1: Critical Care Intravenous Infusion Drugs—Quick Mixing Guide

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Section I Critical Care Intravenous Infusion Drugs—Quick Mixing Guide

ABCIXIMAB (REOPRO)

Bolus dose: Given IV push

Maintenance dose: Add required maintenance dose to 250 mL D5W

ALTEPLASE (ACTIVASE)

Add 100 mg alteplase to 100 mL sterile water or 50 mg alteplase to 50 mL sterile water

Final concentration: 1 mg/mL

AMINOPHYLLINE (THEOPHYLLINE) 500 MG IN 500 ML D5W

Premade solution

Theophylline 400 mg/500 mL or 800 mg/1000 mL

Final concentration: 1 mg/mL of aminophylline

AMIODARONE (CORDARONE)

Bolus dose: Add 150 mg to 100 mL D5W

Maintenance dose: Add 900 mg to 500 mL D5W in glass bottle

Final concentration: 1.8 mg/mL

ARGATROBAN (ACOVA) 250 MG IN 250 ML NS

Add 250 mg (2.5 mL) argatroban to 250 mL NS

Final concentration: 250 mg/250 mL (1 mg/mL)

ATRACURIUM (TRACRIUM) 250 MG (25 ML) IN 250 ML D5W

Add 250 mg (25 mL) atracurium to 225 mL D5W

Final concentration: 1 mg/mL

BIVALIRUDIN (ANGIOMAX) 250 MG (5 ML) IN 50 ML D5W

Add 250 mg (5 mL) bivalirudin to 50 mL D5W

Final concentration: 5 mg/mL

CISATRACURIUM (NIMBEX) 250 MG IN 250 ML D5W

Add 250 mg (25 × 5-mL vials) cisatracurium to 125 mL D5W

Final concentration: 1 mg/mL

CONIVAPTAN (VAPRISOL)

20 mg IV loading dose; 20-40 mg/day IV continuous infusion; maximum duration is 4 days

Final concentration 200 mg in 100 mL D5W (0.2 mg/mL) and 40 mg in 250 mL D5W (0.16 mg/mL)

DEXMEDETOMIDINE (PRECEDEX) 2 MG IN 50 ML NS

Add 2 mL Precedex to 48-mL NS minibag

Final concentration: 4 mcg/mL

DILTIAZEM (CARDIZEM) 125 MG IN 100 ML D5W

Add 125 mg (5 × 25-mg vials) diltiazem to 100 mL D5W or NS

Final concentration: 125 mg/125 mL (1 mg/mL)

DOBUTAMINE (DOBUTREX) 500 MG IN 250 ML D5W

Premade solution

Final concentration: 500 mg/250 mL (2 mg/mL)

DOPAMINE (INTROPIN) 400 MG IN 250 ML D5W

Premade solution

Final concentration: 400 mg/250 mL (1600 mcg/mL)

DROTRECOGIN ALFA (XIGRIS) (2 × 5 MG) 10 MG IN 100 ML NS

Add 10 mg (2 × 5 mg vials) to 100 mL NS

Final concentration: 10,000 mcg/100 mL (100 mcg/mL)

EPINEPHRINE (ADRENALIN) 1 MG IN 250 ML D5W OR NS

Add 1 mg (1 ampule) epinephrine to 250 mL D5W or NS

Final concentration: 1 mg/250 mL (4 mcg/mL)

EPTIFIBATIDE (INTEGRILIN) 75 MG IN 100-ML VIAL

Premade solution

Bolus dose: from 10-mL vial

Maintenance dose: from 75-mg/100-mL vial

ESMOLOL (BREVIBLOC) 2.5 G IN 250 ML D5W OR NS

Add 2.5 g (10 mL of 250-mg/mL vial) esmolol to 250 mL D5W or NS

Final concentration: 10 mg/mL

FENOLDOPAM (CORLOPAM) 10 MG IN 250 ML D5W OR NS

Add 10 mg (1 mL) fenoldopam to 250 mL D5W or NS

Final concentration: 40 mcg/mL

HALOPERIDOL (HALDOL) FOR RAPID TRANQUILIZATION

Available as 5-mg/mL vial for IV push

HEPARIN 25,000 UNITS IN 500 ML D5W

Premade solution

Final concentration: 25,000 units/500 mL (50 units/mL)

IBUTILIDE (CORVERT) 1 MG IN 50 ML D5W OR NS

Add 1 mg (10-mL vial) ibutilide to 50 mL D5W or NS

May also be given IV push over 10 minutes

IMMUNE GLOBULIN DOSES

See dosing chart

INAMRINONE (INOCOR) 500 MG IN 100 ML NS

Add 500 mg (5 × 100-mg ampules) inamrinone to 100 mL NS

Final concentration: 500 mg/200 mL (2.5 mg/mL)

INFLIXIMAB (REMICADE) 100 MG TO 900 MG IN 250 ML NS

Add 100 mg to 600 mg (calculate correct dose by weight in dosing charts) to total volume of 250 mL NS

Final concentration: 0.4 to 4 mg/mL

INSULIN 100 UNITS IN 250 ML NS

Add 100 units (1 mL) insulin to 250 mL NS

Final concentration: 100 units/250 mL (2 units/5 mL)

For intensive insulin protocols add 100 (1 mL) to 100 mL NS

Final concentration: 100 units/100 mL (1 unit/mL)

ISOPROTERENOL (ISUPREL) 1 MG IN 250 ML D5W

Add 1 mg (1 ampule) isoproterenol to 250 mL D5W

Final concentration: 1 mg/250 mL (4 mcg/mL)

LABETALOL (TRANDATE) 200 MG IN 200 ML NS

Add 200 mg (40 mL) labetalol to 160 mL NS

Final concentration: 200 mg/200 mL (1 mg/mL)

LEPIRUDIN (REFLUDAN) 100 MG IN 250 ML NS

Add 100 mg (2 mL) lepirudin to 250 mL NS

Final concentration: 0.4 mg/mL

LIDOCAINE 2 G IN 500 ML D5W

Premade solution

Final concentration: 2 g/500 mL (4 mg/mL)

LORAZEPAM (ATIVAN) 40 MG IN 500 ML D5W

Add 40 mg (10 mL) lorazepam to 500 mL D5W in glass bottle

Final concentration: 0.08 mg/mL

MAGNESIUM SULFATE (MGSO₄)

Add 1 g magnesium sulfate to 50 mL NS or 2 g to 100 mL NS

Premixed doses 4% solution, 4 g/100 mL or 40 g/1000 mL (for eclampsia)

1-2 g (2-4 mL of 50% solution) diluted in 10 mL D5W may be given IV push for cardiac arrest

Final concentration: 1 g/50 mL (20 mg/mL)

MIDAZOLAM (VERSED) 125 MG IN 125 ML NS

Add 125 mg (25 mL of 5 mg/mL vials) midazolam to 100 mL NS

Final concentration: 1.0 mg/mL

MILRINONE (PRIMACOR) 20 MG IN 100 ML D5W

Premade solution

Final concentration: 0.2 mg/mL

NESIRITIDE (NATRECOR) 1.5 MG IN 250 ML D5W

Add 1.5 mg (5 mL) nesiritide to 250 mL D5W

Final concentration: 1.5 mg/250 mL (6 mcg/mL)

NICARDIPINE (CARDENE)

Add 1 ampule (25 mg/10 mL) to 240 mL of Dextrose 5% or NS resulting in 250 mL of solution

Final concentration: 0.1 mg/mL

A premixed 200 mL solution is also available containing 20 mg in NS or D5W

Final concentration: 0.1 mg/mL

NITROGLYCERIN 25 MG IN 250 ML D5W

Premade solution

Final concentration: 25 mg/250 mL (100 mcg/mL)

NITROPRUSSIDE (NIPRIDE) 50 MG IN 500 ML D5W

Add 50 mg (1 vial) nitroprusside to 500 mL D5W

Final concentration: 50 mg/500 mL (100 mcg/mL)

NOREPINEPHRINE (LEVOPHED) 4 MG IN 250 ML D5W OR NS WITH REGITINE 5 MG/250 ML

Add 4 mg (1 × 4-mg ampule) norepinephrine to 250 mL D5W or NS and add 5 mg Regitine (1 × 5–mg vial) to each 250-mL bag

Final concentration: norepinephrine 4 mg/250 mL (16 mcg/mL)

OCTREOTIDE (SANDOSTATIN) 1200 MCG IN 250 ML D5W OR NS

Add 1200 mcg (2.4 mL) Sandostatin to 250 mL D5W or NS

Final concentration: Sandostatin 4.8 mcg/mL

PANTOPRAZOLE (PROTONIX) 40–80 MG IN 100 ML D5W OR NS

Add 10 mL NS to each 40-mg vial and add contents to 90 mL NS

Final concentration: 40 mg/100 mL (0.4 mg/mL) or 80 mg/100 mL (0.8 mg/mL)

PHENYLEPHRINE (NEO-SYNEPHRINE) 10 MG IN 250 ML D5W

Add 10 mg (1 ampule) phenylephrine to 250 mL D5W

Final concentration: 10 mg/250 mL (40 mcg/mL)

PROCAINAMIDE (PRONESTYL) 1 G IN 250 ML D5W OR NS

Add 1 g (1 vial) Pronestyl to 250 mL D5W or NS

Final concentration: 1 g/250 mL (4 mg/mL)

PROPOFOL (DIPRIVAN) 500 MG/50 ML OR 1 G/100 ML EMULSION

Premade solution

Final concentration: 10 mg/mL

RETEPLASE (RETAVASE) 20-UNIT KIT

Add 10 mL sterile water to 10 units Retavase with kit provided

Repeat for second 10-unit dose

TENECTEPLASE (TNKASE)

Add 10 mL sterile water to 50 mg TNKase

Final concentration: 5 mg/mL

TIROFIBAN (AGGRASTAT) 12.5 MG IN 250 ML D5W OR NS

A premixed solution 100 mL or 250 mL container,

Final concentration: 50 mcg/mL or 0.05 mg/mL

VASOPRESSIN (PITRESSIN SYNTHETIC) 250 UNITS IN 250 ML

Add 250 units (12.5 mL of 20 units/mL) vasopressin to 250 mL D5W or NS

Final concentration: 250 units/250 mL (1 unit/mL)

Quick Reference Infusion Drug Compatibility and Incompatibility Chart

Drug	Compatibility	Incompatibility
Abciximab	Unknown or no information	Unknown or no information
Alteplase	Dextrose 5% Lidocaine Metoprolol Propranolol

Aminophylline Amiodarone

Aminophylline

Sodium bicarbonate

Argatroban Unknown or no information Unknown or no information Atracurium

Aminophylline

Bivalirudin

[including Y-site]

Alteplase (tPA)

Amiodarone hydrochloride

Amphotericin B

Chlorpromazine hydrochloride

Prochlorperazine

Reteplase (rtPA)

Streptokinase

Vancomycin hydrochloride

Cisatracurium Conivaptan None

Dilute only with D5W.

Do not mix or

administer with other IV fluids or medications.

Dexmedetomidine

Atracurium besylate

Atropine sulfate

Fentanyl citrate

Glycopyrrolate bromide

Mivacurium chloride

Morphine sulfate

Blood: serum or plasma Diltiazem

Acetazolamide

Aminophylline

Hydrocortisone

Methylprednisolone

Sodium bicarbonate

Dobutamine Dopamine

Amphotericin B

Metronidazole

Sodium bicarbonate

Drotrecogin

Normal saline (NS)

Lactated Ringer’s (LR)

5% Dextrose in water (D5W)

5% Dextrose in normal saline (D5NS)

Unknown Epinephrine

Potassium chloride

Aminophylline

Sodium bicarbonate

Eptifibatide

Alteplase (tPA)

Potassium chloride (up to 60 mEq)

Furosemide Esmolol

Amphotericin B

Fenoldopam

[In-line compatibility]

Cefazolin, dopamine, epinephrine, gentamicin, heparin, lidocaine, and nitroprusside

[In-line incompatibility]

Alkaline solutions

Haloperidol

Nitroprusside

Heparin

Ampicillin/sulbactam

Calcium gluconate

Chlordiazepoxide

Cyclophosphamide

Diphenhydramine

Magnesium sulfate

Potassium chloride

Prochlorperazine

Ibutilide

Avoid use with other antiarrhythmic agents (disopyramide, quinidine, and procainamide) due to increased toxicity. Also, amiodarone and sotalol should be avoided due to their potential to prolong refractoriness.

Avoid use with phenothiazines, tricyclic and tetracyclic antidepressants, and nonsedating antihistamines (terfenadine [Seldane] and astemizole [Hismanal]) due to QT prolongation.

Immune globulin intravenous None. Administer via a separate IV line with no other medications. Unknown Inamrinone

Dextrose solutions

Furosemide (Lasix)

Sodium bicarbonate

Infliximab Unknown or no information Unknown or no information Insulin drip Isoproterenol

Alkaline solutions

Aminophylline

Sodium bicarbonate

Labetalol

Amphotericin B

Sodium bicarbonate

Lepirudin Unknown or no information Unknown or no information Lidocaine

Amphotericin B

Isoproterenol

Norepinephrine

Sodium bicarbonate

Lorazepam

Buprenorphine

Dexamethasone

Imipenem/cilastatin

Magnesium

Calcium gluconate

Cisplatin (Platinol)

Hydrocortisone sodium Succinate (Solu-Cortef)

Isoproterenol (Isuprel)

Linezolid (Zyvox)

Meropenem (Merrem IV)

Methyldopate (Aldomet)

Norepinephrine (Levophed)

Penicillin G potassium

Potassium phosphate

Verapamil (Isoptin)

Metoclopramide (Reglan)

Acyclovir (Zovirax)

Amikacin (Amikin)

Aztreonam (Azactam)

Bivalirudin (Angiomax)

Cefazolin (Kefzol)

Cefoperazone (Cefobid)

Cefotaxime (Claforan)

Cefoxitin (Mefoxin)

Ciprofloxacin (Cipro IV)

Cisatracurium (Nimbex)

Clindamycin (Cleocin)

Dexmedetomidine (Precedex)

Dobutamine (Dobutrex)

Docetaxel (Taxotere)

Doxorubicin liposome (Doxil)

Doxycycline (Vibramycin)

Enalaprilat (Vasotec IV)

Erythromycin (Erythrocin)

Esmolol (Brevibloc)

Etoposide phosphate (Etopophos)

Famotidine (Pepcid IV)

Fenoldopam (Corlopam)

Fludarabine (Fludara)

Gatifloxacin (Tequin)

Gentamicin (Garamycin)

Granisetron (Kytril)

Hetastarch in electrolytes (Hextend)

Hydrocortisone sodium Succinate (Solu-Cortef)

Hydromorphone (Dilaudid)

Idarubicin (Idamycin)

Insulin (regular)

Labetalol (Normodyne)

Linezolid (Zyvox)

Meperidine (Demerol)

Metronidazole (Flagyl IV)

Milrinone (Primacor)

Minocycline (Minocin)

Nafcillin (Nafcil)

Ondansetron (Zofran)

Oxacillin (Bactocill)

Paclitaxel (Taxol)

Penicillin G potassium

Piperacillin (Pipracil)

Piperacillin/Tazobactam (Zosyn)

Potassium chloride (KCI)

Propofol (Diprivan)

Remifentanil (Ultiva)

Sargramostim (Leukine)

Sulfamethoxazole-Trimethoprim (Bactrim)

Thiotepa (Thioplex)

Ticarcillin (Ticar)

Tobramycin (Nebcin)

Vancomycin (Vancocin)

Sodium bicarbonate

Midazolam Milrinone

Nesiritide

Ethacrynic acid (Ethacrynate)

Injectable drugs with the preservative sodium metabisulfite

*Do not administer via heparin-coated central catheter

Nicardipine

Amphotericin B liposome (AmBisome)

Ampicillin sulbactam

Nitroglycerin Do not mix nitroglycerin in the same bottle with any other drugs. Nitroprusside No other drug should be added to the infusion fluid for simultaneous administration with nitroprusside. Norepinephrine

Aminophylline

Chlorothiazide

Phenobarbital

Sodium bicarbonate

Octreotide

Total parenteral nutrition

None specified. Because of lack of data, this drug should not be mixed with other medications except as noted here. Pantoprazole

No known documented.

Protonix should not be infused with other drug infusions.

A single dedicated line is usually preferred. If a Y-site is used, position it closest to the patient. The line should be flushed with D5W, NS, or LR. Phenylephrine

Chloramphenicol

Potassium chloride

Sodium bicarbonate

Nitroglycerin

Nitroprusside

Potassium chloride

Calcium gluconate

Hydrocortisone sodium succinate

Penicillin G potassium

Penicillin G sodium

Sodium bicarbonate

Calcium gluconate

Chlordiazepoxide

Dexmedetomidine

Diphenhydramine

Doxorubicin liposome

Ethacrynate sodium

Etoposide phosphate

Hetastarch in electrolytes

Magnesium sulfate

Methylergonovine

Methylprednisolone

Penicillin G potassium

Piperacillin/Tazobactam

Prochlorperazine

Quinupristin/dalfopristin

Sodium bicarbonate

Succinylcholine

Procainamide

Potassium chloride

Aminophylline

Magnesium sulfate

Sodium bicarbonate

Propofol

Calcium gluconate

Cyclophosphamide

Diphenhydramine

Imipenem/cilastatin

Magnesium sulfate

Potassium chloride

Prochlorperazine

Sodium bicarbonate

Succinylcholine

Ticarcillin/clavulanate

Reteplase None

All medications.

Retavase should be administered in separate IV line whenever possible and should not be mixed with any other medications.

Tenecteplase NS All dextrose solutions. Tirofiban

Potassium chloride

Diazepam (Valium) Vasopressin Unknown or no information Unknown or no information

Related

Critical Care Intravenous Infusion Drug Handbook 3e