DILUTION GUIDELINE FOR INJECTABLE DRUGS
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MOH/S/FAR/11.20(GU)-e
PHARM AC EUT IC AL SERVICES PRO G R AM M E
MINISTRY OF HEALTH, MALAYSIA
DILUTION GUIDELINE
FOR INJECTABLE DRUGS
D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
MOH/S/FAR/11.20(GU)-e
No. Rujukan: A-GU-84
No. Keluaran: 1
Decem ber 2020
© All Rights Reserved
This is a publication of the Pharmaceutical Services Programme, Ministry of Health Malaysia.
Permission is hereby granted to reproduce inform ation contained herein provided that such
reproduction be given due ack nowledgem ent and shall n o t m odif y the text. Enquiries are to be
directed to the address below.
Pharmaceutical Services Pr ogr am m e
Ministry of Health Malaysia
Lot 36, Jalan Universiti,
46200 Petaling Jaya, Selangor, Malaysia
Tel: 603 – 7841 3200 Fax: 603 – 7968 2222
Website: www.pharmacy.gov.my
DILUTION GUIDELINE FOR INJECTABLE DRUGS (Part I – Antimicrobial)
D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
DILUTION GUIDELINE FOR INJECTABLE DRUGS
Publication date December 2020
Summary Dilution Guideline for Injectable Drugs serves as a general reference for
healthcare professionals on the preparation of injectable drugs before
administering to the patient.
The information provided in this guideline is mainly extracted f r o m the
package insert for relevant brand of injectable drugs used and valid at the
t i m e of publication. Nevertheless, users are strongly advised to refer to the
dilution instruction as stated in the product package insert currently used
at the respective facilities and update regularly.
Author Medication Safety Section
Pharmacy Practice and Development Division
Pharmaceutical Services Program m e
Ministry of Health Malaysia
1
Applies to All government and private healthcare facilities
Audience Healthcare professionals
Review Date December 2025
D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
TABLE OF CONTENT
PAGE
CONTENT NUMBER
Disclaimer 4
Preface 4
Foreword 5
Ac k nowledgem ent 6
Reviewers 6
Accreditors 7
Editorial Board 8
Abbreviations & Acronyms 9
List of Drugs
■ Acyclovir Injection 10
■ Am ik acin Injection 11
■ Amoxicillin & Clavulanate Injection 12
■ Am photericin B Injection 13
2 ■ Am picillin Injection 14
■ Am picillin & Sulbactam Injection 15
■ Anidulafungin Injection 16
■ Artesunate Injection 17
■ Azithrom ycin Injection 18
■ Benzathine Penicillin Injection 19
■ Benzylpenicillin Injection 20
■ Caspofungin Acetate Injection 21
■ Cefazolin Injection 23
■ Cefepime Injection 24
■ Cefoperazone Injection 25
■ Cefoperazone & Sulbactam Injection 26
■ Cefotaxime Injection 27
■ Ceftazidime Injection 28
■ Ceftriaxone Injection 29
■ Cefuroxime Injection 31
■ Clindamycin Injection 32
■ Cloxacillin Injection 33
■ Ertapenem Injection 34D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
PAGE
CONTENT NUMBER
■ Erythrom ycin Lactobionate Injection 35
■ Ganciclovir Injection 36
■ Gentamicin Injection 37
■ I m i p e n e m & Cilastatin Injection 38
■ Mer openem Injection 39
■ Micafungin Injection 40
■ Netilm icin Injection 41
■ Pentam idine Isethionate Injection 42
■ Piperacillin & Tazobactam Injection 43
■ Sulphamethoxazole –T rim ethoprim Injection 44
■ Vancomycin Injection 45
■ Voriconazole Injection 46
■ Zidovudine Injection 48
Appendices 49
3
References 55D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
DISCLAIMER
This guideline serves as a general reference for the healthcare professionals in the Ministry of
Health on h o w to prepare dilution of certain injectable drugs before administering to the patient.
The inform ation provided in this guideline m ainly extracted f r o m the package insert for the
brand of injectable drugs used and valid at the t i m e of publication. Nevertheless, users are
strongly advised to refer to the dilution instruction as stated in the produc t package insert
currently used at the respective facilities and update regularly.
The medicines included in this guideline are selected f r o m the Ministry of Health Medicines
Formulary (MOHMF).
The users of this guideline m u s t have the necessary k nowledge and c om peten c y in ord er to
interpret the inform ation provided. In no event shall the Pharmaceutical Services Program m e
be liable for any direct, indirect, incidental, special or consequential event resulting f r o m the
use of or the inability to use this guideline. The c om m ittee reserves the right to am end, update
or remove the content of this guideline when necessary.
PREFACE
The Malaysian National Patient Safety Council Technical Com m ittee on Medication Safety had
p u t in m u c h effort t h r oug h the various stakeholders to p rom ote m edication safety culture in both
the public and private healthcare sector. The prim ary goal of m edication safety is to ensure long
4 t e r m and continuous quality im provem ents in healthcare. One way of achieving it is by
im proving and strengthening m edic ation safe practice. Hence, Pharmaceutical Services
Programme, Ministry of Health Malaysia has tak en the initiative and prepared the Dilution
Guideline for Injectable Drugs.
The purpose of this guideline is to provide inform ation and facilitate the healthcare professionals
at all levels in the preparation of injectable drugs that are listed in the Ministry of Health
(MOH) d r u g formulary wh ic h requires dilution. This guideline will also serve as a preventive
measure to reduce medication errors related to incorrect dilution and adm inistration of
injectable drugs.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
FOREWORD
Mdm A’tia Binti Hashim
Director
Pharmacy Practice & Developm ent Division
Pharmaceutical Services Program m e
Ministry of Health Malaysia
Medication safety has received m u c h attention administration of these drugs. There are a few
after the Institute of Medicine had published “To types of medication errors related to injectable
Err Is Human: Building a Safer Health System” drugs that are comm only reported to
report which was in line with the third World Medication Error Reporting System (MERS), for
Health Organization (WHO) Global Patient example: incorrect dilution, incorrect route of
Safety Challenge. Errors can never be entirely administration, incorrect infusion rate and
eliminated, b u t their numbers and severity can be incorrect diluent. Thus, prom oting safe injection
reduced. The occurrence of medication errors can practices and establishment of standard for
compromise patients’ confidence in healthcare dilution and administration of injectable drugs
system by exposing t h em to the risk of adverse are crucial to ensure patient safety.
drug reactions and increased healthcare cost.
Ensuring safer care for every patient, every time,
Moreover, medication errors are preventable.
everywhere is the vision established by W HO as
The Malaysian Patient Safety Council, Ministry of the goals towards continuous improvements in
Health (MOH) had p u t in m u c h effort through patient safety and m anaging risks to prevent 5
the various stakeholders to promote medication harm (particularly “avoidable harm” during
safety culture in both the public and private treatment and care). Hence, medication safety
healthcare sectors. Pharmaceutical Services is everyone’s responsibility so as to make the
Programme, MOH has been given a mandate to healthcare system safer. This guideline aims to
lead the Technical W orking Group of Medication facilitate the healthcare personnel in preparing
Safety at the national level. The committee, which the dilutions of drugs which are available in the
comprises various stakeholders, will identify any MOH drug lists. The availability of this guideline
issues related to medication safety and plan for will assist in the expansion of quality clinical care
ongoing improvements in the quality and safety pharmacy services throughout MOH facilities.
of the medication m anagem ent system and
I would like to congratulate the editorial
practices.
committee, accreditors and reviewers for their
W ith the aim of reducing the risks related to efforts and contributions in the development
injectable drugs, initiatives have been taken to of this dilution guideline. It is hoped that this
establish Dilution Guidelines for Injectable guideline would be a useful reference for all who
Drugs to promote safe medication use. Moreover, are involved in the dilution and administration of
errors in intravenously administered medications injectable drugs in the healthcare facilities.
may have serious consequences and incident
can happen during preparation,dispensing and All the best and thank you.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
ACKNOWLEDGEMENT
Special thanks dedicated to everyone who were involved directly or indirectly in the establishment of
this guideline.
This guideline consumes enormous amount of work, time efforts and dedication. Thus,
Pharmaceutical Services Programme, Ministry of Health would like to extend our utmost gratitude to
all individuals and organizations that had provided valuable input, advice and information for this
guideline.
We are also grateful for the provision of expertise and technical support in the development of this
guideline. Hopefully, the information provided can lead to the improvements in quality and safe
medication practice.
REVIEWERS
◆ Mdm Phan Hui Sieng ◆ Mdm Norafidah Binti Idris
Senior Principal Assistant Director Pharmacist
Pharmacy Practice & Development Division Serdang Hospital
Sarawak State Health Department
6
◆ Mdm Poh Wei Yoon ◆ Mdm Nor Mazni Binti Mohamad Tamyes
Pharmacist Pharmacist
Selayang Hospital Tengku Am puan Rahimah Hospital
◆ Mdm Noor Liyana Binti Yusup ◆ Mr. Muhammad Faizal Bin Maarof
Pharmacist Pharmacist
Rantau Panjang Health Clinic Tuanku Am puan Najihah Hospital
◆ Mdm Merina Aw Kar Ling ◆ Mdm Ong Su Hua
Pharmacist Senior Principal Assistant Director
Kuala Lum pur Hospital Pharmacy Practice & Development Division
Pharmaceutical Services Programme
Ministry of HealthD I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
ACCREDITORS
◆ Mdm Fajaratunur Binti A. Sani ◆ Mr. Ahmad Ridza Bin Ahmad Nizam
Pharmacist Pharmacist
Johor Bahru District Health Office Tuanku A m p u a n Najihah Hospital
◆ Mdm Nur Mariana Binti Ayub ◆ Mdm Nurul Husna Binti Sodri
Pharmacist Pharmacist
Kajang Hospital Pharmacy Practice & Developm ent Division
Selangor State Health Departm ent
◆ Mdm Wong Jern Ni ◆ Mr. Anuar Bin Mohamad
Pharmacist Pharmacist
Shah Alam Hospital Kajang Hospital
◆ Mdm Ummi Kalsum Binti Lambak ◆ Mdm Haidah Binti Ab Rahim
Pharmacist Nursing Matron
Melaka Hospital Tengku A m p u a n Rahim ah Klang Hospital
7
◆ Mdm Wong Siew Ling ◆ Mdm Kasidah Binti Kasran
Nursing Matron Nursing Sister
Selayang Hospital Shah Alam Hospital
◆ Mdm Sharina Binti Mohd Redzuan
Nursing Sister
Kajang HospitalD IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
EDITORIAL BOARD
ADVISOR
◆ Mdm A’tia Binti Hashim
Director
Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e
Ministry of Health Malaysia
EDITORIAL COMMITTEE
◆ Mdm Munira Binti Muhammad ◆ Mdm Norhayati Binti Musa
Deputy Director Senior Principal Assistant Director
Pharmacy Practice & Developm ent Division Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e Pharmaceutical Services Program m e
Ministry of Health Ministry of Health
◆ Mdm Siew Lee Jin ◆ Mdm Lee Shal Ling
8 Senior Principal Assistant Director Senior Principal Assistant Director
Pharmacy Practice & Developm ent Division Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e Pharmaceutical Services Program m e
Ministry of Health Ministry of Health
◆ Mdm Noor Syuhaidah Binti Radzuan
Principal Assistant Director
Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e
Ministry of HealthD I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
ABBREVIATIONS & ACRONYMS
ABBREVIATION & ACRONYM DESCRIPTION
BW body weight
D10 10% dextrose
D5 5% dextrose
g gram
gtt drops
HCl hydrochloride
HSD5 0.45% s odium chloride + 5% dextrose
IM intram uscular
IV intravenous
kg k ilogram 9
L litre
m ax m axim um
mcg m ic rogram
mg m illigram
ml millilitre
NS 0.9% s odium chloride
NSD5 0.9% s odium chloride + 5% dextrose
RT r o o m tem perature
SC subcutaneous
w/v weight over volum e
W FI water for injectionD IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Acyclovir Injection
Brand Nam e Vaxcel® Acyclovir IV For Infusion (Strength: 250m g)
Reconstitution Reconstitute 1 vial (250mg) wi t h 10ml W FI or NS to provide a solution
containing 25mg/ml.
Further Dilution IV infusion
■ Dilute the required volum e of reconstituted solution wi t h diluent
to give a concentration n o t greater than 5 m g/m l (0.5%w/v) for
adm inistration by infusion.
■ For children and neonates, where it is advisable to keep the volum e
of fluid to a m i n i m u m , dilution is on the basis of 4 m l reconstituted
solution (100mg acyclovir) added to 20m l of infusion fluid.
■ For adult, infusion bags containing 100ml of infusion fluid are used,
even wh e n this would give an acyclovir concentration substantially
below 0.5%w/v. Thus, one 100ml infusion bag m a y be used for any
dose between 250m g and 5 0 0 m g (10 and 20m l of reconstituted
solution) b u t a second bag m u s t be used for doses between 5 0 0 m g
and 1000mg.
Diluents
NS
10
Adm inistration IV infusion
Adm inister by slow IV infusion over 1 hour.
Storage & Stability RT(D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Amikacin Injection
Brand Nam e Apalin (Strength: 500m g/2m l)
Reconstitution Not required
Further Dilution IV infusion
Add 5 0 0 m g am ik acin solution to 100 – 200ml diluent.
Diluents
NS, D5
Adm inistration IM
IV infusion
■ Adult: Adm inister slowly over 30 – 60 minutes.
■ Infants: Adm inister slowly over 1 – 2 hours.
Storage & Stability RT(25°C) Fridge (4°C)
After dilution 24 hours 60 days
Remarks ■ Slow IV infusion m ay help to avoid neurom uscular blockade.
■ Do n o t physically prem ix am ikacin injection or infusion solutions
wi t h other drugs at any point in the infusion apparatus.
11
References 1. Product leaflet Apalin (Duopharm a (M) Sdn Bhd, Malaysia). Revised
date: 16.1.2012.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Amoxicillin & Clavulanate Injection
Brand Nam e Clavam For Injection BP (Strength: 1. 2 g).
Contains: Amoxicillin 1 g as s odium salt, Clavulanic acid 2 0 0 m g as the
potassium salt.
Reconstitution Reconstitute 1 vial (1. 2 g) wi t h 20m l W FI (Final volum e 20.9ml).
Further Dilution IV infusion
Dilute the reconstituted solution to 100ml diluent.
Diluents
NS, W FI
Adm inistration Slow IV bolus
■ Adm inister slowly over 3 – 4 m inutes and wi t hin 20 m inutes of
reconstitution.
■ It m ay be injected directly into the vein or via a drip tube.
IV infusion
Adm inister over 30 – 40 m inutes and com plete wi th i n the t i m e
stated.
Storage & Stability RT (25°C) Fridge (5°C)
12 After reconstitution 20 m inutes -
After dilution 4 hours 8 hours
*Any residual antibiotic solutions should be discarded.
Remarks ■ The colour of the reconstituted solution m a y range f r o m a cream
coloured solution to slight yellow/pale straw-coloured solution.
■ Not suitable for intram uscular administration.
■ Injection solution is less stable in infusions containing glucose,
dextrose or bicarbonate.
■ Should no t be m ixed w i t h blood products, other proteinaceous
fluids such as protein hydrolysates or w i t h intravenous lipid
emulsions.
References Product leaflet Clavam For Injection BP (Alkem Laboratories Limited,
India). Revised date: April 2016.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Amphotericin B Injection
Brand Nam e Photericin B For Injection USP (Strength: 50m g)
Reconstitution ■ Reconstitute 1 vial (50mg) wi t h 10ml of WFI.
■ Shake the vial im m ediately until the colloidal solution is clear.
Further Dilution IV infusion
■ Further dilute wi t h diluent to produce the rec om m ended
concentration of 0.1mg/ml.
■ Final concentration should n o t exceed 0.1m g / m l for peripheral
infusion or 0.25m g / m l for central infusion.
Diluent
D5
Adm inistration IV infusion
■ Adm inister by slow IV infusion over 2 to 6 hours (depending on the
dose).
■ A single IV test dose (1mg in 20m l of D5) administered over 20 to
30 m inutes m ay be preferred.
Storage & Stability RT (25°C) Fridge
After reconstitution 24 hours 7 days
After dilution 24 hours 2 days 13
*Protected f r o m light
Remarks ■ The patient’s temperature, pulse, respiration, and blood pressure
should be recorded every 30 m inutes for 2 to 4 hours.
■ Rapid IV infusion, over less than 1 hour, particularly in patients w i t h
renal insufficiency, has been associated w i t h hyperkalemia and
arrhythmias and should therefore be avoided.
■ The infusion solution (0.1mg/ml) is obtained by further dilution w i t h
D5 of p H above 4.2. The p H of each container of dextrose injection
should be ascertained before used.
■ Do n o t reconstitute wi t h saline solutions.
■ An in-line m e m b r a n e filter m a y be used for IV infusion of
am photericin B (the m ean pore diameter of the filter should n o t be
less than 1 micron).
References 1. Product leaflet Photericin B For Injection USP (Cipla LTD, India).
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
* The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Ampicillin Injection
Brand Nam e Kam pibiotic Injection (Strength: 500m g)
Reconstitution IV
Dissolve 1 vial (500m g) in 10 ml WFI.
IM
Dilute 1 vial (500m g) wi t h 1.5 ml WFI.
Further Dilution IV infusion
Dilute wi t h 50 to 100 ml NS ( m a x i m u m concentration: 30mg/ml).
Diluent
NS
Adm inistration Slow IV bolus
■ Adm inister slowly over 3 to 4 minutes.
■ Do n o t exceed 100mg/minute.
Intermittent IV infusion
Adm inister over 15 – 30 minutes.
IM
14
Storage & Stability Use im m ediately
Remarks ■ Be aware that too-rapid infusion m ay cause seizures.
■ Extemporaneous admixtures of beta-lactam antibacterials and
aminoglycosides m a y result in substantial m u t u a l inactivation. If
these adm inistered concurrently, adm inistered in separate sites at
least 1 hour apart. Do no t m ix t h e m in the same intravenous bag,
bottle or tubing.
■ If ampicillin is prescribed concurrently w i t h an aminoglycoside, the
antibiotics should n o t be m ixed in the syringe, intravenous fluid
container or giving set because loss of activity of the aminoglycoside
can occur under these conditions.
References 1. Product leaflet Kampibiotic Injection (Karnataka Antibiotics &
Pharmaceuticals Limited, India). Revised date: 25.7.2017.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
3. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Ampicillin & Sulbactam Injection
Brand Nam e Am subac Injection (Strength: 1. 5 g)
Contains: Am picillin 1000mg, Sulbactam 5 0 0 m g
Reconstitution IV
■ Reconstitute 1 vial (1. 5 g) wi t h 3.2 m l WFI.
■ To ensure com plete dissolution, allow f oam ing to dissipate to p e rm it
visual inspection.
IM
Reconstitute wi t h 3.2 m l W FI or 0.5% lignocaine HCl.
Further Dilution IV infusion
Further dilute to 50 – 100ml diluent.
Diluent
NS
Adm inistration Slow IV bolus
Adm inister slowly over a m i n i m u m of 3 minutes.
IV infusion
Adm inister over 15 – 30 minutes. 15
IM
Adm inister by deep IM injection.
Storage & Stability Not available
Remarks ■ Do n o t m ix or give t h r ou g h same I.V. line w i t h aminoglycosides, as
this inactivates ampicillin/sulbactam.
■ Rapid infusion m ay cause seizures.
References 1. Product leaflet Amsubac Injection (Karnataka Antibiotics &
Pharmaceuticals Limited, India). Revised date: 23.1.2018.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Anidulafungin Injection
Brand Nam e Eraxis (Strength: 100mg)
Reconstitution Reconstitute 1 vial (100mg) wi t h 30m l W FI to provide a concentration of
3.33mg/ml. The reconstitution t i m e can be u p to 5 minutes.
Further Dilution & IV infusion
Adm inistration
Dilution Requirements For Anidulafungin Administration
Of Water For Injection Presentation
Reconstituted
Total Infusion
Duration of
Number of
Minimum
Required
Required
Infusion
Infusion
Infusion
VolumeA
VolumeB
Rate of
Volume
Dose
Vials
Total
100mg 1 30ml 100ml 130ml 1.4ml/minute 90 minutes
200mg 2 60ml 200ml 260ml 1.4ml/minute 180 minutes
A
Either 9 m g / m l (0.9%) s odium chloride for infusion or 5 0m g /m l (5%)
glucose for infusion.
B
Infusion solution concentration is 0.77m g/m l.
Diluents
NS, D5
16
IV infusion ONLY
The rate of infusion should n o t exceed 1.1mg/minute (equivalent to
1.4ml/minute or 84m l/hour wh e n reconstituted and diluted per
instructions).
Storage & Stability RT (25°C) Fridge (Frozen)
After reconstitution 24 hours -
After dilution 48 hours 72 hours
*For single use only
Remarks ■ Anaphylactic reactions, including shock, have been reported;
discontinue use and appropriate tr eatm ent administered.
■ Infusion-related adverse events have been reported w i t h
anidulafungin, inc luding rash, urticaria, flushing, pruritus, dyspnea,
bronchospasm and hypotension.
■ Infusion-related adverse events are infrequent wh e n the rate of
anidulafungin infusion does n o t exceed 1.1mg/minute.
■ Do n o t give as IV bolus.
1. Product leaflet Eraxis (Pharmacia and Upjohn Company, USA).
References
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Artesunate Injection
Brand Nam e Artesun Powder For Injection (Strength: 60m g)
Reconstitution ■ Reconstitute 1 vial (60mg) w i t h provided diluent (5% s odium
bicarbonate solution).
■ Shake the vial for 2– 3 minutes and wait until completely dissolved
and a clear solution should emerge.
Further Dilution Dilute the reconstituted solution (1 ml) w i t h diluent to produce the
required concentration.
Route of Diluent Total Volume Final
Administration (NS or D5) Concentration
IV 5m l 6ml 10mg/ml
IM 2m l 3m l 20m g/m l
Adm inistration Slow IV bolus
Adm inister the required dose slowly at a rate of 3 – 4 m l/m inute.
IM
Storage & Stability Use im m ediately
17
Remarks ■ Do n o t use in intravenous drip.
■ Discard if solution n o t clear.
References Product leaflet Artesun Powder For Injection (Guilin Pharmaceutical
Co. Ltd, China).
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Azithromycin Injection
Brand Nam e Vaxcel® Azithrom ycin IV For Infusion (Strength: 500m g)
Reconstitution Reconstitute 1 vial (500mg) wi t h 4.8m l WFI to obtain a final
concentration of 100mg/ml.
Further Dilution IV infusion
Dilute the reconstituted solution to the required concentration as
below:
Amount of Final infusion solution Amount of diluent
reconstituted concentration (ml)
solution (ml) (mg/ml)
5 1 500
5 2 250
Diluents
NS, D5
Adm inistration IV infusion
Concentration (mg/ml) Rate of infusion
18 1 over 3 hours
2 over 1 hour
An IV dose of 5 0 0 m g azithrom ycin should be infused for a m i n i m u m
duration of 1 hour.
Storage & Stability
RT Fridge ( 2°C- 8°C)
After reconstitution 24 hours (25±2○C) -
After dilution 24 hours (D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Benzathine Penicillin Injection
Brand Nam e Benzapen Sterile Penicillin G Benzathine USP (Strength: 2.4 Mega
Units)
Reconstitution Reconstitute wi t h 8 m l of WFI.
Further Dilution Not required
Adm inistration IM only
*To avoid sciatic nerve damage, infants and small children should n o t
be injected into the upper outer quadrant of the buttock except in
special cases e.g. in the presence of extensive burns.
Storage & Stability Use im m ediately
Remarks ■ Patient should be alerted to the potential occurrence of allergic
reactions and instructed to report them .
■ Patient should be observed for 30 m inutes after d r u g adm inistration
for any allergic reactions.
■ Must n o t be injected subcutaneously, intravenously or intrathecally
or instilled into body cavities.
References Product leaflet Benzapen Sterile Penicillin G Benzathine USP 2.4MU
(Karnataka Antibiotics & Pharmaceuticals Limited, India). Revised date:
13.7.2009.
19
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Benzylpenicillin Injection
Brand Nam e Bepen Injection (Strength: 1 MU (600mg), 5 MU (3g))
Reconstitution ■ Reconstitute 1 MU vial ( 600m g) wi t h 2 m l or m ore W FI immediately
before use.
■ Reconstitute 5 MU vial (3g) w i t h 10 m l or m or e W FI im m ediatel y
before use.
Further Dilution Intermittent IV infusion
Further dilute in 50 – 100m l diluent.
Continuous IV infusion
Further dilute in 1000 – 2000m l diluent.
Diluent
NS
Adm inistration IM
Alternate sites should be used for repeated injections.
Intermittent IV infusion
■ Adm inister over 1 – 2 hours (adults).
■ Adm inister over 15 to 30 m inutes (children and infants).
20 Continuous IV infusion
■ Adm inister over 24 hours.
■ Preferred for adm inistration of large doses.
Storage & Stability RT (30°C±2°C) Fridge ( 2°C- 8°C)
After reconstitution 2 days 6 days
*Reconstituted solutions of benzylpenicillin s odium BP are intended
for im m ediate administration.
Remarks ■ Should be administered separately w i t h solutions that contain
m etal ions.
■ Too-rapid infusion m ay cause electrolyte im balance or seizures.
References 1. Product leaflet Bepen Injection (Karnataka Antibiotics &
Pharmaceuticals Limited, India). Revised date: 14.2.2017.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Caspofungin Acetate Injection
Brand Nam e Cancidas ® For Injection (Strength: 50m g, 70m g)
Reconstitution Bring the refrigerated vial to r o o m temperature.
50mg vial
Reconstitute 1 vial (50mg) w i t h 10.5ml of NS or W FI to obtain a
concentration of 5.2mg/ml.
70mg vial
Reconstitute 1 vial (70mg) w i t h 10.5ml of NS or W FI to obtain a
concentration of 7.2mg/ml.
Further Dilution Depends on dose required
Preparation of the Patient Infusion Solutions in Adults:
Dose* Volume of Typical
reconstituted preparation
solution for (reconstituted
transfer to IV solution added
bag/bottle to 100ml) final
concentration
7 0 m g (from one 7 0 m g vial) 5m l in each 0.33m g / m l
(Dilute in t wo bags of 100ml) ** 100ml IV bag/
bottle
5 0 m g (from one 5 0 m g vial) 10m l 0.45m g / m l 21
35mg for moderate hepatic 5m l 0.33m g / m l
insufficiency (from one 7 0 m g vial)
35mg for moderate hepatic 7m l 0.33mg/ml
insufficiency (from one 5 0 m g vial)
* 10.5ml should be used for reconstitution of all vials.
** Dilute 5m l of the reconstituted vial in a 100ml IV bag/bottle and the
other 5m l in a second 100ml IV bag/bottle.
Note:
Paediatric patients (≥ 12 months old): Dilute reconstituted solution
(volume equal to the calculated dose) to an IV bag or bottle containing
250m l of diluent or a reduced volum e of diluent, no t to exceed a final
concentration of 0.5mg/ml.
Diluents
NS or 0.45% Sodium Chloride (Paediatric patients)D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Adm inistration IV infusion ONLY
■ Adm inister by slow IV infusion over approximately 1 hour.
■ For a 7 0 m g dose, adm inister each of the bags or bottles sequentially
over 30 minutes, for a total infusion t i m e of approximately 1 hour.
Storage & Stability RT (D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cefazolin Injection
Brand Nam e Cefazolin Sandoz ® Dry Substance For Infusions (Strength: 1 g)
Reconstitution Slow IV or IV infusion
Reconstitute 1 vial (1 g) wi t h 4 m l NS or WFI.
IM
Reconstitute 1 vial (1 g) wi t h 4 m l 0.5% lidocaine solution.
Further Dilution IV infusion
Dilute in 50 – 100m l diluent.
Diluent
NS
Adm inistration Slow IV bolus
Adm inister slowly over 3 – 5 minutes. (Up to a dose 1 g cefazolin).
IV infusion
Adm inister doses > 1 g over 20 – 30 minutes.
IM
Inject into a m ajor m uscle mass.
23
Storage & Stability Use im m ediately
Remarks Do n o t m ix in same infusion w i t h aminoglycoside, because b o t h drugs
m ay be inactivated.
References 1. Product leaflet Cefazolin Sandoz ® Dry Substance For Infusions
(Biochemiestr, Austria).
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cefepime Injection
Brand Nam e Cefmex Powder For Injection (Strength: 1 g)
Reconstitution IV
Reconstitute 1 vial (1 g) w i t h 10ml of diluent (approximate concentration
90mg/ml).
IM
Reconstitute 1 vial (1 g) w i t h 3m l of diluent (approximate concentration
230mg/ml).
Diluents
WFI, D5, NS
Further Dilution IV infusion
Dilute to a volum e of 50 – 100ml of diluent.
Diluents
D5, NS
Adm inistration Slow IV bolus
Adm inister slowly over 3 – 5 minutes.
24 IV infusion
Adm inister over 30 minutes.
IM
Adm inister t h r ou gh deep IM injection into a large m uscle mass.
Storage & Stability Fridge (2°C- 8°C)
After reconstitution 48 hours
After dilution 48 hours
* Intravenous: Cefepime is com patible at concentration of 1– 40m g / m l
wh e n m ixed wi t h diluents.
Remarks Parenteral drugs should be inspected visually for particulate m atter
before administration, and n o t used if particulate m atter is present.
References Product leaflet Cefmex Powder For Injection (Duopharm a (M) Sdn. Bhd,
Malaysia). Revised date: 14.10.2014.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cefoperazone Injection
Brand Nam e Bicafar (Strength: 1 g)
Reconstitution IV
■ Reconstitute 1 vial (1 g) wi t h 5m l of D5, NSD5, NS or WFI.
■ For continuous IV infusion, dissolve each g r a m in 5m l WFI.
IM
W FI m a y be used to prepare cefoperazone for IM injection. However,
w h e n concentrations of ≥250m g / m l to be administered, a lidocaine
solution should be used. A 2-STEP dilution process is recom m ended.
Vial Final Step 1: Step 2: Withdrawable
(g) Cefoperazone Volume Volume of 2% Volume (ml)
Concentration of WFI Lidocaine
(mg/ml) (ml) (ml)
1 250 2.6 0.9 4
333 1.8 0.6 3
*There is sufficient excess present to allow for withdrawal and
adm inistration of the stated volume.
Further Dilution IV (maximum dose of 2 g/day)
Dilute in appropriate diluent to give a final concentration of 100mg/ml.
25
Intermittent IV infusion
Dilute the reconstituted solution wi t h 20 – 100ml of diluent.
Diluents
D5, NSD5, NS
Adm inistration Slow IV bolus
Adm inister slowly over a period of no less than 3 – 5 minutes.
Intermittent IV infusion
Adm inister over a period of 15 m inutes – 1 hour.
IM
Deep IM injection into t he large m uscle mass of gluteus m a x i m u m or
anterior thigh.
Storage & S tability RT (15°C- 25°C) Fridge ( 2°C- 8°C)
After reconstitution 24 hours 5 days
*A solution of 300m g/m l
Remarks Solution of cefoperazone and aminoglycoside should n o t be directly
m ixed since there is a physical incom patibility between them .
References Product leaflet Bicafar (Duopharm a (M) Sdn Bhd, Malaysia). Revised
date: 14.8.2012.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cefoperazone & Sulbactam Injection
Brand Nam e Vaxcel® Cefobactam Injection (Strength: 1 g)
Contains: Cefoperazone 5 0 0 m g and Sulbactam 5 0 0 m g
Reconstitution & IV
Further Dilution
Equiv. Dosage of
Total Volume of Maximum Final
Sulbactam +
Dosage (g) diluent Conc. (mg/ml)
Cefoperazone (g)
1 0.5 + 0.5 3.4 125 + 125
■ Reconstitute 1 vial (1g) wi t h 3.4 m l WFI, D5 or NS.
Intermittent IV infusion
Dilute the reconstituted solution to 20m l wi t h the same solution.
IM
Reconstitute 1 vial (1g) with 3.4ml sterile WFI and further dilute with
2% lidocaine to obtain solutions containing u p to 125mg cefoperazone
and 125mg sulbactam/ml in approximately a 0.5% lidocaine
hydrochloride solution.
Adm inistration Slow IV bolus
Adm inister slowly over a minimum of 3 minutes.
26
Intermittent IV infusion
Adm inister over 15 – 60 minutes.
IM
Storage & Stability RT (D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cefotaxime Injection
Brand Nam e Rekaxime Injection (Strength: 500m g, 1 g)
Reconstitution ■ Reconstitute 1 vial (500mg) wi t h 2m l of WFI.
■ Reconstitute 1 vial (1000mg) wi t h 4 m l of WFI.
Further Dilution IV infusion
■ Short infusion
Dilute in 4 0 m l of W FI or 10% glucose solution.
■ Continuous drip
Dilute in 100ml of isotonic saline or glucose solution.
Diluents
NS, D5, D10 (for short infusion)
Adm inistration Slow IV bolus
Adm inister slowly over a period of 3 – 5 minutes.
Short infusion
Infused in approximately 20 minutes.
Continuous drip
Infuse over 50 – 60 minutes.
IM
27
Inject deep into the gluteus muscle. Not to inject >4m l into either side.
If daily dose exceeds 2 g, IV injection is preferred.
Storage & Stability RT (D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Ceftazidime Injection
Brand Nam e Cefatum Injection (Strength: 1 g , 2 g)
Reconstitution May be constituted wi t h W FI or, for IM injection, wi t h 0.5% lignocaine.
Vial Size Diluent Amount of Approximate
diluent to be Concentration
added (mg/ml)
1g (10ml vial) IM 0.5% lignocaine 3m l 260
IV W FI 10ml 90
2g (20ml vial) IV W FI 10ml 170
Further Dilution Intermittent IV infusion
Dilute in 100ml of diluent.
Diluents
NS, D5
Adm inistration Slow IV bolus
Adm inister slowly over 3 – 5 minutes.
Intermittent IV infusion
Infuse over 30 minutes.
IM
Adm inister by deep IM into a large mass muscle.
28
Storage & Stability
Diluent RT Fridge
(D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Ceftriaxone Injection
Brand Nam e Unocef Injection (Strength: 500m g, 1 g)
Reconstitution IM
■ WFI, NS, D5, 1% lidocaine solution (without ephinephrine)
Vial Dosage Size Amount of Diluent to be Added
250mg/ml 350mg/ml
500mg 1.8ml 1 ml
1g 3.6ml 2.1 ml
*If required, m ore dilute solutions could be utilized.
*A 350m g/m l concentration is n o t r ec om m ended for the 250m g vial
since it m ay n o t be possible to withdra w the entire contents.
IV
■ WFI, NS, D5
Vial Dosage Size Amount of Diluent to be
Added
500mg 4.8m l
1g 9.6ml
Further Dilution IV infusion
Dilute the reconstituted solution to 50 or 100ml diluent. 29
Diluents
NS, D5
Adm inistration IV infusion
Adm inister over a period of 30 minutes. Concentration betwee n
10 - 4 0 m g / m l are recomm ended, lower concentration m a y be used if
desired.
IM (for Gonorrhoea, Chancroid)
■ Adm inister deep IM into large m uscle mass.
■ Doses >1 g should be distributed between t wo injection sites.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Storage & Stability After reconstitution, protection f r o m norm al light is n o t necessary.
Stability varies w i t h concentration and diluents used: The colour of
solutions ranges f r o m light yellow to amber, de pending on the length
of storage, concentration and diluent used.
IM
Concentration
Diluent (mg/ml) RT (25○C) Fridge (4○C)
W FI 100 3 days 10 days
250, 350 24 hours 3 days
NS 100 3 days 10 days
250, 350 24 hours 3 days
D5 100 3 days 10 days
250, 350 24 hours 3 days
1% Lidocaine solution 100 24 hours 10 days
( without ephinephrine)
250, 350 24 hours 3 days
IV solutions stored in glass or PVC containers
Diluent Concentration RT (25°C) Fridge (4°C)
(mg/ml)
30
W FI 10,20,40 3 days 10 days
NS 10,20,40 3 days 10 days
D5 10,20,40 3 days 10 days
Remarks ■ Diluents containing calcium, such as Ringer’s solution or
Hartmann’s solution, are n o t to be used to reconstitute
ceftriaxone vials or to further dilute a reconstituted vial for
intravenous adm inistration because a precipitate can form.
■ Ceftriaxone m u s t n o t be adm inistered simultaneously w i t h calcium -
containing intravenous solutions, including c ontinuous calcium -
containing infusions such as parenteral nutrition via Y-site.
■ In patients other than neonates, ceftriaxone and calcium -containing
solutions m a y be adm inistered sequentially to one another if the
infusion lines are thoroughl y flushed between infusions w i t h
com patible fluid.
References 1. Product leaflet Unocef Injection (Duopharm a (M) Sdn Bhd, Malaysia).
Revised date: 2.10.2013.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cefuroxime Injection
Brand Nam e Pharm aniaga Cefuroxime Injection (Strength: 750mg, 1. 5 g)
Reconstitution IM
Reconstitute 750m g vial wi t h 3 m l of WFI.
IV
■ Reconstitute 750m g vial wi t h 8m l of WFI.
■ Reconstitute 1. 5 g vial wi t h 16 m l of WFI.
Further Dilution Intermittent IV infusion
W ithdr aw the required dose and add to 50 – 100ml of diluent.
Diluents
NS, D5
Adm inistration Slow IV bolus
Adm inister slowly over 3 – 5 minutes.
Intermittent IV infusion
Adm inister over 30 minutes.
IM
Inject deep IM into large m uscle mass (such as gluteus or lateral
part of the thigh). 31
Storage & Stability RT Fridge (2°C –8°C)
After reconstitution - 2 hours
After dilution 24 hours -
Remarks ■ Do n o t m ix wi t h s odium bicarbonate.
■ Do n o t m ix in same infusion w i t h aminoglycoside, because b o t h
drugs m ay be inactivated.
■ Before injecting intramuscularly, aspiration is necessary to avoid
inadvertent injection into a blood vessel.
References 1. Product leaflet Pharm aniaga Cefuroxime Injection (Pharmaniaga
Manufacturing Berhad, Malaysia).
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Dr ug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Clindamycin Injection
Brand Nam e Tidact Injection (Strength: 300m g/2m l)
Reconstitution Not required
Further Dilution ■ Must be DILUTED prior to IV administration.
■ To prepare initial dilution for IV use:
Dose (mg) Diluent (ml) Duration of Administration
300 50 10 m inutes
600 50 20 m inutes
900 100 30 m inutes
1200 100 4 0 m inutes
*Max im um final concentration: 18 m g / m l
*Infusion rates should n o t exceed 30 m g / m i n u t e
Diluents
NS, D5
Adm inistration IV infusion
■ Do n o t adm inister m or e than 1200mg in a single 1 hour infusion.
■ May be adm inistered as a single rapid infusion on the first dose and
followed by continuous IV infusion, as follows:
To Maintain Serum Rapid Infusion Rate Maintenance
Clindamycin Levels Infusion Rate
Above 4 m c g / m l 10 m g / m i n u t e 0.75 m g / m i n u t e
32 for 30 m inutes
Above 5 m c g / m l 15 m g / m i n u t e 1 mg/minute
for 30 m inutes
Above 6 m c g / m l 20 m g / m i n u t e 1. 25 m g / m i n u t e
for 30 m inutes
IM
■ Single IM Injection should n o t exceed 600 m g.
Storage & Stability Not available
Remarks ■ Clindam ycin is physically incom patible with ampicillin,
diphenyldantoin, barbiturates, aminophylline, calcium gluconate
and m agnes ium sulphate.
■ IV adm inistration should n o t be given undiluted or as IV bolus.
■ Rare instances of cardiopulm onary arrest and hypotension have
been reported following too rapid intravenous administration.
■ Contains benzyl alcohol, should be avoided in children under 2 years
of age and n o t to be used in neonates.
1. Product leaflet Tidact Injection (Yung Shin Pharmaceutical Ind. Co., Ltd,
References Taiwan).
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs Guide.
Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Cloxacillin Injection
Brand Nam e Cloxabiotic Injection (Strength: 250mg, 500m g)
Reconstitution The reconstituted solution m u s t be shaken well before use.
Fill Size Volume of Withdrawable Nominal
(mg) Diluent Added Volume Concentration
(ml) (ml) (mg/ml)
IM (Use WFI)
250 1. 9 2 125
500 1.7 2 250
IV Injection (Use WFI)
250 4.9 5 50
500 4.8 5 100
IV infusion
Reconstitute 1 vial in 5m l of WFI.
Further Dilution IV infusion
Dilute the reconstituted solution in 125ml to 250m l of diluent to obtain
a final concentration of 1 – 2mg/ml.
Diluent
NS
Adm inistration Slow IV bolus
■ Adm inister into a vein either directly or via a drip-tube over a period 33
of 3 to 4 minutes.
■ More rapid adm inistration m ay result in convulsive seizures.
IV infusion
Infused over 30 to 4 0 minutes.
IM
Storage & Stability RT (≤25°C) Fridge (2°C- 8°C)
After reconstitution Use within 30 m inutes Up to 48 hours
of preparation
* Solution for injection should be freshly prepared.
* Discard unused portion.
Remarks ■ If cloxacillin is prescribed concurrently w i t h an aminoglycosides,
the t wo antibiotics should n o t be m ixed in the same syringe,
intravenous fluid container or giving set because of loss of activity
of the aminoglycosides can occur under these conditions.
■ Cloxacillin injection should n o t be m ixed w i t h proteinaceous fluids
such as protein hydrolysates, blood or plasma, or w i t h intravenous
lipid emulsions.
Product leaflet Cloxabiotic Injection (Karnataka Antibiotics &
References
Pharmaceuticals Limited, India). Revised Date: 12.2.2018.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Ertapenem Injection
Brand Nam e Invanz ® Injection (Strength: 1 g)
Reconstitution IV infusion
Reconstitute 1 vial (1 g) wi t h 10ml sterile WFI, NS or bacteriostatic WFI.
IM
■ Reconstitute 1 vial (1 g) w i t h 3.2ml of 1% or 2% lidocaine HCl injection
( without epinephrine).
■ The reconstituted solution should n o t be adm inistered intravenously.
Further Dilution IV infusion
Patients 13 years of age and older
Dilute reconstituted d r u g to 50m l of NS.
Patients 3 months to 12 years of age
W ithdr a w a volum e equal to 15mg/kg of body we i ght (not to exceed
1g/day) and dilute in 0.9% Sodium Chloride Injection to a final
concentration of 20m g/m l or less.
Diluent
NS
Adm inistration IV infusion
Adm inister the diluted solution over 30 m inutes and com plete the
34 infusion within 6 hours of reconstitution.
IM
Adm inister the reconstituted solution by deep IM injection into a large
m uscle mass (e.g. gluteal m uscle or lateral part of the thigh).
Storage & Stability RT (25°C) Fridge (5°C)
After reconstitution IV: 6 hours 24 hours and use within
IM: use within 4 hours after
1 hour removal f r o m refrigeration
After dilution IV: 6 hours 24 hours and use within
4 hours after
removal f r o m refrigeration
Remarks ■ Must be reconstituted and diluted prior to administration.
■ Do n o t use diluents containing dextrose.
■ Do n o t m ix or co-infuse Invanz ® wi t h other medications.
■ The diluted solution of Ertapenem should n o t be frozen.
References 1. Product leaflet Invanz ® Injection (Laboratories Merck Sharp &
D o h m e - Chibret). Revised date: August 2015.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Erythromycin Lactobionate Injection
Brand Nam e Eritrotex Injection (Strength: 500m g)
Reconstitution Reconstitute 1 vial (500mg) wi t h 10 m l W FI to obtain final concentration
50m g/m l.
Further Dilution IV infusion
Dilute the reconstituted solution w i t h n o t l e s s t h a n 1 0 0 m l o f diluent
to a final concentration of 1 – 5 m g/m l.
Diluents
NS, D5
Adm inistration Intermittent IV infusion
Adm inister the diluted solution over 60 m inutes every 6 hours.
Continuous IV infusion
Adm inister the diluted solution over 24 hours.
Storage & Stability The injection should be freshly prepared and unused portion should be
discarded.
Remarks ■ Er ythrom ycin should n o t be reconstituted w i t h inorganic salt
solution. Use only WFI.
■ Do n o t adm inister IV push or bolus.
35
■ Rapid infusion is m ore likely to be associated w i t h arrhythmias or
hypotension.
References 1. Product leaflet Eritrotex Injection (Fisiopharma S.r.L, Italy). Revised
date: Novem ber 2008.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Ganciclovir Injection
Brand Nam e Cymevene ® (Strength: 500m g)
Reconstitution ■ Reconstitute 1 vial (500mg) wi t h 10 m l WFI.
■ The vial should be shaken to dissolve the drug.
■ Reconstituted solution should be inspected for particulate m atter
prior to proceeding wi t h adm ixture preparation.
Further Dilution IV infusion
■ W ithdr aw the required dose and dilute to 50 – 250m l of com patible
infusion fluid.
■ The final concentration m u s t n o t exceed 10mg/ml.
Diluents
NS, D5
Adm inistration IV infusion
■ Adm inister over 60 m inutes via a large peripheral or central vein
(adequate blood flow is essential to ensure rapid dilution and
distribution).
■ Infusion concentration greater than 10mg/ml are n o t recom m ended.
Storage & Stability RT Fridge (2°C- 8°C)
After reconstitution 12 hours It should n o t be
36
refrigerated
After dilution Use im m ediately 24 hours
Remarks ■ Do n o t use bacteriostatic water for injection containing parabens in
solution since these are incom patible and m ay cause precipitation.
■ The prepared solution should n o t be m ixed wi t h other IV products.
■ It is a potential teratogen and carcinogen in humans, caution should
be observed in the handling of ganciclovir. Avoid inhalation or direct
contact of the powder contained in the vials or direct contact of the
reconstituted solution wi t h the skin or m uc ous m embranes.
■ Do n o t give by IV bolus or by IM or SC route.
References 1. Product leaflet Cymevene ® (F. Hoffm an-La Rocge Ltd. Basel).
Revised date: June 2010.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Gentamicin Injection
Brand Nam e Garasent (Strength: 80m g/2m l)
Reconstitution Not required
Further Dilution IV infusion
■ Dilute the prescribed dose in 100 – 200ml of diluent.
■ Final infusion concentration should n o t exceed 1mg/ml.
Diluents
NS, D5
Adm inistration IM
Slow IV bolus
Adm inister slowly over 2 to 3 minutes.
IV infusion
Adm inister the diluted solution over 20 – 30 minutes.
Storage & Stability Fridge (2°C- 8°C)
After dilution 24 hours
Remarks ■ Should be used w i t h caution in patients w i t h im paired renal function
(including elderly and prem ature infants).
37
■ IV adm inistration is generally reserved for special indications and
m a y be used wh e n the IM route is n o t feasible, e.g. patients in shock,
wi t h haem orrhagic disorders, severe burns or reduced m uscle mass.
References 1. Product leaflet Garasent (Duopharm a (M) Sdn Bhd, Malaysia).
Revised date: 16.1.2012.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Imipenem & Cilastatin Injection
Brand Nam e I m i p e n e m /Cilastatin Kabi Powder For Solution For Infusion
Contains: 5 0 0 m g I m i p e n a m and 5 0 0 m g Cilastin
Reconstitution ■ Reconstitute 1 vial wi t h 10ml of diluent to the container.
■ Shake well and transfer the resulting m ix ture to the infusion solution
container.
■ Repeat w i t h an additional 10ml of infusion solution to ensure
com plete transfer of container contents to the infusion solution.
■ The resulting m ixture should be agitated until a clear solution is
obtained.
Further Dilution ■ Dilute the reconstituted solution to 100ml of diluent.
■ Final infusion concentration is approximately 5m g/ml.
Diluents
NS, D5
Adm inistration IV infusion ONLY
■ Doses ≤ 500m g/500m g:
Adm inister diluted solution over 20 – 30 minutes.
■ Doses > 500m g/500m g:
Adm inister diluted solution over 4 0 – 60 minutes.
38
Storage & Stability RT (30°C) Fridge (5°C)
After reconstitution 4 hours 24 hours
After dilution 4 hours 24 hours
Remarks ■ Should n o t be reconstituted in diluents containing lactate.
■ In patients w h o develop nausea during the infusion, the rate of
infusion m ay be slowed.
■ Do n o t give by direct IV injection.
References 1. Product leaflet Im i pe nem /Cilastatin Fresenius Kabi Powder For
Solution For Infusion (Facta Farmaceutical S.p.A, Italy). Revised date:
Novem ber 2015.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Dr ug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Meropenem Injection
Brand Nam e Nur onem Inj ec tion (Strength: 500m g, 1 g)
Reconstitution Reconstitute 1 vial (500mg) wi t h 10ml W FI (5ml W FI per 250m g
m er openem ) to obtain a final concentration of 50m g/ml.
Further Dilution IV infusion
Dilute reconstituted solution wi t h 50 – 200m l of diluents.
Diluents
NS, D5
Adm inistration Slow IV bolus
Adm inister slowly over 5 minutes.
IV infusion
Adm inister over 15 – 30minutes.
Storage & Stability RT (25°C) Fridge (4°C)
After dilution 8 hours (NS) 48 hours (NS)
3 hours (D5) 14 hours (D5)
* Reconstituted and diluted solution of m e ro pe n em should n o t be
frozen.
39
Remarks ■ Should n o t be m ixed wi t h or added to other drugs.
■ All vials for single use only.
References 1. Product leaflet Nurone m Injection (Ranbaxy Lab. Limited, India).
Revised date: August 2009.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3 . Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Micafungin Injection
Brand Nam e Mycam ine ® Powder For Solution For Infusion (Strength: 50m g)
Reconstitution ■ Reconstitute 1 vial (50mg) w i t h 5m l of NS or D5 (taken f r o m a 100 m l
bag/bottle) by slowly injected into each vial along the side of the
inner wall.
■ Rotate the vial gently. Do n o t shake.
■ Minim ize the a m o u n t of foam generated.
Further Dilution ■ All of the reconstituted concentrate should be withd ra wn f r o m
each vial and returned to the infusion bag/bottle f r o m whic h it was
originally taken.
Preparation Of Solution For Infusion:
Dose Vials to be Volume Volume Final
used of NS or (concentration) concentration
D5 to be of reconstituted of standard
added powder infusion
per vial (made up to
100ml)
50mg 1 x 50mg 5ml Approx. 5m l 0.5mg/ml
(10mg/ml)
100mg 2 x 50mg 5ml Approx. 10ml 1m g / m l
(10mg/ml)
150mg 3 x 50mg 5ml Approx. 15ml 1.5mg/ml
40 (10mg/ml)
200mg 4 x 50mg 5ml Approx. 20m l 2 mg/ml
(10mg/ml)
■ The infusion bag/bottle containing the diluted infusion solution should
be inserted into a closable opaque bag for protection f rom light.
Diluents
NS, D5
Adm inistration IV infusion ONLY
■ An existing IV line should be flushed wi t h NS prior to infusion.
■ Administer the reconstituted and diluted solution over approximately
one hour.
Storage & Stability
RT (30°C)
After reconstitution 24 hours
6 hours
(In transfusion bag wi t hout light protection)
After dilution
24 hours
(In transfusion bag wi t h light protection)
*when reconstituted with NS or D5
Remarks The concentrate should be used im m ediatel y for further dilution. This
pr oduc t is for single use in one patient only. Discard any residue.
References Product leaflet Mycamine® Powder For Solution For Infusion
(Astellas Pharma Tech Cp. Ltd, Japan). Revised date: July 2013.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer
to the current pr oduc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Netilmicin Injection
Brand Nam e Lotifar Injection (Strength: 150mg/2ml, 100mg/2ml)
Reconstitution Not required
Further Dilution IV infusion
Dilute single dose in 50 to 200m l of diluent.
Diluents
NS, D5
Adm inistration Slow IV bolus
Adm inister slowly over a period of 3 to 5 minutes.
IV infusion
Adm inister the diluted solution over 1.5 to 2 hours.
Storage & Stability RT (D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Pentamidine Isethionate Injection
Brand Nam e DBL TM Pentam idine Isethionate For Injection (Strength: 300m g)
Reconstitution Reconstitute 1 vial (300mg) wi t h 3 to 5m l WFI.
Further Dilution Dilute the required dose in 50 – 250m l of diluent.
Diluents
NS, D5
Adm inistration IV infusion
Adm inister over at least 60 minutes.
Storage & Stability RT (21 ±2°C) Fridge (2°C- 8°C)
After reconstitution 48 hours 48 hours
After dilution 24 hours* 24 hours
*W hen diluted to 1mg/ml and 2.5mg/ml in diluent.
Remarks ■ Direct bolus IV injection or rapid adm inistration m u s t n o t be used.
■ Keep patient supine during adm inistration to m inim ize hypotension.
References 1. Product leaflet DBL TM Pentam idine Isethionate For Injection
(Hospira Australia Pty Ltd, Australia). Revised date: 1.12.2012.
42 2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S
Piperacillin & Tazobactam Injection
Brand Nam e Tapicin Powder For Injection (Strength: 4.5 g)
Contains: Piperacillin 4 g and Tazobactam 0.5 g
Reconstitution Reconstitute 1 vial (4.5 g) wi t h 20m l of diluent.
Diluents
WFI, NS, D5
Further Dilution IV infusion
Dilute reconstituted solution wi t h 50 – 150ml of diluent.
Diluents
NS, D5
Adm inistration Slow IV bolus
Adm inister over 3 – 5 minutes.
IV infusion
Adm inister over 20 – 30 minutes.
Storage & Stability RT (25°C) Fridge (2°C- 8°C)
After reconstitution 24 hours 7 days
43
Remarks ■ This pr oduc t do no t contain preservative, therefore appropriate
aseptic technique should be perform ed during preparation.
■ W henever this produc t is used concurrently w i t h another antibiotic,
the d r u g m u s t be adm inistered separately.
■ This pr oduc t should n o t be used w i t h solution containing only
s odium bicarbonate and should n o t be added to blood products or
album in hydrolysates.
References 1. Product leaflet Tapicin Powder For Injection (Yung Shin
Pharmaceutical Ind. Co, Ltd, Taiwan, ROC).
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.You can also read
