Administration and Stability

Acetylcysteine (Mucomyst)

Concentrate that must be further diluted in Dextrose 5% for IV Infusion.

Acyclovir (Zovirax)

Reconstitute w/ sterile water to concentration of 50 mg/mL.

Infuse over 1 hour to prevent adverse renal effects

Adenosine (Adenocard)

Give by rapid bolus IV only.

Alteplase, Recombinant (Activase)

Reconstitute by adding sterile water to concentration of 1 mg/mL

Amikacin Sulfate (Amikin)

May be used undiluted for IM injections.

IV infusion are prepared by diluting 500mg w/ 100-200mL compatible solution (D5W, NS)

Amiodarone (Cordarone)

Dilute w/ D5W to concentration of 1-6 mg/mL.

Absorbs into PVC so use glass or polyolefin bottles for infusions over 2 hours

Amphotericin B (Fungizone)

50 mg vial should be diluted w/ 10 mL sterile water to concentration of 5 mg/mL.

Dilute for IV infusion to 0.1mg/mL for peripheral or 0.25 mg/mL for central IV.

Ampicillin Sodium (Principen)

Reconstitute w/ small amount of sterile water for IM injection.

For IV, dilute w/ 50-100mL NS

Ampicillin Sodium and Sulbactam Sodium (Unasyn)

May be given IV or IM.

For IM: Reconstitute w/ Sterile water, or Lidocaine.

For IV: Many options (refer to packaging)

Atropine (Atropen)

IM (Autoinjector): Inject into outer thigh (can be given thru clothing).

IV: Administer undiluted via Rapid IV injection.

Intrathecal: Dilute in NS or distilled water.

Azithromycin (Zithromax)

Administer via IV.

Mix w/ compatible diluents to 1mg/mL or 2mg/mL concentration.

Aztreonam (Azactam)

For direct IV Injection, the dose should be diluted w/ 6-10 mL diluent.

For intermittent IV infusion, dilute to concentration not more than 20mg/mL.

For IM, use at least 3mL of diluent.

Bumetanide (Bumex)

Can be given direct IV injection, IM, or IV infusion.

Buprenorphine HCl (Buprenex)

May be given undiluted by IM injection, or direct IV injection.

For continuous IV infusion, dilute w/ NS to 15mcg/mL. Administer via epidural injection

Butorphanol Tartrate (Stadol)

May be given by IM injection or undiluted direct IV

Caspofungin (Caspofungin)

Infuse slowly over 1 hour.

Reconstitute w/ appropriate diluent.

Cefazolin Sodium (Ancef)

Reconstitute to a concentration not more than 330mg/mL.

Cefepime (Maxipime)

Compatible at concetrations between 1-40 mg/mL

Cefotaxime Sodium (Claforan)

Can be given IM or Direct IV injection.

Ceftriaxone Sodium (Rocephin)

For direct IV, reconstitute w/sterile water to 100mg/mL.

Can also be given via IV infusion or IM

Cefuroxime Sodium (Ceftin)

For direct IV, dilute to 90mg/mL.

Can also be given via IV infusion or IM

Chlorpromazine HCl (Thorazine)

Can be given IM undiluted or diluted w/ NS or 2% procaine to lessen tissue irritation.

Can also be given diluted and given via direct IV at concentration not more than 1 mg/mL.

Can also be given via IV infusion

Cidofovir (Vistide)

No Need to Reconstitute

Give by IV infusion over 1 hour. Hydrate Pt w/ NaCl 0.9% prior to infusion.

Must be prepared in class II laminar hood

Ciprofloxacin (Cipro IV)

Dilute to 1-2 mg/mL before administration

Cisplatin (Platinol)

Administer Intra-arterially. Dilute to concentration of 50-500 mg/L

Hydrate w/ NS 2-5 hours before and after.

Don't use Aluminum needles.

Clindamycin Phosphate (Cleocin)

Can give undiluted for IM injection.

IV Infusion: Dilute to not more than 8mg/mL

Dantrolene (Dantrium)

Reconstitute w/ 50mL sterile water for injection. Avoid Glass bottles.

Daptomycin (Cubicin)

Reconstitute 500mg vials w/ 10mL 0.9% NaCl.

Max concentration: 20mg/mL

Darbepoetin Alfa (Aranesp)

Do not dilute. Don't freeze/shake. Inspect for particulates. Discard unused portion due to lack of preservatives.

Dexamethasone Sodium Phosphate (Decadron)

Can be given undiluted for IM or slow IV injection.

Diazepam (Valium)

Absorption by IM is slow and erratic. Only use as last resort.

For IV: Give undiluted.

Digoxin (Lanoxin)

Not generally given IM and should only be used as last resort.

For IV: Give undiluted.

Diltiazem HCl (Cardizem)

For IV: Give undiluted.

Continuous Infusion: Dilute w/ D5W to 1mg/mL

Diphenhydramine HCl (Benadryl)

Give undiluted by IM or (Preferably) IV injection

Dobutamine (Dobutrex)

Administer into large vein. Avoid using Heparin in same IV line.

Dolasetron (Anzemet)

Give undiluted via IV push or diluted in 50mL compatible solution.

Dopamine HCl (Intropin)

Must be diluted before infusion to concentration no more than 3.2mg/mL.

Also available in pre-mixed solutions.

Administer into large vein.

Doripenem (Doribax)

Does not contain bacteriostatic preservative.

Reconstitute w/ sterile water or 0.9% NaCl to 50mg/mL.

Further dilute w/ 100 mL NS or D5W to 4.5 mg/mL

Doxycyline HCl (Vibramycin)

100mg vials should be diluted w/ 10mL of sterile water.

Each 100mg of drug should be further diluted to 100-1000mL of 0.1-1mg/mL.

Droperidol (Inapsine)

Undiluted drug can be given IM or direct IV.

For general anesthesia, may be diluted.

Drotrecogin Alfa (Xigris)

May be given via infusion pump.

Reconstitute w/ Sterile Water to 2mg/mL and further diluted w/ NS to 100-200 mcg/mL

Enalaprilat (Vasotec)

May be given undiluted by direct IV or diluted w/ 50mL D5W

Enoxaparin Sodium (Lovenox)

Give by SQ route only. Do NOT give by IM route. Do not expel air buble prior to injection.

Administer into abdominal wall (alternate sites w/ each injection).

Epinephrine HCl (Adrenaline)

1mg/mL concentrations are preferably given by SQ but if given IM do NOT use in buttocks. DON'T give via IV or intracardially.

In emergencies direct IV can be used but solution should be diluted and the IV line should be flushed afterwards.

Epoetin Alfa (Epogen)

May be given undiluted by SC or Direct IV route. Do NOT shake vials.

Ertapenem (Invanz)

May be given by IV infusion or IM route after reconstitution.

IV infusion is reconstituted w/ compatible solutions.

IM infusion is reconstituted w/ Lidocaine.

Erythromycin Lactobionate (Erythrocin)

500mg and 1g vials should be reconstituted w/ 10 or 20 mL of sterile water to provide solutions of 50mg/mL.

The solution should be further diluted to 1-5mg/mL. Continuous infusion should be 1mg/mL

Direct IV not recommended due to local irritant effect.

Esomprazole (Nexium)

May be given by slow injection or infusion. Flush line w/ NS, LR, D5W.

Reconstitute vial to final volume of 50mL for infusion.

Famotidine (Pepcid)

For IV: 20mg must be diluted to 5-10mL.

For intermittent infusion: 50-100mL.

Fentanyl (Sublimaze)

May be given undiluted by IM or IV, or epidural catheter (more diluted form).

Narcan should be available during use.

Filgrastim (Neupogen)

300mcg/mL may be given by direct rapid SQ injection.

IV infusion: Dilute to 50-100mL w/ D5W to not less than 5mcg/mL.

When diluted to less than 15mcg/mL the solution should have 2mg/mL of Albumin added to lessen likelihood of Adsorption

Fluconazole (Diflucan)

Infusion Solutions should not be given at a rate over 200mg in 1 hour

Foscarnet (Foscavir)

Hydration w/ 750-1000mL NS or D5W prior to infusion is recommended.

Peripheral Line infusion requires dilution to max concentration of 12mg/mL in NS or D5W.

Central Line requires no further dilution.

Hazardous agent that requires precautions for handling/disposal.

Fosphenytoin Sodium (Cerebyx)

Can be given via IV infusion or IM.

Dilute w/ 5% Dextrose or 0.9% NaCl to 1.5-25mg PE/mL

Furosemide (Lasix)

May be given IM or IV when rapid onset of diuresis or pt unable to take oral form.

May be undiluted w/ direct IV infusion.

For high doses, dilution is recommended.

Ganciclovir Sodium (Cytovene)

May be reconstituted w/ 10mL sterile water to 500mg vial to 50mg/mL. Should be further diluted w/ 50-250mL (D5W, NS).

Cytotoxic Agent.

Gatifloxacin (Tequin)

Must be diluted to 2mg/mL w/ compatible solution. Do NOT dilute w/ Sterile Water.

Gentamicin (Garamycin)

May be given undiluted for IM injection.

IV Infusion: Dilute (NS, D5W) to volume 50-200mL.

For babies, concentration should not exceed 5mg/mL

Granisetron (Kytril)

Administer IV Push.

Haloperidol (Haldol)

May be given undiluted for IM use and for SLOW direct IV injection.

IV route should be last resort.

Decanoate salt must NEVER be given by IV.

Lactate form may be given IVPB or IV infusion in D5W.

NS should not be used due to stability/incompatibility issues.

Heparin Sodium

Continuous IV Infusion is preferred.

Hydralazine HCl (Apresoline)

May be given Undiluted by deep IM or deep IV route.

Hydrocortisone Sodium Succinate (A-Hydrocort, Solu-Cortef)

For IM or IV, reconstitute w/ bacteriostatic water or NS.

For Continuous IV infusion, dilute w/ NS or D5W.

Hydromorphone HCl (Dilaudid)

May be given SQ, IM, or IV.

Imipenem-Cilastatin (Primaxin)

For IM: Dilute 500 mg vials w/ 2 mL 1% Lidocaine.

For IV: Suspsend w/ NS or SW.

Infliximab (Remicade)

Dissolve in SW. Use w/in 3 hours.

Iron Dextran (Infed)

IM: Use Z-track.

IV: Dilute in NS.

Iron Sucrose (Venofer)

Dilute in NS and infuse slowly via IV

Ketorolac Tromethamine (Toradol)

Administer Undiluted via deep IM or direct IV

Labetalol HCl (Normodyne, Trandate)

Can be given undiluted for direct IV.

Monitor BP at 5 min intervals.

Leucovorin Calcium (Wellcovorin)

Recon w/ SWFI or Bacteriostatic NS. Can be used for IM or IV.

Don't give w/in 24 hours of Methotrexate.

Levofloxacin (Levaquin)

Only use for IV Infusion.

Levothyroxine (Levoxyl, Synthroid)

Dilute w/ NS.

Lidocaine HCl (Xylocaine)

For IV infusion: Dilute w/ D5W.

Can also be given IM

Linezolid (Zyvox)

Administer IV. Don't mix w/ other drugs.

Lorazepam (Ativan)

IM: Inject undiluted.

IV: Dilute w/ SW, or NaCl, or D5W.

Mannitol (Osmitrol)

Only use for IV infusion.

Use filters for solutions of 20%+ to remove crystals.

Meperidine HCl (Demerol)

May be given by SQ, IM, or IV.

For repeat doses, IM is preferred.

Metropenem (Merren)

Bolus: Recon w/ SW.

Infusion: Compatible w/ most solutions.

Methotrexate (Rheumatrex, Trexall)

Can be given IV, IM, IT, or SQ.

High doses should be followed by Leucovorin.

Dilute w/ NS or D5W.

Methylprednisolone Sodium Succinate (Solu-Medrol, A-Methapred)

Can be used for IM and IV.

Metoclopramide (Reglan)

May be given IM and direct IV undiluted.

For IV infusion: Dilute w/ NS.

Metoprolol (Lopressor)

Inspect visually for particulate matter and discoloration.

Metronidazole (Flagyl)

Recon Powder w/ SW or BSW, or NS.

Micafungin (Mycamine)

Recon w/ NS and administer via IV.

Midazolam HCl (Versed)

May be given undiluted by IM or direct IV.

Milrinone Lactate (Primacor)

Loading dose may be given undiluted or diluted.

Maintenance dose should be diluted w/ NaCl, or D5W.

Morphine Sulfate (Duramorph, Astramorph/PF)

IT and Epidural routes can be given undiluted.

IV route should be mixed w/ water.

Nafcillin Sodium (Unipen)

Dilute w/ BSW or NS.

Nalbuphine HCl (Nubain)

Can be given IM, IV, or SQ

Naloxone (Narcan)

For IT, dilute w/ NS.

IV Push: Give undiluted.

IV: Dilute w/ D5W or NS.

Nitroglycerin (Tridil, Nitro-Bid)

IV: Dilute w/ NS or D5W.

Use special sets for infusion since this drug adsorbs to PVC.

Norepinephrine (Levophed)

Administer into large vein. Dilute w/ D5W, D5NS, (NOT NS).

Olanzapine (Zyprexa)

Only give via IM. Dissolve w/ SW.

Ondansetron HCl (Zofran)

IM and IV: Give undiluted.

IVPB: Dilute in NS or D5W.

Oxytocin (Pitocin)

Dilute w/ NS or LR.

Must use infusion pump for IV.

Palonosetron HCl (Aloxi)

IV Only: Don't mix w/ other drugs. Flush line w/ NS before and after using.

Pamidronate Disodium (Aredia)

Recon w/ SW.

Pantoprazole Sodium (Protonix)

Dilute w/ NaCl and give via IV infusion.

Penicillin-G (Pfizerpen)

Follow package directions