| Drug |
Standard
Dilution |
Infusion
Rate |
Diluents* |
| THIOPENTAL (SODIUM PENTOTHAL) |
Intermittent IV
administration:
(2-5% solution is recommended) .
1 to 2 grams/ 50 ml
5 grams/ 100-250 ml
10 grams/ 500 ml
Continuous infusion (0.2 to 0.4% solution is recommended ) .
1 gram/ 250 ml or 2 grams/ 500ml |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 3 days
(RT); 7 days (REF). Onset: 30-60 seconds. Duration: 10-30
minutes. Ultra short acting barbiturate. Given by slow intravenous
administration only. Dosing: Anesthesia induction(adults):
3-5 mg/kg (2.5% solution) Maintenance: 25-100mg IV as needed. Increased
intracranial pressure: 1.5 to 5 mg/kg/dose; repeat as needed to control
intra-cranial pressure. Seizures:
75 to 250mg/dose. Repeat as needed. [case study: 250 mg IV bolus
followed by 80-120 mg/hr.]
|
|
| TICAR/CLAVU
(TIMENTIN) |
0 to 2.5 grams/ 50 ml
Over 2.5 grams/ 100 ml |
30 min |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT) / 3
DAYS (REF). Label: Refrigerate. Cannot be given IM.
Usual dose: 3.1g IVPB q4-6h. Renal dosing: >60/ 3.1g q4-6h
|| 30-60/q8-12h || 10-30/ q12-24h or 2 grams IVPB
q8h || <10/ 2g q12h or
3.1g q24-48h || <10 + hepatic dysfunction/ 2g q24h || PD: 3.1g q12h ||
Hemodialysis: 2g q12h + 3.1g after dialysis. |
|
| TIGECYCLINE
(TYGACIL) |
| Usual
Diluents |
| NS or D5W |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
Initial dose:
[100 mg] [100 ml] [30–60 min]
Maintenance dose:
[50 mg] [100 ml] [30-60 min]
Maximum concentration: 1 mg/ml.
Reconstitute each 50mg vial with 5.3 mL of 0.9% Sodium Chloride Inj,
USP, or 5% Dextrose Injection, USP, to achieve a concentration of 10
mg/ml of tigecycline. |
|
Stability/Misc.
|
STABILITY/STORAGE:
Note: (reformulated recently - slightly longer stability): Prior to reconstitution, TYGACIL should be stored at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F). Once reconstituted, TYGACIL may be stored at room temperature for up to 24 hours (up to 6 hours in the vial and the remaining time in the IV bag). Alternatively, TYGACIL may be stored refrigerated at 2° to 8°C (36° to 46°F) for up to 45 hours following immediate transfer of the reconstituted solution into the IV bag. Reconstituted solution must be transferred and further diluted for IV infusion.
DOSAGE (adult patients > 18 years old): initial dose of 100 mg, followed by 50 mg every 12 hours. Infuse over 30 to 60 minutes every 12 hours. Usual treatment duration for complicated skin and skin structure infections or for complicated intra-abdominal infections: 5 to 14 days. The duration of therapy should be guided by the severity and site of the infection and the patient’s clinical and bacteriological progress. In patients with severe hepatic impairment (Child Pugh C), the initial dose of TYGACIL should be 100 mg followed by a reduced maintenance dose of 25 mg every 12 hours. Patients with severe hepatic impairment (Child Pugh C) should be treated with caution and monitored for treatment response.
RECONSTITUTION: Each vial of TYGACIL should be reconstituted with 5.3 mL of 0.9% Sodium Chloride Injection,
USP, or 5% Dextrose Injection, USP, to achieve a concentration of 10
mg/mL of tigecycline. (Note: Each vial contains a 6% overage. Thus, 5 mL of reconstituted solution is equivalent to 50 mg of the drug.) The vial should be gently swirled until the drug dissolves. Immediately withdraw 5 mL of the reconstituted solution from the vial and add to a 100 mL IV bag for infusion (for a 100 mg dose, reconstitute two vials; for a 50 mg dose, reconstitute one vial). The maximum concentration in the IV bag should be 1
mg/mL. The reconstituted solution should be yellow to orange in color; if not, the solution should be discarded. Parenteral drug products should be inspected visually for particulate matter and discoloration (e.g., green or black) prior to administration.
SUPPLIED: 50mg lyophilized powder for reconstitution - single-dose 5 mL glass vial. |
|
| TIROFIBAN
(AGGRASTAT) |
12.5 mg
(50ml) / 200 ml (total volume: 250ml conc = 50 mcg/ml)
25 mg (100ml) / 400 ml (total volume: 500ml conc = 50
mcg/ml)
|
UD |
NS / D5W |
Stability/Misc.
|
Indications: In
combination with heparin, treatment of acute coronary syndrome (unstable
angina, non-Q wave MI), including patients undergoing PTCA or
atherectomy.
Dosing: 0.4 mcg/kg/min for 30 min, followed by 0.1 mcg/kg/min.
Therapy should continue through angiography and for 12-24hours after
angioplasty or atherectomy. (Note: Reduce dose by 50% if CRCL < 30
ml/min -- 0.2 mcg/kg/min x 30 minutes, then 0.05 mcg/kg/min.)
Hemodialysis:
USE WITH CAUTION.
Reduce dose by 50% (0.2 mcg/kg /min x 30 minutes, then 0.05 mcg/kg/min).
Supplied: 250 mcg/ml-50 ml vial (12.5 mg/50ml).
Calculation of rate: Loading dose (ml/hr) = 0.48 x weight(kg). Infuse for
30 minutes. Continuous infusion (ml/hr) = 0.12 x weight(kg) |
|
| TOBRAMYCIN |
0 to 40 mg/ 50 ml
Over 40 mg/ 100 ml |
30 min |
NS / D5W |
Stability/Misc.
|
EXP: 1 DAY
(RT) / 3
DAYS (REF). Label: Refrigerate. Note: for dosing guidelines
see under gentamicin. |
|
| VANCOMYCIN |
Updated
dilution data |
|
|
Stability/Misc.
|
Updated
dilution data |
|
| VASOPRESSIN
(PITRESSIN) |
Acceptable concentrations:
(0.1 to 1.0 u/ ml.)
100 units/ 100 to 500 ml
200 units/ 250 ml |
Titrate |
NS / D5W |
Stability/Misc.
|
[Supplied: 20
units/ml-0.5 & 1 ml amp] "Antidiuretic
hormone" Dosing (adults): Diabetes
insipidus: 5-10u IM/SC 2 to 4 times/day as needed. Abdominal distention: 5
units IM stat, followed by 10 units q3-4h.
Bleeding esophageal varices and other types of upper GI bleeds:
initially 0.2 u/min, then increase each hour by 0.2 u/min until the hemorrhage is
controlled. Doses as high as 2 u/min may be tolerated, but a more prudent
dosage limit is 1 u/min. After 12 hours of control of the hemorrhage the
dose of vasopressin may be decreased by 50%, then may discontinue in the next 12-24 hrs.
Intravenous nitroglycerin should be administered concomitantly to control
side effects. MOA: ADH and pressor activity. Portal blood pressure is
significantly decreased. A decrease in porto-systemic collateral flow and an increase
in the muscular tone of the lower esophagus reduces blood flow to
esophageal varices. The smooth muscle of the GI tract is also effected by
large doses and peristaltic activity of the bowel and smooth muscles of
the uterus are stimulated. |
|
| VECURONIUM
(NORCURON) |
Continuous infusion:
50 mg/ 50 ml (Undiluted-viaflex) (Dilute each 10mg vial with 5 ml sterile
water) |
Titrate |
D5W / NS |
Stability/Misc.
|
EXP: 1 DAY
(RT).
Intermittent dosing: initially 0.08 to 0.1 mg/kg ideal body
weight IV bolus. (Higher
initial doses-up to 0.3 mg/kg-may be used for rapid onset.
Maintenance:
0.01 to 0.015 mg/kg q25 to 45min prn.
Continuous infusion: Start IV
bolus (0.08 to 0.3 mg/kg), followed by (after 20-40min),1 mcg/kg/min infusion
(usual range: 0.8 to 1.2 mcg/kg/min). Dosage reductions are not req'd in
renal failure.
Overview: Neuromuscular blocking agents are used in the
ICU setting for 3 reasons: (1) to eliminate spontaneous breathing and
promote mechanical ventilation (eg eliminate urge to fight the vent.)
(2)
Cause a pharmacologic restraint so patients do not harm themselves. (3) To
decrease oxygen consumption. |
|
| VERAPAMIL
(ISOPTIN) |
100 mg/ 160 ml (0.5 mg/ ml)
160 mg/ 100 ml (1 mg/ ml) |
Titrate |
D5W / NS |
Stability/Misc.
|
Dosing:
(PSVT, A-fib,A-flutter): 5-10mg IVpush over 2min (Doses of 10mg
over 10min have also been recommended.) If no response, may repeat dose 15-30
min
later. Alternatively, may give 1 mg/min up to 20 mg based on HR and BP. An
IV infusion may follow bolus: 1 to 5 mcg/kg/min; titrate to HR/BP. Use
lower doses in patients with myocardial dysfunction and/or presence of Beta blocker or
digoxin. [Supplied: 2.5 mg/ml-2 & 4 ml vial] |
|
| VORICONAZOLE
(VFEND) |
| Usual
Diluents |
| NS, D5W, LR,
LR/D5W, 0.45NS, D5W/NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
[Prescribed dose ]
[Final concentration: 0.5 to 5 mg/ml]
[over 1-2 hours (a maximum rate of 3 mg/kg/hr)]
Reconstitute 200mg vial with 19ml of Water for Injection to obtain
an extractable volume of 20 ml of clear concentrate containing 10
mg/ml of voriconazole. (Shake the vial until all the powder is
dissolved.) |
|
Stability/Misc.
|
Dilution:
Vfend ® must be infused over 1-2 hours, at a concentration of 5 mg/mL or
less. Therefore, the required volume of the 10 mg/m Vfend ® concentrate
should be further diluted as follows:
1. Calculate the volume of 10 mg/ml Vfend® concentrate required based on
the patient’s weight. (See package insert)
2. In order to allow the required volume of Vfend® concentrate to be
added, withdraw and discard at least an equal volume of diluent from the
infusion bag or bottle to be used. The volume of diluent remaining in the
bag or bottle should be such that when the 10 mg/ml Vfend ® concentrate
is added, the final concentration is not less than 0.5 mg/mL nor greater
than 5 mg/mL.
3. Using a suitable size syringe and aseptic technique, withdraw the
required volume of Vfend ® concentrate from the appropriate number of
vials and add to the infusion bag or bottle. Discard Partially Used Vials.
The final Vfend ® solution must be infused over 1-2 hours at a maximum
rate of 3 mg/kg per hour.
Supplied:
single use vial as a sterile lyophilized powder equivalent to 200 mg Vfend
® and 3200 mg sulfobutyl ether beta-cyclodextrin sodium (SBECD).
Storage:
Vfend ® I.V. for Injection unreconstituted vials should be stored at 15°
- 30°C (59° - 86°F). Vfend ® is a single dose unpreserved
sterile lyophile. Reconstituted solution should be used immediately.
If not used immediately, in-use storage times and conditions prior to use
are the responsibility of the user and should not be longer than 24 hours
at 2° to 8°C (36° to 46°F). Chemical and physical in-use stability has
been demonstrated for 24 hours at 2° to 8°C (36° to 46°F). This
medicinal product is for single use only and any unused solution should be
discarded. Only clear solutions without particles should be used. |
|
| ZOLEDRONIC
ACID (ZOMETA) |
| Usual
Diluents |
| D5W, NS |
| Standard
Dilutions [Amount of drug] [Infusion volume]
[Infusion rate] |
| [4 mg] [100 ml] [15-30
minutes] |
|
Stability/Misc.
|
EXP:
24 hrs REF.
Label: Refrigerate. Absolute minimum infusion time: 15 minutes.
Reconstitute 4 mg vial with 5ml sterile water. Do not withdraw the drug
until it is completely dissolved.
Maximum dose: 4 mg
Indications: treatment of hypercalcemia of malignancy.
Vigorous saline hydration should be initiated promptly – urine output
goal: 2 L/day throughout treatment. Do not overhydrate (use caution in
cardiac patients, etc).
The safety and efficacy of Zometa in the treatment of hypercalcemia
associated with hyperparathyroidism or with other non-tumor-related
conditions has not been established.
The maximum recommended dose of Zometa is 4 mg (Patients with a corrected
calcium > 12 mg/dl). Retreatment: Must wait at least 7 days to
determine the full effect of the initial dose. Do not administer
subsequent doses before this time.
Renal function must be carefully monitored in all patients receiving
Zometa and possible deterioration in renal function must be assessed prior
to retreatment with Zometa.
Corrected calcium = Ca + 0.8 (mid-range albumin-measured albumin in mg/dL).
RENAL DOSING
Dose adjustments of Zometa are not necessary in treating patients for
hypercalcemia presenting with mild-to-moderate renal impairment prior to
initiation of therapy (serum creatinine <4.5 mg/dL). For bone
metastases, the use of Zometa in patients with severe renal impairment is
not recommended. In studies of patients with bone metastases, patients
with a serum creatinine >3.0 mg/dL were excluded. |
|
