| Drug |
Standard
Dilution |
Infusion
Rate |
Diluents* |
|
*Preferred solution is listed first.
|
ABCIXIMAB
(REOPRO) |
9
mg (4.5 ml) / 250 ml
|
UD |
NS
/ D5W |
Stability/Misc.
|
| 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.
Preparation:
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 |
Stability/Misc.
|
EXP:
1 day (RT). Dilute 500mg vials with at least 5ml.
Recommended route: IVPush (100-500mg/min) |
| |
ACETYLCYSTEINE
(ACETADOTE ®) |
| Usual
Diluents |
| D5W |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
Acetaminophen
Overdose:
Adult Loading dose:
[150mg/kg] [200 ml] [15 min]
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/Misc.
|
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 |
Stability/Misc.
|
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 |
Stability/Misc.
|
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 |
UD |
NS
/ D5W |
Stability/Misc.
|
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 |
Stability/Misc.
|
EXP:
1 day (RT) 7 days (REF). Label: Refrigerate. (See
under gentamicin for dosing guidelines) |
| |
AMINOCAPROIC
ACID
(AMICAR) |
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 |
Stability/Misc.
|
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
Titrate
Titrate |
D5W
/ NS |
Stability/Misc.
|
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. |
| |
| AMIODARONE
(CORDARONE) |
150
mg/ 100 ml
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 |
D5W |
Stability/Misc.
|
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 |
Stability/Misc.
|
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. |
| |
| AMPHOTERICIN
B LIPID COMPLEX
(ABELCET) |
300
mg/ 240 ml
350 mg/280 ml
400 mg/ 320 ml
Minimum dilution: 300mg/ 90ml |
2
hours |
D5W |
Stability/Misc.
|
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 |
Stability/Misc.
|
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. |
| |
|
AMP/SULBACTAM
(UNASYN) |
0
- 1.5 grams/ 50 ml
Over 1.5 grams/ 100 ml |
30
min |
NS |
Stability/Misc.
|
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 |
Stability/Misc.
|
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 |
Stability/Misc.
|
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 |
Stability/Misc.
|
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. |
| |
|
References
Disclaimer
|
