IV drug additives Updated on 1st Aug 2023 Refrences: British National Formulary, (Sep. 2022) v3.1.6 android application * Medscape, (July, 2023) v1131.0 & v181.0 android application **Others: Elsevier’s Intravenous Medications: A Handbook for Nurses and Health Professionals, Mosby’s Drug Reference for Health Professions, Drugs.com website, Professionals, AFHS Monographs, Electronic Medicines Compendium (emc) website, & MMS home website, Drugs, Info.

1. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ / ‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
Drugs N/S
0.9%
G/W
5%
Notes
Acetylcysteine (Assist) Yes Yes G/W 5% preferred
Adenosine Yes - Give over 2 seconds into central/ large CV line by rapid flush
Adrenaline (Epinephrine) Yes Yes Incompatible with bicarbonate and alkaline solution
Dilute 3mg/kg of (1mg/ml ampoule) to final volume of 50ml
(neonates) – inf. rate 0.1ml/hr via CV catheter
Albumin * Yes Yes N/S is preferred, Compatible with G/S, Ringer & R/L
Don’t use sterile water (Potential fatal hemolysis & ARF)
Don’t dilute 5% solution
1 vol. 0f 25% to 4 vol. of diluent is isotonic (use clear solution)
Alteplase
(Actylase) vial Set
Yes - Dissolve in water for inj. to conc. 1-2mg/ml,
least conc. for infusion is 200mcg/ml
Amikacin sulfate Yes Yes Intermittent inf. over 30-60 min
Aminophylline dihydrate Yes Yes Continuous inf. dilution conc. 1mg/ml (children)
Amiodarone HCl (Cordarone) - Yes Incompatible with N/S, avoid plasticizer DEHP equipment
Peripheral infusion may cause pain and inflammation
Initial inf. of 250ml given over 20-120min (max 1.2g/500ml)
Least conc. 600mcg/ml
Amoxicillin Na
Ampicillin Na
Yes Yes Compatible with G/W 10% & N/S 0.54%
Intermittent inf. Over 30-60 min )pediatrics)
Conc. of 50mg/ml for pediatric (100mg/ml neonates)
Ampicillin avoid doses >50mg/kg (CNS toxicity-convulsions)
Infusion volume for adult is 100ml (continuous inf. Not
recommended)
Anti D Ig (Rhophylac)* Yes - For direct iv adm. dilute with 2.5-8.5ml
Atracurium besilate Yes Yes Final conc. for continuous infusion 0.5-5mg/ml
Atropine sulfate* Do Not Add to IV fluids 1-2mg/10ml N/S for endotracheal tube adm. Only
Give into large vein or IV tubing over 1-2min
Ca gluconate Yes Yes Incompatible with bicarbonate, phosphate or sulfate
Continuous inf. conc. of 0.1ml Calcium/ml
Ca Chloride care req. to avoid extravasation
Infusion rate not exceed 1ml/min
Ca chloride* Yes -
Caffiene citrate* - Yes
Cefepime Yes Yes Compatible with G/W10%
Colour after reconstitution is yellow-yellow brown
Cefotaxime Na
(Claforan)
Yes Yes Incompatible with alkaline solutions
Intermittent inf. Over 20-60 min
Ceftazidime pentahydrate Yes Yes Compatible with G/W 10%
Intermittent inf., dilution conc. 40mg/ml over 30 min
Ceftriaxone Na Yes Yes Compatible G/W 10%
Incompatible with Calcium containing fluids (flush line with N/S)
Intermittent inf. over 30-60 min
Ciprofloxacin* (Ciprodar) Yes Yes Compatible with G/W10%, G/S & R/L
10mg/ml vial diluted to final conc. Of 1-2mg/ml over 60 min
Chlorpromazine HCl Yes - IV inf. only for intractable hiccups (adult), max conc. 1mg/ml/min
(with 500-1000ml N/S)
Dexamethasone Na &/HCl
phosphate (Decadron)
Yes Yes Intermittent or continuous inf. over 15-20min (pediatrics)
Diazepam (Valium)* Yes? Yes? Compatibility in N/S, G/W, Ringer & R/L is controversial
Emulsion form in G/W 5-10% only continuous inf.
Diclofenac Na (Voltarin) Yes Yes Infusion fluid Require buffering with 0.5-1ml of Na Bicarbonate 8.4-
4.2% respectively
Intermittent or continuous inf. Dilution 75mg/100-500ml
Diphenhydramine HCl*
(Allermine)
Yes Yes Compatible with G/S, G/W10%, Ringer & R/L
Max inf. rate of 25mg/min
Digoxin Yes Yes Avoid rapid IV adm.
Dilution conc. of 62.5mcg/ml infused over 2hr (least)
Digoxin immune Fab Yes - Given over 30 min
Dobutamine HCl Yes Yes Incompatible with bicarbonate & strong alkaline fluids
Conc. 0.5-1mg/ml (Max. 5mg/ml through CV line)
Dopamine HCl Yes Yes Incompatible with bicarbonate containing fluids
Continuous inf. (Max conc. 3.2mg/ml) via large vein
Enoxaparin*
(Clexane)
Yes Yes Use multidose vial only
Esomeprazole Na (Nexium) Yes - Inf. over 10-30min (stability in N/S is up to 12 hr)
Fentanyl Citrate Yes Yes
Flucloxacillin Na Yes Yes Inf. over 30-60 min

2. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ / ‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
Furosemide Na
(Lasix)
Yes - If pH must be >5.5 (G/W is unsuitable)
Continuous inf. IV rate not exceed 4mg/min
Gentamicin sulfate (Garamycin) Yes Yes Intermittent inf. over 20-30min (60 min for once daily dose)
Glucagon HCl Biosynthetic - Yes Don’t add to Calcium containing fluid (precipitation may occur)
Glucose solution 20 - 50%*
(Hypertonic)
Yes Yes Causes pseudoagglutination of RBCs if adm. with whole blood
Aluminum content may reach toxic levels with prolonged parenteral
adm. If kidney function is impaired
Undiluted 10% sol. adm. via CV line, (Inf. Rate 0.5g/kg/hr)
Glyceryl trinitrate (Angised) Yes Yes Incompatible with PVC containers (glass preferred)
Inf. conc. 100mcg/ml
Haloperidol lactate* No infusion administration Only lactate given IV. (off label)
Heparin Na (UFH) Yes Yes Continuous inf. (motorized pump is advisable)
Hydralazine HCl (Apresoline) Yes - Continuous infusion, in 500ml volume
Hydrocortisone Na PO4/ succinate Yes Yes Intermittent or continuous inf. over 20-30min (children)
Hydroxocobalamin (Vitamin B12) Yes - Intermittent inf. dilute 5g vial with 200ml fluid
Hyoscine butylbromide
(Buscopan)
Yes Yes Given over 1min least
Imipenem/Cilastatin Na Yes - Intermittent inf. over 20-30min (500mg) & 40-60 min (>500mg)
Insulin (soluble)
Biphasic Insulin -Aspart/ - Lispro/
- Isophane
Yes Adsorbed to some extent by plastics of IV sets
Insulin Aspart
Insulin Lispro
Yes Yes Continuous inf. dilute 0.1-0.5-1unit/ml
Iron dextran (Imferon) Yes Yes Intermittent inf. dilute 100-200mg with 100ml
Inf. 25mg Over 15 min/total dose inf. over 4-6hr
Iron sucrose (Venofer) Yes - Intermittent inf. dilution conc. 1mg/ml (rate <6.67mg/min)
Ketamine HCl Yes Yes Continuous inf. conc. of 1mg/ml via microdrip infusion
Labetalol HCl Yes Yes Conc. 1mg/ml (Inf. volume 200ml)
Lidocaine HCl
Lignocaine HCl anhydrous**
Yes Yes
Methylergonovine maleate*
(Methergine)
Do Not Add to IV fluids Some clinicians recommend dilution with 5ml N/S
Methylprednisolone Yes Yes Given over 5-30min acc. to dose
Metoclopramide HCl (Plasil) Yes Yes? Incompatible with G/W 5% at high conc., N/S is preferred
Protect form light
Metoprolol succinate* (Betaloc) No infusion information Give undiluted as necessary
Metoprolol tartrate* Yes Yes
Meropenem Yes Yes Intermittent inf. Final conc. 1-20mg/ml, given over 15-30 min
Metronidazole HCl*
(Flagyl)
Yes Yes Compatible with R/L, Given over 20-60min
Must be neutralized wit 5mEq Na bicarbonate/500mg to achieve pH
of 6-7
Powder vial diluted to final conc. of 100mg/ml
Mg sulfate Yes Yes Continuous inf. dilute 1part Mg 50% with 1.5 part D/W
Conc. of 200mg/ml (adult) & 100mg/ml (pediatrics)
Midazolam Yes Yes May cause seizure-like myoclonus in preterm neonates
(Max conc. 1mg/ml for neonate & child <15kg)
Morphine Sulfate Yes Yes Compatible with G/w 10%
Nefopam HCl** (Accupan) Yes Yes Slow IV bolus adm. Over 15min least
Neostigmine (Prostigmine)* Non specified Administered iv slowly
Noradrenaline Acid tartrate/
Bitartrate (Norepinephrine)
Yes Yes Incompatible with alkalis
Dilute 2mg (20mg) NE with 48ml (480ml) inf. fluid
Omeprazole Na Yes Yes Stable for 6hr in G/W 5% & 12hr in N/S 0.9%
Intermittent or continuous inf. over 20-30 min
Ondansteron HCl/ hydrate Yes Yes Compatible with (add 0.3% KCl), Mannitol 10% & Ringer
Dilute in 50-100ml & adm. over 15min
Oxytocin
(Pitocin)
Yes Yes For prolonged period infusion (inevitable/missed abortion or
postpartum hemorrhage) use low vol. of G/W 5%
Continuous inf. dilute 5-10unit with 500ml fluid
Paracetamol Yes Yes Intermittent inf. conc. < 1mg/ml within 1hr
(child<33kg use 50ml vial)
Phenobarital Na* Yes Yes Compatible with Ringer, R/L & G/S
Conc. 10mg/ml, adm. slowly at 60mg/min
Phenytoin Na Yes - Give into large vein,
Inf. rate not <1mg/kg/min (child) & 50mg/min (adult)
Phytomenadione (Vitamin K1) - Yes Intermittent inf. dilute with 55ml fluid
Pralidoxime chloride Yes - Final conc. 20mg/ml (child) & 50mg/ml (adult)
Propofol amp Yes Yes Final conc. not less 1-2mg/ml for 0.5-1% emulsions respectively
Propranolol HCl*
(Diprivan)
Yes Yes Incompatible with Bicarbonate (NS is preferred)
Inf. rate not> 1mg/min, continuous inf. is not recommended
Protamine Sulfate* IV administration only Reconstitute with 5ml D/W, final conc. (10mg/ml) over 10 min
K chloride Yes - Continuous inf. rate 20-40mmol/hr

3. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ / ‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
Alaa F. Hassan (M.Sc. Pharmacology)
Al-Mahmoudiya General Hospital
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References
British National Formulary, (Sep. 2022) v3.1.6 android application
* Medscape, (July, 2023) v1131.0 & v181.0 android application
**Others: Elsevier’s Intravenous Medications: A Handbook for Nurses and Health Professionals,
Mosby’s Drug Reference for Health Professions,
Drugs.com website, Professionals, AFHS Monographs,
Electronic Medicines Compendium (emc) website,
& MMS home website, Drugs, Info.
Pyridoxine HCl*
(Vitamin B6)
Yes Yes Incompatible with alkaline solution, iron salts & oxidizing solutions
Ranitidine HCl (Zantac) Yes Yes Intermittent inf. conc. 2.5mg/ml over 3min at least(pediatrics)
Remedesivir* Yes Infuse over 30-120min
Reconst. Vial is stable for 24hr at 20-25°C
Do not adm. Conc. Solution 100mg/20ml for pediatrics <40kg or pt.
with eGFR <30ml/min (high amount of sulfobutylether-β-
cyclodextrin sodium salts)
Rocuronium Br inj Yes Yes Continuous infusion or via drip tubing
Salbutamol sulfate (Ventolin IV) Yes Yes Final conc. 200mcg/ml for continuous infusion
Sodium Bicarbonate Yes Yes Compatible with G/W 10%
For continuous infusion use weaker sol. of 1.26% over 3-4 hr (adult)
Suxamethonium Chloride*
(Succinylcholine/Scoline)
Yes Yes Final conc. for continuous inf. is 1-2mg/ml
Thaimine HCl (Vit B1)* Yes Yes Unstable in neutral/alkaline solutions & incompatible with solution
containing sulfites, reducing or oxidizing agent
Teicoplanin (Targocid) Yes Yes Intermittent inf. over 30 min, continuous inf. not recommended
Tramadol HCl (Tramal) Yes Yes
Tranexamic acid
( Exacyl/ Cyclokapron)
Yes Yes
Vancomycin HCl Yes Yes Final conc. of (5mg/ml) over 60 min
Avoid rapid infusion (risk anaphylactoid reaction) & rotate inf. site
Verapamil HCl*
(Isoptin)
Yes Yes Compatible with ringer solution but not recommended with Na
lactate in PVC bags
Will precipitate in any solution with pH >6
Vecuronium Br Yes Yes Final conc. for continuous ifusion 40mcg/ml