IV drug reconstitution and special directions As part of the Rational drug use-Lectures Al MAhmoudiya G. Hospital 14th Sep 2021

1. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ /‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
Drugs N/S
0.9%
G/W
5%
Others Notes
Acetylcysteine
(Assist)
Y Y G/W 5% preferred
Adrenaline
(Epinephrine)
Y Y 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* Y Y N/S is preferred 1 volume 0f 25% to 4
volume of diluent is isotonic
(use only clear solution)
Amikacin sulfate Y Y Intermittent inf.
Over 30-60 min
Aminophylline Y Y Continuous inf. Dilution
conc. 1mg/ml
Amiodarone
(Cordarone)
- Y Peripheral infusion may
cause pain and
inflammation
Initial inf. Of 250ml given
over 20-120min (max
1.2g/500ml)
Amoxicillin Na
Ampicillin Na
Y Y (G/W 10%, N/S
0.45% ) Pediatrics
Intermittent inf. Over 30-60
min
Conc. Of 50mg/ml for
pediatric (100mg/ml
neonates)
Ampicillin avoid doses
>50mg/kg (CNS toxicity-
convulsions)
Infusion volume for adult is
100ml
Atropine sulfate* Do Not Add to IV
fluids
1-2mg/10ml N/S for
endotracheal tube adm. only
Ca gluconate Y Y Continuous inf.
Conc. Of 0.1ml Ca/ml
Ca chloride* Y - Infusion rate not exceed
1ml/min
Cefepime Y Y G/W10% Colour after reconstitution
is yellow-yellow brown
Cefotaxime Na
(Claforan)
Y Y Incompatible with
alkaline solutions
Intermittent inf. Over 20-60
min

2. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ /‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
Ceftazidime
pentahydrate
Y Y G/W 10% Intermittent inf. Dilution
conc. 40mg/ml over 30 min
Ceftriaxone Na Y G/W 10%
Incompatible with
Calcium containing
fluids
Intermittent inf. Over 30-60
min
Ciprofloxacin*
(Ciprodar)
Y Y G/W10%, G/S & R/L 10mg/ml vial diluted to final
conc. Of 1-2mg/ml
Dexamethasone Na
&/HCl phosphate
(Decadron)
Y Y Intermittent or continuous
inf.
Over 15-20min (pediatrics)
Diazepam (Valium) Y Y Emulsion form in
G/W 5-10% only
Continuous inf.
Diclofenac Na
(Voltarin)
Y Y 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)
Y Y G/S, G/W10%,
Ringer & R/L
Digoxin Y Y Avoid rapid IV adm.
Dilution conc. Of
62.5mcg/ml infused over
2hr (least)
Dobutamine Y Y Incompatible with
bicarbonate &
strong alkaline
fluids
Conc. 0.5-1mg/ml
Max 5mg/ml
Dopamine HCl Y Y Incompatible with
bicarbonate
containing fluids
Continuous inf.
Max conc. 3.2mg/ml
Enoxaparin*
(Clexane)
Y Y Use multidose vial only
Esomeprazole Y - Over 10-30min
Flucloxacillin Na Y Y Intermittent inf.
Over 30-60 min
Furosemide Na
(Lasix)
Y - If pH must be >5.5
G/W is unsuitable
Continuous inf. IV rate not
exceed 4mg/min
Gentamicin sulfate
(Garamycin)
Y Y Intermittent inf.
Over 20-30min (60 min for
once daily dose)
Glucose solution
20%*
Y Y Causes pseudoagglutination
of RBCs if adm.

3. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ /‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
(Hypertonic) simultaneously with whole
blood
Aluminum content may
reach toxic levels with
prolonged parenteral adm.
If kidney fuction is impaired
To be adm. Via CV catheter if
used undiluted
Usual inf. Rate 0.5g/kg/hr
Glyceryl trinitrate
(Angised)
Y Y Incompatible with
PVC containers
Suggested conc. 100mcg/ml
Heparin Na (UFH) Y Y Continuous inf.
Hydralazine HCl
(Apresoline)
Y Continuous infusion, in
500ml volume
Hydrocortisone Na
phosphate/Na
succinate
Y Y Intermittent or continuous
inf. Over 20-30min
Hydroxocobalamin
(Vitamin B12)
Y - Intermittent inf. Dilute 5g
vial with 200ml fluid
Hyoscine
butylbromide
(Buscopan)
Y Y Given over 1min least
(pediatrics)
Imipenem/ cilastatin
Na
Y - Intermittent inf. Over 20-
30min (500mg) & 40-60 min
(>500mg)
Insulin (soluble) Y - Adsorbed to some
extent by plastics of
IV sets
Continuous inf.
Insulin Aspart Y Y Continuous inf. Dilute 0.5-
1unit/ml
Iron dextran
(Imferon)
Y Y Intermittent inf. Dilute 100-
200mg with 100ml
Over 15 min/ 4-6hr
Iron sucrose
(Venofer)
Y - Intermittent inf. Dilution
conc. 1mg/ml
Lidocaine HCl Y Y
Mg sulfate Y Y Continuous inf. Dilute 1par
Mg 50% with 1.5 part D/W –
conc. of 200mg/ml (adult) &
100mg/ml (pediatrics)
Methylergonovine
maleate*
(Methergine)
Do Not Add to IV
fluids
Some clinicians recommend
dilution with 5ml N/S
Metoprolol* (Betaloc) Give undiluted as necessary

4. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ /‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
Meropenem Y Y Intermittent inf.
Final conc. 1-20mg/ml
Over 15-30 min
Metronidazole HCl
(Flagyl)
Y Y LR
Must be neutralized
wit 5mEq Na
bicarbonate/500mg
to achieve pH of 6-7
Given over 20-60min
Powder vial diluted to final
conc. Of 100mg/ml
Nefopam HCl*
(Accupan)
Y Y Slow IV bolus adm. Over
15min least
Omeprazole Na Y Y Stable for 6hr in
G/W 5% & 12hr in
N/S 0.9%
Intermittent or continuous
inf.
Over 20-30 min
Oxytocin
(Pitocin)
Y Y For prolonged
period infusion
(inevitable/missed
abortion or
postpartum
hemorrhage) avoid
G/W 5%
Continuous inf.
Dilute 5-10unit with 500ml
fluid
Paracetamol Y Y Intermittent inf. Conc. <
1mg/ml within 1hr
Phytomenadione
(Vitamin K)
- Y Intermittent inf. Dilute with
55ml fliud
K chloride Y - Continuous inf. Rate 20-
40mmol/hr
Pyridoxine HCl*
(Vitamin B6)
Incompatible with
alkaline solution,
iron salts &
oxidizing solutions
Ranitidine HCl
(Zantac)
Y Y Intermittent inf. Conc. Of
2.5mg/ml (pediatrics)
Remedesivir* Y Inf. 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)
Salbutamol sulfate
(Ventolin IV)
Y Y With N/S 0.9% for
bronchodilation
only
Continuous inf.

5. Intravenous Drug Additives
‫االدوية‬ ‫استعالمات‬ ‫مركز‬ /‫الدوائي‬ ‫الرصد‬ ‫وحدة‬
References
 British National Formulary, v.3.0.12 android application
 Elsevier’s Intravenous Medications: A Handbook for Nurses and Health Professionals,
v.3.5.24 android application
 Mosby’s Drug Reference for Health Professions, v.11.1.556 android application
 Drugs.com website, Professionals, AFHS Monographs
 Electronic Medicines Compendium (emc) website
 MMS home website, Drugs, Info
 Medscape website
Teicoplanin
(Targocid)
Y Y Intermittent inf.
Over 30 min
Tramadol HCl
(Tramal)
Y Y Intermittent or continuous
inf.
Tranexamic acid
( Exacyl)
Y Y
Vancomycin HCl Y Y Intermittent inf.
Reconstitute 500mg with
10ml D/W – conc. Of
(5mg/ml)
Over 60 min