Iv Bolus Injection Calculation by jac19503

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									                            Vanderbilt University Medical Center
                                                      IV Information Book

ABCIXIMAB - ReoPro® ............................................................................................................................................5
ACYCLOVIR SODIUM INJECTION® ...................................................................................................................6
ADENOSINE - Adenocard® .......................................................................................................................................8
ALATROFLOXACIN MESYLATE - Trovan®I.V..................................................................................................8
ALBUMIN ....................................................................................................................................................................9
ALTEPLASE - Activase®..........................................................................................................................................11
AMIKACIN SULFATE - Amikin .............................................................................................................................13
AMINOCAPROIC ACID - Amicar ..........................................................................................................................13
AMINOPHYLLINE ..................................................................................................................................................14
AMMONIUM CHLORIDE ......................................................................................................................................17
AMPHOTERICIN B - Fungizone ............................................................................................................................17
AMPHOTERICIN B LIPID COMPLEX INJECTION – Abelcet® ......................................................................18
AMPICILLIN SODIUM- Omnipen® ........................................................................................................................19
AMPICILLIN SODIUM / SULBACTAM SODIUM - Unasyn® ..............................................................................20
AMRINONE LACTATE - Inocor® .........................................................................................................................21
ATGAM® ....................................................................................................................................................................23
ATROPINE SULFATE .............................................................................................................................................24
AZATHIOPRINE - Imuran ® ..................................................................................................................................25
Azithromycin - ZITHROMAX ..................................................................................................................................27
AZTREONAM - Azactam® ......................................................................................................................................28
BETAMETHASONE - Celestone® ..........................................................................................................................28
BRETYLIUM TOSYLATE - Bretylol ® ..................................................................................................................29
BUMETANIDE - Bumex® ........................................................................................................................................30
BUPRENORPHINE - Buprenex®.............................................................................................................................31
BUTORPHANOL - Stadol®.......................................................................................................................................32
CALCIUM CHLORIDE ...........................................................................................................................................33
CALCIUM GLUCONATE .......................................................................................................................................34
CEFAZOLIN for Injection, USP ..............................................................................................................................35
CEFEPIME – MAXIPIME® ....................................................................................................................................36
CEFOTAXIME SODIUM - Claforan® .....................................................................................................................37
CEFOTETAN DISODIUM - Cefotan® .....................................................................................................................38
CEFTAZIDIME - Fortaz®, Tazidime®, Tazicef® ....................................................................................................39
CEFTRIAXONE - Rocephin® ...................................................................................................................................40
CEFUROXIME - Kefurox® -Lilly Brand - Zinacef® - Glaxo Brand .....................................................................41
CHLORAMPHENICOL - Chloromycetin®Sodium Succinate.................................................................................42
CHLORDIAZEPOXIDE HYDROCHLORIDE - Librium® .....................................................................................43
CHLOROTHIAZIDE SODIUM - Diuril® ................................................................................................................44
CHLORPHENIRAMINE MALEATE - Chlor-Trimeton® .......................................................................................45
CHLORPROMAZINE HYDROCHLORIDE - Thorazine® .....................................................................................46
CIMETIDINE - Tagamet ® .......................................................................................................................................47
CIPROFLOXACIN HYDROCHLORIDE - Cipro® ..................................................................................................48
CLINDAMYCIN Phosphate, USP .............................................................................................................................49
COLCHICINE ............................................................................................................................................................50
COTROPIN - ACTH®, Acthar® ................................................................................................................................ 51
COSYNTROPIN - Cortrosyn® ...................................................................................................................................52
CYCLOSPORINE - Sandimmune® ...........................................................................................................................53
CYTOMEGALOVIRUS ..............................................................................................................................................55
Daclizumab - ZENAPAX® ........................................................................................................................................56
DANTROLENE SODIUM - Dantrium® ...................................................................................................................57
DEFEROXAMINE MESYLATE - Desferal® ...........................................................................................................59
DESMOPRESSIN ACETATE - DDAVP® ................................................................................................................60
DEXAMETHASONE SODIUM PHOSPHATE , USP .............................................................................................60
DEXTRAN 40 - in dextrose or in sodium chloride. ................................................................................................ 62
DEXTRAN 70 AND 75 - Travenol brand - in 5% Dextrose or 0.9% NaCl ..........................................................63
DEXTROSE ............................................................................................................................................................... 64
DIAZEPAM - Valium® .............................................................................................................................................64
DIAZOXIDE - Hyperstat® .........................................................................................................................................65
DIETHYLSTILBESTROL DIPHOSPHATE SODIUM - Stilphostrol ® .................................................................66
DIGOXIN - Lanoxin® ................................................................................................................................................67
DILTIAZEM HCL-CARDIZEM ® ..........................................................................................................................69
DIMERCAPROL - BAL® ..........................................................................................................................................69
DIPHENHYDRAMINE HYDROCHLORIDE - Benadryl® .....................................................................................70
DOBUTAMINE HYDROCHLORIDE - Dobutrex® .................................................................................................71
DOPAMINE HYDROCHLORIDE ............................................................................................................................72
DOXAPRAM - Dopram® ...........................................................................................................................................73
DOXYCYCLINE HYCLATE - Vibramycin® ............................................................................................................74
DROPERIDOL - Inapsine® .......................................................................................................................................75
EDROPHONIUM CHLORIDE - Tensilon® .............................................................................................................76
EPINEPHRINE..........................................................................................................................................................77
EPOETIN ALFA - Epogen®, Procrit® .....................................................................................................................78
ERYTHROMYCIN LACTOBIONATE - Erythrocin® ..............................................................................................79
ESMOLOL HYDROCHLORIDE - Brevibloc®.........................................................................................................80
ESTROGEN, CONJUGATED (EQUINE) - Premarin® ..........................................................................................81
ETHACRYNATE SODIUM - Sodium Edecrin® ....................................................................................................82
ETIDRONATE DISODIUM - Didronel® ................................................................................................................83
FAMOTIDINE - Pepcid® ..........................................................................................................................................84
FILGRASTIM - Neupogen, G - CSF® ......................................................................................................................86
FLUCONAZOLE - Diflucan® ...................................................................................................................................87
FOLIC ACID - Folvite®.............................................................................................................................................88
Fomepizole - Antizol .................................................................................................................................................89
FOSCARNET - Foscavir®..........................................................................................................................................90
FOSPHENYTOIN SODIUM - Cerebyx® ..................................................................................................................91
FUROSEMIDE, USP .................................................................................................................................................92
GANCICLOVIR SODIUM - Cytovene® ....................................................................................................................93
GENTAMICIN Injection,USP ...................................................................................................................................94
GRANISETRON - KYTRIL®.....................................................................................................................................94
HALOPERIDOL - Haldol® .......................................................................................................................................96
HEPARIN ...................................................................................................................................................................97
HYDRALAZINE HYDROCHLORIDE - Apresoline®..............................................................................................98
HYDROCORTISONE SODIUM SUCCINATE - Solu-Cortef® ...............................................................................98
HYDROMORPHONE - Dilaudid ® .........................................................................................................................99
HYDROXYZINE HYDROCHLORIDE - Vistaril ................................................................................................ 100
IMIPENEM / CILASTATIN SODIUM - Primaxin® ............................................................................................. 101
IMMUNE GLOBULIN INTRAVENOUS (Human) - IGIV - ..............................................................................102
INDOMETHACIN SODIUM TRIHYDRATE - Indocin® ..................................................................................104
INSULIN, HUMAN - Regular Only .......................................................................................................................105
INTRALIPID ............................................................................................................................................................106
Immune Globulin Intravenous (Human) Polygam S/D ..........................................................................................107
IRON DEXTRAN - Imferon ...................................................................................................................................109
ISOPROTERENOL HYDROCHLORIDE - Isuprel ® ............................................................................................110
Ketorolac Tromenthamine - Toradol® ....................................................................................................................111
LABETALOL HYDROCHLORIDE - Normodyne®; Trandate® ...........................................................................112
LEVOFLOXACIN - Levaquin®............................................................................................................................... 114
LEVOTHYROXINE SODIUM - Synthroid® ..........................................................................................................115
LIDOCAINE HYDROCHLORIDE - Xylocaine® ...................................................................................................115
LORAZEPAM - Ativan® ..........................................................................................................................................116
MAGNESIUM SULFATE ......................................................................................................................................118
MANNITOL ............................................................................................................................................................. 119
MEPERIDINE HYDROCHLORIDE - Demerol®................................................................................................ 120
Meropenam – Merrem® ..........................................................................................................................................121
METHICILLIN SODIUM - Staphcillin® ..............................................................................................................123
METHOCARBAMOL - Robaxin® ........................................................................................................................123
METHOXAMINE - Vasoxyl® ................................................................................................................................ 124
METHYDOPA - Aldomet® .....................................................................................................................................125
METHYLERGONOVINE MALEATE - Methergine® ........................................................................................126
METHYLPREDNISOLONE SODIUM SUCCINATE - Solu-Medrol® ............................................................. 127
METOCLOPRAMIDE Injection,USP - Reglan® .................................................................................................129
METRONIDAZOLE - Flagyl IV RTU® ...............................................................................................................130
MezlCILLIN SODIUM - Mezlin® ..........................................................................................................................131
MiDAZOLAM – VERSED®.....................................................................................................................................134
Minocycline Hydrochloride – MINOCIN® .............................................................................................................134
MORPHINE SULFATE .........................................................................................................................................134
MVI-12 .....................................................................................................................................................................135
NAFCILLIN – NAFCIL ® .....................................................................................................................................137
NALOXONE - Narcan® .........................................................................................................................................137
NEOSTIGMINE - Prostigmin® .............................................................................................................................. 138
NICARDIPINE HYDROCHLORIDE - CARDENE® I.V. ...................................................................................140
NlTROGLYCERIN ...................................................................................................................................................141
NITROPRUSSIDE SODIUM - NIPRIDE® ..........................................................................................................142
NOREPINEPHRINE BITARTRATE - Levophed® ............................................................................................. 143
OCTREOTIDE ACETATE - Sandostatin®...........................................................................................................143
OFLOXACIN - FLOXIN® ......................................................................................................................................145
ONDANSETRON HYDROCHLORIDE - Zofran® ............................................................................................. 146
ORTHOCLONE - OKT-3®....................................................................................................................................146
OXACILLIN SODIUM - Bactocil® Beecham brand; Prostaphlin® Bristol brand .............................................148
OXYTOCIN - Pitocin® ...........................................................................................................................................148
PAMIDRONATE DISODIUM - APD -Aredia® .................................................................................................150
PANCURONIUM BROMIDE - Pavulon® ............................................................................................................151
PENICILLIN G SODIUM - Squibb Brand ............................................................................................................151
PENICILLIN POTASSIUM - Squibb Brand .........................................................................................................152
PENTAMIDINE ISETHIONATE - Pentam®300 .................................................................................................153
PENTAZOCINE LACTATE - Talwin® ................................................................................................................154
PHENOBARBITAL - Luminal ............................................................................................................................... 155
PHENYLEPHRINE HYDROCHLORIDE - Neo-Synephrine® ..........................................................................156
PHENYTOIN SODIUM - Dilantin® ......................................................................................................................157
PHYSOSTIGMINE SALICYLATE - Antilirium® ............................................................................................... 159
PIPERACILLIN SODIUM - Pipracil®..................................................................................................................160
POTASSIUM CHLORIDE........................................................................................................................................162
PROCAINAMIDE HYDROCHLORIDE - Pronestyl® ........................................................................................163
PROCHLORPERAZINE MALEATE - Compazine® ..........................................................................................164
PROMETHAZINE HYDROCHLORIDE - Phenergan® ....................................................................................164
PROPIOMAZINE HYDROCHLORIDE - Largon®............................................................................................165
Propofol - Diprivan® 1% .........................................................................................................................................167
PROPRANOLOL HYDROCHLORIDE - Inderal®............................................................................................. 168
PROTAMINE SULFATE .......................................................................................................................................169
PYRIDOSTIGMINE BROMIDE - Mestinon® .....................................................................................................169
QUINIDINE GLUCONATE ...................................................................................................................................170
Quinupristin/Dalfopristin – Synercid®I.V. ...........................................................................................................172
RANITIDINE HYDROCHLORIDE - Zantac® ....................................................................................................173
Ribavirin - Virazole® ..............................................................................................................................................174
RIFAMPIN - Rifadin®.............................................................................................................................................175
RITODRINE HYDROCHLORIDE - Yutopar® ...................................................................................................176
SARGRAMOSTIM - Leukine® GM-CSF ............................................................................................................177
SODIUM BICARBONATE ....................................................................................................................................177
STREPTOKINASE - Kabikinase® .........................................................................................................................178
STREPTOMYCIN SULFATE ............................................................................................................................... 179
TACROLIMUS –PROGRAF® .................................................................................................................................134
THIAMINE HYDROCHLORIDE ........................................................................................................................183
TICARCILLIN DISODIUM / CLAVULANATE POTASSIUM - Timentin® ...................................................184
TOBRAMYCIN SULFATE - Nebcin® ..................................................................................................................184
TRIMETHOPRIM AND SULFAMETHOXAZOLE - Bactrim® .......................................................................185
TRIMETHAPHAN - Arfonad® .............................................................................................................................. 186
TUBOCURARINE CHLORIDE ............................................................................................................................187
UROKINASE –ABBOKINASE® ............................................................................................................................. 134
VALPROATE –DEPECON® ...................................................................................................................................134
VANCOMYCIN HYDROCHLORIDE - (manufactured by Abbott, Lederle,Lilly) .........................................190
VASOPRESSIN - Pitressin® ...................................................................................................................................191
VERAPAMIL HYDROCHLORIDE - Isoptin®, Calan® .....................................................................................192
VIDARABINE - Vira-A® ........................................................................................................................................193
WinRho SD - Univax® .............................................................................................................................................194
RHo(D) Immune Globulin IV (Human) ..................................................................................................................194
Zidovudine -- Retrovir® IV Infusion .....................................................................................................................195
ABCIXIMAB - ReoPro®

ReoPro® is a Fab fragment of the chimeric human-murine monoclonal antibody 7E3. It
binds to the glycoprotein (GPIIb/IIIa receptor) of platelets.(a)

Concentration: 2 mg/mL, supplied in a 5 mL vial containing 10 mg Abciximab.(a)

Route of Administration: Intravenous bolus followed by continuous infusion.(a)

Dosing: Intravenous bolus (0.25 mg/kg or 0.125 mL/kg).(a) Continuous infusion for
12 hours (10 mcg/min).(a)

Preparation / Expiration / Stability
Please refer to David DiPersio's Memo of April 11, 1996 for further information on the
following pages.




{ Written 1/96; ild;
Pkg Insert: Eli Lilly &Co. 1995
ACETAZOLAMIDE - Diamox ®

Standard Concentration: 100 mg / 1 mL.(a) To a 500 mg vial add 5 mL sterile
water.(a)

Expiration: In syringe: 24 hours; in piggyback: 24 hours;(a,b) in vial: 7 days, under
refrigeration.(a)

Route of Administration: Direct IV or IV infusion. Can be given IM but is painful due
to the alkaline pH of the solution.(a,b)

Minimum Dilution: 500 mg / 5 mL - for direct IV.(a,b) Standard Dilution in Piggyback:
500 mg / 50 mL.(d)

Maximum Rate of IV Administration: 500 mg over 5 minutes - for direct IV.(c)

Standard Rate of IV Administration in Piggyback: 50 mL over 15 - 30 minutes.(b)




Revised JANUARY 1995




ACYCLOVIR SODIUM INJECTION®
How Supplied: Aqueous solution for intravenous infusion containing
50 mg acyclovir per mL in 10 mL or 20 mL vial.(a)

Pediatric pharmacy prepared concentration: 5 mg/ml.(d)
 Instructions for preparing pediatric solution 5 mg/mL.
  Remove 20 mL overfill from D5W 100mL bag.
  Add 10 mL of Acyclovir 50 mg/mL solution into altered bag.
  Use Acyclovir 500 mg vial in solution.
  3 day expiration in bag.
  24 hour expiration in syringe.
  Label as: Acyclovir in Dextrose 5%
            Concentration: 5mg/mL
Route of Administration: Slow Intravenous infusion.(a)
CAUTION--RAPID OR BOLUS INTRAVENOUS AND INTRAMUSCULAR OR SUBCUTANEOUS
INJECTION MUST BE AVOIDED.(a)

Rate of Infusion Administration over one hour.(a)

Dilution: Infusion concentrations of approximately 7 mg/mL or lower are
recommended.(a)
Higher concentrations (e.g., 10 mg/ml) may produce phlebitis or inflammation at the
injection site upon inadvertent extravasation.(a)
Standard, commercially available electrolyte and glucose solutions (e.g.,0.9% sodium
chloride or 5% dextrose) are suitable for intravenous administration; biologic or colloidal
fluids (e.g., blood products, protein solutions, etc) are not recommended.(a)

Expiration: In piggyback: 30 days.(d)
***Note that the expiration in the package insert for acyclovir in piggyback is 24 hours, but in Trissels 10th
edition Hanbook of Injectable Drugs the expiration is 37 days.

Label: DO NOT REFRIGERATE. Refrigeration of solutions may result in formation of a
precipitate which will redissolve at room temperature.(a)

Additional Information:
Administration of acyclovir by intravenous infusion must be accompanied by adequate
hydration. Since maximum urine concentration occurs within the first
2 hours following infusion, particular attention should be given to establish
sufficient urine flow during that period in order to prevent precipitation in renal tubules.
Recommended urine output is > or = 500 mL per gram of drug infused.(a)
Updated: 11/2000idp
(a)Pkg Insert; January 2000, APP- American Pharmaceutical Partners, Inc.
(d)VUH Rx policy;(c) V. Das Gupta, Y. Pramar and C. Bethea, Stability of Acyclovir Sodium in Dextrose
and Sodium Chloride Inj, (1989) 14, 451-456.
                   thEdition
(e) Trissel’s,L; 10          Handbook on Injectable Drugs
ADENOSINE - Adenocard®

Standard Concentration: 6 mg / 2 mL (3 mg/mL).(a)

Route of Administration: Rapid bolus intravenous use ONLY.(a)

Expiration: In Syringe: Withdraw from vial and use immediately.(a)

Minimum Dilution: 6 mg / 2 mL.(a)

Maximum Rate of IV Administration: 6 mg or 12 mg rapidly over 1 - 2 seconds.(a)


Additional Information

w Should be administered either directly into a vein or, if given into an IV line, it should
be given as proximal as possible and followed by a rapid saline flush.(a)
w Contains no preservatives. Discard unused portion.(a)
w Do not refrigerate as crystallization may occur. If crystallization has occurred,
dissolve crystals by warming to room temperature. The solution must be clear at the
time of use.(a)




REVISED JANUARY 1995


ALATROFLOXACIN MESYLATE - Trovan®I.V.
(A prodrug of trovafloxacin, for intravenous administration. Following intravenous
administration, the alanine substituents in alatrofloxacin are rapidly hydrolyzed in vivo
to yield trovafloxacin.(a)

Concentration: 5 mg/mL.(a) Alatrofloxacin mesylate injection is supplied in single
use vials containing either 200 mg / 40 mL or 300 mg / 60 mL.(a)

Route of Administration: Intravenous Infusion.(a)
Rapid or bolus intravenous infusion should be avoided. Tovan is not for intramuscular,
intrathecal, intraperitoneal or subcutaneous administration.(a)

Dilution: Should be diluted with 5% Dextrose, 0.45% sodium chloride, (see package
insert for other recommended solutions.(a) Do not dilute with 0.9% sodium chloride
 (per phone conversation to Pfizer Drug Info--1-800-879-3477)

Preparation: The desired dosage of Trovan I.V. may be prepared according to the
following chart:
DOSAGE STRENGTH VOLUME TO DILUENT TOTAL INFUSION(mg) (trovafloxacin
WITHDRAW VOLUMEVOLUME CONC               equivalent)     (mL) (mL) (mL)
(mg/mL)
      100 mg     20   30    50            2
      100 mg     20         80          100       1

     200 mg        40           60            100             2
     200 mg       40    160     200             1

     300 mg       60     90           150              2

      300 mg                    60                   240           300           1
For example, to prepare a 200 mg dose at an infusion concentration of 2 mg/mL (as
trovafloxacin), 40 mL of TROVAN I.V. is withdrawn from a vial and diluted with 60 mL of
a compatible intravenous fluid to produce a total infusion solution volume of 100mL.(a)
Rate of Infusion: Over 60 minutes.(a)

Stability/Expiration: TROVAN I.V., when diluted with the following intravenous
solutions to concentrations of 0.5 to 2 mg/mL is physically and chemically stable for up
to 7 days under refrigeration or up to 3 days at room temperature stored in glass bottles
or plastic (PVC type) intravenous containers.(a)

written: 6/98 idp
(a) PI (Package Insert), December 1997; Roerig Divion of Pfizer Inc. NY,NY.



ALBUMIN
Concentration: 5% or 25%.(a)

Route of Administration: Direct IV or IV infusion.(bb)

Expiration: When Diluted: Should be given a 4 hour expiration when possible.(bb)
Cutter does not recommend mixing with other solutions.(b)

Minimum Dilution: May be given undiluted or further diluted with 5% Dextrose or 0.9%
NaCl.(bb)

Maximum Rate of IV Administration: Should be adjusted according to the clinical
response of the patient and changes in blood pressure. May be administered as rapidly
as desired in the initial treatment if hypovolemic shock; however, as plasma volume
approaches normal, the rate of administration of the 5% solution should not exceed 2 -
4 mL/minute and the rate of administration of the 25% solution should not exceed 1
mL/minute to minimize the possibility of circulatory overload and pulmonary edema.(bb)

Dosage: Dosage of albumin depends on the condition of the patient, as determined by
such parameters as pulse, blood pressure, presence and degree of shock, plasma
protein content or oncotic pressure, hemoglobin or hematocrit values and degree of
venous and pulmonary congestion.(bb)

Additional Information
5% and 25% Albumin should be filtered. Each vial of the commercially available
product is supplied with an administration set; manufacturer's instructions should be
consulted for proper use of the set provided.(bb)

w Should not be used if more than 4 hours has elapsed since the container was first
entered.(bb) Do not use if turbid.(a)
w Contains 130 - 160 mEq sodium per liter.(bb)
w The concentration of albumin administered depends on the fluid and protein
requirements of the patient. Solutions containing 5% albumin are usually indicated in
hypovolemic patients, whereas the more concentrated 25% solution should be used in
patients in whom fluid and sodium intake must be minimized. The 25% solution may be
particularly useful in patients with hypoproteinemia or cerebral edema or in pediatric
patients, since a large amount of albumin can be administered in a small volume of
fluid.(bb)

REVISED JANUARY 1995
ALTEPLASE - Activase®

Standard Concentration: 1 mg/mL.(a)
| 20 mg (11.6 million IU) packaged with diluent for reconstitution (20 mL sterile water
for injection) 20 mg (11.6 MU) / 20 mL
| 50 mg (29 million IU) packaged with diluent for reconstitution (50 mL sterile water for
injection: 50 mg (29 MU) / 50 mL.(a)

Expiration: 8 hours in 5% Dextrose or 0.9 % NaCl in polyvinyl chloride bags or glass
bottles at room temperature.(a)

Route of Administration: Intravenous infusion only.(a)

Recommended Dose: 100 mg administered as 60 mg (34.8 million IU) in the first hour
(of which 6 to 10 mg is administered as a bolus over the first 1 - 2 minutes), 20 mg
(11.6 million IU) over the second hour, and 20 mg (11.6 million IU) over the third
hour.(a) For smaller patients (less than 65 kg), a dose if 1.25 mg/kg administered over
3 hours, as described above, may be used.(a) A dose of 150 mg of alteplase
(Activase), should not be used because it has been associated with an increase in
intracranial bleeding.(a)

Dilution: Activase may be administered as reconstituted at 1 mg/mL.(a) As an
alternative, the reconstituted solution may be diluted further immediately before
administration in an equal volume of 0.9% NaCl or 5% Dextrose to yield a concentration
of 0.5 mg/mL.(A) Polyvinyl chloride bags or glass bottles are acceptable.(a)

Additional Information
wDo not use if vacuum is not present.(a)

wReconstitute only with sterile water for injection, without preservatives. Do not use
Bacteriostatic Water for Injection.(a)

wReconstitute with large bore needle (e.g., 18 gauge), directing the stream of sterile
water for injection, into the lyophilized cake.(a)

wSlight foaming upon reconstitution is not unusual; standing undisturbed for several
minutes is usually sufficient to allow dissipation of any large bubbles.(a)

wContains no antibacterial preservatives, therefore reconstitute immediately before
use.(a)
wUse reconstituted solution within 8 hours following reconstitution when stored between
2 to 300 C.(a)


wExposure to light has no effect on the stability of these solutions.
wExcessive agitation during dilution should be avoided, mixing should be accomplished
with gentle swirling and/or slow inversion.

wDo not use other infusion solutions, e.g., sterile water for injection, or preservative
containing solutions for further dilution.(a)

wNo other medication should be added to infusion solutions containing alteplase. Any
unused infusion solution should be discarded.(a)

wReconstituted solutions which are prepared but not administered may be returned for
replacement drug. Please collect all such reconstituted products and direct them to the
attention of the pharmacy storeroom or the clinical pharmacy staff.




REVISED JANUARY 1995
AMIKACIN SULFATE - Amikin

Standard Concentration: 5 mg/mL or 250 mg/mL.(a)

Route of Administration: IM or IV infusion.(a)

Expiration: In syringe: 3 days,(b) in piggyback: 3 days.(b)

Minimum Dilution: 50 mg / 10 mL.(a) Standard Dilution: Any dose / 100 mL.(a)

Standard Rate of IV Administration: For adults and pediatrics entire dose over 30
minutes.(bb,cc)


Additional Information

For doses to be sent in a syringe: If the dose is less than 100 mg, a dilution of amikacin
should be made by adding 1 mL amikacin 250 mg/mL to 4 mL sterile saline.
If the dose is 100 mg or more, send the 250 mg/mL concentration. The commercially
available 50 mg/mL concentration should not be used due to the high cost of this
preparation.(d)




REVISED JANUARY 1995




AMINOCAPROIC ACID - Amicar
Standard Concentration: 250 mg/mL.(a)

Route of Administration: IV infusion.(bb) Rapid IV injection of the undiluted drug is
not recommended.(bb) Rapid IV administration should also be avoided.(bb)

Expiration: In syringe or piggyback: 3 days.(c)

Standard Dilution: 1 g / 50 mL.(d)

Standard Rate of IV Administration: Adults 4 - 5 g / 100 mL over first hour then 1 g /
50 mL/hour.(a) Pediatric Rate of Administration: 100 mg/kg or 3 g/m2 during the first
hour, followed by continuous infusion at a rate of 33.3 mg/kg per hour on 1 g/m 2 per
hour.(bb)


Additional Information

wWithdraw an equivalent amount of solution from the bag before adding Amicar if
adding to 250 mL bag or larger for continuous infusion.(d)

wFor subarachnoid hemorrhage, patients are given a continuous infusion of 36 g/day
for 10 days as 18 g of Amicar diluted in 400 mL 5% Dextrose over 12 hours.(b)




REVISED JANUARY 1995




AMINOPHYLLINE
Standard Concentration: 25 mg / 1 mL.(a) (approximately 80% theophylline).(g)

Route of Administration: Undiluted by slow IV injection or IV infusion.(bb) IM route
not recommended.(bb)

Expiration: in syringe: 24 hours;(d) in piggyback or large volume parenteral: 24
hours.(c)

Minimum Dilution: 25 mg/mL (loading dose only).(a,bb) Standard Dilution in large
volume parenteral: 500 mg in 500 mL 5% Dextrose.(d) 500 mg / 250 mL if fluid
restricted.(d)

Maximum Rate of IV Administration: 25 mg/minute(a,bb) 20 - 40 mg/minute in adults
(Loading dose only).(e)


Additional Information

wWithdraw an equivalent amount of solution from the bag before adding aminophylline
if adding to 250 mL bag or larger.(d)

wAminophylline injections reportedly are not stable in solutions having a pH
substantially less than 8; however, the drug appears to be relatively stable in large
volume parenteral solutions over a wide pH range (3.5 - 8.6) if aminophylline
concentrations do not exceed 40 mg (31.6 mg of anhydrous theophylline) per mL.(bb)
If concentration exceeds 40 mg/mL theophylline crystals will form.(bb)

w Searle indicates that refrigeration would not adversely affect its aminophylline,
Elkins - Sinn recommends against refrigerated storage for its product because of
possible reduction in solubility with crystallization.(g)

wTherapeutic serum theophylline concentrations = 10 - 20 mcg/mL.(bb)




REVISED JANUARY 1995
Amiodarone HCl - Cordarone®

Concentration supplied by manufacturer: 50 mg/ mL.(a)
Route of Administration: Intravenous infusion.(a)
Rate of Infusion / Dilution: The recommended starting dose of Cordarone I.V. is
about 1000 mg over the first 24 hours of therapy, delivered by the following infusion
regimen:
Loading infusions First Rapid: 150 mg over the FIRST 10 minutes (15 mg/min).
(Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL).
Infuse 100 mL over 10 minutes.(a)
Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). (Add 18 mL of
Cordarone I.V. (900mg) to 500 mL D5W (concentration = 1.8 mg/mL).(a)
Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min).
Decrease the rate of the slow loading infusion to 0.5 mg/min.(a)

Expiration: Infusions exceeding 2 hours must be administered in glass.
Amiodarone HCL solution stability: In D5W at a concentration1-6 mg/mL in PVC
container 2 hours.(a) In D5W at a concentration of 1-6 mg/mL in glass container
24 hours.(a)

Additional Information
wUse carton to protect contents fromlight until used.(a)
wThe surface properties of solutions containing injectable amiodarone are altered such
that the drop size may be reduced. This reduction may lead to underdosage of the
patient by up to 30%, if dropcounter infusion sets are used. Cordarone I.V. must be
delivered by a volumetric infusion pump.(a)
wWhenever possible, should be administered through a central venous catheter
dedicated to that purpose. An in-line filter should be used during administration.(a)
wCordarone I.V. concentrations greater than 3 mg/mL in D5W have been associated
with a high incidence fo peripheral vein phlebitis; however concentrations of 2.5 mg/mL
or less appear to be less irritating. Therefore, for infusions longer than 1 hour,
Cordarone I.V. concentrations should not exceed 2 mg/mL unless a central venous
catheter is used.(a) Cordarone I.V. infusions exceeding 2 hours must be administered
in glass or polyolefin bottles containing D5W.(a) It is well known that amiodarone
adsorbs to polyvinyl chloride (PVC) tubing and the clinical trial dose administration
schedule was designed to account for this adsorption. All of the clinical trials were
conducted using PVC tubing and its use is therefore recommended. The
concentrations and rates of infusion provided in
dosage and Administration reflect doses identified in these studies. It is important that
the recommended infusion regimen be followed closely.(a)

wCordarone I.V. does not need to be protected from light during administration.(a)
written: 3/96 ild
(a): package insert from Wyeth Laboratories,8/95
AMMONIUM CHLORIDE

Standard Concentration: 26.75% (5 mEq of NH4+ and Cl- per mL).(bb)

Route of Administration: IV infusion.(bb)

Expiration: In syringe: N/A;(b) in piggyback: 24 hours.(d) No studies done per Abbott
on stability in syringe or piggyback.

Suggested Dilution: 100 or 200 mEq of the 26.74% injection to 500 or 1000 mL of
0.9% NaCl.(bb)

Maximum Rate of IV Administration: Not to exceed 5 mL/minute.(bb) Dosage should
be monitored by repeated serum bicarbonate determinations.(a)


Additional Information

|Highly concentrated solutions of ammonium chloride may crystallize when exposed to
low temperatures. If such crystallization does occur, warming to room temperature in a
water bath is recommended.(g)
|1 g Ammonium Chloride contains 18.7 mEq each of Ammonium and Chloride ions.(g)




REVISED JANUARY 1995




AMPHOTERICIN B - Fungizone
Concentration: 5 mg / 1 mL.(a) To a 50 mg vial add 10 mL sterile water.(a)

Route of Administration: Slow IV infusion.(bb) Rapid IV injection of the drug should
be avoided since potentially serious adverse effects (e.g., hypotension, hypokalemia,
arrythmias, shock) may occur. Has been given intra-articularly, and intra-ventricular
(via Ommaya reservoir).(bb)
Expiration: In piggyback or large volume parenteral: 24 hours;(bb) in vial: 7 days.(a)
In syringe for inhalation use: 24 hours.(d)
Minimum Dilution: 1 mg / 5 mL. Standard Dilution: 1 mg / 10 mL.(bb)

Maximum Rate of IV Administration: Total dose over 6 hours(a) 0.25 mg/kg
administration over a 6 hour period; more rapid infusion rates (e.g., over a 2 to 4 hour
period) have also been suggested.(bb)

Additional Information

Mix in 5% Dextrose ONLY.(a)
Protect from direct sunlight.(a) Potency unaffected if the infusion is exposed to ambient
light for less than 8 - 24 hours.(bb)
Refrigerate.(a)
Reconstitute with sterile water for injection. Do not use saline solutions or solutions
with a bacteriostatic agent.(a,bb)

For Intrathecal

Send in a 20 mL syringe, since a mixture of CSF is generally added to the syringe by
the physician when the dose is given.(d) There is no usual dose.(d)
Prepare dilute Amphotericin to a concentration 0.2 mg / mL.(d)
Reconstitute the 50 mg vial with 10 mL of sterile water.(d)
Remove 4.8 mL 5% Dextose or 10% Dextrose from a IV bag into a 6 mL syringe. Pull
syringe plunger back to leave some air space. Add 0.2 mL (1 mg) Amphotericin to
syringe, cap and invert to mix. Withdraw amount ordered plus 0.1 mL for overfill from
syringe tip with needle into a 20 mL syringe. Do not use empty vials which may have
additives to prepare this. DO NOT FILTER. Filtering may remove the Amphotericin.(d)




REVISED JANUARY 1995



AMPHOTERICIN B LIPID COMPLEX INJECTION – Abelcet®
Abelcet® consists of Amphotericin B complexed with two phospholipids in a 1:1 drug-to-lipid molar ratio).
Yellow and opaque in appearance.(a)
Standard Concentration: 5 mg/mL.(a)

Route of Administration: Intravenous infusion after being prepared as an
admixture.(a)

Rate of Infusion: 2.5 mg/kg/hr.(a) To re-suspend the admixed Abelcet®, gently shake the
admixture prior to infusion and every two hours during infusion.(a)
A test dose or bolus of saline is not recommend.(a)

Preparation of Admixture for Infusion:
*Shake the vial gently until there is no evidence of any yellow sediment at the bottom.(a)
*Withdraw the appropiate dose from the required number of vials into one or more sterile
 20 mL syringes using an 18-gauge needle.
*Remove the needle from each syringe filled with Abelcet® and replace with the 5 micron filter
needle supplied with each vial.(a)
*Each filter needle may be used to filter the contents of up to 4-100 mg vials or 8-50mg vials.(a)
*Insert the filter needle of the syringe into an IV bag containing 5% Dextrose and empty the
contents of the syringe into the bag.(a)

Standard Concentration for Infusion: The infusion concentration should be
1 mg/mL(a) The Liposome Co. Inc. has also carried out limited stability studies which indicate
that the stability of the admixture is not adversely affected at final concentrations as low as
0.5 mg/mL.(b)
For pediatric patients and patients with cardiovascular disease the drug may be diluted with D5W to a final
infusion concentration of 2 mg/mL.(a)

Expiration: 48 hours (2 days) under refrigeration and an additional 6 hours at room
temperature as an admixture.(a) Letter from Liposome 3/99, indicates an extention of
the expiration to 10 days under refrigeration for 1-2 mg/mL.(b)

Additional Information:
* Do not dilute with saline solutions or mix with other drugs or electrolytes (as of yet compatability studies
have not been established).(a)
 An existing intravenous line should be flushed with D5W before infusion of Abelcet® or a separate
    infusion line should be used.(a)


* Do not use an in-line filter less than 5 microns.(a)
* Storage prior to admixture should be under refrigeration and protected from exposure to light. Prepared
admixtures do not need to be wrapped for light protection.(a)


updated: 11/2000, ild; (a) Pkg insert: The Liposome Company Inc. 9/99; (b) Letter from Liposome Co.
3/4/99, 10/99.

AMPICILLIN SODIUM- Omnipen®

Standard Concentration: 100 mg / 1 mL.(d)
Diluent to add to vial dose:
{250 mg vial add 2.5 mL;
{500 mg vial add 5 mL;
{1 g vial add 9.5 mL;
{2 g vial add 18.8 mL;
{10 g vial add 94 mL.(d)

Route of Administration: IM, slow IV injection or IV infusion.(bb)

Expiration:
xIn piggyback mixed in 0.9% NaCl: 3 days under refrigeration at a concentration of up
to 20 mg/mL;(bb)
xIn piggyback mixed with 5% Dextrose: 4 hours;(a) in syringe, at a concentration of
100 mg/mL: 12 hours;(b)
xIn syringe, at concentration of 50 mg/mL: 24 hours;(b)
xIn vial: 4 hours under refrigeration.(g)

Minimum Dilution: 1 g / 10 mL for direct IV.(a)

Standard Dilution: In Piggyback: 1 g / 50 mL.(a)

Maximum Rate of IV Administration: 125, 250, 500 mg SLOWLY over 3 - 5
minutes.(a) 1 g - 2 g SLOWLY over at least 10 - 15 minutes.(a,bb) Standard Rate of IV
Administration: In piggyback: 50 mL over 20 - 30 minutes.(d)
More Rapid Administration May Result In Convulsive Seizures.(a)

Additional Information

wMix in 0.9% NaCl unless otherwise specified by physician.(d)

w Keep in refrigerator.(a)



REVISED JANUARY 1995




AMPICILLIN SODIUM / SULBACTAM SODIUM - Unasyn®

Standard Concentration: 375 mg UNASYN/mL (250 mg Ampicillin / 125 mg
Sulbactam/mL).(a)
Route of Administration: IV or IM.(a)

Minimum Dilution: Vials should be further diluted within one hour of reconstitution.
Further diluted with suitable diluent to yield solutions containing 3 - 45 mg Unasyn/mL
(2 - 30 mg Ampicillin / 1 - 15 mg Sulbactam/mL).(a)

Maximum Rate of IV Administration: Slow IV over 10 - 15 minutes. Greater dilutions
with 50 - 100 mL of a compatible diluent (0.9% NaCl or 5% Dextrose) as an intravenous
infusion over 15 - 30 minutes.(a)

Expiration:

In 0.9% NaCl Concentration: Unasyn (ampicillin/sulbactam) mg/mL
45 (30/15) mg/mL 8 hrs @ 250 C
45 (30/15) mg/mL 48 hrs @ 40 C
30 (20/10) mg/mL 72 hrs @ 40 C

In 5% Dextrose Concentration: 30 (20/10) mg/mL 2 hrs @ 250 C
30 (20/10) mg/mL 4 hrs @ 40 C




REVISED JANUARY 1995



AMRINONE LACTATE - Inocor®

Concentration supplied by manufacturer: 5 mg/mL; 100 mg / 20 mL ampule.(a)

Route of Administration: Slow direct IV injection or continuous IV infusion.(bb)
Loading dose undiluted / continuous IV infusion.(a)
Expiration: Diluted solutions should be used within 24 hours.(a)

Minimum Dilution: Undiluted for loading dose.(a) For continuous infusion further
diluted with 0.9% NaCl or 0.45% NaCl to a concentration of 1 mg/mL to 3 mg/mL.(a)
Standard Dilution: 400 mg / 0.9% NaCl 250 mL (1.6 mg / 1 mL).(d)

Maximum Rate of IV Administration: Initial bolus of 0.75 mg/kg over two to three
minutes.(a) Maintenance infusion should be infused at a rate of 5 mcg/kg/minute to
10 mcg/kg/minute.(a)
Refer to package insert for more detailed information on administration.

Additional Information

wMay be injected into running dextrose infusions but should not be diluted in dextrose
solutions prior to injection due to a slow chemical reaction that occurs.(a)
A chemical interation occurs slowly over a 24 hour period when INOCOR is mixed
directly with dextorse containing solutions. Therefore, INOCOR SHOULD NOT BE
DILUTED WITH SOLUTIONS THAT CONTAIN DEXTROSE PRIOR TO INJECTION.
Can be injected into running dextrose infusions through a Y-Connector or directly into
the tubing where preferable.(a)
wFurosemide should not be administered in intravenous lines containing amrinone. A
chemical interaction occurs immediately, which is evident by the formation of
precipitate when furosemide is injected into a intravenous line of an infusion of
amrinone.(a)
wContains sodium metabisulfite that may cause allergic-type reactions including
anaphylactic symptoms and life-threatening or less severe asthmatic episodes in
certain susceptible people. The overall prevalance of sulfite sensitivity in the general
population is unknown and probably low. Sulfite sensitivity is seen more frequently in
asthmatic than in non-asthmatic people.(a)
wProtect INOCOR lactate ampuls from light. Ampul packaging is light resistant for
protection during storage.(a)



Revised: 3/96; ild;
(a)Pkg. insert: SANOFI WINTHROP; 11/93



ATGAM® - Brand of lymphocyte immune globulin, anti-thymocyte globulin
(equine) sterile solution.

Concentration: 50 mg/mL.(bb)

Route of Administration: Slow IV infusion.(bb)
Expiration: When diluted: 24 hours in glass or plastic.(b)

Minimum Dilution: Should not exceed 4 mg / 1 mL if possible.(a,b)

Maximum Rate of IV Administration: Any volume over 4 hours and not less than 4
hours.(a,bb)


Additional Information
wAdd only to sterile 0.45% or 0.9% Sodium Chloride.(a,bb) Do not dilute in Dextrose
Injection USP, as low salt concentration may cause precipitation.(a) The use of highly
acidic infusion solutions is not recommended because of possible physical instability
over time.(a)
wRefrigerate diluted solutions.(a)
wUse 5 micron filter when preparing the solution.(d)
wAmpules should be refrigerated but not frozen.(a)
wThe IV infusion solution container into which ATGAM concentrate is added should be
inverted to prevent contact of undiluted ATGAM with air inside the container.(bb)
wThe container to which ATGAM was added should be gently rotated or swirled to
thoroughly mix the resultant solution. ATGAM concentrate for injection and diluted
solutions of the drug SHOULD NOT be shaken, excessive foaming and/or denaturation
of the protein may occur.(a,bb)
wContact of undiluted ATGAM with air may result in denaturation of the protein.(bb)
wIntradermal sensitivity testing is recommended in all individuals prior to administration
of the initial dose of ATGAM.(bb)
wAdminister via high - flow veins is recommended.(bb)
wIn-line filters should be used (0.2 - 1 micron or 5 micron filters) to prevent inadvertent
administration of any insoluble material that may develop during storage.(bb) SEND
0.22 MICRON IN-LINE FILTER WITH DOSE.




page 1 of 2



ATGAM®
Skin Testing:
wBefore the first infusion of ATGAM, the Upjohn Company strongly recommends that
patients be tested with an intradermal injection of 0.1 mL of a 1:1000 dilution (5 mcg
horse IgG) of ATGAM in sodium chloride injection, and a contralateral sodium chloride
injection control.
w Use only freshly diluted ATGAM for skin testing. The patient and specifically the skin
test should be observed every 15 to 20 minutes over the first hour after intradermal
injection. A local reaction of 10 mm or greater with a wheal or erythema or both with or
without pseudopod formation and itching or a marked local swelling should be
considered a positive test.
wAllergic reactions such as anaphylaxis have occurred in patients whose skin test is
negative. A systemic reaction such as a generalized rash, tachycardia, dyspnea,
hypotension or anaphylaxis precludes any additional administration of ATGAM.(bb)


Preparation of Skin Test: Withdraw 0.1 mL of ATGAM, add to 100 mL 0.9% NaCl.
Shake the bottle. Withdraw 0.1 mL of the 1:1000 dilution for the skin test. Expiration of
the skin test is 12 hours.(a,d)


Vitals once infusion begins: every 15 minutes for the first 30 minutes, then every
hour until the infusion is complete.




Page 2 of 2




REVISED JANUARY 1995

ATROPINE SULFATE

Concentration: 0.1 mg/mL; 0.4 mg/mL; 0.8 mg/mL.(bb)

Route of Administration: IM, SQ or direct IV.(bb)

Expiration: In Syringe: 3 days.(g)
Minimum Dilution: May give undiluted or further diluted with 10 mL sterile water for
injection.(f)

Maximum Rate of IV Administration: 2 mg/minute in emergency situations ONLY.(f)

Standard Rate of IV Administration: Usually 0.3 mg to 0.6 mg/minute until desired
effect is observed. The total dose for adults should not exceed 4 mg.(f) Give rapidly
since slow injection may cause paradoxical slowing of the heart rate.(bb)




REVISED JANUARY 1995


AZATHIOPRINE - Imuran ®

Concentration: 10 mg/mL.(b) To a 100 mg vial add 10 mL sterile water.(a)

Route of Administration: IV infusion or direct IV injection.(bb)

Expiration: In syringe, piggyback or vial: 24 hours.(a)
Minimum Dilution: 100 mg / 10 mL.(bb) Standard Dilution: In piggyback: 100 mg / 50
mL.(b)

Maximum Rate of IV Administration: 100 mg over 5 minutes.(a) Standard Rate of IV
Administration: 100 mg over 30 - 60 minutes.(a)


Additional Information

Do not administer by rapid or bolus IV injection (renal toxicity of ganciclovir may be
increased as a result of excessive plasma levels).(a) Severe tissue irritation can occur
(due to high pH = 11) if given IM or SQ.(a)

Caution should be exercised in the handling and preparation. The use of latex gloves
and safety glasses is recommended to avoid exposure in case breakage of vial or
accidental spillage. If the solution contacts the skin or mucous membranes, wash
thoroughly with soap and water; rinse eyes thoroughly with plain water.(a) Since
ganciclovir has the potential to cause cancer, avoid exposure by inhalation or by direct
contact of the skin or mucous membranes.(a) Handling and disposal should be
according to guidelines issued for cytotoxic drugs.(a)




REVISED JANUARY 1995
Azithromycin - ZITHROMAX

Azithromycin (an azalide, a subclass of macrolide antibiotics) is supplied in lyophilized
form under a vacuum in a 10 mL vial equivalent to 500 mg of azithromycin.(a)
Each vial also contains sodium hydroxide and 413.6 mg citric acid.(a

Standard Concentration: 100 mg/mL.(a)

Route of Administration: For intravenous infusion.(a)
SHOULD NOT be given as a bolus or as an intramuscular injection.(a)

Reconstitution/Stability: Add 4.8 mL of Sterile Water For Injection to the 500 mg
vial.(a) Final concentration: 100 mg/mL.(a)
Reconstituted solution in a vial is stable for 24 hours at room temp (30 degrees C or 86
degrees F).(a)

Rate of Infusion: Over not less than 60 minutes.(a) The infusate concentration and
rate of infusion for azithromycin for Injection should be either 1 mg/mL over 3 hours
or 2 mg/mL over 1 hour.(a) It is recommended that a 500 mg infusion solution as
below, be infused over a period of not less than 60 minutes.(a)

Final Dilution: Concentration range of 1mg/mL - 2 mg/mL.(a) Transfer 5 mL of the
100 mg/mL azithromycin solution into the appropriate amount of any diluent,
e.g., 0.9% sodium chloride, 5% dextrose in water or and other diluent listed in the
package insert.

Final Infusion Solution  Amount of diluent (mL)
Concentration mg/mL
     1 mg/mL      500 mL

     2 mg/mL       250 mL

Stability of Final Dilution: 24 hours when stored below 30 degree C or 86 degree F or
for 7 days if stored under refrigeration (5 degrees C or 41 degrees F.(a)

Stability in a syringe: I talked to the drug info dept at Roche (1-800-526-6367). They
have not done any stability studies of azithromycin in a syringe. (idp)

written: 6/98 idp; update: 11/98
(a)package insert: Feb 1997; Pfizer Labs
AZTREONAM - Azactam®

Standard Concentration: 100 mg/mL.(d) To a 1 g vial add 9.6 mL sterile water,(d) to
a 2 g vial add 19.2 mL sterile water.(d)

Route of Administration: IV injection or infusion; deep IM injection.(bb)

Expiration: In vial: 2 days under refrigeration;(bb) in piggyback: (20 mg or less / mL)
7 days under refrigeration;(bb) in syringe: 2 days.(bb)

Minimum Dilution: 1 g / 3 mL for direct injection.(a,bb)
Standard Dilution: In piggyback: 1 g / 50 mL;(bb) in syringe: 1 g/ 5 mL;(bb)
IV infusion: 20 mg/mL.(bb)

Maximum Rate of IV Administration: Up to 2 g over 3 - 5 minutes.(a,bb) For direct
IV or piggyback over 20 - 60 minutes.(a,bb)


Additional Information

wShake vial immediately and vigorously after the addition of diluent.(bb)




REVISED JANUARY 1995
BETAMETHASONE - Celestone®
Concentration: 6 mg/mL.(a)

Route of Administration: IM, locally by intra-articular, intrasynovial, intralesional
(intradermal, not subcutaneous) or soft tissue injection.(bb) NOT FOR IV USE.(e)

Minimum Dilution: May be given undiluted.(a)




REVISED JANUARY 1995




BRETYLIUM TOSYLATE - Bretylol ® DISCONTINUED
Standard Concentration: 50 mg/mL.(a)

Route of Administration: IM, direct IV or IV infusion.(a)

Expiration: Diluted: 7 days (when diluted to a concentration of 10 mg/mL under
refrigeration; 48 hours room temperature).(bb)

Minimum Dilution: May be given undiluted.(a)
Minimum Dilution for Infusion: 500 mg / 50 mL 0.9% NaCl or 5% Dextrose.(a)
Standard Dilution for Infusion: 1 g / 250 mL 0.9% NaCl or 5% Dextrose.(a)

Rate of IV Administration:
Standard Rate of Administration: 1 - 2 mg/minute continuous infusion or 5 - 10 mg/kg
over a period greater than 8 minutes.
Rapid IV administration may cause severe nausea and vomiting.(a) When treating
existing ventricular fibrillation bretylol should be given as rapidly as possible and may be
given without diluting; 5 mg/kg.(a)

Additional Information

wShould not be diluted when administered by IM injection. Not more than 5 mL should
be injected into one site.(bb)




REVISED JANUARY 1995


BUMETANIDE - Bumex®

Standard Concentration: 0.25 mg/mL.(a)
Route of Administration: IV or IM.(a)

Expiration: In syringe: 1 day.(bb)

Minimum Dilution: 0.25 mg/mL.(a)

Maximum Rate of IV Administration: 0.5 - 1 mg over 1 - 2 minutes.(a) Compatible in
5% Dextrose or 0.9% NaCl for 24 hours.(a)


Additional Information
w Do not exceed 10 mg/day.(a) Dosages up to 20 mg daily IV with impaired renal
functions for the management of edema have been administered.(bb)




REVISED JANUARY 1995


BUPRENORPHINE - Buprenex®

Standard Concentration: 0.3 mg/mL.(a)
Route of Administration: IM, slow IV injection, continuous IV infusion, IM, IV injection
using a patient-controlled infusion device and by epidural injection (not currently
included in the labeling approved by FDA).(bb)

Expiration: When diluted: 72 hours in 5% Dextrose or 0.9 % NaCl.(bb)

Maximum Rate of Continuous Infusion IV: 25 - 250 mcg/hour.(bb)

Minimum Dilution: 15 mcg/mL in 0.9% NaCl and administered via a controlled-
infusion device.(bb)




REVISED JANUARY 1995



BUTORPHANOL - Stadol®

Standard Concentration: 1 mg/mL or 2 mg/mL.(bb)

Route of Administration: IM or IV injection.(bb)
Minimum Dilution: May be given undiluted(a) or further diluted 1 - 2 mg/mL with 5%
Dextrose or 0.9% NaCl. Stable in 5% Dextrose for 24 hours; in 0.9% NaCl, stable for
12 weeks.(b)

Maximum Rate of IV Administration:
Rapid IV, 0.5 mg - 2 mg over 30 seconds - 1 minute.(b)




REVISED JANUARY 1995



CALCIUM CHLORIDE

Standard Concentration:
100 mg/mL (272.6 mg Ca++ / 10 mL; 13.6 mEq Ca++ / 10 mL).(a)

Expiration: In syringe: 3 days.(d)
Route of Administration: Direct IV or IV infusion; may be given intracardially into the
ventricular cavity. However, if injected into the myocardium, coronary arteries may be
lacerated, cardiac tamponade or pneumothorax may be produced, and intractable
ventricular fibrillation may result.(bb)

Minimum Dilution: May be given undiluted or further diluted with 10 mL 5% Dextrose
or 0.9% NaCl.(f)

Maximum Rate of IV Administration: For direct IV or IV infusion,
do not exceed 0.5 mL to 1 mL/minute (0.7 mEq to 1.5 mEq to Ca/minute), if using a
10% solution.(bb) The injection should be stopped if patient complains of
discomfort.(bb)




REVISED JANUARY 1995




CALCIUM GLUCONATE

Standard Concentration: 100 mg/mL (4.6 mEq Ca++ / 10 mL; 93 mg Ca++ / 10 mL).(a)

Route of Administration: IV either directly or by infusion.(a)

Expiration: In syringe or piggyback: 24 hours.(b)
Minimum Dilution: 1 g / 10 mL.(a) Standard Dilution in Large Volume Parenteral:
Depends on the patient's condition.(a)

Maximum Rate of IV Administration: 0.5 - 2 mL/minute.(a) Standard Rate of IV
Administration: By intermittent infusion at a rate not exceeding 200 mg/minute, or by
continuous infusion.(a)


Additional Information

wIf crystallization has occurred, warming in a 600C water bath for 15 - 30 minutes with
occasional shaking may dissolve the precipitate. Cool to body temperature before
use.(a)




REVISED JANUARY 1995

CEFAZOLIN for Injection, USP

Standard Concentration: 100 mg/mL.(a)

Reconstitution Instructions:
To a 1 g vial add 9.5 mL sterile water;(d)
To a 10 g vial add 96 mL sterile water.(d)
Route of Administration: Intramuscular; intravenous injection (into large vein or into
tubing of free-flowing I.V. solution) or by continuous or intermittent infusion.(a)

Expiration: In syringe: 28 days (c); in vial: 4 days(a); in piggyback: 4 days.(a)
Cefazolin Injection in Galaxy Container expiration when thawed and under refrigeration:
30 days;(e)

Minimum Dilution for Administration: 1 g / 5 mL.(a)

Standard Dilution for Administration: In piggyback: 1 g / 50 mL.(a)

Maximum Rate of IV Administration: 1 g in a minimum of 10 mL slowly over
3 - 5 minutes.(a) Do not inject in less than 3 minutes.(a)

Standard Rate of IV Administration: In piggyback: 1 g over 15 - 30 minutes.(a)


Additional Information

Recontituted solutions may range in color from pale yellow to yellow without a change in
potency.(a,b)

Refrigeration of reconstituted solutions of cefazolin sodium may result in crystal
formation.(b)




Revised: 4/2000; idp: (a) Package Insert: Apothecon (Bristol-Myers Squibb) Oct 1998;
(b) Trissel’s 10th edition; (c) Compass 4/00; (d) VUH Pharmacy Dept policy;
(e) Package Insert for Cefazolin in Galaxy Container, june 1998 Baxter Healthcare Co.




CEFEPIME – MAXIPIME®

SUPPLIED AS: 500 mg, 1 g, 2 g.(a)


ROUTE OF ADMINISTRATION: For Intramuscular or intravenous administration.(a)


RATE OF ADMINISTRATION: Intravenously over approximately 30 minutes.(a)
RECONSTITUTION DIRECTIONS:
For a final concentration of 100 mg/mL
To a 500 mg vial add 5 mL; final concentration 560 mg / 5.6 mL. Vial contains a
60 mg / 0.6 mL overfill. Do not use transfer needle for a 500 mg dose. Withdraw 5
mL from the reconstituted vial for 500 mg). (a)

To a 1 g vial add 10 mL; final concentration 1130 mg / 11.3 mL (a)
NOTE: The 1 g vial has a overfill of 103 mg / 1.3 mL. Therefore, once the 1 g vial is
reconstituted withdraw 10 mLs from vial for a 1 g dose. Do not use a transfer needle
when using a 1 G vial.(a)

To a 2 g vial add 17.5 mL; final concentration 2 g / 20 mL.(a) Transfer needle can be
used for a 2 g vial.


EXPIRATION::
In vial: 100 mg/ml; 7 days under refrigeration 24 hours at room temperature.(a)

In piggyback: 1-40 mg/mL; 7 days under refrigeration; 24 hours at room temperature.(a)

In syringe: 100 mg/mL; 7 days under refrigeration; 24 hours at room temperature.(b)




Written: 4/2000 idp; (a) PI: 2/1999;Bristol-Myers Squibb (Dura-Pharmaceuticals
1-(888)-859-8583); (b) Letter from Dura Pharmaceuticals 12/6/99.




CEFOTAXIME SODIUM - Claforan®

Standard Concentration: 100 mg/mL.(d) To a 1 g vial add 9.7 mL sterile water,
to a 2 g vial add 19.4 mL sterile water; to a 10 g vial add 97 mL.(d)

Route of Administration: IM, IV injection or IV infusion.(bb)

Expiration: In piggyback: 5 days; in syringe: 5 days;(a) in vial: 7 days.(a) Frozen
Claforan expiration when thawed and under refrigeration: 10 days;(a) at room
temperature: 24 hours.(a)
Minimum Dilution: 1 - 2 g / 10 mL.(a)
Standard Dilution: In piggyback: 2 g / 50mL.(a)

Maximum Rate of IV Administration: 1 - 2 g over 3 - 5 minutes.(a)
Standard Rate of IV Administration: In piggyback: 1 - 2 g over 15 - 30 minutes.(d)




REVISED December 1995; ild




CEFOTETAN DISODIUM - Cefotan®DISCONTINUED

Standard Concentration: 100 mg/mL.(d)

Reconstitution directions:
To a 1 g vial add 9.6 mL sterile water(d);
To a 2 g vial add 19 mL sterile water(d);
To a 10 g vial add 96 mL sterile water.(d)

Route of Administration: IV injection, infusion or deep IM injection.(a)
Expiration:
In syringe: 24 hours room temperature, 4 days under refrigeration;(a)
In vial: 24 hours at room temperature, 4 days under refrigeration;(a)
In piggyback: 24 hours at room temperature, 10 days under refrigeration.(c)
Thawed solution in Galaxy plastic container remains chemically stable for 48 hours at
room temperature or for 21 days under refrigeration.(a)

Minimum Dilution: 1 g / 5 mL.(a)

Standard Dilution: In piggyback: 1 g / 50 mL.(a)

Maximum Rate of IV Administration:
Intermittent intravenous injection 1 g or 2 g over 3 - 5 minutes.(a)
Intermittent IV infusions infused over 20 –60 minutes.(a)


Additional Information
Cefotetan disodium powder and solutions of the drug may darken (i.e., to a deeper
yellow) with age depending on storage conditions; however, this color change does not
indicate loss of potency.(f)



Revised 11/2000 idp
(a)PI: 3/99 Zeneca Pharmaceuticals;
(c) Compass
(d) VUH pharmacy dept policy
(f) AHFS drug information 2000




CEFTAZIDIME - Fortaz®, Tazidime®, Tazicef®

Standard Concentration: 100 mg/mL.(d)
To a 1 g vial add 9.4 mL; to a 2 g vial add 18.8 mL to a 6 g vial of TAZICEF add 53 mL;
to a 6 g vial of FORTAZ and TAZIDIME add 56 mL.(d)

Route of Administration: IM, IV injection or IV infusion.(bb)

Expiration: In syringe: 3 days under refrigeration; in vial: 7 days when refrigerated.(a)
At a concentration of 1 - 40 mg/mL in 5% Dextrose or 0.9% NaCl: 24 hours at room
temperature and 7 days under refrigeration.(a)
Minimum Dilution: 1 g / 10 mL.(a) Standard Dilution: 1 g / 50 mL.(d)

Maximum Rate of IV Administration: Direct IV injection 1 g over 3 to 5 minutes.(a)
Standard Rate of Infusion: 1 g over 15 to 30 minutes.(d)


Additional Information

wVials are under reduced pressure. When dissolved, ceftazidime releases carbon
dioxide gas and a positive pressure develops. After ceftazidime is in solution,vials must
be vented prior to withdrawing solution.(a)




REVISED JANUARY 1995




CEFTRIAXONE - Rocephin®

Standard Concentration: 100 mg/mL.(a) To a 1 g vial add 9.6 mL sterile Water for
injection.(a) To a 2 g vial add 19.2 mL sterile Water for injection.(a)

Expiration: In syringe: 3 days at room temperature; 10 days under refrigeration.(a)
In piggyback: At a concentration of 10 - 40 mg/mL in 5% Dextrose or 0.9% NaCl at
room temperature: 3 days; under refrigeration: 10 days.(a)
In vial: 3 days at room temperature; 10 days under refrigeration.(a)

Standard Dilution: 2 g / 50 mL.(a)

Standard Rate of Administration: 1 g 30 minutes.(a)
Route of Administration: Intravenous or intramuscular.(a)


Additional Information


   For IM, Rocephin mixed in Lidocaine: Add 2.6 mL of 1% Lidocaine without
    epinephrine to 1 g of Rocephin.(b) Sterile powder of Rocephin should be protected
    from light. After reconstitution, protection from normal light is not necessary.(a) The
    final concentration will be 333 mg/mL of Rocephin.(d)



On 11/11/99
Changed the infusion rate to 1gm over 30 min was 1g over 15to 30 min.
Redid the Im rocephin
Changed the expiration of the vial and syringe from 3 days to 10 days.

Revised: 11/11/99 idp
(a) Package insert revised: January 1998; Roche Pharmaceuticals,
(d) VUMC Pharmacy dept.policy.




CEFUROXIME - Kefurox® -Lilly Brand - Zinacef® - Glaxo Brand

Standard Concentration: 100 mg/mL.(a) To a 750 mg vial add 7 mL; to 1.5 g vial add
14 mL sterile water of KEFUROX;(a,b) to a 1.5 g vial of ZINACEF add 16 mL; to a 7.5 g
vial of KEFUROX add 70 mL.(d)

Route of Administration: IM, direct IV or IV Infusion.(a)

Expiration: In syringe: 48 hours;(a) in piggyback: 7 days;(a) in vial: 48 hours.(a)

Minimum Dilution: 1 g / 10 mL.(a) Standard Dilution: 1.5 g / 50 mL.(a)

Maximum Rate of IV Administration: 750 or 1500 mg over 3 - 5 minutes.(a) Standard
Rate of IV Administration: 50 mL over 15 - 30 minutes.(a)
Additional Information

wWhen sending Zinacef in a syringe, the 24 hour expiration is very important due to the
fact that the drug will fall out of solution after 24 hours at the concentration of
1 g / 10 mL.(b)

wIf Glaxo brand Zinacef is being used, the standard concentration will be 90 mg/mL
approximately. To a 750 mg vial add 8 mL sterile water. To a 1500 mg vial add 14 mL
sterile water.(a,b)

wAt higher concentrations the drug appears to be a suspension.(b)

wThe vials should be protected from light.(a)

wCefuroxime powder as well as solutions and suspensions tend to darken depending
on storage conditions, without adversely affecting product potency.(a)




REVISED JANUARY 1995




CHLORAMPHENICOL - Chloromycetin®Sodium Succinate

Standard Concentration: 100 mg/mL (1 g / 10 mL).(a) To a 1 g vial add 10 mL sterile
water.(a)

Expiration: In syringe: 3 days;(b) in piggyback: 3 days;(b) in vial reconstituted
solution: 30 days at room temperature.(a)

Route of Administration: Intravenous use only.(a) Ineffective when given
intramuscularly.(a)

Minimum Dilution: 1 g / 10 mL.(a) Standard Dilution: In piggyback: 2 g / 50 mL.(b,d)

Maximum Rate of IV Administration: Over at least one minute as a 10% (100mg/mL)
solution.(a)
Standard Rate of IV Administration: In piggyback: 50 mL over 15 - 30 minutes.(d)




Additional Information:
 Each gram (10 mL of a 10% solution) of chloramphenicol sodium succinate contains
  approximately 52 mg (2.25 mEq) of sodium.(a)




Revised: January 2000
(a) package insert: Monarch Pharmaceuticals® 9/98




CHLORDIAZEPOXIDE HYDROCHLORIDE - Librium®

Standard Concentration: 100 mg/ampule; package contains 2 mL ampule of special
intramuscular diluent.(a)

Route of Administration: IM or IV.(a)

Standard Dilution: For IV Use: Dissolve 100 mg powder with 5 mL of 0.9% NaCl or
sterile water immediately prior to administration, agitate ampule gently. Do not use
diluent provided. Resultant solution 20 mg/mL.(bb) For IM Use: Add 2 mL of diluent
supplied by the manufacturer to the ampule containing 100 mg of drug and agitate the
ampule gently until drug is dissolved; the diluent should be added carefully to minimize
air bubble formation.(bb) Resultant solution 50 mg/mL.(bb)

Maximum Rate of Injection: IM: Slowly preferably by deep injection into the upper
outer quadrant of the gluteus muscle.(bb) IV preparation reconstituted with 0.9% NaCl
or sterile water SHOULD NOT be given IM due to pain at site of injection.(bb) IV:
Slowly IV over 1 minute.(bb)

Stability: Any unused portion should be discarded.(a)


Additional Information

wParenteral administration may cause hypotension and/or respiratory depression if the
drug is administered too rapidly IV. Facilities and equipment for respiratory or
cardiovascular assistance should be readily available. Manufacturer suggests
monitoring patients up to 3 hours following parenteral administration.(bb)

wLibrium solution made with the special IM diluent should not be given IV because of
the air bubbles which form when the IM diluent is added to the Librium powder.(a)

wDo not use diluent solution if opalescent or hazy.(a)




REVISED JANUARY 1995




CHLOROTHIAZIDE SODIUM - Diuril®

Standard Concentration: 25 mg/mL.(b)

Route of Administration: IV infusion.(bb) IV route should be used only when patients
are unable to take the drug orally or in emergency situations.(bb)
Must not be administered SQ or IM.(bb)

Expiration: 24 hours at room temperature.(bb)

Minimum Dilution: Can be given undiluted or further diluted with sodium chloride,
dextrose or other compatible infusion fluids before administration.(bb)

Maximum Rate of Administration: Dosage should be individualized according to the
patient's requirements and response.(bb) Give 0.5 g or fraction over 5 minutes.(nn)
Additional Information

wInitially not less than 20 mL of sterile water for injection only to a 500 mg vial should
be added. This will provide a concentration of 20 mg/mL.(bb) May then be further
diluted with sodium chloride, dextrose or other compatible infusion fluids before
administration.(bb)

wDiscard solution after 24 hours.(nn)

wMonitor blood pressure frequently.(nn)

wPrecipitation occurs in less than 24 hours if the pH of the reconstituted solution is less
than 7.4.(bb)

wExtravasation of the alkaline solution must be avoided.(bb)




REVISED JANUARY 1995




CHLORPHENIRAMINE MALEATE - Chlor-Trimeton®

Standard Concentration: 10 mg/mL.(a)

Route of Administration: SQ, IM or IV injection.(bb) The 100 mg/mL injection should
not be administered IV.(bb)

Expiration: 24 hours.(d)

Minimum Dilution: May be given undiluted.(nn)

Maximum Rate of IV Administration: 10 mg/minute.(nn)
REVISED JANUARY 1995




CHLORPROMAZINE HYDROCHLORIDE - Thorazine®

Standard Concentration: 25 mg/mL.(a)

Expiration: In syringe: 3 days.(d)

Route of Administration: IM, direct IV injection or IV infusion.(a,bb)

Minimum Dilution: 1 mg/mL in 0.9% NaCl for direct IV;(bb)
25 - 50 mg in 500 - 1000 mL of 0.9% NaCl for IV infusion.(g)

Maximum Rate of IV Administration: 1 mg/minute in adults and 0.5 mg/minute in
children.(bb)
Standard Rate of IV Administration: 500 - 1000 mL of 0.9% NaCl and administered
slowly.(bb)

Additional Information

wIV administration of undiluted chlorpromazine should be avoided.(bb)
wChlorpromazine solution should be protected from light. A slight yellow discoloration
is not indicative of potency loss but solutions which are very discolored should be
discarded.(hh)




REVISED JANUARY 1995




CIMETIDINE - Tagamet ®

Standard Concentration: 150 mg/mL.(a)

Route of Administration: Direct IV, IV infusion or IM.(a)

Expiration: Vial once opened: 30 days.(d)
             In syringe: 30 days.(d)
             In piggyback: 300 mg / 50 mL. 48 hours.(a)

Minimum Dilution: 300 mg / 20 mL. Do not administer undiluted.(a)

Standard Dilution: In piggyback: 300 mg / 50 mL.(a)
No dilution necessary for IM use but transient pain may occur.(a)

Maximum Rate of IV Administration: 300 mg over not less than 5 minutes.(a)

Standard Rate of IV Administration: In piggyback: 300 mg over 15 - 20 minutes.(a)
Additional Information
 300 mg cimetidine can be diluted in 20 mL.(a)
 Label: DO NOT REFRIGERATE.(a)




updated: 11/1/2000,idp
(a)pkg insert., Abbott Laboratories; May 1997; (d) VUH Rx policy




CIPROFLOXACIN HYDROCHLORIDE - Cipro®

Standard Concentration: 200 mg / 20 mL; 400 mg / 40 mL;(a)
premixed in viaflex bags: 200 mg / 100 mL 5% Dextrose;
400 mg / 200 mL D5W.(a)

Route of Administration: IV infusion only.(a)

Minimum Dilution: Final concentration 1 - 2 mg/mL; 200 mg / 100 mL(a)

Maximum Rate of IV Administration: 200 mg/ 100 mL or 400 mg / 200 mL over
60 minutes.(a)

Expiration: In piggyback: 14 days at room temperature or under refrigeration;(a) when
the wrapper is removed from a premixed bag and when mixed by pharmacy 14 days
expiration.(b) Refrigeration of pre-mixed piggyback is not required.(a)


Additional Information

wCan be mixed in 5% Dextrose or 0.9% NaCl.(a)
REVISED JANUARY 1995




CLINDAMYCIN Phosphate, USP

Standard Concentration: 150 mg/mL.(a)

Route of Administration: IM or IV infusion.(a) Do not administer intravenously undiluted .(a)

Expiration: In vial: 30 days.(d)
            In syringe: 30 days (room temperature).(d)
            In piggyback at a concentration of: 6, 9, or 12 mg/mL in D5W or 0.9% NaCl
16 days at room temperature.(a)

Standard Dilution: 600 mg / 50 mL.(a)
Minimum Dilution: 12 mg/mL.(a)

Maximum Rate of IV Administration: The concentration in diluent for infusion should
not exceed 18 mg/mL Infusion rates should not exceed 30 mg/minute.(a)

Standard Rate of IV Administration:
In piggyback: 300 mg / 50 mL over 10 minutes;
              600 mg / 50 mL over 20 minutes;
              900 mg / 50 -100 mL over 30 minutes;
             1200 mg / 100 mL over 40 minutes.(a)
Administration of more than 1200 mg in a single 1 hour infusion is not recommended.(a)


Additional Information

   Refrigeration may cause crystallization but will resolubilize at room temperature, but
    care should be exercised to ensure that all crystals have redissolved.(b)

   Single IM injections greater than 600 mg are not recommended.(a)

   Label: DO NOT REFRIGERATE.(b)


updated: 11/1/2000, idp
                                                                                                 th
(a) Package Insert ; Abbott Laboratories, May 1994; (b)Trissel’s Handbook of Injectable Drugs 10
Edition; (d) VUH Rx policy




COLCHICINE

Standard Concentration: 0.5 mg/mL.(bb)

Expiration: When diluted: 24 hours.(b)

Route of Administration: IV injection.(bb) Severe local irritation occurs if given SQ or
IM.(bb)

Minimum Dilution: 2 mg in 20 - 50 mL 0.9% NaCl.(b)

Maximum Rate of IV Administration: Dose over a period of 2 - 5 minutes by direct IV
injection or preferably, into the tubing of a free-flowing compatible IV solution.(bb)
REVISED JANUARY 1995




COTROPIN - ACTH®, Acthar®

Add 1 - 2 mL sterile water to a 25 unit or 40 unit vial.(a)
Expiration: When diluted: 24 hours.(a)

Route of Administration: IM, SQ, Direct IV or IV infusion.(bb)

Minimum Dilution: Required dose in 1-2 mL sterile water or 0.9% NaCl.(a)
Dilution: 10-25 units in 500 mL.(bb)

Standard Rate of IV Administration: 500 mL over 8 hours.(a)
Standard Dilution: 10 - 25 units in 500 mL or 0.9% NaCl.(bb)
Maximum Rate of IV Administration: 8 hours.(bb)


Additional Information
wAlthough the manufacturer recommends that the injection be dissolved in 5%
Dextrose, some authorities prefer 0.9% NaCl during diagnostic testing since water
intoxication and adrenal crises may occur in patients with adrenal insufficiency if 5%
Dextrose is used.(bb)
REVISED JANUARY 1995




COSYNTROPIN - Cortrosyn®

Standard Concentration: 0.25 mg/mL.(a) Add 1 mL NaCl 0.9% to a 0.25 mg vial.(a)

Route of Administration: IM, Direct IV or IV infusion.(a,bb)

Expiration: In syringe: Data not available; in piggyback: 12 hours at room
temperature;(bb) in vial: 21 days under refrigeration.(bb)

Minimum Dilution: 0.25 mg/mL.(a)
Standard dilution for IV infusion: 0.25 mg in 250 mL 5% Dextrose or 0.9% NaCl.(a)

w0.25 mg over 2 minutes.(bb)

Standard Rate of IV Administration: 40 mcg/hour over 6 hours.(a)


Additional Information

wCosyntropin 0.25 mg is equivalent to 25 units of corticotropin.(a,bb)
REVISED JANUARY 1995




CYCLOSPORINE - Sandimmune®

Concentration: 50 mg/mL.(a)

Expiration: When diluted: 24 hours when mixed in 5% Dextrose glass container; 12
hours when mixed in 0.9% NaCl in glass container;(b,gg) 6 hours if in plastic bag.(gg)

Minimum Dilution: 50 mg in 20 - 100 mL.(a)

Maximum Rate of IV Administration: 20 - 100 mL over 2 - 6 hours.(a)


Additional Information

wMust be diluted prior to IV infusion.(bb)
REVISED JANUARY 1995
CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN) - CytoGam®

Standard Concentration: Supplied in a single dose vial containing
2500 mg + or - 500 mg of lyophilized immunoglobulin for reconstitution with
50 mL of Sterile Water for Injection,USP. When reconstituted each mL contains
50 mg + or - 10 mg of immunoglobulin, primarily IgG, and trace amounts of IgA and
IgM; 50 mg of sucrose; 10 mg of Albumin (Human). The reconstituted solution should
appear colorless and translucent.(a)

Route of Administration: Intravenous infusion.(a)

Expiration: Infusion should begin within 6 hours after reconstitution and should be
completed within 12 hours of reconstitution.(a)

Preparation for Administration:
w Reconstitute the lyophilized powder with 50 mL of Sterile Water for Injection,USP.
w DO NOT SHAKE VIAL; AVOID FOAMING.
w A double-ended transfer needle or large syringe are suitable for adding the water for
   reconstitution. When using a double-ended transfer needle, insert one end first into
the vial of water.
w The lyophilized powder is supplied in an evacuated vial so the water should transfer
by suction.
w After the water is transferred into the evacuated vial, the residual vacuum should be
released to hasten the dissolving process.
w Rotate the container gently to wet all the undissolved powder.
w A 30-minute interval should be allowed for dissolving the powder.(a)

Infusion: CytoGam should be administered through an intravenous line using a
constant infusion pump (i.e., IVAC pump or equivalent). Pre-dilution of CytoGam may
be "piggybacked" into a pre-existing line if that line contains either Sodium Chloride,
Injection, USP or one of the following dextrose solutions (with or without NaCl added):
2.5% Dextrose, 5% Dextrose, 10% Dextrose, 20% Dextose. If a pre-existing line must
be used, the CytoGam should not be diluted more than 1:2 with any of the above-
named solutions. Admixtures of CytoGam with any other solutions have not been
evaluated. Filters are not necessary for the administration of CytoGam.(a)

Vital signs should be taken pre-infusion, mid-way and post-infusion as well as before
any rate increase.(a)




page 1 of 2
CYTOMEGALOVIRUS
Rate of Infusion:
INITIAL DOSE. Administer intravenously at 15 mg/kg/hr. If no adverse reactions occur
after 30 minutes, the rate may be increased to 30 mg/kg/hr; if no adverse reactions
occur after a subsequent 30 minutes, then the infusion may be increased to 60
mg/kg/hr (volume not to exceed 75 ml/hr). DO NOT EXCEED THIS RATE OF
ADMINISTRATION. The patient chould be monitored closely during and after each rate
change.(a)

SUBSEQUENT DOSES. Administer at 15 mg/kg/hr for 15 minutes. If no adverse
reactions occur, increase to 30 mg/kg/hr for 15 minutes and then increase to a
maximum rate of 60 mg/kg/hr (volume not to exceed 75 mL/hr). DO NOT EXCEED
THIS RATE OF ADMINISTRATION. The patient should be monitored closely during
each rate change.(a)

POTENTIAL ADVERSE REACTIONS ARE: flushing, chills, muscle cramps, back pain,
fever, nausea, vomiting, wheezing, drop in blood pressure. Minor adverse reactions
have been infusion rate related - if the patient develops a minor side effect (i.e.,
nausea, back pain, flushing), slow the rate or temporarily interrupt the infusion, If
anaphylaxis or drop in blood pressure occurs, discontinue infusion and use antidote
such as diphenhydramine and adrenalin.(a)

Additional Information:

w CytoGam contains no preservative. The purified immunoglobulin is derived from
pooled adult human plasma selected for high titers of antibody for Cytomegalovirus
(CMV).
w After reconstitution the vial should be entered only once for administration purposes
and the infusion should begin within 6 hours. The infusion schedule should be adhered
to closely. Do not use if the solution is turbid.
w Cytogam should be stored under refrigeration. Reconstituted CytoGam should be
used within 6 hours. CytoGam should not be stored in the reconstituted state.(a)




page 2 of 2


revised April 1995

Daclizumab - ZENAPAX®
Standard Concentration: 25 mg / 5 mL.(a)

Route of Administration: Intravenous administration.(a) NOT FOR DIRECT
INJECTION.(a)

Dilution and Preparation: Dose (calculated volume) should be mixed in 50 mL of
0.9% NaCl solution.(a)
When mixing the solution gently invert the bag in order to avoid foaming.
DO NOT SHAKE. Do not freeze.(a)

Rate of Administration: Over 15 minutes via a peripheral or central vein.(a)

Expiration: When diluted stable for 4 hours at room temperature and for 24 hours
refrigerated at 2 to 8 degrees C (36 to 46 degrees). After 24 hours the solution should
be discarded.(a)


Additional Information:

** Medications for the treatment of severe hypersensitivity reactions should be available
for immediate use.(a)




written 2/98 ild
(a) Package Insert: December 1997; Hoffman-LaRoche Inc.




DANTROLENE SODIUM - Dantrium®

Standard Concentration: 20 mg vial.(a)
Route Of Administration: Rapid IV injection.(bb)

Dilution: Each vial should be reconstituted with 60 mL sterile water (without
bacteriostatic agent), and shaken until the solution is clear.(a)
The vial should be protected from direct light and used within 6 hours after
reconstitution.(a)

Rate Of Administration: By continuous rapid IV push beginning at a minimum dose of
1 mg/kg, and continuing until symptoms subside or the maximum cumulative dose of
10 mg/kg has been reached.
Administration of dantrium IV should be continuous until symptoms subside.
Prophylactic dose preoperatively 2.5 mg/kg starting 1 1/4 hours before anticipated
anesthesia and infused over 1 hour.(bb)


Additional Information

wDantrium vials should be transferred to an IV sterile plastic bag. Dantrium should
not be transferred to a large glass bottle due to precipitate formation observed with
the use of some glass bottles as reservoirs.(a)

w 5% Dextrose or 0.9% NaCl and other acidic solutions are not compatible with
Dantrium and should not be used.(a)




REVISED JANUARY 1995
DEFEROXAMINE MESYLATE - Desferal®

Standard Concentration: 250 mg/mL.(a) Add 2 mL sterile water to a 500 mg vial.(a).
Route Of Administration: IM, IV or SQ (Utilizing a small portable pump capable of
providing continuous mini-infusion).(a)

Expiration: When diluted: 7 days at room temperature.(a)

Minimum Dilution: 500 mg / 2 mL. May be further diluted with 5% Dextrose, 0.9%
NaCl or Ringer's Lactate to a desired volume.(a)

Maximum Rate Of I V Administration: 15 mg/kg/hour.(a)


Additional Information

wUsually the initial dose is 1 g followed by 0.5 g every 4 hours for 2 doses. Total dose
should not exceed 6 g in 24 hours.(a)




REVISED JANUARY 1995
DESMOPRESSIN ACETATE - DDAVP®

Standard Concentration: 4 mcg/mL(a) Available as 1 mL single-dose ampule and
10 mL multiple-dose vial. 10 mL vial contains chlorobutanol as a preservative
5 mg/mL.(a)
4 mcg of desmopressin acetate solution has an anti-diuretic activity of about 16 IU;
1 mcg of desmopressin is equivalent to 4 IU.(a)

Route of Administration: Subcutaneously or direct intravenous injection for Diabetes
Insipidus. Intravenous infusion for Hemophilia A and von Willebrand's Disease (Type I)
(a)

Dosage and Administration:
Diabetes Insipidus
Administered subcutaneously or by direct intravenous injection. Dosage is determined
for each patient and adjusted according to the pattern of response. Response should
be estimated by two parameters: adequate duration of sleep and adequate, not
excessive, water turnover.(a) Usual dosage range in adults is 2 mcg/0.5 mL to
4 mcg/1 mL daily in two divided doses.(a) The injectable form has an antidiuretic effect
about ten times that of an equivalent dose administered intranasally. The bioavailability
of the subcutaneous route of administration was determined qualitatively using urine
output data. The exact fraction of drug absorbed by the sq route has not been
quantitatively determined.(a)

Hemophilia A and von Willebrand's Disease (Type I)
Administered as an intravenous infusion at a dose of 0.3 mcg DDAVP/kg diluted in NS
and infused slowly over 15-30 minutes. In adults and children weighing more than 10
kg, 50 mL diluent is used; in children weighing 10 kg or less, 10 mL of diluent is used.
Blood pressure and pulse should be monitored during infusion. If DDAVP is used
preoperatively, it should be administered 30 minutes prior to the scheduled procedure.


Rate of Infusion: For Hemophilia A and von Willebrand's Disease (Type I):
0.3mcg/kg;intravenously infused slowly over 15-30 minutes.(a,b)

For Diabetes Insipidus: 0.5-1 mL (2-4 mcg) daily SQ or intravenously.(b)

Expiration: 24 hours after dilution in 50 mL NS when refrigerated.(b) Stability
information for desmopressin in a syringe was not available.(b)


revised: December 1995;
PI 11/93 Rhone-Poulenc Rorer Pharmaceuticals and letter November 1995;
1994 ASHP DI; ild
DEXAMETHASONE SODIUM PHOSPHATE , USP
Standard Concentration: 4 mg/mL; 24 mg/mL.(a)


Route Of Administration: Direct IV, IM, intra-articular, IV infusion, intrasynovial,
intralesional or soft tissue injection.(a)
Dexamethasone sodium phosphate 4 and 24 mg/mL concentrations may be
administered intravenously by direct injection slowly over one to several minutes or by
continuous or intermittent intravenous infusion. Only the 4-mg/mL concentration may
be administered by intramuscular, intra-articular, intrasynovial, intralesional or solft-
tissue injection.(b)

Expiration: In vial once opened: 30 days;(d)
            In syringe: Undiluted: 30 days;(d); Diluted: 14 days.(d)
            In piggyback: 14 hours;(d)
STORE ALL DOSES AT ROOM TEMPERATURE. DO NOT REFRIGERATE.

Standard Dilution: In piggyback: 32 mg / 50 mL.(b)

Maximum Rate Of I V Administration: Dexamethasone sodium phosphate
4 and 24 mg/mL concentrations may be administered intravenously by direct injection
slowly over one to several minutes or by continuous or intermittent intravenous
infusion.(b)
Standard Rate Of I V Administration: In piggyback: 50 mL over 15-30 minutes.(d)


Additional Information

   Each mL of solution containing the equivalent of 24 mg of dexamethasone
    phosphate is equal to 20 mg of dexamethasone. Each mL of solution containing the
    equivalent of 4 mg of dexamethasone phosphate is equal to 3.33 mg of
    dexamethasone.(b)




Updated: 11/7/00 idp;
(a)Package Insert: American Pharmaceutical Partners, Inc. 2/99;
                                             th
(b) Trissel’s Handbook on Injectable Drugs 10 Edition;
(d) VUH Rx policy;
DEXTRAN 40 - in dextrose or in sodium chloride.

How Supplied: Dextran 40 in 5% Dextrose or 0.9% NaCl (10 g Dextran / 100 mL).(a)

Route Of Administration: IV infusion.(bb)

Expiration: 24 hours after spiking.(d)

Maximum Rate Of I V Administration:

When treating shock: The first 500 mL of Dextran 40 solution may be infused rapidly
while central, venous pressure is closely monitored. The remaining dose should be
infused slowly. If central venous pressure is not monitored, infusion of the drug should
be slower and the patient should be closely observed for signs of circulatory
overload.(bb) Total dosage of the 10% solution during the first 24 hours should not
exceed 2 g/kg (20 mL/kg). If therapy is continued beyond 24 hours, dosage should not
exceed 1 g/kg (10 mL/mg) daily. Therapy should not be continued for longer than
5 days.(bb)


Additional Information

wDo Not Refrigerate.(a) If dextran flakes form, they can be dissolved by heating the
solution in a water bath at 1000C until it becomes clear or by autoclaving at 1100C for
15 minutes. Dextran 40 should be stored at a constant temperature.(bb)

wAdverse effects caused by the antigenic properties of dextran include urticaria, nasal
congestion, wheezing, tightness of the chest, and mild hypotension. Severe
anaphylactoid reactions with marked hypotension, occasionally resulting in fatalities,
have also occurred. Anaphylactoid symptoms may be relieved by parenteral
administration of epinephrine; antihistamines and other supportive therapy may be
used.(bb)




REVISED JANUARY 1995
DEXTRAN 70 AND 75 - Travenol brand - in 5% Dextrose or 0.9% NaCl

How Supplied: Each 500 mL of Dextran 70 or Dextran 75 contains 6 g Dextran / 100
mL in 0.9% NaCl or 5% Dextrose.(bb)

Route Of Administration: IV infusion.(bb)

Expiration: 24 hours after spiking.(d)

Maximum Rate Of I V Administration: Total dosage of the 6% solution for adults and
children during the first 24 hours should not exceed 1.2 mg/kg (20 mL/kg); if therapy is
continued beyond 24 hours, dosage should not exceed 0.6 g/kg (10 mL/kg) daily. In
adults the usual dose in 30 g (500 mL). In emergency situation, the drug may be given
to adults at a rate of 1.2 - 2.4 g (20 - 40 mL) per minute. In normovolemic or nearly
normovolemic patients, the rate of infusion should not exceed 0.24 g (4 mL) per
minute.(bb)

Additional Information

w Do Not Refrigerate.(a) Same as for Dextran 40.

wSame as for Dextran 40




REVISED JANUARY 1995
DEXTROSE

How Supplied: 20%; 50%; 70% Solution.(bb)

Route Of Administration: 2.5 - 11.5% Dextrose solutions are administered via
peripheral veins. 40 - 70% Dextrose solutions are administered via central veins.(bb)

Minimum Dilution: As supplied.

Maximum Rate Of I V Administration:

wTo healthy individuals 0.5 g/kg/hour without producing glucosuria; the maximum rate
should generally not exceed 0.8 g/kg/hour.(bb)

wFor the treatment of hypoglycemia resulting from insulin excess or other causes in
adults and children, the usual dose is 20 - 50 mL of 50% Dextrose administered slowly
(3 mL/minute) IV.(bb)

Standard Rate Of I V Administration: Depends on the patients condition.(bb)




REVISED JANUARY 1995




DIAZEPAM - Valium®
Standard Concentration: 5 mg/mL.(a)

Expiration: When diluted: 24 hours.(s)

Route Of Administration: Deep IM (absorption slow and erratic), direct IV or IV
infusion.(bb)

Minimum Dilution: May be given undiluted or, if necessary, further diluted to 0.1 mg or
less/mL of 0.9% NaCl in glass container.(s)

Maximum Rate Of I V Administration: For direct IV do not exceed 5 mg/minutes;(bb)
5 mg / 3 minutes in children.(bb)


Additional Information
w Valium is not recommended to be admixed in solutions in plastic containers, stored in
polyvinyl chloride bags or administered through plastic administration sets. This may
significantly reduce diazepam concentrations.(hh)

w When given IV, diazepam should be administered directly into a large vein to avoid
thrombosis; if this is not feasible, the drug should be given into tubing of a flowing IV
solution as close as possible to the vein insertion.(bb)

wSome clinicians have suggested IV administration of dilute solutions of the drug to
avoid extravation; however, the drug may precipitate when diluted and the
manufacturers do not recommend this method of administration.(bb)




REVISED JANUARY 1995




DIAZOXIDE - Hyperstat®
Standard Concentration: 15 mg/mL.(a)

Route Of Administration: Direct IV only.(a)

Minimum Dilution: Give undiluted, rapidly over 30 seconds or less into a peripheral
vein via an established IV line; extravascular injection or leakage should be
avoided.(bb)

Maximum Rate Of Administration: 1 to 3 mg/kg up to a maximum of 150 mg in a
single injection. This dose may be repeated at intervals of 5 - 15 minutes until a
satisfactory reduction in blood pressure (diastolic pressure below 100 mm Hg) has been
achieved.(a)


Additional Information

wInjection of diazoxide will darken when exposed to light and should be protected from
light, heat and freezing. Darkened solutions may be subpotent and should not be
used.(a)




revised JANUARY 1995



DIETHYLSTILBESTROL DIPHOSPHATE SODIUM - Stilphostrol ®

Standard Concentration: 50 mg/mL.(a)
Expiration: In piggyback or large volume parenteral: 96 hours at room temperature.(b)

Minimum Dilution: 1 g in 250 mL.(b)

Maximum Rate Of I V Administration: Begin slowly 1 - 2 mL/minute during the first
10 - 15 minutes then adjust the rate so that the entire amount is given in 1 hour.(bb)


Additional Information

wCan be mixed in dextrose or saline.(a)




REVISED JANUARY 1995




DIGOXIN - Lanoxin®

Standard Concentration: 100 mcg/mL pediatric; 250 mcg/mL.(bb)

Expiration: In glass syringe: 3 days.(d)
Route Of Administration: Direct IV or IV infusion.(bb)

Standard Dilution: Diluted 4 - fold or greater volume of sterile water, 5% Dextrose or
0.9% NaCl.(bb)

Minimum Dilution: May be given undiluted or further diluted.(bb)

Maximum Rate Of I V Administration: Undiluted over at least 5 minutes or when
diluted over at least 5 minutes.(bb)


Additional Information

wDo not store in plastic bags.(b)




REVISED JANUARY 1995
DILTIAZEM HCL-CARDIZEM ®

Standard Concentration: 5 mg/mL in vials containing 25 mg/5 mL and 50 mg/10
mL.(a)

Route of Administration: Direct intravenous bolus injection and continuous
intravenous infusion.(a)

Standard Dilution for intravenous Infusion: 100 mg diltiazem HCl in 100 mL D5W
or NS to a final concentration 1 mg/mL.(a)
Rate of Administration:
Direct Intravenous Single Injections (Bolus)
The initial dose should be 0.25 mg/kg actual body weight as a bolus administered over
2 minutes (20 mg is a reasonable dose for the average patient). If response is
inadequate, a second dose may be administered after 15 minutes. The second bolus
dose should be 0.35 mg/kg actual body weight administered over 2 minutes (25 mg is a
reasonable dose for the average patient).

Subsequent intravenous bolus doses should be individualized for each patient. Patients
with low body weights should be dosed on a mg/kg basis. Some patients may respond
to an initial dose of 0.15 mg/kg, although duration of action may be shorter. Experience
with this dose is limited.(a)

Continuous Intravenous Infusion
For continued reduction of the heart rate (up to 24 hours) in patients with atrial
fibrillation or atrial flutter, an intravenous infusion may be administered. Immediately
following bolus administration of 20 mg (0.25 mg/kg) or 25 mg (0.35 mg/kg) and
reduction of heart rate, begin an intravenous infusion. The recommended initial
infusion rate is 10 mg/hour. Some patients may maintain response to an initial rate of
5 mg/hr. The infusion may be increased in 5 mg/hour increments up to 15 mg/hour as
needed, if further reduction in heart rate is required. The infusion may be maintained for
up to 24 hours.(a)
Diltiazem shows dose-dependent, non-linear pharmacokinetics. Duration of infusion
longer than 24 hours and infusion rates greater than 15 mg/hour have not been studied.
Therefore, infusion duration exceeding 24 hours and infusion rates exceeding
15 mg/hour are not recommended.(a)

Expiration
24 hours under refrigeration.(a)

Revised 4/96ild
PI December 1992 Marion Merrell Dow



DIMERCAPROL - BAL®
Concentration: 100 mg/mL.(a)

Route Of Administration: Deep IM injection only.(a)

Minimum Dilution: Give undiluted.(a)




REVISED JANUARY 1995




DIPHENHYDRAMINE HYDROCHLORIDE - Benadryl®
Standard Concentration: 50 mg/mL.(a)

Route Of Administration: Deep IM, slow direct IV or IV infusion.(e)

Expiration: In syringe: 3 days;(d) in piggyback: 24 hours.(c)

Minimum Dilution: May be given undiluted or further diluted with 10 mL 5% Dextrose
or 0.9% NaCl or placed in piggyback.(f)

Standard Dilution: In piggyback: 50 mg in 50 mL.(d)

Maximum Rate Of I V Administration: No greater than 25 mg/minute.(f) Maximum
single dose is 100 mg.(a)

Suggested Rate Of I V Administration: In piggyback: 50 mL over 15-30 minutes.(d)




revised January 1995




DOBUTAMINE HYDROCHLORIDE - Dobutrex®

Standard Concentration: 12.5 mg/mL.(a)
Route Of Administration: IV infusion using an infusion pump or other apparatus to
control the rate of flow.(bb) Must be diluted to final volume of at least 50 mL.(bb)

Expiration: In piggyback or large volume parenteral: 24 hours.(a)

Minimum Dilution: 250 mg / 50 mL (5 mg/mL).(a)
Standard Dilution: 250 mg / 250 mL 5% Dextrose.(d)

Maximum Rate Of I V Administration: 40 mcg/kg/minute on rare occasions.(bb)
Standard Rate Of I V Administration: 2.5 to 10 mcg/kg/minute.(bb)


Additional Information

wSolutions containing Dobutrex solution may exhibit a pink color that will increase with
time. This color change is due to slight oxidation of the drug, but there is no significant
loss of potency during the time period of 24 hours.(a)




revised JANUARY 1995




DOPAMINE HYDROCHLORIDE

Concentration: 40 mg/mL, 80 mg/mL, 160 mg/mL.(a)
Commercially available dopamine injections containing 20,400, or 800 mg in 250 mL of
            5% dextrose injections.(a)

Route Of Administration: IV. Must be diluted before administration.(a)

Expiration: When diluted: 48 hours.(b)

Minimum Dilution: 800 mg / 250 mL (3200 mcg/mL).(a) Standard Dilution: 400 mg /
250 mL 5% Dextrose 1600 mcg/mL.(a)

Maximum Rate Of I V Administration: Usually not in excess of 50 mcg/kg/minute
(but rates greater have been used). Rate and duration should be carefully adjusted
according to the patient's response. Usually begun at a rate of 1 - 5 mcg/kg/minute.
The infusion rate may be increased by 1 - 4 mcg/kg/minute at 10 - 30 minute intervals
until the optimal response is attained.(bb)


Additional Information

wDo not use if darker than slightly yellow or discolored in any other way.(a)

wAntidote for Peripheral Ischemia
To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as
soon as possible with 10 to 15 mL of saline solution containing 5 to 10 mg of Regitine®
(brand of phentolamine), an adrenergic blocking agent. A syringe with a fine
hypodermic needle should be used, and the solution liberally infiltrated throughout the
ischemic area. Sympathetic blockade with phentolamine causes immediate and
conspicuous local hyperemic changes if the area is infiltrated within 12 hours.
Therefore, phentolamine should be given as soon as possible after the
extravasation is noted.(a)




revised: 2/98 ild
(a) package insert : 5/96 American Regent Laboratories, INC.
(b) Trissel's, Lawrence A.; Handbook on Injectable Drugs; 9th Edition
(bb) AHFS 1997: Drug Information

EVISED JANUARY 1995




DOXAPRAM - Dopram®
Standard Concentration: 20 mg/mL.(a)

Route Of Administration: IV injection or IV infusion.(a)

Minimum Dilution: May be given undiluted or diluted 1 mg/mL, 250 mg / 250 mL 5%
or 10% Dextrose or 0.9 % NaCl.(a,bb)

Maximum Rate Of I V Administration:
{ IV Injection: Infuse initially 0.5 - 1 mg/kg.(bb) Single doses should not exceed 1.5
mg/kg. When repeated IV injections are administered, the initial dose may be repeated
at 5 minute intervals, if necessary total dose should not exceed 2 mg/kg.(bb)

{ IV Infusion: Infuse initially at a rate of 5 mg/minute until a satisfactory respiratory
response is observed, and maintained at a rate of 1 - 3 mg/minute.(a) The rate of
infusion should be adjusted to sustain the desired level of respiratory stimulation with a
minimum of side effects.(a) IV infusion dose 0.5 - 4 mg/kg; total dose administered
should not exceed 3 g (4 mg/kg).(bb)




REVISED JANUARY 1995

DOXYCYCLINE HYCLATE - Vibramycin®

Standard Concentration: 10 mg/mL.(a) To a 100 mg vial add 10 mL sterile water, to
a 200 mg vial add 20 mL sterile water, draw out entire contents of vial.(a)
Route Of Administration: Slow IV infusion.(bb)

Expiration: In syringe: 3 days;(d) in piggyback: 3 days under refrigeration,(a,b) 12
hours at room temperature;(b) 6 hours if diluted in Lactate Ringer's or 5 % Dextrose in
Lactate Ringer's;(a,b) in vial: 3 days.(a)

Standard Dilution: 100 mg / 100 mL.(a)

Maximum Rate Of IV Administration: 100 mg of a 0.5 mg/mL (100 mg / 200 mL)
solution over 1 hour or 100 mg of a l mg/mL (100 mg / 100 mL) solution over 2
hours.(a) Suggested rate of iv administration: 100 - 200 mg over 1-4 hours.(a)

Additional Information
Rapid IV administration should be avoided.(a) Parenteral therapy is indicated only
when oral therapy is not indicated.(a) If IV therapy is given over prolonged periods of
time, thrombophlebitis may result.(a) The solution must be protected from direct
sunlight during infusion.(a) IV infusion must be completed within 12 hours to insure
adequate stability.(a) Do not give IM or SQ.(a)

DOXYCYCLINE USAGE FOR INTRAPLEURAL SCLEROSIS to prevent
reaccumulation of pleural exudates which can occur with certain malignancies. (As of
January 1994, this procedure has not been included in the labeling approved by the
FDA)(bb)
Dosage: 500 mg in 30 mL Normal Saline. Dispense in a syringe unless requested
differently by the physician.
Route: Instilled via chest tube, followed by 10 mL normal saline flush.

Lidocaine 1% 20-100 mg (2-10 mL) has been given into clamped chest tube 15 minutes
prior to sclerosis for anesthesia. Chest tube suction is discontinued for about 4 hours
when dose is given. If > 50 mL fluid reaccumulates in 24 hours dose can be repeated.
Most patients require >1 dose.
2-4 doses is usually required.
If lidocaine is added to doxycycline then the dose should be used immediately (no
information on compatibility).
Doxycycline 200-300 mg (mixed 20 mg/mL) has been used for malignant pericardial
effusions.
Updated November 1995; 1994 ASHPDI; ild



DROPERIDOL - Inapsine®

Standard Concentration: 2.5 mg/mL.(a)

Route Of Administration: IM or IV injection.(a) IV infusion should only be used in
high risk patients.(bb)
Expiration: When diluted: 7 days.(g)

Minimum Dilution: May be given undiluted or further diluted with 5% Dextrose or
Lactated Ringer's.(bb)

Maximum Rate Of I V Administration: 10 mg/minute, titrated to patient
response.(nn)




REVISED JANUARY 1995



EDROPHONIUM CHLORIDE - Tensilon®

Standard Concentration: 10 mg/mL.(a)

Route Of Administration: Usually IV, may also give IM or SQ.(bb)

Minimum Dilution: Undiluted(a,bb)
Maximum Rate Of I V Administration: 10 mg IV over 30-45 seconds when used as a
curare antagonist.(a)




REVISED JANUARY 1995




EPINEPHRINE

Standard Concentration: 1 mg/mL;(a) 0.01 mg/mL (pediatric).(a)

Route of Administration: SQ, IM, IV or intracardiac.(bb)

Minimum Dilution: 1 mg / 10 mL premixed syringe.(a)
Standard Dilution: 1 mg / 250 mL 5% Dextrose.(bb)

Maximum Rate Of I V Administration: Depends on the patient's condition and
response.(bb)

Expiration: 48 hours.(ee)


Additional Information

w Withdrawal of doses from multiple-dose vials introduces air into the vials, subjecting
the remaining epinephrine to oxidation. Oxidation of the drug imparts first a pink, then a
brown color; epinephrine preparations must not be used if they have a pinkish or
darker than slightly yellow color or contain a precipitate. In some commercially
available injections, the air has been replaced with nitrogen to avoid oxidation.(bb)




REVISED JANUARY 1995




EPOETIN ALFA - Epogen®, Procrit®

Concentration: 2,000 units; 3,000 units; 4,000 units; 10,000 units / mL single dose
vials. Contains no preservative. Ready to use.

Expiration:

wUse immediately after withdrawal from vial.(b)
wStability in syringe greater than 12 hours has not been established.(b)
wSterility cannot be guaranteed when held for extended periods of time greater than
12 hours in a syringe.(b)
wShould be refrigerated 2 - 80C (36 - 460F) Do Not Freeze. Stable at room
temperature for a period of 24 hours provided it has not been subjected to temperature
extremes of less than 00C (320F) and greater than 320C (850F).(b)

Route Of Administration: Direct IV bolus (no specific rate) or SQ.(a,b) IV line should
be flushed with 0.9% NaCl pre and post Epoetin alfa administration.(a,b) Should not be
diluted prior to use.(a,b)


Additional Information

wDO NOT SHAKE.(a)
wInspect visually for particulate matter and/or discoloration.(b)
wUse only one dose per vial, contains no preservative.(b)
wDo not administer with any other medications.(b)
wWhile Epogen and Procrit and identical products, Procrit should be dispensed to non-
dialysis patients and Epogen should be dispensed to dialysis patients.(d)




revised APRIL 1995


ERYTHROMYCIN LACTOBIONATE - Erythrocin®

Standard Concentration: 50 mg/mL.(a)
To a 500 mg vial add 10 mL; to a 1 g vial add 20 mL sterile water only.(a)

Route Of Administration: Continuous or intermittent IV infusion.(a,bb) IV push is an
unacceptable route of administration due to the irritative properties.(a,bb)

Expiration: In piggyback: 8 hours(a); in vial: 14 days under refrigeration and 24 hours
at room temperature(a); in syringe: 24 hours(a).
Minimum Dilution: 500 mg / 100 mL.(a,bb)

Maximum Rate Of I V Administration: 500 mg / 100 mL over 20-60 minutes.(a,bb)
1g / liter (1 mg/mL) for continuous infusion.(a)
Additional Information

wErythromycin is further diluted in 0.9% NaCl, Lactated Ringer's or Normosal - R.(a,bb)
If further diluted in 5% Dextrose 1 mL of 4% Sodium Bicarbonate must be added first to
100 mL. A pH of at least 5.5 is desirable.(a,bb) Immediately after the diluent is added,
the vial should be shaken well to enhance dissolution; lack of immediate agitation
greatly increases the time required for complete dissolution.(a,bb) Do not reconstitute
with 0.9% NaCl, precipitation will result.(bb)




revised: 10/98 idp
(a) Package Insert, Nov 1996 Abbot;




REVISED APRIL 1995




ESMOLOL HYDROCHLORIDE - Brevibloc®

Standard Concentration: 250 mg/mL or 10 mg/mL.(bb)

Route Of Administration: IV infusion (usually via a controlled infusion device to
facilitate dosage titration).(bb)

Minimum Dilution: 5 g / 500 mL of compatible solution. The final concentration
should be 10 mg/mL.(bb)
Expiration: In IV bag: 24 hours at room temperature.(bb)

Maximum Rate Of I V Administration: Rate and duration of infusion should be
adjusted carefully according to the patient's tolerance and response (heart rate, blood
pressure, respiratory rate, ECG).(bb)


Additional Information

wTo prepare IV, remove 20 mL from 500 mL solution and then add 5 g / 20 mL to
approximately 480 mL. Final concentration should be 10 mg/mL.(a,bb) The use of
butterfly needles and small veins for infusion should be avoided. (a,bb)




REVISED JANUARY 1995




ESTROGEN, CONJUGATED (EQUINE) - Premarin®

Standard Concentration: 5 mg/mL.(a) Reconstitute with the sterile diluent provided to
yield a concentration of 25 mg / 5 mL.(a)

Route Of Administration: For IV or IM use.(a) IV mode of administration is preferred
since more rapid response can be expected.(a)

Expiration: Unreconstituted Premarin is stored under refrigeration. After
reconstitution, the solution should be used within a few hours, however, it may be
stored under refrigeration for 60 days. DO NOT USE if darkening or precipitation of the
solution occurs.(a)

Minimum Dilution: Infusion with other agents is not recommended. However, when
an infusion has already been started it may be expedient to inject the Premarin solution
into the tubing just distal to the infusion needle. If this is done, compatibility of solutions
must be considered. Premarin is compatible with Normal Saline, Dextrose, and Invert
Sugar Solutions. It is not compatible with protein hydrolysate, ascorbic acid or any
solution with an acid pH.(a)

Maximum Rate Of I V Administration: Administer slowly to avoid flushing
reaction.(a)




REVISED JANUARY 1995




ETHACRYNATE SODIUM - Sodium Edecrin®

Standard Concentration: 5 mg/mL.(d) To a 50 mg vial add 10 mL sterile water.(d)

Route Of Administration: Direct IV or through the tubing of a running IV.(e)

Expiration: When diluted to 5 mg/mL: 24 hours (a)

Minimum Dilution: 50 mg / 50 mL.(a)

Maximum Rate Of I V Administration: 50 mg by direct IV over several minutes (3 -
5).(a,bb) IV solution through the tubing of a running IV slowly over 20 - 30 minutes. (bb)
Additional Information

wSingle IV doses should not exceed 100 mg.(bb) Usually one dose is necessary; if a
second dose is needed a new injection site should be selected in order to avoid
possible thrombophlebitis.(bb) If reconstituted with 5% Dextrose having a pH of 5 or
lower, the solution may be hazy or opalescent and should not be used.(a,bb)




REVISED JANUARY 1995




ETIDRONATE DISODIUM - Didronel®

Standard Concentration: 50 mg/mL (300 mg / 6 mL amp).(a,bb)

Route Of Administration: IV infusion only.(bb)

Expiration: Diluted solution at room temperature or under refrigeration 48 hours.(a)

Minimum Dilution: 300 mg / 250 mL 0.9 NaCl.(a,bb)

Maximum Rate Of I V Administration: Over at least 2 hours.(a,bb)


Additional Information
wRegardless of the volume of solution, slow infusion is important.(a) May be diluted in
larger volumes.(a,bb) Usual course of treatment is one infusion of 7.5 mg/kg/day X 3
days; sometimes up to 7 days.(a)

wNo matter what the dose, it must be diluted in 250 mL of 0.9% NaCl.(a,bb)




REVISED JANUARY 1995




FAMOTIDINE - Pepcid®

Standard Concentration: 10 mg/mL(a)

Route Of Administration: Direct IV or IV infusion.(a,bb)

Expiration: in piggyback: 14 days;(a)
      in syringe: 2 days.(a)
              in vial out of refrigeration: 6 months.(c)

Minimum Dilution: 10 mg/mL for direct IV. (d)
                    20 mg diluted in a syringe to 5 ml with D5W or NS and injected
over not more than one minute.(e)
Standard Dilution: in piggyback: 20 mg / 100 mL for IV infusion.(a)

Maximum Rate Of I V Administration:
{ For direct IV: no faster than 10 mg/ml/minute).(a)
{ For IV infusion:, over 15 - 30 minutes.(a)




revised: May 1997; ild
(a) PI, Merck & Co., INC, March 1996
(c) 9th edition; Handbook on Injectable Drugs (ASHP) Lawrence A. Trissell
(d) Pharmacotherapy; Volume 15, Number 1, 1995,p.48-51, Hemodynamic Effects of
Intravenous Famotidine in Critically Ill Patients
(e) Am J Health-Syst Pharm; Vol 52, Sep 1 1995, p.1889-1894; Safety and cost of
rapid i.v. injection of famotidine in critically ill patients
FILGRASTIM - Neupogen, G - CSF®

Standard Concentration: 300 mcg/mL.(a)

Route Of Administration: SQ or IV(a) or continuous 24 hour intravenous or
subcutaneous infusion.(b)

Minimum Dilution: 300 mcg/mL.(a) For IV use: Not less than 15 mcg/mL(b) not less
than 750 mcg/ 50 mL 5% Dextrose.(b)

Rate Of Administration: Dose may be given no faster than 20 - 30 minutes.(b)

Expiration: In syringe: 24 hours at room temperature; 7 days under
refrigeration;(a,bb) in piggyback: 24 hours at room temperature; 7 days under
refrigeration.(a,b)


Additional Information

wRecommended starting dose 5 mcg/kg/day.(a)
{Should be stored in refrigerator.(a) Do not freeze.(a)
wAvoid shaking. If the solution is frothy, allow the vial to sit undisturbed for a few
minutes. This should result in a decrease in froth and bubbles.(a)
{Prior to injection Neupogen may be allowed to reach room temperature for a minimum
of 6 hours. Any vial left at room temperature for greater than 6 hours should be
discarded.(a)
wDo not use in the period 24 hours before to 24 hours after the administration of
cytotoxic chemotherapy.(a)
{Stable only in 5% Dextrose. Do Not Use 0.9% NaCl. Any kind of saline will denature
the drug.(b)
wIV line should be flushed with 5% Dextrose before and after infusing Neupogen IV.(b)
{Should be mixed to final exact total volume of a 15 mcg/mL dilution or greater .(b)
wShould not be sent in pneumatic tube system. Should be hand delivered since the
solution is fragile.(d)
{Be sure to choose the vial volume that minimizes the amount left over for each
dose.(d)
wNeupogen should not be diluted to concentrations less than 2 mcg/mL.(b)
{Vials are for single use.(a,b)

REVISED JANUARY 1995
FLUCONAZOLE - Diflucan®

Standard Concentration: 2 mg/mL.(a)
Supplied: 200 mg/ 100 mL; 400 mg/ 200 mL in glass bottles or Viaflex® Plus plastic
containers in nacl or d5w.(a)

Route Of Administration: Intravenous infusion only.(a)

Maximum Rate Of Administration: Do not exceed 200 mg/hour.(a)

Expiration: Once wrapper removed: 30 days(d); Bags altered: 30 days.(d)




Updated: 11/7/00 idp;
(a) package insert: Pfizer/Roerig june 1998;
(d)VUH Rx policy 11/2000
FOLIC ACID - Folvite®

Standard Concentration: 5 mg/mL.(a)

Route Of Administration: Deep IM, SQ or IV injection/infusion.(bb)

Expiration: In syringe: 3 days;(d) in piggyback: 3 days.(b)

Minimum Dilution: 5 mg/mL for direct IV.(a)
Standard Dilution: In piggyback: 5 mg/ 50 mL.(bb)

Maximum Rate Of I V Administration: 1 mL over 2-3 minutes.(d)
Standard Rate Of Administration: 100 mL over 30 - 60 minutes.(d)




REVISED JANUARY 1995
Fomepizole - Antizol
A synthetic alcohol dehyrogenase inhibitor.(a)

Concentration: 1 gm/mL (each vial contains 1.5 g). (a)

Route of Administration: Slow intravenous infusion.(a)
Should not be given undiluted or by bolus injection.(a) Must be diluted prior to use.(a)
Can cause venous irritation and phlebosclerosis when given undiluted or by bolus
injection.(a)

Rate of Infusion: Administered as a slow intravenous infusion over 30 minutes.(a)

Dilution: Appropriate dose of Antizol should be drawn into at least 100 mL of 0.9%
Normal Saline or 5% Dextrose in Water.(a)

Stability: Stable for at least 48 hours when stored under refrigeration or at room
temperature and diluted in 0.9% sodium chloride injection or dextrose 5% Injection.(a)
After dilution, do not use beyond 24 hours, due to sterile precautions, diluents generally
do not contain preservative.(a)


Additional Information:

Antizol solidifies at temperatures less than 25 degree C (77 degreeF). If the Antizol
solution has become solid in the vial, the solution should be liquefied by running the vial
under warm water or by holding in the hand. Solidification does not affect the efficacy,
safety or stability of Antizol.(a)

Antizol is a clear to yellow liquid at room temperature.(a),




written: 6/98 ild
     (a) Package insert: Dec 1997 ; Orphan Medical Inc., Ben Venue Laboratories.
FOSCARNET - Foscavir®

STANDARD CONCENTRATION: 24 mg/mL.(a)

ROUTE OF ADMINISTRATION: By controlled intravenous infusion; either by using a
central venous line or by using a peripheral vein.(a)
The drug should not be administered by rapid IV infusion or direct IV injection since
potentially toxic plasma foscarnet concentrations may result.(a)

MINIMUM DILUTION: The standard 24 mg/mL solution may be used without dilution
when using a central venous catheter for infusion.
When a peripherel vein catheter is used, the 24 mg/mL solution MUST be diluted to 12
mg/mL with 5% Dextose or with 0.9% Sodium Chloride prior to administration to avoid
local irritation of peripheral veins.(a)

MAXIMUM RATE OF ADMINISTRATION: An infusion pump must be used to control
the rate of infusion.(a)

Induction Treatment (with normal renal function) 60 mg/kg, adjusted for individual
patients renal function, given at a constant rate over a minimum of one hour.(a)

Maintenance Treatment: is individualized. See package insert for further dosing
information.(a)

EXPIRATION: 14 days at room temperature.(b)

Additional Information

wFoscarnet should only be administered with 0.9% NaCl or 5% Dextrose and no other
drugs or supplement should be administered concurrently via the same catheter.(a)

wThe recommended dosage, frequency, or infusion rates should not be exceeded.(a)
All doses must be individualized for patients' renal function.(a)



revised: 2/98; ild
(a) package insert 7/96; Astra Pharmaceutical Products, Inc.
(b) Trissel's, Lawrence A.; Handbook of Injectable Drugs; 9th Edition
FOSPHENYTOIN SODIUM - Cerebyx®

Cerebyx® is a prodrug intended for parenteral administration; its active metabolite is
phenytoin.(a) It is to be used at Vanderbilt for status epilepticus, for prophylaxis of
seizures during neurosurgery, and in the PICU for patients who have suffered vascular
adversities to phenytoin.(d)

Standard Concentration: 75 mg/ml equivalent to 50 mg/ml phenytoin sodium after
administration.(a)

Route Of Administration: IV or IM.(a)

IMPORTANT NOTE:
The dose, concentration in dosing solutions, and infusion rate of IV Cerebyx is
expressed as phenytoin sodium equivalents (PE) to avoid the need to perform
molecular weight-based adjustments when converting between fosphenytoin and
phenytoin sodium doses. Cerebyx should always be prescribed and dispensed in
phenytoin sodium equivalent units (PE). Cerebyx has important differences in
administration from those for parenteral phenytoin sodium.

Dilution: Dilute to a concentration ranging from 1.5 to 25 PE/ml in 5% dextrose or
0.9% saline solution.(a)

Rate Of Administration: No faster than 150 mg PE/min.(a)

Expiration: When mixed in NS or D5W: 8 hours at room temperature;
12 hours under refrigeration.(b)

Additional Information
wCerebyx can be substitution for oral phenytoin sodium therapy at the same total daily
dose. (a)
wShould not be stored at room temperature for more than 48 hours.(a)




written: 5/97 ild;
(a) Pkg.I., july 1996; Parke-Davis;
(b) phone call/letter from Parke-Davis (1-800-223-0432)
(d) e-mail/Phil Johnston, April 15,1997
FUROSEMIDE, USP

Standard Concentration: 10 mg/mL.(a)

Route Of Administration: IM, direct IV or IV infusion.(a)

Expiration: In vial once opened: 30 days(d);
             In syringe: 30 days(d);
             In piggyback: 24 hours.(b)

Minimum Dilution: Undiluted 20 – 80 mg slowly over 1-2 minutes.(a)

Standard Dilution: In piggyback: No more dilute than 100 mg in 500 mL.(b)

Maximum Rate of IV Administration: 10 mg/minute for direct IV; 40 - 80 mg over
1 - 2 minutes.(b) 4 mg/minute for IV infusion.(a)

Standard Rate of IV Administration: In piggyback: 4 mg/minute.(b)


Additional Information

Furosemide is soluble in alkaline solutions and is prepared as a mildly buffered alkaline
product. It should not be mixed with acidic solutions having a
pH below 5.5.(b)




Updated: 11/7/00,idp;
(a) Package Insert 5/97 American Regent Lab.’Inc.
(b) Handbook on Injectable Drugs 10th edition
(d) VUH Rx policy
GANCICLOVIR SODIUM - Cytovene®

Concentration: 50 mg/mL.(a)

Route Of Administration: Intravenous infusion only.(a)
Do not administer by rapid or bolus IV injection (renal toxicity of ganciclovir may be
increased as a result of excessive plasma levels).(a) Severe tissue irritation can occur
(due to high pH = 11) if given IM or SQ.(a)

Reconstitution: Reconstitute 500 mg vial with 10 mL Sterile Water for Injection,U.S.P.

Expiration: Reconstituted solution in vial at a concentration of 50 mg/mL stable for
12 hours at room temperature.(bb) Do not refrigerate since precipitate may form.(bb)
In piggyback at a concentration of 10 mg/mL or less 5 days under refrigeration.(bb)

In syringe: I talked to Roche drug info 11/16/98 (1-800-526-6367) on stability info in a
syringe. They have no stability information on ganciclovir in a syringe. They do not
recommend giving an expiration beyond 12 hours.(idp)

Minimum Dilution: 10 mg or less per mL.(bb)

Standard Dilution: Appropriate dose diluted in 50 - 250 (usually 100) mL 5%
Dextrose or 0.9% NaCl < or = 10 mg/mL.(bb) Use of more concentrated solutions is not
recommended.(bb)

Maximum Rate Of Administration: Infusion (100 mL) over one hour.(a)


Additional Information

wCaution should be exercised in the handling and preparation. The use of latex gloves
and safety glasses is recommended to avoid exposure in case breakage of vial or
accidental spillage. If the solution contacts the skin or mucous membranes, wash
thoroughly with soap and water; rinse eyes thoroughly with plain water.(a) Since
ganciclovir has the potential to cause cancer, avoid exposure by inhalation or by direct
contact of the skin or mucous membranes.(a) Handling and disposal should be
according to guidelines issued for cytotoxic drugs.(a)


revised: 11/98 ild
(a) package insert; 1995 Syntex Laboratories, Inc.
(bb) AHFS 1997; Drug Information
(b) Trissel's, Lawrence; 9th edition; Handbook of Injectable Drugs
GENTAMICIN Injection,USP

Standard Concentration: 10 mg/mL pediatric, 40 mg/mL standard or 2 mg/mL
intrathecal.(a)

Route Of Administration: IM, IV infusion, intrathecally.(a)

Expiration: Vial once opened: 30days,(d)
            In syringe: 30 days;(d)
            In piggyback: 3 days.(b)

Minimum Dilution: A single dose may be diluted in 50-200 mL(a)
Standard Dilution: Same as for minimum dilution.(a)
                   For intrathecal or intraventricular use: 2 mg/mL.

Maximum Rate of IV Administration: Any dose over 30 minutes.(b)
Standard Rate of IV Administration: Any dose over 30 minutes.(b)


Additional Information

*Gentamicin intrathecal concentration: 2 mg/mL; (preservative free) expiration when
drawn up into a syringe: 24 hours because it has no preservative; filter only with 5
micron filter. Withdraw dose into a 3 mL syringe with a 0.1 mL overfill capping the
syringe and labeling the syringe properly.(d)




updated 11/7/00 idp; (a) package insert: APP, january 2000; (b)Trissel’s, Handbook of Injectable drugs
  th
10 Edition, (d)VUH Rx policy 11/2000




GRANISETRON - KYTRIL®

Standard Concentration: 1 mg/ mL in a 1 mL Single-Use Vials.(a)
Route Of Administration: Intravenously.(a)

Expiriation: 7 days when diluted in 0.9% NaCl or 5% Dextrose and stored under
refrigeration and 3 days stored at room temperature.(b)

Dosage and Administration: 10 mcg/kg infused intravenously over
5 minutes, beginning within 30 minutes before initiation of chemotherapy, and only on
the day(s) chemotherapy is given.(a)

Minimum Dilution: Should be diluted in 0.9% NaCl or 5% Dextrose to a total volume
of 20 - 50 mL.(a)

Additional Information:

wPediatric use: Recommended dose in children 2 - 16 years of age is 10 mcg/kg.
Children under 2 years of age have not been studied.(a)

wUse in the Elderly, Renal Failure, or Hepatically Impaired Patients: No dosage
adjustment is recommended.(a)




Revised April 1995
HALOPERIDOL - Haldol®

Standard Concentration: 5 mg/mL.(a)

Route Of Administration: IM or IV.(b)

Minimum Dilution: May be given undiluted.(b)

Maximum Rate Of I V Administration: 10 mg/minute.(b)


Additional Information
w IV route is an "unapproved" route.(b)

Indications for Continuous Infusion of Haloperidol(c)
w More than eight 10 mg haloperidol boluses required in a 24 hr period or >10 mg/hr
for >5 consecutive hrs.(c)

Guidelines for Preparing Haloperidol Infusion(c)
wStandard: 200 mg in 160 mL of D5W (1 mg/mL). Maximum concentration with normal
saline to 0.75 mg/mL or D5W to 3 mg/ml.(c)

Indications and Method To Start or Increase Infusion

wBolus dose of 10 mg, followed by 10 mg/hr initial infusion rate. If agitation persists, can
repeat bolus with 10 mg every 30 minutes accompanied by an increase in infusion rate
by 5 mg/hr. Consider addition of benzodiazepine therapy.

Indications and Methods To Decrease Infusion

wOnce control attained with few or no boluses required for 24 hrs, decrease infusion rate
by half or, if Sedation-Agitation Scale score is </= -2, stop infusion and return to bolus
infusions as required.


revised: 3/96 ild
(a) Package insert:
(b) AHFS DI 1995
(c) Riker,R.; Fraser,G.;Cox,P.: Continuos infusion of haloperidol controls agitation in
critically ill patients. Critical Care Medicine; Vol.22, No.3,March,1994 pg 433-440.
     Williams & Wilkins; Critical Care Medicine; Vol. 22, No. 3; March 1994;pg 433-440
HEPARIN

Standard Concentrations: 1000 units/mL, 5000 units/mL, 10,000 units/mL, 20,000
units/mL.(a,bb)

Route Of Administration: Deep SQ, intermittent IV or IV infusion.(a,bb) Should not be
given IM due to irritation, pain and hematoma at the injection site.(bb)

Expiration: In syringe undiluted: 3 days;(d) in piggyback or large volume parenteral:
48 hours.(w)

Minimum Dilution: May be given undiluted or further diluted with 50-100 mL 5%
Dextrose or 0.9% NaCl.(bb)

Standard Dilution for Infusion: 25,000 units in 500 mL 5% Dextrose.(d)
Standard Dilution For Heparin Flush For Arterial Line: 1000 units / 500 mL 5%
Dextrose or 1000 units / 500 mL 0.9% NaCl.(d)

Maximum Rate Of I V Administration: Initial bolus by rapid IV.(a)
Standard Rate Of Administration: Infusion rate depends on patient's response.(a)


Additional Information

wUnless using heparin 20,000 units/mL or 10,000 units/mL, withdraw an equivalent
amount of solution from the large volume parenteral bag before adding heparin.(d)

wThere is a list of IV administration rates for our standard heparin solution posted at
each nursing station. A copy is also included in this book.(d)

wSlight yellow color does not affect potency.(bb)

wIt is recommended when heparin is added to an IV solution the container be inverted at
least 6 times to insure adequate mixing and prevent pooling of the drug in the
solution.(bb)




REVISED APRIL 1993
HYDRALAZINE HYDROCHLORIDE - Apresoline®

Standard Concentration: 20 mg/mL.(a)

Route Of Administration: IM, direct IV or IV infusion.(bb)

Minimum Dilution: May be given undiluted or further diluted with 20 mL of 5% Dextrose
or 0.9% NaCl.(f)
Standard Dilution: For IV infusion: 40 mg or less in 50 mL.(f)

Maximum Rate Of I V Administration: For IV bolus give slowly 5 mg/minute
over 1 - 2 minutes.(g)
Standard Rate Of I V Administration: For IV infusion, the rate is adjusted according to
the patient response.(f) Usual Dose: 20 - 40 mg repeated as necessary at 4 - 6 hour
intervals.(g)



Additional Information

wDo Not Refrigerate.(g)




REVISED JANUARY 1995




HYDROCORTISONE SODIUM SUCCINATE - Solu-Cortef®

Standard Concentration: 50 mg/mL.(a)
Route of Administration: IM, direct IV or IV infusion.(a)

Expiration:
||STORE ALL DOSES AT ROOM TEMPERATURE ONLY||

xVial in solution = 3 days.(a)

wIn piggyback: In D5W or 0.9% NaCl at a concentration of 1 mg/mL stability = 24 hours;
at concentrations >1 mg/mL to <25 mg/mL stability = unpredictable, 4 to 6 hours;
at concentration 25 mg/mL stability = 3 days.(b)

ˆIn syringe: No stability info available/found per Upjohn, Micromedex.
Recommend mixing dose as above for piggyback.

Minimum Dilution: May be given undiluted for intravenous or intramuscular injection.(a)

Standard Dilution: In piggyback: 100 mg / 100 mL.(a)
For intravenous infusion: 100 mg add to 100 - 1000 mL
       250 mg add to 250 - 1000 mL
       500 mg add to 500 - 1000 mL
      1000 mg add to 1000 mL

For fluid restriction: 100 mg - 3000 mg hydrocortisone / 50 mL of diluent.(a)

Maximum Rate Of I V Administration: 30 seconds (eg, 100 mg) to
10 minutes (eg, 500 mg or more).(a)
In life-threatening shock, (eg, 50 mg/kg initially or 0.5-2 g IV initially direct IV injection
over one to several minutes.(c)

Standard Rate Of I V Administration: In piggyback: 100 mg over 15 minutes.(e)
Direct IV injection: 30 seconds.(a)



revised: 11/98 idp
(a) Package Insert: Sept 1995, Upjohn
(b) Letter from Upjohn, 11/98
(c) AHFS Drug Information®97; p2363


HYDROMORPHONE - Dilaudid ®

Standard Concentration: 1 mg/mL, 2 mg/mL, 3 mg/mL, 4 mg/mL, 10 mg/mL.(a)

Route Of Administration: SQ, IM or direct IV.(bb)
Minimum Dilution: May be given undiluted.(bb)

Maximum Rate Of I V Administration: Inject slowly over a period of 2-3 minutes.
Have equipment for assisted respirations available.(a)




REVISED JANUARY 1995




HYDROXYZINE HYDROCHLORIDE - Vistaril

Standard Concentration: 25 mg/mL, 50 mg/mL.(bb)

Route Of Administration: IM only.(bb) Because severe adverse effects may occur, the
drug must not be administered by SQ, intra-arterial or IV injection.(bb)
REVISED January 1995




IMIPENEM / CILASTATIN SODIUM - Primaxin®

Standard Concentration 250 mg (of imipenem) and 250 mg (of cilastatin) per vial;
or 500 mg (of imipenem) and 500 mg (of cilastatin) per vial.(bb)

Route Of Administration IV infusion.(bb)
Minimum Dilution: 500 mg / 100 mL.(a)

Maximum Rate Of Administration: 250 mg to 500 mg over 20 to 30 minutes.(a,bb) 1
g over 40 - 60 minutes.(a)

Expiration: In piggyback: Reconstituted with 0.9 % NaCl 10 hours at room temperature
or 48 hours under refrigeration.(bb) When reconstituted with 5% Dextrose 4 hours at
room temperature or 24 hours under refrigeration.(bb)


Additional Information

wSuspension is not for direct injection.(a)

wReconstitute vials with solution to be used (e.g., 5 % Dextrose or 0.9 % NaCl).(d) Add
approximately 10 mL from the appropriate infusion solution to the vial. Shake well and
transfer the resulting suspension to the infusion solution. Repeat with an additional 10
mL of infusion solution to ensure complete transfer of vial contents to the infusion
solution. The resulting mixture should be agitated until clear.(a)

wDosage of imipenem / cilastatin is generally expressed in terms of the imipenem
content of the fixed combination.(bb)




Revised January 1995




IMMUNE GLOBULIN INTRAVENOUS (Human) - IGIV -
(Lyophilized Preparation)
Standard Concentration: Package sizes:
w Supplied as kits containing lyophilized preparation, and one double ended spike for
reconstitution. Sterile Water is the preferred diluent for IVIG.(a)
w 3 package sizes: 1 g Sandoglobulin and 33 mL reconstitution fluid
3 g Sandoglobulin and 100 mL reconstitution fluid
6 g Sandoglobulin and 200 mL reconstitution fluid.(a)
Expiration: 24 hours.(a)
Route Of Administration: Intravenous use only.(a)
Rate Of Administration: The first infusion of Immune Globulin Intravenous (Human)
Sandoglobulin, in previously untreated patients must be given as a 3% immunoglobulin
solution (use the total volume of fluid provided, or see table below to reconstitute the
lypholized product.)

              REQUIRED DILUENT VOLUME
               1 g 3 g 6 g 12 g
              Concentration Vial Vial Vial Vial
              3% 33 mL100 mL 200 mL****
              6% 16.6 mL 50 mL100 mL200 mL
              9% 11 mL 33 mL 66 mL132 mL
                    12% 8.3 mL 25 mL 50 mL100 mL
       (****Container not large enough to permit this concentration)

Initial Infusion: Start at 15 - 30 mL/hour for 30 minutes; if no reaction, increase rate to
45 - 75 mL/hour as tolerated.(a)
Subsequent Infusions: If no prior reaction, may administer at 60 - 90 mL/hour for 30
minutes, increasing to 180 mL/hour if tolerated.(a) There exists a small possibility of an
adverse reaction even if no reaction occurred with an initial infusion. If a prior reaction
has been documented, then use rates noted in initial infusion criteria listed above.(a) It is
important that IVIG be infused at the correct rate (as most adverse reactions are a result
of exceeding the recomended infusion time).


All doses must be sent to the floor with rate instructions on the bottle. A free form
label has been saved under the mnemonic "SANDO RATE" to assist in this.
******************************************************
******INFUSE @ 0.5 - 1 ML/ML X 30 min (30-60 ML/HR)***** **THEN GRADUALLY
INCREASE RATE TO 1.5-3 ML/MIN** *******AS TOLERATED BY PATIENT (90-180
ML/HR)******
******************************************************




IVIG
Additional Information

wNormally dissolves within a few minutes, though in exceptional cases it may take up to
20 minutes. DO NOT SHAKE! Excessive shaking will cause foaming. Any
undissolved particles should respond to careful rotation of the bottle. Avoid foaming.
Parenteral drug products should be inspected visually for particulate matter and
discoloration prior to administration, whenever solution container permit.
Filtering is acceptable but not required. Pore sizes of 15 microns or larger will be
required. Pore sizes of 15 microns or larger will be less likely to slow infusion, especially
with hicher concentrations. Antibacterial filters (0.2 microns) may be used.(a)
Speeding dissolution by warming the diluent beyond 98 0F should be avoided because
high temperatures may cause harmful denaturation of valuable proteins.(b) A slight
amount of foam is normal after reconstitution.(b)
wPartially used vials should be discarded.(a)
wProceed with infusion only if solution is clear and at approximately room
temperature.(a)
wIf several vials are to be pooled, a glass container should be used.(b)
wTo decrease foaming of the solution when transferring use: Large bore needles, low
vacuum containers and direct the solution stream toward the side of the tilted glass.(b)
wThe apparent volumetric increment imposed by the lyophilized powder is 2 mL/g of
dissolved protein.(b)
wThe package directions to "begin administration promptly" are directed at maintenance
of product sterility rather than stability. For this reason the storing and redistribution of
unadministered portions cannot be recommended.(b)
wAdverse reactions that generally occur become apparent only 30 minutes to one hour
after the beginning of the infusion, these are: Flushing of the face, feelings of tightness
in the chest, chills, fever, dizziness, nausea, diaphoresis and hypotension. In such
cases the infusion should be temporarily stopped until the symptoms have subsided.(a)
If a reaction occurs, first instruct the nurse to slow the rate down. If the reaction
continues, the dose should be stopped and the patient's physician notified.
Hydrocortisone 50-100 mg IV prior to Sandoglobulin has been very effective in
preventing adverse reactions (such as chills, fever, facial flushing, tightness in the chest,
dizziness, headache, diaphoresis, nausea, and hypotention).(d)


page 2 of IMMUNE GLOBULIN INTRAVEOUS (HUMAN)-IGIV-Sandoglobulin (Sandoz
brand)
revised April 1995




INDOMETHACIN SODIUM TRIHYDRATE - Indocin®

Standard Concentration: 1 mg/mL.(a) To a 1 mg vial add 1 mL of preservative free
sterile water or normal saline. (bb)

Expiration: Contains no preservatives, therefore, should be used immediately after
reconstitution.(bb)
Minimum Dilution: 0.1 mg / 0.1 mL.(bb) Further dilution is not recommended as
Indocin does not have a buffer and further dilution may result in precipitation.(a)

Maximum Rate Of I V Administration: Total dose may be injected over 5 to 10
seconds.(bb)


Additional Information

wCare should be taken to avoid extravasation of the drug since it may be irritating to
extravascular tissues.(bb)




REVISED JANUARY 1995



INSULIN, HUMAN - Regular Only

Standard Concentration: 100 unit/mL.(a)

Route Of Administration: SQ, direct IV, IM or IV infusion.(bb)

Expiration: When diluted: 24 hours; in vial, at room temperature: 24 months.(bb)
Minimum Dilution: May be given undiluted or further diluted with 5% Dextrose or 0.9%
NaCl.(bb)

Standard Dilution: 100 units / 100 mL 0.9% NaCl;(d) To be routinely mixed in viaflex
bags.(d)

Maximum Rate Of I V Administration: Depends on patient condition and
response.(bb)


Additional Information

wDo not use unless clear and colorless;(g) some loss of drug occurs due to absorbance
to plastics and glass containers and tubing.(a) Changes in purity, strength, brand, type
and/or species source or method of manufacture may necessitate a change in
dosage.(bb)




REVISED JANUARY 1995




INTRALIPID

Standard Concentration: 10% (1.l cal/mL) or 20% (2 cal/mL) in 50 mL, 100 mL, 250
mL, 500 mL.(a,bb)

Expiration: 24 hours after spiking.(a)

Maximum Rate Of I V Administration:
{ For 10 % Solution in Adults: initial rate 1 mL/minute for the first 15 - 30 minutes, if no
reactions occur, increase rate to 2 mL/minute.(a) Not more than 500 mL of Intralipid
10% should be infused on the first day of therapy. If no reactions, the rate can be
increased on the second day. The daily dosage should not exceed 2.5 g of fat/kg (75
mL of Intralipid 10%/kg).(a)

{ For 20% Solution In Adults: Initial rate 0.5 mL/minute for the first 15 - 30 minutes, if
no reactions occur, the infusion rate can be increased to 1 mL/minute. Not more than
500 mL of Intralipid 20% should be infused on the first day of therapy. If no reactions,
the dose can be increased on the following day. Daily dosage should not exceed 2.5
g/kg (12.5 mL of Intralipid 20%/kg).(a)

Standard Rate Of I V Administration: Follow guidelines for maximum rate of i v
administration.


Additional Information

wDo not filter (a)

wDo not add any medications to the solution.(a)

wUsed in combination with amino acid and dextrose solutions during parenteral nutrition.
Dosage, route of administration (peripheral or central IV) and concomitant infusion of
protein and other nonprotein calories depend on various factors including nutritional and
metabolic status of the patient, anticipated duration of parenteral nutritional support and
tolerance of veins.(bb)

wDo not use any bottle in which there appears to be an oiling out on the surface of the
emulsion.(a)



REVISED JANUARY 1995



Immune Globulin Intravenous (Human) Polygam S/D
                                 SOLVENT/DETERGENT TREATED

Description: Immune Globulin Intravenous (Human) [IGIV], Polygam S/D, is a
solvent/detergent treated, sterile, freeze-dried preparation of highly purified
immunoglobulin G (IgG) derived from large pools of human plasma.(a)

HOW SUPPLIED: Immune Globulin Intravenous (Human), Polygam S/D, is supplied in
2.5 g, 5 g or 10 g single use bottles. Each bottle of Immune Globulin Intravenous
(Human), Polygam S/D, is furnished with a suitable volume of Sterile Water for Injection
USP, a transfer device and an administration set which contains an integral airway and a
15 micron filter.(a)

Required Diluent Volume:
For a 5% Concentration: To a 2.5g bottle add 50 mL
  To a 5g bottle add 96 mL
  To a 10g bottle add 192 mL

For a 10% Concentration: To a 2.5g bottle add 25 mL
        To a 5g bottle add 48 mL
  To a 10g bottle add 96 mL

To prepare a 10% (100mg/mL) solution for infusion, half the volume of the diluent should
be added. In this case, the stabilizing agents and other components will be double the
concentrations for the 5% solution.(a)

Reconstitution Procedures:
ˆReconstitute immediately before use.
ˆUse only Sterile Water for Injection, USP (diluent) (either that comes with the product or
use the set up pump in the .(a) Tap the vial containing the powder lightly to loosen the
powder from the sides of the vial.(b)
‰Thoroughly wet the dried material by tilting or inverting and gently rotating the bottle.
DO NOT SHAKE. AVOID FOAMING. Repeat gentle rotation as long as undissolved
product is observed.

Rate of Administration:
ˆIt is recommended that initially a 5% solution be infused at a rate of 0.5 mL/kg/hr. If
infusion at this rate and concentration causes the patient no distress, the administration
rate may be gradually increased to a maximum rate of 4mL/kg/hr. Patients who tolerate
the 5% concentration at 4 mL/kg/hr can be infused with the 10% concentration starting at
0.5 mL/kg/hr. If no adverse effects occur, the rate can be increased gradually up to a
maximum of 8 mL/kg/hr.(a)
page 1of 2
‰It is recommended that antecubital veins be used especially for 10% solutions, if
possible. This may reduce the likelihood of the patient experiencing discomfort at the
infusion site.(a)

‰A rate of administration which is too rapid may cause flushing and changes in pulse
rate and blood pressure. Slowing or stopping the infusion usually allows the symptoms
to disappear promptly.(a)

‰Follow directions for use which accompany the administration set provided. If another
administration set is used ensure that the set contains a similar filter.(a)
Do not send the administion set that comes with Polygam S/D product since it will not fit
on our pumps.(d) Send a mannitol filter (5 micron) filter with each bottle, to be attached
at the end of the administration set used by the nurse.(d)

EXPIRATION: Administration should begin not more than 2 hours after reconstitution
(for sterility reasons).(a) But is stable for 24 hours.(b)
The reconstituted material should be at room temperature (or will reach room
temperature thru the tubing while being infused) during administration.(a)


page 2 of 2




written: 7/96 ild;
Pkg Insert: 2/95; manuf:Baxter Healthcare Co.; distrib:American Red Cross




  IRON DEXTRAN - Imferon

              1.Standard Concentration: 50 mg/mL elemental iron.(a)

              2.Route Of Administration: IV, deep IM.(bb)

              3.Expiration: When diluted: 24 hours.(g)

              4.Minimum Dilution: Undiluted 2 mL or less per dose.(a)
             5.Maximum Rate Of I V Administration: 1 mL/minute (2 mL or less per
             dose) one hour after giving a test dose of 0.5 mL (a)


Additional Information

             Although the manufacturers do not recommend dilution of iron dextran
             injection or administration of the drug in single IV doses larger than 100
             mg, numerous reports have been made in which the total dose of iron
             dextran was administered as a single dose either by direct IV
             administration or as an IV infusion. The manufacturers caution that large
             IV doses, such as those used in total - dose infusions, may be associated
             with an increased frequency of adverse effects, especially delayed
             reactions (e.g., arthralgia, myalgia, fever).(bb) In the total - dose infusion
             technique, the total calculated dose of iron dextran is diluted in 250 - 1000
             mL of 0.9% NaCl. The use of 5% Dextrose has been reported to be
             associated with a higher incidence of local pain and phlebitis. A test dose
             of 25 mg of iron should be administered slowly over 5 minutes. If no
             reaction occurs, the remainder of the dose may be infused (e.g. over 1 - 6
             hours); after the infusion is completed, the vein is often flushed with 0.9%
             NaCl.(bb)




REVISED JANUARY 1995



ISOPROTERENOL HYDROCHLORIDE - Isuprel ®

Standard Concentration: 0.2 mg/mL (1:5000); 0.02 mg/mL (1:50,000).(a)

Route Of Administration: IV, IM, SQ, IV infusion or in extreme cases, intracardiac.(bb)

Expiration: When diluted: 24 hours.(bb)

Minimum Dilution For IV Push: 0.2/10 mL (bb), maximum recommended IV push dose
is 0.1 mg.(g) Minimum Dilution for IV Drip: 4 mg / 250 mL.(q)
Standard Dilution for IV Drip: 1 mg / 250 mL of 5% Dextrose (d) or 1 mg / 50 mL
syringe 5% Dextrose.(e)

Maximum Rate Of I V Administration: 0.02-0.06 mg over 1 - 3 minutes.(g) Standard
Rate Of I V Administration: Must be titrated to the patients response but usually 2-4
mcg/minute, should be kept under 10 mcg/minutes.(q)


Additional Information

wDiscard if pinkish to brownish in color or contains a precipitate.(a)




REVISED JANUARY 1995




Ketorolac Tromenthamine - Toradol®

Concentration supplied by manufacturer: 15 mg/mL and 30 mg/mL.(a)

Route of Administration: IV or IM.(a)

Administration:
| IV bolus must be given over no less than 15 seconds.(a)

| IM should be given slowly and deeply into the muscle.(a)
Additional Information

wContraindicated for intrathecal or epidural administration due to its alcohol content
contains 10% w/v alcohol / mL.

wSterile solutions are clear and slightly yellow in color.

wIndicated for short-term up to 5 days management.

written 2/96; ild;
(a) Pkg insert: Syntex, 3/95.




LABETALOL HYDROCHLORIDE - Normodyne®; Trandate®

Standard Concentration: 5 mg/mL; 200 mg / 40 mL.(a)

Route Of Administration: IV injection or slow continuous infusion.(a)

Expiration: When diluted: 24 hours at room temperature or under refrigeration.(a)

Minimum Dilution: May be given undiluted.(a)
Standard Dilution for Continuous Infusion: 200 mg / 250 mL 5% Dextrose.
(Concentration 0.8 mg / 1 mL).(d)
Maximum Rate Of I V Administration: 20 mg over 2 minutes;(a)
Standard Rate Of I V Administration: Diluted solution 200 mg / 250 mL
(approximately 2 mg / 2 mL) should be infused to deliver 2 mg/minute.(a)
 A standard dilution infused at 3 mL/minute delivers approximate 2 mg/minute. (a)




REVISED JANUARY 1995
LEVOFLOXACIN - Levaquin®

Supplied as
wSINGLE-USE VIALS: 25 mg/mL, total of 500 mg / 20 mL / vial.(a)
wPREMIX IN FLEXIBLE CONTAINERS: Each bag contains a dilute solution of 5 mg/mL
with the equivalent of 250 mg / 50 mL or 500 mg / 100 mL of levofloxacin
in 5% Dextrose (D5W).(a)


Rate Of Administration
Should only be administered by slow intravenous infusion over a period of 60
minutes.(a)

CAUTION: RAPID OR BOLUS INTRAVENOUS INFUSION MUST BE AVOIDED.
A rapid or bolus intravenous injection may result in hypotension.
Intramuscular, intrathecal, intraperitoneal or subcutaneous administration IS NOT
recommended.(a)

Expiration: Once the overwrap is removed from the bag:
w50 mL bags should not be stored longer than 14 days;(b)
w100 mL bags should not be stored longer than 28 days.(b)

Additional Information
wLevofloxacin has the potential to form stable coordination compounds with many metal
ions. This in vitro chelation potential has the following formation order:
Al+3 > Cu+2 > Zn+2 > Mg+2 > Ca+2.(a)

wThe appearance of levaquin may range from a clear yellow to a greenish-yellow
solution. This does not adversely affect product potency.(a)

The flexible container is fabricated from a specially formulated non-plasticized,
thermoplastic copolyester (CR3). The amount of water that can permeate from the
container into the overwratp is insufficient to affect the solution significantly. Solutions in
contact with the flexible container can leach out certain of the container's chemical
components in very small amounts within the expiration period. The suitability of the
container material has been confirmed by tests in animals according to USP biological
tests for plastic containers.



written: 5/97; ild; updated: 9/98 idp
(a) PI, Ortho/McNeil Pharmaceutical December 1996
(b) Letter from Ortho-McNeil; 9/98
LEVOTHYROXINE SODIUM - Synthroid®

Standard Concentration: 100 mcg/mL.(bb) To 200 mcg add 2 mL of 0.9% NaCl. To
500 mcg add 5 mL of 0.9% NaCl.(a)

Expiration: Use immediately after reconstitution.(a)

Route Of Administration: IV.(a)

Maximum Rate Of I V Administration: Any dose over 1 minute.(a)


Additional Information

wDo not add to other IV fluids.(a)




REVISED JANUARY 1995




LIDOCAINE HYDROCHLORIDE - Xylocaine®
Standard Concentration: 20 mg/mL (5 mL syringe, 2% solution). Premixed bags of 8
mg/mL.(250 mL bags).(a)

Route Of Administration: Direct IV, IV infusion or IM.(bb)

Expiration: When diluted: In IV: 24 hours in 5% Dextrose;(bb,f) in syringe: 3 days.(g)

Minimum Dilution: May give the 2% solution undiluted or further dilute with 5%
Dextrose.(g)
Standard Dilution: 2 g / 250 mL 5% Dextrose.(d)

Maximum Rate Of Administration: For direct IV: 25 to 50 mg/minute and not more
than 200 to 300 mg in 1 hour.(bb) For continuous infusion,the rate is 20 to 50
mcg/kg/minute.(1 - 4 mg/minute in a 70 kg adult).(bb) When administering by
continuous intravenous infusion, it is advisable to use a precision volume control IV
set.(a)




REVISED JANUARY 1995


LORAZEPAM - Ativan®

Standard Concentration: 2 mg/mL or 4 mg/mL.(a)
Route Of Administration: IM or IV.(a)

Minimum Dilution: May be given undiluted for IM use. If given IV, the dose should be
diluted with an equal volume of compatible solution, such as sterile water for injection,
0.9% NaCl or 5% Dextrose.(bb)

Maximum Rate Of IV Administration: 2 mg/minute.(a)

Expiration: The current approved direction circular indicates that Ativan be stored
under refrigeration. Wyeth-Ayerst laboratories has demonstrated acceptable physical
and chemical stability data when Ativan Injection has been stored for two months at
room temperature. It should be noted that if the product is stored in this manner and
not used within the two month period, any unused product should be destroyed. Prior
to administration, the product should be visually inspected for discoloration and/or
particulate matter.(b)


Additional Information

To dilute a pre-filled syringe (Tubex) containing Lorazepam injection:

x Extrude the entire amount of air in the half-filled tubex.

x Slowly aspirate the desired volume of diluent.

x Pull back slightly on the plunger to provide additional mixing space.

x Immediately mix contents thoroughly by gently inverting tubex repeatedly until a
homogenous solution results. The syringe should not be shaken vigorously since this
will cause air entrapment.(a,bb) Alternatively, a dilution for IV administration may be
prepared by withdrawing the desired dose from a vial of lorazepam injection into an
empty syringe, and then following the procedure for mixing described for the pre-filled
syringe.(bb) Following dilution of the drug, Lorazepam may be injected directly into a
vein or into the tubing of a free-flowing compatible IV infusion (e.g., 0.9% NaCl, 5%
Dextrose) at a rate not exceeding 2 mg/minute.(bb)




Lorazepam

page 1 of 2
Lorazepam usage as a continuous intravenous infusion:
{Has been used as a continuous intravenous infusion for sedation.(b)
{The use of lorazepam for purposes other than the approved indication is not
recommended and is considered investigational.(b)
Dosage:
wLoading dose: 2 mg iv push.(b)
wContinuous infusion: Lorazepam 20 or 40 mg in 250 mL D5W or NS at a rate
of 1 mg/hr.
Infusion rate is adjusted to achieve and maintain adequate sedation at the lowest
effective dose.(b)

Dilution: Diluted with NS or D5W using the 2 mg/mL or 4 mg/mL vials to
concentrations of 0.1 mg/mL; 0.16 mg/mL; 0.2 mg/mL.(b)

Expiration: The solubility of diluted lorazepam is a function of lorazepam's aqueous
solubility plus the amount of propylene glycol in the admixture. Therefore, lorazepam's
solubility is not linear.(b)
Stored at room temperature and room light.(b)
**Precipitates forming at concentrations ranging from 0.1 mg/mL to 0.2 mg/mL have
been observed in the container or in the tubing. Further analysis (by Wyeth-Ayerst) is
necessary before an explanation can be rendered as to why lorazepam dilutions
occasionallyprecipitate.(b)**

Using the 2 mg/mL lorezepam formulation to a final concentration of:

0.1 mg/mL: Stable for 12 hrs in plastic (pvc); 24 hrs in glass.(b)
0.16 mg/mL: Stable for 12 hrs in plastic (pvc); 24 hrs in glass.(b)
0.2 mg/mL: Stable for 12 hrs in plastic (pvc); (not tested in glass).(b)

Using the 4 mg/mL lorezepam formulation to a final concentration of:
0.1 mg/mL: Stable for 12 hrs in plastic (pvc); 24 hrs in glass.(b)
0.16 mg/mL: Stable for 12 hrs in plastic (pvc); 24 hrs in glass.(b)
0.2 mg/mL: Stable for 12 hrs in plastic (pvc); 24 hrs in glass.(b)
***Pre-diluting Ativan with an equal volume of diluent prior to admixing or the
temperature of the Ativan prior to mixing did not make a difference in the admixture
stability.(b)***

Page 2 of 2
revised: September 1995 ildPI: from Sanofi Winthrop Pharmaceuticals, February
1994; letter from Wyeth-Ayerst January 1995

MAGNESIUM SULFATE

Standard Concentration: 1 g / 2 mL of 50% concentration. 1 g = 8.1 mEq of
magnesium.(bb)
Route Of Administration: Direct IV, IV infusion or IM.(bb)

Expiration: In syringe: 3 days;(a) in piggyback: 3 days;(d) in vial: Discard after 24
hours of initial use.(a)

Minimum Dilution: 20% solution (200 mg/mL) for eclampsia.(a)

Standard Dilution: 100 mg/mL.

Standard Dilution: In piggyback or large volume parenteral: 5 g / 250 mL 5%
Dextrose.(a)

Maximum Rate Of I V Administration: 100 mg/mL at l50 mg/minute.(a) In severe
pre-eclampsia or eclampsia 40 mL of a 10% solution or 20 mL of a 20% solution over
3 - 4 minutes.(a)

Standard Rate Of I V Administration: l.5 mL of a 10% solution over 1 minute
(l50 mg/min).(a) 5 g (40 mEq) added to 1000 mL 5% Dextrose or 0.9% NaCl for slow
IV infusion over 3 hours.(a)




Revised JANUARY 1995

MANNITOL

Standard Concentration: 12.5 g in 50 mL vial or 20% solution in 250 mL or
500 mL bags.(a)

Route Of Administration: IV infusion.(a,bb)
Expiration: In piggyback: 24 hours.(d)

Minimum Dilution: 20% solution to avoid crystallization.(a)

Standard Dilution: In piggyback or large volume parenteral: 12.5 g in 100 mL.(d)

Maximum Rate Of I V Administration: A test dose of 75 mL of a 20% solution or
100 mL of a 15% solution for patients with marked oliguria or those believed to have
inadequate renal function over 3 - 5 minutes to produce a urine flow of at least
30 - 50 mL/hour.(a)

Standard Rate Of I V Administration: Governed by the nature and severity of the
condition being treated, fluid requirement and urinary output.(a)
Rate Of Administration is usually adjusted to maintain a urine flow of at least
30 - 50 mL/hour.(a)


Additional Information

Mannitol should be filtered through a particulate matter filter. 5 micron conical filters
should be sent with every mannitol dose.(d) Filter should be used for infusions of
injections containing 15% or more, since mannitol crystals may be present.(bb)

   Mannitol is not drawn up in a syringe due to crystal formation.(d)

   Solutions in concentrations of 15% and more, mannitol may crystallize when
    exposed to low temperature. If crystallization occurs, the mannitol solution should
    be autoclaved or warmed by immersing the container in hot water (approximately
    600C) and periodically shaking vigorously. The solution should be cooled to body
    temperature before administration.(bb)




REVISED JANUARY 1995
MEPERIDINE HYDROCHLORIDE - Demerol®

Standard Concentration: 25, 50, 75 and 100 mg/mL.(a)

Route Of Administration: IM, SQ, slow IV injection or slow continuous IV infusion.(bb)

Minimum Dilution: For direct IV: 10 mg/mL; for IV infusion dilute to 1 mg/mL.(bb)
Maximum Rate Of I V Administration: 25 mg/min.(d)

Standard Rate Of I V Administration: Titrate to patient's needs.(d)




REVISED JANUARY 1995




Meropenam – Merrem®

Standard Concentration: 50 mg/mL.(a)

Route of Administration: Intravenous bolus administration or intravenous infusion
administration.(a)
Rate of Administration: Infuse intravenous bolus injection (5-20 mL) over
approximately 3-5 minutes and intraveous infusion over approximately 15-30
minutes.(a)

Preparation and dilution:
Constitute Injection vials (500 mg and 1 g) with sterile Water for Injection.
Shae to dissolve and let stand until clear. To a 500 mg vial add 10 mL and to a 1 g vial
add 20 mL for a final concentration of 50 mg/mL.(a)
METHICILLIN SODIUM - Staphcillin®

Standard Concentration: 100 mg/mL. To a 1 g vial add 9.5 mL sterile water.(d)

Route Of Administration: IM, slow IV injection or infusion.(bb)

Expiration: In syringe: 7 days;(a) in piggyback: 7 days under refrigeration;(a) in vial:
             7 days.(a)

Minimum Dilution: 1 g / 50 mL.(a)

Maximum Rate Of I V Administration: 10 mL/minute (50 mL / 5 min).(a) Standard
Rate Of I V Administration: In piggyback: 50 mL over 20 - 30 minutes.(bb)




REVISED JANUARY 1995



METHOCARBAMOL - Robaxin®
Standard Concentration: 100 mg/mL.(bb)

Route Of Administration: IM, IV injection, IV infusion.(a) Do not give SQ.(bb)

Expiration: In syringe:     ; in piggyback: 6 days at room temperature.(bb)

Minimum Dilution: 1 g in no more than 250 mL 5% Dextrose or 0.9% NaCl.(a) May
           give undiluted.

Maximum rate of IV infusion: Undiluted 300 mg / 3 mL/min.(bb)




Additional Information

   IV infusion solutions should not be refrigerated since precipitation and haze
    formation may occur.(bb)




REVISED JANUARY 1995

METHOXAMINE - Vasoxyl®

Standard Concentration: 20 mg/mL.(a)
Route Of Administration: IM, IV injection, IV infusion.(a) IV infusion not currently
included in the labeling approved by FDA.(bb)

Minimum Dilution: 20 mg/mL.(a)

Standard Rate Of I V Administration: 3 - 5 mg injected slowly.(a)


Additional Information

   Blood pressure should be checked frequently during IV infusion.




REVISED JANUARY 1995


METHYDOPA - Aldomet®

Standard Concentration: 50 mg/mL.(a)

Route Of Administration: IV infusion.(bb) IM or SQ not recommended because of
unpredictable absorption.(bb)
Expiration: In piggyback: 24 hours.(bb)

Minimum Dilution: 500 mg / 50 mL.(bb)
Standard Dilution: In piggyback: 500 mg / 100 mL.(bb)

Maximum Rate Of I V Administration: 500 mg / 50 mL slowly over 30-60
minutes.(bb)

Additional Information

   Exposure to air may accelerate decomposition.(bb)




REVISED JANUARY 1995

METHYLERGONOVINE MALEATE - Methergine®

Standard Concentration: 0.2 mg/mL.(a)

Route Of Administration: IM or IV injection.(bb)

Minimum Dilution: May be given undiluted or further diluted with
5 mL 0.9% NaCl.(bb)
Maximum Rate Of I V Administration: Usual dose of 200 mcg (0.2 mg) IV over not
less than 1 minute.(bb)


Additional Information

   Discard any discolored solution.(bb)




REVISED JANUARY 1995




METHYLPREDNISOLONE SODIUM SUCCINATE - Solu-Medrol®

Standard Concentration: 40 mg/mL.(a)

Route Of Administration: IM, IV injection or IV infusion.(bb)

Expiration: In vial: 48 hours(a); in syringe: 24 hours(b); in piggyback: 24 hours.(b)
STORE ALL DOSES AT ROOM TEMPERATURE.
Minimum Dilution: May be given undiluted or further diluted with 5% Dextrose or 0.9%
NaCl.(a)

Standard Dilution: 2 g / 50 mL.(b)

Reconstitution: Methylprednisolone sodium succinate (expressed in terms of
methylprednisolone) is so extremely soluble in water that it may be administered in a
small volume of diluent and is especially well suited for intravenous use in situations in
which high blood levels of methylprednisolone are required rapidly.(a)
IMPORTANT-- Use only the accompanying diluent or Bacteriostatic Water for Injection
with Benzyl Alcohol when reconstituting SOLU-MEDROL
40 mg Act-O-Vial® -- each mL contains 40 mg;
125 mg Act-O-Vial® System -- each 2 mL (when mixed) contains 125 mg;
500 mg Vial -- each 8 mL (when mixed as directed) contains 500 mg (62.5 mg/mL);
500 mg Act-O-Vial System (Single-Dose Vial)--each 4 mL (when mixed) contains500mg
1 g Vial -- each 16 mL (when mixed as directed) contains 1 g.
1 g Act-O-Vial System (Single-Dose Vial)-- each 8 mL (when mixed) contains 1 g.
2g Vial -- each 30.6 mL (when mixed as directed) contains 2 g.
2 g Vial with Diluent -- each 30.6 mL (when mixed as directed) contains 2g.

Maximum Rate Of I V Administration: Direct IV injection administer dose over a
period of at least 1 minute or over several minutes.(c) High-dose therapy is given IV
over at least 30 minutes.(c)
Standard Rate Of I V Administration: 50 mL over 30-60 minutes.(b)
Additional Information
 When used to treat motor and/or sensory deficits and potentially minimize disability
   in patients with acute spinal cord injury, an initial dose of 30 mg/kg of the
   methylprednisolone given by rapid IV injection over 15 minutes, followed in 45
   minutes by IV infusion of 5.4 mg/kg/hour for 23 hours (total dose administered over
   24 hours), has been recommended.(c)

   Haze formation in solutions of methylprednisolone sodium succinate in intravenous
    fluids is caused by hydrolysis of the ester to free methylprednisolone. The time it
    takes for ehis haze to appear in solutions is quite variable, however, even among
    solutions of the same concentration. Turbidity was substantially higher in D5W than
    in 0.9% NaCl.(b)
revised November 1998,idp
(a) Package Insert February 1997, Upjohn
(b) (b) Letter from Upjohn, Nov 1998
(c)AHFS Drug Information® 97, p.2365
(d) AHFS Handbook on Injectable Drugs; 10th Edition
METOCLOPRAMIDE Injection,USP - Reglan®

Standard Concentration: 5 mg/mL.(a)

Route Of Administration: IM, IV injection or IV infusion.(a)

Expiration: Vial once opened: 30 days.(d)
            In syringe: 30 days.(d)
            In piggyback: 48 hours.(a)

Minimum Dilution: 10 mg / 2 mL (a)
Standard Dilution: In piggyback: Any amount in 50 mL.(a)

Maximum Rate of IV Administration: 10 mg undiluted slowly over 1 - 2 minutes.(a)

Standard Rate of IV Administration: Doses greater than 10 mg should be diluted in
50 mL over 15 minutes.(a)


Additional Information

   Reglan may be mixed with Benadryl in the same bag if high dose Reglan is being
    given. The Benadryl counteracts the extrapyramidal side effects of Reglan and
    Benadryl are physically compatible for up to 48 hours.(a)




Updated: 11/1/2000, idp; (a)package insert, AHRobins, july1998; (d) VUH Rx policy 11/2000




METRONIDAZOLE - Flagyl IV RTU®

Standard Concentration: 100 mg/mL.(a)

Route of Administration: Intermittent or continuous IV infusion.(bb)

Expiration: In syringe: 30 days.(d)
            Piggyback once wrapper is removed: 30 days.(d)
            Piggyback that has been altered: 30 days.(d)

Standard Dilution: In piggyback: 500 mg/100 mL.(a)

Maximum Rate of I V Administration: 500 mg - 1 g over 1 hour.(a)
Additional Information
 Label: DO NOT REFRIGERATE.(a)
   Flagyl IV RTU do not interact with aluminum when administered over the time period
    specified by manufacturer. Some discoloration of these solutions may occur when
    they are in contact with aluminum for periods of 6 hours or longer.(bb) Therefore, it
    is not necessary to use stainless steel needles when drawing out Flagyl IV RTU or
    running into IV line.(b)
   No dilution or buffering is required for Flagyl IV RTU.
   Each bag of Flagyl IV RTU 500 mg / 100 mL contains 14 mEq of Na +.(a)
   No need to protect from light.(b) Protect from light only during storage.(a)
   Some opacity of the plastic (Flagyl IV RTU) occurs due to moisture absorption
    during the sterilization process. This is normal and does not affect the solution
    quality or safety.(a)



updated: 11/1/2000 idp; (a)pkg insert:::::::: (d) VUH Rx policy 11/2000




MezlCILLIN SODIUM - Mezlin®

Standard Concentration: 100 mg/mL.(a) To a 2g vial add 20 mL; to a 3 g vial add 30
mL; to a 4 g vial add 40 mL; to a 20 g vial add 186 mL.(d)

Route Of Administration: IM, IV by intermittent infusion or direct IV injection.(a)

Expiration: In syringe or piggyback: 7days;(a) in vial: 7 days.(a)

Minimum Dilution: 1 g / 10 mL.(a)
Standard Dilution: In piggyback: 4 g / 50 mL.(a)

Maximum Rate Of I V Administration: 1 g over 3 - 5 minutes.(a) To minimize
venous irritation, the concentration of drug should not exceed 10%.(a)
Standard Rate Of I V Administration: In piggyback: 50 mL over 30 minutes.(a)


Additional Information

   May slightly darken in color but does not affect potency.(g)

   Refrigeration may cause precipitation but will resolubilize by warming the solution
    to 370C in a water bath for 20 minutes and by vigorous agitation.(bb)




REVISED JANUARY 1995
MIDAZOLAM HCL - Versed®

Concentration: 1 mg/mL and 5 mg/mL.(a)

Route of Administration: Intramuscularly; Intravenously.(a)

SHOULD NOT BE ADMINISTERED BY RAPID OR SINGLE BOLUS INTRAVENOUS
ADMINISTRATION.(a)

Expiration: Versed mixed in D5W or NS to a final concentration of 0.5 mg/mL or less
is stable for up to 24 hours at room temperature/refrigeration and in LR for up to 4
hours.(a,b)
Versed mixed in NS to a final concentration of 1mg/mL is stable for 10 days.
Both the 1 mg/mL and 5 mg/mL formulations of Versed may be diluted with NS or
D5W.(a)
Admixtures do not require protection from light for short-term storage and
administration.(Trissel 8th;1994)

Standard IV concentration for continuous infusion: 100 mg/250 mL D5W (final
concentration 0.5 mg/mL) or 50 mg in 50 mL NS (final concentration 1 mg/mL).(a,b)


Additional Information

   Versed Injectable has shown compatibility at a 1:1 ratio for 30 minutes when mixed
    with morphine sulfate, meperidine, atropine sulfate and scopolamine in both glass
    and Plastipak plastic disposable syringes.(b)

   Versed Injectable is also compatible with Robinul® (glycopyrrolate), Vistaril®
    (hydroxyzine hydrochloride), Phenergan® (promethazine), Sufenta® (sufentanil
    citrate), Sublimaze® (fentanyl). Ketalar® (ketamine hydrochloride) and Nubain®
    (nalbuphine hydrochloride) in a 1:1 ratio in glass syringes for 8 hours.(b)


updated 4/96 ild
(a) Pkg.Insert: Roche 6/94; (b) Roche letter 2/96 & 1/96
Minocycline Hydrochloride – MINOCIN®

Description: A semisynthetic derivative of tetracycline (primarily bacteriostatic).(a)
Available as a cryodesicated powder 100 mg vial.(a)

 Reconstitute: 100 mg vial reconstitute with 5 mL of sterile water for injection to yield a
20 mg/mL solution.(a) Then, immediately further dilute to a concentration of
100 to 200 mcg/mL in 500 to 1,000 mL 0.9 NaCl; D5W (refer to package insert for other
compatible infusion solution).(a,b)

Administration: Intravenous infusion.(a) Infused slowly, usually over 6 hours.(b)
Rapid infusion should be avoided.(c)


Stability: Reconstituted solution stable for 24 hours at room temperature.(b) Final
dilutions (500 – 1,000 mL) are stable for 24 hours at room temperature.(a)

Caution: If intravenous therapy is given over prolonged periods of time,
thrombophlebitis may result.(a)




Written: 9/01/99 ild
      (a) Package insert Lederle Parenterals, inc., 1/95
      (b) Trissel, Lawrence; Handbook on Injectable Drugs, 10 th Edition
      (c) Letter from Wyeth-Ayerst Laboratories, 9/18/1999




MORPHINE SULFATE
Standard Concentration: 1 mg/mL, 2 mg/mL, 4 mg/mL, 5 mg/mL, 8 mg/mL, 10
mg/mL, 15 mg/mL.(bb)
Route Of Administration: SQ, IM, direct IV, continuous IV infusion, epidural or
intrathecal.(bb) Continuous method of administration is not approved by FDA.(b)

Minimum Dilution: May be given undiluted or further diluted with 5% Dextrose or 0.9%
NaCl for titration purposes.(bb)

Maximum Rate Of I V Administration: Slow IV.(bb) Must be individualized according
to the response and tolerance.(b) Rapid IV injection may result in an increased
frequency of opiate - induced adverse effects.(bb)

Expiration: IV piggyback or syringe: 42 days stability.(b) Due to the question of
sterility epidurals: 24 hours;(d) PCA syringes: 7 days.(d)




REVISED JANUARY 1995




MVI-12
Standard Concentration: Vial 1 (5 mL) and Vial 2 (5 mL), both vials to be used as a
single dose 10 mL total.(a)

Expiration: When diluted: 48 hours;(a) combined vials: 24 hours.(a)

Minimum Dilution: Vials: 1 and 2 must be added to at least 500 mL, preferably
1000 mL fluid.(a)

Maximum Rate Of I V Administration: 500 mL over 3 - 4 hours.(d)


Additional Information

   Should not be given as a direct, undiluted intravenous injection as it may give rise to
    dizziness, faintness and possible tissue irritation.(a)

   MVI-l2 must be sufficiently diluted due to the presence of propylene glycol and
    tween used as stabilizers.(d)




REVISED JANUARY 1995




NAFCILLIN SODIUM - Unipen, Wyeth brand; Nafcil, Bristol brand; Nallfen,
Beecham brand.
Standard Concentration: 100 mg/mL.(d) To a 1 g vial add 9.4 mL sterile water.(d)
To a 2 g vial add 18.8.(d) To a 10 g vial of Nafcil add 43 mL sterile water.(d) To a 10 g
vial of Unipen add 44 mL sterile water.(d)

Route Of Administration: Deep IM, slow IV injection or infusion.(bb)

Expiration: In syringe:    ; in piggyback: 4 days;(bb) in vial: 7 days at a
concentration of 1 g / 10 mL.(bb)

Minimum Dilution: 1 g in 15 - 30 mL.(bb) Standard Dilution: 1 g / 50 mL.(a)

Maximum Rate Of I V Administration: 1 g slowly over 5-10 minutes into the tubing of
a free - flowing compatible IV solution.(g)
Standard Rate Of I V Administration: 50 mL over 30 - 60 minutes.(a)




REVISED JANUARY 1995




NALOXONE - Narcan®

Standard Concentration: 0.02 mg/mL, 0.4 mg/mL, 1 mg/mL.(a)
Route Of Administration: Direct IV, SQ, IM or IV infusion.(e)

Standard Dilution: 2 mg / 500 mL 0.9% NaCl or 5% Dextrose (0.004 mg/mL).(bb)
Minimum Dilution: May give undiluted as IV in emergency situations.(bb)
Maximum Rate Of I V Administration: Direct IV of 0.4 mg / 15 sec.(f) Continuous IV
infusion dosage regimens have not been well established, and the rate of
administration must be titrated according to the patients's response. Some
recommendations 0.4 mg load; followed by a continuous infusion at an initial rate of 0.4
mg/hour.(bb)

Expiration: In 2 mg/ 500 mL bag 24 hours.(bb)




REVISED JANUARY 1995




NEOSTIGMINE - Prostigmin®

Standard Concentration: 0.25 mg/mL, 0.5 mg/mL, 1 mg/mL.(bb)

Route Of Administration: IV, IM or SQ.(bb)
Minimum Dilution: May be given undiluted.(bb)

Maximum Rate Of I V Administration: Slow IV.(bb)

Additional Information

   Dosage, route, and frequency of administration depend on the requirements and
    clinical response of the patient.(bb)




REVISED JANUARY 1995
NICARDIPINE HYDROCHLORIDE - CARDENE® I.V.

Concentration supplied by manufacturer: 2.5 mg/mL (available as 25 mg / 10 mL
ampules).(a)

Route of Administration: Slow continuous infusion.(a) Bolus doses greater than
0.1 mg/mL have been administered over a period of up to two minutes (this as of yet is
not FDA approved but is being studied by Wyeth).(b)

Expiration: Diluted solution is stable for 24 hours at room temperature.(a)

Standard Dilution: WARNING: AMPULS MUST BE DILUTED BEFORE
INFUSION.(a)

2 ampules in 80 ml (0.5 mg/ml); 1 ampule in 240 ml (0.1 mg/ml) mixed in Normal
Saline.(Dr. Tobia's protocol)
Maximum Rate of IV Administration:
 Start at 10 mcg/kg/min and then decrease to1-3 mcg/kg/min once target blood
   pressure is reached.

   Alternatively, start at 10 to 20 mg/hr and then decrease to 3 to 5 mg/hr (5 mg/hr =
    1.2 mcg/kg/min in 70 kg patient).(a)

   Standard infusion rate 0.1 mg/mL by continuous infusion.(b) Wyeth-Ayerst cannot
    advocate the use of more concenrated infusion.(b) A letter from Wyeth-Ayerst
    states that nicardipine infusion concentrations greater than 0.1 mg/mL have been
    administered over a period of up to two minutes in the treatment of hypertension.(b)

   Cardene I.V. is a potent arterial vasodilator with minimal effects on cardiac
    conduction and contractility. Therefore rapid infusions of greater than 2 mg may be
    associated with more pronounced increases in heart rate. Further, studies are
    needed to define the optimal protocol for the treatment of hypertensive emergencies
    with sequential bolus doses of nicardipine.(b)




written: 2/96;ild
Wyeth Laboratories Inc.; Pkg Insert; 9/93
NlTROGLYCERIN
Standard Concentration: 5 mg/mL, 10 mg/mL.(bb)
Route Of Administration: For intravenous use ONLY. Not for direct intravenous
injection.(bb)
Expiration: When diluted: 2 days.(a)
Minimum Dilution: 400 mcg/mL.(a)
Standard Dilution: In large volume parenteral: 25 mg in 250 mL 5% Dextrose or 0.9%
NaCl (100 mcg/mL).(a)
Standard Rate Of I V Administration: 10 - 20 mcg/minute increased by 5-10
mcg/minute every 5 - 10 minutes until desired hemodynamic response obtained.(q)
Tridil concentration should not exceed 400 mcg/mL.(a)

Additional Information
 Nitroglycerin must be mixed in glass containers since Nitroglycerin readily migrates
    into plastics.(bb)
 40 - 80% of the total amount of Nitroglycerin in the final diluted solution for infusion
    is absorbed by the PVC tubing of IV administration sets currently in use. The higher
    rates of absorption occur when flow rates are low, Nitroglycerin concentrations are
    high, and the administration set is long. Although the rate of loss is highest during
    the early phase of infusion (when flow rates are lowest) the loss is neither constant
    nor self-limiting; consequently no simple calculation or correction can be performed
    to convert the theoretical infusion rate (based on the concentration of the infusion
    solution).(bb) We do not use the manufacturer's set (which are not made of PVC
    tubing) due to the fact that the set does not fit our IV pumps. Since the drug is
    titrated, it is more important to have it on a pump than to use the manufacturer's
    tubing.(d)
 Withdraw an equivalent amount of solution from the bottle before adding
    nitroglycerin.(d)
 Since some filters also absorb Nitroglycerin, use of filters with IV solutions should be
    avoided.(bb)
 Several preparations of Nitroglycerin are available. They differ in concentration
    and/or volume per vial. When switching from one product to another attention must
    be paid to the dilution, dosage and administration instructions.(bb)
 There is no fixed optimum dose of Nitroglycerin. Due to variations in the
    responsiveness of individual patients to the drug, each patient must be titrated to the
    desired level of hemodynamic function. Therefore, continuous monitoring of
    physiologic parameters (e.g., blood pressure, heart rate, pulmonary capillary wedge
    pressure) must be performed to achieve the correct dose. Adequate systemic
    blood pressure and coronary perfusion pressure must be maintained.(bb)
Stability of Nitroglycerin solutions is variable: Diluted solutions of Nitrostat or Nitrol are
stable for at least 96 hours at room temperature and 7 days under refrigerated.(bb)
revised january 1995
NITROPRUSSIDE SODIUM - NIPRIDE®

Standard Concentration: 25 mg/mL.(a) Add 2.3 mL 5% Dextrose to vial to
reconstitute flip top vial. No other diluent should be used.(a)

Route Of Administration: IV infusion only.(a)

Expiration: When diluted: 24 hours.(a)

Minimum Dilution: 100 mg / 250 mL.(a) Standard Dilution: 50 mg / 250 mL.(a)

Maximum Rate Of I V Administration: Usually not more than 10 mcg/kg/minute.(a)

Standard Rate Of I V Administration: Average dose of 3 mcg/kg/minute with a
range of 0.5-10 mcg/kg/minute.(a)

Additional Information

   Mix only in 5% Dextrose.(a)

   Protect from light with Aluminum Foil, light - protective sleeve supplied with product
    or other opaque materials to protect from light.(a)

   Exposure to light causes deterioration which may be evident by a change from a
    brown to a blue color caused by a reduction of the ferric ion to the ferrous ion.(bb)




REVISED JANUARY 1995
NOREPINEPHRINE BITARTRATE - Levophed®

Standard Concentration: 1 mg/mL.(a)

Route Of Administration: IV infusion using an infusion pump or other apparatus to
control the rate of flow.(bb)

Expiration: When diluted: 24 hours.(bb)

Minimum Dilution: 4 mg / 250 mL.(bb)
Standard Dilution: 4 mg / 250 mL 5% Dextrose.(bb)

Standard Rate Of I V Administration: Titrate to patient's needs but 8-12 mcg/minute
usual initial dose.(bb)


Additional Information

   Discard brown solution.(bb)

   Dilute with 5% Dextrose with or without 0.9% NaCl; 0.9% NaCl alone is not
    recommended.(bb)

   Care must be taken to avoid extravasation - local necrosis may result.(bb)




REVISED JANUARY 1995



OCTREOTIDE ACETATE - Sandostatin®
Standard Concentration: Ampuls: 50 mcg/mL, 100 mcg/mL, 500 mcg/mL.
Multi-Dose Vials: 200 mcg/mL or 1000 mcg/mL.(a)
Route Of Administration: SQ, IV push, IV "minibag", continuous SQ infusion.(b)
Minimum Dilution: 50 mcg/mL.(a)
Expiration: In syringe: 28 days under refrigeration and 8 days at room temperature
when stored in light resistant overwraps.(b) Stability data provided by Sandoz using
Becton Dickinsons syringes, which are constructed of polypropylene and have natural
rubber piston joints sealed with B-D Leur Tip Caps.(b)
In D5W and NS using 500 mcg/mL concentration diluted to the following
concentrations: 1:1, 1:9, 1:99 stable for 4 days at room temperature and 14 days stored
under refrigeration.(b)
Rate of Infusion: 25-50 mcg/hr via continuous intravenous infusion.(b) In emergency
situations IV push over 3 minutes.(b)
In 50 or 100 mL of NS or D5W can be infused over 20-30 minutes.(b)

Additional Information
Protection from light is not necessary during the routine preparation and
administration, but is required for prolonged storage.(b) Do not freeze.(b)

Reducing pain at injection site can be minimized by using the smallest volume of
fluid that will deliver the desired dose; rotate the injection sites; using the smallest
diameter needle possible; and allow the drug to warm to room temperature pior to
injection. DO NOT WARM ARTIFICIALLY. (b)
As stated in a letter from Sandoz: "Sandoz does not have any experience with the use
of lidocaine and Sandostatin together, there is no evidence to suggest that a drug
interaction would be encountered with their combined use. To date we have not
received any adverse reports from health care professionals who have used this
method of administration. Although we cannot make any specific recommendations, it
would be prudent to start with the smallest strength and quantity of lidocaine the
individual clinician is accustomed to using and adjust the dose accordingly."(b)

Sandostatin is NOT compatible in TPN solutions. Octreotide acetate will complex
with the higher concentrations of dextrose to form glycosyl conjugates of unknown
pharmacologic activity.(b)
Is used for variceal bleeding, although it is not approved for this use.(b) Duration of
therapy has lasted from 18 hours to 5 days.(b)
Somatostatin and Sandostatin (octreotide acetate) are NOT interchangeable.(b)

UPDATED: November 1995; PI: Sandoz, April 1994; Letter: Sandoz June 1995; ild
OFLOXACIN - FLOXIN®

STANDARD CONCENTRATION: 20 mg/mL (20 mL vial); 40 mg/mL (10mL vial).(a)

route of administration: Only by slow intravenous infusion.(a)

MINIMUM DILUTION: 4 mg/mL.(a)

MAXIMUM RATE OF ADMINISTRATION: Slowly over a period of not less than 60
minutes.(a)

EXPIRATION: In IV at a concentration between (0.4 mg/mL and 4 mg/mL) stable for
72 hours at room temperature: and 14 days under refrigeration in glass or plastic.(a)

ADDITIONAL INFORMATION:

   Floxin I.V. is also supplied in 50 mL and 100 mL flexible containers. These are pre-
    mixed, ready-to-use ofloxacin in D5W for single-use.

   NO FURTHER DILUTION OF THE PREPARATION IS NECESSARY.

   Each 50 mL pre-mixed flexible container already contains a dilute solution with the
    equivalent of 200 mg of ofloxacin (4 mg/mL) in 5% Dextrose (D5W).

   Each 100 mL pre-mixed flexible container already contains a dilute solution with the
    equivalent of 400 mg of ofloxacin (4 mg/mL) in 5% Dextrose (D5W).

   Because the pre-mixed flexible container is for single use only, any unused portion
    should be discarded.(a)

   A 14 day expiration should be given once the outer wrapper is removed from the
    pre-mixed, ready -to-use ofloxacin flexible containers.(d)




REVISED JANUARY 1995
ONDANSETRON HYDROCHLORIDE - Zofran®

Standard Concentration: 2 mg/mL in 2 mL single dose vials or 20 mL multi-dose
vials.(a)

Route Of Administration: IV infusion only.(a)
Expiration: In piggyback: 48 hours at room temperature under normal lighting
conditions in 0.9% NaCl or 5% Dextrose.(a)
Minimum Dilution: Dose should be diluted in 50 mL 5% Dextrose or 0.9% NaCl.(a)
Individual doses as large as 145 mg and total daily dosages (3 doses) as large as 252
mg have been administered without significant adverse events.(a)

Maximum Rate Of Administration: Dose infused over 15 minutes.(a)

Additional Information

DOSAGE FOR CANCER CHEMOTHERAPY: DILUTE BEFORE USE
 The recommended IV dosage is a single 32 mg dose or three 0.15 mg/kg doses.
  The single 32 mg dose is infused over 15 minutes beginning 30 minutes before the
  start of emetogenic chemotherapy. The recommended infusion rate should not be
  exceeeded. With the three-dose (0.15 mg/kg) regimen the first dose is infused over
  15 minutes beginning 30 minutes before the start of emetogenic chemotherapy.
  Subsequent doses (0.15 mg/kg) are administered 4 and 8 hours after the first
  dose.(a)
 PEDIATRIC USE: On the basis of the limited available information the dosage in
  children 4-18 years of age should be three 0.15 mg/kg doses. little information is
  available about dosage in children 3 years of age or younger.(a)
 Use in elderly: The dosage is thee same as for the general population.

PREVENTION OF POSTOPERATIVE NAUSEA AND/OR VOMITING:
NO DILUTION NECESSARY.
 Immediately before induction of anesthesia, or postoperatively if the patient
   experiences nausea and/or vomiting occurring shortly after surgery, administer 4 mg
   UNDILUTED intraveously in not less than 30 seconds, preferably over 2-5 minutes.
 There is no experience with the use of Zofran in the prevention or treatment of
   postoperative nausea and vomiting in childrens.
 USE IN ELDERLY: NO DILUTION NECESSARY. The dosage recommendation is
   the same as for the general population.
  For further information refer to the package information.
 REVISED APRIL 1995


ORTHOCLONE - OKT-3®
Standard Concentration: 1 mg/mL in an ampule containing 5 mg / 5 mL.(a)

Route of Administration: IV bolus.(a)

Expiration: In syringe: 16 hours.(b)

Maximum Rate Of I V Administration: Administer as an IV bolus in less than
one minute.(a)

Administration Instructions:
 Because ORTHOCLONE OKT3 is a protein solution, it may develop a few
  fine translucent particles which have been shown not to affect its potency.(a)

   No bacteriostatic agent is present in this product. Once the ampule is opened use
    immediately and discard the unused portion.(a)

   To prepare ORTHOCLONE OKT3 for injection by drawing the solution into a
    syringe through a low protein-binding 0.2 or 0.22 micron filter. Discard filter and
    attach a new needle for intravenous bolus injection (this last part will be done by the
    nurse).(a)

   Since no data is available on compatibility of ORTHOCLONE OKT3 with other
    intravenous substances or additives, other medications/substances should not be
    added or infused simultaneously through the same intravenous line. If the same
    intravenous line is used for sequential infusion of several different drugs, the line
    should be flushed with saline before and after infusion of ORTHOCLONE OKT3.(a)

   Do not administer by intravenous infusion or in conjunction with other drug
    solutions.(a)

   Store under refrigeration. DO NOT FREEZE OR SHAKE. (a)
   Intravenous mehtylprednisolone sodium succinate 8 mg/kg given 1 to 4 hours prior
    to administering the first dose of ORTHOCLONE OKT3 is strongly recommended to
    decrease the incidence and severity of reactions to the first dose, which have been
    attributed to the ORTHOLONE OKT3 mediated Cytokine Release Syndrome.
    Acetaminophen and antihistamines given concomitantly with ORTHOCLONE OKT3
    may also help to reduce some early reactions.(a)
revised APRIL 1995
OXACILLIN SODIUM - Bactocil® Beecham brand; Prostaphlin® Bristol brand

Standard Concentration: 100 mg/mL.(bb)
 To a 1 g vial add 10 mL sterile water (1 g / 10 mL).
 To 4 g vial add 40 mL sterile water.(d) To a 10 g vial add 92 mL sterile water for
   Beecham brand.(a)
 To a 10 g vial add 93 mL sterile water for Bristol brand.(a)

Expiration: In syringe: 2 days Beecham brand; 2 days for Bristol brand;(a,b)
 In piggyback: 8 days Beecham brand; 4 days for Bristol brand;(a,b)
 In vial: 8 days Beecham brand; 7 days Bristol brand.(a)

Route Of Administration: IM, IV injection or IV infusion.(bb)

Minimum Dilution: 1 g / 10 mL.(a)

Standard Dilution: In piggyback: 2 g / 50 mL for Beecham brand and 2 g / 100 mL for
Bristol brand.(a)

Maximum Rate of I V Administration: 1-4 g over 10 minutes.(a)

Standard Rate of I V Administration: In piggyback: 50 mL over 15-30 minutes for
Beecham brand and 100 mL over 15-30 minutes for Bristol brand.(d) Administered as
slowly as possible to avoid vein irritation.(a)




REVISED JANUARY 1995




OXYTOCIN - Pitocin®
Standard Concentration: 10 units/mL.(a)

Route Of Administration: IV infusion.(bb)

Expiration: When diluted: 2 days.(b,d)

Minimum Dilution: 40 units in 1000 mL.(a)

Standard Dilution: In large volume parenteral: 10 - 20 units in 1000 mL.(a)

Maximum Rate Of I V Administration: For initial dose, do not exceed
1 unit/minute. Increase the infusion rate 1 unit/minute every 15 minutes until response
is observed. Further increase may be to 1 - 2 units/minute and the intervals between
increments extended toward 30 minutes, until a pattern comparable to spontaneous
labor can be observed. Total dose should not exceed 30 units in a 12 hour period due
to the risk of water intoxication(a) see package insert for further details.(a)




REVISED JANUARY 1995
PAMIDRONATE DISODIUM - APD -Aredia®
A bone-resorption inhibitor. (a)
Concentration:
Supplied in Vials:
 30 mg -containing 30 mg lyophilized pamidronate disodium and 470mg mannitol;
 60 mg -containing 60 mg lyophilized pamidronate disodium and 400 mg mannitol;
 90 mg -containing 90 mg lyophilized pamidronate disodium and 375 mg mannitol
Preparation of Solution: Add 10 mL to each vial, i.e., 30 mg, 60 mg, or 90 mg
resulting in a solution of 30 mg/10 mL, 60 mg/10 mL, or 90 mg/10 mL.(a)
The pH of the reconstituted solution is 6 - 7.4.(a)
Route of Administration: Intravenous infusion.(a)
Rate of Administration:
For Moderate Hypercalcemia:
60 mg dose (as a single-dose) as an intravenous infusion over at least 4 hours.(a)
90 mg dose (as a single-dose) as an intravenous infusion over 24 hours.(a)
For Severe Hypercalcemia:
90 mg dose (as a single-dose) as an intravenous infusion over 24 hours.(a)
For Paget's Disease:
30 mg dose as an intravenous infusion administered over 4 hour.(a)
For Osteolytic Bone Lesions of Multiple Myeloma:
90 mg dose as an intravenous infusion administered over 4 hours.(a)
For Osteolytic Bone Metastases:
90 mg dose as an intravenous infusion administered over 2 hours.(a)
Hypercalcemia of Malignancy
60 mg dose as an intravenous infusion over at least 4 hours.(a)
90 mg dose as an intravenous infusion over 24 hours.(a)
Dilution: The recommended dose should be diluted in 0.45% or 0.9% sodium chloride
or dextrose 5%. (a)
Expiration: The infusion solution is stable for up to 24 hours at room temperature.(a)
Adria reconstituted with Sterile Water for Injection may be stored under refrigeration for
up to 24 hours.(a)
Additional Information
 Aredia must not be mixed with calcium-containing infusion solutions, such as
    Ringer's solution and should be given in a single intravenous solution and line
    separate from all other drugs.(a)
 Mannitol and phosphoric acid are concidered inactive ingredients used for
    adjustment to pH 6.5 prior to lyophilization.(a)
A limited number of patients have received more than one treatment with Aredia for
hypercalcemia. Retreatment with Aredia may be considered if hypercalcemia recurs. It
is reommended that a minimum of 7 days elapse before retreatment, to allow for full
response to the initial dose. The dose and manner of retreatment is identical to that of
the initial therapy.
(a)revised 6/98, idp(a) Pkg insert of 8/98 (Ciba-Geigy Corporation)
PANCURONIUM BROMIDE - Pavulon®

Standard Concentration: 1 mg/mL or 2 mg/mL.(a)

Route Of Administration: IV.(bb)

Minimum Dilution: May be given undiluted.(e)

Maximum Rate Of I V Administration: Dosage and rate must be carefully adjusted
according to individual requirements and response.(bb)




REVISED JANUARY 1995




PENICILLIN G SODIUM - Squibb Brand
Standard Concentration: 500,000 units/mL.(a)
 To a 5 MU vial add 8.2 mL sterile water;
 To a 20 MU vial add 31.6 mL sterile water.(b)

Route Of Administration: IM, continuous or intermittent IV infusion.(bb)

Expiration: In syringe or piggyback: 3 days;(b) in vial: 7 days.(bb)

Minimum Dilution: 5 MU / 50 mL.(b)

Standard Dilution: In piggyback: 5 MU / 100 mL .(d)

Standard Rate Of I V Administration: In piggyback: 50 mL over 1 - 2 hours.(bb)




REVISED JANUARY 1995




PENICILLIN POTASSIUM - Squibb Brand

Standard Concentration: 500,000 units/mL.(d)
wTo a 20 MU vial add 31.6 mL sterile water for Bristol or Squibb brand;
wTo 20 MU vial add 33 mL sterile water for Pfizer brand.(a)

Route Of Administration: IM, continuous or intermittent IV infusion.(bb)

Expiration: In syringe or piggyback: 3 days;(b) in vial: 7 days.(a)

Minimum Dilution: 5 MU / 50 mL.(b)

Standard Dilution: In piggyback: 5 MU / 100 mL .(d)

Standard Rate Of I V Administration: In piggyback: 50 mL over 1 - 2 hours.(bb)




REVISED JANUARY 1995




PENTAMIDINE ISETHIONATE - Pentam®300
Standard Concentration: 100 mg/mL.(a) To a 300 mg vial add 3 mL of sterile water
to yield a concentration of 100 mg / 1 mL.(a)

Route Of Administration: IM, slow IV infusion or inhalation.(bb) Should not be
administered by rapid IV injection or infusion.(bb)

Expiration: In vial, syringe or piggyback: 48 hours at room temperature.(b)
30 days in vial or syringe under refrigeration.(b)

Minimum Dilution: 300 mg / 50 mL.(a)

Standard Dilution: 300 mg / 100 mL 5% Dextrose.(d)

Standard Rate Of I V Administration: Any dose over 60 minutes.(a)


Additional Information

ˆReconstitute with sterile water.

ˆHas a tendency to crystallize in solution when refrigerated or frozen. These crystals
will go back in solution upon thawing. Crystallized and thawed product is still stable and
retains potency.(b)

ˆIf administering through a heparin lock, flush with normal saline since pentamidine is
incompatible with heparin.(ee)




REVISED JANUARY 1995

PENTAZOCINE LACTATE - Talwin®

Standard Concentration: 30 mg/mL.(a)
Route Of Administration: IM, IV or SQ. When frequent injections necessary, should
be administered IM.(bb) Rotation of injection site is essential. SQ route should be
used only when necessary because of possible severe tissue damage at the site of
injection.(bb)

Minimum Dilution: May be given undiluted.(bb)

Maximum Rate Of I V Administration: 5 mg or less over 1 minute.(d)




REVISED JANUARY 1995




 PHENOBARBITAL - Luminal

Standard Concentration: 130 mg/mL.(a)

Route Of Administration: SQ, IM or IV.(e)
Minimum Dilution: May be given undiluted.(e)

Maximum Rate Of I V Administration: Not greater than 60 mg/minute.(e)




REVISED JANUARY 1995




PHENYLEPHRINE HYDROCHLORIDE - Neo-Synephrine®

Standard Concentration: 10 mg/mL.(a)

Route Of Administration: SQ, IM, slow IV or continuous IV infusion.(bb)
Expiration: When diluted: 48 hours in 5% Dextrose.(bb)

Minimum Dilution: 10 mg/mL - for direct IV.(a)

Standard Dilution: In piggyback: l mL in 9 mL sterile water for injection.(a) For IV
infusion: 10 mg / 250 mL 5% Dextrose.(d)

Standard Rate Of I V Administration: Sufficient to adjust BP.(a)


Additional Information

ˆDiscard brown solutions.(bb)

ˆMust be protected from light and air. Solutions containing phenylephrine are subject to
oxidation.(bb)




REVISED JANUARY 1995




PHENYTOIN SODIUM - Dilantin®

Standard Concentration: 50 mg/mL.
Available in 100 mg / 2 mL or 250 mg / 5 mL vials.(a)

Route Of Administration: Direct IV. Not recommended for use in IV infusions
because of the possibility that precipitation may occur. IV infusions are feasible
provided that appropriate precautions are taken.
ˆMixed in 0.9% NaCl.
ˆUsing a sufficiently diluted solution e.g., up to 4 mg/mL.
ˆStarting infusion immediately after preparation and completing administration within a
relatively short period using a 0.22 micron in-line filter.
ˆCarefully observing the admixture.(bb) IM route should be administered ONLY as a
last resort. Absorption is erratic and painful when given IM.(bb)

Minimum Dilution: May be given undiluted.(bb)

Maximum Rate Of I V Administration: 10 - 15 mg/kg at a rate not exceeding
50 mg/minute.(bb)

Additional Information

ˆSlight yellow color does not affect stability.(bb)
ˆRefrigeration may cause precipitation but will resolubilize at room temperature with no
effect on stability.(bb)
ˆExcessive dilution may result in precipitation.
ˆPharmacy may prepare the dilution of phenytoin if requested or otherwise prepared on
the floor.(d)
ˆShould never be administered with any other drug or IV fluid.(d)
ˆStable in solution for up to 4 hours.(d)
ˆIntermittent infusions of phenytoin sodium in 0.9% NaCl may be hung in critical care
areas only.(d)
ˆIV push phenytoin sodium may be administered to patients on a cardiac monitor in a
critical care area in any dose.(d) Doses less than or equal to 300 mg may be
administered in step down and in general care units, if the patient's cardiac status can
be monitored and interpreted by the nursing staff or if a physician is present.(d)
ˆExtra caution should be used in patients with marked bradycardia, second or third
degree heart block, active arteriosclerotic heart disease, hypotension, seizures without
underlying seizure disorder and seizures due to electrolyte abnormalities of the
potential for bradydysrhythmias and hypotension.(d)
page 1 of 2
ˆExtravasation of intravenous phenytoin sodium can result in severe tissue necrosis and
in rare instances has led to amputation.(d) Frequent monitoring of peripheral IV sites is
extremely important during administration.(d)
ˆIf patient complains of pain or is in a high risk group, as mentioned above, the rate of
 administration should be reduced by half for a maximum rate of 25 mg/min.(d)
‰It is recommended that doses > 300 mg be given via an infusion pump as an
intermittent infusion.(d) This is to assure a safe administration rate and decrease the
amount of time the nurse has to directly administer the drug and allows more time for
assessment.(d)
ˆThe mixed dose of phenytoin should not exceed 4 mg/mL.(d)
‰The line must be flushed with normal saline before the start of the infusion and after
the completion of the infusion.(d)
‰The patient's blood pressure and heart rate will be taken prior to administering the
phenytoin sodium and after the completion of the administration of the phenytoin
sodium. If the dose is greater than 500 mg, the blood pressure and heart rate will be
taken at the halfway point of administering the dose of phenytoin sodium.(d) If the
blood pressure drops > 20 mm Hg or if bradycardia or an irregular heart rate occurs the
infusion should be stopped and physician should be notified.(d)




page 2 of 2

REVISED JANUARY 1995




 PHYSOSTIGMINE SALICYLATE - Antilirium®

Standard Concentration: 1 mg/mL.(a)

Route Of Administration: Usually IV, IM or sometimes SQ.(bb)

Minimum Dilution: May be given undiluted.(bb)

Maximum Rate Of I V Administration: 1 mg/minute.(a)
REVISED JANUARY 1995




PIPERACILLIN SODIUM - Pipracil®

Standard Concentration: 200 mg/mL.(d)
wTo a 4 g vial add 17.5 mL sterile water.(d)
wTo 40 g vial add 172 mL sterile water.(d)

Route Of Administration: Slow IV injection, infusion or deep IM injection.(bb)

Expiration: In vial: 7 days;(a) in syringe: 3 days;(bb) in piggyback: 7 days.(bb)
Minimum Dilution: 1 g / 5 mL.(a)

Standard Dilution: In piggyback: 4 g / 50 mL.(a)

Maximum Rate of I V Administration: 2 g over 3 - 5 minutes.(a)

Standard Rate of I V Administration: In piggyback: 3 - 4 g over 30 minutes.(bb)


Additional Information

ˆOther IV solutions flowing through a common administration tubing or site should be
 discontinued while pipracillin is being infused.(bb)




REVISED JANUARY 1995
POTASSIUM CHLORIDE

MAXIMUM INFUSION RATES

TYPE OF INFUSION MAXIMUM INFUSION RATE

Routine IV Fluids & Peripheral TPN 10 mEq/hour

Central TPN 20 mEq/hour

Potassium Rapid Infusion (K runs)

Adults, Routine 10 mEq/hour

Adults, with continuous cardiac monitoring 20 mEq/hour

Adults, with measured serum K < 2.5 mEq/L 20 mEq/hour

Adults with measured serum K < 2.5 mEq/L
and with continuous cardiac monitoring 40 mEq/hour

Peds/Neonates

Usual 0.25-0.5 mEq/kg/hr

Maximum         1 mEq/kg/hr*
*not to exceed 10 mEq/hr
        1n



  PROCAINAMIDE HYDROCHLORIDE - Pronestyl®

Standard Concentration: 100 mg/mL or 500 mg/mL.(a)

Route Of Administration: Direct IV injection or IV infusion.(bb)

Expiration: When diluted: 24 hours.(bb)

Minimum Dilution: 1 g / 50 mL.(a)
Standard Dilution: 1 g / 250 mL 5%Dextrose.(bb)

Maximum Rate of IV Administration: 50 mg/minute.(a)

Standard Rate of IV Administration: Depends on patient's response, but
usually 2 - 6 mg/minute.(a)

Additional Information

ˆDiscard solutions darker than light amber.(bb)

‰All infusions should be made up to a final volume with 5% Dextrose.(a)

ˆAdvisable to dilute prior to IV injection to facilitate control of dosage rate.(a)




REVISED JANUARY 1995
PROCHLORPERAZINE MALEATE - Compazine®

Standard Concentration: 5 mg/mL.(a)

Route Of Administration: Deep IM, direct IV and IV infusion.(bb) SQ route not
recommended due to local irritation.(bb)

Minimum Dilution: 1 mg/mL.(g)

Standard Dilution: For IV infusion: 20 mg/liter.(g)

Maximum Rate of IV Administration: Suggested 1 mg/minute for direct IV.(g)
Not greater than 5 mg/min. Do not use bolus injection.(a)

Standard Rate of IV Administration: 1 mg/minute.(g)


Additional Information

ˆProtect from light.(h)




REVISED JANUARY 1995




PROMETHAZINE HYDROCHLORIDE - Phenergan®
Standard Concentration: 25 mg/mL.(a)

Route of Administration: Deep IM, direct IV or IV infusion.(bb)
Do not give SQ.(bb)

Expiration: In piggyback: Mix immediately prior to use due to plastic container - see
below.(h)

Minimum Dilution: 25 mg/mL.(a)

Standard Dilution: In piggyback: 50 mg / 50 mL.(d)

Maximum Rate of IV Administration: 25 mg/minute.(a)

Standard Rate of IV Administration: In piggyback: 50 mL over 15 - 30 minutes.(d)


Additional Information

ˆDo Not Store In Plastic Containers.(h)




REVISED JANUARY 1995




 PROPIOMAZINE HYDROCHLORIDE - Largon®
Standard Concentration: 20 mg/mL.(bb)

Route Of Administration: Direct IV or IM.(bb)

Minimum Dilution: May be given undiluted or further diluted with 10 mL
0.9% NaCl for titration purposes.(e)

Maximum Rate of IV Administration: 10 mg/minute for direct IV.(g)




REVISED JANUARY 1995
Propofol - Diprivan® 1%

Concentration as supplied by the manufacturer: 10 mg/mL.(a)

Route of Administration: Emulsion for IV administration.(a)

Expiration/Stability: Diprivan is a single-use parenteral product, contains no
antimicrobial preservatives and support rapid growth of micro organisms.(a) There
have been reports in chich failute to se aseptic technique when handlind diprivan
Injection was associated with microbial contamination of the product and with fever,
infection/sepsis.
Do not use if contamination is suspected.(a)

Compatibility/Stability: Should not be mixed with other therapeutic agents prior to
administration.(a)

Dilution prior to administration: When diprivan is diluted prior to administration it
should only be diluted with D5W. It should not be diluted to a concentration less than 2
mg/mL, because it is an emulsion. In diluted form it has been shown to be more stable
when in contact with glass than with plastic. (95% potenc;y after 2 hours of running
infusion in plastic).(a)

Dosage/Administration: add part of package insert

Additional Information
ˆMust not be administered through filters with a pore size less than 5 micron because
this could restrict the flow of diprivan injection and/or cause the breakdown of the
emmulsion.(a)
ˆDo not use if there is evidence of separation of the phases of the emulsion.(a)
ˆDiprivan should be prepared for use prior to initiation of each individual
anesthetic/sedative procedure. Should be drawn into sterile syringes immediately after
ampules or vials are opened.
ˆShould be prepared for single patient use only.(a)
ˆAny unused portions of Diprivan injection reservoirs, dedicated administration tubing
and/or solutions containing Diprivan Injection must be discarded at the end of the
anesthetic procedure or at 6 hours, whichever occurs sooner.(a)
‰The IV line shoulld be flushed every 6 hours and at the end of the anesthetic
procedure to remove residual DIPRIVAN injection.(a)


written 3/96 ild
(a) pkg insert: 10/94, Zeneca Pharmaceuticals
PROPRANOLOL HYDROCHLORIDE - Inderal®

Standard Concentration: 1 mg/mL.(a)

Route Of Administration: IV only in life threatening arrhythmias or those occurring
under anesthesia.(a)

Minimum Dilution: May be given undiluted or further diluted with 10 mL 5% Dextrose
or 0.9% NaCl.(f)

Maximum Rate of IV Administration: No greater than 1 mg/minute (reserve for life
threatening arrhythmias).(a)

Standard Rate of IV Administration: Give in small increments of 0.1 mg - 0.2 mg up
to a total dose of 1 mg in 10 - 15 minutes.(f)




REVISED JANUARY 1995
 PROTAMINE SULFATE

Standard Concentration: 10 mg/mL, 5 mL and 25 mL ampules.(a)

Route Of Administration: Very slow IV injection.(bb)

Expiration: When diluted: 24 hours.(a)

Minimum Dilution: 10 mg/mL.(a)

Maximum Rate Of I V Administration: Slow IV over a 1 - 3 minute period - not more
than 50 mg in any 10 minute period.(bb)


Additional Information

‰Has been administered by continuous IV infusion but not FDA approved.(bb)

ˆCan be further diluted with 0.9% NaCl or 5% Dextrose.(bb)




REVISED JANUARY 1995



PYRIDOSTIGMINE BROMIDE - Mestinon®
Standard Concentration: 5 mg/mL.(a)

Route Of Administration: IM or very slow IV.(bb)

Minimum Dilution: May be given undiluted.(bb)

Maximum Rate Of I V Administration: Slow IV (suggested 1 mL/min).(b)


Additional Information

‰Oral dosage requirements are approximately 30 times those required of an IM or IV
dose.(bb)




REVISED JANUARY 1995




 QUINIDINE GLUCONATE

Standard Concentration: 800 mg quinidine gluconate / 10 mL (500 mg anhydrous
quinidine).(bb)
Route Of Administration: IM or IV infusion.(bb)

Expiration: When diluted: 24 hours.(b)

Minimum Dilution: 10 mL (800 mg) / 40 mL 5 % Dextrose (16 mg/mL).(a,bb)

Maximum Rate Of I V Administration: 16 mg/mL solution over 1 mL/minute.(a,bb)


Additional Information

ˆTo determine possible idiosyncrasies to quinidine, a test dose of 200 mg quinidine
sulfate orally or 200 mg quinidine gluconate IM (2 mg/kg in children) should be given
several hours before full dosage is begun or initial IV doses are given, if time permits.
‰Use only clear colorless solutions.(bb)
ˆOn a molar basis, approximately 267 mg of quinidine gluconate or 275 mg of quinidine
polygalacturonate is equivalent to 200 mg of quinidine sulfate.(bb)
ˆIM injections are painful and may result in muscle damage and elevation in creatinine
kinase (CK) enzymes.(bb)
ˆIntravenous quinidine gluconate may cause vasodilation and hypotension which may
be severe if infused rapidly. Monitor blood pressure and ECG continuously during initial
infusions and administer using a controlled infusion device. Discontinue infusion if the
ECG shows excessive widening of the QRS complex (beyond 25% of that observed
before infusion), disappearance of the P wave is noted or severe adverse effects
appear.(bb)




REVISED JANUARY 1995
Quinupristin/Dalfopristin – Synercid®I.V.
A streptogramin antibacterial agent a sterile lyophilized formulation of two semisynthetic
pristinamycin derivatives, quinupristin and dalfopristin.(a)
Supplied as: Each vial contains sterile lyophilized pyrogen-free preparation sufficient
quinupristin/dalfopristin to deliver 500mg (150 mg of quinupristin and 350 mg
dalfopristin).(a)

Route of Administration: Intravenous infusion.(a)

Preparation and administration of solution:
1. Reconstitute the single dose vial by slowly adding 5 mL D5W or SWFI.(a)
2. GENTLY SWIRL the vial by manual rotation without shaking to ensure dissolution of
contents while LIMITING FOAM FORMATION.(a)
3. Allow the solution to sit for a few minutes until all the foam has disappeared. The
resulting solution should be clear. This will result in 100 mg/mL.(a)
CAUTION: FURTHER DILUTION REQUIRED BEFORE INFUSION.(a)
4. According to the patient’s weight, the reconstituted Synercid solution should be
added to 250 mL D5W (to a final concentration, not more than 2 mg/mL). An infusion
volume of 100 mL may be used for central line infusions.(a)
5. If moderate to severe venous irritation occurs following peripheral administration of
Synercid diluted in 250 mL of D5W consideration should be given to increasing the
infusion volume to 500 or 750 mL, changing the infusion site, or infusing by a
peripherally inserted central catheter (PICC) or a central venous catheter.(a)
6. The desired dose should be administered by intravenous infusion over 60
minutes.(a)
DO NOT DILUTE WITH SALINE SOLUTIONS BECAUSE SYNERCID IS NOT
COMPATIBLE WITH THESE AGENTS.(a)

If Synercid is to be given concomitantly with another drug, each drug should be given
separately except for the drugs that compatibility has been established; (listed in the
package insert).(a) With intermittent infusion of synercid and other drugs through a
common intravenous line, the line should be flushed before and after administration
with D5W.(a)

Expiration of Reconstituted and Infusions Solutions:
The stability of the reconstituted single dose vial is 30 minutes.(a, b)
Stability of the diluted solution: 5 hours at room temperature or 54 hours if stored under
refrigeration.(a)


Written: January 2000 idp;
(a) Package Insert Rhone-Poulec Rorer Pharmaceuticals INC. 7/99. Now AVENTIS.
(b) Phone conversation & letter with AVENTIS jan 13,1999.
RANITIDINE HYDROCHLORIDE - Zantac®

Standard Concentration: 25 mg/mL.(a)

Route Of Administration: IM, slow IV injection or slow IV infusion.(bb)

Expiration: In syringe: 3 days.(a) At a concentration of 1 mg/mL in 5 % Dextrose or
0.9 % NaCl 48 hours at room temperature and 10 days under refrigeration.(i,z) At a
concentration of 0.5 mg/mL 14 days under refrigeration.(aa)

Minimum Dilution: 50 mg / 20 mL.(a) Standard Dilution: 50 mg / 100 mL.(a)

Maximum Rate Of I V Administration: 50 mg over 5 minutes.(a)

Standard Rate Of I V Administration: 50 mg / 100 mL over 15 - 20 minutes.(a)




REVISED JANUARY 1995
Ribavirin - Virazole®

Concentration: Supplid as 6 g sterile, lyophilized drug. Reconstituted with 300 mL of
Sterile Water for injection for inhalation (no preservative added).(a)

Route of Administration: Inhalation use only.(a) Administered only by a Small
Particle Aerosol Generator (SPAG-2).(a)

Expiration: Reconstituted solutions may be stored under sterile conditions at room
temperature for 24 hours. Solutions which have been placed in the SPAG-2 unit should
be discarded at least every 24 hours.
IMPORTANT
The water should NOT have had any antimicrobial agent or other substance added.
The solution should be inspected visually for particulate matter and discoloration prior
to administration. Solutions that have been placed in the SPAG-2 unit should be
discarded at least every 24 hours and when the liquid level is low before adding newly
reconstituted solution.(a)

Reconstitution: By sterile technique, reconstitute drug with a minimum of 75 mL of
sterile water for injection or inhalation in the original 100 mL glass vial. SHAKE WELL.
Transfer to the clean, sterilized 500 mL SPAG-2 reservoir and further dilute to a final
volume of 300 mL with Sterile Water for Injection or Inhalation. The final concentration
should be 20 mg/mL.(a)

wPrepare under vertical flow hood.




Written: 2-96; ild;
ICN Pharmaceuticals, Inc., Pkg. Insert 5-94
RIFAMPIN - Rifadin®

STANDARD CONCENTRATION: 60 mg/mL (600 mg / 10 mL).(a)
To a 600 mg vial add 10 mL.(a)

ROUTE OF ADMINISTRATION: Intravenous infusion only.
Must not be administered by IM or SQ route.(a)

EXPIRATION: In vial: 24 hours at room temperature.(a)
In IV: 4 hours.(a,b) Precipitation of rifampin may occur beyond 4 hours.(a)

MINIMUM DILUTION: 600 mg in 100 mL.(a,b)

MAXIMUM DILUTION: 600 mg in 500 mL.(a,b)

MAXIMUM RATE OF I V ADMINISTRATION: 600 mg in 100 mL over 30 minutes.(a,b)
600 mg in 500 mL over 3 hours.(a,b)

ADDITIONAL INFORMATION
‰5% Dextrose or 0.9 % Sodium Chloride are recommended infusion medium. Other
infusion media are not recommended.(b)

‰Do not infuse if precipitate is present.(a)

ˆStains body fluids orange.(a)

ˆWhen reconstituting, the vial should be swirled gently to facilitate dissolution of the
drug.(bb)

‰The total time for preparation and infusion of rifampin (in 100 or 500 mL)  should
be completed within 4 hours; beyond this time, precipitation of rifampin may occur.(b)

Please note the AHFS DRUG INFORMATION 1992 and the PDR 1992 expiration data
is incorrect. The package insert (per phone call to Merrell Dow Pharmaceutical,Inc.) is
the most recent updated information.




REVISED JANUARY 1995
RITODRINE HYDROCHLORIDE - Yutopar®

Standard Concentration: 10 mg/mL or 15 mg/mL.(a)

Route Of Administration: IV infusion using an infusion pump or other apparatus to
control the rate of flow.(bb)

Minimum Dilution: 150 mg / 500 mL (final concentration of 300 mcg/mL).(bb)

Maximum Rate Of Administration: 150 - 350 mcg/minute.(bb) Initial IV dosage 50 -
100 mcg/minute. Dosage may be gradually increased by 50 mcg/minute every 10
minutes until the desired effects are obtained.(bb) Maximum volume of fluid that might
be administered after 12 hours with the recommended dilution at the highest dose (350
mcg/minute) will be about 840 mL.(bb)

Expiration: 48 hours at room temperature.(bb)


Additional Information
ˆ30 minutes before IV termination, oral Ritodrine maintenance should be initiated.(bb)

‰Due to increased risk of pulmonary edema, dilution in 0.9.% NaCl, Ringer's or
Lactated Ringer's injection should be reserved for use when dextrose is medically
undesirable (e.g. Diabetes Mellitus).(bb)

ˆSolutions that are discolored or contain a precipitate or particulate matter should be
discarded.(bb)

‰Monitoring the amount of administered IV fluids and the rate of administration is
necessary to avoid circulatory fluid overload.(bb)

ˆInfusion should generally be continued for at least 12 hours after uterine contractions
cease.(a)




REVISED JANUARY 1995
SARGRAMOSTIM - Leukine® GM-CSF

Standard Concentration: 250 mcg, 500 mcg per vial as a lyophilized powder.(a)

Route Of Administration: IV infusion.(a)

Minimum Dilution: Dilute with 1.1 mL sterile water without preservative; therefore, 250
mcg/mL or 500 mcg/mL(a) dose to make a final concentration of 10 mcg/mL or greater
with 0.9% NaCl.(a) If the final concentration is below 10 mcg/mL, Albumin (Human) at
a final concentration of 0.1% should be added to the saline prior to the addition of
Leukine to prevent absorption to the components of the drug delivery system. To
obtain a final concentration of 0.1% Albumin (Human), add 1 mg Albumin (Human) per
1 mL 0.9% NaCl (e.g., use 1 mL 5 % Albumin (Human) in 50 mL 0.9% NaCl).(a)

Rate Of Administration: 250 mcg/m2/day as a 2 hour IV infusion.(a)

Expiration: In vial: 6 hours under refrigeration;(a) in IV solution: 6 hours (under
refrigeration).(a)

Additional Information:
ˆThe single-use vial should not be re-entered or reused. Do not save any unused
portion for later administration.(a)

‰During reconstitution the sterile water for injection, should be directed at the side of
the vial and the contents gently swirled to avoid foaming during dissolution.

ˆAVOID EXCESSIVE OR VIGOROUS AGITATION; DO NOT SHAKE.

‰The recommended dose 250 mcg/m2/day for 21 days beginning 2 to 4 hours after the
autologous bone marrow infusion, and not less than 24 hours after the last dose of
chemotherapy and 12 hours after the last dose of radiotherapy.(a) Leukine should be
discontinued if the ANC exceeds 20,000 cells/mm 3.(a)

‰Store Leukine solutions under refrigeration at 36 - 460 F; DO NOT FREEZE(a)

‰USE ONLY 0.9 % NaCl to prepare IV infusion solutions.(a)


REVISED JANUARY 1995


SODIUM BICARBONATE

Standard Concentration: 50 mEq / 50 mL or 44.6 mEq / 50 mL.(a)
Route Of Administration: Rapid direct IV injection or IV infusion.(bb)

Expiration: When diluted: 24 hours.(c)

Minimum Dilution: May be given undiluted or may be further diluted with
5% Dextrose or 0.9 % NaCl.(g)

Maximum Rate Of I V Administration: Depends on patient's condition and
response.(g)


Additional Information

‰Can be administered by subcutaneous injection if diluted to isotonicity (1.5 % sodium
bicarbonate solution. Extravasation of hypertonic sodium bicarbonate injections must
be avoided.(bb)




REVISED JANUARY 1995




STREPTOKINASE - Kabikinase®

Standard Concentration: 50,000 or 150,000 IU/mL.(a) Reconstitute 250,000 IU or
750,000 IU vial with 5 mL 0.9% NaCl or 1,500,000 IU reconstitute with 10 mL.(a)
Expiration: When diluted: 24 hours.(a)

Route Of Administration: Regardless of route, should be administered via a
controlled - infusion device. IV infusion or intra-arterial infusion into cannula.(bb)

Minimum Dilution: 1,500,000 IU in 50 mL.(bb) Standard Dilution: 250,000 IU or
750,000 IU in 50 mL.(a)

Maximum Rate Of Administration: Depends on the route (Intracoronary artery or IV,
etc.) See package insert for specifics.(a)




REVISED JANUARY 1995




STREPTOMYCIN SULFATE

Standard Concentration: 200 mg/mL.(a) To a 1 g vial add 4.5 mL sterile water.(a)

Route Of Administration: Deep IM injection only.(bb)
Expiration: In piggyback: 2 days;(a) in large volume parenteral: 2 days;(d)
in vial: 14 days.(a)

Minimum Dilution: In piggyback: 0.5 - 1 g in 30-40 mL 0.9 % NaCl.(b)

Standard Dilution: In large volume parenteral: 1 - 2 g in 1000 mL 0.9 % NaCl.(b)

Maximum Rate Of I V Administration: In piggyback: 0.5-1.0 g / 30 - 40 minutes.(b)

Standard Rate Of I V Administration: In large volume parenteral: 25 drops per
minute (of a concentration of 1 - 2 g / 1000 mL).(b)

Additional Information

ˆIV administration of streptomycin is not recommended by most clinicians because high
serum concentrations and an increased risk of toxicity may result.(bb)

ˆSolutions having a concentration greater than 500 mg/mL should not be used.(bb)




REVISED JANUARY 1995
TACROLIMUS (previously known as FK506)-PROGRAF®                       page 1 of 2

Standard Concentration: 5 mg/mL. Each mL contains polyoxyl 60 hydrogenated
castor oil (HCO-60) 200 mg and dehydrated alcohol USP 80% v/v. Supplied as
1 mL ampules.(a)
Route of Administration: Intravenous infusion ONLY.(a)
Dilution: With 0.9% Sodium Chloride or D5W to a concentration between 0.004
mg/mL and 0.02 mg/mL prior to use.(a)
Dosage and Administration: Initial dose should not be administered no sooner than 6
hours after transplantation. Recommended starting dose is 0.05-0.10 mg/kg/day as a
continuous infusion.(a)
Expiration: Diluted infusion solution should be stored in glass or polyethylene
containers and should be discarded after 24 hours. The diluted solution should not be
stored in a PVC container due to decreased stability and the potential for extraction of
phthalates.(a)

Additional Information
Anaphylactic reactions have occurred with injectables containing castor oil
derivatives.(a)

It is recommended that adult patients should receive doses at the lower end of the
dosing range (0.05-0.1 mg/kg/day). Pediatric patients should receive doses at the
higher end of the recommended adult intravenous dosing range (0.1 mg/kg/day) and
oral (0.3 mg/kg/day) dosing ranges.(a)
The first dose of oral therapy should be given 8-12 hours after discontinuing the IV
infusion (0.15 - 0.3 mg/kg/day) administered in two divided daily doses every 12
hours.(a)

Concomitant adrenal corticosteroid therapy is recommended early post-
transplantation.(a)

Continuous intravenous infusion of tacrolimus should be continued only until the patient
can tolerate oral administration of tacrolimus capsules.(a)

Patients with renal or hepatic impairment should receive doses at the lowest value of
the recommended intravenous and oral dosing ranges. Further reductions in doses
below these ranges may be required.(a)

Tacrolimus should not be used simultaneously with cyclosporine. Tacrolimus or
cyclosporin concentrations should be discontinued at least 24 hours before initiating the
other. In the presence of elevated tacrolimus or cyclosporine concentrations, dosing
with the other drug usually should be further delayed.(a)
page 2 of 2

Blood Concentration Monitoring
Data from the U.S. clinical trials show that tacrolimus whole blood concentrations, as
measured by ELISA, were most variable during the first week post-transplantation.
After the early period
of therapy, the median trough blood concentrations, measured at intervals from the
second week to one year post transplantation, ranged from 9.8 ng/mL to 19.4 ng/mL.(a)

updated 12/95 ild; PI: April, 1994, Fujisawa.
THIAMINE HYDROCHLORIDE

Standard Concentration: 100 mg/mL.(a)

Route Of Administration: IV or IM.(bb)

Minimum Dilution: 100 mg/mL for IM.(a) 100 mg in 100 mL of 0.9 % NaCl.(d)

Maximum Rate Of I V Administration: Slow IV 100 mg / 100 mL over 1 hour.(e)
Hypersensitivity reactions, including feelings of warmth, tingling, pruritus, pain, urticaria,
weakness, sweating, nausea, restlessness, tightness of the throat, angioedema,
respiratory distress, cyanosis, pulmonary edema, GI bleeding, transient hypotension,
vasodilation, vascular collapse and death have occurred occasionally, mainly following
repeated IV administration. For this reason, the preferred route of administration is
IM.(bb)


Additional Information

‰High carbohydrate diets or IV Dextrose solutions increase thiamine requirements and
may worsen symptoms in thiamine - deficient patients.(bb) Thiamine is also used when
IV dextrose is administered to patients with marginal thiamine status to avoid
precipitation of heart failure.(bb)

ˆInitial IV dose of Thiamine should be in 0.9% NaCl; subsequent doses may be mixed in
5% Dextrose or 0.9% NaCl.(v)




REVISED JANUARY 1995
TICARCILLIN DISODIUM / CLAVULANATE POTASSIUM - Timentin®

Standard Concentration: 3.1 g / 10 mL.(a) To a 3.1 g vial add 8 mL of sterile water
for injection to yield concentrations of Ticarcillin 300 mg/mL and Clavulanate
Potassium 10 mg/mL.(a,d) To a 31 g vial add 76 mL.(a)

Route Of Administration: IV infusion.(a,bb)

Expiration: In syringe or vial: 6 hours at room temperature, 72 hours under
refrigeration.(a) At a concentration of 10 - 100 mg/mL in 0.9 % NaCl: 24 hours at
room temperature and 7 days under refrigeration. At a concentration of 10-100
mg/mL in 5 % Dextrose: 24 hours at room temperature and 3 days under
refrigeration.(a)

Standard Dilution: 3.1 g / 50 mL.(d)

Maximum Rate Of I V Administration: 3.1 g over 30 minutes.(a)

Additional Information

‰Powder or solutions of the drug should not be exposed to temperatures warmer than
24 degree C since this results in degradation of clavulanate potassium. If the sterile
powder of solutions of the drug darken, this indicates degradation of clavulanate
potassium and a loss of potency. When this occurs the drug should be discarded.
Therefore, when not using Timentin reconstituted solution make sure that it is
refrigerated. Reconstituted Timentin has a 6 hour expiration at room temperature.(bb)




REVISED JANUARY 1995


TOBRAMYCIN SULFATE - Nebcin®

Standard Concentration: 10 mg/mL; 40 mg/mL.(a,bb)

Route Of Administration: IM or IV infusion.(a)
Expiration: In syringe: 3 days;(d) in piggyback: 4 days.(c)

Minimum Dilution: any dose in 50 mL(a)

Maximum Rate Of I V Administration: any dose over 30 minutes.(e)

Do Not Infuse in Less Than 20 minutes.(a,bb) Blood specimens for "peak" drug
concentrations should be obtained 30 minutes after a 30 minute infusion or 1 hour after
an IM injection. Blood specimens for "trough" drug concentrations should be obtained
immediately prior to the next IM or IV dose.(d,bb)




REVISED JANUARY 1995




TRIMETHOPRIM AND SULFAMETHOXAZOLE - Bactrim®

Standard Concentration: 5 mL vial contains 80 mg trimethoprim and 400 mg
sulfamethoxazole.(a)

Route Of Administration: IV infusion only.(bb)
Expiration: When 5 mL vial mixed in 125 mL: 6 hours;(bb) when 5 mL vial mixed in
100 mL: 4 hours; 5 mL mixed in 75 mL: 2 hours;(bb) in syringe: 3 days.(d)

6 hrs          4 hrs 2 hrs
 5 mL in   125 mL 5 mL in 100 mL 5 mL in 75 mL
10 mL in   250 mL 10 mL in 200 mL 10 mL in 150 mL
15 mL in   375 mL 15 mL in 300 mL 15 mL in 225 mL
20 mL in   500 mL 20 mL in 400 mL 20 mL in 300 mL
25 mL in   625 mL 25 mL in 500 mL 25 mL in 375 mL

Minimum Dilution: 5 mL vial in 75 mL.(bb)
Standard Dilution: In piggyback: 5 mL vial in 100 mL with 4 hour expiration.(a)

Standard Rate Of I V Administration: Total dose over 60-90 minutes.(a) If volume
too large to give over 60-90 minutes, further divide twice daily dosage into 4 times
daily.(d)


Additional Information

ˆDo not give IM or direct IV.(a)

ˆDo not refrigerate.(a)

‰Mix in 5% Dextrose only.(bb)

ˆAfter initial entry into the vial, the remaining contents must be used within 48 hours.(a)




REVISED JANUARY 1995


TRIMETHAPHAN - Arfonad®

Standard Concentration: 50 mg/mL (500 mg / 10 mL ampule).(bb)

Route Of Administration: IV infusion.(a)

Expiration: When diluted: 24 hours at room temperature.(bb)
Minimum Dilution: 1 mg/mL.(a)
Standard Dilution: 500 mg / 500 mL 5 % Dextrose or 0.9 % NaCl.(bb)

Maximum Rate Of I V Administration: Depends on what is being treated. Standard
Rate Of I V Administration: Depends on patient's response.(a) Rates are dependent
on treatment: Management of malignant hypertension: Initial rate 0.5 - 1 mg/minute
with gradual increases in the rate of infusion until the blood pressure response is
achieved (not less than 2/3 of the pretreatment level). Hypertension with acute
dissecting aneurysms of the aorta: 1 - 2 mg/minute maintain SBP 100 - 120 mmHg.
Controlled hypertension during surgery: 3 - 4 mg/minute rate of administration is
adjusted to maintain blood pressure at the desired level and usually ranges from 0.3 - 6
mg/minute.(bb) Tachyphylaxis to hypotensive effects of trimethaphan may occur in 24 -
72 hours.




REVISED JANUARY 1995




TUBOCURARINE CHLORIDE

Standard Concentration: Each 3 mg of tubocurarine is equivalent to approximately 20
units of crude curare extract.(bb)

Route Of Administration: IV injection or IM. (a,bb)

Minimum Dilution: Dilute to at least 3 mg/mL with 0.9 % NaCl or sterile water.(e)

Maximum Rate Of I V Administration: 6 - 9 mg over 1 - 1.5 minutes.(bb)
Patient must be on supported respiration. Have reversal drugs available.


Additional Information

Solutions of the drug should not be used if they become faintly discolored.(bb)




REVISED JANUARY 1995




UROKINASE (ABBOKINASE OPEN CATHR) 5,000 IU/ML STERILIZED
LYOPHILIZED POWDER WITH DILUENT

Standard Concentration: 5,000 IU/mL.(a)

Route Of Administration: Used to clear a central venous catheter.
See package insert for procedure of administration.
REVISED JANUARY 1995
VALPROATE - Depacon®

Standard concentration: 100 mg/mL (5mL vial).(a)

Route of administration: INTRAVENOUS USE ONLY.(a)

Rate of administration: Should be administered as a 60 minute infusion, but not more
than 20 mg/min.(a)

Dilution: With at least 50 mL of compatible dilutent (D5W; 0.9% NaCl;
Lactated Ringers).(a)

Expiration: 24 hours when stored in glass or polyvinyl chloride (PVC) at room
temperature.(a)

Additional Information:
wInfusion times of less than 60 min or rates of infusion > 20 mg/min have not been
studied.(a)

wUnused portion should be discarded. No preservatives have been added.(a)




written: 8/97ild
(a) Package Insert: jan 1997; Abbott




VANCOMYCIN HYDROCHLORIDE - (manufactured by Abbott, Lederle,Lilly)
Standard Concentration: 100 mg/mL.(d)

Route Of Administration: Slow IV infusion.(bb)

Expiration: In syringe: 3 days.(d) In piggyback: 14 days.(a) In vial: 14 days.(a)
Minimum Dilution: 500 mg / 100 mL.(bb)

Maximum Rate Of I V Administration: Any dose over 1 hour.(bb)

Dilution: To a 500 mg vial add 5 mL; 1g add 10 mL; 5g add 48 mL;
10g add 95 mL sterile for a final concentration 100 mg/mL.(d)


Additional Information

For Vancomycin intrathecal: Concentration: 10 mg/mL; Expiration: 24 hours, filtered
through 0.22 Micron Filter.

ˆReconstitute a 500 mg vial with 10 mL 0.9% NaCl for injection, resulting in a
50 mg/mL concentration.
‰Remove 1 mL or 50 mg and further dilute to 5 mL in a syringe, resulting in a final
concentration of 10 mg/mL.
ˆThis final concentration should then be filtered through a 0.22 Micron filter and placed
in a sterile vial, properly labeled with date, concentration filtered and initialed.
ˆWithdraw 1 mL with 0.1 mL overfill into a 3 mL syringe, capping the syringe and labeling
the syringe properly.(d)




revised: 7/96 ild; pi: Abbott 6/94




VASOPRESSIN - Pitressin®

Standard Concentration: 20 units/mL.(a)
Expiration: When diluted: 24 hours.(d)

Route Of Administration: For vasopressin injection: IV, SQ, IM, topically to nasal
mucosa, continuous IV or intra-arterial infusion.(bb) For vasopressin tannate in oil: IM.
Must Not Be Administered IV.(bb)

Minimum Dilution: 20 units / 20 mL.(bb)

Standard Dilution: 250 units / 250 mL 5% Dextrose.(bb)

Maximum Rate Of I V Administration: Initiated at 0.2 - 0.4 units/minute and
progressively increased to 0.9 units/minute if necessary.(bb)




REVISED JANUARY 1995



VERAPAMIL HYDROCHLORIDE - Isoptin®, Calan®

Standard Concentration: 2.5 mg/mL.(a)
Route Of Administration: IV injection; has been given by IV infusion, but safety and
efficacy of this method has not been established.(bb)

Expiration: When diluted: 24 hours.(bb)

Minimum Dilution: 5 mg / 2 mL.(a)

Standard Dilution: In large volume parenteral: 40 mg / 1000 mL.(bb)

Maximum Rate Of I V Administration: 5 - 10 mg over 2 minutes and in geriatric
patients not less than 3 minutes.(bb)

Standard Rate Of I V Administration: In large volume parenteral: Must be carefully
titrated accordingly to individual requirements and response.(bb)




REVISED JANUARY 1995




VIDARABINE - Vira-A®

Standard Concentration: 200 mg/mL.(bb)

Route Of Administration: Only by IV infusion.(bb)
Expiration: In piggyback or large volume parenteral: 48 hours.(bb)

Minimum Dilution: 1 mg in 2.22 mL.(bb)
Standard Dilution in Large Volume Parenteral: 450 mg in 1000 mL.(bb)

Maximum Rate Of I V Administration: 1000 mL over 12-24 hours.(a)


Additional Information

‰Warm the IV solution before adding Vira-A.(a)

‰Shake the Vira-A well before drawing up the dose.(a)

‰Shake the IV solution after adding Vira-A until it becomes clear.(a)

ˆDo not refrigerate the diluted solution.(a)

ˆAdminister with an in-line membrane filter 0.45 micron or smaller.(bb)

‰Avoid rapid or bolus IV.(a)




REVISED JANUARY 1995

WinRho SD - Univax®

RHo(D) Immune Globulin IV (Human)
RHo(D) immune globulin IV (RHo[D] IGIV) is a sterile, freeze-dried gamma globulin (IgG)
fraction containing antibodies to RHo(D). For use in the suppression of Rh
isoimmunization.(a)
Concentration: Contains approximately 2 mcg IgA per 1500 IU (International Units).(a)
Potency and dosing recommendations are now expressed in IU by comparison to the
WHO Anti-D standard. The conversion of "mcg" to "IU" is 1 mcg = 5 IU .(a) Rho(D)
immune globulin is prepared from plasma by an anion-exchange column
chromatography method. A 1500 IU (300 mcg) vial contains sufficient anti-Rho(D) to
effectively suppress the immunizing potential of approximately 17 mL of Rho(D) antigen-
positive red blood cells.(a)
 Route of Administration:
w Must be administered IV for the treatment of immune thrombocytopenic purpura
(ITP).(a) Efficacy of the IM or SC routes has not been established.(a)
wRho(D) IGIV may be given IV or IM for the suppression of Rh isoimmunization. (a)
Reconstitution / Infusion Rate / IM Administration:
|IV administration: Reconstitute shortly before use with 2.5 mL of NS. Inject the
dilutent slowly onto the inside wall of the vial and wet the pellet by gently swirling until
dissolved. DO NOT SHAKE.
wInfuse over 3-5 minutes.(a)
|IM administration: Reconstitute shortly before use with 1.25 mL of NS. Inject the
diluent slowly onto the inside wall of the vial and wet the pellet by gently swirling until
dissolved. DO NOT SHAKE. Administer into the deltoid muscle of the upper arm or the
anterolateral aspects of the upper thigh. Due to the risk of sciatic nerve injury, the
gluteal region should not be used as a routine injection site. If the gluteal region is used,
use only the upper, outer quadrant.

For IV injection:
w To a 600 IU (120 mcg) vial add 2.5 mL diluent for a final available volume of
2.4 mL and final concentration of 240 IU (48 mcg) / mL.(a)
w To a 1500 IU (300 mcg) vial add 2.5 mL diluent for a final available volume of 2.4 mL
and a final concentration of 600 IU (120 mcg) / mL.(a)
For IM injection:
x To a 600 IU (120 mcg) vial add 1.25 mL diluent for a final available volume of 1.2 mL
and a final concentration of 480 IU (96 mcg).(a)
x To a 1500 IU (300 mcg) vial add 1.25 mL diluent for a final available volume of 1.2 mL
and a final concentration of 1200 IU (240 mcg).(a)           STORAGE / STABILITYDo
not freeze. If the unused product is not used immediately, store it at room temperature
for no longer than 4 hours. Use the product within 4 hours of reconstitution. Discard any
unused portion.
4/96 ild; Facts & Comparisons 6/95
Zidovudine -- Retrovir® IV Infusion
FOR INTRAVENOUS INFUSION ONLY

Description: A pyrimidine nucleoside analogue active against human immunodeficiency
virus (HIV).(a)

Route of Administration: Intravenous infusion only.(a)
Concentration: 10 mg/mL.(a)

Dosage and administration: Recommended intravenous dose 1 mg/kg infused over
1 hour.(a) Rapid infusion or bolus injection should be avoided. Retrovir IV infusion
should not be given intramuscularly.(a)

Method of Preparation:
 Must be diluted prior to administration.(a)
 Add to D5W to achieve a concentration no greater than 4 mg/mL.(a)
 Admixture in biologic or colloidal fluids (eg., blood products, protein solutions, etc.) is
   not recommended.(a)

Stability:
Stable for 24 hours at room temperature.(a)
Stable for 48 hours refrigerated.(a)

As an additional precaution to prevent inadvertant contamination, the manufacturer
recommends that the diluted solution should be administered within 8 hours (if stored at
room temperature) or 24 hours if refrigerated to minimize potential administration of a
microbially contaminated solution.(a)




Written: 8/18/99 ild
(a) Package Insert GLAXO WELLCOME, Feb 1998

								
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