Intravenous Dilution guidelines for pharmacists. Drug list (M). By D.McAuley

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*Preferred solution is listed first.
Dilution List     [ M ]
This document Copyright © 2005-06  D.McAuley, GlobalRPh Inc. All Rights Reserved.
Magnesium Sulfate
Mesna (Mesnex)
Meropenem (Merrem)
Methyldopate (Aldomet)
Methylprednisolone (Solu Medrol)
Metoclopramide (Reglan)
Metoprolol (Lopressor)
Metronidazole (Flagyl)
Midazolam (Versed)
Milrinone (Primacor)
Drug Standard  Dilution Infusion Rate Diluents*
2 grams/ 100 ml
3 grams/ 100 ml
4 grams/ 250 ml
5 grams/ 250 ml
30 min
60 min
2 hours
3 hours
4 hours
D5W / NS

1 gram = 8.12 meq. Maximum rate: 1 gram/ 7 minutes.  Normal range:1.5 to 2.5 meq/L or 1.7 to 2.6 mg/dl.    Magnesium content: Mag Oxide: 49.6 meq/gram  ||  Mag Gluconate: 4.5 meq/gram  ||   MOM: @ 13.4 meq/5 ml
MANNITOL 12.5 grams/ 33 ml (15%)
25 grams/ 67 ml (15%)
50 grams/ 133 ml (15%)
12.5 to 100 grams/ empty viaflex
As directed D5W

Label: Do not Refrigerate.  Note: Diluted solutions of mannitol are less likely to crystallize, especially if the final concentration is less than 15%. An administration set with a filter should be used for infusions containing 20% or more of mannitol. At concentrations of 15% or greater, mannitol may crystallize at low temperatures. Dosing: Oliguria: 50 to 100 grams (15 to 25% solution) over 90 min to several hours. Test dose may be given: 12.5 g over 3 to 5 minutes. May repeat. Usual adult dosage ranges (50 to 200 g/ 24hrs).
[0.5 - 1 gram]  [100 ml]  [30 min]
(Minimum volume= 50 ml) 
30 min NS,   D5W

EXP: 2 hr (RT)/18 hours (REF) in saline. vs 8 hr stability in D5W. Label: Refrigerate. 
Reconstitute 500mg vial with 10 ml; 1 gram vial with 20ml. 
MESNA (MESNEX) Usual dose / 100 ml D5W or
 NS (over 15 min.)
(Concentration range: 1-20 mg/ml)
15-30 min D5W / NS

Dosing: usual dose=20% of ifosfamide dose given just before and 4 and 8 hours after ifosfamide (total=60%). May also be given as a continuous IV infusion concurrently with ifosfamide. Total daily dose= 60% to 160% of ifosfamide dose or 60% to 200% of cyclophosphamide dose.  May give 20% W/W 15min prior, and then q3hrs x 3-6 doses. Administration: IVPB in 50 ml or more of D5W or normal saline over 5 minutes or longer. Also by continuous IV infusion.   Storage/stability: Vials stored at RT.   Diluted solutions (1-20 mg/ml)-24 hrs (REF).   20 mg/ml (D5W)-48hrs RT; 1-mg/ml (D5W)-24 hours RT.   Preparation: May be further diluted in D5W, NS, D5/.45NS, or LR to a final concentration of 1-20 mg/ml. Availability: 2-,4-,10-ml ampules (100mg/ml)
METHYLDOPATE (ALDOMET) 0 to 500 mg/ 100 ml
over 500 mg/ 250 ml
60 min D5W

60 to 100 mg/ 50 ml
101 to 500 mg/ 100 ml
501 to 1250 mg/ 250 ml
(Spinal cord injury) Bolus dose (30mg/kg)/ 50 ml D5W over 15 min, pause 45min. Maintenance dose: 5.4 mg/kg/hr x 23. Dilute to 230ml (total volume) D5W. Infuse at 10 ml/hr x 23 hours.
(Methylpred dose/ 0.8 )=prednisone dose
30 min

EXP: 1 DAY (RT)   Label: Do not Refrigerate.     May be given IM, IVpush, or IVPB. High dose: 30 mg/kg over 30 min (may rpt q4-6h) in a 48hr period. Asthma: 2 mg/ kg q4 -6h until severe symptoms controlled, then reduce dose. MS acute exacerbation: 500 mg once daily x 5 days. PCP: 40 to 60 mg every 6 hours or pulse dosing: 250 to 1000mg once daily x 3 to 5 days. Spinal cord injury: 30 mg/kg (over 15 to 30 minutes) then 5.4 mg/kg/hr x 23 hours. (higher doses possible). 
(Upjohn): 125,250,500 mg/100ml D5W [ 1-1.25g/ 250ml D5W] [1.5 to 3g/50ml NS] [ 3 to 6g/100ml NS] [6 to 12g/200 ml normal saline--total volume] [7.5 to 15g/ 250 ml NS]
Medrol dose pack: (4mg tab # 21): Day#1: 2 tabs before breakfast, 1 tab after lunch & dinner, and 2 tabs at bedtime. (Total=6 tabs)  If received later in the day, may take all 6 tablets at once or in divided doses. Day#2: 1 tab before breakfast, 1 tab after lunch & dinner, and 2 tablets at bedtime. Day#3: Same as day#2 except 1 tab at bedtime.  Day#4: 1 tab before breakfast, after lunch and at bedtime. Day#5: 1 tab after breakfast and at bedtime. Day#6: 1 tab after breakfast.
METOCLOPRAMIDE (REGLAN) All doses / 50 ml 30 min D5W

EXP: 1 DAY (RT).     Dosing: GI hypomotility: 10mg (PO/IM/IV) 30min AC & hs.   Antiemetic: 1-2 mg/kg IV 30min prior to chemo, then q2-4hr.   Crcl [10-40]- decrease dose by 50%. [<10]--75% decrease
METOPROLOL (LOPRESSOR) 0 to 20 mg/ 50 ml
21 to 40 mg/ 100 ml
30 min
60 min
D5W / NS

EXP: 1 DAY (RT).     The dilutions listed are conservative guidelines that can be used in non-acute conditions. The infusion times were formulated to mimic the onset of an oral formulation. (@ onset-oral= 45-60min). 
Oral to IV conversion
(2.5 to 1) : eg 50mg oral=20mg IV (equivalent beta-blockade). Lopressor may be given by IV bolus (HR, BP, and EKG should be carefully monitored). IV therapy permits rapid control of HR and contractility. Post MI (early tx): 5 mg IV bolus x 3 doses q2 minutes. In patients who tolerate full 15 mg dose, oral lopressor 50mg po q6h should be started 15 min after last IV dose x 48 hours. Unstable angina: 5 mg IV bolus x3 q2min f/b 2 to 5 mg hourly titrated to min HR of 55 to 60 BPM or min systolic BP of 80 . May switch to oral dosing (50 to 100mg po q6h) after IV bolus therapy. Supraventricular tachycardias(PAT, A-fib/flutter): 5 to 15 mg (usually 5 mg) over 2.5 min at 7.5min intervals-usually a high response rate.
Over 500 mg/ 250 ml
60 min NS

Label: Do not Refrigerate. Reconstituted vials must be neutralized with 5 meq sodium bicarbonate for each 500 mg used. IV: 500mg or 7.5 mg/kg q6h (range: q6-12h --long T ½ ). Oral: 250-750mg orally three times daily. (occasionally twice daily). Max 4g/day.  Renal Dosing: > 10/ no change || <10/ 500mg ivpb q12h.
Usual Diluents
NS or D5W
Standard Dilutions   [Amount of drug]  [Infusion volume]  [Infusion rate]
[ 50 mg ] [ 100 ml] [ 1 hour]
[ 150 mg ] [100 ml] [1 hour]

Reconstitute each 50mg vial with 5 ml 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent).

Stability: 24 hours room temperature. Label: Protect from light. 

Indications: Treatment of patients with esophageal candidiasis: 150mg qd. Prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation: 50 mg qd.

The diluent to be used for reconstitution and dilution is 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent). Alternatively, 5% Dextrose Injection, USP, may be used for reconstitution and dilution of MYCAMINE. Do not mix or co-infuse MYCAMINE with other medications.

Reconstitution: MYCAMINE 50 mg vial:
Aseptically add 5 mL of 0.9% Sodium Chloride Injection, USP (without a bacteriostatic agent) to each 50 mg vial to yield a preparation containing approximately 10 mg micafungin/mL.

Dissolution: To minimize excessive foaming, GENTLY dissolve the MYCAMINE powder by swirling the vial. DO NOT VIGOROUSLY SHAKE THE VIAL.Visually inspect the vial for particulate matter. MYCAMINE is preservative-free. Discard partially used vials.

MYCAMINE is a trademark of Astellas Pharma, Inc., Tokyo , Japan.
MIDAZOLAM (VERSED) 100 mg/ 100 ml 
(0 to 100 mg/ 100 ml)

Usual dose requested: 1 to 5 mg/hr

Titrate D5W / NS

EXP: 1 DAY (RT).      Premedication: usually  5mg (70 to 80 mcg/kg) IM 30-60min before surgery. Anesthesia induction: 0.3 to.35 mg/kg over 20-30 seconds (range: 0.15 to 0.6). Status epilepticus: 0.1 to 0.35 mg/kg load, followed by continuous infusion: 0.05 to 1.08 mg/kg/hr (possibly up to 2? Based on EEG).   Mechanical ventilator patient: usually 0.05 to 0.2 mg/kg/hr for sedation. Maximum dose: In isolated reports, midazolam has been given in doses ranging from 0.3 to 0.85 mg/kg/hr (20 to 55 mg/hr) without respiratory depression or decreased BP. Decrease dose by 50% for patients with renal failure.   [Little support for doses > 0.35 mg/kg/hr-disregarding limited case studies.] 
MILRINONE (PRIMACOR) 50 mg/ 200 ml (final volume = 250 ml) Titrate D5W / NS

EXP: 3 DAYS (RT).   Remove 50 ml from 250ml bag.  Dosing: initially give loading dose: 50 mcg/kg IV over 10 minutes, followed by continuous infusion: 0.375 to 0.75 mcg/kg/min (usually 0.5 mcg/kg/min). Lower doses are required in renal failure (0.2 to 0.23 mcg/kg/min for crcl <10 ml/min,  crcl 10-30 ml/min-0.23 to 0.33 mcg/kg/min).   Venodilator: 0   Arterial dilator: ++ Inotropic effect: +++    Calculation of drip rate: 50 mg/250ml (ml/hr) = wt (kg) x 0.3 x mcg/kg/min
Recommended infusion rates: renal insufficiency
   Creatinine Clearance
   (mL/min/1.73 m 2 )
Infusion Rate
 5 0.20
10 0.23
20 0.28
30 0.33
40 0.38
50 0.43

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