, and coma. duration > 72 hr
Duration: 1-10 min Increased risk of cyanide toxicity in
Half-life: 3-4 min pt with renal dysfunction or hepatic
insufficiency. ** Do not run infusion at 10
mcg/kg/min for longer than 5-
Tachyphylaxis has been reported May need to check thiocyanate 10 min – if this high of dose
particularly with doses > 10 (renally cleared metabolite) levels. needed, call physician for
mcg/kg/min – d/c drug immediately if S/sx thiocyanate toxicity: fatigue, alternative**
occurs!! muscle weakness, tinnitus, confusion,
psychosis, hallucinations, nystagmus,
coma
Norepinephrine 1 mg/ml- NO Continuous Infusion: Central Line Advised! Critical Care
(Levophed) 4 ml amp Usual dose range: 2 – 12 mcg/min
Avoid infiltration – Phentolamine Check with pharmacist
System Standard Conc: 4 mg/250 ml (Regitine) SQ recommended for
Vasopressor regarding compatibility
NS (16 mcg/ml) management of infiltration information
System “Concentrated” Conc: 8 ( PPO 5046)
mg/250 ml NS (32 mcg/ml)
Monitor BP, HR every 5-15 min
Onset: immediate
Duration: 1-2 min Monitor urine output every 1-2 hr
Octreotide 0.05 mg/ml Yes, Intermittent Infusion – Refrigerate undiluted product
(SandoSTATIN) 1 ml, 0.1 Give dose over 3 Dilute with 50ml NS – Infuse over 15
mg/ml 1 minutes minutes Multi-dose vial stable 14 days
ml, 0.5 refrigerated after initial use
Hormone - Somatostatin mg/ml 1 ml May be given SQ Continuous IV/Subcutaneous Infusion
ampules; System Standard Conc: 500 mcg/250
0.2 mg/ml ml NS (2 mcg/ml)
5 ml, 1 System “Concentrated” Conc: 1000
mg/ml 5 ml mcg/100 ml NS (10 mcg/ml)
vials
Ondansetron 2mg/ml – 2 Yes, Intermittent Infusion – Chemotherapy Recommended max dose is 32
(Zofran) & 20ml 4 mg over 1-2 8, 12, 16, 20 or 24 mg in 50ml NS mg/day
Vials min for post-op Infuse over 15 minutes
Antiemetic/ 5HT3 nausea/vomiting Flat dose response from 1-4mg.
receptor antagonist Continuous infusion: Max of
32mg/day
Oxytocin 10 units/ml NO Continuous Infusion – Metro: See MWH-11-MAT:
(Pitocin) 1 ml Induction of labor: 1-2 milli-units/min, Women’s Health Policy and
syringe/vial increase by 1-2 milli-units every 15-30 Procedures – Maternal for Oxytocin:
minutes as needed Induction and Augmentation of Labor
*HIGH ALERT
MEDICATION* System Standard Conc: 20 units/1000 Metro: Pre-printed order set available
ml NS (0.02 units/ml) for Labor Induction/Stimulation
Hormone – Uterine
stimulant System “Concentrated” Conc: 40 See site specific administration policy
units/ 1000 ml NS (0.04 units/ml)
Monitor VS – may cause
Postpartum Hemorrhage: Infusion hypotension, hypertension,
titrated to absence of hemorrhage. bradycardia
Pamidronate 30 mg/10 NO Infuse over 3 to 24 hr Renal function should be assessed

(Aredia) ml and 90 prior to each dose
mg/10 ml
vials Dose should not exceed 90 mg
Bisphosphonate May cause HTN and bone pain
Infusion site reactions possible – slow
infusion rate if occurs
Pancuronium 1 mg/ml 10 Yes, Continuous Infusion – Refer to Clinical Nursing Policies Store undiluted product (vial) Controlled airway
(Pavulon) ml vial, 0.1 mg/Kg bolus System Standard Conc: 100mg/50 ml on Neuromuscular Blockade under refrigeration and ventilation
2 mg/ml 2 given rapidly NS (total volume 100 ml) (1 mg/ml) (i.e MN13) required;
*HIGH ALERT ml and 5 ml Critical Care only
MEDICATION* vials/ Refer to Preprinted order sets
syringes available for ICU neuromuscular Sedation must
Neuromuscular blockade be administered
blocker prior to and
during paralytic
use!
Pantoprazole 40mg Yes, Continuous infusion: Continuous infusion duration should Vial: stable at room
(Protonix) /10ml vials 40–80mg over not exceed 72 hr temperature or refrigeration 24
2min System Standard Conc: 80 mg/ 500 ml hrs after reconstitution.
NS (0.16 mg/ml) Run separately!! Do not infuse with
Proton Pump Inhibitor any other medications!! Intermittent / Continuous
Dilute 40 mg vial System “Concentrated” Conc: 80 mg/ Infusion (40mg-80mg/100mL):
with 10 ml NS 100 ml NS (0.8 mg/ml) Check with pharmacist for possible Stable for 24hrs room temp.
compatible medications.
Infusion (80mg/500mL NS):
Stable for 12hrs at room temp.
Filtration not required during

preparation or administration.
Parenteral Nutrition ----------- No
Route of administration: Central line
(PN) Do not administer any
If no central line access, confirm with
medications/solutions/blood
pharmacist that osmolality (< 900
products etc. with PN. If
millimoles) is appropriate for
alternative IV access is a
peripheral administration.
problem, contact the
PN which includes lipids: change information.
tubing every 24 hours. Use 1.2 micron
filter for PN with lipids.
PN with no lipids: change tubing every

96 hours. Use 0.22 micron filter for PN
without lipids.
Paricalcitrol 2 mcg/ml 1 Yes – IV push preferred Discard vial after use.

Used in the prevention and treatment
(Zemplar) ml, 5 mcg/min of secondary hyperparathyroidism in
5 mcg/ml 1 chronic renal failure patients.
Vitamin D Analog ml
vials
Pegfilgrastim 6mg/0.6ml NO Give only SQ!! Long acting filgrastim Refrigerate
(Neulasta) syringe Give 6 mg SQ as May cause bone pain
a 1 time dose only Do not shake product or
White cell stimulating transport via tube system
hormone
Penicillin G 1,5,10 & 20 NO Intermittent Infusion – Penicillin allergy precautions –
(sodium or potassium Million Up to 3 Million Units/50 ml NS. Infuse Check allergies
salt) Unit Vials over 30 minutes
Premix: 3 3.1 - 5 Million Units/100 ml NS. Avoid rapid infusions – seizures may
Million Infuse over 60 minutes result
Antibiotic/ Penicillin Unit/50ml Dose reduction recommended for
container CrCl < 50 ml/min
Watch K+ -- 1 million units PCN G
contains 1.7 mEq K+
Pentamidine 300mg vial NO Intermittent Infusion – Monitor BP every 15 min during 60
(Pentam) 4 mg/Kg diluted into 250ml D5W – min infusion
over 60 minutes Do NOT refrigerate –
Administer in supine position crystallization may occur
Antiprotozoal Monitor blood glucose daily during
therapy-hypoglycemia common
Nebulized product also available. Daily BUN/SCr, and LFTs
recommended
Metallic taste noted to be common
Pentazocine 30 mg/ml 1 Yes, Not recommended Recommended max dose is 360 Pentazocine 30 mg = Morphine
(Talwin) ml syringe Max rate of 5 mg/24 hr 10 mg IV
and amp, mg/min
30 mg/ml Monitor respiratory status – may
Narcotic Analgesic 10 ml vial cause respiratory depression
Reverse with naloxone (Narcan)
PENTobarbital 50mg/ml – Yes, Undiluted solution is alkaline – avoid Incompatible with most Controlled
(Nembutal) 1 ml Give slowly at System Standard Conc: 2000 mg/210 infiltration. Central line medications/solutions – check airway and
syringe, 20 max rate of 50 ml NS (total volume 250 ml) (8 administration preferred. with pharmacist ventilation
& 50 ml mg/min mg/ml) required –
Vials With IV administration Use 0.22 micron filter with
*HIGH ALERT Metro: Preprinted order set available monitor respiration & cardiac infusion Critical care
MEDICATION* for Barbiturate Coma for elevated ICP. function continuously only!
Refer to ICP protocol (PPO 02974) – Monitor pentobarbital levels.
Sedative/ Barbiturate Loading /Bolus Doses: 2.5-10mg/kg Goal levels:
over 15-60min, respectively. Hyponotic/sedation: 1–5 mcg/ml
Continuous Infusion: Initiate at Coma: 10-50 mcg/ml
1.5mg/kg/hr.
Perphenazine 5 mg/ml 1 Yes – but only use Usual dose is 1 mg every 2-3 min
(Trilafon) ml amp IV if absolutely Recommended max dose is 5 mg
necessary
Dilute 5 mg w/ 9 May cause contact dermatitis;
Antipsychotic Agent ml NS and give 0.5 Extrapyramidal symptoms (ie.
mg/min Dystonia rxn) possible
IM
administration Postural hypotension may occur –
recommended monitor BP
PHENObarbital 60 mg/ml 1 Yes, Intermittent Infusion: Undiluted solution is very alkaline – *See footnote
(Luminal) ml, 130 Give slowly at Loading dose: 15mg/kg in 100 ml NS avoid infiltration
mg/ml 1 ml max rate of 60 Infuse over 15-30 minutes Incompatible with most Critical Care for
syringes mg/min Monitor BP, HR, RR medications/solutions – check continuous
Anticonvulsant/ Maintenance doses: 1-3mg/kg/day With continuous IV administration with pharmacist infusions
Sedative/ Barbiturate (divided doses) may be given slow IV monitor respiration & cardiac
push function continuously
Too rapid administration may cause
respiratory distress and hypotension
Phentolamine 5mg/ml – Yes, SQ administration preferred Antidote for peripheral ischemia Use reconstituted solution
(Regitine) 1ml Vial 5mg/10ml NS due to dopamine, dobutamine, immediately
Give over 30 Administer within 12 hr of norepinephrine, metaraminol,
seconds extravasation epinephrine , phenylephrine.
Vasodilator See PPO 5046
SQ administration
preferred SQ admin: dilute to 0.5-1 mg/ml and
inject 0.5 ml in multiple sites to cover
extravasation area (doses up to 50 mg
have been used)
Phenylephrine 10 mg/ml – Yes, rarely. Continuous Infusion Critical Care
Avoid infiltration – Phentolamine
(Neosynephrine) 1 & 5ml 0.1-0.5 mg given System Standard Conc: 50 mg/250 ml (Regitine) SQ recommended for
Vial over at least 1 NS (200 mcg/ml)
management of infiltration -see PPO
min
System “Concentrated” Conc: 50 mg/ 5046 for general extravasation
Vasopressor
100 ml NS (0.5 mg/ml) guidelines / management
Prep: add 1 ml of
phenylephrine 10 Usual dose range: 40-60 mcg/min is
mg/ml to 100 ml usually adequate Monitor BP, HR every 15 min
NS – final conc 0.1
Monitor urine output every 1-2 hr
mg/ml
Central line advised!
PhenyTOIN 50 mg / ml Yes, Dilute with only NS to a concentration Monitor BP Administer immediately after
(Dilantin) 2ml Max rate of 50 between 2 & 10 mg/ml. dilution. Stable only 4 hr.
Syringe & mg/min Central line administration required
2 or 5ml for doses > 300mg. Fosphenytoin Use in-line filter (0.22 micron)
Anticonvulsant vial Rate of 25 mg/min Recommended loading dose: 15-20 may be given peripherally.
mg/kg Flush IV line with 10 ml NS
recommended in Watch for crystal formation. before and after dose
elderly or presence Recommended maintenance dose: 5 Alkaline solution – local burning administered
of coronary artery mg/kg/day upon administration is common –
disease. slow infusion if occurs
Fosphenytoin is preferred – refer to
fosphenytoin entry.
Phosphate – Potassium 5 & 10 ml NO Infuse slowly as dilute solutions Lower dose recommended with Not compatible with calcium
or Sodium Salts Vial Recommended infusion rates: concomitant hyper-calcemia solutions
3 mMol 5 mMol Phos/100 ml D5W over 1 hr
*HIGH ALERT (Millimoles 10 mMol Phos/150 ml D5W over 2 hr Recommended dose range is 0.08 –
MEDICATION* ) Phosphate 15 mMol Phos/250 ml D5W over 3 hr 0.24 mMol/Kg
& 4.4 mEq 20 mMol Phos/250 ml D5W over 4 hr Sodium Phosphate or Potassium
Electrolyte K or 4 mEq 30 mMol Phos/250 ml D5W over 6 hr Phosphate should always be ordered
Na per ml in millimoles (mMol)
Physostigmine 1mg/ml – Yes, NO For reversal of anti-cholinergic Too rapid administration *See footnote
(Antilirium) 2ml Amp at max rate of toxicity may cause bradycardia and Do not confuse
1mg/min respiratory distress with
Cholinergic Recommended max dose is 4 mg in pyridostigmine.
30 min
Atropine readily
available (UBC)
Phytonadione 1 mg/0.5 NO Intermittent infusion- Usual Dose: Severe anaphylactoid reactions have Use immediately after dilution.
IV route
(Vitamin K – ml amp/ 5-10mg/50 ml NS over 30-60minutes, occurred – usually during / immediate restricted to
Aquamephyton) syringe respectively. Protect from light.
following infusions. Fatal reactions Critical Care,
10 mg/ml have been reported. OR & ED
amp May be administered over 15min in
administration.
Vitamin/ Reversal of 50mg/5 ml emergency reversal (ICH). Monitor closely for signs of
Anticoagulation vial flushing, weakness, tachycardia, Outside of these
SOB, abdominal pain, and areas: physician
hypotension; discontinue infusion. administration
Consider fluids, diphenhydramine, only.
epinephrine, corticosteroids &
supportive therapy.
Piperacillin 2, 3, and 4 NO Dilute in 100 ml NS/D5W and infuse

Penicillin derivative – Check
(Pipracil) gm vials over minimum of 30 minutes
allergies
IM administration
recommended
Slow infusion rate if vein irritation
Antibiotic/Penicillin
occurs
CrCl < 40 ml/min
Piperacillin/Tazo- 2/0.25, NO Infuse over minimum of 30 min
Penicillin derivative – Check
bactam (Zosyn) 3/0.375 &
allergies
4/0.5 Gm
Vial and
Slow infusion rate if vein irritation
Antibiotic/ Penicillin Premix
occurs
2/0.25 in 50
ml, 3/0.375 Dose reduction recommended for CrCl
in 50 ml, < 40 ml/min
4/0.5 in 100 Extended infusions over 3 -4 hours
ml may be used for treatment of resistant
pathogens.
Potassium Chloride Vials – NEVER GIVE Maximum concentration: Slowing potassium infusion rate, * See footnote if
Avoid extravasation – see PPO 5046
2mEq/ml IV PUSH!! • Intermittent infusion, peripheral for general guidelines / management. increasing maintenance fluid rate of infusion
*HIGH ALERT Premix line: 20 mEq/100 ml rate, or increasing SVP volume exceeds
MEDICATION* bags: • Intermittent infusion, central line: may reduce stinging if 20mEq/Hr
10mEq/ 50 20 mEq/50 ml encountered with peripheral
& 100ml, administration. If these
• LVP/IV fluids: 80 mEq/L
Electrolyte 20mEq /50 measures fail, lidocaine 10-50
& 100ml mg may be added for peripheral
Administration rate:
administration upon MD order.
• Usual: 10 mEq/hr (20 mEq/hr for Greater than 100 mg/day not
20 mEq/50 ml) recommended.
• Max admin rate without
telemetry: 20 mEq/hr
• Max. admin rate with telemetry:
40 mEq/hr (exceeding 40mEq/hr
for severe, life-threatening,
symptomatic hypokalemia requires
cardiac monitoring & physician
presence)
Pramlintide No, Not advised Metro:
Used as adjunct to mealtime insulin in
(Symlin) Type I & Type 2 DM. Do NOT mix with insulin!! Pramlintide will
SC NOT be
administration Can cause severe hypoglycemia when Unopened vials: dispensed for
*HIGH ALERT
used with insulin – monitor for s/sx of refrigerate/protect from light. inpatients per
MEDICATION* only!
hypoglycemia See vial for expiration date. P&T. See Metro
Caution: Product labeled in mg/mL. Pharmaceutical
Synthetic analog of
Dosed in mcg. Administered using Opened vials: Discard after 28 Services P&P
amylin/ adjunct 3.55 (06/06)
insulin syringes labeled in units. days
treatment of diabetes
Procainamide 100 mg/ml Yes, Continuous Infusion: * See footnote
Monitor BP every 2-3 min during
(Pronestyl) 10 ml vials Diluted to Usual dose range: 2 – 6 mg/min Check with pharmacist
loading dose then every 15 min until
20mg/ml and give regarding compatibility
stable during initial infusion.
500 mg/ml at 20-50 mg/min System Standard Conc: 1 Gm/250 ml information.
Cardiovascular/ Anti- 2 ml vials Up to total dose of NS (4mg/ml) Continuous ECG monitoring.
arrhythmic for IM 1 Gm Elimination half-life extended in renal
injections System “Concentrated” Conc: 1
Gm/100 ml NS (10 mg/ml) failure.
Prochlorperazine 5mg/ml, Yes, 5 mg per Intermittent Infusion – Protect diluted solutions from Contraindicated
Do not exceed 40 mg in 24 hours
(Compazine) syringes minute maximum 10mg in 50ml NS over 15min light in patients with
and Vials rate Slow rate if extra-pyramidal symptoms Parkinson’s
(dystonia, motor restlessness, disease
Antiemetic parkinson-like symptoms) occur
Monitor for hypotension – recommend
patient lay down or sit for 30 min after
dose
Profilnine SD
See Factor 9 Complex -
Human
Promethazine 25 & Yes, Not advised – IM Preferred Metro:
Monitor for hypotension, tachycardia.
(Phenergan) 50mg/ml - max of 25 mg/min Promethazine
Vials For IV admin: Avoid extravasation --Apply warm injection is not
Antihistamine/ Dilute to 10-20 ml compresses for 20-30 minutes 4-6 available due to
antiemetic with NS and admin times a day for 1-2 days. safety concerns
via running IV line Extravasation – see PPO 5046 for including
general guidelines / management extravasation.
IM Preferred
Propofol 10mg/ml – Yes, Continuous Infusion – ICU sedation Do not mix with other solutions or Discard unused solutions after Critical Care for
(Diprivan) 20ml Amp, Give slowly over 5mcg/kg/min with additional 5-10 infuse if emulsion appears separated 12 hours continuous
50 & 3-5 min. mcg/kg/min increments every 5 infusion;
*HIGH ALERT 100ml minutes to sedation level desired. Propofol contains 1.1 Kcal/ ml Change tubing every 12 IV push mode
MEDICATION* bottles – fat hours limited to areas
emulsion Usual dose range: 5-50 mcg/kg/min Monitor closely for hypotension, that can provide
Sedative bradycardia, and respiratory Do not filter respiratory
System Standard Conc: 1000 mg/100 depression monitoring and
ml Premix (10 mg/ml) prompt
For infusions > 72 hours, intubation
recommend checking
triglycerides
Propranolol 1mg/ml – Yes, NO BP every 5 min during titration, then q May dilute w/ 10 ml D5W or * See footnote
(Inderal) vial 0.5mg then 15min until stable give undiluted
1mg/min every 5- Monitor Heart Rate-bedside monitor +
10 min to max of defibrillator
Cardiovascular/ Beta- 0.1mg/Kg
Blocker IV maintenance dose may be given
Max rate: 1 every 4 hrs
mg/min
Protamine 10mg/ml – Yes, NO Monitor for hypotension &

5 and 25ml 10mg/ml given bradycardia
Heparin antagonist Vials over 1-3 minutes.
Max dose: 50mg in 1 mg protamine for approx 100 units
any 10 minute USP Heparin
period
Pyridostigmine 5 mg/ml 2 Yes NO Used in pt with myasthenia gravis Incompatible with many Monitored bed
(Mestinon) ml amp, 5 Max rate of 5 medications/solutions – check recommended.
mg/ml 5 ml mg/min May be used to reverse effects of non- with pharmacist Do not confuse
Cholinergic vial depolarizing neuromuscular blockers. with
Other agents preferred. physostigmine.
Pyridoxine 100mg/ml Yes, Intermittent Infusion – Antidote: Isoniazid poisoning or
(Vitamin B-6) in 10 & 50 – 100 mg/min 5 Gm in 50ml NS over 30min overdose - Give equivalent amounts of
30ml vials 50-100mg in 50mL NS over 30min pyridoxine as ingested Isoniazid.
Vitamin/ Nutritional Antidote: Ethylene glycol toxicity –
Supplement administer 50-100mg q6h until
ethylene glycol levels undetectable /
resolution of acidosis
Ranitidine 25mg/ml – Yes, Slow IV-Push preferred
(Zantac) vial and Dilute 50mg dose
syringe up to 5ml with NS Continuous Infusion:
H2Receptor and give over 2-3 System Standard Conc: 150mg/250ml
Antagonist minutes NS (0.6 mg/ml)
Remifentanil Powder for Yes, over 30-60 Slow IV push or via continuous Risk of apnea / respiratory depression. Anesthesia /
(Ultiva) Injection: seconds by infusion Anesthesia
1mg,2mg, Anesthesia or with Consult Only
*HIGH ALERT 5mg vials continuous airway Continuous Infusion:
MEDICATION* support System Standard Conc: 2mg/100mL
Narcotic Analgesic (20mcg/mL). Dose range 0.025-
2mcg/kg/min
Reteplase 1 unit/ml Yes, May be used for treatment of Thrombolytic medication: Monitor Do not shake or transport via *See footnote for
(r-PA, Retevase) 10 ml vial For AMI: Peripheral Arterial Occlusion (PAO) for bleeding. tube system. cardiopulmonary
10 units over 2 Minimize potential risks for bleeding: indications (ie:
min. Repeat 10 Establish all IV’s prior to therapy. Incompatible with heparin!! AMI, PE).
*HIGH ALERT units after 30 min (Minimum of 2 peripheral IVs Check compatibilities with
MEDICATION* recommended in addition to pharmacist Monitoring is at
Do not confuse with Flush with thrombolytic infusion site.) physician
other thrombolytic minimum of 30-50 Avoid unnecessary arterial/venous Do not mix with any discretion for
medicines. ml NS or D5W punctures, excessive blood sampling, meds/solutions. peripheral
and IM injections for at least 24 hr vascular
after d/c’d (malnourished patients 48 indications.
Thrombolytic hr).
Apply pressure dressings to all
puncture sites.
RifAMPIN 600mg Vial NO Intermittent Infusion – May cause a reddish-orange
(Rifamycin) for Up to 600mg diluted into 100ml D5W discoloration of urine, saliva, tears, Protect from light
Injection or NS over 30 minutes sweat and stool
Permanent discoloration of soft Expires 4 hours after
Antibiotic contact lenses may occur. preparation.
Avoid infiltration = local irritation and
inflammation. If this occurs, the
infusion should be discontinued and
started at another site.
Rocuronium 10mg/ml – Yes, Continuous Infusion: Refer to Nursing Clinical Policies Refrigerate vials. Unopened Controlled airway
(Zemuron) 5ml Vial intubation dose 0.6 Usual dose range: 5-20 mcg/Kg/min on Neuromuscular Blockade (i.e. vial stable at room temp x 60 and ventilation
mg/Kg rapidly MN-13) days but then must be required;
*HIGH ALERT discarded. Critical Care
MEDICATION* only:
ED, ICU, Surgery
Neuromuscular
be administered
prior to and
during paralytic
use!
Sargramostim 500mcg/ml NO Intermittent infusion: 25 ml NS Infuse Do not filter solution Concentrations less than
(GM-CSF – Leukine) vial over 2 hours Use only NS to dilute 10mcg/mL require albumin
0.1% added to solution to
Colony Stimulating Monitor BP – syncope may occur prevent adsorption.
Factor especially after 1st dose
Sodium Bicarbonate 8.4% Yes, Do not mix with other medications –

solution 50 mEq (50 ml) Check with pharmacist
1mEq/ml & over 1-2 minutes Sodium bicarbonate may be added to
Electrolyte syringe IV fluids – check with pharmacist for Neonates: Flush w/ 10-20 ml NS
Neonatal: Neonates: avoid compatibility/stability information before after administration
4.2% admin of 10
solution 0.5 ml/min
mEq/ml 10 or greater
Avoid extravasation!! Central line
ml syringe administration advised when ever
possible. (See PPO 5046)
Sodium Chloride 3% 500 ml bag Not advised Hypertonic (3%) saline is non- Do not mix with any
Rate and infusion duration variable. physiologic and is only indicated in medications/solutions. Contact Metro:
*HIGH ALERT neurosurgical patients or patients pharmacist for compatibility Mandatory PPO
MEDICATION* with severe (Na+ < 120) or information. with serial
symptomatic hyponatremia. sodium levels
(minimum q 4
Hypertonic solution Chronic Hyponatremia: hr) and
Risk associated with rapid sodium Central line administration and mandatory call
correction (greater than Critical Care admission parameters
0.5mEq/L/hr or 8 mEq/24 hr) advised. (minimum order
includes osmotic demyelination and to call if Na+
permanent neurologic damage. correction
exceeds 8
Periodically hypertonic saline is used mEq/24 hr) – if
at low rates for short periods of times not included in
s/p urological surgeries, etc. – the original order,
limitations/restrictions need not apply physician must
in such instances. be contacted per
P&T.
Sodium citrate, 4% 500 ml NO NOT to be infused directly May be used as an alternative to
bags intravenously. capping with heparin (ex. PICC lines,
Mahukar lines, etc.)
Anticoagulant
StreptoMYCIN 1g vial NO Intermittent IV Infusion - usual dose: Dose adjustment in elderly / reduced
(powder) 500-1000mg in 100mL NS over 30- renal function.
Antimicrobial 60min
Monitor hearing, renal function &
May administer via deep IM injection serum concentrations as indicated.
Succinylcholine 20mg/ml Yes, Other medications preferred as Refer to Nursing Clinical Policies - Refrigerate Controlled airway
10ml Vial prior to intubation continuous infusions Neuromuscular Blockade and ventilation
*HIGH ALERT 0.6mg/kg slowly (i.e. MN-13) required;
MEDICATION* over 30 seconds Contraindicated in patients with Critical Care
personal or family history of Too rapid administration may cause only:
malignant hyperthermia or bradycardia ED, ICU,
Neuromuscular Surgery.
history of skeletal muscle
blocker May cause hyperkalemia – increased
myopathy!! risk with use in patients with burns, Sedation must
severe trauma, stroke, spinal cord be administered
injury, muscular dystrophy, multiple prior to and
sclerosis, tetanus, Parkinson’s disease. during paralytic
use!
May cause rhabdomyolysis
Tacrolimus 5mg/ml – NO Continuous Infusion – *NOTE: Sublingual administration
(Prograf) 1ml Amp Usual dose: 0.05 – 0.1 mg/Kg/Day preferred due to risk of allergic
Standard conc: 5 mg/250 ml NS reaction with IV product* Use admin set provided by
(Excel) (20 mcg/ml) pharmacy
Immunosuppressant Monitor for allergic reaction
Intermittent infusion (q12h) – run over especially during initial 30 minutes IV = ¼ PO Dose
4 hr of first infusion – anaphylaxis
Conc must be 0.004 – 0.02 mg/ml
Monitor for hyperkalemia,
hyperglycemia and elevated BP
Monitor trough tacrolimus levels

Tenecteplase 50mg vial Yes, Acute Coronary Syndrome/Acute Thrombolytic medication: Monitor *See footnote for
(Tnkase) Weight based Myocardial Infarction: for bleeding. cardiopulmonary
bolus dosing (15 - Preprinted order set available Minimize potential risks for bleeding: May precipitate in IV lines indications (ie:
50mg depending Establish all IV’s prior to therapy. with D5W. Flush line with NS AMI, PE).
*HIGH ALERT on weight) Give Peripheral Vascular Thrombolysis: (Minimum of 2 peripheral IVs before and after
MEDICATION* dose over 5 Per Interventional Radiology. recommended in addition to administering. Monitoring is at
Do not confuse with seconds into Preprinted order set available thrombolytic infusion site.) physician
other thrombolytic running NS line Avoid unnecessary arterial/venous Do not mix with other discretion for
medicines. punctures, excessive blood sampling, medications/solutions. peripheral
and IM injections for at least 24 hr vascular
Thrombolytic after d/c’d (malnourished patients 48 indications.
hr).
puncture sites.
Terbutaline 1 mg/ml NO Continuous infusion: Used to inhibit Monitor for s/sx pulmonary edema in * See footnote
(Brethine) ampule SQ administration pre-term labor contractions (tocolysis). pt on continuous infusion Protect ampule from light
preferred – 0.25
Sympathomimetic mg SQ x 1, may Titrate to contractions >/= 15 minutes or Monitor HR (maternal and fetal), BP,
repeat x 1 after 15- absence of contractions ECG, I&Os
30 min. Max dose
of 0.5 mg in 4 hr Uterine relaxation: 0.25 mg in 5 ml NS See site specific administration policy
recommended. – given IV push
Metro: See MWH-17-MAT: Women’s
Health Policies & Procedures –
Terbutaline sulfate: Administration for
Tocolysis
Theophylline Premix NO Intermittent Infusion – Theophylline serum level monitoring
bags: 5mg/kg theophylline loading dose over is recommended periodically during
800mg/500 30 min IV infusion
Bronchodilator ml Continuous Infusion – 0.4mg/Kg/hr
theophylline Monitor HR, BP
System Standard Conc: 800mg/500ml (Note: Aminophylline is 80%

Premix (1.6 mg/ml) theophylline:
500mg aminophylline = 400mg
theophylline)
Thiamine 100mg/ml Yes, A common component in a “banana ** Verify dose to be given. Discard
(Vitamin B-1) – 2ml vial Administer via bag” – 1000 ml bag. vial after drawing up correct dose. **
large vein over at
least 3 min with May also be given as intermittent Pain at IV site noted at times.
Vitamin/ Nutritional running IV fluids. infusion: 100 mg/50 ml D5W. Infuse
supplement Also may be given over 15 – 30 min.
IM
Thiopental 400 mg & Yes, Avoid infiltration – may treat Controlled airway
(Pentothal) 500 mg Over 10-15 affected area with lidocaine 1% and ventilation
syringes seconds Central line administration preferred required –
Sedative/ Barbiturate
Monitor respiration & cardiac Critical care
function continuously only!
Contraindicated in patient with
porphyria
Tigecycline 50 mg/5 ml NO Intermittent infusion: Dose reduction needed for patients w/ Diluted solution is
(Tygacil) vial 100 mg in 100 ml D5W or NS then 50 hepatic impairment yellow/orange in color
mg in 100 ml D5W or NS. Infuse over
Antibiotic 30-60 minutes Stable 6 hrs at room temp/ 24
hrs refrigerated after dilution
Max conc = 1 mg/ml
Contact pharmacist for
compatibility information
Tirofiban 12.5 mg/ml Yes, Continuous Infusion – Pre-printed orders for unstable angina
(Aggrastat) 50 ml vial, 25 mcg/Kg over 3 PTCA: 0.15mcg/Kg/min or PTCA applications are available
minutes in PTCA Unstable Angina: 0.4 mcg/Kg/min x
12.5mg/250 30min then 0.1 mcg/Kg/min Monitor for signs of bleeding!!
Antiplatelet IIb/IIIa ml premix Monitor VS every 15 min
bag Standard Conc: 12.5mg/250ml NS
(50mcg/ml) Dose reduction to 0.05mcg/kg/min
recommended for pt with CrCl <
30ml/min
Monitor APTT, Hgb/Hct, PT/INR,
and platelets daily while receiving
tirofiban
Tobramycin 10mg/ml & NO Intermittent Infusion – Aminoglycoside dosing and
(Nebcin) 40mg/ml – All doses diluted into 50 - 100ml NS monitoring service available from
Vial or D5W and infused over 30-60 pharmacy upon physician order.
Antibiotic/ minutes
Aminoglycoside Monitor renal function.
Torsemide 10mg/ml – Yes, May be given as continuous infusion. Recommended max single dose is 200
(Demadex) 2 & 5ml Max 5 mg/min mg
Amps System Standard Conc: 100 mg/100 ml
Loop Diuretic NS (1 mg/ml)
Tranexamic acid 100mg/ml NO IV infusion during cardiac surgery. Do not mix with penicillin
(Cyclokapron) – 10ml Refer to PPO as needed.
Amps
Antifibrinolytic
Treprostinil 1, 2.5, 5, NO Subcutaneous or intravenous Avoid infusion interruptions SC: Stable 28 days after initial * See footnote
(Remodulin) and 10 continuous infusion – loss of disease control could lead use if refrigerated; 14 days at
mg/ml 20 to death room temp
ml vials SC administration: Only use
Cardiovascular/ *** Metro: Use of preprinted Monitor for hypotension, flushing, syringe pump provided by
Vasodilator order set advised *** headache, N/V, anxiety & chest pain. home health care agency.
A “Remodulin Dosing Weight” is IV: 1 mg in 100ml NS stable

established and used throughout the 48 hr at room temp.
patient’s therapy. The “Remodulin
Dosing Weight” should be used when
calculating infusion rate.
Trimethoprim & 80mg TMP NO Intermittent Infusion – Flush line before and after Sulfa
Sulfamethoxazole + 400mg PCP (Pneumocystis Carinii Cotrimoxazole with D5W 5 ml in 100 ml D5W derivative –
(Cotrimoxazole) SMX per Pneumonia): 15-20mg/kg/day into 4 Stable 4 hours check
(Bactrim, Septra) 5ml vial doses (q 6h) Do not mix with any other
medications/solutions – contact allergies!!
Each 80mg (5ml) TMP diluted into 5 ml in 75 ml D5W
100ml D5W pharmacist Stable 2 hours
Antibiotic/ Sulfonamide Infuse dose over 90min
Urokinase 250,000 Varying doses Varying continuous infusions Thrombolytic medication: Monitor Critical Care for
(Abbokinase) unit vial depending on depending on indication – consult for signs of bleeding. continuous
indication – external reference or pharmacist Minimize potential risks for bleeding: infusion
consult external Establish all IV’s prior to therapy.
reference or System Standard Conc: 1 million (Minimum of 2 peripheral IVs Monitoring is at
pharmacist. units/250 ml NS (4000 units/ml) recommended in addition to physician
*HIGH ALERT
Give over 10 min thrombolytic infusion site.) discretion for
MEDICATION*
Avoid unnecessary arterial/venous peripheral
punctures, excessive blood sampling, vascular
Thrombolytic
and IM injections for at least 24 hr indications.
after d/c’d (malnourished patients 48
hr).
puncture sites.
Thrombin time elevated
Valproate Sodium 100mg/ml NO Intermittent Infusion – Dosing and monitoring service
(Depacon) – 5ml vial Loading dose: 15 mg/Kg in 50-100 ml available from pharmacy per
NS or D5W over 10-15 minutes physician order.
Anticonvulsant Maintenance dose: 2-5 mg/kg q6-8h in
50-100 ml NS or D5W
Infusion rate may be up to 3
mg/kg/min (total dose </= 15 mg/kg)
Vancomycin 500mg & NO Intermittent Infusion – Slow rate of infusion if hypotension or
1Gm vial, <500mg in 100ml NS/D5W flushing occur
Antibiotic/Glycopeptide Premix > 500 mg in 250ml NS/D5W
Avoid extravasation – Refer to PPO
bag: 500mg
Infuse doses < 500 over 60 minutes 05046
/100ml
Infuse doses < 1 gm over 90 minutes Aminoglycoside dosing and
Infuse doses > 1 gm over 120 minutes monitoring service available from
pharmacy upon physician order.
Monitor renal function.
Vasopressin 20 units/ml Yes, Continuous Infusion – Avoid extravasation/infiltration – Critical Care
(Pitressin) –1 & 10ml For persistent Usual dose range: central line advised.
vial VF/pulseless VT 0.2-1.0 units/min (GI bleeds)
Hormone or asystole/PEA 0.02- 0.1 units/min (Shock) Monitor BP, HR every 15 min
40 units IV push x Monitor urine output every 1-2 hr
1 – after flush w/ System Standard Conc: 100 Units/
100ml NS (1 unit/ml) Monitor fluid and electrolyte status
10 ml NS
Bradycardia and hypertension are
early signs of toxicity
Vecuronium 10 & 20 mg Yes, Continuous Infusion: Refer to Nursing Clinical Policies Controlled airway
(Norcuron) vials intubation dose 0.1 Usual dose range: 1-2 mcg/Kg/min on Neuromuscular Blockade and ventilation
(powder) mg/Kg rapidly (i.e. MN-13) required;
*HIGH ALERT System Standard Conc: 50 mg/50 ml Critical Care
MEDICATION* NS (total vol=100 ml) (0.5 mg/ml) Preprinted order set available for ICU only:
neuromuscular blockade ED, ICU,
Neuromuscular Surgery.
be administered
prior to and
during paralytic
use!
Verapamil 2.5mg/ml – Yes, Continuous Infusion: Not compatible with bicarbonate * See footnote
(Isoptin) 2 & 4ml 5-10 mg over 2 Usual dose range: 5-20 mg/hr solutions
vial minutes (max rate Standard conc: 125 mg/150 ml NS
Cardiovascular/ Calcium of 5 mg/min) (total vol=200 ml) (0.625 mg/ml) Avoid mixing with other
Channel Blocker Slower in elderly “Concentrated” conc: 125 mg/50 ml medications/solutions – check with
patients – max rate NS (total vol=100 ml) (1.25 mg/ml) pharmacist
of 2 mg/min
Vitamin K – See
Phytonadione
Voriconazole 10 mg/ml NO Recommended dose: 6 mg/kg IV every IV formulation contraindicated in pt
(Vfend) 20 ml vial 12 hr x 2 doses then 4 mg/kg IV every with CrCl < 50 ml/min. PO
12 hr formulation not contraindicated in pt
Antifungal with renal insufficiency nor is any
Dilute in 250 ml NS dose reduction recommended
Infuse over 2 hr Dose reduction recommended in pt
with hepatic insufficiency/drug-drug
Refer to preprinted order set (PPO interactions
2627) for dose, indications &
contraindications Transient visual disturbances may
occur
Warfarin 5 mg vial Yes, NO ** Verify dose to be given. Discard Use only sterile water for
(Coumadin) Give dose over 1- vial after drawing up correct dose. ** reconstitution
2 minutes Once reconstituted, use within
Anticoagulant Monitor INR 4 hours
IM administration
NOT advised! Keep vial in carton until use
Do NOT refrigerate
Ziconotide intrathecal 100 mcg/ml Indicated for the management of Approved only for use in Medtronic Refrigerate
infusion 1 & 5 ml Intrathecal severe chronic pain in patients whom SynchroMed EL, SynchroMed II
(Prialt) vials, 25 administration intrathecal therapy is warranted, and Infusion Systems and Simms Deltec Dilute only with preservative
mcg/ml 20 only!! who are intolerant of or refractory to CADD Micro External Microinfusion free NS
*HIGH ALERT ml vial other treatments. Device and Catheter.
MEDICATION*
due to intrathecal Expiration once placed in infusion Protect from light
administration!! pump:
Initial fill: 25 mcg/ml undiluted = 14
Non-opioid analgesic days
Refill of pump:
25 mcg/ml & 100 mcg/ml undiluted =
60 days
100 mcg/ml diluted = 40 days
Zidovudine 10 mg/ml NO Intermittent infusion: May cause anemia or neutropenia Stable after dilution:
20 ml vial Infuse over 30-60 min 8 hr at room temp
24 hr refrigerated
Antiviral L&D: 2mg/kg IV bolus over 1hour 100 mg PO zidovudine every 4 hr = 1
followed by 1mg/kg/hr IV infusion mg/kg IV every 4 hr Vial: Protect from light
until cord clamped, then PO regimen Do not mix with other
for infant(s). medications/solutions
Zoledronic Acid 4 mg vial NO Hypercalcemia / Bone Metastases: Assess baseline renal function, serum Restricted to
(Zometa / Reclast) 5mg 4 mg/100ml NS or D5W over a calcium and vitamin D levels prior to outpatient use.
premixed minimum of 15 minutes X 1 dose administration.
solution Repeat prn usually every 3-4 weeks, Monitor renal function (I/O, SCr) Mandatory
Bisphosphonate but no more than once per week System-wide
Dose reduction recommended for orders required
Paget’s Disease / Osteoporosis: patients with CrCl < 60 ml/min. for use.
5mg/100mL premixed solution over Not recommended if CrCl <30ml/min
minimum of 15minutes once yearly.
Hypotension in 10% of patients
Doses given over < 15 minutes Bone pain common
increase risk of renal toxicity! Mild fever and flu-like symptoms
Reference: Aurora Health Care - Department of Pharmacy Services – March 2009
Insulin & Parenteral Antiglycemic Agents
Aurora Hospitals
Rapid-Acting Insulin
Apidra; Insulin Glulisine
Onset: 5 minutes
Duration: 2-4 hours
May be mixed with Novolin N (NPH) only

1 unit Apidra ≈ 1 unit regular human insulin
Give within 15 minutes before a meal or within 20
minutes after starting a meal
In hospital: administer only when meal tray
available
Therapeutically equivalent to insulin aspart / lispro.
Note: peak & duration extended in T2DM
Rapid-Acting Insulin
Novolog; Insulin Aspart *
Onset: 5-15 minutes

Duration: 3-5 hours
May be mixed with Novolin N (NPH)

Therapeutically equivalent to Lispro (Humalog)
In hospital: administer only when meal tray
available
Short-Acting Insulin
Novolin R; Regular Insulin *
Onset: 30-60 minutes

Duration: 5-8 hours
May be mixed with: Novolin N (NPH)

Therapeutically equivalent to Humulin R
Intermediate-Acting Insulin
Novolin N; NPH Insulin *
Onset: 2-4 hours

Duration: 14-18 hours
May be mixed with Novolog and Novolin R
Therapeutically equivalent to Humulin N
Long-Acting Insulin
Lantus; Insulin Glargine*
Onset: 1.5-2 hours

Can not be mixed with any other insulins

Administered once daily in most patients.
Long-Acting Insulin
Levemir®; Insulin Detemir *
Onset: 3-14 hours

Can not be mixed with any other insulins

Administered once or twice daily
Insulin Aspart Mix

Novolog Mix 70/30
Onset: More rapid than regular insulin mixes -

administer with meals
Peak effect: 1-4hours
Duration: up to 24hours
Administered once or twice daily.
Do not mix with other insulin products. Shake prior
to use – must appear uniformly white & cloudy.
Premixed 70/30 Insulin

Novolin 70/30 *
Onset: 30-60 minutes

Premixed with 70% NPH and 30% Regular

Cannot be mixed with any other insulin
Parenteral Antigylcemic Agents – These are not Insulin Products

Symlin®; Pramlintide
Do not use pramlintide if the patient is NPO,
Amylin Analog - augments effects of insulin and
likely to skip a meal/not eat enough,
reduces prandial insulin requirements by ≈ 50%
hypoglycemic, or has gastroparesis
Should not be started in hospitalized patients due Give SQ immediately prior or within 15 min
to high risk of nausea, vomiting, & before each major meal, do not give after
hypoglycemia. meals.
Do not mix with insulin products.
Byetta®; Exenatide
Glucagon-like Peptide-1 Analog (GLP-1) used in

Twice daily SQ injection, before
Type 2 DM only, as an alternative to insulin
breakfastand supper.
Peak response: 2-3 hours
Dose anytime within 1 hour before meals.
Duration: up to 5 hours
Hold if NPO.
Formulary Insulins & Antiglycemics are indicated with an asterix (*).
Insulin Product Ordered AHC Formulary Substitution

Insulin Glulisine (Apidra) Equivalent number of units of Insulin Aspart (Novolog)
Insulin Lispro (Humalog) Equivalent number of units of Insulin Aspart (Novolog)
Humulin 50/50 50% of the ordered dose as NPH and 50% of ordered dose as Insulin Aspart (Novolog)
Humalog (Lispro Mix) 75/25 Equivalent number of units of Insulin Aspart Mix 70/30 (Novolog Mix 70/30)
Humalog (Lispro Mix) 50/50 50% of the ordered dose as NPH and 50% of the ordered dose as Insulin Aspart (Novolog)
Novolin 70/30 Equivalent number of units of Insulin Aspart Mix 70/30 (Novolog Mix 70/30)
Note: Formulary Substitutions as of April 2009. Contact your pharmacist with questions regarding substitutions as necessary.

Medication Administration Policy

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Medication Administration Policy

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Section II Parenteral Medication Administration Guidelines

This section can be copied and kept for reference at bedside.

AcetaZOLAMIDE 500 mg Yes IV Push Preferred ** Verify dose to be given. Discard

N-acetylcysteine should continue until

Used as anticoagulant for the machines

Central line administration

Calcitriol 1 mcg/ml 1 Yes, Not advised Discard ampule after use.

Monitor neuro status – may cause

Total duration of therapy not to exceed VASCULAR IRRITANT!

Serial serum sodium levels

Reverse with flumazenil

Monitor HR and BP.

Contraindicated in patients with

Pre-printed order set available for

Hold infusion x 2 hr prior to invasive

Doses rounded to nearest 10mg Dose reduction recommended

Do not administer with other

Etomidate 2 mg/ml Yes NO Monitor BP, HR and RR Critical Care

Famotidine 10mg/ml – Yes, IV Push preferred Dose reduction recommended for pt

Filgrastim 300mcg/ 1 SQ preferred Intermittent infusion: Refrigerate

Fluconazole Premix NO Intermittent administration

Gentamicin 10mg/ml NO Dilute all doses in 50 -100ml NS or Aminoglycoside dosing and

Haloperidol 5mg/ml Yes, Recommended to flush line

HydrALAZINE 20mg/ml Yes, Incompatible with many

Antidiabetic Monitor blood glucose

Iron Sucrose Complex 20mg/ml – Yes, Hypotensive reactions may be

May cause hypotension or

Max recommended length of

Methyldopate 50mg/ml – NO Intermittent Infusion Monitor BP / Orthostasis

Reverse effects with naloxone

Moxifloxacin 400 mg/250 NO Infuse over 60 min

Avoid direct contact with solution.

May cause withdrawal in opioid

Neostigmine 1 mg/ml = Yes, NO Antidote for non-depolarizing *See footnote

Pamidronate 30 mg/10 NO Infuse over 3 to 24 hr Renal function should be assessed

Filtration not required during

PN with no lipids: change tubing every

Paricalcitrol 2 mcg/ml 1 Yes – IV push preferred Discard vial after use.

Piperacillin 2, 3, and 4 NO Dilute in 100 ml NS/D5W and infuse

Protamine 10mg/ml – Yes, NO Monitor for hypotension &

Sodium Bicarbonate 8.4% Yes, Do not mix with other medications –

Monitor trough tacrolimus levels

System Standard Conc: 800mg/500ml (Note: Aminophylline is 80%

A “Remodulin Dosing Weight” is IV: 1 mg in 100ml NS stable

Reference: Aurora Health Care - Department of Pharmacy Services – March 2009

May be mixed with Novolin N (NPH) only

Onset: 5-15 minutes

May be mixed with Novolin N (NPH)

Onset: 30-60 minutes

May be mixed with: Novolin N (NPH)

Onset: 2-4 hours

Therapeutically equivalent to Humulin N

Onset: 1.5-2 hours

Can not be mixed with any other insulins

Onset: 3-14 hours

Can not be mixed with any other insulins

Insulin Aspart Mix

Onset: More rapid than regular insulin mixes -

Premixed 70/30 Insulin

Onset: 30-60 minutes

Premixed with 70% NPH and 30% Regular

Parenteral Antigylcemic Agents – These are not Insulin Products

Glucagon-like Peptide-1 Analog (GLP-1) used in