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Latest Intravenous Dilution Guidelines


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Outdated Guidelines - Use newer guidelines above

*Preferred solution is listed first.
Dilution List     [ C ]
This document Copyright © 2005-06  D.McAuley, GlobalRPh Inc. All Rights Reserved.
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Calcium Chloride
Calcium Gluconate
Caspofungin Acetate (Cancidas)
Cefazolin
Cefepime (Maxipime)
Cefotetan
Cefotaxime
Cefoxitin
Ceftazidime (Fortaz)
Ceftriaxone (Rocephin)
Cefuroxime
Chloramphenicol
Chlorpromazine (Thorazine)
Cimetidine
Ciprofloxacin
Cisatracurium (Nimbex)
Clindamycin
Corlopam (Fenoldopam)
Drug Standard  Dilution Infusion Rate Diluents*
CALCIUM CHLORIDE See updated guidelines   D5W  / NS
Stability/Misc.


1 gram= 13.6 meq/10 ml. Normal range: 8.4 to 10.2 mg/dl     Ionized Ca++: 1.19 to 1.29.     Maximum IV rate: 100mg (1 ml)/ min.   Too rapid injection may decrease BP/ cardiac syncope.  
 
CALCIUM GLUCONATE See updated guidelines   D5W  / NS
Stability/Misc.

1 gram= 4.65 meq (93 mg) 10 ml.  Maximum IV rate: 1.5 ml/min or approximately 1 gram/ 7 minutes Too rapid injection may decrease blood pressure or cause cardiac syncope. Calcium administration: (Onset: rapid   Duration: 30min to 2 hours. ).  Recommended only in cases of hyperkalemia, hypocalcemia, or calcium antagonist blockade. Treatment of hypocalcemia: Acute hypocalcemic tetany (unless induced by alkalosis): give 1 gram calcium gluconate IV over 5 - 15 minutes. After 1-2 hours may be necessary to repeat dose or add 2-3 grams calcium gluconate to 250-500ml and infuse over 12-24hours. Alternatively: Symptomatic patient: give 1 gram calcium gluconate over 5 - 15 minutes q1-2hours. If Tetany returns after 6 hours (3 grams calcium gluconate  given) start continuous infusion [5-10g of calcium gluconate /1000 ml D5W infused at rate to prevent tetany-usually 30 to 100 ml/hr]. Make sure magnesium levels are corrected first - patients with hypocalcemia and hypomagnesemia will not respond to calcium replacement.  Alternative therapy: give 0.3 to 2 mg elemental calcium/kg/hour as a continuous infusion.   Asymptomatic patient: 1 gram calcium gluconate IV q6-12h with careful monitoring of Ca++ levels.  Monitoring: during intensive therapy, monitor calcium levels at least twice daily. Differentiation of hypoparathyroidism vs Vitamin D deficiency: Hypoparathyroidism: Decreased serum Ca++/serum PO4 increased/Alk phos normal.  Vitamin D deficiency: decreased Ca++ & PO4/ Alk phos increased. 
 
CASPOFUNGIN ACETATE (CANCIDAS) 35 to 75 mg/ 250 ml 1 hour NS
Stability/Misc.

Stability: 24 hours RT / REF. Label: Refrigerate. Vials are stored in the refrigerator. Reconstitution: 50 and 70 mg vial: add 10.5 ml normal saline. Transfer 10 ml of the reconstituted solution to 250ml normal saline IV bag. If using two 50mg vials to obtain the 70mg loading dose, add 10.5 ml to each vial and then withdraw 14 ml of the reconstituted solution to 250ml normal saline IV bag. Patients who are fluid restricted: 50mg dose may be added to 100 ml normal saline. Hepatic dosing: Patients with moderate hepatic insufficiency should receive 35mg once daily. To prepare this dose, reconstitute the 50mg vial with 10.5 ml and then withdraw 7 ml from the vial and transfer this to 250ml normal saline. Dosing: 70 mg loading on day 1, followed by 50mg once daily thereafter. Patients with moderate hepatic insufficiency should receive the 70mg loading dose on day 1, and then 35mg IV once daily thereafter. Indications: treatment of invasive aspergillosis in patients who are refractory to or intolerant of other therapies (ampho B, itraconazole etc.).
 
CEFAZOLIN (ANCEF) 0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Pre-pack [1 gram-iso D5W 50ml]
30 min D5W  / NS
Stability/Misc.

EXP: 2 Days (RT)/   4 Days (REF).   Label: Refrigerate.   Maximum dose/day=12 grams. IM injection: 500mg/ 2 ml; 1 gram/ 2.5 ml H20/BS-H20. Usual dosage: 500mg to 1g ivpb 8h. Severe: 1.5g ivpb q6h. Life threatening: 6-12g/day.  Renal dosing: >55/q6-8h || 35-54/q8h || 11-34/ 50% usual dose q12h || <10 ml/min/ 50% to full dose q24-48h. || Hemodialysis: 0.5-1g after dialysis
 
CEFEPIME HCL (MAXIPIME) 0 to 2 grams/ 50 ml 30 min D5W  / NS
Stability/Misc.

EXP: 24 hr (RT)/ 7 Days (REF).  Label: Refrigerate.   IM Injection: 500mg vial/ 1.3 ml; 1 gram vial/ 2.4 ml (Sterile H2O; BS-SW; Lidocaine 0.5 to 1%; Normal saline). Mild to moderate infection: 500mg to 2g ivpb q12h. Severe: 2g ivpb q8h.  Renal Dosing: >60/ 0.5-2g q12h || 30-60/ 0.5g-2g q24h || 11-29/ 0.5g-1g q24h || <10/ 250-500mg q24h or 0.5-2g q48h. || HD: 1g AD || PD: 1-2g q48h
 
CEFOTAXIME (CLAFORAN) 0-2 grams/ 50 ml 30 min D5W  / NS
Stability/Misc.

EXP: 1 day (RT / 5 days (REF).  Label: Refrigerate.  Mild infection: 1-2g ivpb q12h. Moderate: 1-2g ivpb q8h; Severe: 2g ivpb q6-8h; Life threatening: 2g ivpb q4h (Max dose/day= 12g).  Renal dosing: >50/ Usual dose || 10-50/ q8-12h || <10/ q24h || HD: 0.5 to 2g ivpb q24h AD. || PD: 1g ivpb q24h.
 
CEFOTETAN (CEFOTAN) 0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
30 min D5W  / NS
Stability/Misc.

EXP: 1 DAY (RT);   4 DAYS (REF). Label: Refrigerate.    Maximum dose: 3 grams ivpb q12h.  Do not exceed q12h interval.   IM injection: 1 gram/ 2 ml; 2 grams/ 3 ml SW /BS-SW /NS /0.5 to 1% lidocaine. Usual dose: 1g ivpb q12h. Severe: 2-3g ivpb q12h. (Max 6g/day).  Renal dosing: >30/ Usual dose || 10-30/ 50% of dose q12h || <10/ 25% of dose q12h.|| Hemodialysis or PD: 50% of usual dose q24h
 
CEFOXITIN (MEFOXIN) 0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
30 min D5W  / NS
Stability/Misc.

EXP: 1 Day (RT)/ 7 Days (REF). Label: Refrigerate.   IM injection: 1 gram/ 2ml ; 2 grams/ 4 ml. (Sterile water or lidocaine 0.5-1%). Usual dose 1g q6-8h. Moderate-severe: 2g q6-8h. Severe: 2g q4h.  Renal dosing: 10-50/ q8-12h || <10/ q24-48h || HD: give 1g after Dialysis: e.g. Give Cefoxitin 1 gram ivpb M-W-F after dialysis + a supplemental dose on Sunday.
 
CEFTAZIDIME (FORTAZ) 0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Prepack:1&2 grams/ iso D5w 50ml
30 min D5W  / NS
Stability/Misc.

EXP: 1 DAY (RT) ;  7 DAYS (REF) Label: Refrigerate.   Maximum dose: 2 grams ivpb q8h.   IM injection: 500mg/ 1.5 ml;   1 gram/ 3 ml SW / BS-SW  / 0.5-1% lidocaine. (Intragluteal or lateral aspect of thigh). Usual dose: 1g ivpb q8-12h. Severe: 2g ivpb q8-12h. (Max dose/day= 6 grams).  Renal dosing: Crcl 30-50/ q12h   ||  10-30/ q24h  || <10/ q48h
 
CEFTRIAXONE (ROCEPHIN) 0 to 1 gram/ 50 ml
Over 1 gram/ 100 ml
Prepack:1&2 grams/ iso D5w 50ml
30 min D5W  / NS
Stability/Misc.

EXP: 1 DAY (RT) / 10 DAYS (REF). Label: Refrigerate.   Total daily dose should not exceed 4 grams.  IM injection preparation: 250 mg/ 0.9 ml; 500mg/ 1.8 ml; 1 gram/3.6 ml; 2grams/ 4.2 or 7.2 ml H20;BS-H20; 0.5 to 1% lidocaine.  Usual dose: 1-2g ivpb q24h. Severe: 2g ivpb q12h.  No dosage adjustments req'd in renal failure. PD: 750mg ivpb q12h
 
CEFUROXIME (ZINACEF) 0 to 750 mg/ 50 m
Over 750 mg/ 100 ml
30 min D5W  / NS
Stability/Misc.

EXP: 1 DAY (RT) ;   7 DAYS (REF).  Label: Refrigerate.   IM injection: 750 mg vial/ 3ml SW.  Usual: 750mg to 1.5g ivpb q8h. Severe: 1.5g ivpb q6-8h.  Renal Dosing: >20/q8h || 10-20/ q12h || <10/ 750mg q24h. || Hemodialysis: Give single dose after dialysis or give 750mg q12h. || PD: 750mg-1.5g q24h. 
 
CHLORAMPHENICOL
(CHLOROMYCETIN)
0 to 2 grams/ 50 ml
Over 2 grams/ 100 ml
30 min
60 min
D5W  / NS
Stability/Misc.

EXP: 1 DAY (RT). Supplied: 1 gram vial (Powder)-dilute with 10 ml. Dosing: 12.5 to 25 mg/kg q6h IVPB. Reduce dose in hepatic disease.
 
CHLORPROMAZINE (THORAZINE) 25 mg/ 100 ml
50 mg/ 100 ml
30 min
50-60 min
NS / D5W
Stability/Misc.

EXP: 1 DAY (RT).  Label: Do not refrigerate// Monitor BP closely.   The IV route is very irritating and should be reserved for severe cases only (intractable hiccups-- oral or IM dosing were not effective). Intractable hiccups: (1) 25 to 50 mg po tid -qid. (2) 25-50mg IM if hiccups persist for 2-3 days (3) Last choice: slow IV infusion: 25- 50mg/500- 1000 ml NS. If irritation at the IM injection site is a problem use the dilution listed at the beginning. IV therapy should be reserved for recumbent patients because of the potential for severe hypotension.
 
CIMETIDINE (TAGAMET) 0 to 300mg/ 50 ml
400 mg/ 100 ml
900 mg/ 100 to 250 ml
901 to 2400mg/ 250 to 1000 ml
30 min
30 min
24 hours
24 hours
NS / D5W
Stability/Misc.

EXP: 7 DAYS (RT/REF). Patients requiring > 300mg/dose may be a good candidate for continuous infusion.   Renal dosing: >40/ q6h; 20 to 40/ q8h; 5 to 20/q12h; <5/200 mg q12h.  Tagamet may be given IM.
 
CIPROFLOXACIN (CIPRO) 200 mg/ 100 ml
400 mg/ 250 ml
Pre-pack: 400mg/ 200 ml D5W
60 min D5W
Stability/Misc.

EXP: 14 DAYS (RT/REF).  Cipro 400mg ivpb produces the same levels as 500mg tablet. Oral dosing: 250-750mg po q12h; cystic fibrosis: 750mg po q8h. IV dosing: 200-400mg ivpb q12h. Febrile neutropenic patient: 400mg ivpb q8h.  Renal dosing: >50/ no change || 10-50/ 50-75% of usual dose q12h || <10/50% of usual dose q12. Alternatives: [200mg ivpb or 250mg po q12h] or [400 mg ivpb or 500mg po q24h]. || HD/PD: 250-500mg po or 200-400mg ivpb q24h AD or 200mg ivpb or 250mg po q12h.
 
CISATRACURIUM (NIMBEX) New hospital  standard (Detroit VA)
(Use 200mg/20ml vials) 
200 mg/ 180 ml  (Total volume=200 ml)
or 100 mg/ 90 ml  (Total volume =100 ml)
40 mg/ 80 ml (Total volume=100 ml)
100 mg/ 200 ml (Total volume=250 ml)
200 mg/ 400 ml (Total volume=500 ml)
(Concentration= 0.4 mg/ml)*
Titrate NS / D5W
Stability/Misc.



EXP: 1 DAY (RT/REF). [Supplied: 10mg/ 5ml and 20 mg/10 ml vials (In refrigerator)]. Usual dilution: 0.1 to 0.4 mg/ml. Dosing: Intermittent: initial dose: 0.15 to 0.2 mg/kg IV bolus followed by 0.03 mg/kg IV q40-60min. Continuous infusion:  0.1 to 0.2 mg/kg IV bolus followed by 1 to 3 mcg/kg/min. The average infusion rate for long term use in the ICU is approximately 3 mcg/kg/min (range: 0.5 to 10.2 mcg/kg/min). In some cases, re-administration of the bolus dose may be req'd while titrating. Dosage reductions are not required in renal or hepatic failure. 
Drug of choice in the following cases (1) hemodynamically significant increases in HR (e.g. >20%) while paralyzed with pancuronium or MAP>110. (2) Concurrent corticosteroid administration (>72hrs) (3) Significant renal dysfunction (CRCL < 30 ml/min)    (4) History of asthma or bronchospasm.
 
CLINDAMYCIN (CLEOCIN) 0 to 600 mg/ 50 ml
Up to 1200 mg/ 100 ml
30 min
40 to 60 min
D5W / NS
Stability/Misc.

EXP: 2 DAYS (RT) / 10 DAYS (REF).  Label: Refrigerate.   Maximum dose/day: 4800 mg.   May be given IM.  Usual oral dose: 150-450mg  po q6h. Usual IV dose: 600mg ivpb q6-8h or 900mg ivpb q8h. Maximum daily dose= 4800mg.  Renal Dosing: No dosage adjustments req'd for renal failure
 
CORLOPAM (See Fenoldopam)      
 

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The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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