Latest Intravenous Dilution Guidelines

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*Preferred solution is listed first.
Dilution List     [ L ]
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Labetalol (Normodyne)
Lepirudin (Refludan)
Levofloxacin (Levaquin)
Levothyroxine (Synthroid)		 Lidocaine
Linezolid
Lorazepam (Ativan)
Drug Standard  Dilution Infusion Rate Diluents*
LABETALOL (NORMODYNE) 200 mg/ 160 ml (1 mg/ml)  (Total volume=200ml)
300 mg/ 240 ml (1 mg/ml)  (Total volume=300ml)
600 mg/ 480 ml (1 mg/ml)  (Total volume=600ml)		 Titrate D5W / NS
Stability/Misc.

 EXP: 1 DAY (RT)   Label: Concentration= 1 mg/ ml      Supplied: 100 mg/20 ml vial.  Dosing: initially 20 mg IV push over 2 minutes. May repeat 20 to 80 mg q10 minutes (up to 300 mg total dose) until desired BP is reached or start continuous infusion: 2 mg/min (range: 1 to 3 mg/min)--titrate to blood pressure.
LEPIRUDIN (REFLUDAN) 100 mg / 250 ml
(Concentration: 0.4 mg/ml)
100 mg/ 500 ml
 (Concentration: 0.2 mg/ml)		 UD D5W / NS
Stability/Misc.




 EXP: 1 DAY (RT).  Recombinant hirudin derived from yeast cells. Used for treatment of disseminated intravascular coagulation, in particular heparin-induced thrombocytopenia type II. Mechanism of action: reacts with thrombin in a 1:1 molar ratio to form a noncovalent complex; directly inhibits all actions of thrombin. There is no physiologic inhibitor of lepirudin. Lepirudin provides more stable level of anticoagulation than heparin. Lepirudin does not require endogenous cofactors and acts independently of antithrombin-III.  Preparation: Bolus dose: use concentration of 5 mg/ml. Dilute 50mg vial with 1 ml NS or sterile water, then transfer to at least 10 ml syringe and qs to 10ml with sterile water, NS or D5W. Continuous infusion: Dilute two 50mg vials, each with 1 ml sterile water or NS and add to 250 or 500ml bag of D5W or NS. (Concentration: 0.2 or 0.4 mg/ml) Stability: 24hr (RT).
LEVOFLOXACIN (LEVAQUIN) 250 mg/ 40 ml
500 mg/ 80 ml		 60 min D5W / NS
Stability/Misc.

 EXP: 3 DAYS (RT) / 14 DAYS (REF). Label: Refrigerate. Usual dose: 500mg orally or ivpb q24h. UTI or pyelonephritis: 250mg orally/ivpb q24h.  Renal dosing: >50/ no change || 20-49/ 500mg x 1 then 250mg q24h || <19/HD/PD: 500mg x 1 then 250mg q48h
LEVOTHYROXINE (SYNTHROID) Prescribed dose/ 50 ml 10-15 min NS
Stability/Misc.

 Mix on floor just prior to administration.  Normally given IVpush.
LIDOCAINE (XYLOCAINE) 2 grams/ 250 ml
(1 to 2 grams/ 250 to 500 ml)		 Titrate D5W / NS
Stability/Misc.

 Maximum concentration: 8 mg/ml    Dosing: Treat  Vtach / V fib: 50 to 100mg (1 to 1.5 mg/kg) IV bolus (25 to 50 mg/min) Decrease by 50% in elderly/CHF/Hepatic disease. Repeat bolus q3 to 5min until arrhythmia subsides or side effects (convulsions/hypotension/bradycardia). Do not exceed 3 mg/ kg bolus in a 1 hour period. IV infusion: 1 to 4 mg/ min. Calculation of drip rate: 1 gram/250 ml (ml/hr) = mg/min x 15. Decrease rate by 50% after 24 hours.
LINEZOLID (ZYVOX) 600 mg/ 300 ml 
400 mg/ 200 ml
    (Pre-made) 		60 minutes
(range: 30 to 120 minutes)		 Isotonic D5W
(Pre-made)
Stability/Misc.

 Usual dose: 600 mg q12 hours for 10 to 28 days.  Store at room temperature / Protect from light / Do not freeze.  Dosage adjustment not required in renal failure.  ZYVOX has been shown to be clinically active against key Gram-positive pathogens, including vancomycin-resistant strains of Enterococcus species (VRE).
LORAZEPAM (ATIVAN) Dilutions for 2 mg/ ml vials (1:1 Dilution):
20 mg/ 20 ml (total vol) = 1 mg/ml
  (withdraw 40 ml from 50ml bag)
40 mg/ 40 ml (total vol) = 1 mg/ml
 (withdraw 30 ml from 50 ml bag)
80 mg/ 80 ml (total vol)= 1 mg/ml
 (withdraw 10 ml from 50 ml bag)
40 mg/250 ml (glass-250ml D5W)

Dilutions for 4 mg/ ml vials:
40 mg/ 20 ml (total vol) = 2 mg/ml
  (withdraw 40 ml from 50ml bag)
80 mg/ 40 ml (total vol) = 2 mg/ml
 (withdraw 30 ml from 50 ml bag)
160 mg/ 80 ml (total vol)= 2 mg/ml
 (withdraw 10 ml from 50 ml bag)
40 mg/250 ml (glass-250ml D5W) 		Titrate NS / D5W
Stability/Misc.

 EXP: 1 DAY (RT)    Label: Do not Refrigerate /An in-line 0.22u filter should be used.     Concentrations recommended by the manufacturer: 0.1 , 0.16, or 0.2 mg/ml.   May also dilute 4 mg/ml and 2 mg/ml vials 1:1 with D5W or NS. Do not send if solution is yellow or contains a precipitate. Maximum infusion rate: 2 mg/min.  Dosing: Status epilepticus: 4 mg IV push (range: 2 to 8 mg). May repeat q5 to 15 minutes.  //  Monitor patient for acidosis.
 
 

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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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