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Stability of reconstituted injectable antibiotics
- 1. Page1of14 Stability of reconstitutedinjectable antibiotics Dilution of antibiotics is an essential part to ensure that patients receive the optimum therapy. It is important that the concentration of antibiotics ’dilution is correct to minimize the side effects. This reference is produced to standardize the practice among all pharmacists aiming to provide comprehensive information regarding antibiotics dilution. I hope this work will be beneficial for you. You also should follow up of any new developments in the fields. Cell wall synthesis inhibitors Beta-lactams Carbapenems Monobactams vancomycin semisynthetic glycopeptide polypeptide antibioticspenicillins cephalosporins Benzathine penicillin ……..p 2 Benzyl penicillin ……..…..p2 Amoxicillin …………..…..p2 Ampicillin ……………...…p3 Amoxicillin + clavulanate ..p3 Ampicillin + Sulbactam ….p3 Amoxicillin + flucloxacillin.p3 Piperacillin + Tazobactam ..p4 Cloxacillin Sodium ……….p4 Cephradine ...p4 Cefuroxime ….p4 Cefoperazone ..p5 Ceftazidime …p5 Ceftizoxime …p5 Cefotaxime ….p6 Ceftriaxone ….p6 Cefepime …....p6 Imipenem + Cilastatin ..p7 Meropenem ………..…p7 Doripenem ………..…p7 Aztreonam …p8 Vancomycin ….p8 Teicoplanin …. P9 Polymycin B ..p9 Protein synthesis inhibitors Macrolides Aminoglycosides Clindamycin Linezolide Fucidic acid Tetracyclins & glycylcycline antibiotic that is structurally similar to tetracycline Chloramphenicol Erythromycin …. P9 Azithromycin …..p9 Amikacin ……. P10 Gentamicin ….p10 Streptomycin ….p10 Clindamycin ….. p10 Linezolide ……p11 Fucidic acid..p11 Tigecycline ………p11 Nucleic acid inhibitors Fluoroquinolones Sulfonamides Ciprofloxacin ….…..p12 Levofloxacin ……..p12 Moxifloxacin ..…...p12 Sulfamethoxazole + Trimethoprim …p12
- 2. Page2of14 Medication Diluent IM& IV injection Intermittent IV infusion Stability Natural penicillins Benzathine penicillin 2.4 MIU/5 ml Retarpen Depo-pen Durapen NA IM injection: Deep IM into upper outer quadrant of buttock Children < 2 year old: IM into midlateral muscle of thigh NOT for IV, intra- arterially or subQ administration NA Should be freshly prepared. Benzyl penicillin 1 MIU 5 MIU (Penicillin G 1 & 5 MIU) 600 mg = 1 MIU NS D5W (less stable) IM injection: Reconstitute 1 MIU with 1.6 ml WFI: Conc. 300 mg/ml IV injection: Reconstitute 1 MIU with 5.6 ml WFI/NS: Conc. 100 mg/ml Over 5 minutes. Max rate: 300 mg/min Intermittent infusion Withdraw required dose and further dilute with diluents. Usually 100 ml NS 6 mg/ml Over 30-60 minutes Should be freshly prepared. Broad spectrum penicillins Amoxicillin Amoxil 1 gm Biomox 250mg, 500 mg, 1 gm E-mox 250mg, 500 mg, 1 gm Farconcil 250mg, 500 mg, 1 gm D5W NS Ringer’s Solution or Compound Sodium Lactate IM injection Add 1.5 mL WFI to … 250-mg Add 2.5 mL WFI to ….500-mg If pain occurs, 1% lidocaine may be used Do not use the 1-g vial for IM use (two separate 500-mg injections should be given if a 1-g dose is required). IV injection Reconstitute each 250-mg …..with 5 mL WFI 500-mg …. with 10 mL 1-g ………. with 20 mL over 3--4 minutes. Intermittent IV infusion Withdraw the required dose and add to a suitable volume of NaCl 0.9% (usually 100 mL) - Infuse over 30 – 60 minutes. - Conc. 5mg/ml - Continuous Infusion not recommended. Should be freshly prepared
- 3. Page3of14 Ampicillin 500 mg Epicocillin NS Incompatiblewith D5W & Hartmann’s IM injection: Reconstitute 500 mg with 1.8 ml WFI: Conc. 250 mg/ml. IV injection: Reconstitute 500 mg with 5 ml WFI: Conc. 100 mg/ml Over 3-5 min Intermittent IV infusion: Withdraw required dose and add to suitable volume of diluents. Dose ≤ 1g to 50 ml Dose >1g to 100 ml Over 30-60 min Reconstituted vials: Used immediately IM & IV injection: Use within 1 hr after preparation. Prepared infusion in NS: 8 hrs ……….... (RT) 12 hrs ……….. (2-8ºC) Beta-lactam/Beta-lactamase Inhibitor Combinations Amoxicillin 1 g + Clavulanate 200 mg Augmentin Curam Magnabiotic Megaclavox NS Ringer’s Solution Ringer’s Lactate Water for injection Incompatible with D5W Not suitable for I. M. IV injection: Dissolve 600mg with 10ml WFI: Conc. 60 mg/ml Infuse over 3 – 4 minutes. Reconstitute 1.2 g with 20 ml WFI: Conc. 60 mg/ml Infuse over 3 – 4 minutes. Intermittent IV infusion: Withdraw required dose and further dilutes to with diluents. Dose 600 mg in 50 ml NS Conc. 12 mg/ml Infuse over 30 – 40 minutes. Dose 1.2 g in 100 ml NS Conc. 12 mg/ml Infuse over 30 – 40 minutes Reconstituted vials & prepared infusion: Used immediately. 4 hrs in ….. 25°C 8 hrs in ….. 2-8 °C Ampicillin 1 g + Sulbactam Sodium 500 mg Ampictam Fortibiotic Sulbin Unictam Unasyn NS D5W 0.5% or 2% lidocaine hydrochloride for IM administration only IM injection: 375 mg …….. 0.8 ml WFI 750 mg …….. 1.6 ml WFI 1500 mg …… 3.2 ml WFI 3000 mg …… 6.4 ml WFI Conc. 375 mg/ml IV injection: 750 mg …….. 25 ml WFI 1500 mg …… 50 ml WFI 3000 mg …… 100 ml WFI Over 10-15 min Intermittent IV infusion: Withdraw required dose and further dilute with 50 – 100 ml diluent. Over 15 - 30 min Prepared IM/ IV injection: Use within 1 hr after preparation Prepared infusion in NS: 8 hrs ………..…. (RT) 72 hrs …………. (2-8ºC) Prepared infusion in D5W: 2 hrs ………….. (RT) 4 hrs ……………(2-8ºC) Amoxicillin + flucloxacillin 500 mg, 1gm Flumox Flucamox NS D5W IM injection: 500-mg …. with 2 mL 1-g ………. with 4 mL IV injection: 500-mg …. with 5 mL 1-g ………. with 10 mL Over 3-4 min Intermittent IV infusion: 500-mg …. with 10 mL 1-g ………. with 20 mL Infuse over 30 – 40 minutes Reconstituted vials: Used immediately 24 hrs …………. (2-8ºC)
- 4. Page4of14 Piperacillin 4 g+ Tazobactam 500 mg Pipracil Tazocin NS D5W Incompatible with Hartmann’s IM injection: Not recommended IV injection: Reconstitute 4.5 g with 20 ml WFI/ NS. At least over 3-5 min Intermittent IV infusion: Withdraw required dose and further dilute with diluents. Usually 50-100 ml NS over 20-30 min Should be used immediately. or 12 hours at 2-8°C. Beta-lactamase-Resistant Penicillins Cloxacillin Sodium 500 mg D5W NS IM injection: Reconstitute 500 mg with WFI 2 ml, 250 mg/ml 4 ml, 125 mg/ml Conc. 125 or 250 mg/ml IV injection: Reconstitute 500 mg with WFI 5 ml, 100 mg/ml 10 ml, 50 mg/ml Conc. 50 or 100 mg/ml Over 3 - 4 min IV infusion: Reconstitute 500 mg with 5 ml WFI: Conc. 100 mg/ml. Withdraw required dose and further dilute with diluents. Dose ≤ 500 mg to 250 ml Dose >500 mg to 500 ml 1-2 mg/ml Reconstituted solution: 24 hrs ……….(RT) 48 hrs ……….(2-8ºC) Prepared infusion: 12 hrs ………. (RT) First Generation Cephalosporins Cephradine 500 mg, 1 gm Cephradin Farcosef Velosef NS D5W IM injection: 500 mg ….. 2 ml WFI 1 gm ….… 4 ml WFI IV injection: 500 mg ….. 5 ml WFI 1 gm ….… 10 ml WFI 2 hrs ………...(RT) 24 hrs ………..(2-8ºC) Second Generation Cephalosporins Cefuroxime 750 mg, 1.5 g Cefumax NS D5W Gluc-NaCI Harmann’s Lactate Ringer’s IM injection: Reconstitute 750 mg with 3 ml WFI Conc. 250 mg/ml IV injection: 750 mg …. 6ml WFI - Conc. 125mg/ml - 1.5gm …. 15ml WFI - Conc. 100mg/ml Over 3-5 min Intermittent IV infusion: Dilute reconstituted solution up to 50- 100ml of infusion fluid. - Conc. 15 - 7.5mg/ml Infuse over 30 minutes 24 hrs ………..(RT) 48 hrs ……… (2-8ºC)
- 5. Page5of14 Third Generation Cephalosporins Cefoperazone 250mg, 500 mg, 1 gm, 2 gm Cefoperazone Cefozone Cefobid Cefrone Peracef D5 W NS Lactate Ringers’ (not for reconstitution) 2% lidocaine for IM administration only IM injection: 250 mg 0.7 ml WFI … 0.2 ml lidocaine 500 mg 1.3 ml WFI … 0.4 ml lidocaine 1 gm …2.6 ml WFI … 0.9 ml lidocaine 2 gm …5.2 ml WFI … 1.8 ml lidocaine Conc. 250 mg/ml IV injection: Reconstitute 1 g with 10 ml diluents/WFI conc. 100 mg/ml Over 3-5 min Intermittent IV infusion: Withdraw required dose and further dilute with 20 – 100 ml diluents Conc. 10 -50 mg/ml 15 – 60 min * Note; If water for injection is used as diluent, --Not more than 20 ml is added to the vial. - For Continuous infusion - Each 1gm of injection is dissolved in 5 ml water for injection. Then added to appropriate intravenous diluent. Reconstituted & prepared infusion: 24 hrs………… (RT) 5 days …………(2-8ºC) Ceftazidime 250 mg, 500 mg, 1 gm Cefzim Cetazime Fortazedim Fortum Sigmazidim NS D5 W Gluc-NaCI Hartmann’s Lactate Ringer’s IM injection: 250 mg …… 1 ml WFI 500 mg …… 1.5 ml WFI 1 gm ……… 3 ml WFI Conc. 333 mg/ml. IV injection: 250 mg …… 2.5 ml WFI 500 mg …… 5 ml WFI 1 gm ……… 10 ml WFI Conc. 100 mg/ml Over 3-5 min Intermittent IV infusion: Withdraw required dose and further (usually 50-100 ml NS) with diluents. Minimum 50 ml for 2 g Minimum 100 ml for 3 g ≤ 100 mg/ml over 20-30 min 12 hrs ………….(RT) 7 days …………..(2-8ºC) Ceftizoxime (Cefizox 1gm) - Normal Saline - Dextrose 5% - Ringer’s Lactate IM injection: Dissolve with 4ml of Lidocaine 1%. Or Water for Injection. - Conc. 250mg/ml IV injection: Dissolve with 10ml Water for Injection. Conc. 100mg/ml Slowly over 3 – 5 minutes. Intermittent Infusion: - Dilute reconstituted solution up to 50 – 100ml of infusion fluid. Conc. 20 – 10mg/ml - Infuse over 20 – 60 minutes. 24 hrs ………….(RT) 96 hrs …………..(2-8ºC)
- 6. Page6of14 Cefotaxime 250 mg, 500mg, 1 gm Cefause, Cefaxim Ceforan, Claforan Cefotax, Foxime Rametax Sigmataxim Taximodel Xorin NS D5 W Gluc- NaCI Hartmann ’s 2% lidocaine for IM injection only IM injection: 250 mg …… 2 ml WFI 500 mg …… 2 ml WFI 1 gm ……… 4 ml WFI Conc. 250 mg/ml IV injection: 250 mg …… 2 ml WFI 500 mg …… 2 ml WFI 1 gm ……… 4 ml WFI Conc. 250 mg/ml Over 3-5 min Intermittent IV infusion: Withdraw required dose and further dilute with 40-100 ml diluents Conc. 10-20 mg/ml Over 20-60 min 24 hrs …….(2-8ºC) Cefotax (Epico) 24 hrs …………(RT) 10 days …………(2-8ºC) Ceforan (Pharco) 7 days …………(2-8ºC) If diluent D5W or NS 5 days …………(2-8ºC) Ceftriaxone 250 mg, 500 mg, 1 gm Cefaxone, Cefotrix Enoxirt, Epicephin Kempoxone Longacef Mesporin Nercefaxon Ramecetrax Triamerican Trixamarc Trixomash Wintriaxone Xoraxon D5 W NS Gluc-NaCI 1% lidocaine for IM injection only Must not be administered simultaneously with calcium containing solution (Ringer, Hartman solution) IM injection: 250 mg …… 1 ml WFI 500 mg …… 2 ml WFI 1 gm ……… 3.5 ml WFI IV injection: 250 mg …… 5 ml WFI 500 mg …… 5 ml WFI 1 gm ……… 10 ml WFI Conc. 100 mg/ml Over 2-4 min Intermittent IV infusion: Withdraw required dose and further dilute up to 40 ml Conc. 25 mg/ml Over at least 30 min Reconstitute & prepared solution: 6 hrs …………. (RT) 24 hrs ………….(2-8ºC) Fourth Generation Cephalosporin Cefepime 500 mg, 1 gm Cefepime Forcetax Maxipime Pimfast Spectracef Wincef D5W NS IM injection: 500 mg ……. 1.3 ml WFI 1 gm ………… 2.4 ml WFI Conc. 280 mg/ml. IV injection: 500 mg ….……. 5 ml WFI 1 gm …………. 10 ml WFI 2 gm …………. 10 ml WFI Conc. 100 mg/ml. Give over 3 – 5 min Intermittent IV infusion: Withdraw required dose and further dilute in 50 or 100 ml diluents. Usually 1 g in 50 ml diluents Over 30 min Reconstituted & prepared infusion: 24 hrs …………..(RT) 7 days ………….(2-8ºC) Cefepime (Pharco) … 24 hrs …………..(RT) 3 days ………….(2-8ºC)
- 7. Page7of14 Carbapenems Imipenem 500 mg +Cilastatin 500 mg Tienam NS D5W Incompatible with lactate containing solution. Never administer as IV BOLUS Intermittent IV infusion: Reconstitute 500 mg imipenem with 10 ml NS conc. 50 mg/ml Withdraw required dose and further dilute to ≤ 5mg/ml with diluents. (usually 100-250 ml NS) Conc. ≤ 5mg/ml Dose ≤ 500 mg imipenem over 20-30 min Dose ≥ 750 mg imipenem over 40-60 min Prepared infusion: 4 hrs ………….(RT) 24 hrs ………..(2-8ºC) Meropenem 500 mg 1 g Meronem Mirage NS D5W IV injection: Reconstitute to conc. of 50 mg/ml 500 mg with.. 10 ml WFI/NS 1 g with …….20 ml WFI/NS Over 3-5 min Intermittent IV infusion: Withdraw required dose and further dilute to1-20 mg/ml with diluents Usually 50 – 200 ml NS Conc. 1-20 mg/ml over 15-30 min Reconstituted solution in WFI: 3 hrs ………..(RT) 12 hrs ………(2-8ºC) Prepared infusion: In NS: 3 hrs …………..(RT) 24 hrs …………(2-8ºC) Prepared infusion In D5W : Immediately Doripenem Monohydrate 500 mg D5W NS Less stable in D5W Intermittent IV infusion: Reconstitute 500 mg with 10 ml WFI or NS Conc. 50 mg/ml Withdraw required dose and further dilute with diluents Usually 100 ml NS Over 1 hr May infuse over 4 hrs which allow the serum concentration to maintain above MIC Reconstituted solution: 1 hr Prepared infusion in NS: 8 hrs ………… (RT) 24 hrs ………...(2-8ºC) Prepared infusion in D5W: 4 hrs …………… (RT) 24 hrs …………….(2-8ºC)
- 8. Page8of14 Monobactams Aztreonam 500 mg, 1gm Azactam - Normal Saline - Dextrose 5% - Ringer’s Solution IM injection: 1.5 mL WFI or NaCl 0.9% to …………. 500-mg vial use 3 mL …. 1-g vial Conc. 333.3mg/ml. IV injection: - Dissolve with 6– 10ml Water for Injection. - Conc. 166.6mg - 100 mg/ml Give over 3 – 5 minutes. Intermittent infusion dilute reconstituted solution up to 50ml of infusion fluid, - Conc. 20mg/ml infuse over 20 – 60 minutes. 24 hours….. RT 72 hours ……. 2-8ºC Vancomycin Vancomycin 500 mg Edicin Kempovancom Vancobact Vancolon Vancomycin D5W NS Hartmann’s NOT for IM administration Intermittent IV infusion: Solution must be diluted prior to administration 500 mg …… 10 mL WFI 1000 mg …… 20 mL WFI Conc. 50 mg/ml Intermittent IV infusion: Withdraw required dose and further dilute 500 mg dilutes with at least 100 ml diluents Over at least 1 hr Over 2 hrs for 1g dose. Max rate 10 mg/min If red man syndrome appear: Infuse over 1.5 hrs - 2 hrs and increase the dilution volume Continuous IV infusion: Withdraw required dose and add with sufficiently large volume of diluents. Over 24 hrs (only if intermittent technique is not feasible) Rotate infusion site frequently to avoid extravasation 96 hrs………… (2-8ºC)
- 9. Page9of14 semisynthetic glycopeptide Teicoplanin 200 mg Targocid NS D5W Gluc-NaCI Hartmann’s IMinjection Reconstitute 200 mg in 3 ml IV injection: Reconstitute 200 mg in 3 ml Over 3-5 minutes Intermittent IV infusion: Withdraw required dose and further dilute with diluents. Usually 100 ml NS/ D5W Over 30 minutes 24 hrs ………. (2-8ºC) polypeptide antibiotics Polymycin B 500,000 IU NS Procaine solution D5W for IV infusion only IM injection: Reconstitute 500,000 IU with 2 ml WFI/diluents IV infusion: Reconstitute and further dilute 500,000 with 300-500 ml D5W Reconstituted solution: 3 days……….. (2-8ºC) Macrolides Erythromycin Lactobionate 500 mg NS Do not use D5W as a diluents unless 0.5 mL 8.4% NaHCO3 added per each 100 ml D5W Never administer as direct IV injection (Fatal ventricular arrhythmias) Intermittent IV infusion: Reconstitute 500 with 10 ml WFI Conc. 50 mg/ml. Withdraw required dose and further dilute to 1 - 2 mg/ml with diluents. At least 100 ml NS of infusion solution. If phlebitis/pain occur with used dilution, consider further dilution Conc. 1-2 mg /ml Max: 5 mg/ ml Give more slowly in patients with risk factors or history of arrhythmias. Over 20-60 min Reconstituted solution: 8 hrs………… (RT) 14 days……… (2-8ºC) Prepared infusion: 24 hrs Protect from light Azithromycin 500 mg Zithromax Azithroglob NS D5W Lactated Ringer’s NOT for IM or IV bolus administration Intermittent IV infusion: Over 3 hrs (1 mg/ml) Over 1 hr (2 mg/ml) Minimum duration of 1 hr Reconstitute 500 mg with 4.8 ml WFI: Conc. 100 mg/ml Reconstituted solution 100 mg/ml further dilute with diluents to: 500 ml, 1 mg/ml 250 ml, 2 mg/ml Reconstituted solution: 24 hrs ………… (< 30ºC) Prepared infusion 1-2 mg/ml: 24 hrs ……………… (RT) 7 days ……………… (2-8ºC)
- 10. Page11of14 ž Aminoglycosides Amikacin 100 mg/2mL 500 mg/2mL Amikabiotic Amikacin Amikaskiv Ramikabiotic D5W NS Lactate Ringer’s IM (preferred route) IV injection: Over 2-3 min IM & IV injection: Withdraw required dose without further dilution. Intermittent IV infusion: Withdraw required dose & further dilute to 0.25 – 5mg/ ml with diluents. (usually 100 ml NS) Adult: over 30 – 60 min Infant: 1-2 hrs Prepared infusion 0.25 – 5 mg/ml: 24 hrs ……….. (RT) 2 days ……….. (2-8ºC) Unused portion in vial should be discarded Protect from light and do not freeze Gentamicin 20, 80 mg /2 ml Epicogent Garamycin Gentamycin NS D5W Gluc-NaCl IM injection: Volume > 4 ml, distributed btw ≥ 2 injection site IV injection: (↑ risk of neuromuscular blockage) - Conc. 40mg/ml Over 2-3 min Intermittent IV infusion: Withdraw required dose and further dilute with diluents. Conc. 1 mg/ml - Dilute up to 50 – 200ml of infusion fluid. - Infuse over 30-120 min Prepared IV infusion: 24 hrs Streptomycin Sulphate 1g Streptomycin NA IM injection Reconstitute 1 g with WFI 4.2 ml, 200 mg/ml 3.2 ml, 250 mg/ml 1.8 ml, 400 mg/ml NOT recommended for IV administration Injection should be freshly prepared and discard unused portion Protect from light Clindamycin Clindamycin Phosphate 300 mg, 600 mg Dalacin Alfaclindamycin D5W NS Gluc-NaCI IM injection: Administration of more than 600mg at once is not recommended. - Conc. 150mg/ml Never administer as BOLUS Intermittent IV infusion: Withdraw required dose and further dilute to ≤ 18 mg/ml with diluents. Over at least 10-60 minutes 300 mg ...50ml…….10 min 600 mg …50ml……20 min 900 mg ….100ml….30 min 1200 mg ..100ml…..40 min 24 days ………. (RT)
- 11. Page11of14 Linezolid Linezolid 600 mg/300 ml Linezolid Linezomentin Zyvoxenam Zyvox NS D5W Gluc-NaCI Hartmann’s Lactate Ringer’s IntermittentIV infusion: Over 30- 120 min Flush line with D5%W, NS or Lactate Ringers’ before and after infusing linezolid Withdraw required dose without further dilution. Once opened, use immediately Discard any unused solution. glycylcycline antibiotic that is structurally similar to tetracycline antibiotics Tigecycline 50 mg Standiga Tygacil D5W NS Intermittent IV infusion: Reconstitute 50 mg with 5.3 ml diluents Conc. 10 mg/ml Withdraw required dose and further dilute to ≤1 mg/ml. Usually 100 ml diluents Conc. ≤ 1 mg/ml Over 30-60 minutes 48 hrs ……….(2-8ºC) Fusidic Acid Fusidic Acid 500 mg D5W NS Hartmann’s NOT for IM or subQ administration Intermittent IV infusion: Reconstitute 500 mg with 10 ml of supplied diluents: Conc. 50 mg/ml. Withdraw required dose and further dilute to 1 - 2 mg/ml with diluents (usually 500 ml NS) Conc. 1-2 mg/ml For patient < 50 kg, required dose should be diluted to at least 10 FOLD in compatible diluents. Over ≥ 2 hrs Prepared infusion: 24 hrs
- 12. Page12of14 Fluoroquinolones Ciprofloxacin 200 mg/100 ml Cipro-sol Ciprocin Ciprofloxacin Rancif NAIntermittent IV infusion: 200 mg infuse over 30 min 400 mg infuse over 60 min Use opened vials immediately. Discard any unused solution. Levofloxacin 500 mg Alfacef Levoflox Levoxin Tavanic NS D5W 2.5% Dextrose in Normal saline Intermittent IV infusion: Infusion time must be at least 60 minutes. 3 hours after perforation of the rubber stopper Moxifloxacin 400 mg/250 ml Moxiflox Moxifloxacin Never administer as BOLUS Intermittent IV infusion: Over 60 minutes Once opened, use immediately Discard any unused solution ž Sulfonamides Sulfamethoxazole 400 mg+ Trimethoprim 80 mg D5W NS Gluc-NaCI Limited stability in NS NOT for IM administration Intermittent IV infusion: over 60-90 hrs IV infusion duration NOT > 1.5 hrs Solution must be diluted prior to administration Withdraw required dose and further dilute with diluents. Dilute 1 mL Bactrim to 25-30 mL diluents. Usually 15 ml dilute to 500 ml diluents Fluid restriction: Add each 5 ml to 75 ml D5W & infuse ≤ 60 min Prepared infusion: 24 hrs, except: 6 hrs: 5 ml/125 ml 4 hrs: 5 ml/100 ml 2 hrs: 5 ml/75 ml Do not refrigerate Protect from light Crystallization or turbidity may develop at any time. Discard if occur.
- 13. Page13of14 Anti-Anaerobic Metronidazole 500 mg/100 mL NS D5W Gluc-NaCI Incompatiblewith D10%W & Hartmann’s Intermittent IV infusion: over 30-60 min Once opened, use immediately Discard any unused solution Do not refrigerate Anti-fungal Amphotericin B 50 mg Ambisome Photericin D5W Incompatible with NS and all electrolyte solutions Intermittent IV infusion: Over 20-30 min (test dose) Over 4 to 6 hrs or longer if not tolerated. Flush line again with D5W after infusion complete Reconstitute 50 mg with 10 ml WFI: Conc. 5 mg/ml Withdraw required dose and further dilute to: Peripheral infusion 500 ml, ≤ 0.1 mg/ml Central infusion: 250 ml, ≤ 0.25 mg/ml Reconstituted solution 5 mg/ml: 24 hrs ……. (RT) 7 days ……(2-8ºC) Prepared infusion: 24 hrs ……..(RT) 2 days ……. (2-8ºC) Protect from light Fluconazole 100 mg/50ML Diflucan Flucand Fluctobar Naviluca Sunnyfungal NS D5W Hartmann’s Ringer’s Intermittent IV infusion: Over 1-2 hrs Max rate: 200 mg/hr (100 ml/hr) Infusions are single use only. Discard any unused portion Caspofungin Acetate 50 mg/70 mg Cancid NaCl solution Hartmann’s Incompatible with Glucose solution Intermittent IV infusion: Reconstitute 50 mg / 70 mg with 10.5 ml WFI: conc. 50 / 70 mg/ml Withdraw required dose and further dilute to ≤ 0.5 mg/ml with diluents. Usually 250 ml NS Over 1 hr Reconstituted solution: 1 hrs ………… (RT) Prepared infusion: 24 hrs ………...(RT) 2 days ………..(2-8ºC)
- 14. Page14of14 Anti-viral Acyclovir 250 mg Zovirax Aciclovir Supraviran D5W NS Lactate Ringer’s NOTfor IM or subQ administration Intermittent IV infusion: Over a minimum of 1 hr Reconstitute 250 mg with 10 ml WFI Conc. 25 mg/ml Withdraw required dose and further dilute concentration ≤ 5 mg/ml with diluents (usually NS) ≤ 5 mg/ml dose ≤ 500 mg to 100 ml dose > 500 mg to 250 ml Reconstituted solution 25 mg/ml: 12 hrs ……… (RT) Prepared infusion ≤ 5 mg/ml : 24 hrs ……… (RT) Do not refrigerate, may precipitate Abbreviations D5W 5% Dextrose in Water Gluc- NaCI Glucose / Sodium Chloride Solution IM Intramuscular IV Intravenous LT Lactated Ringers NS Normal Saline 0.9% References: Handbook on Injectable Drugs Injectable Drugs Guide Drug inserts If you have any comment or you find a mistake, please send e-mail yousryamin_2010@yahoo.com