Drug Dilution Guide
Standard concentrations, recommended diluents, and administration rates for common IV medications.
Norepinephrine
Standard Diluent
D5W or NS
Final Concentration
4 mg / 250 mL (16 mcg/mL) or 8 mg / 250 mL (32 mcg/mL)
Infusion Rate
Titrate to MAP > 65 mmHg (usually 1 - 30 mcg/min)
Max: No absolute max, but > 30 mcg/min implies profound shock
Stability
24 hours at room temp
Administration Notes
Central line preferred due to extravasation risk. D5W is traditionally preferred to prevent oxidation, though NS is commonly used.
Amiodarone
Standard Diluent
D5W
Final Concentration
900 mg / 500 mL (1.8 mg/mL)
Infusion Rate
1 mg/min for 6 hrs, then 0.5 mg/min for 18 hrs
Stability
24 hours
Administration Notes
Requires in-line filter. Use glass or polyolefin bags to prevent PVC adsorption.
Insulin (Regular)
Standard Diluent
Normal Saline (0.9% NaCl)
Final Concentration
100 Units / 100 mL (1 Unit/mL)
Infusion Rate
0.1 Units/kg/hr (DKA/HHS protocol)
Stability
24 hours
Administration Notes
Flush tubing with 20-50 mL of solution before connecting to patient due to insulin binding to plastic tubing.
Epinephrine
Standard Diluent
D5W or NS
Final Concentration
4 mg / 250 mL (16 mcg/mL)
Infusion Rate
Titrate to effect (usually 1 - 10 mcg/min)
Max: No absolute max; depends on clinical response
Stability
24 hours at room temp
Administration Notes
Central line strongly preferred. Can cause profound tachycardia and ischemia.
Vasopressin
Standard Diluent
D5W or NS
Final Concentration
40 Units / 100 mL (0.4 Units/mL)
Infusion Rate
0.03 - 0.04 Units/min (septic shock)
Max: 0.04 Units/min (higher doses risk splanchnic ischemia)
Stability
24 hours
Administration Notes
Not titrated like other pressors; usually set at a fixed rate as an adjunct to Norepinephrine.
Propofol
Standard Diluent
Ready to use (lipid emulsion)
Final Concentration
10 mg/mL
Infusion Rate
5 - 50 mcg/kg/min
Max: Generally avoid > 80 mcg/kg/min for prolonged periods
Stability
12 hours (due to lipid emulsion infection risk)
Administration Notes
Strict aseptic technique required. Monitor triglycerides if infused > 48 hours to avoid PRIS.
Dexmedetomidine
Standard Diluent
NS
Final Concentration
400 mcg / 100 mL (4 mcg/mL)
Infusion Rate
0.2 - 1.5 mcg/kg/hr
Max: 1.5 mcg/kg/hr
Stability
24 hours
Administration Notes
Does not cause respiratory depression. Watch for bradycardia and hypotension.
Fentanyl
Standard Diluent
NS or D5W
Final Concentration
1,000 mcg / 100 mL (10 mcg/mL) or 2,500 mcg / 250 mL
Infusion Rate
25 - 200 mcg/hr
Max: Titrate to RASS/pain scores
Stability
24 hours
Administration Notes
Highly lipophilic, accumulates in fat with prolonged infusions.
Heparin
Standard Diluent
D5W or NS
Final Concentration
25,000 Units / 250 mL (100 Units/mL)
Infusion Rate
Weight-based protocol (e.g., 12-18 Units/kg/hr)
Max: Per nomogram
Stability
24 hours
Administration Notes
Monitor aPTT or Anti-Xa levels strictly. Watch for HIT (platelet drop).
Nitroglycerin
Standard Diluent
D5W or NS
Final Concentration
50 mg / 250 mL (200 mcg/mL)
Infusion Rate
5 - 200 mcg/min
Max: 200 mcg/min
Stability
24 hours
Administration Notes
Requires glass bottles or special non-PVC tubing to prevent adsorption.
Diltiazem
Standard Diluent
NS or D5W
Final Concentration
125 mg / 125 mL (1 mg/mL)
Infusion Rate
5 - 15 mg/hr
Max: 15 mg/hr
Stability
24 hours
Administration Notes
Usually preceded by a 0.25 mg/kg bolus over 2 minutes.
Dobutamine
Standard Diluent
D5W or NS
Final Concentration
500 mg / 250 mL (2,000 mcg/mL)
Infusion Rate
2 - 20 mcg/kg/min
Max: 20 mcg/kg/min
Stability
24 hours
Administration Notes
Inotrope. May cause significant tachycardia and arrhythmias. Can cause hypotension if patient is volume depleted.
Milrinone
Standard Diluent
D5W or NS
Final Concentration
20 mg / 100 mL (200 mcg/mL)
Infusion Rate
0.375 - 0.75 mcg/kg/min
Max: 0.75 mcg/kg/min
Stability
72 hours
Administration Notes
Inodilator. Needs renal dose adjustment. May drop blood pressure significantly.
Nicardipine
Standard Diluent
NS or D5W
Final Concentration
25 mg / 250 mL (0.1 mg/mL)
Infusion Rate
5 - 15 mg/hr
Max: 15 mg/hr
Stability
24 hours
Administration Notes
Change site every 12 hours if peripheral to avoid phlebitis. Central line preferred.
Labetalol
Standard Diluent
D5W
Final Concentration
200 mg / 200 mL (1 mg/mL)
Infusion Rate
2 - 8 mg/min
Max: 8 mg/min (Total max 300mg in 24 hours)
Stability
24 hours
Administration Notes
Avoid in patients with severe asthma or bradycardia (non-selective beta blocker).
Phenylephrine
Standard Diluent
NS or D5W
Final Concentration
40 mg / 250 mL (160 mcg/mL) or 100 mg / 250 mL (400 mcg/mL)
Infusion Rate
10 - 200 mcg/min
Max: 200 mcg/min
Stability
24 hours
Administration Notes
Pure alpha-1 agonist. Can cause reflex bradycardia.
Ketamine
Standard Diluent
NS or D5W
Final Concentration
500 mg / 50 mL (10 mg/mL)
Infusion Rate
1 - 10 mcg/kg/min (Analgesia/Sedation)
Max: Depends on indication
Stability
24 hours
Administration Notes
Does not usually drop blood pressure; may actually increase sympathetic tone. Can cause emergence delirium.
Cisatracurium
Standard Diluent
D5W or NS
Final Concentration
100 mg / 50 mL (2 mg/mL) or 200 mg / 100 mL
Infusion Rate
1 - 3 mcg/kg/min
Max: Titrate to Train of Four (TOF) usually 1-2 twitches
Stability
24 hours refrigerated, shorter at room temp
Administration Notes
Requires secure airway and mechanical ventilation. Independent of hepatic/renal function (Hoffmann elimination).
Pantoprazole
Standard Diluent
NS
Final Concentration
80 mg / 100 mL (0.8 mg/mL)
Infusion Rate
8 mg/hr
Max: 8 mg/hr
Stability
12 hours (protect from light if prolonged)
Administration Notes
Use dedicated line or flush thoroughly. Incompatible with many drugs.
Octreotide
Standard Diluent
NS
Final Concentration
500 mcg / 500 mL (1 mcg/mL)
Infusion Rate
25 - 50 mcg/hr
Max: 50 mcg/hr
Stability
24 hours
Administration Notes
Used for esophageal variceal bleeding. Often started with a 50 mcg IV push bolus.
Magnesium Sulfate
Standard Diluent
NS or D5W
Final Concentration
4 g / 100 mL or 4 g / 250 mL
Infusion Rate
1 - 2 g/hr (replacement) or 2 g over 10 min (Torsades)
Max: Varies; high rates used for eclampsia/Torsades
Stability
24 hours
Administration Notes
Monitor deep tendon reflexes and respiratory rate if using high doses.
Adenosine
Standard Diluent
Undiluted (Rapid IV Push)
Final Concentration
3 mg/mL
Infusion Rate
6 mg rapid IV push, followed by 12 mg if needed
Max: Give over 1-2 seconds
Stability
Room temperature
Administration Notes
Requires immediate rapid 20 mL NS flush and elevation of the extremity. Half-life is < 10 seconds.
Alteplase (tPA)
Standard Diluent
Sterile Water
Final Concentration
1 mg/mL
Infusion Rate
Stroke: 0.9 mg/kg (10% as bolus, 90% over 1 hour)
Max: Max total dose 90 mg (for stroke)
Stability
Use within 8 hours of reconstitution
Administration Notes
Strict BP control required (< 185/110) before and during administration.
Aminophylline
Standard Diluent
D5W or NS
Final Concentration
1 mg/mL or 2 mg/mL
Infusion Rate
0.5 - 0.7 mg/kg/hr
Max: Depends on serum theophylline levels
Stability
24 hours
Administration Notes
Narrow therapeutic index. Monitor for arrhythmias and seizures.
Atracurium
Standard Diluent
NS or D5W
Final Concentration
0.2 mg/mL or 0.5 mg/mL
Infusion Rate
5 - 10 mcg/kg/min
Max: Titrate to TOF
Stability
Refrigerate intact vials; degrades rapidly at room temp
Administration Notes
Can cause histamine release (hypotension, tachycardia).
Atropine
Standard Diluent
Undiluted
Final Concentration
0.1 mg/mL or 1 mg/mL
Infusion Rate
1 mg IV push every 3-5 mins (Bradycardia)
Max: Max total dose 3 mg
Stability
Room temperature
Administration Notes
Paradoxical bradycardia can occur with doses < 0.5 mg or slow administration.
Bivalirudin
Standard Diluent
D5W or NS
Final Concentration
5 mg/mL
Infusion Rate
0.15 - 0.2 mg/kg/hr (titrated to aPTT)
Max: Per nomogram
Stability
24 hours
Administration Notes
Direct thrombin inhibitor. Preferred in patients with HIT history.
Bumetanide
Standard Diluent
D5W or NS
Final Concentration
0.25 mg/mL
Infusion Rate
0.5 - 2 mg/hr (continuous infusion)
Max: Max 10 mg/day
Stability
24 hours
Administration Notes
Loop diuretic. ~40x more potent than furosemide (1 mg bumetanide = 40 mg furosemide).
Caspofungin
Standard Diluent
NS (Do NOT use Dextrose)
Final Concentration
0.5 mg/mL
Infusion Rate
Infuse over 1 hour
Max: Avoid rapid infusion (histamine release)
Stability
24 hours (Room Temp) or 48 hours (Refrigerated)
Administration Notes
Echinocandin antifungal. Specifically incompatible with dextrose-containing solutions.
Cefepime
Standard Diluent
NS or D5W
Final Concentration
10 - 40 mg/mL
Infusion Rate
Give over 30 mins (Standard) or 3-4 hours (Extended Infusion)
Max: Avoid rapid push
Stability
24 hours (Room Temp)
Administration Notes
Neurotoxicity (encephalopathy, seizures) risk in renal failure if not dose adjusted.
Dexamethasone
Standard Diluent
Undiluted (IV Push) or 50mL NS/D5W
Final Concentration
4 mg/mL or 10 mg/mL
Infusion Rate
Push over 1-2 mins or infuse over 15 mins
Max: Varies by indication
Stability
24 hours
Administration Notes
Rapid IV push can cause intense perineal burning sensation.
Digoxin
Standard Diluent
NS, D5W, or Undiluted
Final Concentration
100 - 250 mcg/mL
Infusion Rate
Give over at least 5 minutes
Max: Avoid rapid push (vasoconstriction)
Stability
24 hours
Administration Notes
Monitor potassium closely (hypokalemia increases risk of digoxin toxicity).
Enalaprilat
Standard Diluent
Undiluted or 50mL NS/D5W
Final Concentration
1.25 mg/mL
Infusion Rate
1.25 mg IV push over 5 minutes
Max: Max 5 mg/dose every 6 hours
Stability
24 hours
Administration Notes
IV ACE inhibitor. Can cause profound, unpredictable hypotension.
Eptifibatide
Standard Diluent
NS or D5W
Final Concentration
2 mg/mL or 0.75 mg/mL
Infusion Rate
2 mcg/kg/min (ACS)
Max: 2 mcg/kg/min
Stability
Protect from light until administration
Administration Notes
Glycoprotein IIb/IIIa inhibitor. Requires renal adjustment (CrCl < 50 mL/min = 1 mcg/kg/min).
Flumazenil
Standard Diluent
Undiluted
Final Concentration
0.1 mg/mL
Infusion Rate
0.2 mg over 15 seconds (repeat up to 3 mg)
Max: 0.2 mg/min
Stability
24 hours
Administration Notes
Benzodiazepine reversal. High risk of inducing seizures in chronic benzo users.
Furosemide
Standard Diluent
Undiluted or NS/D5W
Final Concentration
10 mg/mL
Infusion Rate
Push: max 20 mg/min. Infusion: max 4 mg/min.
Max: 4 mg/min (to avoid ototoxicity)
Stability
24 hours (protect from light)
Administration Notes
Rapid push of large doses (>120mg) can cause permanent deafness.
Glucagon
Standard Diluent
Manufacturer's Diluent or Sterile Water
Final Concentration
1 mg/mL
Infusion Rate
1-5 mg IV push (Beta-blocker/CCB overdose)
Max: Infusions at 1-5 mg/hr if response to bolus
Stability
Use immediately after reconstitution
Administration Notes
Can cause severe nausea and vomiting; pretreat with antiemetics.
Haloperidol
Standard Diluent
D5W (preferred) or NS
Final Concentration
5 mg/mL
Infusion Rate
IV push over 1 min, or continuous infusion 3-25 mg/hr
Max: Depends on agitation severity
Stability
24 hours
Administration Notes
High risk of QTc prolongation and Torsades de Pointes. Baseline ECG required.
Hydralazine
Standard Diluent
Undiluted
Final Concentration
20 mg/mL
Infusion Rate
10 - 20 mg IV push over 1 minute
Max: Max 20 mg per dose
Stability
Use immediately; degrades upon contact with metal/light
Administration Notes
Onset is delayed (10-30 mins). Do not stack doses too quickly.
Hydrocortisone
Standard Diluent
NS or D5W
Final Concentration
1 mg/mL or 2 mg/mL
Infusion Rate
50-100 mg IV push, or 200 mg/24hr continuous
Max: Administer push over 3-5 mins
Stability
24 hours
Administration Notes
Drug of choice for relative adrenal insufficiency in septic shock.
Isoproterenol
Standard Diluent
D5W
Final Concentration
1 mg / 250 mL (4 mcg/mL)
Infusion Rate
2 - 10 mcg/min
Max: Titrate to heart rate
Stability
24 hours (protect from light)
Administration Notes
Pure beta agonist. Used for refractory bradycardia/heart block. Causes profound vasodilation.
Vancomycin
Standard Diluent
NS or D5W
Final Concentration
5 mg/mL
Infusion Rate
1-2 hours depending on dose
Max: 10 mg/min (to prevent Red Man Syndrome)
Stability
14 days refrigerated
Administration Notes
Requires therapeutic drug monitoring (troughs).
Meropenem
Standard Diluent
NS
Final Concentration
1 - 20 mg/mL
Infusion Rate
15-30 mins or 3-hour extended infusion
Max: 3-hour extended
Stability
24 hours refrigerated
Administration Notes
Broad spectrum carbapenem. May lower seizure threshold.
Piperacillin/Tazobactam
Standard Diluent
NS or D5W
Final Concentration
200 mg/mL
Infusion Rate
30 mins or 4-hour extended infusion
Max: 4-hour extended
Stability
24 hours room temp
Administration Notes
Extended infusion optimizes time above MIC for pseudomonas.
Linezolid
Standard Diluent
Ready to use bags (D5W)
Final Concentration
2 mg/mL
Infusion Rate
30 - 120 mins
Max: 120 mins
Stability
Room temp (protect from light)
Administration Notes
Weak MAOI; risk of serotonin syndrome with SSRIs.
Fluconazole
Standard Diluent
Ready to use (NS)
Final Concentration
2 mg/mL
Infusion Rate
1 - 2 hours
Max: 200 mg/hr
Stability
Room temp
Administration Notes
No renal adjustment for single doses.
Amphotericin B
Standard Diluent
D5W ONLY
Final Concentration
0.1 mg/mL
Infusion Rate
2 - 6 hours
Max: Over 6 hours
Stability
24 hours (protect from light)
Administration Notes
Pre-medicate with APAP/Diphenhydramine to prevent rigors.
Acyclovir
Standard Diluent
NS or D5W
Final Concentration
7 mg/mL
Infusion Rate
1 hour
Max: 1 hour minimum
Stability
24 hours room temp (do not refrigerate)
Administration Notes
Ensure adequate hydration to prevent crystal nephropathy.
Metronidazole
Standard Diluent
Ready to use (NS)
Final Concentration
5 mg/mL
Infusion Rate
30 - 60 mins
Max: 60 mins
Stability
Room temp (do not refrigerate)
Administration Notes
Disulfiram-like reaction with alcohol.
Levofloxacin
Standard Diluent
Ready to use (D5W)
Final Concentration
5 mg/mL
Infusion Rate
60 - 90 mins
Max: 90 mins
Stability
Room temp
Administration Notes
QTc prolongation risk. Adjust in renal failure.
Ciprofloxacin
Standard Diluent
Ready to use (D5W)
Final Concentration
2 mg/mL
Infusion Rate
60 mins
Max: 60 mins
Stability
Room temp
Administration Notes
Tendon rupture risk (Black Box Warning).
Azithromycin
Standard Diluent
NS or D5W
Final Concentration
1 - 2 mg/mL
Infusion Rate
1 hour (500mg) or 3 hours
Max: 1 hour minimum
Stability
24 hours
Administration Notes
Do not give as a bolus.
Ceftriaxone
Standard Diluent
NS or D5W
Final Concentration
10 - 40 mg/mL
Infusion Rate
30 mins
Max: 30 mins
Stability
3 days room temp
Administration Notes
Do not mix with calcium (e.g., Lactated Ringers).
Cefazolin
Standard Diluent
NS or D5W
Final Concentration
10 - 20 mg/mL
Infusion Rate
30 mins
Max: 30 mins
Stability
24 hours room temp
Administration Notes
Common surgical prophylaxis.
Gentamicin
Standard Diluent
NS or D5W
Final Concentration
1 - 10 mg/mL
Infusion Rate
30 - 60 mins
Max: 60 mins
Stability
24 hours
Administration Notes
Nephrotoxic and ototoxic. Requires peak/trough monitoring.
Tobramycin
Standard Diluent
NS or D5W
Final Concentration
1 - 10 mg/mL
Infusion Rate
30 - 60 mins
Max: 60 mins
Stability
24 hours
Administration Notes
Similar to gentamicin; preferred for Pseudomonas.
Esmolol
Standard Diluent
NS or D5W
Final Concentration
10 mg/mL
Infusion Rate
50 - 300 mcg/kg/min
Max: 300 mcg/kg/min
Stability
24 hours
Administration Notes
Ultra-short acting beta blocker (half-life 9 mins).
Nitroprusside
Standard Diluent
D5W ONLY
Final Concentration
200 mcg/mL
Infusion Rate
0.3 - 10 mcg/kg/min
Max: 10 mcg/kg/min (for max 10 mins)
Stability
24 hours (wrap in foil to protect from light)
Administration Notes
Risk of cyanide/thiocyanate toxicity with prolonged use.
Procainamide
Standard Diluent
NS or D5W
Final Concentration
2 - 4 mg/mL
Infusion Rate
20 - 50 mg/min (loading) then 1-4 mg/min
Max: 50 mg/min
Stability
24 hours
Administration Notes
Stop if QRS widens >50% or hypotension occurs.
Lidocaine
Standard Diluent
D5W
Final Concentration
4 mg/mL or 8 mg/mL
Infusion Rate
1 - 4 mg/min
Max: 4 mg/min
Stability
24 hours
Administration Notes
Signs of toxicity: numbness, confusion, seizures.
Epoprostenol
Standard Diluent
Special diluent
Final Concentration
3000 - 15000 ng/mL
Infusion Rate
Titrated in ng/kg/min
Max: Varies
Stability
24-48 hrs with ice packs depending on brand
Administration Notes
Pulmonary hypertension. Abrupt stopping causes rebound fatal PH crisis.
Treprostinil
Standard Diluent
NS or D5W
Final Concentration
Varies
Infusion Rate
Titrated in ng/kg/min
Max: Varies
Stability
48 hours at room temp
Administration Notes
Longer half-life than epoprostenol.
Nesiritide
Standard Diluent
D5W or NS
Final Concentration
5 mcg/mL
Infusion Rate
0.01 mcg/kg/min
Max: 0.03 mcg/kg/min
Stability
24 hours
Administration Notes
BNP analog. Used for decompensated heart failure.
Clonidine
Standard Diluent
NS
Final Concentration
15 - 30 mcg/mL
Infusion Rate
15 - 150 mcg/hr (if used IV)
Max: 150 mcg/hr
Stability
24 hours
Administration Notes
Central alpha-2 agonist. Rebound hypertension if stopped abruptly.
Phentolamine
Standard Diluent
NS
Final Concentration
1 mg/mL
Infusion Rate
Extravasation: 5-10 mg injected locally
Max: N/A
Stability
Use immediately
Administration Notes
Antidote for vasopressor extravasation.
Argatroban
Standard Diluent
NS or D5W
Final Concentration
1 mg/mL
Infusion Rate
2 mcg/kg/min
Max: 10 mcg/kg/min
Stability
24 hours
Administration Notes
Direct thrombin inhibitor. Falsely elevates INR.
Phenobarbital
Standard Diluent
NS or D5W (slow push preferred)
Final Concentration
130 mg/mL
Infusion Rate
60 mg/min (adults)
Max: 60 mg/min
Stability
Room temp
Administration Notes
Long acting barbiturate. Respiratory depression risk.
Pentobarbital
Standard Diluent
Undiluted
Final Concentration
50 mg/mL
Infusion Rate
1 - 5 mg/kg/hr
Max: Titrate to burst suppression
Stability
Use fresh
Administration Notes
Used for refractory status epilepticus or high ICP.
Thiopental
Standard Diluent
NS or Sterile Water
Final Concentration
25 mg/mL (2.5%)
Infusion Rate
Rapid IV push for induction
Max: N/A
Stability
24 hours refrigerated
Administration Notes
Highly alkaline. Causes tissue necrosis if extravasated.
Midazolam
Standard Diluent
D5W or NS
Final Concentration
1 mg/mL or 5 mg/mL
Infusion Rate
1 - 10 mg/hr (continuous)
Max: Titrate to RASS
Stability
24 hours
Administration Notes
Accumulates in renal failure (active metabolite).
Lorazepam
Standard Diluent
D5W or NS
Final Concentration
0.1 - 1 mg/mL
Infusion Rate
1 - 10 mg/hr
Max: Max 10 mg/hr
Stability
24 hours
Administration Notes
Risk of propylene glycol toxicity at high doses.
Diazepam
Standard Diluent
Undiluted (do not mix in bags)
Final Concentration
5 mg/mL
Infusion Rate
5 mg/min (push)
Max: 5 mg/min
Stability
Immediate use
Administration Notes
Binds to plastic bags/tubing. Give via slow IV push.
Remifentanil
Standard Diluent
NS or D5W
Final Concentration
50 mcg/mL
Infusion Rate
0.05 - 0.25 mcg/kg/min
Max: Varies by setting
Stability
24 hours
Administration Notes
Ultra-short acting (hydrolyzed by plasma esterases). Does not accumulate.
Sufentanil
Standard Diluent
NS or D5W
Final Concentration
5 mcg/mL
Infusion Rate
0.1 - 0.5 mcg/kg/hr
Max: Varies
Stability
24 hours
Administration Notes
5-10x more potent than fentanyl.
Morphine
Standard Diluent
NS or D5W
Final Concentration
1 mg/mL
Infusion Rate
1 - 10 mg/hr
Max: Titrate to effect
Stability
24 hours
Administration Notes
Histamine release can cause hypotension and pruritus.
Hydromorphone
Standard Diluent
NS or D5W
Final Concentration
0.2 mg/mL
Infusion Rate
0.2 - 3 mg/hr
Max: Titrate to effect
Stability
24 hours
Administration Notes
5-7x more potent than morphine.
Methadone
Standard Diluent
NS
Final Concentration
1 - 5 mg/mL
Infusion Rate
IV push
Max: N/A
Stability
Use immediately
Administration Notes
Prolongs QTc. Has NMDA antagonist properties.
Ketorolac
Standard Diluent
Undiluted
Final Concentration
15 - 30 mg/mL
Infusion Rate
IV push over 15 seconds
Max: 15 seconds
Stability
Room temp
Administration Notes
NSAID. Max duration of therapy is 5 days (GI bleed/renal risk).
Metoclopramide
Standard Diluent
NS or D5W
Final Concentration
5 mg/mL
Infusion Rate
Push over 1-2 mins
Max: 2 mins
Stability
24 hours (protect from light)
Administration Notes
Risk of EPS and tardive dyskinesia.
Ondansetron
Standard Diluent
NS or D5W
Final Concentration
2 mg/mL
Infusion Rate
Push over 2-5 mins
Max: 5 mins
Stability
24 hours
Administration Notes
QTc prolongation risk.
Promethazine
Standard Diluent
NS
Final Concentration
Max 25 mg/mL
Infusion Rate
Dilute in 50mL and give over 10-15 mins
Max: Do not give rapid push
Stability
Use immediately
Administration Notes
High risk of tissue necrosis. Dilution strongly recommended.
Erythromycin
Standard Diluent
NS
Final Concentration
1 - 5 mg/mL
Infusion Rate
3 mg/kg over 45 mins (for gastroparesis)
Max: 45 mins
Stability
8 hours at room temp
Administration Notes
Potent CYP3A4 inhibitor and QTc prolonger.
Levothyroxine
Standard Diluent
NS
Final Concentration
20 - 40 mcg/mL
Infusion Rate
IV push over 1-2 minutes
Max: 2 mins
Stability
Reconstitute immediately before use
Administration Notes
IV dose is ~50% of the oral dose.
Methylprednisolone
Standard Diluent
NS or D5W
Final Concentration
Varies
Infusion Rate
Push over 3-15 mins depending on dose
Max: High doses (>250mg) must be given over >30 mins
Stability
24 hours
Administration Notes
Used for acute spinal cord injury, MS exacerbations, COPD.
Terlipressin
Standard Diluent
NS
Final Concentration
1 mg/10 mL
Infusion Rate
1-2 mg IV push over 1 min
Max: 1 min
Stability
Refrigerate before use
Administration Notes
Used for hepatorenal syndrome and variceal bleeding.
Naloxone
Standard Diluent
NS
Final Concentration
0.4 mg/mL
Infusion Rate
IV push or infusion (0.4 - 4 mg/hr)
Max: Titrate to resp rate
Stability
24 hours
Administration Notes
Half life is short (30-60 mins). Rebound opioid toxicity common.
Protamine
Standard Diluent
Undiluted
Final Concentration
10 mg/mL
Infusion Rate
Give over 10 mins (Max 5 mg/min)
Max: 5 mg/min
Stability
Room temp
Administration Notes
Heparin reversal. Rapid push causes profound hypotension and bradycardia.
N-acetylcysteine
Standard Diluent
D5W
Final Concentration
Varies (3 bag regimen)
Infusion Rate
150mg/kg over 1hr, 50mg/kg over 4hr, 100mg/kg over 16hr
Max: Per protocol
Stability
24 hours
Administration Notes
Acetaminophen antidote. Anaphylactoid reactions common with first bag.
Fomepizole
Standard Diluent
NS or D5W (100 mL)
Final Concentration
15 mg/mL
Infusion Rate
Give over 30 mins
Max: 30 mins
Stability
24 hours
Administration Notes
Antidote for ethylene glycol / methanol poisoning.
Physostigmine
Standard Diluent
Undiluted
Final Concentration
1 mg/mL
Infusion Rate
Give over 5 mins (Max 1 mg/min)
Max: 1 mg/min
Stability
Room temp
Administration Notes
Antidote for anticholinergic toxicity. Have atropine ready for bradycardia.
Dexrazoxane
Standard Diluent
LR
Final Concentration
10 mg/mL
Infusion Rate
Give over 15 mins
Max: 15 mins
Stability
Use within 6 hours
Administration Notes
Antidote for anthracycline (doxorubicin) extravasation or cardiotoxicity.
Doxorubicin
Standard Diluent
NS
Final Concentration
2 mg/mL
Infusion Rate
IV Push over 3-5 mins
Max: 5 mins
Stability
Protect from light
Administration Notes
Severe vesicant. Highly cardiotoxic (lifetime dose limit).
Cisplatin
Standard Diluent
NS
Final Concentration
0.5 - 2 mg/mL
Infusion Rate
Over 1-2 hours
Max: Varies
Stability
Do NOT refrigerate
Administration Notes
Highly nephrotoxic and highly emetogenic.
Carboplatin
Standard Diluent
D5W or NS
Final Concentration
0.5 - 10 mg/mL
Infusion Rate
Over 15-60 mins
Max: 60 mins
Stability
24 hours
Administration Notes
Dosed via Calvert formula (based on AUC and GFR).
Paclitaxel
Standard Diluent
NS
Final Concentration
0.3 - 1.2 mg/mL
Infusion Rate
Over 3 hours
Max: 3 hours
Stability
27 hours (room temp)
Administration Notes
Requires non-PVC tubing and in-line filter. Premedicate for hypersensitivity.
Docetaxel
Standard Diluent
NS or D5W
Final Concentration
0.3 - 0.74 mg/mL
Infusion Rate
Over 1 hour
Max: 1 hour
Stability
4 hours
Administration Notes
Fluid retention is common; premedicate with dexamethasone.
Fluorouracil
Standard Diluent
NS or D5W
Final Concentration
Up to 50 mg/mL
Infusion Rate
Continuous infusion over 46-96 hours
Max: Varies
Stability
24 hours
Administration Notes
Can cause severe hand-foot syndrome.
Cyclophosphamide
Standard Diluent
NS
Final Concentration
20 mg/mL
Infusion Rate
Over 30-60 mins
Max: 60 mins
Stability
24 hours
Administration Notes
Risk of hemorrhagic cystitis (hydrate aggressively, sometimes use Mesna).
Ifosfamide
Standard Diluent
NS or D5W
Final Concentration
10 - 40 mg/mL
Infusion Rate
Over 2-24 hours
Max: Varies
Stability
24 hours
Administration Notes
High risk of hemorrhagic cystitis; ALWAYS give with Mesna.
Etoposide
Standard Diluent
NS
Final Concentration
0.2 - 0.4 mg/mL
Infusion Rate
Over 30-60 mins
Max: 60 mins
Stability
Concentration dependent (cracks if >0.4 mg/mL)
Administration Notes
Hypotension if infused too rapidly.
Vincristine
Standard Diluent
NS
Final Concentration
1 mg/mL
Infusion Rate
IV Push over 1 min
Max: 1 min
Stability
Refrigerate
Administration Notes
FATAL if given intrathecally. Severe vesicant.
Infliximab
Standard Diluent
NS only
Final Concentration
0.4 - 4 mg/mL
Infusion Rate
Over 2 hours
Max: 2 hours
Stability
24 hours (do not shake)
Administration Notes
Use in-line filter. High risk of infusion reactions.
Rituximab
Standard Diluent
NS or D5W
Final Concentration
1 - 4 mg/mL
Infusion Rate
Start at 50 mg/hr, titrate up
Max: 400 mg/hr
Stability
24 hours
Administration Notes
Premedicate with APAP and diphenhydramine.
Trastuzumab
Standard Diluent
NS only
Final Concentration
21 mg/mL
Infusion Rate
Over 30-90 mins
Max: 90 mins
Stability
28 days refrigerated
Administration Notes
Cardiotoxic (monitor LVEF). Do not mix with D5W.
Bevacizumab
Standard Diluent
NS
Final Concentration
1.4 - 16.5 mg/mL
Infusion Rate
Over 30-90 mins
Max: 90 mins
Stability
24 hours
Administration Notes
Risk of severe bleeding, GI perforation, and impaired wound healing.
Pembrolizumab
Standard Diluent
NS or D5W
Final Concentration
1 - 10 mg/mL
Infusion Rate
Over 30 mins
Max: 30 mins
Stability
24 hours refrigerated
Administration Notes
Immune-mediated adverse effects (pneumonitis, colitis, endocrinopathies).
Nivolumab
Standard Diluent
NS or D5W
Final Concentration
1 - 10 mg/mL
Infusion Rate
Over 30 mins
Max: 30 mins
Stability
24 hours
Administration Notes
Immune checkpoint inhibitor. Monitor for immune-mediated toxicities.
Tacrolimus
Standard Diluent
NS or D5W
Final Concentration
0.004 - 0.02 mg/mL
Infusion Rate
Continuous infusion
Max: Varies
Stability
24 hours
Administration Notes
Use non-PVC tubing. Highly nephrotoxic.
Cyclosporine
Standard Diluent
NS or D5W
Final Concentration
0.5 - 2.5 mg/mL
Infusion Rate
Over 2-6 hours
Max: 6 hours
Stability
24 hours
Administration Notes
Risk of anaphylaxis (cremophor vehicle). Premedicate.
Mycophenolate
Standard Diluent
D5W only
Final Concentration
6 mg/mL
Infusion Rate
Over 2 hours
Max: 2 hours
Stability
Use within 4 hours of reconstitution
Administration Notes
Do not mix or administer with other IV medications.
Basiliximab
Standard Diluent
NS or D5W
Final Concentration
0.4 mg/mL
Infusion Rate
Over 20-30 mins
Max: 30 mins
Stability
24 hours refrigerated
Administration Notes
Used for induction therapy in solid organ transplants.
Levetiracetam
Standard Diluent
NS or D5W
Final Concentration
5 - 15 mg/mL
Infusion Rate
Over 15 mins
Max: 15 mins
Stability
24 hours
Administration Notes
Can cause behavioral changes or agitation.
Fosphenytoin
Standard Diluent
NS or D5W
Final Concentration
1.5 - 25 mg PE/mL
Infusion Rate
Up to 150 mg PE/min
Max: 150 mg PE/min
Stability
24 hours
Administration Notes
Prodrug of phenytoin. Less risk of purple glove syndrome.
Phenytoin
Standard Diluent
NS only
Final Concentration
Max 5 mg/mL
Infusion Rate
Max 50 mg/min
Max: 50 mg/min
Stability
Use immediately
Administration Notes
Must use in-line filter. High risk of phlebitis/tissue necrosis.
Valproic Acid
Standard Diluent
NS or D5W
Final Concentration
Max 5 mg/mL
Infusion Rate
Over 60 mins (max 20 mg/min)
Max: 20 mg/min
Stability
24 hours
Administration Notes
Risk of hyperammonemia and hepatotoxicity.
Lacosamide
Standard Diluent
NS or D5W
Final Concentration
Max 10 mg/mL
Infusion Rate
Over 15-60 mins
Max: 60 mins
Stability
24 hours
Administration Notes
Can prolong PR interval (risk of heart block).
Brivaracetam
Standard Diluent
NS or D5W
Final Concentration
Max 5 mg/mL
Infusion Rate
IV Push over 2 mins or infusion
Max: 2 mins
Stability
24 hours
Administration Notes
Similar to levetiracetam but faster onset.
Palonosetron
Standard Diluent
Ready to use
Final Concentration
0.05 mg/mL
Infusion Rate
IV Push over 30 seconds
Max: 30 seconds
Stability
Room temp
Administration Notes
Long-acting 5-HT3 antagonist (half-life 40 hours).
Granisetron
Standard Diluent
NS or D5W
Final Concentration
0.02 - 0.2 mg/mL
Infusion Rate
IV Push over 30 seconds
Max: 30 seconds
Stability
24 hours
Administration Notes
Alternative to ondansetron; less QTc prolongation risk.
Fosaprepitant
Standard Diluent
NS
Final Concentration
1 mg/mL
Infusion Rate
Over 20-30 mins
Max: 30 mins
Stability
24 hours
Administration Notes
NK1 receptor antagonist for highly emetogenic chemo.
Famotidine
Standard Diluent
NS or D5W
Final Concentration
2 mg/mL
Infusion Rate
IV Push over 2 mins
Max: 2 mins
Stability
48 hours
Administration Notes
H2 blocker. Adjust dose in renal impairment.
Esomeprazole
Standard Diluent
NS or D5W
Final Concentration
0.8 mg/mL
Infusion Rate
Continuous infusion (8 mg/hr)
Max: 8 mg/hr
Stability
12 hours (protect from light)
Administration Notes
PPI used for acute upper GI bleeding.
Chlorpromazine
Standard Diluent
NS
Final Concentration
1 mg/mL
Infusion Rate
1 mg/min
Max: 1 mg/min
Stability
Protect from light
Administration Notes
High risk of severe hypotension when given IV.
Ibutilide
Standard Diluent
NS or D5W
Final Concentration
0.017 mg/mL
Infusion Rate
Over 10 mins
Max: 10 mins
Stability
24 hours
Administration Notes
Class III antiarrhythmic. High risk of Torsades (monitor ECG for 4 hrs).
Sotalol
Standard Diluent
NS or D5W
Final Concentration
1 - 2 mg/mL
Infusion Rate
Over 5 hours
Max: 5 hours
Stability
24 hours
Administration Notes
Initiation requires continuous ECG monitoring (QTc prolongation).
Metoprolol
Standard Diluent
Undiluted
Final Concentration
1 mg/mL
Infusion Rate
IV Push: 5 mg over 2 mins
Max: 3 doses max
Stability
Immediate use
Administration Notes
Cardioselective beta blocker.
Propranolol
Standard Diluent
NS or D5W
Final Concentration
1 mg/mL
Infusion Rate
IV Push: 1 mg over 1 min
Max: 1 min
Stability
24 hours
Administration Notes
Non-selective beta blocker. Used for thyroid storm.
Chlorothiazide
Standard Diluent
NS or D5W
Final Concentration
10 mg/mL
Infusion Rate
IV Push over 3-5 mins
Max: 5 mins
Stability
24 hours
Administration Notes
The only IV thiazide diuretic available.
Acetazolamide
Standard Diluent
Sterile Water
Final Concentration
50 mg/mL
Infusion Rate
IV Push over 1-2 mins
Max: 2 mins
Stability
12 hours
Administration Notes
Carbonic anhydrase inhibitor. Used for metabolic alkalosis or high ICP.
Torsemide
Standard Diluent
Undiluted
Final Concentration
10 mg/mL
Infusion Rate
IV Push over 2 mins
Max: 2 mins
Stability
24 hours
Administration Notes
Loop diuretic. Longer half-life than furosemide.
Ethacrynic Acid
Standard Diluent
D5W or NS
Final Concentration
1 mg/mL
Infusion Rate
Over 20-30 mins
Max: 30 mins
Stability
24 hours
Administration Notes
Used in patients with severe sulfa allergies.
Calcium Gluconate
Standard Diluent
NS or D5W
Final Concentration
10 - 50 mg/mL
Infusion Rate
1-2 g over 30-60 mins
Max: 60 mins
Stability
24 hours
Administration Notes
Can be given peripherally. Max rate 200 mg/min for cardiac arrest.
Calcium Chloride
Standard Diluent
NS or D5W
Final Concentration
100 mg/mL
Infusion Rate
IV Push (Code) or over 60 mins
Max: Varies
Stability
24 hours
Administration Notes
Requires central line (severe vesicant). 3x more potent than gluconate.
Potassium Chloride
Standard Diluent
NS (Avoid D5W)
Final Concentration
Max 10 mEq/100 mL peripheral
Infusion Rate
10 mEq/hr (Peripheral) or 20 mEq/hr (Central)
Max: 20 mEq/hr
Stability
24 hours
Administration Notes
NEVER give IV push. Fatal if given rapidly.
Sodium Bicarbonate
Standard Diluent
D5W or NS
Final Concentration
0.5 - 1 mEq/mL
Infusion Rate
IV Push (Arrest) or continuous infusion
Max: Varies
Stability
24 hours
Administration Notes
Highly alkaline. Ensure line patency.
Sodium Chloride 3% (Hypertonic)
Standard Diluent
Undiluted
Final Concentration
3%
Infusion Rate
Varies (e.g. 30 mL/hr)
Max: Varies
Stability
24 hours
Administration Notes
Must be given via central line. Risk of osmotic demyelination if corrected too fast.
Thiamine
Standard Diluent
NS or D5W
Final Concentration
1 - 10 mg/mL
Infusion Rate
Over 15-30 mins
Max: 30 mins
Stability
24 hours
Administration Notes
Give BEFORE glucose in malnourished/alcoholic patients to prevent Wernicke's encephalopathy.
Folic Acid
Standard Diluent
NS or D5W
Final Concentration
Varies
Infusion Rate
IV Push or short infusion
Max: Varies
Stability
24 hours
Administration Notes
Usually given with thiamine in a 'banana bag'.
Cyanocobalamin
Standard Diluent
NS or D5W
Final Concentration
Varies
Infusion Rate
IM preferred, can be given IV
Max: Varies
Stability
Protect from light
Administration Notes
Vitamin B12. Can cause hypokalemia as RBCs rapidly form.
Dexmedetomidine
Standard Diluent
NS
Final Concentration
4 mcg/mL
Infusion Rate
0.2 - 1.5 mcg/kg/hr
Max: 1.5 mcg/kg/hr
Stability
24 hours
Administration Notes
Does not cause respiratory depression. Watch for bradycardia and hypotension.
Isoproterenol
Standard Diluent
D5W
Final Concentration
4 mcg/mL
Infusion Rate
2 - 10 mcg/min
Max: Titrate to HR
Stability
24 hours
Administration Notes
Pure beta agonist. Refractory bradycardia.