Latest Intravenous Dilution Guidelines

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*Preferred solution is listed first.
Dilution List     [ T - V ]
This document Copyright © 2005-06  D.McAuley, GlobalRPh Inc. All Rights Reserved.
Thiopental (Sodium Pentothal)
Ticarcillin/clav (Timentin)
Tirofiban (Aggrastat)
Vasopressin (Pitressin)
Vecuronium (Norcuron)
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

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

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.
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/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 greater than 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)

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.)

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

EXP: 1 DAY (RT) / 3 DAYS (REF). Label: Refrigerate.   Note: for dosing guidelines see under gentamicin.
VANCOMYCIN Updated dilution data    

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

[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

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. 
: 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. 
: 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

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]
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.)

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.

single use vial as a sterile lyophilized powder equivalent to 200 mg Vfend ®  and 3200 mg sulfobutyl ether beta-cyclodextrin sodium (SBECD).

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.
Usual Diluents
D5W,  NS
Standard Dilutions   [Amount of drug]  [Infusion volume]  [Infusion rate]
[4 mg] [100 ml] [15-30 minutes]

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). 

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.

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