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Dilution List     [ A ]
This document Copyright © 2005-06  D.McAuley, GlobalRPh Inc. All Rights Reserved.
Drug Standard  Dilution Infusion Rate Diluents*
*Preferred solution is listed first.
9 mg (4.5 ml) / 250 ml   UD NS / D5W
Stability / Miscellaneous
Indications: Adjunct to percutaneous transluminal coronary angioplasty or atherectomy for the prevention of acute cardiac ischemic complications in patients at high risk for abrupt closure (restenosis) after treatment. (Patients at high risk include: acute MI within 12 hours of onset of symptoms; Non q-wave MI; Early postinfarction angina or unstable angina with at least 2 episodes of angina associated with EKG changes during past 24hrs.)
Use as an adjunct with heparin to prevent cardiac ischemic complications in patients with unstable angina not responding to conventional treatment when a percutaneous coronary intervention(PCI) is scheduled within 24 hours.
Bolus dose: Use 0.22 micron filter to withdraw dose into syringe. [supplied: 10mg/5 ml vial (REF) ]

Continuous infusion: withdraw 9mg (4.5 ml) through a 0.22 micron filter into a syringe; inject into 250 ml NS or D5W (35 mcg/ml). Infuse at 17 ml/hr (10 mcg/min) x 12 hours.

Filter all infusions.
ACETAZOLAMIDE 250-500 mg/ 50 ml 15-30 min NS  / D5W

EXP: 1 day (RT). Dilute 500mg vials with at least 5ml.
    Recommended route: IVPush (100-500mg/min)
Usual Diluents
Standard Dilutions   [Amount of drug]  [Infusion volume]  [Infusion rate]
Acetaminophen Overdose:
Adult Loading dose

[150mg/kg] [200 ml] [60 minutes]

Maintenance dose:
[50 mg/kg] [500ml] [over 4 hrs]
Followed by:
[100 mg/kg] [1000ml] [over 16 hrs]

Important note: in fluid restricted patients or patients <40kg: the volume of D5W used should be reduced proportionately.

Stability: 24 hours room temp. 
Supplied: Acetadote injection is available as a 20% solution in 30 ml (200mg/ml) single glass vials. 

Do not use previously opened vials for IV administration. See package insert for additional comments.
ACYCLOVIR (ZOVIRAX) 0-350 mg/ 50 ml
351-700 mg/ 100 ml

60 min

D5W / NS

EXP: 1 day (RT). (Note: conflicting data regarding estimated stability. Some studies have reported much longer stability (3- 4 weeks), while other studies confirm the stability indicated by the manufacturer (24 hours).   Label: Do not refrigerate.     Maximum concentration = 7 mg/ml.   Mucocutaneous herpes simplex: IV: 5 mg/kg/dose q8h x 5-10 days. Encephalitis: 10mg/kg/dose IV q8h. Primary HSV infection-genital (Oral therapy): 200mg q4h while awake (5x/day) or 400mg po tid x 10 days. Recurrent genital: 400mg po tid x 5 days. Herpes Zoster: 800mg po q4h while awake (5x/day) x 7 days. If severe give 10-12 mg/kg IV q8h x 7-14 days. Chronic suppression (genital herpes): 400mg po bid. Zovirax ointment: apply ½" q3h (6 x/day).   Renal Dosing: 50 - 90/ 5 to 12.4 mg/kg q8h || 10-50 / 5-12.4 mg/kg q12-24h || <10 / 2.5 to 6 mg/kg q24h. Alternatively: (Oral): 10-25 / dose q8h || <10 / dose q12h. (IV): 25-50/ 5-10mg/kg q12h || 10-25/ 5-10mg/kg q24h || <10/ 2.5 to 5mg/kg IV q24h. || HD: dose after dialysis || CAPD: see < 10.
AGGRASTAT (See TIROFIBAN). Related agents: Reopro, Eptifibatide (Integrilin)      
ALBUMIN 12.5 gm / 50 ml vial
25 gm / 100ml (2 vials)
12.5 gm / 250ml (5%)
25 gm / 500 ml (5%)

30 min
45-60 min
30-60 min
1-3 hours

NS  / D5W
Infusion rate for 25% vials: 2-3 ml/minute maximum.   5% soln: 5-10 ml/min maximum. Discard unused solution after 4 hours. Dilute if necessary with D5W or NS.    Hypoproteinemia (Usual dose): 0.5- 1 gram/kg/dose q1-2 days as calculated to replace ongoing losses. Maximum dose/day: 250 grams/48 hours.
ALTEPLASE (ACTIVASE, TPA) 50 mg vial/ 50 ml SW c/o preservatives
100 mg vial/ 100 ml SW


NS / D5W

EXP: 8 hours (RT).  Prepare just before use. Results in concentration of 1 mg/ml. May be infused at this concentration or may dilute further with equal volume of normal saline or D5W (0.5 mg/ml). Dosing: Acute MI: (2 protocols)-
(1) (Preferred) Accelerated infusion: for patients > 65kg: 15 mg IV bolus f/b 50mg over next 30min, and the remaining 35mg (100mg total) infused over the next 60 min. Patients <65kg: 15 mg bolus, then 0.75 mg/kg (max 50 mg) over 30 minutes, then 0.5 mg/kg (max 35 mg) over next 60 minutes. 
(2) 3-hour infusion (may be less effective): In 1st hour, 60 mg is administered (of which 6-10mg is administered ivpush in first 1-2 minutes),  followed by 20 mg/hr x 2 hours. (100mg total). For patients <65 kg: administer 1.25 mg/kg in the same manner over 3 hours.
 Pulmonary embolism: 100 mg over 2 hours. Stroke: (Give within first 3 hours): 0.9 mg/kg (max 90mg)-10% of dose given ivpush, followed by a continuous infusion over 1 hour.   Catheter clearance: See Alteplase in catheter clearance
AMIKACIN 0-1000 mg/ 100 ml

30 min

D5W / NS

EXP: 1 day (RT) 7 days (REF).   Label: Refrigerate. (See under gentamicin for dosing guidelines)
1 gram/ 50 ml
2 gram/ 100 ml
3 gram/ 150 ml
4-5 grams/ 250 ml
6-10 grams/ 500 ml
11-24 grams/ 1000 ml
1 hour
2 hours
3 hours
( see note
for rate of infusion).
NS / D5W

Manufacturer recommends 20 mg/ml as the maximum concentration, however, some studies have used concentrations up to 100 mg/ml. Supplied: 5 g/20ml & 24g/96ml vials. Treatment of acute bleeding syndromes: Usual dose: 4-5 grams IV during the first hour followed by a continuous infusion: 1 to 1.25 grams/hour. Maintenance doses may be given ivpb (Exp: 3 grams ivpb q3h etc). Doses above 30 grams/24 hours are not recommended.
AMINOPHYLLINE 0-250 mg/ 50 ml   (loading dose)
251-500 mg/ 100 ml    loading dose
500 mg/ 500 ml   (standard)
500 mg/ 250 ml    (fluid restricted)
30 min
30 min
D5W / NS

EXP: 1 day (Room temp).  Maximum rate: 25 mg/min. IV loading: 5 mg/kg TBW based on theophylline or 6 mg/kg based on aminophylline. Previous therapy: [Loading dose= 0.5 L/kg TBW x (desired level - current level)]    IV maintenance dose based on IBW and theophylline. For aminophylline dosing divide result by 0.8.      Adult non-smoker: 0.4 mg/kg/hr       Adult (smoker): 0.7 mg/kg/hr      Elderly (smoker): 0.5 mg/kg/hr          Elderly (non-smoker)/ CHF/ Liver disease: 0.2 mg/kg/hr.       Obtain level 24-48 hours after initiation of therapy.  Average half-life: 3 to 12 hrs.  Vd: 0.5 L/kg.  Therapeutic range: 5-20 mcg/ml.   IVPB is the least desirable route of admin. It is less effective than a continuous infusion. IVPB-cyclic improvement is seen at the peak with a rapid decline towards the trough.
720 mg/ 500 ml  (glass bottle)
900 mg/ 500 ml   (glass bottle)
(an in-line 0.22 micron filter should be used).
10 min
See note
See note

Recommended concentration: 1-6 mg/ml. Central line is req'd for concentrations > 2 mg/ml. 
[Supplied: 3 ml amp (50 mg/ml)]. 
Infusion: whenever possible administer through a central venous catheter. Also, an in-line filter should be used during administration. Cordarone I.V. concentrations greater than 3 mg/mL in D 5 W have been associated with a high incidence of 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. Cordarone I.V. infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W. Use of evacuated glass containers for admixing Cordarone I.V. is not recommended as incompatibility with a buffer in the container may cause precipitation.
Amiodarone: I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. 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: First Rapid:  150 mg over the FIRST - 10 minutes (15 mg/min).  Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D 5 W. Infuse 100 mL over 10 minutes. 
Followed by Slow:  360 mg over the NEXT  6 hours (1 mg/min).  Add 18 mL of Cordarone I.V. (900 mg) to 500 mL D 5 W (conc = 1.8 mg/mL). 
Maintenance infusion:  540 mg over the REMAINING  18 hours (0.5 mg/min).
After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL (Cordarone I.V. concentrations greater than 2 mg/mL should be administered via a central venous catheter). In the event of breakthrough episodes of VF or hemodynamically unstable VT, Give 150-mg/100 ml D5W over 10 minutes to minimize potential for hypotension.  The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression.  The initial infusion rate should not exceed 30 mg/min. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function. There is limited experience in patients receiving Cordarone I.V. > 3 weeks. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. INFUSION 
Duration of Cordarone I.V. Infusion*: <1 week
Initial Daily Dose of Oral Cordarone : 800-1600 mg
Duration of Cordarone I.V. Infusion: 1 to 3 weeks
Initial Daily Dose of Oral Cordarone : 600-800 mg

Duration of Cordarone I.V. Infusion: >3 weeks
Initial Daily Dose of Oral Cordarone : 400 mg
 *Assuming a 720 mg/day infusion (0.5 mg/min). Cordarone I.V  is not intended for maint therapy.
Restated:  Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ;  >3 weeks: 400mg po qd initially. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days);
Administration of Cordarone in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs.) If side effects become excessive, the dose should be reduced.
Loading Dose (Daily): (Ventricular Arrhythmias)  800 to 1,600 mg x 1-3 weeks, then 600 to 800 mg x ~1 month, then start maintenance of 400mg/day. 
Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant.
AMPHOTERICIN B 1 mg/ 10 ml
Central line: 0.25 mg/ml
(higher concentrations possible)
4-6 hours D5W

EXP: 1 Day (RT).  Label:  REFRIGERATE.  Precipitates in normal saline or solution with bacteriostatic agent. Test dose: 1 mg/20 ml D5W over 10-30 min. Monitor Temp, pulse, RR and BP q30min x 4 hours. Dosing: initially  0.25 to 0.3 mg/kg (possibly up to 0.5 mg/kg for life threatening infections). Increase as tolerated on the following days to 0.5 to 1.0 mg/kg/day or 1.5 mg/kg qod. If central line is used, may increase concentration up to 0.25 mg/ml. Bladder irrigation: add 10-50mg to 1000ml sterile water. Instill 200-300ml into bladder then clamp off for 60-90min, then allow bladder to drain-then repeat. Continue treatment for 2-5 days.
350 mg/280 ml
400 mg/ 320 ml
Minimum dilution: 300mg/ 90ml
2 hours D5W

EXP: 15 hours (REF).  Standard concentration: 1 mg/ml Minimum dilution: 2 mg/ml Supplied: 100mg/20ml vial. Indications: treatment of aspergillosis in patients who are refractory to or intolerant of conventional ampho B treatment. Dosing: 5 mg/kg given as a single infusion once daily.
AMPICILLIN 0 - 1 gram/ 50 ml
Over 1 gram/ 100 ml
30 min NS

EXP: 8 hours (RT); 3 Days (REF).  Label:REFRIGERATE.   Max rate: 100mg/min.   IM injection: 500mg/ 1.8 ml;  1 gram/ 3.5 ml;     2 grams/ 6.8 ml H20 or BS-H20. Injection site: Intragluteal or lateral aspect of thigh.  Dosing: Mild to moderate infection: 500mg to 2g ivpb q6h. Severe infection: 2g ivpb q4h (150-200mg/kg/day).  Renal Dosing:>50/ q6h || 10-50/ q6-12h || <10/ q12-24h || Hemodialysis: Dose after dialysis || PD: 250mg q12h.


0 - 1.5 grams/ 50 ml
Over 1.5 grams/ 100 ml
30 min NS

EXP: 1 DAY (RT) / 3 Days (REF).  Label: Refrigerate.  IM injection: 1.5 gram/ 3.2 ml of SW or 0.5-2% lido. 3 gram vial/ 6.4 ml. Renal dosing: >30/ q6-8h || 15-29/ q12h || 5-14/ q24h. Dosing:1.5 to 3g ivpb q6h
ATRACURIUM (TRACRIUM) 100 mg/ 100 ml
250 mg/ 100 ml
1000 mg/ 250 ml
(Usual concentration: 0.2 to 5 mg/ ml)
Titrate D5W  / NS

EXP: 24 hours (RT/REF).   May be given undiluted by IV bolus.  IMPORTANT NOTE: Use Ideal body weight in obese patients, otherwise use actual body weight.   Dosing (adult): initial bolus of  0.4 to 0.5 mg/kg IV bolus, followed by  0.08 to 0.1 mg/kg q20-45 min after initial dose. Continuous infusion: initial IV bolus of  0.4 to 0.5 mg/kg, followed by an initial infusion rate of 5 to 10 mcg/kg/min initially. Maintenance infusion rates of 5 to 9 mcg/kg/min are usually adequate. (Range: 2 to 15 mcg/kg/min). Toxic metabolite (laudanosine) may accumulate in renal failure. [Supplied: 50 mg/5 ml ; 100 mg/10ml vial]
AZITHROMYCIN (ZITHROMAX) 500 mg/ 250 ml 60 min D5W  / NS

EXP: 24hrs (RT)  ;   7 Days (REF). Label: refrigerate. Dosing: Community acquired pneumonia: 500 mg ivpb once daily for 2-5 days, followed by 500mg orally once daily x 7 to 10 days.
AZTREONAM (AZACTAM) 0 - 1 gram/ 50 ml
Over 1 gram/ 100 ml
30 min
60 min
D5W  / NS

EXP: 1 Day (RT);    7 Days (REF).   Label: Refrigerate.   May be given IM (preparation):  500mg/1.5 ml; 1 gram/ 3 ml; 2 grams/6 ml H20, BS-H20, NS. Greater volumes may be used. Usually restricted to one of the following: (1) Gram negative infections (primarily Pseudomonas) in penicillin allergic patients. (2) Patients at increased risk of aminoglycoside toxicity (poor renal function or rapidly changing renal function) with a gram negative infection. ***Lacks anaerobe coverage***     Dosing: Mild infection (i.e. UTI): 500mg to 1g ivpb q8-12h. Usual dose: 1-2g ivpb q8-12h. Severe or life threatening: 2g ivpb q6-8h. Max 8g/day.   Renal Dosing:>30/ no change || 10-30/ 50% of usual dose q6-8h || <10/ 25% of usual dose q6-8h || HD/PD: see <10 guidelines. (HD: 500mg AD) Give loading dose of 1-2g before starting regimens above.

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