MEdication

Standard admixture

Maximum concentration  (via central line) or special infusion instructionS

Abciximab

(ReoproÒ)

IV bolus: may be given undiluted

                (2 mg/mL vial)

Infusion: 10 mg/250 mL in D5W

                (40 mcg/mL)  

Must be filtered with a 0.2m filter before administering the bolus and the infusion.

12 hour expiration time, D5W or NS

Patients may also receive heparin

Alprostadil

1 mcg/mL in NS

(250 mcg/250 mL, 500 mcg/500 mL)

Various volumes may be used for final concentrations 1-20 mcg/mL

D5W or NS

24 hour stability

Alteplase

(TPA)

Arterial occlusion:

0.1 mg/mL in NS

Catheter clearance: 2 mg or 2.5 mg syringes available from pharmacy.  May be used in all patient care areas.

Various volumes used based on rate and anticipated infusion time

24 hour stability

(usual dose = 0.25-1 mg/hr x 6-24 hrs)

Amiodarone

(CordaroneÒ)

Load: 150 mg/100 mL D5W bag    

           (1.5 mg/mL)

Infusion: 900 mg/500 mL D5W glass        

               (1.8 mg/mL)

Cardiac arrest: 300 mg or 5 mg/kg

            bolus, flush with 10mL D5W

            (50 mg/mL amp)

1-6 mg/mL (900 mg/150 mL)

PVC bags only suitable for loading doses

Glass containers used for solutions given

over more than 2 hours

Concentrations over 2 mg/mL for longer  than 1 hour must infuse via central line

Argatroban

For HIT (heparin-induced thrombocytopenia)

1 mg/mL in NS

(125 mg/125 mL, 250 mg/250 mL)

Must be properly protected from light

1 mg/mL

NS or D5W

24 hour stability

Monitor aPTT and adjust dose as needed

Bumetanide

(BumexÒ)

0.25 mg/mL undiluted drug

(24 mg/96 mL)

Must be properly protected from light

May be further diluted per request

D5W or NS

Cisatracurium

(NimbexÒ)

IV bolus: may be given undiluted

                (10 mg/mL vial)

Infusion: 200 mg/100 mL NS

                (2 mg/mL)

2 mg/mL

NS or D5W

Train-of-Four monitoring

Diltiazem (CardizemÒ)

IV bolus: may be given undiluted

                (5 mg/mL vial)

Infusion: 100 mg/100 mL D5W 

                (1 mg/mL)

1 mg/mL 

D5W or NS

Dobutamine

1000 mg/250 mL D5W

(4000 mcg/mL)

Premade: 250/500/1000 mg in 250 mL D5W

5000 mcg/mL  (1250 mg/250 mL)

D5W or NS

Some institutions report up to

8000 mcg/mL (2000 mg/250 mL)

Dopamine

400 mg/250 mL D5W

(1600 mcg/mL)

Premade: 400/800 mg in 250 mL D5W

3200 mcg/mL  (800 mg/250 mL)

D5W or NS

Some institutions report up to

6400 mcg/mL (1600 mg/250 mL)

Epinephrine

4 mg/250 mL D5W

(16 mcg/mL)

2-120 mcg/mL in D5W or NS

(30 mg/250 mL for ACLS)

Eptifibatide

(IntegrilinÒ)

IV bolus: may be given undiluted

                (2 mg/mL vial)

Infusion: 75 mg/100 mL pre-made

               (0.75mg/mL)

Patients may also receive heparin

Esmolol

(BreviblocÒ)

IV bolus: may be given undiluted

**only use 10 mg/mL amp for this**

Infusion: 10 mg/mL in D5W

(2500 mg/250 mL, 5000 mg/500 mL)

10 mg/mL in D5W or NS

Some institutions report up to

20 mg/mL (5000 mg/250 mL)

Fenoldopam

(CorlopamÒ)
Must meet guideline criteria for use

40 mcg/mL in NS

(10 mg/250 mL, 20 mg/500 mL)

200 mcg/mL in NS or D5W 

(20 mg/100 mL)

Manufacturer states up to 273 mcg/mL

Fentanyl

Infusion: 10 mcg/mL in NS 

               (1000 mcg/100 mL)

PCA: 50 mcg/mL undiluted drug

          (2500 mcg/50 mL)

Epidural: 2.5, 5 or 10 mcg/mL with bupivicaine 0.125% in 250 mL NS

50 mcg/mL undiluted drug

May be further diluted per request

Furosemide

(LasixÒ)

10 mg/mL undiluted drug

(1000 mg/100 mL)

Must be properly protected from light

May be further diluted per request:

1-10 mg/mL

D5W or NS

Heparin

40 units/mL in D5W

(20,000 units/500 mL)

Various concentrations given for IV use

Maximum infusion concentration

200 units/mL

Hydromorphone

(DilaudidÒ)

PCA: 40 mg/200 mL NS

          (0.2 mg/mL)

10 mg/mL undiluted

May be diluted per request to yield various concentrations for PCA or continuous infusion, D5W or NS

Insulin, regular

1 unit/mL in NS

(100 units/100 mL)

0.1-1 unit/mL in NS or ½NS

Isoproterenol

(IsuprelÒ)

1 mg/250 mL D5W

 (4 mcg/mL)

20 mcg/mL in D5W or NS

Some institutions report up to

40 mcg/mL (10 mg/250 mL)

Lepirudin (RefludanÒ)

For HIT (heparin-induced thrombocytopenia)

IV bolus: 5 mg/mL in NS

                (prepared in syringe)

Infusion: 100 mg/500 mL NS

                (0.2 mg/mL)

100 mg/250 mL NS or D5W

(0.4 mg/mL)

24 hr stability

Monitor aPTT and adjust dose if needed

Lidocaine

(XylocaineÒ)

4000 mg/500 mL D5W

(8 mg/mL)

8 mg/mL in D5W

Some institutions report up to

16 mg/mL (4000 mg/250 mL)

Lorazepam

(AtivanÒ)

1 mg/mL in D5W glass bottle only

(40 mg/40 mL, 80 mg/80 mL)

Must be properly protected from light.

0.1, 0.2 and 1 mg/mL

D5W or NS glass bottle

Short stability, depends on final concentration

Midazolam

(VersedÒ)

50 mg/50 mL NS 

(1 mg/mL)

0.5-2 mg/mL in D5W or NS

May be diluted per request

Milrinone

(PrimacorÒ)

Load:  May be given undiluted

            (1 mg/mL vial)

IV infusion: 20 mg/100 mL D5W

                     (0.2 mg/mL) pre-made

100 mg/250 mL in D5W or NS

(0.4 mg/mL)

Morphine

Infusion: 100 mg/100 mL D5W 

                (1 mg/mL)

PCA: 300 mg/30 mL SW

          (10 mg/mL)

May be diluted per request to yield various concentrations

Nicardipine

(CardeneÒ)

0.1 mg/mL in NS

(25 mg/250 mL, 50 mg/500 mL)

0.2 mg/mL in NS or D5W

(50 mg/250 mL), must be in central line

Nitroglycerin

50 mg/250 mL D5W glass bottle

(200 mcg/mL)

25-400 mcg/mL

(100 mg/250 mL)

D5W or NS glass bottle

Some institutions report up to

800 mcg/mL (200 mg/250 mL)

Nitroprusside

(NitropressÒ)

50 mg/250 mL in D5W

 (200 mcg/mL)

Must be properly protected from light

50-400 mcg/mL in D5W or NS

(100 mg/250 mL)

Some institutions report up to  

800 mcg/mL (200 mg/250 mL)

Norepinephrine

(LevophedÒ)

4 mg/250 mL D5W

(16 mcg/mL)

(NS alone not recommended due to loss of potency from oxidation)

4-64 mcg/mL in D5W or D5W ½ NS

(16 mg/250 mL)

Some institutions report 80-128 mcg/mL

(20-32 mg/250 mL)

Octreotide

(SandostatinÒ)

IV bolus: may be given undiluted

Infusion: 500 mcg/100 mL NS bag

               (5 mcg/mL)

10 mcg/mL in NS or D5W bag or glass

May be diluted per request

Pancuronium

(PavulonÒ)

IV bolus: may be given undiluted

                (1 mg/mL)

Infusion: 100 mg/100 mL undiluted

               (1 mg/mL)

1 mg/mL

Train-of-Four monitoring

Phenylephrine

(NeosynephrineÒ)

10 mg/250 mL NS

(40 mcg/mL)

20-160 mcg/mL in NS or D5W

(40 mg/250 mL)

Some institutions report up to

400 mcg/mL  (100 mg/250 mL)

Procainamide

(PronestylÒ)

Load: 500-1000 mg diluted to a final concentration of 20-30 mg/mL D5W

Infusion: 1000 mg/250 mL D5W

               (4 mg/mL)

16 mg/mL in D5W or NS for infusion

(4000 mg/250 mL)

Propofol

(DiprivanÒ)

1000 mg/100 mL glass bottle

(10 mg/mL)

1% Lipid emulsion, 1.1 Kcal/mL

10 mg/mL undiluted drug

May be further diluted using only D5W to a concentration no less than 2 mg/mL

Tirofiban (AggrastatÒ)

12.5 mg/250 mL bag

(50 mcg/mL)

50 mcg/mL in NS or D5W

Patients may also receive heparin

Vecuronium

(NorcuronÒ)

100 mg/100 mL NS

(1 mg/mL)

0.1-1 mg/mL in NS or D5W

Train-of-Four monitoring