| Drug |
Standard
Dilution |
Infusion
Rate |
Diluents* |
| DAKINS
SOLUTION |
Full Strength
(0.5%) |
|
|
Stability/Misc.
 |
Remove 120 ml from 1
liter sterile water irrigation bottle. Add 100ml bleach (sodium
hypochlorite) plus 20 ml sodium bicarbonate. -
Label: External Use Only -
|
| |
DANTROLENE
(DANTRIUM) |
20 mg vial/ 60 ml
sterile water without a bacteriostatic agent |
Bolus |
|
Stability/Misc.
|
Dantrium is given by
direct injection and is incompatible with D5W or normal saline. Prepare just before
use. EXP: 6hours (RT). Treat severe muscle rigidity: 1 mg/kg rapid
IV push, may
repeat q1-3 minutes until muscle relaxation or total dose of 10 mg/kg. When patient can
tolerate po may substitute 1-2 mg/kg orally 4 times daily. If refractory (NMS) consider
adding bromocriptine 5 mg tid initially-if response is inadequate, increase dose
rapidly to max of 10-20 mg orally every 6 hours. Discontinue when patient improves or CPK
(normal).
Prevention of malignant hyperthermia: 2.5 mg/kg IV over 1 hr approximately 75
minutes prior. |
| |
DAPTOMYCIN
(CUBICIN) |
| Usual
Diluents |
| NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
| [(4 mg/kg) /50 ml] [30
min] |
|
Stability/Misc.
|
DOSAGE
AND ADMINISTRATION
Complicated Skin and Skin Structure Infections: CUBICIN 4 mg/kg should be
administered over a 30-minute period by IV infusion in 0.9% NACL q 24
hours x 7-14 days. Doses of CUBICIN higher than 4 mg/kg/day have not been
studied in Phase 3 controlled clinical trials. In Phase 1 and 2 clinical
studies, CPK elevations appeared to be more frequent when daptomycin was
dosed more frequently than once daily. Therefore, CUBICIN should not be
dosed more frequently than once a day.
Renal Dosing:
CrCl >= 30 ml/min: 4 mg/kg q24h
CrCl < 30 ml/min: 4 mg/kg q48h (Including patients receiving
hemodialysis or CAPD.)
PREPARATION: CUBICIN 250 mg vial: reconstitute with 5 mL of
0.9% NACL injection. 500 mg vial should be reconstituted with 10 mL
of 0.9% NACL injection. Reconstituted CUBICIN should be further diluted
with 0.9% sodium chloride injection (50ml) and infused over a period of 30
minutes.
SUPPLIED: CUBICIN is supplied in single-use vials containing either
250 or 500 mg daptomycin as a sterile, lyophilized powder.
STABILITY: Stability studies have shown that the reconstituted
solution is stable in the vial for 12 hours at
room temperature or up to 48 hours if stored under refrigeration at 2 to 8°C
(36 to 46°F). The diluted solution is stable in
the infusion bag for 12 hours at room temperature or 48 hours if stored
under refrigeration. The combined time (vial and
infusion bag) at room temperature should not exceed 12 hours; the combined
time (vial and infusion bag) under refrigeration
should not exceed 48 hours.
Compatible Intravenous Solutions: CUBICIN is compatible with 0.9%
sodium chloride injection and lactated Ringer’s injection. CUBICIN is
not compatible with dextrose-containing diluents.
STORAGE: Store original packages at refrigerated temperatures 2 to
8°C (36 to 46°F); avoid excessive heat. |
| |
| DESMOPRESSIN
(DDAVP) |
0
to 35 mcg/ 50 ml
|
15
to 30 min |
NS |
Stability/Misc.
|
Supplied: 4 mcg/ml-1 ml
vial. Indications: Hemophilia (increases factor VIII levels): 0.3 mcg/kg
in 50ml normal saline over 15-30 minutes. Diabetes insipidus: 2-4 mcg/day
IV push or SC.
Decrease bleeding following cardiac bypass: 0.3 mcg/kg ivpb. Provide short
term protection for uremic hemorrhagic tendency: 0.3 mcg/kg ivpb q8h x 2
doses (diminishing response). Greatly enhanced ADH activity. Less
vasopressor activity. Longer DOA. (Synthetic analog of vasopressin-posterior
pituitary hormone). ADH activity : Pressor activity [DDAVP: 2000-4000: 1
Vasopressin: 1:1] |
| |
| DEXAMETHASONE
(DECADRON) |
0 to 50 mg/ 50 ml
51 to 100 mg/ 100 ml |
30 min
UD |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT). Label: Do not Refrigerate/ protect from light. Dexamethasone my be given
ivpush undiluted (slowly). Spinal cord compression: 10 to 100mg (usually 10
mg) IV stat; followed by 4 to 24 mg IV q6h. Use larger doses (eg up to 100mg
initially)
in patients with profound or rapidly progressive neurologic injury, and lower
doses in patients with mild or equivocal signs. |
| |
| DIGOXIN
(LANOXIN) |
All
doses/ 50 ml |
15 min |
NS / D5W |
Stability/Misc.
|
Immediate use is
recommended. Minimum of a 4-fold dilution.
Loading dose: CHF:
8-12 mcg/kg in divided doses (q4-8h) over 12 to 24 hours. [Normally, give
50% of the total digitalizing dose in the initial dose, then give 25% of
the total dose in each of the two subsequent doses at 8 to 12 hr
intervals--Obtain EKG 6 hours after each dose to assess potential toxicity
(AV block, sinus bradycardia, atrial or nodal ectopic beats, ventricular
arrhythmias); Other: vision changes, confusion.]
If pt has renal
insufficiency give 6 to 10 mcg/kg IBW.
A-fib: 10 to
15 mcg/kg IBW given as above. (If given IVPush - administer over at least 5
minutes).
Maintenance dose: Digoxin clearance= [CRCL + 40] x 1.44 (add
20 instead of 40 if pt has CHF). Predicted Css= (Dose)
(0.65 to 0.8)/ Digoxin clearance. Alternatively, maintenance dose= Loading dose
x [0.14 x crcl / 500
] Avoid IM injections-can lead to severe pain (If it must be given by this
route, give deep IM followed by massage).
Monitoring: Obtain
blood samples at least 4 hours after IV dose and
6-8hours after oral dose.
Serum levels: 0.5 to 2.5 ng/ml Onset/peak:
IV: 5-30min/ 1-4hours
Oral: 1-2hours/ 2-8 hours. Time to steady state: 5-7 days (average)
ESRD: 15-20
days. Half-life: 38-48 hours. (anephric: 4-6 days). Conversion from
oral to IV: Decrease IV dose by 20 to 25%. When the maintenance
dose is given IV, the onset and peak will occur earlier, however the
duration of action is the same. Patients' on the "floors" may
receive once daily IV maintenance doses, however, IV loading regimens
(multiple doses) are restricted to patients on a monitor- ICU's. [Oral
bioavailability (tablets): 70 to 80%]. |
| |
| DILTIAZEM
(CARDIZEM) |
125
mg (25 ml)/ 100 ml |
Titrate |
D5W /
NS |
Stability/Misc.
|
EXP: 1 DAY
(RT)
Label:
Refrigerate/ concentration= 1 mg/ ml. Dosing (A-fib/flutter) initially
0.25 mg/kg over 2
min. If inadequate give 0.35 mg/kg over 2 min-15 min after 1st dose.
Subsequent doses should be individualized. Continuous infusion: started
immediately following an effective bolus dose. Initial rate= 10 mg/hr
(some may respond to 5 mg/hr). If needed, may increase up to 15 mg/hr.
Contraindicated: AMI, hypotension (sys<90), 2nd & 3rd degree AV
block. |
| |
| DIPHENHYDRAMINE
(BENADRYL) |
0
to 100 mg/ 50 ml |
20
to 30 min |
D5W /
NS |
Stability/Misc.
|
EXP: 1 DAY
(RT). Maximum
dose/ 24 hours= 400 mg. Dosing: 10 to 50mg IM or IV q2 to 6h. |
| |
| DOBUTAMINE |
500 mg/ 250 ml
(0 to 1000 mg/ 250 ml) |
Titrate |
D5W /
NS |
Stability/Misc.
|
EXP: 1 DAY
(RT). Drip
rate (500mg/250 ml) ml /hr= wt(kg) x (mcg/min) x 0.03. Direct beta agonist
that increases cardiac output with little direct effect on BP. Uses: refractory
CHF or hypotensive patients in whom vasodilators cannot be used because of
effects on blood pressure. |
| |
| DOPAMINE |
400 mg/ 250 ml
800 mg/ 250 ml
(200 to 800 mg/ 250 to 500 ml) |
Titrate |
D5W /
NS |
Stability/Misc.
|
EXP: 1 DAY (RT). The
ICU's prefer 400 to 800mg/250 ml. Calculation of drip rate (ml/hr)
400mg/250 ml: wt(kg) x mcg/min x 0.0375. Refractory CHF: initially 0.5 to 2
mcg/kg/min Renal: 1 to 5 mcg/kg/min. Severely ill pt: initially 5 mcg/kg/min,
increase by 5 to 10 mcg/kg/min (q10 to 30 min) up to max of 50 mcg/kg/min. [0.5
to 2 mcg/kg/min-dopa; 2-10-dopa/beta; >10-primarily alpha. Used to
support BP, CO and renal perfusion in shock. |
| |
| DOXYCYCLINE
(VIBRAMYCIN) |
0 to 100 mg/ 100 ml
Up to 200 mg/ 250 ml |
1 hour
2 hours |
D5W / NS |
Stability/Misc.
|
EXP: 12 hours
(RT) / 3
DAYS (REF) Label: Refrigerate//protect from light Concentrations < 0.1
mg/ml or > 1 mg/ml are not recommended. Cannot be given IM. Usual
dose: 100mg po bid x1 f/b 100mg qd or divided bid (if severe: 100mg po
bid) or 100-200mg ivpb qd or divided doses q12h. No dosage adjustments
req'd for renal failure |
| |
| DROPERIDOL
(INAPSINE) |
1 to 3 mg/ 50 ml
4 to 10 mg/ 100 ml
25 mg/ 500 ml |
30 min
ud
ud |
D5W / NS |
Stability/Misc.
|
Label: Do not
Refrigerate. Marked sedation/ antiemetic.
Premedication: 2.5 to 10mg IV / IM. Usually 1.25 to 2.5 mg q3-6h prn.
Continuous infusion: 25 mg/500 ml D5W at 1 mg/hr initially for
treatment of
hyperemesis gravidarum (give 1 to 2.5 mg loading initially). May increase by
0.25 mg at 4hr intervals if patient not responding (usual range: 1 to 1.25
mg/hr). Also add benadryl 50mg q6h until infusion is stopped. When patient is
ready to take oral meds switch to Reglan 10mg qid + hydroxyzine 50mg. |
| |
| ENALAPRILAT
(VASOTEC) |
All
doses/ 50 ml |
15-20min |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT). The
dose for pt's being converted from oral to IV is the same. May also be
given IV push over 5 min. Ace inhibitor conversion: [Captopril 12.5mg] =
[lisinopril,fosinopril,quinapril,
benazepril 5 mg] = [enalapril,ramipril 2.5mg] //
25mg-10mg-5 mg;
50mg-20mg-10mg etc. |
| |
| EPINEPHRINE |
1
to 4 mg/ 250 ml |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Dosing: Continuous infusion: 1 to 4 mcg/min. Anaphylaxis (adult): 0.1 to 0.5 SC / IM (1:1000) repeat q10 to 15
minutes prn or give 0.1 to 0.25 mg IV (1:10,000) over 5-10min repeat q5 to
15 minutes
as needed or start continuous infusion: 1 to 4 mcg/min. Cardiac arrest: 0.5
to 1 mg bolus (1:10,000) q5min prn. May give 0.3 mg SC or
start continuous infusion
(range: 1 to 10 mcg/min). High dose epinephrine: 0.1 mg/kg q3-5 min;
Intermediate: 1 - 3 - 5 mg q3-5min.Calculation of drip rate (ml/hr) 1
mg/250 ml: mcg/min x 15. |
| |
| EPTIFIBATIDE
(INTEGRILIN) |
100 ml
vial (0.75 mg/ml)
100 ml vial (2.0 mg/ml)
Administer directly from vial. (No
dilution required)
|
UD |
|
| Stability/Misc.
|
Indications:
Treatment of patients with acute coronary syndrome (unstable angina or
Non-Q wave MI). Administration:
Bolus: withdraw dose from 10ml vial and give by ivpush over 1-2 minutes.
Continuous infusion: administer calculated rate directly from 100ml
vial. [Supplied: 0.75 mg/ml (100ml) vial; 20 mg/10 ml vial. (REF) ] Properties:
Onset: within 1 hr. // T1/2: 2.5 hours
// Platelet function restored in @ 4hours after discontinuation.
Acute Coronary Syndrome: The recommended adult dosage of eptifibatide in patients with acute coronary syndrome and normal renal function is an intravenous bolus of 180 µg/kg
(maximum: 22.6 mg) over 1-2 minutes as soon as possible following diagnosis, followed by a continuous infusion of 2.0 µg/kg/min
(maximum: 15 mg/hour) until hospital discharge or initiation of CABG surgery, up to 72 hours.
If a patient is to undergo a percutaneous coronary intervention (PCI) while receiving eptifibatide, the infusion should be continued up to hospital discharge, or
for up to 18-24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy. Concurrent aspirin
(160-325 mg initially and daily thereafter) and heparin therapy
(target aPTT 50-70 seconds) are recommended.
| Dosing adjustment in renal impairment:
Patients with CRCL less than 50 ml/min:
The recommended adult dosage of eptifibatide in patients with
acute coronary syndrome with an estimated CRCL <50 ml/min (using the Cockcroft-Gault
equation) is an IV bolus of 180 µg/kg (maximum: 22.6 mg) as soon as possible following diagnosis, immediately followed by a continuous infusion of 1.0
µg/kg/min
(maximum: 7.5 mg/hour). |
Percutaneous Coronary Intervention (PCI):
The recommended adult dosage of eptifibatide in patients with normal renal function is an intravenous bolus of 180 µg/kg
(maximum: 22.6 mg) over 1-2 minutes administered immediately before
the initiation of PCI followed by a continuous infusion of 2.0 µg/kg/min
(maximum: 15 mg/hour) and a second 180 µg/kg bolus (maximum: 22.6 mg) 10 minutes after the first bolus. Infusion should be
continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended. Concurrent aspirin (160-325
mg 1-24 hours before PCI and daily thereafter) and heparin therapy
(ACT 200-300 seconds during PCI) are recommended. Heparin infusion
after PCI is discouraged.
| Dosing adjustment in renal impairment:
Patients with CRCL less than 50 mL/min: The recommended adult dose of eptifibatide in patients with an estimated
CRCL < 50 ml/min (using the Cockcroft-Gault equation) is an IV bolus of 180 µg/kg (maximum: 22.6 mg) administered immediately before the initiation of the procedure, immediately followed by a continuous infusion of 1.0 µg/kg/min
(maximum: 7.5 mg/hour) and a second 180 µg/kg bolus (maximum: 22.6 mg)
administered 10 minutes after the first. In patients who undergo coronary artery bypass graft surgery, eptifibatide infusion should be discontinued prior to surgery. |
Use the Cockcroft-Gault equation with actual body weight to calculate
CRCL:
Males:
[ (140 – age) x (actual body wt in kg) ]
----------------------------------------
72 x (serum
creatinine)
Females:
[ (140 – age) x (actual body wt in kg) x (0.85)]
----------------------------------------------
72 x (serum creatinine) |
| Weight |
180 µg/kg
Bolus Volume |
2.0 µg/kg/min
Infusion Volume |
1.0 µg/kg/min
Infusion Volume (recommended in patients with serum creatinine between
2.0 and 4.0 mg/dL) |
| (kg) |
(lb) |
(from
2 mg/mL vial) |
(from 2
mg/mL
100-mL vial) |
(from 0.75
mg/mL
100-mL vial) |
(from 2
mg/mL
100-mL vial) |
(from 0.75
mg/mL
100-mL vial) |
| 37-41 |
81-91 |
3.4 mL |
2.0 mL/h |
6.0 mL/h |
1.0 mL/h |
3.0 mL/h |
| 42-46 |
92-102 |
4.0 mL |
2.5 mL/h |
7.0
mL/h |
1.3 mL/h |
3.5
mL/h |
| 47-53 |
103-117 |
4.5 mL |
3.0 mL/h |
8.0 mL/h |
1.5 mL/h |
4.0 mL/h |
| 54-59 |
118-130 |
5.0 mL |
3.5 mL/h |
9.0 mL/h |
1.8 mL/h |
4.5 mL/h |
| 60-65 |
131-143 |
5.6 mL |
3.8 mL/h |
10.0 mL/h |
1.9 mL/h |
5.0 mL/h |
| 66-71 |
144-157 |
6.2 mL |
4.0 mL/h |
11.0 mL/h |
2.0 mL/h |
5.5 mL/h |
| 72-78 |
158-172 |
6.8 mL |
4.5 mL/h |
12.0 mL/h |
2.3 mL/h |
6.0 mL/h |
| 79-84 |
173-185 |
7.3 mL |
5.0 mL/h |
13.0 mL/h |
2.5 mL/h |
6.5 mL/h |
| 85-90 |
186-198 |
7.9 mL |
5.3 mL/h |
14.0 mL/h |
2.7 mL/h |
7.0 mL/h |
| 91-96 |
199-212 |
8.5 mL |
5.6 mL/h |
15.0 mL/h |
2.8 mL/h |
7.5 mL/h |
| 97-103 |
213-227 |
9.0 mL |
6.0 mL/h |
16.0 mL/h |
3.0 mL/h |
8.0 mL/h |
| 104-109 |
228-240 |
9.5 mL |
6.4 mL/h |
17.0 mL/h |
3.2 mL/h |
8.5 mL/h |
| 110-115 |
241-253 |
10.2 mL |
6.8 mL/h |
18.0 mL/h |
3.4 mL/h |
9.0 mL/h |
| 116-121 |
254-267 |
10.7 mL |
7.0 mL/h |
19.0 mL/h |
3.5 mL/h |
9.5 mL/h |
| >121 |
>267 |
11.3 mL |
7.5 mL/h |
20.0 mL/h |
3.7 mL/h |
10.0 mL/h |
|
| |
ERTAPENEM
SODIUM
(INVANZ) |
| Usual
Diluents |
| NS only |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
| [1 gram] [50 ml] [30 min] |
|
Stability/Misc.
|
Stability:
6 hours RT / 24 hours REF. Label: Refrigerate.
Preparation:
(IV): Reconstitute 1 gram vial with 10 mL of Water for
Injection, 0.9% Sodium Chloride Injection, or Bacteriostatic Water for
Injection and then add contents to 50 ml normal saline. Complete the
infusion within 6 hours of reconstitution.
(IM): Reconstitute 1 gram vial with 3.2 mL of
lidocaine 1% injection without epinephrine. Give deep IM into a large
muscle mass (gluteal or lateral aspect of thigh). Administer solution
within 1 hour of preparation. DO
NOT give this solution Intravenously
Dosing: 1 gram IV or IM q24h.
Renal dosing:
CRCL: >/= 30 ml/min: no changes.
< 20-30 ml/min: 0.5 grams IM or IV q24h. |
| |
| ERYTHROMYCIN |
0 to 500 mg/ 100 ml
Up to 1000 mg/ 250 ml |
60 min
120 min |
NS |
Stability/Misc.
|
EXP: 1 DAY
(RT/REF). Label: Refrigerate. If D5W is used must neutralize
solution with sodium bicarbonate (0.5 meq/ 100ml). Usual oral dose: 500mg to 1g po q12h or 250mg
to 1g po q6h. Usual IV dose: 250mg to 1g q6h. Max 4 g/day. Renal
dosing: >10/ No change || <10/ 50-75% of usual
dose. Max 2g/day. || Hemo: no supplement. |
|
| ESMOLOL |
2.5 grams / 250 ml
5 grams / 500 ml |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT). Note:
the listed dilutions are for the 2.5 gram ampules. If the ampules are not
available, the 10 ml (10mg/ml) vials must be transferred to an empty
viaflex bag. Do not dilute the contents of the "vial," they are
pre-diluted. Dosing: PSVT: 500 mcg/kg over 1 min, then 50 mcg/kg/min x 4 to
5min. If heart rate not controlled, repeat load of 500 mcg/kg and increase
infusion to 100 mcg/kg/min. Repeat load and increase infusion q5 to 10min as
needed to max of 200 (up to 300?) mcg/kg/min. Watch blood pressure.
Calculation of
drip rate (ml/hr): 2.5 grams/250 ml: wt (kg) x mcg/min x 0.006 |
| |
