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http://www.unc.edu/~bangel/quiz/testivh.htm
http://emsstaff.buncombecounty.org/inhousetraining/ivdriprates/ivdriprates_overview2.htm
http://atitesting.com/ati_next_gen/skillsmodules/content/iv-therapy/equipment/calculating-iv.html
http://www.ugapharmd.com/
Chemotherapy Drugs Reconstitution and Stability
Information
Drug
Add
Final
listed
Concentration
volume
Stability at Stability
Other Information
Room
Under
Temp
Refrigeration
1.1mg/ml
50mg/ml
2,000 units/ml
5,000 units/ml
15 units/ml
3 units/ml
15 units/ml
3 units/ml
6mg/ml
10mg/ml
10mg/ml
10mg/ml
3.3mg/ml
48 hours
5 hours
8 hours
8 hours
14 days
14 days
14 days
14 days
8 hours
24 hours
24 hours
24 hours
8 hours
Cisplatin
Cladribine 1mg/ml
Cyclophosphamide 100mg
1mg/ml
1mg/ml
20mg/ml
24 hours 24 hours
n/a 14 days
24 hours 6 days
----5ml
48 hours
24 hours
8 hours
8 hours
28 days
28 days
28 days
28 days
12 hours
5 days
5 days
5 days
24 hours
Cyclophosphamide 200mg
Cyclophosphamide 500mg
Cyclophosphamide 1000mg
Cyclophosphamide 2000mg
Cytarabine 100mg
Cytarabine 500mg
Cytarabine 1000mg
Cytarabine 2000mg
Dacarbazine 100mg
Dacarbazine 200mg
Dactinomycin 0.5mg
Daunorubicin 20mg
Dexrazoxane 250mg
Dexrazoxane 500mg
Docetaxel 20mg
Docetaxel 80mg
Doxorubicin liposomal (Doxil) 2mg/ml
Doxorubicin 10mg
Doxorubicin 20mg
Doxorubicin 50mg
Doxorubicin 150mg
Doxorubicin 2mg/ml
Epirubicin 2mg/ml
Etoposide 20mg/ml
Etoposide Phosphate 10mg
Floxuridine 500mg
Fludarabine 50mg
Gemcitabine 200mg
Gemcitabine 1000mg
Idarubicin 1mg/ml
Ifosfamide 1gm
Ifosfamide 3gm
Interferon alpha 2b 3 million I.U.
Interferon alpha 2b 5 million I.U.
Interferon alpha 2b 10 million I.U.
10ml 20mg/ml
24 hours
25ml 20mg/ml
24 hours
50ml 20mg/ml
24 hours
100ml 20mg/ml
24 hours
5ml
20mg/ml
48 hours
10ml 50mg/ml
48 hours
10ml 100mg/ml
48 hours
20ml 100mg/ml
48 hours
9.9ml 10mg/ml
24 hours
19.7ml 10mg/ml
24 hours
1.1ml 0.5mg/ml
24 hours
4ml
5mg/ml
24 hours
25ml 10mg/ml
24 hours
50ml 10mg/ml
24 hours
1.8ml 10mg/ml
8 hours
???
10mg/ml
8 hours
--- 2mg/ml
n/a
5ml
2mg/ml
7 days
10ml 2mg/ml
7 days
25ml 2mg/ml
7 days
75ml 2mg/ml
7 days
--- 2mg/ml
7 days
--- 2mg/ml
14 days
--- 20mg/ml
24 hours
10ml 10mg/ml
24 hours
5ml 100mg/ml
n/a
2ml 25mg/ml
16 days
5ml 38mg/ml
24 hours
25ml 38mg/ml
24 hours
--- 1mg/ml
72 hours
20ml 50mg/ml
7 days
60ml 50mg/ml
7 days
1ml
3 million IU/ml 28 days
1ml
5 million IU/ml 28 days
1ml
10 million IU/ml 28 days
6 days
6 days
6 days
6 days
n/a
n/a
n/a
n/a
96 hours
96 hours
24 hours
48 hours
n/a
n/a
8 hours
8 hours
24 hours
15 days
15 days
15 days
15 days
15 days
14 days
n/a
7 days
14 days
16 days
n/a
n/a
n/a
6 weeks
6 weeks
n/a
n/a
n/a
Do NOT refrigerate
Do NOT refrigerate
***Protect from light***
1ml
18 million IU/ml 28 days n/a
5ml
5 million IU/ml 28 days n/a
1ml
50 million IU/ml 28 days n/a
--- 20mg/ml
28 days 28 days
10ml 10mg/ml
n/a
7 days
34.5ml 10mg/ml
n/a
7 days
17ml 20mg/ml
n/a
7 days
10ml 1mg/ml
Use Immediately
10ml 5mg/ml
Use Immediately
--- 100mg/ml
24 hours n/a
1ml
20mg/ml
7 days n/a
19.4ml 50mg/ml
7 days n/a
--- 25mg/ml
7 days n/a
10ml 500mcg/ml
7 days 14 days
40ml 500mcg/ml
7 days 14 days
80ml 500mcg/ml
7 days 14 days
--- 2mg/ml
48 hours 48 hours
--- 6mg/ml
48 hours n/a
5ml
2mg/ml
48 hours 96 hours
9.5ml 100mg/ml
48 hours 96 hours
--- 10mg/ml
24 hours n/a
1.6ml 15mg/ml
24 hours 48 hours
4ml
1mg/ml
24 hours n/a
10ml 1mg/ml
24 hours 21 days
--- 1mg/ml
24 hours 7 days
--- 10mg/ml
24 hours 24 hours
Do NOT refrigerate
Stability in 0.9% NaCl
Do NOT refrigerate
***Protect from light***
***Protect from light***
*** Stability is that of an IV solution, not that diluted drug in the vial unless otherwise noted
Cytarabine (Cytosar U)
Compatible with dextrose and NaCl
Stable for at least 48 hours at room temperature
May be given intrathecally, SubQ, IM, IV push, or continuous/intermittent IV infusion
No specific dilution information available
Usually infused over 1-3 hours
Dacarbazine (DTIC-Dome)
***Protect from light***
Compatible with dextrose and NaCl
Stable for 24 hours at room temperature and 96 hours under refrigeration if protected from light
Dilute in 250ml of fluid and infuse over 15-30 minutes
Dactinomycin (Cosmegen)
Stable for 24 hours
***Do NOT give IM or subq; IV only***
May be given IV push or IV infusion
Compatible with dextrose and NaCl
Do not dilute with a preservative containing solution, it may cause precipitation
May be pushed without further dilution over a few minutes in the vein with a free flowing fluid,
and be sure to flush the line when you're done; you can also dilute it in a minibag
Daunorubicin (Cerubidine) (Daunoxome is liposomal formulation)
Compatible with dextrose and NaCl
Stable for 24 hours at room temperature or 48 hours under refrigeration
Give IV only
Administration option 1: Dilute with 10-15ml and give IV push over 2-3 minutes in a line with a rapidly flowing large volue fluid
Administration option 2: Dilute in 100ml and infuse over 30-45 minutes
Dexrazoxane (Zinecard)
***Do not refrigerate*** may cause precipitation
Stable for 24 hours at room temperature
Give by slow IV push or rapid IV infusion
Compatible with dextrose and NaCl, but slightly more stable in dextrose than NaCl (5% vs. 9% loss in 24 hours)
Docetaxel (Taxotere)
Compatible with dextrose and NaCl
Stable for at least 8 hours under refrigeration or at room temperature; may be much longer (see Trissels)
Infusion should be between 0.3 and 0.74mg/ml
Mix in a glass bottle
Infuse over 1 hour
Doxorubicin liposomal (Doxil)
Do NOT mix in 0.9% NaCl
Dilute in 250ml of dextrose 5% in water
Stable for 24 hours under refrigeration
For AIDS related Kaposi's sarcoma: infuse over 30 minutes
For Ovarian cancer: initiate at 1mg/minute and if it's tolerated give the full dose over 1 hour
Doxorubicin NON-liposomal (Adriamycin)
Compatible with dextrose and NaCl
Stable for 7 days at room temperature and 15 days under refrigeration
Infuse no faster than over 5 minutes
No specific dilution information available
Epirubicin (Ellence)
Compatible with dextrose and NaCl
Stable for 14 days at room temp and under refrigeration
Dilute to 50-100mcg/ml for infusion
Infuse over 3-5 minutes
Do NOT give IV push due to extravasation
Etoposide
Compatible with dextrose and NaCl
Stable for 24 hours at room temperature
Dilute to 0.2-0.4mg/ml for infusion
Infuse over 30-60 minutes
Etoposide Phosphate (Etopophos)
Gemcitabine (Gemzar)
Compatible with dextrose and NaCl
Do NOT refrigerate; may cause crystallization
Stable for 24 hours at room temperature
Dilute to 0.1-38mg/ml for infusion
Administered once weekly by IV infusion over 30 minutes
Idarubicin (Idamycin)
Compatible with dextrose and NaCl
***Protect from light***
Stable for at least 72 hours at room temperature if protected from light
Infuse over 10-15 minutes
No specific dilution information available
Ifosfamide (Ifex)
Compatible with dextrose and NaCl
Stable for 7 days at room temperature or 6 weeks under refrigeration
IV DRUG INFORMATION
1/4 Normal Saline Water 1000ml + 23.4% NaCl (4meq/ml) 38.8meq (9.7ml)
D12W 500ml
0.16-0.83mg/ml
1-5mg/kg, Start at 1mg/kg
May increase in daily 1mg/kg increments
1-2mg/ml
Neonate Conc.:
Rate = 2.5mg/kg/hr i.e. run over 2 hours
Stable for 48 hours under refrigeration plus an additional 6 hours at room temp.
Dosing Calculator
Acetadote (Acetylcysteine for Tylenol overdose)
150mg/kg in 200ml D5W over 15 minutes
50mg/kg in 500ml D5W over 4 hours
100mg/kg in 1000ml D5W over 16 hours
Dosing Calculator
Dosing Protocol
Activase (Alteplase)
Dilute 50mg vial with 50ml or 100mg vial with 100ml of sterile water to make 1mg/ml
Must be used within 8 hours of mixing
Dosing:
(TIA) - 0.09mg/kg over 1 minute, then 0.81mg/kg over 1 hour (maximum total of 90mg)
(Arterial thrombosis) 0.05-0.1mg/kg/hr over 1-8 hours
(PE) 100mg IV over 2 hours or 30-50mg via pulmonary artery over 1.5-2 hours
(MI: 3 hr infusion) 0.75mg/kg over 1 hour, then 0.25mg/kg/hr x 2 hours (If BW < 65kg)
(MI: 3 hr infusion) 60mg over 1 hour, then 20mg/hr x 2 hours (If BW > 65kg)
(MI: accelerated infusion) 15mg over 1-2 minutes, then 0.75mg/kg (max 50mg) over 30 minutes,
then 0.5mg/kg (max 35mg) over 1 hour
(Prevention for reocclusion Post-MI) 3.3mcg/kg/minute x 4 hours
Dosing Calculator
Aminocaproic acid
Stable in dextrose and NaCl
Stable for at least 7 days
10-100mg/ml concentrations have been used
Manufacturer recommends diluting to approximately 20mg/ml or 50ml of diluent for each gram of drug
For acute bleeding syndromes manufacturer recommends 4-5gm over 1 hour
followed by 1gm per hour for about 8 hours or until bleeding is controlled.
Maximum daily dosage: 30 grams
Ambisome (Amphotericin B Liposome)
***Protect from Light***
Mix in D5W
***Do not mix in any electrolyte solutions***
4mg/ml concentration made by adding 12ml sterile water to 50mg vial (stable for 24 hours),
then further dilute for infusion (stable for 6 hours)
Must be refrigerated
Adult Dose: 3-5mg/kg q24
Adult Concentration:
1-2mg/ml
Neonatal Dose:
1-5mg/kg, Start at 1mg/kg
May increase in daily 1mg/kg increments
Neonate Conc.:
Less than 2mg/ml
Rate = Run over 2 hours
Dosing Calculator
Amphotec (Amphotericin B Cholesteryl Sulfate Complex)
***Protect from Light***
Mix in D5W
***Do not mix in any electrolyte solutions***
Adult Dose: 3-4mg/kg q24
Adult Concentration: 0.16-0.83mg/ml
Brevibloc (Esmolol)
Compatible in dextrose and NaCl
Mix in D5W
Available as 10mg/ml premix
Stable when mixed for 7 days at room temperature or under refrigeration
Dosing Protocol
Calcium Gluconate
Stable for at least 24 hours
Compatible with dextrose and NaCl
May push undiluted or give as an infusion
Do not exceed 1.8meq/min (2-3 minutes per 10ml amp)
Cancidas (caspofungin):
70mg load followed by 50mg/day
Mix in 250ml of 0.9% NaCl
***Unstable in dextrose***
May be mixed in 100ml if patient requires fluid restriction
In patients with moderate hepatic insufficiency, dose may be 35mg
Run over 1 hour
Stable 24 hours out of fridge
Stable 24 hours out of fridge
Cardene IV (Nicardipine HCl)
Compatible in dextrose and NaCl
Dilute 25mg/10ml vial with 240ml to make 0.1mg/ml infusion
Stable for 24 hours at room temperature
NOT compatible with Lactated Ringers or Sodium Bicarbonate
Dosing Protocol
Cardizem
(Diltiazem)
Compatible in dextrose and NaCl
Put 125mg (25ml) in 100ml of fluid to make 1mg/ml
Stable for at least 48 hours under refrigeration
Dosing Protocol
Cerebyx (Fosphenytoin)
Compatible in dextrose and NaCl
75mg = 50mg PE (phenytoin equivalents)
Mix in concentration of 1.5-25mg/ml of PE
Run no faster than 150mg/min PE
Stable for 30 days under refrigeration, 2 days at room temperature
Cordarone (Amiodarone)
Mix only in dextrose, it can precipitate in NaCl
Must be mixed in glass if infusion exceeds 2 hours (i.e. a bolus can be put in a bag
Mix in concentrations of 1-6mg/ml
Concentrations greater than 2mg/ml must be given via a central line
Stable for at least 5 days at room temperature
Must be administered by a volumetric infusion pump *** NOT drop counter infusion sets
Dosing Calculator
Dosing Protocol
Corlopram (Fenoldopam)
Compatible with dextrose and NaCl
Mix 10mg in 250ml to make a final concentration of 40mcg/ml
Stable for 24 hours at room temperature
DO NOT USE A BOLUS
Dosing Calculator
Dosing Protocol
Cortrosyn (Cosyntropin)
May be given IM, IV push, or by IV infusion
If given IV push, silute 0.25mg vial with 1ml of 0.9% NaCl and push over 2 minutes.
For IV infusion, dilute in dextrose or saline and give 0.25mg dose over 6 hours
Normal patients will have a baseline cortisol level of greater than 5mcg/dL
and a level of 18mcg/dL with an increase of at least 7mcg/dL 30 minutes
after recieving Cortrosyn. If the level is taken 60 minutes after recieving
Cortrosyn, there should be an increase of at least 11mcg/dL.
Do not give Cortrosyn with blood or plasma infusions due to enzyme degredation
Dosing Protocol
Corvert (Ibutilide)
Compatible with dextrose and NaCl
Add drug to 50ml of fluid and infuse over 10 minutes
Dose for Patients 60+kg: 1mg = 10ml (whole vial)
Dose for Patients < 60kg: 0.01mg/kg = 0.1ml/kg of vial
Stable for 24 hours at room temperature or 48 hours under refrigeration
Dosing Calculator
Dosing Protocol
Demadex (Torsemide)
Compatible in dextrose and NaCl
Mix in dextrose at concentration of 0.1-0.8mg/ml
Mix in NaCl at concentration of 0.1-0.4mg/ml
Stable for 24 hours at room temperature
OR
Infed (Iron
Dextran)
0.9% NaCl is the suggested diluent for iron dextran
Using Dextrose had a greater incidence of phlebitis
Stable for at least 3 months under refrigeration
First, give a test dose of 25mg, wait one hour, then give the remainder of the dose over one to six hours
Dose in adults: 50*[0.0442*(Desired Hemoglobin - Actual Hemoglobin) * IBW + (0.26*IBW)]
Inocor (Inamrinone)
Discard after 24 hours
Compatible with NaCl (Do NOT mix in dextrose)
Dilute to 1.25-2.5mg/ml
Dosing Protocol
Integrilin Drip (eptifibatide):
Bolus: 180mcg/kg
Drip Rate: 2 mcg/kg/min
Drip Concentration: 2mg/ml
If CrCl < 50ml/min, the rate is half with same bolus
Available in 100ml premixed vial
Dosing Calculator
Dosing Protocol
Isuprel
(Isoproterenol)
***Protect from light***
Concentration 0.4-4mcg/ml (1-10ml of 0.2ml/ml injection in 500ml of fluid.
Compatible in dextrose and NaCl
Stable for at least 24 hours if protected from light.
Dosing Protocol
Levophed (Norepinephrine)
***Protect from light***
Compatible in dextrose and NaCl
Synagis (Palivizumab)
Dose: 15mg/kg once monthly during RSV season (roughly November through April)
50mg vial - add 0.6ml of sterile water, 50mg = 0.5ml
100mg vial - add 1.0ml of sterile water, 100mg = 1.0ml
Use within 6 hours of reconstitution
Theophylline Drip (Aminophylline)
Max rate 20mg/min
Loading dose 6mg/kg over 20-30 minutes
(Only load if patient is not taking Theophylline)
Theophylline available as premix as 400mg (equivalent to 500mg aminophylline) in 500ml D5W
Also stable in 0.9% NaCl for at least 24 hours
Mix with 500mg in 500ml to make a 1mg/ml (aminophylline)(Theophylline premix is of equivalent concentration)
Dosing Calculator
Dosing Protocol
Loading dose (Only load if patient is not taking Theophylline): 6mg/kg over 20-30 minutes
Maintenance Dose:
For 12 Hours following bolus
6 months - 9 years
1.2mg/kg/hr
9-16 years
1mg/kg/hr
Young adult smoker
1mg/kg/hr
Nonsmoking adult
0.7mg/kg/hr
Elderly
0.6mg/kg/hr
Cor Pulmonale Pt.
0.6mg/kg/hr
CHF or Liver Failure
0.5mg/kg/hr
***Doses are based on Aminophylline, NOT Theophylline
TNKase (Tenecteplase)
Dilute 50mg vial with 10ml to make 5mg/ml
Must be used within 8 hours of mixing
Give IV push over 5 seconds
Dosing:
Vibramycin (Doxycycline)
***Protect from light***
Compatible in dextrose and NaCl
Stable for 72 hours under refrigeration
Mix in 0.1-1mg/ml
Infuse over 1-4 hours
Vitamin K
***Protect from light***
Compatible in dextrose and NaCl
May be given IV push or by infusion
Use immediately after mixing
Do not exceed 1mg/min
Xigris (Drotrecogin alfa (activated))
Compatible with dextrose and NaCl
Dilute to concentration of 0.1-0.2mg/ml
Infusion Rate: 24mcg/kg/hour X 96 hours
Dose based on actual body weight at the start of the infusion
Stable 14 hours at room temperature
If refrigerated then hung, discard after 24 hours
Dosing Calculator
Dosing Protocol
Zantac (Ranitidine)
***Protect from light***
Compatible in dextrose and NaCl
Put 150mg in 250ml (0.6mg/ml)
Infuse at a rate of 6.25mg/hr or 10.4ml/hr
Stable for at least 24 hours if protected from light.
Zovirax (Acyclovir)
Compatible in dextrose and NaCl
Mix in concentrations of no greater than 7mg/ml
Infuse over 1 hour
DO NOT REFRIGERATE
Do not use bacteriostatic water to dissolve powder
Dosage 5-20mg/kg every 8 hours
Do not exceed 20mg/kg every 8 hours in any patient
Sources:
American Hospital Formulary Service. Drug Information. Bethesda, MD: ASHP, 2005
Trissel LA. Handbook on Injectable Drugs. 13th ed. Bethesda, MD: ASHP, 2005
Various Package Inserts