Management Guide

of Medications
Parenteral
Moses S. Ponce Rodríguez
Servicio de Farmacia
Nezahualcóyotl Regional Hospital, ISSEMyM
Zaragoza Faculty of Higher Studies, UNAM
2
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Guide to the Administration of Parenteral Medications

Moisés S. Ponce Rodríguez

Pharmacy Service
Nezahualcóyotl Regional Hospital, ISSEMyM
Zaragoza Faculty of Higher Studies, UNAM

November 2018
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PREPARATION AND REVIEW

Elaborated:
Moses Salvador Ponce Rodríguez
Pharmaceutical Chemist Biologist
Pharmacy Service, Nezahualcóyotl Regional Hospital, ISSEMyM
Zaragoza Higher Studies Faculty, UNAM

Reviewed:

Ms. Ejicela Vargas Morales

Head of the Pharmacy Service, Nezahualcóyotl Regional Hospital, ISSEMyM

Ms. Mireya García Casas

Professor of Hospital and Community Pharmacy in the terminal area Clinical Pharmacy, degree in Chemistry
Pharmaceutical-Biological, Faculty of Higher Studies Zaragoza, UNAM

NOTE
Medicine and pharmacy are sciences in constant change. As new research, the
clinical experience and changes in government regulations expand our knowledge due to
The constant flow of information related to pharmacological therapy requires modifications in the
therapeutic modalities and pharmacological treatments. The author and reviewers of this guide have verified
all the information from reliable sources to ensure that it is complete and in accordance with the
accepted standards at the time of publication. However, in light of the possibility of an error
human or changes in medical and pharmaceutical sciences, nor the authors, reviewers, or any person
involved in the publication of this work, guarantee that all the information contained herein is
exacta, completa o absoluta y no se responsabilizan por errores u omisiones o por los resultados obtenidos
the use of this information. All this is due to the fact that from a clinical point of view there is a variability of
response to medications depends on many factors specifically related to the individual patient and
of the pathological condition itself.
Readers are advised that, in case of any doubts or requests related to the information contained
in this guide, contact the hospital pharmacy service by any means.
It is the responsibility of each health professional to assess the suitability of a particular opinion in the
context of clinical situations and with the due considerations.

FEEDBACK
The improvement of this guide will be impossible without doubts, suggestions, comments, clarifications, or information.
additional that the reader considers. Therefore, feel free to contact us through the following means:
Emails:farmaciaclinicaneza@[Link], moisesponce@[Link]
Phones: +52(55) 57 16 64 00, 57 33 73 83, 57 33 72 05, 57 32 36 67, Extension: 3307. Direct phone: +52(55)
54 41 93 92.
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THANKS
Directorial, administrative, and teaching authorities of the Nezahualcóyotl Regional Hospital, by
support the implementation of this project.

Pharmacy service, as it is the origin and an indispensable part for the production of this guide.

Deputy Pharmacy Directorate, Health Services Coordination, for the resources that make it possible.
this guide.

Nursing staff of the hospital for their invaluable support, knowledge, experiences, and time
provided for the completion of this work.

Attached doctors and residents of the medical unit, for their support in this and other activities
pharmaceuticals.

Drug Information Center of the Children's Hospital DIF Pachuca, Hidalgo, Mexico
provided support.

Zaragoza Faculty of Higher Studies UNAM, for the advice and review of this guide.

Dedication

For Eva, Saulo, Caleb, Salvador, and Angélica.

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CONTENT

PREPARATION AND REVIEW....................................... 4 CEFUROXIME50

NOTE................................................................................ 4 Ciprofloxacin......................................................52
FEEDBACK................................................ 4 CLINDAMYCIN54
ACKNOWLEDGMENTS.................................................... 5 Chloropiramine56
PROLOGUE........................................................................ 8 Darbepoetin alfa57
CARACTERÍSTICAS DE LA GUÍA ............................... 9 DEXAMETHASONE59
HOW TO USE THE GUIDE?............................................... 9 DEXKETOPROFEN....................................................60
ABBREVIATIONS USED IN THE GUIDE....................11 DEXMEDETOMIDINE..................................................62
GENERAL RULES FOR THE DIAZEPAM....................................................................63
ADMINISTRATION........................................................11 DICLOFENAC.............................................................65
PARENTERAL ROUTES OF ADMINISTRATION......12 DICLOXACILLIN..........................................................67
STABILITY OF MEDICINES DIFENIDOL....................................................................68
PARENTERAL14
Digoxin......................................................................70
MONOGRAPHS15
DOBUTAMINE..............................................................72
ACYCLOVIR16
DOPAMINE..............................................................74
ADENOSINE.................................................................18
ENOXAPARINA............................................................ 77
HUMAN ALBUMIN..................................................19
EPINEPHRINE (ADRENALINE)..................................79
Alteplase..................................................................21
ERTAPENEM................................................................ 81
Amikacin.................................................................. 23
ESMOLOL......................................................................83
Aminophylline...............................................................24
STREPTOKINASE..................................................85
AMIODARONE.............................................................. 26
PHENYTOINA 86
AMPICILLIN29
FILGRASTIM......................................................... 88
ATOSIBAN.....................................................................30
PHYTOMENADIONE (VITAMIN K1)............................90
ATROPINE..................................................................... 32
FLUCONAZOLE..............................................................92
Sodium bicarbonate.........................................33
FLUMAZENIL93
Butylhyoscine.......................................................... 36
Furosemide...............................................................95
Calcium Gluconate................................................. 37
GELATIN.....................................................................96
Carbetocin.............................................................40
HALOPERIDOL.............................................................98
CEPHALOTINA41
HEPARIN.................................................................. 100
CEFEPIMA.....................................................................43
HYDRALAZINE............................................................ 102
CEFOTAXIME................................................................44
HYDROCORTISONE................................................... 103
Ceftazidime46
HYDROXOCOBALAMIN.......................................... 105
Ceftriaxone.............................................................48
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Insulin Glargine.............................................. 107 OMEPRAZOLE.............................................................. 145

NPH INSULIN.......................................................... 108 ONDANSETRON........................................................ 147
LISPRO INSULIN..................................................... 110 OXYTOCIN.................................................................. 149
LISPRO INSULIN/LISPRO PROTAMINE............. 111 PARACETAMOL (ACETAMINOPHEN)...................... 150
REGULAR RAPID INSULIN................................. 113 PENICILLIN G (CRYSTALLINE SODIUM)................. 152
KETOROLAC............................................................. 115 Piperacillin/Tazobactam.............................. 154
LEVOFLOXACIN....................................................... 116 Potassium Chloride.................................................. 156

Lidocaine.................................................................. 118 PROPOFOL.................................................................. 158

LINEZOLID............................................................... 120 Ranitidine................................................................ 159
MAGNESIUM SULFATE................................................122 Ferric Saccharate................................................ 161
MANNITOL..................................................................... 124 SUCCINYLCHOLINE (SUXAMETHONIUM)..................... 163
MEROPENEM126 TERLIPRESSIN.......................................................... 165
METAMIZOLE (DIPYRONE)..........................................127 TIGECYCLINE.............................................................. 166
Methylprednisolone............................................129 TRAMADOL................................................................. 167
METOCLOPRAMIDE.................................................. 131 TRIMETOPRIMA/SULFAMETOXAZOL.................. 169
METRONIDAZOLE........................................................ 133 Glycerin trinitrateO.................................... 170
MIDAZOLAM............................................................... 134 VALPROIC ACID................................................... 172
MULTIVITAMINS......................................................136 VANCOMYCIN174
NALBUFINE............................................................... 138 VERAPAMIL............................................................. 176
Nimodipine............................................................... 140 ZOLEDRONIC ACID............................................. 177
Sodium Nitroferricyanide..................................... 141 REFERENCES........................................................... 180
Norepinephrine (Noradrenaline)............... 143
8

PROLOGUE
The administration of parenteral medications is a key and fundamental component in healthcare.
hospital care of patients, therefore, pharmacological knowledge is essential for success of
treatment; in which a multidisciplinary team is involved, including a doctor, nurse, and
recent training in pharmacy.

Within the current context regarding patient safety and the implementation of goals and actions for
to avoid adverse effects and errors associated with pharmacotherapy, the nursing staff of the Institute of
Social Security of the State of Mexico and Municipalities (ISSEMyM) plays an important role as it is the
responsible for administering medication to patients. Remembering that as staff of
nursing our activity must be based on the knowledge and application of guidelines such as
clinical practice guidelines, the standards and other updates that may arise; it is essential to have
materials that help improve our practice day by day and promote patient safety, being
an international goal of the World Health Organization (WHO).

Therefore, the contribution of this guide for the administration of parenteral medications by
hospital pharmacy service, we consider it a support tool of great importance since
we will have practical and concise information to properly carry out the administration process
medications through these routes and at the same time we expect a decrease in medication errors. Thus
same, this takes on special relevance due to the fact that there were previously no documents of this type in the
hospital and because there is no standardized information among the staff to carry out this activity, due to
Such reason this guide could be a starting point to begin to standardize activities and improve the
training of personnel in the management processes of each medication used.

On the other hand, the guide has been designed and organized in alphabetical order with the medications of
intravenous, subcutaneous, and intramuscular administration that the hospital has; likewise for each
Medication will be able to find information related to preparation, infusion speed,
compatibilities, stability, and precautions that we must consider for adult patients, as well as
pediatric

Finally, we recognize the value of guidance and trust that the information contained herein has been
carefully selected and assessed from a pharmaceutical approach of the needs we have
as nursing staff, reaffirming the commitment that the pharmacist has to provide
specialized information on medications with the purpose of promoting rational use of
medications.

María Nieves Baeza Capetillo

Guadalupe Elsa Palafox Galicia
Nurses, Hospitalization Service, Nezahualcóyotl Regional Hospital
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CHARACTERISTICS OF THE GUIDE

The guide includes 93 medications, which are intravenous medications.
subcutaneous and intramuscular most commonly used in hospital services of the unit
medical according to the basic medicine list.

The guide brings together the minimum recommendations to consider for safe management of
medications by intravenous and other parenteral routes.

Includes information for adult and pediatric patients, so it should be reviewed.

carefully.

In the development of this guide, several sources of information about medications were evaluated.
which are indicated in the section of consulted sources for a more extensive search if so
wish.

If additional information not included in this guide is required, it must be requested from the service.
from the pharmacy directly or by any means of contact.

The information contained in the guide corresponds to what is available at the time of publication.

The guide has an electronic version that will contain periodic updates accordingly.
with the availability of information.

HOW TO USE THE GUIDE?

It is important that the guide is always available for the nursing staff in each area of the
hospital where parenteral medications are administered.

It is recommended to use the guide in conjunction with the hospital's manuals, policies, and procedures.

The guide is structured in monographs of each medication ordered alphabetically.

Each monograph contains eight fields, which are indicated below, as well as the information that
can be found in each one:

GENERIC NAME: It is the title of each monograph and corresponds to the name according to the
generic name of the drug.

CLASSIFICATION: It is found after the generic name and indicates the pharmacological group
therapeutic use of the medication.

PRESENTATION: Section that describes the pharmaceutical form, drug, content, and packaging
primary of the medication.
10

PREPARATION: This field is divided into two parts: compatible solutions, in which it is indicated
the compatible solutions for the medication, with which it is possible to mix and dilute it and that
According to the information consulted, there are no data on incompatibility. The other part is:
reconstitution and dilution, in which instructions and recommendations are given for reconstituting and/or
dilute the medication, also providing data on concentrations and volumes.

STABILITY: This section outlines the conditions, recommendations, and timelines

drug conservation before its preparation and once reconstituted and/or diluted in order
to ensure patient safety and medication effectiveness.

ADMINISTRATION: This section presents two tables, for adult patients and for patients
pediátrico. En cada cuadro se coloca información del método de administración parenteral,
infusion speed and comments that should be taken care of at the time of carrying out the process.
Depending on the method of parenteral administration, the feasibility of using it with a
symbol when the administration method is not recommended or there is no evidence of
favorable information to recommend its use. A symbol to indicate that it is possible
administer the medication using that method according to the consulted information. It is
It is important to note that what is established in the table are recommendations and should not be understood
as absolute norms or rules; instead, the medical, nursing, and pharmaceutical personnel must
evaluate the patient's clinical situation in the administration process.

COMPATIBILITY: Part that contains the medications that are compatible and that can be
combinations. A table is presented divided into three sections:

Site Y: Refers to the compatible medications to be administered at site Y of a line of

administration while another is being administered simultaneously.
Mix: Here are the medications that can be added to a mixture or dilution.
carried out and that according to the consulted information are compatible. It is important to take into account the
dilution solution being used; since this will also depend on whether the second
the medication that is added to the solution is compatible with it.
Syringe: Understand the compatible medications that can be loaded and mixed in the same one.
syringe, for subsequent administration.

It is important to note that there are various factors related to the medication and the environment.
that influence the occurrence of physical or chemical incompatibilities. We must also
to know that the information provided in these sections is obtained from databases that
they gather information from certain compatibility and stability studies conducted on
certain conditions, probably different from those we have in our practice
daily.

OBSERVATIONS AND PRECAUTIONS: This last part corresponds to the care and precautions
what should be considered in the medication management process.
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ABBREVIATIONS USED IN THE GUIDE

EDTA Ethylenediaminetetraacetic acid (for its initials in English)
DEHP Diethylhexyl phthalate (for its initials in English)
g grams
Intramuscular
IV Intravenous
KCl Potassium chloride
The liter
mcg micrograms
mEq milliequivalent
mg milligrams
mL milliliters
mOsm milliosmol
PVC Polyvinyl Chloride
Subcutaneous SC

GENERAL RULES FOR ADMINISTRATION

Before administering a medication, the following basic rules must be taken into account:

CHECK THAT THE PATIENT IS NOT TAKING ANY MEDICATION OTHER THAN PRESCRIBED.

BEFORE PREPARING AND ADMINISTERING A MEDICATION, WASH YOUR HANDS.

ADMINISTER THE CORRECT MEDICATION

Review the generic name of the medication and check the expiration date.
Review the pharmaceutical form and presentation of the medication.
If there is any doubt, do not administer and consult.

ADMINISTER THE MEDICATION TO THE CORRECT PATIENT

Check the patient's identification data.

ADMINISTER THE CORRECT DOSE

Check the quantity of the medication in grams, milligrams, micrograms, etc. according to
correspond.
Whenever a prescribed dose seems inadequate, verify it with the prescriber.

ADMINISTER THE MEDICATION BY THE CORRECT ROUTE

Ensure that the route of administration is correct.
Check if the formulation is compatible with the route of administration.
If the route of administration is not specified in the prescription or medical indication, consult.

ADMINISTER THE MEDICATION AT THE CORRECT TIME

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Respect the dosage interval according to medical instructions.

Organize the administration taking into account the infusion times of medications.
intravenous.
Special attention must be paid to the administration of medications that require an interval of
strict dosage.

REGISTER ALL ADMINISTERED MEDICATIONS

Register and sign the administration of each medication as soon as possible.
If for any reason a medication is not administered, record it in the nursing sheet.
specifying the reason.
When single doses of a medication are administered, note the reason for the administration.

INFORM AND INSTRUCT THE PATIENT ABOUT THE MEDICATIONS THEY ARE RECEIVING.
Precautions and care during administration.

PARENTAL ADMINISTRATION ROUTES

Parenteral administration (from the Greek para enteron, 'next to the intestine') of drugs differs from
all the other ways due to the singular requirements arising from direct injection of the
medications in the body tissue, after passing through the primary protective system of the skin and the
mucous membranes. Consequently, medications must be exceptionally pure and free of
physical, chemical, and biological contaminants. The parenteral administration route in the strict sense makes
reference to the administration of medications outside the digestive tract and is preferably applied to the
intravenous, intramuscular, subcutaneous, intradermal, etc.

WAY CONSIDERATIONS
INTRADERMAL A small dose is introduced in a volume
small between the epidermis and the dermis and the
absorption is practically nil. The area of
the election is the front face of the forearm. It is used
for diagnostic and testing purposes
hypersensitivity.
Subcutaneous It is important to rotate the puncture sites.
to avoid sterile abscesses and fat atrophy
subcutaneous.
Pinch a fold of tissue of 1.5 cm and pin it.
needle in it, forming a 90-degree angle, not
release the pinch until the needle is removed.
Do not check for blood reflux or apply
massage over the area after the injection, already
that the small vessels can break
blood vessels and cause a bruise.
In prefilled syringes, do not remove the bubble.
air to prevent the loss of the medication.
INTRAMUSCULAR The site of choice for puncture and the size of the
the needle will depend on the muscle development of
patient. Always aspirate to check that the
the needle has not punctured a glass.
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DIRECT INTRAVENOUS It is characterized by the direct management of the

medications intravenously, or through a point of
catheter injection or infusion equipment.
Depending on the duration and the volume of
managed solution is distinguished by several forms
of direct intravenous administration.

Direct intravenous in 'bolus' It is called that when the administration lasts

less than 1 minute.

Slow direct intravenous When the administration lasts for 2-5 minutes.

Avoid the veins of irritated, infected, or

injured.
In prolonged treatment, start in the veins of
the hand and gradually moving to more points
proximal of the arm.
Ensure during the drug injection that
there is reflux.
Intravenous infusion For acidic, alkaline, or hypertonic solutions,
use a large caliber vein to facilitate the
dilution and avoid irritation.
The area adjacent to it will be inspected daily.
puncture point in case signs appear of
inflammation, infiltration or bruises in whose
in cases the route will be replaced.
Monitor the perfusion rate.
In case of obstruction, do not irrigate the pathway to avoid
embolisms or infections.
Ensure that the solution does not contain particles in
suspension before and during administration.
Avoid multiple mixtures and if there are any, check.
that are compatible with each other.
The mixtures will always be made with a
strictly aseptic mixing.

Intermittent IV infusion This technique is used in case the

medications are injected through a device of
infusion directly or dissolved in solutions of
small volume. The duration of administration
oscillate between 15 minutes and several hours.

Continuous IV infusion Administration similar to the previous one with the

difference in infusion time that is continuous (12
hours, 24 hours or more) and that are usually used
high volume solutions such as diluents or
also continuous infusion pumps.
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STABILITY OF PARENTERAL MEDICATIONS

An important aspect of parenteral therapy is to ensure that the patient receives the indicated dose of each.
medication. A portion of the medication will be lost during the preparation time of the solution.
and its administration to the patient, for example, if the medication experiences degradation, it precipitates with the
diluent, interacts with the administration container or shows microbiological multiplication. It is
it is important to understand the reasons for such effects in order to assess the clinical implications
probables.

The stability of a medication means the ability of the pharmaceutical form to maintain the
physical, chemical, therapeutic, and microbiological properties during the conservation period and use of
medication by the patient. After the original packaging of the medication is opened, the expiration date
it will be shorter as a result of the decrease in the concentration of the drug or the risk
microbiological due to the effect of external factors. Among the factors that affect the stability of the
medications are found at temperature, pH, humidity, light, pharmaceutical form, concentration,
incompatibility, oxygen, adsorption to plastics, time, preservatives, among others.

The guide recommends times and storage conditions once the parenteral medication has been
prepared either by reconstitution and/or dilution. These conditions are based on the sources
consulted and refer to uncontrolled conservation conditions in an uncontrolled environment, due to
Currently, many hospitals do not have the infrastructure to preserve the
parentral mixtures in controlled extended storage conditions that ensure their optimal use.
Thus, for the medications included in the guide, there is information on conditions and stability times.
extended under controlled conditions, which must be requested from the pharmacy service through
any means if required.
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MONOGRAPHS
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ACICLOVIR
Antiviral

PRESENTATION:

Vial ampoule with powder containing sodium acyclovir equivalent to 250 mg of acyclovir.

Preparation

Compatible solutions: Dextrose 5%, sodium chloride 0.9%, dextrose 5% in sodium chloride 0.9%, dextrose
5% sodium chloride 0.45%.

Reconstitution and dilution:

IV: Reconstitute 250 mg, 500 mg or 1 g of acyclovir with 10 or 20 mL of injectable water (do not use water that
contains benzyl alcohol or parabens, as it may cause precipitation), respectively, to obtain
a final concentration of 25 mg, 50 mg, or 100 mg per milliliter (if done with 10 mL). Shake well to
ensure complete dissolution. Furthermore, this reconstituted solution must be diluted before the
administration. For IV infusion, dilute the acyclovir concentrate with a compatible solution to a
concentration less than or equal to 7 mg/mL (concentrations greater than 10 mg/mL increase the risk of
phlebitis). Alternatively, dilute the reconstituted powder solutions before IV infusion with 50-125
mL of a compatible solution. For patients with fluid restriction, dilute the reconstituted solution in
a proportion of approximately 1 part of reconstituted solution to 9 parts of infusion solution
a concentration less than or equal to 7 mg/mL.

STABILITY:

a) Keep the unopened ampule at room temperature (no more than 30°C).
b) Do not refrigerate reconstituted or diluted solutions as they may precipitate.
c) The reconstituted solution remains stable for 12 hours at room temperature (no more than 30°C).
d) Once the IV infusion solution is diluted, use it within 24 hours at room temperature (no more than
of 30°C).
e) If the solution is refrigerated, a precipitate may form which dissolves once it is placed.
the ambient temperature. If the precipitate does not disappear, discard the solution.

ADMINISTRATION:

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer for at least 1 hour Maintain adequate hydration of
Intermittent IV
to prevent kidney damage. patient.
IV continues As per medical indication.
IM Do not administer by this method.
SC Do not administer by this method.
 17

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Manage in at least 1 hour to maintain hydration suitable.
IV intermittent
prevent kidney damage. Maximum concentration: 7 mg/mL.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, sodium ampicillin, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate
["cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","sodium dexamethasone phosphate"]
dexmedetomidine hydrochloride, digoxin, ephedrine sulfate, ertapenem sodium, fentanyl citrate, filgrastim, fluconazole
furosemide, sodium heparin, hydrocortisone sodium succinate, linezolid, magnesium sulfate, mannitol
["methylprednisolone sodium succinate","metronidazole","multivitamins","morphine sulfate","oxytocin","penicillin G"]
["potash","potassium chloride","ranitidine hydrochloride","succinylcholine chloride","tigecycline","sodium thiopental","trinitrate of"]
glycerol, vancomycin hydrochloride, zoledronic acid.

Mix
Fluconazole.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Wash the line with 0.9% sodium chloride before and after the IV infusion.
b) The injectable solution should not be administered via SC, IM, topical, or ophthalmic routes. Do not administer by
rapid IV injection (in less than 10 minutes). Avoid rapid infusion as it is associated with
nephrotoxicity due to crystalluria and tubular renal damage.
c) In pediatric patients, do not use benzyl alcohol or preparations as a diluent that
contain parabens.
It is recommended that the concentration of the infusion solution be 7 mg/mL or less, since
higher concentrations are associated with phlebitis or inflammation at the injection site
with extravasation.
e) Acyclovir is irritating; avoid extravasation. If extravasation occurs, stop the infusion.
immediately and disconnect (leave the cannula/needle in place); gently aspirate the solution
extravasated (do not wash the line); remove the needle/cannula; elevate the limb and apply compresses
with dry heat.
18

ADENOSINE
Antiarrhythmic

PRESENTATION

Vial ampule with 2 mL of injectable solution containing 6 mg of adenosine (3 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: Does not require dilution to a concentration of 3 mg/mL. The solution must be clear and free of particles.

STABILITY

a) Keep the unopened ampule at room temperature (no more than 30°C).
b) Do not refrigerate as crystallization may occur. The crystals can be dissolved at room temperature.
environment.
c) Once the ampule bottle is opened, the medication is stable for 48 hours at room temperature.
(no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Inject for 1 or 2 seconds. Inject directly into a vein or site
IV peripheral as close as possible to the
Direct IV patient's cannula. After injecting
adenosine follow with a 20 mL rinse
0.9% sodium chloride.
IV intermittent Use only as directed by a physician.
IV continues Use only as directed by a physician.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Inject for 2 seconds. After injecting adenosine, continue with
a rinse of 5-10 mL of chloride
sodium 0.9%. It can be diluted with chloride of
Direct IV sodium 0.9% for doses less than 0.2 mL
(600 mcg). Use 1 mL (3000 mcg) with 9 mL
of solution to obtain a solution of
final concentration of 300 mcg/mL.
Intermittent IV Use only as directed by a physician.
IV continues Use only under medical guidance.
 19

IM Do not manage by this method.

SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
No mezclar con otros medicamentos.

OBSERVATIONS AND PRECAUTIONS

a) Continuous cardiac monitoring is recommended; therefore, adenosine should only be used where it is
available cardiac monitoring and cardiopulmonary resuscitation equipment.
IV infusions are ineffective in treating supraventricular tachycardia.
c) Adenosine has a very short duration of effect (half-life less than 10 seconds). Any
adverse effect is generally reversible quickly.
d) Measure blood pressure in the arm opposite to where adenosine is administered to avoid an effect
speak for adenosine.

HUMAN ALBUMIN
Plasma volume expander

PRESENTATION

Vial with 50 mL of injectable solution containing 12.5 g of human albumin (25% solution)
12.5g/50mL.

PREPARATION

Compatible solutions: Sodium chloride 0.9%, sodium chloride 0.45%, dextrose 5%, dextrose 10%, dextrose
5% in sodium chloride 0.9%, dextrose 5% in sodium chloride 0.45%.
20

Reconstitution and dilution:

IV: No additional dilution is needed. Do not dilute in injectable water as it may cause hemolysis and there is a risk.
of acute kidney damage. Do not mix with protein hydrolysates or solutions that contain alcohol. The
solutions must be light amber in color.

STABILITY

a) The unopened vial of human albumin (5, 20, 25% are the most common) should be stored at
ambient temperature (no more than 30 °C). The solution should not be frozen. Should not be used
solutions that have been frozen.
b) Do not use if the solution is cloudy and/or contains sediments.
c) Use the solution within 4 hours after the vial has been opened or punctured.
first time, because it does not contain antibacterial preservative.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Only by medical indication.
Solution 25%: 1-3 mL/minute. It is usually administered in 30-120.
IV intermittent
minutes.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Only by medical indication.
Solution 25%: 1 mL/minute. The 25% albumin solution can be
Usually in 30-60 minutes. diluted according to the patient. By
Intermittent IV
example, dilute each 1 mL of albumin to
25% with 4 mL of 5% dextrose.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Esmolol hydrochloride.

Mix
Furosemide.

Syringe
Do not mix with other medications.
 21

OBSERVATIONS AND PRECAUTIONS

a) It is recommended that the administration rate be adjusted according to the patient's condition.
and your response.
b) Do not administer if the solution has other colors different from the mentioned one (light amber),
particles or sediments.
c) The albumin formulation contains 130-160 mEq/L of sodium. Use with caution in patients with
sodium restriction.
d) Do not dilute with injectable water as it may cause hemolysis and acute kidney failure, which can
be fatal. Only infusion solutions such as 5% dextrose or 0.9% sodium chloride should be
to be used to dilute human albumin.
e) Avoid using the 25% concentration in preterm infants due to the high risk of bleeding.
intraventricular

ALTAPLACE
Thrombolytic agent

PRESENTATION

Vial ampoule with powder containing 50 mg of alteplase (Human tissue plasminogen activator).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Reconstitute 50 mg with 50 mL of injectable water to produce a concentration of 1 mg/mL. Turn.
gently until it dissolves completely. Do not shake vigorously. Allow to rest for
several minutes to dissipate the large bubbles. The solution is colorless to pale yellow. Immediately
Before administration, the reconstituted solution can be additionally diluted to a concentration
from 0.2-0.5 mg/mL with 0.9% sodium chloride using PVC containers or glass bottles. The dilution
Additionally, the use of injectable water to dilute or generally the use of carbohydrate solutions, for
example, dextrose, is not recommended due to the formation of turbidity in the solution.

STABILITY

a) Store the unopened ampule at room temperature (no more than 30 °C) and protect from light
excessive.
b) The reconstituted and/or diluted solution must be used within 8 hours at room temperature.
(no more than 30 °C) or in refrigeration (2-8 °C).
22

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Inject for 1-2 minutes.
As per medical advice. There are schemes of infusion
intermittent IV
accelerated and 3-hour infusion
The speed and duration will depend. Do not dilute to less than 0.2 mg/mL as
IV continues
from the medical indication. it can precipitate.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV According to medical indication. Limited data.
According to medical instruction. Limited data. Usual concentration: 0.5
IV intermittent
mg/mL or 1 mg/mL
IV continues Según indicación médica. Limited data.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Lidocaine hydrochloride, vancomycin hydrochloride

Mix
Lidocaine hydrochloride, glyceryl trinitrate.

Syringe
Do not mix with other medications

OBSERVATIONS AND PRECAUTIONS

a) Monitor blood pressure during and for up to 24 hours after the infusion.
b) Monitor signs and symptoms of bleeding, especially in arterial punctures or sites
surgical.
c) Avoid administering IM injections during treatment with alteplase.
d) Infusion reactions that include rash, urticaria, and bronchospasm are usually mild,
but in rare cases they can be severe, if they occur stop the infusion and treat accordingly.
e) Angioedema may develop during or several hours after the infusion.
f) Check that there are no particles, sediments, or discolorations before administering the solution.
g) Avoid excessive agitation during dilution; mix by gently swirling and/or slow inversion.
h) In all situations, follow the total dosage with at least 30 mL of 0.9% sodium chloride administered through
the IV line to ensure the administration of the total dose.
 23

AMIKACIN
Aminoglycoside antibiotic

PRESENTATION

Vial with 2 mL of injectable solution containing 500 mg of amikacin sulfate (250 mg/mL).
Ampule with 2 mL of injectable solution containing 100 mg of amikacin sulfate (50 mg/mL).

PREPARATION

Soluciones compatibles:Dextrosa 5%, dextrosa 10%, cloruro de sodio 0.45%, cloruro de sodio 0.9%, dextrosa
5% in sodium chloride 0.9%, dextrose 5% in sodium chloride 0.45%.

Reconstitution and dilution:

IV: For intermittent IV infusion, dilute 100 mg or 500 mg in 100-200 mL of a compatible solution for
obtain concentrations of 0.25-5 mg/mL.
For IM administration, it can be used undiluted at concentrations of 250 mg/mL and 50 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30 °C).
b) The open ampule and/or the diluted solution are stable for 24 hours at room temperature (no more
at 30°C) or in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer for 30-60 minutes. Maximum concentration: 5 mg/mL.
IV continues Do not administer by this method.
Inject into muscle mass well
I am
developed.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer for 1-2 hours. Maximum concentration: 5 mg/mL.
IV continues Do not administer by this method.
IM Recommended concentration: 50 mg/mL
SC Do not administer by this method.
24

COMPATIBILITY

Sitio Y
Sodium acyclovir, aminophylline, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride, bicarbonate of
sodium, calcium gluconate, cisatracurium besilate, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine
["hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride"]
["adrenaline","sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","filgrastim","phytonadione"]
(vitamina K1), fluconazol, furosemida, hidrocortisona succinato sódico, ketamina clorhidrato, ketorolaco
["tromethamine","levofloxacin","lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol","methylprednisolone"]
sodium succinate, metoclopramide hydrochloride, metronidazole, midazolam hydrochloride, morphine sulfate
multivitamínicos, nalbufina clorhidrato, nitroprusiato sódico, norepinefrina bitartrato (noradrenalina), ondansetrón
hydrochloride, oxytocin, potassium chloride, ranitidine hydrochloride, succinylcholine chloride, tigecycline, trinitrate of
glycerol, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Sodium bicarbonate, ciprofloxacin, clindamycin phosphate, epinephrine hydrochloride (adrenaline), ergonovine maleate
["phytomenadione (vitamin K1), fluconazole, furosemide, hydrocortisone phosphate and sodium succinate, mannitol"]
["metronidazole","norepinephrine bitartrate (noradrenaline)","ranitidine hydrochloride","succinylcholine chloride","verapamil"]
hydrochloride.

Syringe
Clindamycin phosphate.

OBSERVATIONS AND PRECAUTIONS

a) Monitor signs of ototoxicity, such as tinnitus (ringing) and vertigo, especially when
they indicate high dosages or prolonged therapy with amikacin.
b) Administer other antibiotics such as penicillins and cephalosporins at least 1 hour before or
after the dose of amikacin.
c) Patients should be well hydrated to minimize chemical irritation of the tubules.
renal issues which can occur as a result of high concentrations of amikacin in urine.
d) Renal function should be evaluated before and during therapy with amikacin.

Aminophylline
Bronchodilator
Respiratory stimulant and smooth muscle relaxant

PRESENTATION

Vial containing 250 mg of aminophylline in 10 mL of injectable solution (25 mg/mL).

Preparation

Soluciones compatibles:Dextrosa 5%, dextrosa 10%, cloruro de sodio 0.45%, cloruro de sodio 0.9%, dextrosa
5% in sodium chloride 0.9%, dextrose 5% in sodium chloride 0.45%.
 25

Reconstitution and dilution:

IV: Does not require reconstitution. It can be diluted according to dosage requirements and indication.
doctor. For example: Dilute 250 mg in 250 mL of compatible solution to produce a concentration of 1
mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30 °C). Do not administer if the
the solution is colorful or a precipitate forms.
b) Aminophylline, at concentrations of 250 mg and 500 mg in 100 mL, 250 mL or 500 mL of chloride of
0.9% sodium or 5% dextrose, has a stability of up to 24 hours at room temperature (not more
of 25°C).
c) The aminophylline added to solutions containing dextrose may result in an increase in the
yellowish coloration, which does not occur in other solutions. This coloration appears more
quickly at high temperatures and with long exposure. This does not affect the power of
medication.
d) Protect the aminophylline solution from light.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 20-30 minutes. Dissolve the dose in 50 mL of solution
intermittent IV
compatible.
According to medical advice. The infusion rate should not exceed
IV continues
25 mg/hour.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Infuse for 30-60 minutes. Do not exceed 25 mg/minute.
IV continues Según indicación médica.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, atropine sulfate, sodium bicarbonate, calcium gluconate, cephalothin sodium
cefotaxime, ceftazidime, ceftriaxone sodium, cefuroxime, clindamycin phosphate, sodium dexamethasone phosphate
dexmedetomidine hydrochloride, digoxin, dopamine hydrochloride, ephedrine sulfate, ergonovine maleate, ertapenem
["sodium","esmolol hydrochloride","streptokinase","fentanyl citrate","filgrastim","phytomenadione (vitamin K1)","fluconazole"]
26

["furosemide","sodium heparin","sodium succinate hydrocortisone","ketorolac tromethamine","levofloxacin","lidocaine"]

hydrochloride, linezolid, mannitol, meropenem, sodium methylprednisolone succinate, metoclopramide hydrochloride
metronidazol, morfina sulfato, multivitamínicos, nalbufina clorhidrato, nitroprusiato sódico, oxitocina, potasio
["chloride","ranitidine hydrochloride","succinylcholine chloride","tigecycline","nitroglycerin trinitrate","vecuronium bromide"]
zoledronic acid.

Mix
["Sodium bicarbonate","calcium gluconate","cefuroxime","sodium dexamethasone phosphate","dopamine hydrochloride","esmolol"]
hydrochloride, furosemide, sodium heparin, sodium hydrocortisone succinate, lidocaine hydrochloride, mannitol
meropenem, potasio cloruro, ranitidina clorhidrato, trinitrato de glicerilo.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The rapid IV injection of aminophylline can cause dizziness, weakness, palpitations, syncope, pain.
precordial, redness, bradycardia, premature ventricular complexes (contractions), hypotension
severe cardiac arrest.
b) Aminophylline should not be mixed in the same syringe with other medications.
c) Vesicant medication; ensure proper placement of the needle or catheter before and during the
IV infusion. Avoid extravasation. If extravasation occurs, stop the infusion immediately.
and disconnect (leave the needle/cannula in place); gently aspirate the extravasated solution (do not
rinse the line); consult with the doctor about the start of the antidote; remove the needle/cannula; apply
cold dry compresses; elevate the limb.

AMIODARONE
Class III antiarrhythmic

PRESENTATION

Vial with 3 mL of injectable solution containing 150 mg of amiodarone hydrochloride (50 mg/mL).

PREPARACIÓN

Compatible solutions: Dextrose 5%.

Reconstitution and dilution:

IV: No need for reconstitution. Dilute the amiodarone concentrate before administration by infusion.
intravenous. It is recommended to administer solutions that contain a concentration of amiodarone
mayor a 2 mg/mL via central venous catheter. IV infusion: For the first rapid infusion or infusions
supplements, add 150 mg to 100 mL of 5% dextrose, resulting in a final concentration of 1.5
mg/mL. For the slow loading infusion and maintenance infusion, add 900 mg (18 mL) of amiodarone
a 500 mL of 5% dextrose, resulting in a final concentration of 1.8 mg/mL. For the infusions of
subsequent maintenance, solutions that have a concentration of amiodarone of 1-6 mg/mL
they can be used. Alternatively, in cardiac arrest secondary to pulseless tachycardia or fibrillation
ventricular, the initial dose can be diluted in 20-30 mL of compatible solution.
 27

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C); protect from light and...
excessive heat. Light protection is not necessary during its administration. The solution must
it is clear and colorless to pale yellow.
b) When mixed in 5% dextrose to a final concentration of 1-6 mg/mL, the solution is stable at
ambient temperature (no more than 30°C) for 24 hours in polyolefin or glass containers, or for 2 hours
in PVC.
c) Solutions containing less than 600 mcg/mL in 5% dextrose are unstable.

ADMINISTRATION

Adult
Method Use Speed Comment
Manage for at least 3 minutes. It can be administered quickly and
Direct IV without dilution. Dilution is recommended in
20-30 mL of 5% dextrose.
Administer for at least 10 Infuse supplemental doses of 150 mg
intermittent IV minutes. It can be administered over 10 minutes (speed 15
period of 20 minutes to 2 hours. mg/minute). Do not exceed 30 mg/minute.
Fast charging phase: 15 mg/minute. Do not exceed the recommended speed.
in 10 minutes. initial loading infusion speed
Slow loading phase: 1 mg/minute in 6 (fast) must not exceed 30 mg/min.
hours (33.3 mL/hour of solution to infuse supplemental doses of 150 mg
IV continues
1.8 mg/mL) for 10 minutes (at a speed of 15
Initial maintenance phase: 0.5 mg/minute). Continue with infusion of
mg/minute for 18 hours (16.6 maintenance as per medical indication.
mL/hour of solution of 1.8 mg/mL.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Manage for at least 3 minutes. Can be administered quickly and
Direct IV
undiluted.
intermittent IV Administer for 20-60 minutes. Dose: 5 mg/kg (maximum: 300 mg/dose)
5 mcg/kg/minute. Adjust the speed according to
IV continues
medical indication.
I am Do not administer by this method.
SC Do not administer by this method.
28

COMPATIBILITY

Site Y
Amikacin sulfate, atropine sulfate, buprenorphine hydrochloride, cefepime hydrochloride, ciprofloxacin, cisatracurium
["besilate","clindamycin phosphate","dexmedetomidine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine"]
["hydrochloride (adrenaline)","esmolol hydrochloride","fluconazole","hydralazine hydrochloride","ketamine hydrochloride","lidocaine"]
["hydrochloride","linezolid","mannitol","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine sulfate"]
nalbuphine hydrochloride, nimodipine, ondansetron hydrochloride, penicillin G potassium, succinylcholine hydrochloride
["tramadol hydrochloride","glyceryl trinitrate","vancomycin hydrochloride","vecuronium bromide","zoledronic acid"]

Mix
Lidocaine hydrochloride, potassium chloride, verapamil hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) It can cause hypotension and bradycardia, which is associated with the infusion rate; from this
the speed must be reduced if these symptoms develop.
Continuous cardiac monitoring is recommended.
c) It is recommended that amiodarone infusions exceeding 2 hours should be administered
in 5% dextrose and in containers that are not PVC (for example, glass or polyolefin) to prevent
the adsorption. It should be rinsed with 0.9% sodium chloride solution before and after the infusion.
d) Visually inspect for particles or discolorations before administration and
discard if they are present. Prepare the solutions only in glass containers, except for
initial balls or later balls, which can be prepared in PVC containers.
e) Preferably, concentrations should not exceed 2 mg/mL for longer infusions at 1
hour via peripheral vein; concentrations greater than 2 mg/mL must be administered via line
central.
f) The administration at lower infusion rates (potentially associated with use in
pediatrics) and concentrations higher than the recommended may result in leaching of
plasticizer (DEHP) from the intravenous line.
g) The medication is very irritating and can be vesicant; therefore, repeated infusions or
continues to be managed via the central line.
h) Ensure the proper placement of the needle or catheter before and during the IV infusion. Avoid
extravasation. If extravasation occurs, stop the infusion immediately and disconnect.
(leave the needle/cannula in place); gently aspirate the extravasated solution (do not flush the
line); start treatment according to medical indication; remove needle/cannula; apply
dry heat compresses; elevate extremity.
 29

AMPICILLIN
Penicillin antibiotic (aminopenicillin)

PRESENTATION

Vial ampoule with powder containing sodium ampicillin equivalent to 500 mg of ampicillin.

Preparation

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: For direct IV administration, reconstitute the vials of 125 mg, 250 mg, and 500 mg with 5 mL of water.
injectable or compatible solution; reconstitute the 1 g and 2 g vials with 7.4 mL and 14.8 mL of injectable water,
respectively. For IV infusions, after reconstitution, the solution may be diluted with a
solution compatible with a concentration of up to 30 mg/mL. Another alternative for intermittent IV infusion
is to mix with 50-100 mL of 0.9% sodium chloride.
Reconstitute the vials of 250 mg, 500 mg, 1 g, 2 g with 1 mL, 1.8 mL, 3.5 mL and 6.8 mL of injectable water.
respectively, for a concentration of 250 mg/mL.

STABILITY

a) Store the unopened ampoule at room temperature (not exceeding 30 °C) and protect from light.
b) After reconstitution for IM or IV administration with injectable water, the
the medication is stable for only 1 hour at room temperature (no more than 30°C).
The stability of the diluted solution in 0.9% sodium chloride is 8 hours at room temperature.
(no more than 30°C) and 24 hours in refrigeration (2-8°C) at concentrations of up to 30 mg/mL.
d) The solutions for IV infusion will be inactivated in dextrose at room temperature; if the
Solutions containing dextrose will be used as diluents, the solution will only be stable.
for 2 hours. The solutions should not be frozen.
e) Adjust the infusion rate so that the total dose is administered before stability
from the dilution expires.

ADMINISTRATION

Adult
Method Use Speed Comment
Administer for 3-5 minutes. Dose range: 250-500 mg. Do not exceed
direct IV 100 mg/minute. The rapid administration
it can cause seizures.
Administer for at least 15-30 The maximum concentration should be 30
intermittent IV
minutes. mg/mL. Dose range: 1-2 g.
IV continues Do not administer by this method.
30

Suck back first to avoid injection into

I am
a blood vessel.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Administer for 3-5 minutes Do not exceed 100 mg/minute. The
Direct IV fast administration can cause
seizures.
Administer for at least 15-30 Maximum concentration: 30 mg/mL. No
intermittent IV
minutes. exceed 10 mg/kg/minute.
IV continues Do not administer by this method.
IM Concentration: less than 250 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, dexmedetomidine hydrochloride, filgrastim, levofloxacin, linezolid, metronidazole, tigecycline
vecuronium bromide, zoledronic acid.

Mix
Clindamycin phosphate, furosemide.

Syringe
Sodium heparin, lidocaine.

OBSERVATIONS AND PRECAUTIONS

a) If anaphylaxis occurs, stop the administration of the medication and notify immediately to the
doctor.
b) If an aminoglycoside antibiotic (e.g., amikacin) is also being administered
gentamicin, tobramycin), preferably administer at a different site. If this is not possible,
completely flush the infusion line with a solution compatible between the two medications
or to administer at a separate time.

ATOSIBAN
Oxytocin receptor antagonist

PRESENTATION

Ampoule bottle with 5 mL of injectable solution containing 37.5 mg of atosiban acetate (7.5 mg/mL).
 31

PREPARATION

{"compatible_solutions":"Dextrose 5%, Sodium Chloride 0.9%."}

Reconstitution and dilution:

IV: Withdraw 10 mL from a 100 mL compatible solution container and discard. Replace with 10 mL of
concentrated solution of atosiban 37.5 mg/5 mL to obtain a final concentration of 75 mg of atosiban
in 100 mL (0.75 mg/mL).

STABILITY

a) Keep the unopened ampule in its original packaging under refrigeration (2-8 °C) and protect from
the light.
b) Once the solution is diluted, it is stable for up to 24 hours at room temperature (no more than 30°C) and
it must be used within this time.

ADMINISTRATION

Adult
Method Use Speed Comment
Manage in 1 minute. Initial dose of 6.75 mg in bolus (First
direct IV
stage). Carry out the dose proportion.
Administer the loading infusion at a concentration of 0.75 mg/mL (Second
300 mcg/minute or 18 mg/hour (24 stage).
Intermittent IV
mL/hour) over a period of 3
hours.
Subsequent infusion, reduce to 100 Concentration: 0.75 mg/mL (Third
IV continues mcg/minute o 6 mg/hour (8 stage). Up to 45 hours.
mL/hour
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Magnesium sulfate.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.
32

OBSERVATIONS AND PRECAUTIONS

a) Monitor the total treatment hours according to the medical indication.

b) Use an infusion pump to achieve exact dosing and control the speed.

ATROPINE
Anticholinergic agent
Antiarrhythmic
Bronchodilator

PRESENTATION

Vial with 1 mL of injectable solution containing 1 mg of atropine sulfate (1 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: For direct IV administration: It can be administered undiluted or diluted in 10 mL of injectable water.
Inject via site "Y" or through a 3-way valve.

STABILITY

a) Keep the unopened ampoule at room temperature (not exceeding 30°C). Protect from light and do not
freeze.
b) The opened ampoule and/or the diluted solution must be used within 24 hours at room temperature.
(no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Inject for no more than 1 minute. Continue the rapid injection with 20 mL.
0.9% sodium chloride rinse.
Direct IV
slow administration (greater than 1 minute)
it can cause paradoxical bradycardia.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Only by medical indication.
SC Only by medical indication.
 33

Pediatric
Method Use Speed Comment
Inject for no more than 1 minute. Administer undiluted or it can be diluted in
Direct IV
4 mL of solution.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
IM Only by medical indication.
SC Only by medical prescription.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, amiodarone hydrochloride, sodium bicarbonate, buprenorphine hydrochloride, calcium
["gluconate","cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","dexamethasone phosphate"]
["sodium","dexmedetomidine hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate"]
epinefrina clorhidrato, ergonovina maleato, esmolol clorhidrato, estreptoquinasa, fentanilo citrato, fitomenadiona
(vitamin K1), fluconazole, furosemide, sodium heparin, hydrocortisone sodium succinate, ketorolac tromethamine,
["lidocaine hydrochloride","magnesium sulfate","mannitol","methylprednisolone sodium succinate","metoclopramide hydrochloride"]
["midazolam hydrochloride","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine"]
bitartrate (norepinephrine), ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride
["ranitidine hydrochloride","succinylcholine chloride","glycerin trinitrate","vancomycin hydrochloride","verapamil hydrochloride"]

Mix
Do not mix with other medications.

Syringe
Fentanyl citrate, sodium heparin, metoclopramide hydrochloride, midazolam hydrochloride, morphine sulfate, nalbuphine
hydrochloride, ondansetron hydrochloride, ranitidine hydrochloride.

OBSERVATIONS AND PRECAUTIONS

Continuous cardiorespiratory monitoring is required.

b) Do not add the medication to intravenous solutions.

Sodium bicarbonate
Alkalizing agent

PRESENTATION

Vial with 10 mL of injectable solution containing 750 mg of sodium bicarbonate equivalent to 8.9
mEq of bicarbonate and 8.9 mEq of sodium. Injectable solution at 7.5% (0.892 mEq/mL).
34

PREPARATION

Compatible solutions: Sodium chloride 0.9%, sodium chloride 0.45%, dextrose 5%, dextrose 10%, dextrose
5% sodium chloride 0.9%, 5% dextrose in 0.45% sodium chloride.

Reconstitution and dilution:

IV: It can be used undiluted in certain emergency situations. For intermittent IV infusion:
Dilute the dose in 50-100 mL of a compatible IV solution; the infusions must be diluted to a
maximum concentration of sodium bicarbonate of 0.5 mEq/mL. For continuous IV infusion, dilute the dose
prescribed in 500-1,000 ml of a compatible IV solution.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C). Avoid freezing and exposure.
In extreme heat. Use only clear solutions.
b) Sodium bicarbonate solutions in water will slowly decompose at temperature
environment with loss of carbon dioxide and formation of sodium carbonate, a more substance
alkaline and caustic than sodium bicarbonate. Therefore, it is recommended to store the solution
in an airtight container.
c) The concentration of sodium carbonate increases and the concentration of bicarbonate decreases in
the passage of time with a resulting increase in pH. This process accelerates at high
temperatures. It is recommended to refrigerate the sodium bicarbonate solutions when not in use.
using.
d) Sodium bicarbonate is a clear and colorless solution. Discard any solution that is not.
Clara, what developed a precipitate.
e) The open ampoule and/or the diluted solution are stable for 24 hours at room temperature (no more
at 25°C) or in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer for 5 minutes. Only emergency situations. Wash the
Direct IV line IV before and after the
administration.
intermittent IV Administer for at least 30 minutes.
It can be administered in 4-8. The infusion rate generally does not...
IV continues
hours. It must exceed 1 mEq/kg/hour.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Administer at a lower speed This method is reserved for
or equal to 1-2 mEq/kg/min (do not exceed emergency situations, such as cardiac arrest
10 mEq/min) to minimize the cardiac. Use 0.5 mEq/mL (4.2%) in
Direct IV
acute hypertonicity and the expansion of neonates and infants under 2 years.
of volume. The concentration of 1 mEq/mL (8.4%)
 35

can be used in children over 2

years.
Infuse for 2 hours (maximum Dilute to a maximum concentration of 0.5
Intermittent IV administration speed: 1 mEq/mL.
mEq/kg/hour or 8 mEq/kg/day.
According to medical advice. Concentration of 0.5 mEq/mL if it is a line
IV continues peripheral and 1 mEq/mL if it is a catheter
central.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
["Sodium acyclovir","Amikacin sulfate","Aminophylline","Atropine sulfate","Cefepime hydrochloride","Ceftazidime","Ceftriaxone"]
sodium, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine hydrochloride, digoxin, ephedrine sulfate
["sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","filgrastim","phytonadione (vitamin K1)"]
fluconazol, furosemida, heparina sódica, hidrocortisona succinato sódico, ketorolaco trometamina, linezolida,
["mannitol","methylprednisolone sodium succinate","metoclopramide hydrochloride","metronidazole","morphine sulfate"]
multivitamins, nimodipine, sodium nitroprusside, oxytocin, penicillin G sodium and potassium, potassium chloride
ranitidina clorhidrato, tigeciclina, trinitrato de glicerilo, vancomicina clorhidrato, vecuronio bromuro, zoledrónico
acid.

Mix
Aminophylline, ceftazidime, sodium ceftriaxone, clindamycin phosphate, sodium diclofenac, esmolol hydrochloride,
["furosemide","mannitol","ranitidine hydrochloride","sodium thiopental","tramadol hydrochloride","vancomycin hydrochloride"]
verapamil hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Use only clear solutions. Sodium bicarbonate is incompatible with Ringer solutions.
Lactated Ringer's (Hartmann). Solutions with concentrations greater than 1.26% must be
managed through the central line, except in emergency situations.
b) Do not administer simultaneously with calcium or catecholamines (such as norepinephrine,
dobutamine, dopamine). If the patient is receiving sodium bicarbonate along with any of
these medications, flush the IV line completely after each dose to prevent contact
between medications and consequently incompatibilities.
c) One milliequivalent (mEq) of sodium bicarbonate is equal to 84 mg of sodium. The concentration of
Sodium bicarbonate at 7.5% is equivalent to 0.892 mEq/mL; each ampoule contains 8.9 mEq/10 mL
of bicarbonate and produces an osmolarity of 1.786 mOsm/L.
d) Sodium bicarbonate 84 mg is equal to 1 mEq of both sodium and bicarbonate.
e) Hypertonic sodium bicarbonate solutions must be diluted to isotonicity (1.5%) with
injectable water, sodium chloride 0.9%, dextrose 5% or another compatible solution before its
36

Administration. To prepare a 1.5% solution, dilute 1 mL of the 7.5% solution with 4 mL of water.
injectable.
f) Blistering medication (at concentrations greater than or equal to 8.4%); ensure placement
appropriate use of the needle or catheter before and during intravenous infusion. Avoid extravasation. If
extravasation occurs, stop the infusion immediately and disconnect (leave the needle/cannula in
its place); gently aspirate the extravasated solution (do not rinse the line); start treatment of
agreement with medical indication; remove the needle/cannula; apply cold dry compresses; elevate the
extremity.

BUTYLOSCINE
Antispasmodic agent

PRESENTATION

Vial with 1 mL of injectable solution containing 20 mg of butylhyoscine (butylbromide of hyoscine) (20

mg/mL.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: It can be administered undiluted or it can be diluted with 10 mL of compatible solution.
IM: Does not require dilution at a concentration of 20 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30 °C). Protect from light.
b) The opened ampule and/or the diluted solution of butylscopolamine must be used within 8 hours.
ambient temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Manage in 2-3 minutes.
Intermittent IV Manage in 30 minutes.
IV continues Do not manage by this method.
Suck before to avoid injecting into a
IM
blood vessel.
SC Only by medical indication.

Pediatric
Method Use Speed Comment
Direct IV Manage in 2-3 minutes.
IV intermittent Manage in 30 minutes.
 37

IV continues Do not administer by this method.

Breathe in first to avoid injecting into a
I am
blood vessel.
SC Only by medical indication.

COMPATIBILITY

Site Y
Fentanyl citrate, sodium heparin, sodium hydrocortisone succinate, morphine sulfate, potassium chloride.

Mix
Midazolam hydrochloride, succinylcholine chloride.

Syringe
Atropine sulfate, fentanyl citrate, metoclopramide hydrochloride, midazolam hydrochloride, morphine sulfate, nalbuphine
hydrochloride, ranitidine hydrochloride, thiopental sodium.

OBSERVATIONS AND PRECAUTIONS

a) Evaluate the patient to find signs of urinary retention, monitor the heart rate.
b) Monitor adverse reactions in the patient, cases of anaphylaxis have been observed.
c) Not to be confused with hyoscine hydrobromide.
d) Do not exceed 100 mg/day in adults.

Calcium Gluconate
Electrolytic replenisher
Cardiotonic

PRESENTATION

Vial with 10 mL of injectable solution containing 1 g of calcium gluconate equivalent to 0.093 g of

ionizable calcium. Injectable solution at 10% (0.1 g of calcium gluconate/mL).

PREPARATION

The dosages are expressed in weight of calcium gluconate (unless otherwise specified)
as elemental calcium): 1 g of calcium gluconate contains 93 mg (4.65 mEq) of elemental calcium. A
The milliequivalent of elemental calcium is equivalent to 20 mg.
The dosages expressed in terms of calcium gluconate are based on a concentration of
Solution of 100 mg/mL (10%) containing 0.465 mEq (9.3 mg)/mL of elemental calcium.
38

Compatible solutions: 5% dextrose, 10% dextrose, 0.9% sodium chloride, 5% dextrose in sodium chloride.
0.9%.

Reconstitution and dilution:

IV: Does not require reconstitution. For IV administration, the solution must reach body temperature and be
administered through a small gauge needle in a large vein to minimize phlebitis. For
intermittent/continuous infusion, can be diluted to 5.8-50 mg/mL with a compatible solution.
Alternatively, it can be diluted with 100-1000 mL of compatible solution.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30 °C). Do not freeze.
b) If crystals are observed inside the ampoule, place it in a warm water bath until dissolved.
let it cool to room temperature before administering it.
c) Do not administer if the solution is not clear, contains suspended particles or sediments.
d) Es químicamente estable en soluciones acuosas, pero puede precipitar en combinación con varios
components of medications and solutions. Do not mix in the same solution or line with
carbonates, phosphates, sulfates or tartrates.
e) The open ampoule and/or the diluted solution are stable for 4 hours at room temperature (not more)
of 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer in 3-5 minutes. Can be administered slowly without
Velocidad máxima: 50-100 mg de diluir en bolo. Velocidad máxima: 200
Direct IV
calcium gluconate/minute (0.5-1 mg/minute (2 mL/minute of the solution
mL/minute of 10% solution. injectable at 10%.
Administer for 30-60 minutes. May cause a burning sensation.
Maximum speed: 200 mg/minute cutaneous, peripheral vasodilation and
(2 mL/minute of 10% solution). decrease in blood pressure. The
intermittent IV
the patient must remain lying down for
30-60 minutes after of the
administration.
Administer for 8-24 hours. It can be diluted in 1000 mL of solution.
IV continues
compatible.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Administer for 3-5 minutes or can be administered undiluted as a bolus.
Direct IV a maximum speed of 50-100 mg Maximum speed: 100 mg/minute (1
of calcium gluconate/minute. mL/minute of 10% solution.
It can be administered for 10 Not to exceed 200 mg/minute of gluconate
Intermittent IV minutes to 2 hours. of calcium. Bradycardia may occur,
Hypotension and cardiac arrhythmias.
The total daily dose should not exceed 200 mg/minute of gluconate.
IV continues
infused for 24 hours. of soccer.
 39

I am Do not administer by this method.

SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, atropine sulfate, buprenorphine hydrochloride, cefepime hydrochloride,
cefotaxime, ceftazidime, cefuroxime, cisatracurium besilate, clindamycin phosphate, dexmedetomidine hydrochloride
["digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)"]
["ergonovine maleate","sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","filgrastim"]
["phytomenadione (vitamin K1)","furosemide","sodium heparin","lidocaine hydrochloride","linezolid","magnesium sulfate"]
mannitol, metoclopramide hydrochloride, metronidazole, midazolam hydrochloride, morphine sulfate, multivitamins
nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride
["oxytocin","sodium and potassium penicillin G","potassium chloride","ranitidine hydrochloride","succinylcholine chloride","tigecycline"]
glycerin trinitrate, vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride.

Mix
Aminophylline, furosemide, sodium heparin, sodium succinate hydrocortisone, lidocaine hydrochloride, norepinephrine
["bitartartrate (norepinephrine)","sodium penicillin G","potassium chloride","vancomycin hydrochloride","verapamil"]
hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Continuous cardiorespiratory monitoring is required.

b) Clarify incomplete orders of indicated doses and salts.
c) Administer slowly. High concentrations can cause cardiac arrest.
d) Rapid administration may cause tingling, a feeling of warmth, and a metallic taste. Stop the
infusion if these symptoms occur, resume the infusion at a slower rate when the
symptoms disappear.
e) After intravenous administration, the patient should remain lying down for a short while.
time.
f) Administer calcium salts slowly intravenously through a small needle in a
large vein to prevent too rapid an increase in serum calcium. Monitor the
serum calcium concentrations.
g) Do not administer solutions that are not clear or contain a precipitate.
h) The medication should not be injected IM or SC due to the potential for severe local reactions, for
example, necrosis.
i) Due to the potential for serious sequelae after the infiltration of solutions containing calcium,
It is preferred that the infusion be through a central line.
j) Parenteral calcium is a vesicant; ensure the correct position of the catheter/needle before and during the
infusion. Avoid extravasation; the adverse events of extravasation can be devastating (for
example, deep tissue necrosis). Monitor the administration site closely.
40

k) If extravasation occurs, stop the infusion immediately and disconnect (leave the needle/catheter in
their place); gently aspirate the extravasated solution (do not flush the line); start treatment
according to medical advice; remove the needle/cannula; apply dry cold compresses; elevate the
extremity.
Each milliliter of a 10% calcium gluconate solution contains 9.3 mg (0.465 mEq) of calcium.
elemental.

CARBETOCIN
Synthetic analog of oxytocin

PRESENTATION

Vial with 1 mL of injectable solution containing 100 mcg of carbetocin (100 mcg/mL)

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Does not require reconstitution. Does not require dilution before use.

STABILITY

a) Keep the unopened ampoule under refrigeration (2-8 °C), do not freeze, and protect from light.
b) Use immediately after opening the ampoule.

ADMINISTRATION

Adult
Method Use Speed Comment
Inject in 1 minute, quickly Preferably before extracting the
direct IV
after the child's extraction, placenta.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.
 41

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

Carbetocin is only administered as a single dose and additional doses should not be given.

CEFALOTINA
First generation cephalosporin antibiotic

PRESENTATION

Vial ampoule with powder containing cefalotin sodium equivalent to 1 g of cefalotin.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: Reconstitute 1 g with 10 mL of injectable water. For intermittent IV infusion, dilute the reconstituted solution.
in 50-100 mL of compatible solution. Patients with fluid restriction may receive a
maximum concentration of 100 mg/mL for intermittent peripheral IV infusion.
Reconstitute the powder with 4 or 5 mL of injectable water per gram.

STABILITY

a) Store the unopened ampule at room temperature (no more than 30°C) and protect from light.
b) The powder may gradually darken during storage, but this change does not affect
the power if only a slight coloration is present.
c) Do not keep the reconstituted cefalotin solution in plastic syringes.
d) Under refrigeration (2-8°C), reconstituted solutions of cephalothin maintain their potency until
96 hours after reconstitution and 12 hours at room temperature (no more than 30°C).
e) If precipitation occurs in solution, it can redissolve at room temperature with agitation.
constant.
f) Keep the solution at room temperature (no more than 30°C), the solution for IM injection must
to be administered within 12 hours after reconstitution.
g) Intravenous infusions must be initiated within 12 hours and completed within 24.
hours. For prolonged infusions, replace with a new solution at least every 24 hours.
h) Do not freeze reconstituted or diluted solutions.
42

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Manage in 3-5 minutes. Maximum concentration: 100 mg/mL.
Administer in 15-60 minutes. Final concentration for infusion
Intermittent IV peripheral should not exceed 20 mg/mL.
Manage within no more than 24 hours. Not recommended. Only by indication
IV continues
doctor.
Maximum concentration: 250 mg/mL.
IM Suck in first to avoid injection in
blood vessel.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Administer for 3-5 minutes. Concentration not greater than 100 mg/mL.
Intermittent IV Administer for 10-60 minutes. Concentration not greater than 100 mg/mL.
Administer within no more than 24 hours. Not recommended. Only by indication
IV continues
doctor.
The administration through this means is
I am
painful.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reaction data, especially if the patient has a history of allergies to the
penicillins, as there may be cross-reactivity hypersensitivity reactions.
 43

CEFEPIMA
Fourth generation cephalosporin antibiotic

PRESENTATION

Vial ampoule with powder containing cefepime hydrochloride equivalent to 1 g of cefepime.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose, 10% dextrose, 5% dextrose in sodium chloride
0.9%.

Reconstitution and dilution:

IV: Reconstitute the ampule vial with 10-20 mL of compatible solution. If only part of the
dose, reconstitute the 1 g vial with 8.7 mL or the 2 g vial with 17.4 mL of compatible solution to obtain a
concentration of 100 mg/mL. Approximate powder volume: 1 g - 1.3 mL, 2 g - 2.6 mL. Subsequently, dilute
the dose with 50-100 mL of compatible solution.
IM: Reconstitute the 1 g ampule with 3 mL of 0.9% sodium chloride, injectable water or 0.5% lidocaine.
1% or 2% (without epinephrine) to obtain a volume of 4.4 mL and a concentration of 230 mg/mL.

STABILITY

a) Store the unopened ampoule at room temperature (not above 30 °C) and protect from light.
b) The reconstituted and/or diluted solution is stable for 24 hours at room temperature (no more than 30)
°C) or 3 days under refrigeration at (2-8 °C).
c) The reconstituted solution is clear and colorless to pale yellow or amber. It may darken when
It is stored, but this does not indicate loss of power.

ADMINISTRATION

Adult
Method Use Speed Comment
Inject slowly for 3 to 5 only under medical advice.
Direct IV
minutes.
Administer for at least 30 Maximum concentration: 40 mg/mL
intermittent IV
minutes. (example: 1 g in 25 mL)
Administer for 3-4 hours. In certain patients where the infusions
IV continues
extended are appropriate.
Divide volumes greater than 5 mL into
IM
multiple injection sites.
SC Do not administer by this method.
44

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Administer over at least 30 minutes. Concentration of 1-40 mg/mL.
IV continues Manage for 3 hours. Concentration of 1-40 mg/mL.
I am Maximum concentration: 280 mg/mL
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, amiodarone hydrochloride, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate,
["sodium phosphate dexamethasone","dexmedetomidine hydrochloride","esmolol hydrochloride","fluconazole","furosemide"]
["hydrocortisone phosphate and sodium succinate","ketamine hydrochloride","levofloxacin","linezolid","methylprednisolone"]
["sodium succinate","metronidazole","oxytocin","ranitidine hydrochloride","tigecycline","zoledronic acid"]

Mix
Amikacin sulfate, clindamycin phosphate, sodium heparin, mannitol, potassium chloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Contraindicated in persons with severe hypersensitivity to penicillins, carbapenems and

cephalosporins.

Cefotaxime
Third generation cephalosporin antibiotic

PRESENTATION

Ampoule vial with powder containing sodium cefotaxime equivalent to 1 g of cefotaxime.

PREPARATION

Compatible solutions: 5% dextrose, 10% dextrose, 0.9% sodium chloride, 5% dextrose in sodium chloride
0.9%, dextrose 5% in sodium chloride 0.45%.

Reconstitution and dilution:

IV: For intermittent IV infusion, reconstitute 1 g with at least 10 mL of injectable water. Dilute the vial.
vial containing 1 or 2 g of cefotaxime with 50-100 mL of compatible solution to obtain solutions that
contain 10-20 or 20-40 mg/mL, respectively. For continuous IV infusion, the reconstituted solution
it can be diluted in up to 1000 mL of compatible solution.
 45

Reconstitute the ampoule vial containing 500 mg, 1 g, or 2 g of cefotaxime with 2, 3, or 5 mL.
respectively, injectable water or lidocaine at 1% or 2% (without epinephrine) to obtain solutions that
contain approximately 230, 300, or 330 mg/mL, respectively.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C) and protect from light.
b) The powder and the solutions may take on a slight yellowish hue, without loss of potency. If it
it presents a bright yellow or brown coloration, the medication must be discarded.
c) The reconstituted and/or diluted solution is stable for 24 hours at room temperature (no more than 30
°C) or 72 hours in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer for 3-5 minutes. Concentration: 100 mg/mL (maximum: 150
Direct IV mg/mL in patients with restriction of
fluids).
IV intermittent Administer in 20-60 minutes.
IV continues Administer in 6-24 hours. Dilute to 1000 mL of solution.
The administration of 2 g must be
I am
distributed in various places.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Administer for 3-5 minutes. Concentración: 180-200 mg/mL
IV intermittent Administer in 20-30 minutes. Final concentration of 10-60 mg/mL.
IV continues Administer within 24 hours. Only by medical indication.
IM Concentración: 230-330 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, aminophylline, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, sodium ceftriaxone
cefuroxima, clindamicina fosfato, dexametasona fosfato sódico, dexmedetomidina clorhidrato, digoxina, dopamina
["chloride, ephedrine sulfate, epinephrine chloride (adrenaline), esmolol chloride, streptokinase, fentanyl"]
citrate, phylloquinone (vitamin K1), furosemide, sodium heparin, sodium succinate hydrocortisone, ketorolac
tr tromethamine, lidocaine hydrochloride, linezolid, magnesium sulfate, mannitol, metoclopramide hydrochloride
["metronidazole","midazolam","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside"]
norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium
["chloride","ranitidine hydrochloride","succinylcholine chloride","glycerol trinitrate","sodium valproate","verapamil"]
zoledronic acid hydrochloride.
46

Mix
Clindamycin phosphate, verapamil hydrochloride.

Syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Do not administer intravenously in less than 3 minutes; rapid injection (in less than 1
minute) is associated with potentially lethal arrhythmias.
b) During the infusion, discontinue other solutions that are flowing through an IV line or site
of management unless the solutions are known to be compatible and the flow rate
properly controlled.
c) If used in combination with an aminoglycoside (for example, amikacin.), administer
preferably in a different site. If this is not possible, rinse the line thoroughly with
a compatible solution.
d) Monitor signs of phlebitis or extravasation.
e) Monitor adverse reaction data, especially if the patient has a history of allergies to the
penicillins, as cross-reactivity hypersensitivity reactions may occur.
f) Do not use preparations that contain benzyl alcohol in neonates.

Ceftazidime
Third generation cephalosporin antibiotic

PRESENTATION

Vial containing powder that contains ceftazidime pentahydrate equivalent to 1 g of ceftazidime.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose, 10% dextrose, 5% dextrose in sodium chloride
0.9%, dextrose 5% in sodium chloride 0.45%.

Reconstitution and dilution:

IV: Reconstitute the ampoule vial with 10-20 mL of injectable water. Shake to dissolve. The solution
it will produce a little effervescence and will clarify in 1 to 2 minutes. If only part of the dose is needed,
Reconstitute the 1 g and 2 g vials with 9.4 mL and 8.5 mL of injectable water, respectively, to produce a
concentration of 100 mg/mL and 200 mg/mL, respectively. Then, dilute with 50-100 mL of solution
compatible.
Reconstitute the 1 g ampoule vial with 3 mL of injectable water or lidocaine at 0.5%, 1% or 2% (without
epinephrine) to achieve a concentration of 260 mg/mL. Shake to dissolve. The solution will produce a
a little effervescence and it will clear up in 1 to 2 minutes.
 47

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30 °C) and protect it from light.
b) The reconstituted and/or diluted solution must be used within 24 hours at room temperature.
(no more than 30°C) and 48 hours in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer for 3 to 5 minutes. Only by medical instruction.
Administer for at least 15-30 Recommended concentrations 10-40
Intermittent IV
minutes. mg/mL.
IV continues As per medical advice.
Deep injection in the gluteus or thigh.
IM Administer doses greater than 1 g via
intravenous.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Administer for 3 to 5 minutes. Alone for indication doctor.
direct IV
Maximum concentration: 100-200 mg/mL.
Administer for at least 30 Concentration of 1-40 mg/mL.
intermittent IV
minutes.
IV continues According to medical advice.
IM Maximum concentration: 280 mg/mL
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate,
sodium ceftriaxone, cefuroxime, ciprofloxacin, clindamycin phosphate, sodium dexamethasone phosphate
dexmedetomidine hydrochloride, digoxin, dopamine hydrochloride, ephedrine sulfate, epinephrine hydrochloride (adrenaline)
["esmolol","streptokinase","fentanyl citrate","filgrastim","phytomenadione (vitamin K1)","furosemide","sodium heparin"]
["sodium hydrocortisone succinate","ketorolac trometamol","levofloxacin","lidocaine hydrochloride","linezolid","magnesium"]
["sulfate","mannitol","methylprednisolone sodium succinate","metoclopramide hydrochloride","metronidazole","morphine sulfate"]
multivitamins, nalbuphine hydrochloride, norepinephrine bitartrate (noradrenaline), oxytocin, penicillin G sodium
potásica, potasio cloruro, ranitidina clorhidrato, succinilcolina cloruro, tigeciclina, trinitrato de glicerilo, vecuronio
bromide, sodium valproate, zoledronic acid.

Mix
Sodium bicarbonate, cefuroxime, clindamycin phosphate, fluconazole, sodium heparin, linezolid, metronidazole,
potassium chloride.
48

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Contraindicated in people with severe hypersensitivity to penicillins, carbapenems and

cephalosporins.
b) All vials of ceftazidime are provided under reduced pressure. As the powder dissolves,
carbon dioxide is released and positive pressure develops. When a dose is removed from a vial
reconstituted, consider that the solution may contain carbon dioxide bubbles which
They must be released from the syringe before the injection.
c) The solutions can range from light yellow to amber depending on the concentration.
diluent and storage conditions. Such color variations do not affect the potency of
medication if stored under recommended conditions.
d) Intraperitoneal administration: Reconstitute with injectable water and then dilute in a solution of
peritoneal dialysis compatible to obtain a solution that contains 250 mg of ceftazidime per
every 2000 mL of dialysis solution.
e) Ceftazidime should not be administered via intra-arterial route as necrosis may occur.
f) If used in combination with an aminoglycoside (e.g., amikacin), administer
preferably in a different location. If this is not possible, then wash the line completely
with a compatible solution between the two medications.

Ceftriaxone
Third generation cephalosporin antibiotic

PRESENTATION

Vial ampule with powder containing sodium ceftriaxone equivalent to 1 g of ceftriaxone.

PREPARATION

["Compatible solutions: Sodium chloride 0.9%, sodium chloride 0.45%, dextrose 5%, dextrose 10%, dextrose"]
5% sodium chloride 0.9%, 5% dextrose in 0.45% sodium chloride.

Reconstitution and dilution:

For direct IV administration, reconstitute a vial of 1 g of ceftriaxone with 10 mL of water.
Injectable. For IV infusion, the solution is prepared in two phases: reconstitute the 1 g ampule bottle with
9.6 mL of compatible solution to achieve a concentration of 100 mg/mL. After reconstitution
from powder, dilute with 50-100 mL of compatible solution.
Reconstitute with injectable water, sodium chloride 0.9%, dextrose 5% or lidocaine hydrochloride 1% or 2% (without
epinephrine). Reconstitute by adding 3.6 mL and 2.1 mL to a 1 g vial to obtain solutions of
concentration 250 mg/mL and 350 mg/mL, respectively.
 49

STABILITY

a) Store the unopened ampule at room temperature (not exceeding 30°C) and protect it from light.
b) The reconstituted and diluted solutions must be protected from light and should not be frozen.
c) The reconstituted and/or diluted solution must be used within 2 days at room temperature (not
more than 30°C) or 3 days in refrigeration (2-8ºC).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer in 2-4 minutes Only by medical indication. Dose of
Direct IV
up to 1 g.
Administer for at least 30 Recommended concentration: 10-40
Intermittent IV
minutes. mg/mL.
IV continues Do not administer by this method.
The administration of 2 g must be
IM
spread over various places.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
direct IV Do not administer by this method.
Administer in 10-30 minutes. Final concentration must not exceed 40
Intermittent IV
mg/mL.
IV continues Do not administer by this method.
I am Concentration: 100-350 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, cefotaxime,
ceftazidime, cefuroxime, cisatracurium besilate, sodium dexamethasone phosphate, dexmedetomidine hydrochloride
digoxin, dopamine hydrochloride, ephedrine sulfate, esmolol hydrochloride, epinephrine hydrochloride (adrenaline)
["streptokinase","fentanyl citrate","phytonadione (vitamin K1)","furosemide","sodium heparin","hydrocortisone"]
sodium succinate, ketorolac tromethamine, levofloxacin, lidocaine hydrochloride, linezolid, mannitol
["sodium methylprednisolone succinate","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine"]
["sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)"]
["oxytocin","paracetamol (acetaminophen)","penicillin G sodium and potassium","potassium chloride","ranitidine hydrochloride"]
["succinylcholine chloride","tigecycline","glycerol trinitrate","vecuronium bromide","verapamil hydrochloride","zoledronic"]
acid.

Mix
Sodium bicarbonate, mannitol, metronidazole, potassium chloride.
50

Syringe
Acetaminophen (paracetamol), lidocaine hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) Do not use diluents that contain calcium (for example, Ringer solution and lactated Ringer's solution.
(Hartmann), to reconstitute or dilute ceftriaxone because a precipitate may form.
b) Ceftriaxone should not be administered simultaneously with solutions that contain calcium.
including continuous infusions such as parenteral nutrition, even in infusion lines
different or in different sites in any patient (regardless of age).
c) Products that contain calcium should not be administered intravenously within 48 hours.
to administer ceftriaxone, including solutions through different IV lines and in different
sites, because they can precipitate in the lung or kidney and could be fatal.
d) Frequently monitor the intravenous administration site for phlebitis (pain,
redness, swelling). Change sites every 48-72 hours to prevent phlebitis.
e) If an aminoglycoside antibiotic (for example, amikacin) is indicated, administer it together with
times separated by at least 1 hour and wash the administration line well with sodium chloride
0.9%.
f) For IM administration, ceftriaxone can be diluted with 0.5, 1, or 2% lidocaine (without epinephrine)
to minimize the discomfort of the injection and the pain.
g) Monitor adverse reaction data considering and reviewing the patient's allergies, especially.
if the patient has a history of penicillin allergies, as there may be reactions of
cross hypersensitivity.
h) Ceftriaxone is contraindicated in neonates (under 28 days of age) if they are receiving (or
they expect to receive treatment with solutions that contain calcium, including continuous infusions
such as parenteral nutrition.
i) Rapid IV injection can cause tachycardia, anxiety, diaphoresis, and palpitations; therefore,
not recommended.

Cefuroxime
Cephalosporin antibiotic of the 2nd generation

PRESENTATION

Vial ampoule with powder containing sodium cefuroxime equivalent to 750 mg of cefuroxime.

PREPARATION

["Compatible solutions: 0.9% sodium chloride, 0.45% sodium chloride, 5% dextrose, 10% dextrose, dextrose"]
5% sodium chloride 0.9%, 5% dextrose in sodium chloride 0.45%.

Reconstitution and dilution:

IV: For direct IV injection, reconstitute the vial containing 750 mg with 8 mL of injectable water.
respectively, to obtain a solution that contains approximately 90 mg/mL. For IV infusion
 51

intermittent or continuous, the reconstituted solution can be diluted with 100 mL of compatible solution for
obtain a solution that contains approximately 7.5 mg/mL.
IM: Reconstitute the 750 mg cefuroxime ampule with 3 mL of injectable water to obtain a
solution containing approximately 220 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C) and protect from light.
b) The powder for injection and the solutions of cefuroxime may become slightly darker; this does not
indicates power loss.
c) The reconstituted and/or diluted solution is stable for up to 24 hours at room temperature (no
more than 30 °C) and for 48 hours in refrigeration (2-8 °C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer in 3-5 minutes.
intermittent IV Administer in 15-60 minutes.
IV continues Administer in 6-24 hours. Only by medical indication.
Suck first to avoid injection in
I am
glass.
SC Do not administer by this method.

Pediatric
Method To use Speed Comment
Direct IV Manage in 3-5 minutes. Maximum concentration: 100 mg/mL.
Intermittent IV Administer in 15-60 minutes. It can be diluted to 1-30 mg/mL.
IV continues Administer within a maximum of 24 hours. Concentration of 7.5-15 mg/mL.
IM Dilute the concentration of 220 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, aminophylline, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefalotin sodium,
cefotaxime, ceftazidime, sodium ceftriaxone, clindamycin phosphate, dexmedetomidine hydrochloride, digoxin, dopamine
["hydrochloride, ephedrine sulfate, epinephrine (adrenaline), esmolol hydrochloride, streptokinase, fentanyl citrate"]
["phytomenadione (vitamin K1)","furosemide","sodium heparin","sodium succinate hydrocortisone","ketorolac"]
["trometamol","levofloxacin","lidocaine hydrochloride","linezolid","mannitol","sodium methylprednisolone succinate"]
metoclopramida clorhidrato, metronidazol, morfina sulfato, multivitamínicos, nalbufina clorhidrato, nitroprusiato
sodium, norepinephrine bitartrate, ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride
["ranitidine hydrochloride","succinylcholine chloride","tigecycline","glycerin trinitrate","vecuronium bromide","verapamil"]
zoledronic acid hydrochloride.
52

Mix
Aminofilina, ceftazidima, clindamicina fosfato, furosemida, heparina sódica, metronidazol, midazolam clorhidrato,
potassium chloride.

Syringe
Fentanyl citrate.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reaction data, especially if the patient has a history of allergy to
penicillin, since there may be cross-reactivity hypersensitivity reactions.
b) Change the administration sites every 48-72 hours to prevent phlebitis. Monitor the site.
frequently to check for the presence of thrombophlebitis (pain, redness, swelling).
c) If cefuroxime is administered together with an aminoglycoside (for example, amikacin), administer
in a time interval of at least 1 hour, and wash the administration line with chloride of
sodium 0.9%.

CIPROFLOXACIN
Fluoroquinolone antibiotic

PRESENTATION

Bottle with 100 mL of injectable solution containing 200 mg of ciprofloxacin lactate (2 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%, dextrose 10%, dextrose 5% in 0.45% sodium chloride, sodium chloride
0.9%.

Reconstitution and dilution:

IV: The ciprofloxacin solution at a concentration of 2 mg/mL can be administered without additional dilution.

STABILITY

a) Store the unopened jar at room temperature (no more than 30°C), protect from light and heat
excessive; should not be frozen.
b) Once the vial with the injectable solution is opened, use within 24 hours at room temperature.
(no more than 30°C) or 72 hours in refrigeration (2-8°C); protect from light.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
 53

Administer for at least 60 The shortest infusion recommended

minutes. (less than 30 minutes) or through a vein
IV intermittent
small increases the incidence of
local reactions.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amiodarona clorhidrato, ceftazidima, cisatracurio besilato, dexmedetomidina clorhidrato, digoxina, dobutamina
["chloride","dopamine hydrochloride","lidocaine hydrochloride","linezolid","metoclopramide hydrochloride","metronidazole"]
midazolam clorhidrato, ondansetrón clorhidrato, oxitocina, potasio cloruro, ranitidina clorhidrato, vancomicina
["chloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid."]

Mix
Amikacin sulfate, dobutamine hydrochloride, dopamine hydrochloride, fluconazole, lidocaine hydrochloride, linezolid,
{"midazolam clorhidrato":"midazolam hydrochloride","norepinefrina bitartrato (noradrenalina)":"norepinephrine bitartrate (noradrenaline)","potasio cloruro":"potassium chloride","ranitidina clorhidrato":"ranitidine hydrochloride","vecuronio":"vecuronium"}

bromide.

Syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Intravenous infusions should be performed in a large vein and slowly to

minimize discomfort and reduce the risk of venous irritation (burning, pain, erythema, swelling).
it is administered on site 'Y', the flow of the other IV solution must be interrupted while the
ciprofloxacin is being administered unless the solutions are compatible. Carry out the
track washing.
b) Patients must be properly hydrated.
c) Its use in pediatric patients is not recommended unless the doctor indicates it, due to the
reported adverse reactions.
d) Ciprofloxacin reduces the seizure threshold and should be used with caution in patients with
history of seizures.
Serious and sometimes fatal hypoglycemia has been reported with the use of fluoroquinolones; also
Hyperglycemia has been reported; closely monitor patients for signs/symptoms.
of abnormal glucose levels.
f) Fluoroquinolones have been associated with serious disabling adverse reactions and
potentially irreversible conditions, which include: tendinitis and tendon rupture, neuropathy
peripheral and effects on the central nervous system.
g) It may exacerbate muscle weakness in patients with myasthenia gravis: avoid fluoroquinolones
in patients with this background.
h) Discontinue the medication immediately and avoid systemic use of fluoroquinolones in
patients who experience any of these serious adverse reactions.
54

CLINDAMYCIN
Lincosamide antibiotic

PRESENTATION

Vial with 4 mL of injectable solution containing clindamycin phosphate equivalent to 600 mg of

clindamycin (150 mg/mL).

Preparation

{"compatible_solutions":["0.9% sodium chloride","5% dextrose","10% dextrose","5% dextrose in sodium chloride"]}

0.45, dextrose 5% in sodium chloride 0.9%.

Reconstitution and dilution:

IV: Before the IV infusion, clindamycin phosphate solutions must be diluted with a solution.
compatible with a concentration less than or equal to 18 mg/mL. It is suggested to dilute doses of 300 or 600 mg in 50 mL.
of compatible solution; dose of 900 mg dilute in 50-100 mL of compatible solution; dose of 1.2 g must be
diluted in 100 mL of compatible solution.
IM:Administer without diluting the injectable solution of concentration 150 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C).
b) The open ampoule and/or the diluted solution must be used within 24 hours at temperature
ambient (no more than 30°C) or refrigeration (2-8°C).
c) It is recommended not to refrigerate the solution as it may crystallize (the crystals may
dissolve at room temperature without affecting the potency.

ADMINISTRATION

Adult
Method Use Speed Comment
Do not administer by this method. It may
Direct IV
to cause cardiac arrest.
300 mg for 15 minutes; The speed must not exceed 30
600 mg for 30 minutes. mg/minute. The dose should not exceed
intermittent IV
900 mg for 45 minutes; 1.2 g in a period of 1 hour.
1.2 g for 60 minutes.
IV continues Administer at 0.75-1.25 mg/minute. Maximum speed: 30 mg/minute.
It is quite aggressive on the tissue.
I am muscular. Do not administer more than 600 mg
in a single injection.
SC Do not administer by this method.
 55

Pediatric
Method Use Speed Comment
Do not manage by this method. You can
IV directa hypotension occurs disable y
cardiorespiratory.
Administer for 10-60 minutes. Concentration: 6-12 mg/mL. Speed
Intermittent IV
maximum: 30 mg/minute.
Administer at speeds of 0.75 - Only by medical indication.
IV continues
1.25 mg/minute.
IM The maximum dose per injection is 600 mg.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate,
buprenorphine hydrochloride, calcium gluconate, cefotaxime, ceftazidime, cefuroxime, cisatracurium besilate
["sodium phosphate dexamethasone","dexmedetomidine","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine"]
["sulfate","epinephrine hydrochloride (adrenaline)","esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione"]
["vitamin K1","furosemide","sodium heparin","sodium succinate hydrocortisone","ketorolac tromethamine","hydrochloride"]
levofloxacin, lidocaine hydrochloride, linezolid, magnesium sulfate, mannitol, sodium methylprednisolone succinate
["metoclopramide hydrochloride","metronidazole","morphine sulfate","multivitamins","nalbuphine hydrochloride","nitroprusside"]
sodium, norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin, paracetamol (acetaminophen)
sodium and potassium penicillin G, potassium chloride, ranitidine hydrochloride, succinylcholine chloride, tigecycline, trinitrate of
["glycerol","vancomycin hydrochloride","vecuronium bromide","verapamil hydrochloride","zoledronic acid"]

Mix
Amikacin sulfate, sodium ampicillin, sodium bicarbonate, cefepime hydrochloride, cefotaxime, ceftazidime
cefuroxime, fluconazole, sodium heparin, sodium hydrocortisone succinate, sodium methylprednisolone succinate
metoclopramide hydrochloride, sodium and potassium penicillin G, potassium chloride, verapamil hydrochloride.

syringe
Acetaminophen (paracetamol), amikacin sulfate, sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Never administer as a bolus; hypotension and cardiac arrest have been reported following the
rapid intravenous administration.
The final concentration for intravenous administration should not exceed 18 mg/mL. Some
Prepared products contain benzyl alcohol (should not be used in neonates, especially preterm infants).
56

Chloropiramine
H1 Antihistamine

PRESENTATION

Vial with 2 mL of injectable solution containing 20 mg of chlorpheniramine maleate (10 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Does not need reconstitution. Dilute the prescribed dose in 10-50 mL of compatible solution.
IM: No additional dilution is required to a concentration of 10 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C).
b) Once the ampoule has been opened or the dilution has been made, the solution must be used within
for 24 hours at room temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer in 2-3 minutes. The patient may experience nausea and
Direct IV
dizziness.
Intermittent IV Administer in 10-30 minutes.
IV continues Do not administer by this method.
Suction first to avoid injecting into a vessel
I am
sanguine.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Manage in 3-5 minutes. The patient may experience nausea and
direct IV
dizziness.
Intermittent IV Manage in 30 minutes.
IV continues Do not administer by this method.
I am Suck in to avoid injecting into a vein.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.
 57

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor for the presence of adverse reactions, do not administer if the injectable solution is not
transparent or contains suspended particles or sediments.
b) Do not use in pediatric patients under 5 years old.

Darbepoetin alfa
Erythropoiesis stimulating agent

PRESENTATION

Pre-filled syringe with 0.4 mL of injectable solution containing 40 mcg of darbepoetin alfa.

PREPARATION

Compatible solutions: None.

Reconstitution and dilution:

SC: Not required. Do not dilute. Do not shake. Allow to reach room temperature in about 30 minutes.
before administering. Do not heat the medication in any other way (do not heat in a microwave)
or in hot water). The syringe should not be exposed to direct sunlight.

STABILITY

a) Store the prefilled syringe in refrigeration at (2-8 °C). Do not freeze. Do not use the medication if
it was previously frozen. Protect from light.
b) Do not shake as this may denature darbepoetin alfa making it biologically inactive.
c) When the preloaded syringe has been removed from the refrigerator and has acclimated to temperature
room temperature (no more than 25°C) for approximately 30 minutes before injection, it should be used
within the next 7 days or be discarded.
d) Check the appearance of the injectable solution, which must be a clear and colorless liquid.
58

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Only by medical indication.
Intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Rotate the injection site and do not rub it.

Pediatric
Method Use Speed Comment
Direct IV Administer for 1-3 minutes. Only by medical indication.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Rotate the injection site and do not rub it.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Hypersensitivity reactions have been reported including rash, angioedema, and anaphylaxis.
Immediately suspend if signs/symptoms of anaphylaxis occur.
b) Monitor blood pressure before and during therapy.
Darbepoetin alfa has a plasma half-life that allows it to be administered once a week.
or every two weeks.
It can be administered at any stage of the dialysis session: there is no evidence that the
Darbepoetin alpha adsorbs to dialysis membranes or catheters or is purified through the process of
dialysis.
e) Do not dilute or administer in conjunction with other medications and/or solutions.
 59

Dexamethasone
Corticosteroid

PRESENTATION

Ampoule with 2 mL of injectable solution containing sodium phosphate of dexamethasone equivalent to 8 mg of

dexamethasone phosphate (4 mg/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: The direct IV injection can be administered directly undiluted at a concentration of 4 mg/mL. For
intermittent IV infusion, dilute in 50-100 mL of compatible solution.
IM: No additional dilution is required at a concentration of 4 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C).
b) The opened ampoule and/or the diluted solution must be used within 24 hours at temperature
environment (no more than 30°C).
c) The solution must be protected from light. Freezing and exposure to heat should be avoided.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer in 1-3 minutes. Only doses less than or equal to 10mg.
Intermittent IV Manage in no less than 15
minutes.
IV continues Only by medical indication.
I am Concentration: 4 mg/mL or 10 mg/mL.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Administer for 1-4 minutes. Only doses less than or equal to 10 mg.
Intermittent IV Administer for 15-30 minutes. Concentration: 0.1 to 1 mg/mL
IV continues Only by medical indication.
I am Concentración: 4 mg/mL y 10 mg/mL.
SC Do not administer by this method.
60

COMPATIBILITY

Site Y
Sodium aciclovir, amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride
["cefepime","cefotaxime","ceftazidime","sodium ceftriaxone","cisatracurium besilate","clindamycin phosphate","dexmedetomidine"]
["chloride, digoxin, dopamine hydrochloride, sulfate ephedrine, epinephrine hydrochloride (adrenaline), ergonovine"]
["maleate","sodium ertapenem","streptokinase","fentanyl citrate","filgrastim","phytomenadione (vitamin K1)","fluconazole"]
["furosemide","sodium heparin","sodium succinate hydrocortisone","ketorolac tromethamine","levofloxacin","lidocaine"]
["hydrochloride","linezolid","mannitol","meropenem","sodium methylprednisolone succinate","metoclopramide hydrochloride"]
["metronidazole","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine"]
bitartarate (noradrenaline), ondansetron hydrochloride, oxytocin, paracetamol (acetaminophen), sodium penicillin and
["potassium, potassium chloride, ranitidine hydrochloride, succinylcholine chloride, tigecycline, glycerol trinitrate"]
vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Aminophylline, butylhyoscine, dopamine hydrochloride, furosemide, lidocaine hydrochloride, linezolid, meropenem
metronidazole, ranitidine hydrochloride, verapamil hydrochloride.

Syringe
Acetaminofén (paracetamol), aminofilina, fitomenadiona (vitamina K1), furosemida, heparina sódica, hidrocortisona
["sodium succinate","metoclopramide hydrochloride","potassium penicillin G","ranitidine hydrochloride","tramadol hydrochloride"]

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions during and after the administration of dexamethasone.

b) The injectable suspension of DEXAMETHASONE ACETATE is only for intramuscular injection.
intralesional, intraarticular and injection into soft tissue; NEVER administer intravenously.
c) Use preservative-free formulations in neonates, especially in preterm infants.
Rapid administration may be associated with perineal irritation (especially with doses
high); consider a greater dilution and administration by intermittent IV infusion for 5-15
minutes.

DEXKETOPROFEN
Non-Steroidal Anti-Inflammatory Analgesic

PRESENTATION

Ampule with 2 mL of injectable solution containing dexketoprofen trometamol equivalent to 50 mg of

dexketoprofen (25 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%, dextrose 5%.

Reconstitution and dilution:

IV: Dilute in 30-100 mL of compatible solution.
 61

The solution at a concentration of 25 mg/mL does not require additional dilution.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30 °C) and protect from light.
b) The open ampoule and/or the diluted solution must be used within 24 hours at room temperature.
(no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer for at least 15 only under medical supervision.
Direct IV
seconds.
Intermittent IV Administer for 10-30 minutes.
IV continues Do not administer by this method.
I am Deep and slow injection into muscle.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The total daily dose should not exceed 150 mg.

b) Its use in pediatric patients is not recommended.
62

DEXMEDETOMIDINE
Sedative

PRESENTATION

Vial ampoule with 2 mL of injectable solution containing dexmedetomidine hydrochloride equivalent to

200 mcg of dexmedetomidine.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose, 20% mannitol.

Reconstitution and dilution:

IV: Dilute the 2 mL vial (200 mcg) with 48 mL of 0.9% sodium chloride (total 50 mL) to obtain a
concentration of 4 mcg/mL or dilute 4 mL (400 mcg) of dexmedetomidine with 96 mL of 0.9% sodium chloride
for a total volume of 100 mL. Gently shake to completely mix.

STABILITY

a) Store the unopened ampule at room temperature (not more than 30°C) and protect from light.
The opened ampule and/or the diluted solution can be stored for up to 24 hours at room temperature.
environment (no more than 30ºC) and for 48 hours under refrigeration (2-8 °C).

ADMINISTRATION

Adult
Método Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Manage in 10 minutes. For initial loading doses.
IV continues Usually 0.2-0.7 mcg/kg/hour.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
direct IV Do not administer by this method.
Intermittent IV Manage 5-10 minutes. For initial loading dose.
IV continues According to medical prescription. Concentration: 2 mcg/mL or 4 mcg/mL.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, sodium ampicillin, atropine sulfate,
sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate, cefepime hydrochloride, cefotaxime sodium
 63

ceftazidime, sodium ceftriaxone, sodium cefuroxime, ciprofloxacin, cisatracurium besilate, clindamycin phosphate
["sodium dexamethasone phosphate","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine"]
["hydrochloride (adrenaline)","sodium ertapenem","esmolol hydrochloride","fentanyl citrate","fluconazole","furosemide","heparin"]
sodium, hydrocortisone succinate and sodium phosphate, ketorolac trometamol, levofloxacin, lidocaine hydrochloride
linezolid, magnesium sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride
metronidazol, meropenem, metilprednisolona succinato sódico, metoclopramida clorhidrato, metronidazol,
midazolam clorhidrato, morfina sulfato, nalbufina clorhidrato, nitroprusiato sódico, norepinefrina bitartrato
["norepinephrine","ondansetron hydrochloride","oxytocin","paracetamol (acetaminophen)","potassium chloride","ranitidine"]
["chloride, succinylcholine chloride, tigecycline, sodium thiopental, glyceryl trinitrate, vancomycin hydrochloride"]
vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Mannitol.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Use only with available cardiac monitoring equipment and cardiopulmonary resuscitation.
It is recommended to use an infusion pump during the administration of dexmedetomidine.
c) Do not administer simultaneously with blood and plasma products in the same IV line.
d) The diluted solution must be visually inspected for particles and coloration before the
administration.

DIAZEPAM
Sedative
Anticonvulsant

PRESENTATION

Vial with 2 mL of injectable solution containing 10 mg of diazepam (5 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9% (variable), dextrose 5% (variable).

Reconstitution and dilution:

IV: Direct IV injection can be administered undiluted. The solution must be clear and colorless to yellow.
pale. Visually inspect the solution to rule out particles or other colorations. Discard if
this is present. The preparation of diluted solutions is not recommended due to the possible
precipitation. Request detailed information from the pharmacy service.
IM: Does not require dilution to a concentration of 5 mg/mL.
64

STABILITY

a) Store the unopened ampoule at room temperature (not exceeding 30°C); protect from light. Do not
to freeze.
b) PVC plastic containers should not be used, as more than 50% of the dose contained
In solution it can be adsorbed. Glass or polyethylene should preferably be used. If the
Diazepam solution should be administered by IV infusion, use the solutions immediately.
prepared.
c) Stability depends on the container, solution, concentration, pH, and the device.
management, which makes it difficult to predict. It is recommended to prepare the solutions in containers
made of glass.
d) Administer immediately after preparing the solutions and use within a maximum of 24 hours
the ambient temperature (no more than 25°C).

ADMINISTRATION

Adult
Method To use Speed Comment
Administer for 3 minutes, no the rapid injection can cause apnea,
Direct IV
> 5 mg/minute. hypotension, bradycardia or cardiac arrest.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
Absorption can be slow and erratic,
I am
injection is painful and rarely used.
SC Do not administer by this method.

Pediatric
Method To use Speed Comment
Administer for 3 minutes, no Concentration: 5 mg/mL. The injection
Direct IV exceed 1-2 mg/minute. fast food can cause depression
respiratory or hypotension.
intermittent IV Do not manage by this method.
IV continues Do not administer by this method.
The absorption can be slow and erratic, the
IM
injection is painful and rarely used.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

syringe
Do not mix with other medications.
 65

OBSERVATIONS AND PRECAUTIONS

a) Perform cardiorespiratory monitoring during and after the administration of diazepam.

b) Have available resuscitation equipment, as well as respiratory support.
c) Rapid administration can cause respiratory depression and/or hypotension.
d) The addition of diazepam to IV solutions or plastic syringes can result in adsorption of
diazepam in the container or IV plastic line.
Continuous IV infusion is not recommended due to precipitation in IV solutions and adsorption.
from the drug to the containers and lines.
f) Do not dilute or mix the injectable diazepam solution with any other medication.
g) Diazepam can only be used in pediatric patients over 30 days of age. In patients
pediatrics, do not exceed 1-2 mg/minute when given as a bolus; in adults 5 mg/minute.
h) Administer in a large vein to avoid thrombosis. Avoid intra-arterial administration or
extravasation. Thrombophlebitis and necrosis associated with infiltration can develop. To reduce
the possibility of venous thrombosis, phlebitis, local irritation, and vascular damage, inject slowly (to
less than 1 minute for every 5 mg) into a large vein.
i) Vesicant medication; ensure proper placement of the needle or catheter before and during the
administration; avoid extravasation. If extravasation occurs, stop the administration
immediately and disconnect (leave the cannula/needle in place); gently aspirate the solution
extravasated (do not flush the line); remove the cannula/needle; elevate the limb. Apply
cold dry compresses.
Currently, two formulations of diazepam are marketed, one is a solution and the other is an emulsion.
which should not be confused.

DICLOFENAC
Non-Steroidal Anti-Inflammatory Drug

PRESENTATION

Ampule with 3 mL of injectable solution containing 75 mg of sodium diclofenac (25 mg/mL)

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: For intermittent IV infusion, dilute 75 mg in 100-250 mL of compatible solution.
IM: Does not require additional dilution to a concentration of 25 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (not exceeding 30°C) and protected from light.
66

b) The open ampoule and/or the diluted solution must be used within 24 hours at room temperature.
(no more than 30°C).
c) Only use clear solutions; if particles or precipitation are observed, discard the solution.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer for 30 seconds.
Intermittent IV Administer in 30-120 minutes.
IV continues Do not administer by this method.
I am Suck to avoid injecting into a vein.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer within 30-120 minutes.
IV continues Do not administer by this method.
I am Suction to avoid injecting into a vessel.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Tiocolchicoside.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions during or after the administration of the medication.

b) Intravenous bolus administration of diclofenac is not recommended.
c) The administration of the injectable sodium diclofenac solution is not recommended in children.
 67

DICLOXACILLIN
Penicillin antibiotic

PRESENTATION

Vial ampoule with powder containing monohydrate dicloxacillin sodium equivalent to 500 mg of
dicloxacillin.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: Reconstitute 500 mg or 1 g with 10 mL and 15-20 mL of injectable water. Then, dilute with 50-200 mL of
compatible solution.
Reconstitute 500 mg with 3-5 mL of injectable water.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25°C).
b) The reconstituted solution must be used within 24 hours when stored in refrigeration.
(2-8°C) or 4 hours at room temperature (no more than 25°C).
c) The diluted solution must be used within 24 hours at room temperature (no more than 25ºC) or
in refrigeration (2-8°C)

MANAGEMENT

Adult
Method Use Speed Comment
Manage for at least 5
IV direct
minutes.
Manage for at least 60
Intermittent IV
minutes.
IV continues Do not administer by this method.
Suck to avoid injecting into the vessel
I AM
sanguine
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
It can cause seizures if it
Direct IV
administers by this method.
IV intermittent Administer in 30-60 minutes.
68

IV continues Do not administer by this method.

Suck to avoid injecting into a vessel
I am
sanguine
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions during and after the administration of the medication.
b) To reduce the risk of phlebitis or thrombophlebitis, intravenous administration must be performed
by slow infusion.

DIFENIDOL
Antiemetic

PRESENTATION

Vial with 2 mL of injectable solution containing diphenidol hydrochloride equivalent to 40 mg of diphenidol

(20 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: For intermittent IV infusion, dilute 40 mg of diphenidol hydrochloride in 50-100 mL of compatible solution.
IM: No dilution is required at a concentration of 20 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C).
b) The opened ampoule and/or the diluted solution must be used within 24 hours at temperature
environment (no more than 30°C).
 69

ADMINISTRACIÓN

Adult
Method Use Speed Comment
direct IV Administer in 3 minutes. Only by medical indication.
Intermittent IV Administrar en 30-60 minutos.
IV continues Do not administer by this method.
Suck to avoid injecting into a vein
IM
sanguine
SC Do not administer by this method.

Pediatric
Method To use Speed Comment
Direct IV Do not administer by this method.
IV intermittent Do not administer by this method.
IV continues Do not administer by this method.
I am Suction to avoid injecting into a vein
sanguine
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions. During rapid administration, the patient may experience dizziness.
anxiety, tinnitus, paleness, vomiting or hypotension, if this occurs it is recommended
decrease the infusion rate.
b) Difenidol is not recommended for children under 6 months of age. Administration is not recommended.
intravenous or subcutaneous in children of any age. Normally, in children it should not
to be administered with a frequency of less than 4 hours.
.
70

DIGOXIN
Antiarrhythmic
Ionotropic agent

PRESENTATION

Vial with 2 mL of injectable solution containing 0.5 mg (500 mcg) of digoxin (250 mcg/mL).

PREPARATION

Compatible solutions: 5% dextrose, 0.9% sodium chloride, 0.45% sodium chloride, 0.9% sodium chloride
in dextrose 5%, sodium chloride 0.45% in dextrose 5%.

Reconstitution and dilution:

It can be administered by direct IV injection undiluted or can be diluted to at least 4 times its volume.
with a compatible solution (i.e., 1 mL of digoxin with 4 mL of solution); using a smaller volume
The indicated may result in precipitation of digoxin. Use diluted solutions of digoxin.
immediately. For intermittent IV infusion, dilute 0.5 mg in 100 mL of compatible solution.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C). Protect from light.
b) The opened ampoule and/or the dilution solution must be used within 48 hours at temperature
environment (no more than 25°C) or in refrigeration (2-8°C).

MANAGEMENT

Adult
Method Use Speed Comment
Administer for at least 5 Administer without diluting or dilute in at least
Direct IV
minutes. 4 times its volume.
Initial doses: 10-20 minutes.
intermittent IV
Post dose: minimum 2 hours.
IV continues Do not administer by this method.
Do not administer more than 2 mL (500 mcg) in
IM each site. The IM administration is not
recommended.
SC Do not administer by this method.
Pediatric
Method Use Speed Comment
Administer for at least 5 Maximum concentration: 100 mcg/mL.
minutes. infusion fast can cause
Direct IV
coronary arteriolar vasoconstriction and
systemic.
intermittent IV Administer for 15-30 minutes. Concentration less than 25 mcg/mL.
IV continues Do not administer by this method.
 71

Not recommended due to local pain,

I am irritation and tissue damage. Do not inject
more than 200 mcg in a single site.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride,
calcium gluconate, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, ciprofloxacin, cisatracurium besilate
clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine hydrochloride, dobutamine hydrochloride
["dopamine hydrochloride","ephedrine sulfate","ergonovine","maleate","epinephrine hydrochloride (adrenaline)","ertapenem sodium"]
["esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione (vitamin K1)","furosemide","sodium heparin"]
sodium hydrocortisone succinate, ketorolac tromethamine, levofloxacin, lidocaine hydrochloride, linezolid, magnesium
["sulfate","mannitol","meropenem","methylprednisolone sodium succinate","metoclopramide hydrochloride","metronidazole"]
midazolam clorhidrato, morfina sulfato, multivitamínicos, nalbufina clorhidrato, nitroprusiato sódico, norepinefrina
bitartrate (norepinephrine), ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride
["ranitidine hydrochloride","succinylcholine chloride","tigecycline","glycerol trinitrate","vancomycin hydrochloride","vecuronium"]
bromide, verapamil hydrochloride, zoledronic acid.

Mix
Furosemide, lidocaine hydrochloride, potassium chloride, ranitidine hydrochloride, verapamil hydrochloride.

Syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Cardiorespiratory monitoring is recommended during and after the administration of digoxin.

b) Monitor adverse reactions to the medication.
c) Do not mix with other medications in the same container nor administer simultaneously.
same line IV, unless there is information about compatibility.
d) Administer carefully in hypertensive patients because IV administration can
to temporarily increase blood pressure.
e) Slow IV infusion is preferred over rapid (bolus) infusion. Rapid IV infusion can cause
coronary and systemic arteriolar constriction, which may be clinically undesirable; doing so with
caution.
f) Blistering medication; ensure proper placement of the needle or catheter before and during
administration; avoid extravasation. If extravasation occurs, stop the IV administration
immediately and disconnect (leave cannula/needle in place); gently aspirate the solution
extravasated (do not wash the line); remove the needle/cannula; elevate the limb.
g) IM administration is not recommended due to local irritation, pain, and tissue damage; if it is
necessary, administer by deep injection followed by a massage at the injection site. Can
cause intense pain.
72

DOBUTAMINE
Cardiac stimulant
Inotropic agent

PRESENTATION

Vial ampule with 20 mL of injectable solution containing dobutamine hydrochloride equivalent to 250 mg
12.5 mg/mL

PREPARATION

Soluciones compatibles:Cloruro de sodio 0.9%, cloruro de sodio 0.45%, dextrosa 5%, dextrosa 10%, dextrosa
5% in sodium chloride 0.45, dextrose 5% in sodium chloride 0.9%.

Reconstitution and dilution:

IV: The concentrated injectable solution MUST be diluted before administration; 20 mL of the solution
concentrated injectables should be diluted in at least 50 mL of diluent and 40 mL of injectable solution
concentrated must be diluted in at least 100 mL of diluent. The concentration used is
individualized according to the patient's dosage and fluid requirements, but should not
exceeding 5000 mcg (5 mg) /mL. Other examples of dilution: Dilute 250-1,000 mg in 250-500 mL of solution
compatible 250 mg in 250 mL of compatible solution (final concentration of 1000 mcg/mL).

Dilution of the concentrated injectable solution for administration as IV infusion.

Quantity of Add (volume To a compatible solution To obtain (concentration
concentrated from concentrate) (volume of solution) of the final dilution
250 mg 20 mL 1L 250 mcg (0.25 mg) /mL
250 mg 20 mL 500 mL 500 mcg (0.5 mg) /mL
250 mg 20 mL 250 mL 1,000 mcg (1 mg) /mL
250 mg 20 mL 50 mL 5000 mcg (5 mg) /mL

Calculation for preparation:

1. To calculate the AMOUNT of medication needed per final liquid volume:

Desired final concentration (mg/mL) x final liquid volume (mL) = AMOUNT of medication
to add to a final solution (mg).

2. To calculate the VOLUME of medication needed per final liquid volume:

Amount of medication to add (mg) ÷ Concentration of vial ampoule of medication
(mg/mL) = Volume of medication to add (mL)

Example: Preparation of 30 mL of a dobutamine solution at 2000 mcg/mL using a solution

dobutamine concentrate of 12.5 mg/mL.
2000 mcg/mL = 2 mg/mL
2 mg/mL x 30 mL = 60 mg of dobutamine.
60 mg ÷ 12.5 mg/mL = 4.8 mL of dobutamine.
Add 4.8 mL of dobutamine solution with a concentration of 12.5 mg/mL to 25.2 mL of compatible solution.
to obtain 30 mL of infusion solution at a concentration of 2000 mcg/mL.
 73

STABILITY

a) Keep the unopened ampule vial at room temperature (no more than 30°C) and protected from the
light. The appearance of a yellowish coloration in the solution does not affect the potency of the medication.
b) Solutions containing dobutamine may exhibit a pink coloration, which increases
Over time. The pink coloration of the solutions indicates slight oxidation of the drug; however,
There is no significant or important loss of potency if the medication is administered within
of the recommended time period.
c) Dilute solutions are stable for a maximum of 24 hours at room temperature (not
more than 25°C.
d) The diluted solutions can be stored for up to 24 hours under refrigeration (2-8ºC), and
after being used within a maximum of 24 hours after being removed from refrigeration. The portions
Unused solutions must be discarded.
e) Due to potential incompatibilities, it is recommended that dobutamine solutions
Dihydrochloride should not be mixed with other medications. Dobutamine solutions are
incompatible with sodium bicarbonate or other strongly alkaline solutions and should not be
used in conjunction with other medications or diluents that contain sodium bisulfite or
ethanol.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
Initial: 0.5-1 mcg/kg/minute Speeds may also be required.
IV continues
Posterior: 2-20 mcg/kg/minute from 5-40 mcg/kg/minute.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
Administer usually at 2-20 Maximum: 40 mcg/kg/minute. Dilute to a
IV continues
mcg/kg/minute. concentration of 0.25-5 mg/mL.
I am Do not administer by this method.
SC Do not administer by this method.

Infusion speed calculation:

Infusion speed (mL/hour) = [dose (mcg/kg/min) x weight (kg) x 60 (min/h)] / Solution concentration
prepared (mcg/mL).
74

COMPATIBILITY

Site Y
Amikacin sulfate, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, ciprofloxacin, cisatracurium besilate
["clindamycin phosphate","dexmedetomidine hydrochloride","digoxin","dopamine hydrochloride","ephedrine sulfate","esmolol"]
["chloride, streptokinase, fentanyl citrate, fluconazole, levofloxacin, lidocaine hydrochloride, linezolid, magnesium"]
sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride, metronidazole, morphine sulfate
multivitamins, nalbuphine hydrochloride, norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride,
oxytocin, potassium chloride, ranitidine hydrochloride, succinylcholine chloride, tigecycline, glyceryl trinitrate
["vancomycin hydrochloride","vecuronium bromide","verapamil hydrochloride","zoledronic acid"]

Mix
["Atropine sulfate","ciprofloxacin","dopamine hydrochloride","epinephrine hydrochloride (adrenaline)","flumazenil","hydralazine"]
["hydrochloride","lidocaine hydrochloride","mannitol","meropenem","morphine sulfate","norepinephrine bitartrate (noradrenaline)"]
ranitidine hydrochloride.

Syringe
Ranitidine hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) Patients should be monitored for increases in heart rate, blood pressure and
ventricular ectopic activity.
b) Direct IV bolus administration is not recommended.
It is recommended to use an infusion pump to administer the medication.
d) Vasoactive medications are potentially dangerous. It is recommended to perform double
check for the original order, calculations, dosages, dilutions, infusion rates, etc.
e) Do not confuse dobutamine with dopamine. If available as floor stock, store in areas
separated.
f) Administer in a large vein and frequently evaluate the administration site. Extravasation
it can cause pain and inflammation. Visually inspect the solutions to observe
particles and colorations before administration.
g) Do not administer through the same IV line with sodium heparin, sodium bicarbonate, acid
etacrinic, cefazolin or penicillin.

DOPAMINE
Cardiac stimulant
Ionotropic agent
Vasopressor

PRESENTATION

Vial with 5 mL containing 200 mg of dopamine hydrochloride (40 mg/mL).

 75

PREPARATION

Compatible solutions: Dextrose 5%, dextrose 10%, sodium chloride 0.9%, sodium chloride 0.45%, dextrose
5% sodium chloride 0.9%, 5% dextrose in 0.45% sodium chloride.

Reconstitution and dilution:

IV: Dilute 200-400 mg in 250-500 mL of compatible solution; the typical concentration range is 0.8-1.6
mg/mL, although up to 3.2 mg/mL have been used. Examples of dilution: 400 mg in 250 mL (concentration:
1600 mcg/mL or 800 mg in 250 mL (concentration: 3200 mcg/mL).

Dilution of injectable solutions for IV infusion.

Add Concentration The solution To reach (final concentration
volume of of the ampule compatible (volume of the solution)
ampoule) of solution)
5 mL (200 mg) 40 mg/mL 500 mL 400 mcg/mL (0.4 mg/mL)
5 mL (200 mg) 40 mg/mL 250 mL 800 mcg/mL (0.8 mg/mL

Calculation for preparation:

1. To calculate the AMOUNT of medication needed per final liquid volume:

Desired final concentration (mg/mL) x final liquid volume (mL) = AMOUNT of medication
to add to a final solution (mg).

2. To calculate the VOLUME of medication needed per final liquid volume:

AMOUNT of medication to add (mg) ÷ Concentration of the vial ampoule of medication
(mg/mL) = VOLUME of medication to add (mL)

Example: Preparation of 30 mL of a dopamine solution at 1600 mcg/mL using a solution

dopamine concentrate of 40 mg/mL
1 600 mcg/mL = 1.6 mg/mL
1.6 mg/mL × 30 mL = 48 mg of dopamine.
48 mg ÷ 40 mg/mL = 1.2 mL of dopamine.
Add 1.2 mL of dopamine solution with a concentration of 40 mg/mL to 28.8 mL of compatible solution for
obtain 30 mL of infusion solution at a concentration of 1600 mcg/mL.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30 °C). Protect from light.
b) Diluted solutions should not be frozen. The yellowish, brown, pink to purple coloration indicates
decomposition. Solutions with any coloration should not be used.
c) The open ampoule and/or the diluted solution are stable for 24 hours at room temperature (no more
at 25ºC) or in refrigeration (2-8°C).
76

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
Initial: 1-5 mcg/kg/minute. The infusion speed varies according to
IV continues
Posterior: 2-50 mcg/kg/minute. with the required individual dose.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
IV continues 0.5-30 mcg/kg/minute. Concentration 0.2-3.2 mg/mL.
I am Do not administer by this method.
SC Do not administer by this method.

Calculation of infusion speed:

Infusion speed (mL/hour) = [dose (mcg/kg/min) x weight (kg) x 60 (min/h)]/Concentration (mcg/mL).

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride, calcium gluconate,
cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, ciprofloxacin, cisatracurium besilate, clindamycin phosphate
["sodium phosphate dexamethasone","dexmedetomidine","digoxin","dobutamine hydrochloride","ephedrine sulfate","epinephrine"]
["chloride (adrenaline)","sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione"]
(vitamin K1), fluconazole, sodium heparin, phosphate hydrocortisone and sodium succinate, ketamine hydrochloride
["ketorolac tromethamine","levofloxacin","lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol"]
["sodium succinate methylprednisolone","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine"]
sulfate, multivitamins, nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline)
ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride, ranitidine hydrochloride
["succinylcholine chloride","tigecycline","glyceryl trinitrate","vancomycin hydrochloride","vecuronium bromide","verapamil"]
zoledronic acid hydrochloride.

Mix
["Aminophylline","Ciprofloxacin","Sodium dexamethasone phosphate","Dobutamine hydrochloride","Sodium heparin","Lidocaine"]
["chloride","mannitol","meropenem","methylprednisolone sodium succinate","potassium chloride","ranitidine hydrochloride"]
verapamil hydrochloride.

Syringe
Sodium heparin, ranitidine hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) The medication must be diluted before administration. Avoid bolus administration. The
IV infusion must be performed in a large vein (central line), using an infusion pump to avoid the
 77

unintended administration in a bolus. The dorsal veins of the hand or ankle should be avoided, if it is
possible, due to the risk of extravasation. These veins are less favorable and should be used
only when the patient's condition requires it, but the site should be changed as soon as possible to a
large vein.
b) Examine the administration site frequently. Extreme caution if administered in a
umbilical arterial catheter due to the risk of vasospasm, administration is not recommended for
this method.
c) Caution should be exercised in asthmatic patients due to injectable solutions of
Dopamine may contain sodium bisulfite as an excipient, which can cause reactions.
adverse.
d) The solutions for IV infusion at a concentration of 3200 mcg (3.2 mg/mL) are useful when they are
required high doses in patients with fluid restriction.
e) When it is necessary to interrupt the infusion, gradually decrease the dose of dopamine, since the
Sudden interruption can cause hypotension.
f) Do not add dopamine to sodium bicarbonate or any other strongly alkaline solution.
Extravasation can cause severe irritation, necrosis, and tissue detachment.
h) It is a vesicant medication; ensure the proper placement of the needle or catheter before and during.
the infusion; avoid extravasation. If extravasation occurs, stop the infusion immediately and
disconnect (leave the cannula/catheter in place); gently aspirate the extravasated solution (do not
clean the line); remove the needle/cannula; elevate the extremity. Start the antidote according to
medical indication. Apply compresses with dry heat.

ENOXAPARIN
Anticoagulant

PRESENTATION

Prefilled syringe with 0.2 mL of injectable solution containing 20 mg of sodium enoxaparin

(equivalent to 2,000 IU).

Pre-filled syringe with 0.6 mL of injectable solution containing 60 mg of sodium enoxaparin

(equivalent to 6,000 IU).

PREPARATION

Compatible solutions: Dextrose 5%, Sodium chloride 0.9%.

Reconstitution and dilution:

Does not require reconstitution or additional dilution.

STABILITY

a) Store the unopened pre-filled syringe at room temperature (not exceeding 30°C). Protect from
light.
78

b) The prefilled syringes do not contain preservatives, discard the unused portions.
24 hours have passed at room temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Only by medical indication.
Intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not rub the injection site.

Pediatrics
Method Use Speed Comment
Direct IV Only by medical prescription.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not rub the injection site.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) In subcutaneous administration, it is advised that the patient be lying down. It should be inserted completely.
the length of the needle in a skin fold created by the thumb and index finger; it should be held
the skin folded until the needle is withdrawn. Do not aspirate or massage.
b) Alternate the administration sites between the anterolateral and posterolateral abdominal wall
left and right.
c) Enoxaparin should not be mixed with other medications in solution, site 'Y' or syringe.
d) Do not administer via IV routinely due to the risk of hematoma.
It can be administered IV as part of the specific treatment only under the doctor's indication.
f) Rinse line IV with enough 5% dextrose solution or 0.9% sodium chloride beforehand.
y después de la administración de bolo IV para evitar mezclarse con otros medicamentos.
g) The injectable solution must be clear; do not inject solutions that contain particulate matter. If
Bruises occur, massage with an ice cube, this is also to prevent bruises.
h) To avoid the loss of medication, do not expel the air bubble from the syringe before the
injection.
 79

EPINEPHRINE (ADRENALINE)
Adrenergic agent
Cardiac stimulant
Vasopressor

PRESENTATION

Ampule with 1 mL of injectable solution containing 1 mg of epinephrine hydrochloride (adrenaline) (1 mg/mL)

(1:1000)

Preparation

Compatible solutions: Dextrose 5%, dextrose 10%, sodium chloride 0.9%, dextrose 5% in sodium chloride
0.9%, dextrose 5% in sodium chloride 0.45%.

Reconstitution and dilution:

IV: For direct injection, dilute 1 mg in 5-10 mL of 0.9% sodium chloride. For continuous IV infusion, dilute 1
4 mg in 250 mL (16 mcg/mL); 4 mg in 250 mL (16 mcg/mL); 1 mg in 100 mL (10 mcg/mL) or 1 mg in 1000 mL (1
mcg/mL) of compatible solution. More concentrated solutions (for example, 16-32 mcg/mL) may
to be used in patients with fluid restriction.

Calculation for preparation:

1. To calculate the AMOUNT of medication needed per volume of final liquid:

Desired final concentration (mg/mL) x final liquid volume (mL) = AMOUNT of medication
to add to a final solution (mg).

2. To calculate the VOLUME of medication needed per final liquid volume:

Amount of medication to add (mg) ÷ Concentration of medication vial ampoule
(mg/mL) =VOLUMEN de medicamento a agregar (mL)

Example: Prepare 50 mL of epinephrine solution at 20 mcg/mL using a 1 mg/mL epinephrine solution.

20 mcg/mL = 0.02 mg/mL
0.02 mg/mL × 50 mL = 1 mg of epinephrine.
1 mg ÷ 1 mg/mL = 1 mL of epinephrine.
Add 1 mL of epinephrine solution with a concentration of 1 mg/mL to 49 mL of compatible solution for
obtain 50 mL of infusion solution at a concentration of 20 mcg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (not more than 30 °C).
b) The medication is sensitive to light and air. It is recommended to protect it from light. Oxidation
first convert the drug from pink to brown.
80

c) Prepared solutions should not be used if they have a pink or brown color or contain a
precipitate. Discard solutions that have a pink or dark color more than slightly.
yellowish.
d) Epinephrine, epinephrine salts, and prepared solutions containing the drug
they gradually darken due to exposure to light and air; therefore, they must be stored in
closed and light-resistant containers.
e) The stability of the diluted solution at room temperature (no more than 25°C) or refrigeration (2-8°C)
It is 24 hours.
f) Commercially available preparations vary in stability, depending on the form in which they are
which epinephrine is present and in the preservatives used.
g) Consider the instructions and recommendations of the manufacturing laboratory regarding the
conservation requirements of each product.

ADMINISTRATION

Adult
Method Use Speed Comment
Administer in a bolus or in 2-10 Follow with a wash of 20 mL of solution
minutes. compatible. Raise the limb by 10-
Direct IV
20 seconds to facilitate distribution
of the drug to the central circulation.
Intermittent IV Do not administer by this method.
IV continues Usually 1-10 mcg/minute.
I am Only by medical indication.
SC Only by medical indication.

Pediatric
Method Use Speed Comment
Administer in a bolus or in 1-3 Concentration: 0.1 mg/mL.
Direct IV
minutes.
intermittent IV Do not administer by this method.
IV continues 0.1-1 mcg/kg/minute Concentration: 1-64 mcg/mL
IM Only on medical advice.
SC Only by medical prescription.

Calculation of infusion rate:

Infusion rate (mL/hour) = [dose (mcg/kg/min) x weight (kg) x 60 (min/h)]/Concentration (mcg/mL)

COMPATIBILITY

Site Y
Amikacin sulfate, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefotaxime,
ceftazidima, ceftriaxona sódica, cefuroxima, cisatracurio besilato, clindamicina fosfato, dexametasona fosfato
sodium, dexmedetomidine hydrochloride, digoxin, dobutamine hydrochloride, dopamine hydrochloride, ephedrine sulfate,
["ergonovine maleate","sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione"]
(vitamin K1), fluconazole, furosemide, sodium heparin, hydrocortisone sodium succinate, ketorolac tromethamine
levofloxacin, lidocaine hydrochloride, linezolid, magnesium sulfate, mannitol, sodium methylprednisolone succinate
["metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine sulfate","multivitamins","nalbuphine"]
["hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)","ondansetron hydrochloride","oxytocin"]
sodium and potassium penicillin G, potassium chloride, ranitidine hydrochloride, succinylcholine chloride, tigecycline, trinitrate of
["glycerol","vancomycin hydrochloride","vecuronium bromide","verapamil hydrochloride","zoledronic acid"]
 81

Mix
Amikacin sulfate, dobutamine hydrochloride, fentanyl citrate, furosemide, ranitidine hydrochloride, verapamil
chloride

Syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Due to the fact that different dilutions are required during the preparation of the solutions, having
caution to avoid errors in the selection of the solution and dosing.
b) Administer in a large vein, if possible. More concentrated solutions (for example, 16-32)
mcg/mL) can be used in patients with fluid restriction when administered to
through a central line.
c) Inject epinephrine subcutaneously, being careful not to inject intradermally. Massage.
the injection site after administration to increase absorption and to decrease
local vasoconstriction. The injection may cause tissue irritation.
d) Inject intramuscularly preferably in the deltoid or anterior thigh (vastus lateralis). The glutes should be
avoided due to the risk of tissue necrosis.
e) Extravasation can cause local ischemia and tissue necrosis.
f) Blistering medication; ensure proper placement of the needle or catheter before and during
infusion; avoid extravasation. If extravasation occurs, stop the infusion immediately and
disconnect (leave the cannula/needle in place); gently aspirate extravasated solution (do not
rinse the line); remove the cannula/needle; elevate the limb. Start the antidote according to
Medical indication. Apply dry heat compresses.

ERTAPENEM
Carbapenem antibiotic

PRESENTATION

Vial ampoule with powder containing sodium ertapenem equivalent to 1 g of ertapenem.

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Reconstitute the ampule vial with 10 mL of injectable water or 0.9% sodium chloride to obtain a
approximately 100 mg/mL concentration. Shake well to dissolve. The solution is colorless to yellow.
pale. Then dilute the dose with 50 mL of 0.9% sodium chloride.
82

Reconstitute the ampule with 3.2 mL of 1% or 2% lidocaine to obtain a concentration

approximately 250 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25°C).
b) The reconstituted and diluted solution for IV use is stable for 6 hours at room temperature (not
more than 25°C) or for 24 hours in refrigeration (2-8°C). Do not freeze. The solution must be used
within 4 hours after removing it from refrigeration. Do not freeze.
c) The reconstituted solution for IM use must be used immediately or stored for up to 1
after the preparation.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer in at least 30 minutes.
IV continues Only by medical prescription.
I am Deep injection in the buttock or thigh.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer over at least 30 minutes. Dilute to a concentration of 20 mg/mL or
IV intermittent
less.
IV continues Do not administer by this method.
IM Deep injection in the buttock or thigh.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, buprenorphine hydrochloride, calcium gluconate, ciprofloxacin
cisatracurium besilate, sodium dexamethasone phosphate, dexmedetomidine hydrochloride, digoxin, dopamine hydrochloride
["sulfate ephedrine","hydrochloride epinephrine (adrenaline)","hydrochloride esmolol","fluconazole","furosemide","sodium heparin"]
["sodium hydrocortisone succinate","ketorolac tromethamine","levofloxacin","lidocaine hydrochloride","linezolid","magnesium"]
sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride, metronidazole, morphine sulfate
nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), oxytocin, potassium chloride
ranitidine hydrochloride, succinylcholine chloride, tigecycline, glycerol trinitrate, vancomycin hydrochloride, vecuronium
bromide, zoledronic acid.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.
 83

OBSERVATIONS AND PRECAUTIONS

a) Contraindicated in patients with severe hypersensitivity to penicillins, carbapenems and

cephalosporins.
b) Do not inject intravenously solutions that have been reconstituted with lidocaine.
c) Do not use solutions containing dextrose to reconstitute or dilute ertapenem.

ESMOLOL
Beta blocker
Antiarrhythmic

PRESENTATION

Vial ampoule with 10 mL of injectable solution containing 2.5 g of esmolol hydrochloride (250 mg/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 0.45% sodium chloride, 5% dextrose, 5% dextrose in chloride
0.9% sodium, 5% dextrose in 0.45% sodium chloride.

Reconstitution and dilution:

IV: Dilute the 2.5g/10 mL ampule in 250 mL of a compatible solution to obtain a concentration of
10 mg/mL.

STABILITY

a) Store the unopened ampule at room temperature (no more than 25°C).
b) Avoid excessive heat exposure and avoid freezing.
c) Once the ampoule is opened or the solution is diluted, they are stable for 24 hours at temperature.
ambient (no more than 25°C) or in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer in 30-60 seconds. For initial doses.
intermittent IV Do not administer by this method.
IV continues Start at 50 mcg/kg/minute and adjust. Maximum rate: 200 mcg/kg/minute.
IM Do not administer by this method.
SC Do not administer by this method.
84

Pediatric
Method Use Speed Comment
Direct IV Administer for 1-2 minutes. For initial doses.
intermittent IV Do not administer by this method.
According to medical indication. Dilute the concentration of 20 mg/mL or
IV continues
less.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Human albumin, amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate,
buprenorphine hydrochloride, calcium gluconate, cefepime hydrochloride, cefotaxime, ceftazidime, sodium ceftriaxone
["cefuroxime","cisatracurium besylate","clindamycin phosphate","dexmedetomidine hydrochloride","digoxin","dobutamine"]
hydrochloride, dopamine hydrochloride, sulfate ephedrine, hydrochloride epinephrine (adrenaline), ertapenem sodium
["streptokinase","fentanyl citrate","phytonadione (vitamin K1)","fluconazole","sodium heparin","levofloxacin","lidocaine"]
["hydrochloride","linezolid","magnesium sulfate","mannitol","meropenem","metoclopramide hydrochloride","metronidazole"]
["midazolam hydrochloride","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside"]
norepinefrina bitartrato (noradrenalina), ondansetrón clorhidrato, oxitocina, paracetamol (acetaminofén),
sodium and potassium penicillin G, potassium chloride, ranitidine hydrochloride, succinylcholine chloride, tigecycline, trinitrate of
glycerol, vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Aminophylline, sodium bicarbonate, sodium heparin, potassium chloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

Continuous cardiorespiratory monitoring is recommended.

b) Hypotension and significant bradycardia may occur; therefore, vital signs must be monitored.
closely monitored and the dosage should be adjusted as necessary.
c) Do not abruptly stop the infusion due to the possibility of withdrawal effects.
Medication intended for short-term use, no more than 48 hours.
e) Solutions for infusion with a concentration greater than 20 mg/mL are associated with irritation.
venous and thrombophlebitis.
f) Monitor the infusion site. Do not administer in small veins or through a butterfly catheter.
Extravasation can cause damage to the tissue or necrosis.
g) Vesicant medication; ensure the proper placement of the needle or catheter before and during the
infusion; avoid extravasation. If extravasation occurs, stop the infusion immediately and
disconnect (leave the cannula/needle in place); gently aspirate the leaked solution (do not
rinse the line); remove the cannula/needle; elevate the limb.
 85

STREPTOKINASE
Thrombolytic agent

PRESENTATION

Vial ampoule with powder containing 1,500,000 units of streptokinase.

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Reconstitute streptokinase 1,500,000 units with 5 mL of 0.9% sodium chloride to obtain a
concentration of 300,000 units/mL. Add the solution along the walls of the bottle rather than
directly into the powder. It is recommended that the bottle be gently rotated and tilted when mixing.
The vials should not be shaken to avoid foam formation. Slight flocculation (fibers) may occur.
thin transparent), but it does not interfere with the safe use of the solution. Once reconstituted it must be
diluted with 50-100 mL of 0.9% sodium chloride.

STABILITY

a) Store the unopened ampoule at room temperature (not exceeding 30 °C).

b) The reconstituted and/or diluted solution is stable for 24 hours in refrigeration (2-8 °C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer for 60 minutes.
According to medical advice. For 12-72 hours. Use pump
IV continues
infusion.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate,
["cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","sodium dexamethasone phosphate"]
["dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride","(adrenaline)","esmolol"]
["hydrochloride","fentanyl citrate","phytomenadione (vitamin K1)","fluconazole","furosemide","sodium heparin","hydrocortisone"]
sodium succinate, ketorolac tromethamine, lidocaine hydrochloride, magnesium sulfate, mannitol, methylprednisolone
["sodium succinate","metoclopramide hydrochloride","midazolam hydrochloride","morphine sulfate","multivitamins"]
86

sodium nitroprusside, norepinephrine bitartrate (noradrenaline), oxytocin, sodium and potassium penicillin G, potassium
chloride, ranitidine hydrochloride, succinylcholine chloride, glyceryl trinitrate, verapamil hydrochloride.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The medication is antigenic and adverse reactions are common. Consider the administration.
parenteral corticosteroid prophylaxis when used systemically, prior to medical indication.
b) Use an infusion pump for the administration of streptokinase.
c) It can be administered via intracoronary only under medical indication.

PHENYTOIN
Anticonvulsant

PRESENTATION

Vial with 5 mL of injectable solution containing 250 mg of sodium phenytoin (50 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9% (variable).

Reconstitution and dilution:

IV: 0.9% sodium chloride is the recommended diluent; dilutions of 1-10 mg/mL have been used and
they must be administered as soon as possible after preparation. Do not refrigerate. For
intermittent IV infusion: Dilute the dose of phenytoin in 0.9% sodium chloride to a final lower concentration
or equal to 6.7 mg/mL. For example: A dose of 1000 mg would be diluted with a minimum volume of 150 mL or
dilute 1000 mg with 500 mL. The prepared solutions should be visually inspected for
particles and colorations before use.

STABILITY

a) Keep the unopened ampule at room temperature (no more than 30 °C).
b) It is generally not recommended for IV infusions because precipitation may occur; however
embargo, it can be safely managed if adequate precautions are provided; not
refrigerate and avoid freezing.
c) Phenytoin is highly unstable in any IV solution, therefore, it should only be diluted in
sodium chloride 0.9% and should not be mixed with other medications.
 87

d) Do not add phenytoin to dextrose or solutions containing dextrose; it lacks solubility and may
precipitation occurs.
e) If the ampoule is cooled, it may form a precipitate; however, this will dissolve afterwards.
place it at room temperature. A slight yellowish coloration of the solution will not affect the
power, but the solution should not be used if it is not clear or if it contains any precipitate.
The stability time of the diluted solution is 1 hour at room temperature (no more than 30°C),
It is therefore recommended that the administration be completed within this time period.
g) The undiluted injectable solution and the ampoule once opened should be used within 4-6 hours
the ambient temperature (no more than 30°C), after this time it is recommended to discard them.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Do not administer by this method.
Administer at 25-50 mg/minute. Do not exceed 50 mg/minute. Complete the
Intermittent IV
infusion in 1 hour.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
IV direct Do not administer by this method.
Administer at 0.5-1 mg/kg/minute Concentration less than 6 mg/mL. Wash
Intermittent IV in neonates; 1-3 mg/kg/minute before and after administration.
infants and children.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.
88

OBSERVATIONS AND PRECAUTIONS

a) Administer immediately after dilution. Complete within 1 hour.

b) In patients who may develop hypotension, patients with cardiovascular disease or
geriatric patients, the maximum speed is 25 mg/minute (it can be as slow as 5-10
mg/minute.
c) Monitor the cardiac function during and after the administration of the medication. The
rapid intravenous administration can cause hypotension and/or cardiac arrhythmias; to reduce
Due to these risks, phenytoin should be administered slowly.
d) The IM route is not recommended due to severe pain at the injection site, risk of necrosis.
formation of abscess, erratic absorption, and possible drug precipitation in the tissue.
e) Rinse line IV with 0.9% sodium chloride before and after administering phenytoin for
reduce local venous irritation of the alkaline solution. Avoid extravasation; phenytoin is
caustic to the tissues; it can lead to the "purple glove syndrome". Monitor the site of
narrow infusion.
f) Blistering medication; ensure proper placement of the needle or catheter before and during the
IV infusion. Avoid extravasation. If extravasation occurs, stop the infusion immediately and
disconnect (leave the needle/cannula in place); gently aspirate the extravasated solution (do not
rinse the line); remove the needle/cannula; elevate the limb and apply dry heat; monitor for
search for tissue detachment or compartment syndrome. Some sources recommend not
use antidote.

FILGRASTIM
Stimulating factor of granulocyte colonies

PRESENTATION

Pre-filled syringe with 1 mL of injectable solution containing 300 mcg of filgrastim (30 million of
units).

PREPARATION

Compatible solutions: Dextrose 5%.

Reconstitution and dilution:

The pre-filled syringe does not require dilution. Allow the pre-filled syringe to reach room temperature.
let stand for at least 30 minutes before administering. Do not shake.
IV: Dilute with 25-50 mL of 5% dextrose. Do not dilute to a concentration lower than 5 micrograms/mL.
Concentrations lower than 15 micrograms/mL require the addition of human albumin (concentration
from the final albumin of 2 mg/mL) to prevent loss by adsorption to plastic. Do not dilute with sodium chloride
0.9% because the medication may precipitate.

STABILITY

a) Keep the unopened pre-filled syringe refrigerated (2-8 °C), do not freeze.
b) Keep the prefilled syringe in the original packaging to protect it from light.
c) The solution must be clear and colorless.
 89

d) Once the pre-filled syringe has been removed from refrigeration, it must be used within a period of
24 hours at room temperature (no more than 30°C). Discard any pre-filled syringe.
maintained at room temperature for more than 24 hours.
e) The diluted solution can be stored for up to 24 hours under refrigeration (2-8 °C) or at
ambient temperature (no more than 30°C) and the infusion must be completed within 24 hours
after preparation; discard any unused portion of the solution.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer for 30-60 minutes. Rinse the IV line before and after the
intermittent IV
medication administration.
According to medical advice. Rinse the IV line before and after the
IV continues
medication administration.
I AM Do not administer by this method.
If the volume to be administered is more than 1
SC
mL, separate the injection sites.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer for 30-60 minutes. Rinse the IV line before and after the
Intermittent IV
medication administration.
According to medical instruction. Rinse the IV line before and after the
IV continues
medication administration.
IM Do not administer by this method.
SC Rotate the injection site.

COMPATIBILITY

Site Y
Sodium acyclovir, aminophylline, sodium ampicillin, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate.
sodium dexamethasone phosphate, hydrocortisone phosphate and sodium succinate, levofloxacin, metoclopramide
["hydrochloride","sulfate morphine","nalbuphine hydrochloride","ondansetron hydrochloride","potassium chloride","ranitidine hydrochloride"]
vancomycin hydrochloride.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.
90

OBSERVATIONS AND PRECAUTIONS

a) Anaphylactic reactions are rare, but they are a medical emergency. Stop the infusion and
start treatment immediately.

PHYTOMENADIONE (VITAMIN K1)

Vitamin (prothrombinogenic)
Antidote

PRESENTATION

Vial with 1 mL of injectable solution containing 10 mg of phytonadione (vitamin K1) (10 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%, dextrose 10%, dextrose 5% in sodium chloride 0.9%, dextrose 5% in
sodium chloride 0.45%, sodium chloride 0.9%, sodium chloride 0.45%.

Reconstitution and dilution:

For IM administration, no dilution is needed at a concentration of 10 mg/mL.
IV: Dilute in 50-100 mL of compatible solution. Administer immediately after dilution.
The solution container must be protected from light at all times. The solution must be clear to yellow.
pale.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C). Protect from light. Do not
refrigerate.
b) The medication is photosensitive and must be protected from light at all times with opaque material.
c) Use immediately after dilution; discard the unused portion of the contents of the ampoule.
and from the dilution within 24 hours at room temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 30-60 minutes. Only by medical indication. Do not exceed 1
IV intermittent
mg/minute.
IV continues Do not administer by this method.
IM Only by medical prescription.
SC Only by medical indication.
 91

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 15-30 minutes. Only by medical indication. Do not exceed 1
IV intermittent
mg/minute.
IV continues Do not administer by this method.
I am Only by medical indication.
SC Only by medical indication.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate
["cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","sodium dexamethasone phosphate"]
["digoxin","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)","esmolol hydrochloride"]
estreptoquinasa, fentanilo citrato, fluconazol, furosemida, heparina sódica, hidrocortisona succinato sódico,
ketorolac tromethamine, lidocaine hydrochloride, mannitol, metoclopramide hydrochloride, midazolam hydrochloride
["morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate"]
(norepinephrine), ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride, ranitidine
["chloride, succinylcholine chloride, glycerin trinitrate, vancomycin hydrochloride, verapamil hydrochloride."]

Mix
Amikacin sulfate.

Syringe
Aminophylline, sodium dexamethasone phosphate, sodium heparin, potassium penicillin G.

OBSERVATIONS AND PRECAUTIONS

a) Severe adverse reactions have occurred, including fatal anaphylaxis, shock, and cardiac arrest.
cardiorespiratory, during or immediately after the IM or IV administration of
Phytomenadione. Such severe reactions have occurred despite the use of measures to prevent them.
hypersensitivity reactions, including the dilution of the solution and administration by
slow infusion.
b) Limit intravenous administration to situations where an alternative route of administration is not feasible
and the benefit of therapy outweighs the risk of hypersensitivity reactions; the appropriate
dosage, dilution and administration will minimize the risk. Reactions have also occurred.
allergic to IM and SC injections, although less frequently.
c) The subcutaneous route is preferred due to the risk of hypersensitivity with IV or IM administration.
d) The injectable formulation, undiluted, can be used for oral administration.
92

FLUCONAZOLE
Antifungal

PRESENTATION

Vial with 50 mL of injectable solution containing 100 mg of fluconazole (2 mg/mL).

PREPARATION

Compatible solutions: 5% Dextrose.

Reconstitution and dilution:

IV: The solution containing 100 mg of fluconazole in 50 mL of solution does not require dilution to be
administered.

STABILITY

a) Store the unopened jar at room temperature (no more than 30°C).
b) Avoid freezing or exposing the medication to high temperatures.
c) Do not use the medication if the solution is cloudy or has precipitate.
d) Once the bottle is opened, the medication must be used within a maximum of 24 hours when stored.
the ambient temperature (no more than 30°C) or in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer for 1-2 hours. Do not exceed 200 mg/hour.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method To use Speed Comment
Direct IV Do not administer by this method.
Administer for 1-2 hours. Infuse doses greater than 6 mg/kg
Intermittent IV
for 2 hours.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.
 93

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate,
buprenorphine hydrochloride, cefepime hydrochloride, cisatracurium besilate, dexamethasone sodium phosphate
dexmedetomidine hydrochloride, dobutamine hydrochloride, dopamine hydrochloride, ephedrine sulfate, epinephrine
["hydrochloride (adrenaline)","ertapenem sodium","esmolol hydrochloride","streptokinase","fentanyl citrate","filgrastim"]
phytomenadione (vitamin K1), sodium heparin, hydrocortisone succinate and sodium phosphate, ketorolac trometamol,
levofloxacino, lidocaína clorhidrato, linezolida, magnesio sulfato, manitol, meropenem, metilprednisolona
sodium succinate, metoclopramide hydrochloride, metronidazole, midazolam hydrochloride, morphine sulfate
["multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)","ondansetron"]
hydrochloride, oxytocin, potassium penicillin G and sodium, potassium chloride, ranitidine hydrochloride, succinylcholine chloride
tigeciclina, trinitrato de glicerilo, vancomicina clorhidrato, vecuronio bromuro, verapamilo clorhidrato, zoledrónico
acid.

Mix
Sodium acyclovir, amikacin sulfate, ceftazidime, ciprofloxacin, clindamycin phosphate, sodium heparin, meropenem,
metronidazole, morphine sulfate, ondansetron hydrochloride, potassium chloride, ranitidine hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor for the presence of adverse reactions during or after the administration of fluconazole.

FLUMAZENIL
Benzodiazepine antagonist

PRESENTATION

Vial with 5 mL of injectable solution containing 0.5 mg (500 mcg/5 mL, 0.1 mg/mL, 100 mcg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%, dextrose 5%.

Reconstitution and dilution:

IV: The 100 mcg/mL concentration solution can be administered undiluted or may be diluted for infusion.
0.5 mg in 50 mL (500 mcg in 50 mL) of compatible solution to obtain a concentration of 0.01 mg/mL
(10 mcg/mL).
94

STABILITY

a) Store the unopened ampoule at room temperature (no more than 25 °C). Protect from light.
b) The open ampoule and/or the diluted solution must be used within 24 hours if stored.
ambient temperature (no more than 25°C) or refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Inject for 15 seconds. Do not exceed 500 mcg/minute.
intermittent IV Only by medical indication.
IV continues Administer at 100-500 mcg/hour. Evaluate response.
IM No administrar por este método.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Inject for 15-30 seconds. Do not exceed 200 mcg/minute. Evaluate.
Direct IV
response.
Intermittent IV Do not administer by this method.
Initial dose: 0.01 mg/kg followed by Assess response.
IV continues
5-10 mcg/kg/hour.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Aminophylline, hydrochloride dobutamine, hydrochloride dopamine, sodium heparin, sodium lidocaine, hydrochloride ranitidine.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Use with caution in patients with epilepsy, patients who are known or suspected
dependence on benzodiazepines and those who have been treated with high doses of
benzodiazepines during the weeks leading up to treatment. It can cause syndrome of
withdrawal from benzodiazepine; symptoms include tachycardia, agitation, and seizures.
b) Observe the patient for at least 4 hours after the last dose for signs of re-sedation.
c) Severe hypersensitivity reactions are rare, but they are a medical emergency. Stop
the infusion and start the treatment immediately.
d) Avoid extravasation.
 95

Furosemide
Diuretic

PRESENTATION

Vial with 2 mL of injectable solution containing 20 mg of furosemide (10 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%, dextrose 10%, sodium chloride 0.9%, mannitol 20%.

Reconstitution and dilution:

IV: For direct IV administration, it can be administered undiluted at a concentration of 10 mg/mL. For infusion
IV intermittent/continuous diluent in 50-500 mL of compatible solution. The maximum concentration of
Furosemide for administration is 10 mg/mL.
No dilution is required at a concentration of 10 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C); protect from light. Do not
refrigerate.
b) Exposure to light can cause discoloration; do not use if the furosemide solutions have a
yellowish color.
c) The opened ampoule and/or the diluted solution are stable for 24 hours at room temperature (no more
at 30°C). Do not refrigerate.
d) Cooling can cause precipitation or crystallization; however, it dissolves again in
ambient temperature without affecting the potency of the drug.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Manage in 3-5 minutes. Do not exceed 4 mg/minute.
IV intermittent Administer over at least 15 minutes. Do not exceed 4 mg/minute.
IV continues According to medical advice.
Suction to avoid injecting into a vessel
I am
sanguine
SC Only by medical indication.

Pediatric
Method Use Velocidad Comment
direct IV Administer for 1-2 minutes. Do not exceed 0.5 mg/kg/minute.
Intermittent IV Administer in 15-30 minutes. Do not exceed 4 mg/minute
96

IV continues Administer within 24 hours. As per medical advice.

Suction to avoid injecting into the vessel
I am
sanguine
SC Only by medical indication.

COMPATIBILITY

Site Y
["Sodium acyclovir","amikacin sulfate","aminophylline","atropine sulfate","sodium bicarbonate","calcium gluconate","cefepime"]
["chloride, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, clindamycin phosphate, dexamethasone phosphate"]
sódico, dexmedetomidina clorhidrato, digoxina, efedrina sulfato, epinefrina clorhidrato (adrenalina), ergonovina
["maleate","sodium ertapenem","streptokinase","fentanyl citrate","phytonadione (vitamin K1)","hydrocortisone"]
["sodium succinate","ketorolac tromethamine","lidocaine hydrochloride","linezolid","mannitol","meropenem"]
["methylprednisolone sodium succinate","metronidazole","multivitamins","nimodipine","sodium nitroprusside","oxytocin"]
["sodium and potassium penicillin G","potassium chloride","ranitidine hydrochloride","succinylcholine chloride","tigecycline","zoledronic"]
acid.

Mix
Human albumin, aminophylline, sodium ampicillin, atropine sulfate, sodium bicarbonate, butylhyoscine, calcium
["gluconate","cefuroxime","sodium dexamethasone phosphate","digoxin","epinephrine hydrochloride (adrenaline)","sodium heparin"]
lidocaine hydrochloride, mannitol, meropenem, morphine sulfate, sodium and potassium penicillin G, potassium chloride, ranitidine
hydrochloride.

Syringe
Sodium phosphate dexamethasone, sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) The risk of ototoxicity increases with high doses and/or rapid administration of furosemide.
associated transient and permanent ototoxicity with administration speed greater than 4
mg/minute or greater than 0.5 mg/kg/minute.

GELATIN
Plasma volume expander

PRESENTATION

Bottle with 500 mL of injectable solution containing 20 g of succinylated gelatin (4%, 4 g/100 mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Does not require reconstitution or additional dilution to a concentration of 4%.
 97

STABILITY

a) Store the unopened bottle at room temperature (not more than 30 °C). Do not freeze or refrigerate.
b) Once the bottle with the solution is opened, it must be used within 4 hours at room temperature.
environment (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
The total dose, duration, and rate in severe acute blood loss can
the infusion depends on the amount to be administered quickly (500 mL
IV intermittent
total blood or plasma lost and in 5-10 minutes).
of the patient's condition.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method To use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV As instructed by the doctor.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.
98

OBSERVATIONS AND PRECAUTIONS

a) Anaphylactic reactions, hypotension, shock, bronchospasm, cardiac arrest may occur. Observe the
patient carefully for the first 20-30 mL of the infusion. The means for resuscitation
must be available.
b) Monitor the patient for signs and symptoms of anaphylaxis. Stop the infusion.
immediately if symptoms appear and start treatment according to medical advice.
c) When the solution is administered quickly, it should be warmed to no more than 37°C if possible.
d) Caution should be taken regarding the calcium content of some available gelatin solutions.
commercially.

HALOPERIDOL
Antipsychotic

PRESENTATION

Vial with 1 mL of injectable solution containing 5 mg of haloperidol lactate (5 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%.

Reconstitution and dilution:

The 5 mg/mL solution does not require dilution.
IV: Haloperidol lactate can be administered intravenously in 5% dextrose. For intermittent IV infusion, it can
dissolve in 30-100 mL of 5% dextrose. For continuous IV infusion, dilute in 250 mL of compatible solution.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C); do not freeze or expose to
temperatures above 40°C. Protect from light; exposure to light may cause discoloration and
development of a reddish-gray precipitate.
b) The opened ampoule and/or the diluted solution must be used within 48 hours when stored at
ambient temperature (no more than 30°C).
c) 0.9% sodium chloride solutions should not be used for diluting the medication.
due to its low stability and incompatibility.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer at 5 mg/minute. Cardiac monitoring is recommended.
Intermittent IV Manage in 30 minutes. Cardiac monitoring is recommended.
Administer at 3-5 mg/hour. The infusion rate can reach
IV continues
up to 25 mg/hour.
 99

Keep the patient lying down for the

less than 30 minutes after the
IM
injection to minimize the effects
antihypertensives.
SC Only by medical indication.

Pediatric
Method Use Speed Comment
Direct IV Administer in 1-2 minutes. Cardiac monitoring is recommended.
Intermittent IV Administer for 30-45 minutes. Cardiac monitoring is recommended.
IV continues As per medical indication.
IM Concentration: 5 mg/mL.
SC Only by medical prescription.

COMPATIBILITY

Site Y
Cisatracurio besilato, ertapenem sódico, filgrastim, ketamina clorhidrato, levofloxacino, linezolida, metronidazol,
vecuronium bromide, zoledronic acid.

Mix
Butylscopolamine, metoclopramide hydrochloride, midazolam hydrochloride, ondansetron hydrochloride, tramadol hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The formulation as lactate or decanoate can be administered via IM, but the decanoate must be
administered only IM; do not administer the decanoate via IV. Haloperidol lactate may be
administered via IV; however, this may increase the risk of altered cardiac conduction.
b) The patient must be monitored periodically. The dosage must be reduced or the
The medication should be discontinued if there is a prolongation of the QT interval and arrhythmias. They may
hypotension and dystonia reactions may occur. Use with caution in patients with a history of
epilepsy.
There is a higher risk of QT interval prolongation and torsades de pointes when administered
by IV route or in high doses, but cases have been reported in the absence of factors
predisposing factors. Use with caution if treating patients with prolonged conditions
QT interval, concomitant use of medications that prolong the QT interval, abnormalities
underlying heart conditions and hypothyroidism.
100

HEPARIN
Anticoagulant

PRESENTATION

Vial ampoule with 5 mL of injectable solution containing sodium heparin equivalent to 25000 units.
of heparin (5000 units/mL).

Vial ampoule with 10 mL of injectable solution containing sodium heparin equivalent to 10,000 units
of heparin (1000 units/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 0.45% sodium chloride, 5% dextrose in sodium chloride
0.45%, dextrose 5% in sodium chloride 0.9%, dextrose 5%.

Reconstitution and dilution:

IV: The injectable solution of sodium heparin can be used diluted and undiluted. For infusion, it can be
diluted in 50-100 mL of compatible solution. Invert the container at least 6 times to ensure mixing
suitable and to prevent the medication from settling in the solution. Alternatively, dilute 25000
heparin units in 250-500 mL (concentration: 100-50 units/mL) of compatible solution.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25°C) and protect from light.
b) The solution must be clear; do not administer solutions that contain particles, sediments or
colorations. Do not freeze.
c) Once the ampule vial is opened, it must be used within 28 days stored at
ambient temperature (no more than 25°C) or in refrigeration (2-8°C).
d) The diluted solution can be stored in refrigeration (2-8 °C) and infused at room temperature.
environment (no more than 25°C) within 48 hours.

ADMINISTRATION

Adult
Method Use Speed Comment
Administer for at least 1 Solo for the initial dose, according to
Direct IV
minute. medical indication.
According to medical instructions. Flush the IV line to prevent the
intermittent IV
clot formation.
IV continues Administer in 4-24 hours. According to medical indication.
IM Do not administer by this method.
SC Rotate the injection sites.

Pediatric
Method Use Speed Comment
direct IV Do not administer by this method.
 101

Administer for at least 10 only for initial dosage, according to

intermittent IV
minutes. medical indication.
IV continues According to medical instruction. Concentrations: 10-500 units/mL.
I am Do not administer by this method.
SC Rotate injection sites.

COMPATIBILITY

Site Y
Sodium acyclovir, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate,
cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, clindamycin phosphate, sodium dexamethasone phosphate
dexmedetomidine hydrochloride, digoxin, dopamine hydrochloride, ephedrine sulfate, epinephrine hydrochloride (adrenaline)
["ergonovine maleate","sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione"]
(vitamin K1), fluconazole, sodium succinate hydrocortisone, ketorolac trometamol, lidocaine hydrochloride, linezolid
magnesio sulfato, manitol, meropenem, metoclopramida clorhidrato, metronidazol, midazolam clorhidrato, morfina
sulfate, multivitamins, nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline)
["ondansetron hydrochloride","oxytocin","paracetamol (acetaminophen)","sodium and potassium penicillin G","potassium chloride"]
["ranitidine hydrochloride","succinylcholine chloride","tigecycline","sodium thiopental","glycerin trinitrate","vecuronium bromide"]
verapamil hydrochloride, zoledronic acid.

Mix
Aminophylline, sodium bicarbonate, calcium gluconate, cefepime hydrochloride, ceftazidime, cefuroxime, clindamycin
["phosphate","dopamine hydrochloride","esmolol hydrochloride","fluconazole","flumazenil","furosemide","lidocaine hydrochloride"]
["magnesium sulfate","meropenem","methylprednisolone sodium succinate","norepinephrine bitartrate (noradrenaline)"]
potassium chloride, ranitidine hydrochloride, verapamil hydrochloride.

Syringe
Aminophylline, sodium ampicillin, atropine sulfate, buprenorphine hydrochloride, cefotaxime, clindamycin phosphate,
sodium phosphate dexamethasone, digoxin, hydrochloride dobutamine, hydrochloride dopamine, hydrochloride epinephrine
["adrenaline","fentanyl citrate","phytomenadione (vitamin K1)","furosemide","lidocaine hydrochloride","metoclopramide"]
hydrochloride, sodium nitroprusside, paracetamol (acetaminophen), sodium and potassium penicillin G, ranitidine hydrochloride
succinilcolina cloruro, tramadol clorhidrato, trinitrato de glicerilo, verapamilo clorhidrato.

OBSERVATIONS AND PRECAUTIONS

a) Use an infusion pump during the administration of heparin.

b) Fatal hemorrhages have occurred in pediatric patients due to errors in which the
sodium heparin vials were confused with rinse vials. Examine
carefully all the vials of sodium heparin to confirm the correct vial selection
before the administration. If possible, it is recommended that a second independent staff member,
Review the original order, dosage calculation, and infusion.
c) Be careful not to confuse the vials of heparin with those of insulin.
d) The unwanted concomitant use of two heparin products (unfractionated heparin and heparins
of low molecular weight) have resulted in serious harm and death. Review the previous records
recent and current administration (emergencies, etc.) before administering any product
heparin-like.
102

e) Do not administer via IM due to the frequency and danger of hematoma formation at the site of
injection.
f) It can be administered subcutaneously, injecting deeply. Alternate the sites of
injection between the arm and the right and left abdominal wall above the iliac crest. Inject
the full length of the needle at a 45° or 90° angle in a skin fold, held with the finger
thumb and index finger. Keep the skin taut throughout the injection. Do not aspirate or massage.
g) The solution is colorless to slightly yellowish. To prevent incompatibility of heparin with
other medications, rinse with injectable water or 0.9% sodium chloride before and after the
medication is administered.
h) Due to the fatal risk of Gasping Syndrome, do not use heparin solutions that contain alcohol.
benzyl in neonates.

HYDRALAZINE
Antihypertensive

PRESENTATION

Vial with 1 mL injectable solution containing 20 mg of hydralazine hydrochloride.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 0.45% sodium chloride.

Reconstitution and dilution:

It can be used undiluted or you can dilute the dose with 10-100 mL of compatible solution.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25 °C). Do not refrigerate and protect.
of the light.
b) The open ampoule and/or the diluted solution are stable for 24 hours at room temperature (not more
of 30°C.
c) Hydralazine interacts with stainless steel resulting in a pink coloration. It should be avoided.
contact with metals. It is not known if the power is affected.
d) Hydralazine should not be diluted in dextrose or solutions containing sugars due to the
formation of hydrazones, which are associated with toxicity (for example, headache, nausea,
vomiting.
The color changes that occur within 8-12 hours after mixing with many solutions
Intravenous generally do not indicate a loss of potency.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Administer for 3-5 minutes.
Intermittent IV Administer for 30-60 minutes.
 103

IV continues Only by medical indication.

IM Concentration: 20 mg/mL.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Inject for 1-2 minutes. Maximum: 5 mg/minute. Can be diluted to 1.
mg/mL, using 0.5 mL of the solution
Direct IV
20 mg/mL with 9.5 mL of solution
compatible.
Intermittent IV According to medical indication. Only by medical indication.
IV continues Only by medical prescription.
IM Only by medical indication.
SC Do not administer by this method.

COMPATIBILITY

Site Y
["Amiodarone hydrochloride","ergonovine maleate","linezolid","metronidazole","vecuronium bromide","zoledronic acid"]

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor blood pressure and heart rate during and after administering hydralazine.

HYDROCORTISONE
Corticosteroid

PRESENTATION

Vial ampoule with powder containing sodium succinate hydrocortisone equivalent to 500 mg of
hydrocortisone.

Vial ampoule with powder that contains sodium hydrocortisone succinate equivalent to 100 mg of
hydrocortisone
104

PREPARATION

Compatible solutions: Dextrose 5%, dextrose 10%, dextrose 5% in 0.9% sodium chloride, dextrose 5% in
sodium chloride 0.45%, sodium chloride 0.9%, sodium chloride 0.45%.

Reconstitution and dilution:

IV: For direct IV injection, reconstitute with 5 mL of compatible solution. For IV infusion, dilute the solution.
reconstituted with 50-1000 mL to a concentration range of 0.1-1 mg/mL. If there are vials of 100 mg,
reconstitute them with no more than 2 mL. The concentration should generally not exceed 1 mg/mL. However,
in cases where the administration of a small volume of solution is desired, 100-3000 mg may be
added to 50 mL of compatible solution.
Reconstitute the 100 mg vial with 2 mL of injectable water or 0.9% sodium chloride.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C). Protect from light.
b) Hydrocortisone phosphate and sodium succinate are clear, slightly yellow solutions, the
which are labile to heat.
c) After the initial reconstitution, the sodium succinate hydrocortisone solution is stable for 48
hours at room temperature (no more than 25°C) or in refrigeration (2-8°C).
d) Dilute solutions are stable for 24 hours at room temperature (no more than 30°C) or
under refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer no less than 30 doses equal to or greater than 500 mg.
Direct IV seconds per 100 mg. to be managed for at least 10
minutes.
Intermittent IV Administer for 20-30 minutes. Usual maximum concentration: 5 mg/mL.
IV continues According to medical instructions.
Deep injection in the gluteus for
I am
prevent local tissue atrophy.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Manage in 3-5 minutes.
Intermittent IV Administer in 20-30 minutes. Maximum concentration: 5 mg/mL.
IV continues According to medical indication. Concentration: 0.1-1 mg/mL.
Deep injection into the gluteus for
I am
prevent atrophy of local tissue.
SC Do not manage by this method.
 105

COMPATIBILITY

Site Y
["Sodium acyclovir","Amikacin sulfate","Aminophylline","Atropine sulfate","Sodium bicarbonate","Buprenorphine hydrochloride"]
cefepime hydrochloride, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, cisatracurium besilate, clindamycin
["phosphate","sodium dexamethasone phosphate","dexmedetomidine hydrochloride","digoxin","dopamine hydrochloride","ephedrine"]
["sulfate","epinephrine hydrochloride (adrenaline)","ergonovine maleate","sodium ertapenem","streptokinase","fentanyl"]
citrate, filgrastim, phytonadione (vitamin K1), fluconazole, furosemide, sodium heparin, ketorolac tromethamine
levofloxacin, lidocaine hydrochloride, mannitol, metoclopramide hydrochloride, metronidazole, morphine sulfate
multivitamins, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin
paracetamol (acetaminofén), penicilina G sódica y potásica, potasio cloruro, ranitidina clorhidrato, succinilcolina
chloride, tigecycline, glyceryl trinitrate, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
["Amikacin sulfate","Aminophylline","Sodium bicarbonate","Calcium gluconate","Clindamycin phosphate","Lidocaine hydrochloride"]
magnesium sulfate, metronidazole, norepinephrine bitartrate, penicillin G sodium and potassium, potassium chloride, thiopental
sodium, vancomycin hydrochloride, verapamil hydrochloride.

Syringe
Aminophylline, sodium dexamethasone phosphate, paracetamol (acetaminophen), potassium penicillin G, sodium thiopental.

OBSERVATIONS AND PRECAUTIONS

a) Only the sodium phosphate or sodium succinate formulations of hydrocortisone can be administered.
intravenously.
b) NEVER administer the suspension formulation of hydrocortisone acetate via
intravenous.
c) Visually inspect the solutions to observe particles and colorations before their
administration.
d) Avoid IM injection in the deltoid muscle (high incidence of subcutaneous atrophy).

Hydroxocobalamin
Vitamin B12

PRESENTATION

Vial with 2 mL of injectable solution containing 100 mcg of hydroxocobalamin (50 mcg/mL).

Preparation

{"compatible_solutions":"Sodium chloride 0.9%, dextrose 5%."}

106

Reconstitution and dilution:

IV: Dilute 100 mcg in 100 mL of compatible solution.
IM: Does not require dilution to a concentration of 50 mcg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25 °C), protect from light, do not
freeze.
b) The open ampoule and/or the diluted solution are stable for 6 hours at room temperature (no more
of 25°C).

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Do not administer by this method.
IV intermittent Administer in at least 15 minutes. Only by medical indication.
IV continues Do not administer by this method.
IM Inject into the appropriate muscle mass.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Administer in at least 30 minutes. Only by medical indication.
IV continues Do not administer by this method.
IM Inject into appropriate muscle mass.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Anaphylactic reactions have been reported, closely monitor signs and symptoms during
and after the administration of hydroxocobalamin.
 107

Insulin Glargine
Long-acting insulin

PRESENTATION

Lantus: Pre-filled pen device with 3 mL of injectable solution containing 300 units (100
units/mL). Each mL contains 100 units of glargine insulin equivalent to 3.64 mg of insulin.
glargine.

PREPARATION

Compatible solutions: None.

Reconstitution and dilution:

SC: No additional preparation is required. Do not shake the pre-filled pen as this may produce foam.
Allow to reach room temperature for approximately 30 minutes to 1 hour before administering.

STABILITY

a) Store the unopened pen device in refrigeration (2-8 °C). Do not freeze and protect them from
light.
b) Once the pen device is opened, store at room temperature (no more than 30°C) and protect
from excessive heat and direct light. Do not return to the refrigerator. Discard any portion of
unused product after 28 days.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not manage by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Rotate the injection sites.

Pediatric
Method Use Speed Comment
direct IV Do not administer by this method.
IV intermittent Do not administer by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Rotate the injection sites.
108

COMPATIBILIDAD

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Do not substitute brands or strengths of insulin.

b) Not suitable for use in insulin infusion pumps.
c) Do not dilute or mix insulin glargine with other formulations or solutions.

NPH INSULIN
Intermediate-acting insulin

PRESENTATION

Vial with 10 mL of injectable suspension containing 1000 units of human insulin

intermediate action (100 units/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

Allow to reach room temperature for approximately 30 minutes to 1 hour before
administer. To ensure the uniform dispersion of NPH insulin, gently rotate the vial between the
Wash hands before each dose. Avoid vigorous shaking as it may result in the formation of bubbles or
foam. NPH insulin should appear uniformly milky after gentle mixing. Do not use
if any white substance remains at the bottom of the jar, clumps or if white particles are adhered
at the bottom or to the wall of the jar.

STABILITY

a) Novolin N: Store the unopened vial in refrigeration (2-8°C) until its expiration date or to
ambient temperature (no more than 25°C) for up to 42 days; do not freeze; keep away from heat and
 109

the sunlight. Once punctured (in use), store the bottle at room temperature (no more than
25°C) for up to 4 weeks; refrigeration of the bottle in use is not recommended.
It is necessary to verify the specific conservation and stability conditions of each.
formulation according to the manufacturer laboratory.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
IM Only by medical indication.
Rotate the injection site. Do not massage the
SC
site.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Only on medical advice.
Rotate the injection sites. Do not massage.
SC
the site.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The onset of action of NPH insulin is around 60 to 90 minutes. The duration of action is
16 to 24 hours.
b) Administer 15 minutes before the meal (breakfast and dinner) or immediately after the meal
food
110

c) Before administering the medication, examine the injectable suspension for presence of
suspended particles, at the bottom or on the wall of the vial. If this is the case, do not administer.
d) Check if the formulation of NPH insulin can be mixed with other specific types of insulin
according to information from the manufacturer.
e) Rotate injection sites within the same region to reduce the risk of lipodystrophy.

LISPRO INSULIN
Rapid-acting insulin

PRESENTATION

Humalog: Cartridge with 3 mL of injectable solution containing 300 units of lispro insulin (100
units/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Dilute to a concentration of 0.1-1 units/mL.

STABILITY

a) Keep the unopened cartridge (unused) refrigerated (2-8°C). Do not freeze. Do not use if it has been
frozen. Protect from excessive heat or light.
b) The insulin lispro cartridge in use should not be refrigerated, store at room temperature (do not
more than 30°C), for up to 28 days. Do not expose it directly to sunlight or excessive heat.
c) The prepared solution for IV infusion is stable for up to 48 hours when stored in
refrigeration (2-8°C) or at room temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV In correction schemes.
intermittent IV Do not administer by this method.
According to medical instruction. Frequently monitor the levels
IV continues
of glucose.
IM Do not administer by this method.
Rotate the injection site. Do not massage the
SC
site after injection.

Pediatric
Method Use Speed Comment
direct IV Only by medical indication.
intermittent IV Do not administer by this method.
 111

IV continues According to medical advice.

I am Do not administer by this method.
SC Rotate the injection sites. Do not massage.
the site after injecting.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The onset of action of insulin lispro is 15-30 minutes and the duration of effect is less than or equal to 5
hours.
Monitor the effect of the medication during intravenous administration as it may be
adsorbed to the container and to line IV of the solution.
b) To minimize the adsorption of insulin to the container and IV line, wash the IV line with 20 mL of the
insulin solution, whenever a new IV infusion set is placed in the container of the
solution.
c) Due to the adsorption of insulin to the IV line and containers, the actual amount of insulin being
administrada vía infusión IV puede ser sustancialmente menos que la cantidad aparente. Por lo
thus, the adjustment of the IV infusion speed should be based on the effect and not solely on the
apparent insulin dosage.

Insulin Lispro/Lispro Protamine

Combination of intermediate and rapid-acting insulin

PRESENTATION

Humalog Mix 25: Vial with 10 mL of injectable suspension that contains 25 per milliliter
75 units of insulin lispro and 75 units of insulin lispro protamine.
112

PREPARATION

{"compatible_solutions":"None."}

Reconstitution and dilution:

Rotate the bottle in your hands or gently shake to resuspend the suspension immediately.
Before use. The properly resuspended suspensions should appear milky.
uniform; do not use if any white substance remains at the bottom of the container, there are lumps, the suspension
remains clear after mixing or if white particles are adhered to the bottom or on the wall of the
bottle.

STABILITY

a) Keep the unopened jar in refrigeration (2-8°C) until its expiration date or at room temperature
store in an environment (no more than 30°C) for 28 days, do not freeze; keep away from heat and sunlight.
b) Once punctured (in use), the vial can be stored at room temperature (no more than 30°C)
up to 28 days.

PREPARATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
Rotate the injection site. Do not massage it.
SC
site after injection.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
IV continues Do not administer by this method.
I am Do not administer by this method.
Rotate the injection sites. Do not massage.
SC
the site after injection.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.
 113

OBSERVATIONS AND PRECAUTIONS

a) The onset of action is in about 10-25 minutes and the duration of action is 16 to 24 hours.
b) Administer within 15 minutes before the meal (breakfast and dinner); typically administered
once or twice a day.
c) Do not mix or dilute with other insulins or solutions. Do not use for IV administration with or without
infusion pump.

REGULAR RAPID INSULIN

Rapid-acting insulin

PRESENTATION

Novolin R: Vial with 10 mL of injectable solution containing 1000 units of human insulin
regular quick action (100 units/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%, dextrose 5%, dextrose 10%, dextrose 50%.

Reconstitution and dilution:

Allow to reach room temperature for approximately 30 minutes to 1 hour before
to manage.
IV: Dilute a concentration of 0.05 units/mL to 1 unit/mL with a compatible solution. For example, you can
dilute 50 units in 50 mL of compatible solution to obtain a concentration of 1 unit/mL.

STABILITY

a) Novolin R: Store the unopened vial in refrigeration (2-8°C), not inside or very close to the
freezer. Keep the jar in its original container. Do not freeze.
b) Do not expose to excessive temperatures or direct sunlight.
c) The bottle in use should not be kept in refrigeration and can be stored at room temperature.
(no more than 30°C) for up to 6 weeks.
d) Avoid excessive shaking of the vial before withdrawing the insulin dose as it may occur
loss of power, agglomeration, cremation or precipitation.
e) The diluted solution of rapid insulin is stable for up to 24 hours at room temperature (no more than
30 °C)
f) The conservation and stability conditions change according to the manufacturing laboratory, for
Therefore, it is necessary to verify the specific information.
114

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV In correction schemes.
Intermittent IV According to medical indication.
IV continues As per medical instruction.
I am Only on medical advice.
Rotate the injection site. Do not massage the area.
SC
site after injecting.

Pediatric
Method Use Speed Comment
Direct IV In correction schemes.
intermittent IV As per medical advice.
IV continues According to medical indication.
IM Only by medical prescription.
Rotate the injection sites. Do not massage.
SC
the site after injection.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Jeringa
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The onset of action is around 10-20 minutes and the duration of action is 3-5 hours.
b) Inject immediately (no more than 15 minutes) before a meal or shortly after the start.
of a meal.
c) Regularly monitor glucose levels.
d) There will be adsorption of insulin on the surfaces of the containers. The amount is difficult to establish and
The effect on the amount of insulin released seems to vary over time. Monitor the response.
to the medication and adjust the doses.
e) To minimize the adsorption of insulin to plastic, wash the IV line with 20 mL of the solution of
insulin, whenever a new IV infusion set is placed in the solution container to
infusion.
f) Use only if the solution is clear and colorless; do not use if the solution is viscous, cloudy, colored, or if it has
lumps or particles.
g) Do not dilute or mix with other insulins.
 115

KETOROLAC
Non-Steroidal Anti-Inflammatory Analgesic

PRESENTATION

Vial with 1 mL of injectable solution containing 30 mg of ketorolac trometamine (30 mg/mL).

PREPARATION

Compatible solutions: 5% dextrose, 5% dextrose in 0.9% sodium chloride, 0.9% sodium chloride.

Reconstitution and dilution:

IV: No reconstitution is needed. For direct IV administration, dilution is not necessary. For IV infusion
intermittent, dilute the prescribed dose in 50-100 mL of compatible solution. For continuous IV infusion, dilute
the prescribed dose is 500-1000 mL of compatible solution.
IM: Does not require additional dilution at a concentration of 30 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (not exceeding 30 °C). Protect from light. Do not
refrigerate or freeze. Prolonged exposure may cause discoloration and precipitation.
b) The injectable solution is clear and has a slight yellowish color. Any additional color change
indicates degradation; precipitation may occur at relatively low pH.
It is recommended that the opened ampoule be used within 24 hours at room temperature (no more
of 30°C).
d) Once diluted, ketorolac is stable for at least 48 hours at room temperature (no more than
30°C.

ADMINISTRATION

Adult
Method Use Speed Comment
Manage for at least 15
Direct IV
seconds.
intermittent IV Manage in 30 minutes.
IV continues Administer at 5 mg/hour
Slow and deep injection. Aspirate to
IM
avoid injecting a blood vessel.
SC Do not administer by this method.
116

Pediatric
Method Use Speed Comment
Direct IV Administer for 1-5 minutes. Concentración: 15 y 30 mg/mL.
intermittent IV Administer in 30 minutes.
IV continues Administer at 0.17 mg/kg/hour
Administer slowly and deeply in
I am
well-developed muscle.
SC Do not administer by this method.

COMPATIBILITY

Site Y
["Amikacin sulfate","Aminophylline","Atropine sulfate","Sodium bicarbonate","Buprenorphine hydrochloride","Cefotaxime"]
["ceftazidime","sodium ceftriaxone","cefuroxime","cisatracurium besilate","clindamycin phosphate","dexamethasone phosphate"]
sodium, dexmedetomidine hydrochloride, digoxin, dopamine hydrochloride, ephedrine sulfate, epinephrine hydrochloride
["adrenaline","ertapenem sodium","streptokinase","fentanyl citrate","phytonadione (vitamin K1)","fluconazole"]
furosemida, heparina sódica, hidrocortisona succinato sódico, lidocaína clorhidrato, linezolida, magnesio sulfato,
["mannitol","methylprednisolone sodium succinate","metoclopramide hydrochloride","metronidazole","morphine sulfate"]
multivitamins, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin
["paracetamol (acetaminophen)","penicillin G sodium and potassium","potassium chloride","ranitidine hydrochloride","succinylcholine"]
chloride, tigecycline, glycerol trinitrate, verapamil hydrochloride, zoledronic acid.

Mix
Sodium dexamethasone phosphate, butylscopolamine, ranitidine hydrochloride, tramadol hydrochloride.

Syringe
Metoclopramide hydrochloride, paracetamol (acetaminophen), tiocolchicoside, tramadol hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) It is recommended that ketorolac not be administered for more than 5 days.

LEVOFLOXACIN
Fluoroquinolone antibiotic

PRESENTATION

Bottle with 100 mL of 5% dextrose containing 500 mg of levofloxacin hemihydrate (5 mg/mL).

PREPARATION

{"compatible_solutions":"Dextrose 5%, sodium chloride 0.9%, dextrose 5% in sodium chloride 0.9%."}

 117

Reconstitution and dilution:

IV: The pre-mixed solution with a concentration of 5 mg/mL with 5% dextrose does not require further dilution.

STABILITY

a) Store the unopened vial at room temperature (no more than 30°C); protect from light and
excessive heat.
b) Once the vial is opened, the solution at a concentration of 5 mg/mL is stable for 72 hours at
ambient temperature or refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Dosage of 250 or 500 mg: 60 minutes. Maintain proper hydration of the
Intermittent IV
Dose of 750 mg: 90 minutes. patient to prevent crystalluria.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, sodium ampicillin, buprenorphine hydrochloride, cefepime hydrochloride, ceftazidime
["sodium ceftriaxone","cefuroxime","cisatracurium besilate","clindamycin phosphate","sodium dexamethasone phosphate"]
["dexmedetomidine hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine"]
["hydrochloride (adrenaline)","sodium ertapenem","esmolol hydrochloride","fentanyl citrate","filgrastim","fluconazole","haloperidol"]
lactate, hydrocortisone succinate and sodium phosphate, lidocaine hydrochloride, linezolid, methylprednisolone succinate
["sodium","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","nalbuphine hydrochloride","ondansetron"]
hydrochloride, oxytocin, penicillin G sodium, potassium chloride, ranitidine hydrochloride, succinylcholine chloride
vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Linezolid, potassium chloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor the presence of adverse reactions during and after administration.

b) Hydrate patients adequately to avoid concentrated urine and the development of crystalluria.
the cylindruria.
118

c) Rapid infusion is associated with hypotension and should be avoided.

d) Do not mix or infuse simultaneously through the same IV line with other medications.
e) Do not infuse through the same IV line any solution that contains multivalent cations.
(for example, magnesium).
f) If the same administration equipment is used for sequential infusion of medications
different, wash the line before and after administration using a compatible solution with
levofloxacin and the other medications.
g) Unless the doctor makes a different recommendation, its use in children is not advised due to the
association with the risk of severe adverse reactions.

Lidocaine
Local anesthetic
Antiarrhythmic

PRESENTATION

1% solution: Ampule bottle with 50 mL of injectable solution containing 500 mg of lidocaine hydrochloride
(10 mg/mL).

2% solution: Ampule vial with 50 mL of injectable solution containing 1000 mg of lidocaine hydrochloride
(20 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%, sodium chloride 0.45%, sodium chloride 0.9%, dextrose 5% in chloride
0.45% sodium, 5% dextrose in 0.9% sodium chloride.

Reconstitution and dilution:

IV: Only the 1% and 2% solutions are used for direct IV injection. For infusion, remove the dose.
required solution at 1% or 2% and add it to an appropriate volume (usually 500 mL) of solution
compatible to obtain a solution containing between 1-4 mg/mL. Alternatively, dilute 1-2 g of
lidocaine with 250 mL, 500 mL, and 1000 mL of compatible solution.

STABILITY

a) Store the unopened ampule at room temperature (no more than 30°C). Do not freeze;
protect from excessive heat. The solution must be clear and colorless.
b) The diluted solutions (1-4 mg/mL) are stable at room temperature (no more than 30°C) for the
less than 24 hours.
c) Once the ampoule bottle is opened, it must be used within 7 days when stored at
ambient temperature (no more than 30°C) or refrigerated (2-8°C).
 119

ADMINISTRATION

Adult
Method Use Speed Comment
Administer at 20-50 mg/minute. Do not administer doses higher than 200-
direct IV 1% solution: 2-5 mL/minute. 300 mg in 1 hour. It is recommended.
2% solution at 1.25-2.5 mL/minute. cardiac monitoring.
Intermittent IV Do not administer by this method.
Administer 1-4 mg/minute (14-57). Cardiac monitoring is recommended.
IV continues
mcg/kg/minute.
IM Only by medical prescription.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Administer for 2-3 minutes. Do not exceed 0.7 mg/kg/minute or 50
Direct IV
mg/minute, whichever is lower.
IV intermitente Do not administer by this method.
IV continues Administer at 10-50 mcg/kg/minute. Dilute to a concentration: 0.8-8 mg/mL.
IM Only by medical indication.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Alteplase, amicacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride, calcium
["gluconate","cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","ciprofloxacin","cisatracurium besilate"]
clindamycin phosphate, dexamethasone sodium phosphate ["dexmedetomidine hydrochloride","digoxin","dobutamine"]
["hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)","ergonovine maleate"]
sodium ertapenem, esmolol hydrochloride, streptokinase, fentanyl citrate, phytonadione (vitamin K1), fluconazole,
["furosemide","sodium heparin","sodium succinate hydrocortisone","ketorolac tromethamine","levofloxacin","linezolid"]
magnesium sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride, metronidazole
["midazolam hydrochloride","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine"]
["bitartrate (norepinephrine)","ondansetron hydrochloride","oxytocin","paracetamol (acetaminophen)","potassium chloride"]
["oxytocin","sodium penicillin G","potassium chloride","ranitidine hydrochloride","tigecycline","glycerin trinitrate"]
succinylcholine chloride, vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Alteplase, aminophylline, amiodarone hydrochloride, calcium gluconate, ciprofloxacin, sodium dexamethasone phosphate.
digoxina, dobutamina clorhidrato, dopamina clorhidrato, efedrina sulfato, fentanilo citrato, flumazenil, furosemida,
["sodium heparin","sodium succinate hydrocortisone","potassium penicillin G","potassium chloride","ranitidine hydrochloride"]
glycerin trinitrate, verapamil hydrochloride.

Syringe
Fentanyl citrate, sodium heparin, ketamine hydrochloride, metoclopramide hydrochloride, morphine sulfate.
120

OBSERVATIONS AND PRECAUTIONS

a) It is recommended to use an infusion pump for continuous infusion.

b) Solutions containing epinephrine should not be used to treat arrhythmias nor should they be
administered intravenously.
c) Stop the infusion immediately if signs of excessive cardiac depression occur (for example,
prolongation of the PR interval and QRS complex, appearance or worsening of arrhythmias.
d) Lidocaine hydrochloride solutions containing 40, 100, or 200 mg/mL must be diluted beforehand.
of the administration.
e) An overdose from the administration of lidocaine via direct IV without prior dilution can cause cardiac arrest.
cardiac, seizures and/or death.
f) Do not add lidocaine to blood products. Visually inspect the solutions for
find particles or discolorations before administration, discard if this is present.

LINEZOLID
Oxazolidinone antibiotic

PRESENTATION

Bag with 300 mL of injectable solution containing 600 mg of linezolid (200 mg/100 mL, 2 mg/mL).

PREPARATION

Compatible solutions: 0.9% Sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: No additional preparation is required, the infusion bag is ready for use. The solution is clear and
yellowish color.

STABILITY

a) Store the unopened infusion bag at room temperature (no more than 30°C).
b) Keep the infusion bag in its original metal container before and during administration.
c) Once the infusion bag is opened, use immediately and within no more than 24 hours at room temperature.
environment (no more than 30°C).
d) Do not freeze and protect from light. Do not add additives to the solution bag.
The yellowish color of the solution may intensify over time without affecting the
potency of the medication.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Do not administer by this method.
intermittent IV Infuse for 30-120 minutes.
 121

IV continues Do not administer by this method.

I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
direct IV Do not administer by this method.
Intermittent IV Infuse for 30-120 minutes.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, sodium ampicillin, sodium bicarbonate
buprenorphine hydrochloride, calcium gluconate, cefepime hydrochloride, cefotaxime, ceftazidime, sodium ceftriaxone
["cefuroxime","ciprofloxacin","cisatracurium besylate","clindamycin phosphate","sodium dexamethasone phosphate"]
dexmedetomidina clorhidrato, digoxina, dobutamina clorhidrato, dopamina clorhidrato, efedrina sulfato, epinefrina
["hydrochloride (adrenaline)","ertapenem sodium","esmolol hydrochloride","fentanyl citrate","fluconazole","furosemide","glycerol"]
trinitrate, haloperidol lactate, sodium heparin, hydralazine hydrochloride, ketorolac trometamol, levofloxacin
lidocaine hydrochloride, magnesium sulfate, mannitol, meropenem, metoclopramide hydrochloride, metronidazole
["midazolam hydrochloride","morphine sulfate","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate"]
["norepinephrine","ondansetron hydrochloride","oxytocin","potassium chloride","ranitidine hydrochloride","succinylcholine chloride"]
tigeciclina, trinitrato de glicerilo, vancomicina clorhidrato, vecuronio bromuro, verapamilo clorhidrato, zoledrónico
acid.

Mixture
Ceftazidime, ciprofloxacin, sodium dexamethasone phosphate, levofloxacin.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) When the same intravenous line is used for sequential infusion of other medications, flush.
the IV line with 5% dextrose or 0.9% sodium chloride before and after the infusion.
122

MAGNESIUM SULFATE
Electrolyte replenisher
Anticonvulsant
Antiarrhythmic
Uterine relaxant

PRESENTATION

Vial with 10 mL of injectable solution containing 1 g of magnesium sulfate, equivalent to 8.1 mEq of
magnesium and 8.1 mEq of sulfate (10%, 100 mg/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: For intermittent IV infusion, dilute in 100 mL of 0.9% sodium chloride. The concentrated sulfate solution
Magnesium must be diluted to a concentration of 20% or less before administration.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C). Protect from light. Do not
do not refrigerate or freeze.
b) The cooling of the solution can result in precipitation or crystallization.
c) The open ampoule and/or the diluted solution must be used within 24 hours at room temperature.
environment (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer a 150 mg/minute, Risk of vasodilation or hypotension if
Direct IV except in severe eclampsia where it is administered quickly.
convulsion.
Administer in 30 minutes. Not for except in severe eclampsia with
exceed 150 mg/minute (for example, 1.5 seizures where the initial dose is
Intermittent IV mL/minute of 10% solution. administered 4 g in 20-30 minutes and
other instructions according to the
doctor.
Infuse within 2-24 hours. Do not exceed. The dose can be diluted with 250 mL of
IV continues a rate of 1 mEq/kg/hour (125 sodium chloride 0.9%).
mg/kg/hour.
Concentration: 200 mg/mL. It also
I am can use at 250-500 mg/mL (25-
50%).
SC Do not administer by this method.
 123

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 10-60 minutes. No Concentration: 0.5 mEq/mL (60mg/mL),
exceed 1 mEq/kg/hour (125 (maximum concentration: 1.6 mEq/mL, 200
Intermittent IV
mg/kg/hour or 150 mg/minute or 1.5 mg/mL.
mL/minute of 10% solution.
Infuse for 2-24 hours. Do not exceed 1 mEq/kg/hour (125
IV continues
mg/kg/hour.
I am Concentration: 200 mg/mL or less.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefotaxime
["ceftazidime","cisatracurium besilate","clindamycin phosphate","dexmedetomidine hydrochloride","digoxin","dobutamine"]
["hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)","ertapenem sodium","esmolol"]
["chlorhydrate","streptokinase","fentanyl citrate","fluconazole","sodium heparin","ketorolac trometamol","lidocaine"]
["hydrochloride","linezolid","mannitol","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine sulfate"]
["multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)","ondansetron"]
["hydrochloride","oxytocin","paracetamol (acetaminophen)","sodium and potassium penicillin G","potassium chloride","ranitidine"]
["hydrochloride","succinylcholine chloride","tigecycline","glycerin trinitrate","vancomycin hydrochloride","vecuronium bromide"]
verapamil hydrochloride, zoledronic acid.

Mix
Sodium heparin, meropenem, metronidazole, norepinephrine bitartrate (noradrenaline), potassium chloride, verapamil
hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Visually inspect the solution for particles and discolorations before the
administration.
b) The accidental overdose of IV magnesium has resulted in serious harm to the patient and death. Having a
second independent person for double-checking the original indication, dosage calculations, and
infusion speeds. Do not confuse dosages in milligrams (mg), grams (g) or milliequivalents.
(mEq)
c) Do not exceed 5-7 days of continuous treatment; a longer duration of treatment may lead to
adverse effects on the fetus.
d) IM administration is painful and should be reserved for those patients with IV access
limited and hypomagnesemia.
e) The administration of IV in the bolus can cause redness, sweating, and a feeling of heat, and must
to be avoided, if possible.
124

Mannitol
Osmotic diuretic

PRESENTATION

20% solution: Bottle with 250 mL of injectable solution containing 50 g of mannitol (20 g/100 mL, 0.2 g/mL).

PREPARATION

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: Does not require reconstitution or additional dilution. The solution must be at body temperature before
the infusion.

STABILITY

a) Store the unopened bottle at room temperature (20-30 °C); do not refrigerate or freeze.
b) At concentrations greater than 15%, crystallization may occur at low temperatures; do not use.
solutions that contain crystals.
c) If crystallization occurs, heat in a water bath and stir vigorously to dissolve.
the crystals.
d) Do not mix with strongly acidic or alkaline solutions; potassium chloride or sodium chloride.
They can cause precipitation of 20% or 25% mannitol.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Manage in 3-5 minutes. Only by medical indication.
intermittent IV Administer in 30-90 minutes. Assess urinary volume.
IV continues Manage in 2 to several hours. Assess urinary volume.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Manage in 3-5 minutes. Only by medical prescription.
Intermittent IV Infuse for 15-60 minutes. Evaluate urinary volume.
IV continues Infuse for 2 to several hours. Assess urinary volume.
I am Do not administer by this method.
SC Do not administer by this method.
 125

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate,
buprenorphine hydrochloride, calcium gluconate, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, cisatracurium
besilate, clindamycin phosphate, dexamethasone sodium phosphate, dexmedetomidine hydrochloride, digoxin, dobutamine
["hydrochloride","dopamine hydrochloride","sulfate ephedrine","epinephrine hydrochloride","ertapenem sodium","esmolol hydrochloride"]
estreptoquinasa, fentanilo citrato, fitomenadiona (vitamina K1), fluconazol, furosemida, heparina sódica,
sodium hydrocortisone succinate, ketorolac tromethamine, lidocaine hydrochloride, linezolid, magnesium sulfate
metilprednisolona succinato sódico, metoclopramida clorhidrato, metronidazol, midazolam clorhidrato, morfina
["sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)"]
ondansetron hydrochloride, oxytocin, paracetamol (acetaminophen), sodium and potassium penicillin G, potassium chloride
["ranitidine hydrochloride","magnesium sulfate","succinylcholine chloride","tigecycline","glyceryl trinitrate","vancomycin"]
["hydrochloride","vecuronium bromide","verapamil hydrochloride","zoledronic acid"]

Mix
["Amikacin sulfate","Aminophylline","Sodium bicarbonate","Sodium ceftriaxone","Dexmedetomidine hydrochloride","Dobutamine"]
hydrochloride, dopamine hydrochloride, furosemide, metoclopramide hydrochloride, ondansetron hydrochloride, tramadol
chloride, verapamil hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The dosage, concentration of the solution, and the rate of administration vary with the condition.
that will be addressed and the patient's fluid requirements, urinary volume, and response to
medicine.
Rapid administration can result in hypotension, hyperosmolality, and elevations in the
intracranial pressure.
c) Do not administer with blood or hematological products. Crenation and agglutination may occur.
red blood cells.
d) Do not use the solution if there are undissolved crystals.
It is preferable to infuse via central venous catheter due to the risk of vein damage.
f) Frequently check the infusion site for infiltration. Extravasation can cause
tissue irritation and necrosis.
g) Vesicant medication (at concentrations greater than 5%); ensure proper placement of the
catheter or needle before and during IV infusion. Avoid extravasation. If extravasation occurs, stop
the infusion immediately and disconnect (leave the needle/cannula in place); gently aspirate the
extravasated solution (do not flush the line); start treatment according to the doctor; remove the
needle/cannula; apply dry cold compresses; elevate the limb.
126

MEROPENEM
Carbapenem antibiotic

PRESENTATION

Vial with powder containing 1 g of meropenem.

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Reconstitute the vial of 1 g with 20 mL of injectable water to obtain an approximate concentration of
50 mg/mL. The bottle should be shaken to dissolve the powder; allow to rest until the solution is
clear and colorless to pale yellow. Dilute the dose with 50-250 mL of compatible solution.

STABILITY

a) Keep the unopened ampule at room temperature (no more than 30°C). Do not freeze.
b) Reconstituted solution: Use immediately or as soon as possible. The solution is stable for 2
Hours at room temperature (no more than 25°C) and 12 hours in refrigeration (2-8 °C). Do not freeze.
c) Diluted solution: The 0.9% sodium chloride solution is stable for 4 hours at temperature
environment (no more than 25°C) and 18 hours in refrigeration (2-8 °C). The solution in 5% dextrose and dextrose
sodium chloride is stable for 1 hour at room temperature (no more than 25°C) and 8 hours in
refrigeration (2-8 °C). Do not freeze.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer for 3-5 minutes. Not recommended.
Intermittent IV Administer for 15-30 minutes. Concentration: 2.5-50 mg/mL.
IV continues Manage in a maximum of 4 hours. Consider stability of the solution
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
direct IV Administer for 10 minutes. Not recommended.
Intermittent IV Administer for 15-30 minutes. Concentration: 1-20 mg/mL.
IV continues Administer in 3-4 hours. Consider the stability of the solution.
I am Do not administer by this method.
SC Do not administer by this method.
 127

COMPATIBILITY

Site Y
Aminophylline, sodium dexamethasone phosphate, dexmedetomidine hydrochloride, digoxin, esmolol hydrochloride, fluconazole,
["furosemide","sodium heparin","linezolid","metoclopramide hydrochloride","metronidazole","morphine sulfate","norepinephrine"]
["bitartrate (norepinephrine)","oxytocin","potassium chloride","tigecycline","vancomycin hydrochloride","vecuronium bromide"]
zoledronic acid.

Mix
Aminophylline, atropine sulfate, sodium dexamethasone phosphate, dobutamine hydrochloride, dopamine hydrochloride,
["fluconazole","furosemide","sodium heparin","magnesium sulfate","metoclopramide hydrochloride","morphine sulfate"]
norepinephrine bitartrate (noradrenaline), ranitidine hydrochloride, vancomycin hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Contraindicated in patients with severe hypersensitivity to penicillins, cephalosporins, and

carbapenems.
b) Monitor the presence of adverse reactions associated with meropenem.
c) Monitor the infusion site for inflammation and/or extravasation.

METAMISOL (DIPYRON)
Analgesic
Antipyretic

PRESENTATION

Ampule with 2 mL of injectable solution containing 1 g of dipyrone (500 mg/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: Dilute the dose of metamizole with 50-100 mL of compatible solution.
128

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C).
b) The open ampoule and/or the diluted solution must be used within 24 hours at temperature
environment (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Do not manage by this method. It can
Direct IV
cause hypotension and shock.
intermittent IV Administer for 1-2 hours.
IV continues Do not administer by this method.
Suck in before injecting a
IM
glass
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Do not administer by this method. It may
direct IV
cause hypotension and shock.
intermittent IV Administer for 1-2 hours.
IV continues Do not administer by this method.
In children under 11 months, use only the route.
IM
intramuscular.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

{"text":"OBSERVATIONS AND PRECAUTIONS"}

a) Monitor adverse reactions associated with the medication. Adverse reactions have been reported.
severe including agranulocytosis, aplastic anemia, thrombocytopenic purpura, and anemia
hemolytic.
b) Monitor blood pressure, heart rate, and respiration during and after administration
about metamizole.
c) The patient must remain lying down during and after the administration of metamizole.
 129

d) The patient must be hemodynamically stable with a minimum blood pressure of 100/60
mmHg.

Methylprednisolone
Corticosteroid

PRESENTATION

Vial ampoule with powder containing sodium methylprednisolone succinate equivalent to 500 mg of
methylprednisolone

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose, 5% dextrose in 0.9% sodium chloride, dextrose
5% in sodium chloride 0.45%.

Reconstitution and dilutions:

IV: To administer by infusion IV, reconstitute with the diluent provided by the manufacturer.
Subsequently, dilute with 100-250 mL of compatible solution.
Reconstitute with the diluent provided by the manufacturer and shake well. Do not dilute or add others.
solutions.

STABILITY

a) Keep the unopened ampule vial at room temperature (no more than 30°C). Protect from light.
b) The reconstituted solution of sodium methylprednisolone succinate should be stored at
ambient temperature (no more than 30°C) or refrigerated (2-8°C) and should be used within 48
hours.
c) The diluted solution with 0.9% sodium chloride must be used within 48 hours stored at
ambient temperature (no more than 30°C) or in refrigeration (2-8°C).
d) The diluted methylprednisolone solution with dextrose must be used within the first 8
hours stored at room temperature (no more than 30°C) or in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer in 15-60 minutes.
IV continues According to medical instructions. Concentration: 2.5-20 mg/mL
Suction first to avoid injecting a
IM
glass.
130

SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer in 20-120 minutes.
IV continues Manage in 3 hours or more. Concentration of 2.5-20 mg/mL.
Aspirate first to avoid injecting a
I am
glass.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, atropine sulfate, aminophylline, sodium bicarbonate, buprenorphine
["chloride","cefepime hydrochloride","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","dexamethasone"]
["sodium phosphate","dexmedetomidine hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine"]
["sulfate","epinephrine hydrochloride (adrenaline)","ertapenem sodium","streptokinase","fentanyl citrate","fluconazole"]
furosemide, ketorolac tromethamine, levofloxacin, lidocaine hydrochloride, mannitol, metoclopramide hydrochloride
metronidazol, midazolam clorhidrato, morfina sulfato, multivitamínicos, nitroprusiato sódico, norepinefrina
bitartarate (norepinephrine), oxytocin, paracetamol (acetaminophen), sodium and potassium penicillin G, ranitidine
["chloride hydrochloride","succinylcholine chloride","glycerol trinitrate","vancomycin hydrochloride","verapamil hydrochloride"]
zoledronic acid.

Mix
Clindamycin phosphate, dopamine hydrochloride, sodium heparin, norepinephrine bitartrate (noradrenaline), penicillin G
potassium, potassium chloride, ranitidine hydrochloride, verapamil hydrochloride.

Syringe
Paracetamol (acetaminophen), metoclopramide hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) Blood pressure monitoring is recommended, as rapid infusion has been associated with collapse.
circulatorio.
b) Do not administer if the solution is not transparent, if it contains suspended particles or sediments.
c) The formulation of methylprednisolone ACETATE should not be administered intravenously.
d) Do not use benzyl alcohol as a diluent in neonates, especially in preterm infants.
 131

METOCLOPRAMIDE
Gastrointestinal stimulant
Antiemetic

PRESENTATION

Vial with 2 mL of injectable solution containing 10 mg of metoclopramide hydrochloride (5 mg/mL).

PREPARATION

["Compatible solutions: 0.9% sodium chloride, 5% dextrose, 10% dextrose, 5% dextrose in sodium chloride"]
0.45%, dextrose 5% in sodium chloride 0.9%, mannitol 20%.

Reconstitution and dilution:

IV: For direct IV administration, it can be used undiluted. If the dose is greater than 10 mg, dilute in 50 mL of
a compatible solution. For intermittent IV infusion, dilute the prescribed dose in 50-100 mL of solution
compatible. For continuous IV infusion, dilute the prescribed dose in 100-500 mL of compatible solution.

STABILITY

a) Store the unopened ampule at room temperature (no more than 30 °C) and protect from light.
b) After dilution, it is stable for 48 hours under refrigeration (2-8°C), without freezing and up to 24
hours at room temperature (no more than 30°C). Protect from light.
c) The 0.9% sodium chloride solution is preferred because metoclopramide hydrochloride is more
stable in this solution.

ADMINISTRATION

Adult
Method Use Speed Comment
Administer in 1-2 minutes for each The fast administration can cause
Direct IV 10 mg. intense feelings of anxiety and
restlessness, followed by drowsiness.
Administer for at least 15-30 Maximum speed: 5mg/minute.
intermittent IV
minutes.
IV continues Administer in 8-12 hours.
Aspire first to avoid injecting a vessel.
I am
sanguine
SC Do not administer by this method.
132

Pediatric
Method Use Speed Comment
Administer in 1-2 minutes for each. Quick administration can cause.
direct IV 10 mg. intense feelings of anxiety and
restlessness, followed by drowsiness.
Administer for at least 15-30 Maximum speed: 5 mg/minute. Dilute to
intermittent IV
minutes 0.2 mg/mL
IV continues Administer in 8-12 hours. Concentration: 0.2-3.2 mg/mL.
I am Concentration: 5 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate, buprenorphine
["hydrochloride","calcium gluconate","cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","ciprofloxacin","cisatracurium"]
["besilate","clindamycin phosphate","sodium dexamethasone phosphate","dexmedetomidine","digoxin","dobutamine hydrochloride"]
["dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)","ertapenem sodium","esmolol hydrochloride"]
streptokinase, fentanyl citrate, filgrastim, phytonadione (vitamin K1), fluconazole, sodium heparin
["sodium succinate hydrocortisone","ketorolac tromethamine","levofloxacin","lidocaine hydrochloride","linezolid","magnesium"]
["sulfate","mannitol","meropenem","methylprednisolone sodium succinate","metronidazole","midazolam hydrochloride","morphine"]
["sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)"]
ondansetron hydrochloride, oxytocin, paracetamol (acetaminophen), sodium and potassium penicillin G, potassium chloride
ranitidine hydrochloride, succinylcholine chloride, glyceryl trinitrate, vancomycin hydrochloride, vecuronium bromide
verapamil hydrochloride, zoledronic acid.

Mix
["Butilhyoscine","clindamycin phosphate","mannitol","meropenem","multivitamins","potassium chloride","ranitidine hydrochloride"]
tramadol hydrochloride, verapamil hydrochloride.

Syringe
Aminophylline, atropine sulfate, sodium dexamethasone phosphate, fentanyl citrate, sodium heparin, hydrocortisone
["sodium phosphate","lidocaine hydrochloride","sodium methylprednisolone succinate","midazolam hydrochloride","ondansetron"]
hydrochloride, paracetamol (acetaminophen), ranitidine hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with metoclopramide.

b) Visually inspect for particles or change in the coloration of the solution (degradation is
indicated by the yellowish coloration) before administration and discard if they occur.
 133

METRONIDAZOLE
Antibiotic
Antiparasitic

PRESENTATION

Vial with 100 mL of injectable solution containing 500 mg of metronidazole (5 mg/mL).

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: The vial with pre-mixed solution of concentration 5 mg/mL does not require dilution or neutralization.
before the IV administration.

STABILITY

a) Keep the unopened jar at room temperature (no more than 30°C). Protect from light.
b) The vial with ready-to-use injectable solution (5 mg/mL) should not be exposed to temperature of
cooling due to the possibility of forming crystals. The crystals dissolve when taken
the ambient temperature.
c) Prolonged exposure to light will cause darkening of the solution.
d) Once the vial with injectable solution is opened, use within 24 hours when stored at
ambient temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Do not administer by this method.
Intermittent IV Administer for 60 minutes.
IV continues According to medical advice. Only by medical indication.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Manage in 60 minutes. Concentration: 5-8 mg/mL.
IV continues According to medical indication. Only by medical prescription.
IM Do not administer by this method.
134

SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, sodium ampicillin, sodium bicarbonate
buprenorphine hydrochloride, calcium gluconate, cefepime hydrochloride, cefotaxime, ceftazidime, sodium ceftriaxone
cefuroxime, ciprofloxacin, cisatracurium besilate, clindamycin phosphate, sodium dexamethasone phosphate
dexmedetomidina clorhidrato, digoxina, dobutamina clorhidrato, dopamina clorhidrato, efedrina sulfato, epinefrina
["sulfate (adrenaline)","sodium ertapenem","esmolol hydrochloride","fentanyl citrate","fluconazole","furosemide","heparin"]
["sodium, haloperidol lactate, sodium heparin, hydralazine hydrochloride, sodium succinate hydrocortisone, ketamine"]
["hydrochloride","ketorolac trometamol","levofloxacin","lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol"]
["meropenem","methylprednisolone sodium succinate","metoclopramide hydrochloride","midazolam hydrochloride","morphine"]
sulfate, nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), ondansetron
["oxytocin","potassium chloride","ranitidine hydrochloride","succinylcholine chloride","sodium thiopental","glyceryl trinitrate"]
vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Ceftazidime, sodium ceftriaxone, cefuroxime, ciprofloxacin, sodium dexamethasone phosphate, fluconazole, magnesium
sulfate, midazolam hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with the medication.

b) Do not use equipment that contains aluminum to reconstitute or transfer the solutions.

MIDAZOLAM
Sedative
adjunct anesthetic

PRESENTATION

Vial with 5 mL of injectable solution containing 5 mg of midazolam hydrochloride (1 mg/mL).

Ampoule with 10 mL of injectable solution containing 50 mg of midazolam hydrochloride (5 mg/mL).

PREPARATION

["Compatible solutions: Dextrose 5%, dextrose 10%, sodium chloride 0.9%, sodium chloride 0.45%, dextrose"]
5% sodium chloride 0.9%, 5% dextrose in 0.45% sodium chloride.
 135

Reconstitution and dilution:

IV: Dilute the solution to a concentration of 0.5-1 mg/mL. For example, dilute 100 mg of midazolam in 100 mL.
a compatible solution. The 1 mg/mL solution is recommended to facilitate slow direct IV injection
of the medication.

STABILITY

a) Keep the unopened ampoule at room temperature (not exceeding 30 °C) and protect it from light.
b) The opened ampoule and/or the diluted solution must be used within 24 hours when it is
store at room temperature (no more than 30 °C) or under refrigeration (2-8 °C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer for 2-5 minutes. Concentration: 1 mg/mL. Evaluate effect
Direct IV
después de 2 minutos.
IV intermittent Do not administer by this method.
IV continues According to medical advice. Concentration: 0.5-1 mg/mL.
Only for indication médica.
IM
Maximum concentration: 1 mg/mL.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Administer for 2 to 5 minutes. Concentration: 0.5-1 mg/mL. Evaluate
Direct IV
effect after 2 minutes.
Intermittent IV Do not administer by this method.
IV continues As per medical indication. Concentration: 0.5 mg/mL.
Only for indication doctor.
IM
Maximum concentration: 1 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefotaxime
["sodium ceftriaxone","ciprofloxacin","cisatracurium besylate","dexmedetomidine hydrochloride","digoxin","dopamine"]
clorhidrato, efedrina sulfato, epinefrina clorhidrato (adrenalina), esmolol clorhidrato, estreptoquinasa, fentanilo
["citrate","phytonadione (vitamin K1)","fluconazole","sodium heparin","ketamine hydrochloride","levofloxacin","lidocaine"]
["hydrochloride","linezolid","magnesium sulfate","mannitol","metoclopramide hydrochloride","metronidazole","morphine sulfate"]
multivitamins, nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), ondansetron
hydrochloride, oxytocin, paracetamol (acetaminophen), penicillin G potassium, potassium chloride, ranitidine hydrochloride
136

["succinylcholine chloride","tigecycline","tramadol hydrochloride","glyceryl trinitrate","vancomycin hydrochloride","vecuronium"]

bromide, hydrochloride verapamil, zoledronic acid.

Mix
Butilhioscina, cefuroxime, ciprofloxacin, haloperidol lactate, metoclopramide hydrochloride, ketamine hydrochloride,
["metronidazole","morphine sulfate","ranitidine hydrochloride","tramadol hydrochloride"]

Syringe
Acetaminophen (paracetamol), atropine sulfate, buprenorphine hydrochloride, butylscopolamine, fentanyl citrate,
metoclopramide hydrochloride, nalbuphine hydrochloride, ondansetron hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) Make sure to select the vial with the correct concentration.

b) Use an infusion pump during the administration of midazolam.
c) The dose of midazolam needs to be individualized based on the patient's age, diseases
adjacent and concomitant medications.
d) Use continuous cardiorespiratory monitoring.
e) Having equipment for mechanical ventilation. The necessary equipment and personnel for resuscitation.
Cardiopulmonary support must be available during the administration of midazolam.
Rapid administration can result in respiratory depression, airway obstruction.
respiratory arrest.
g) Do not administer by rapid IV injection in neonates (hypotension and seizures reported,
especially when used concomitantly with fentanyl.
h) Do not administer via intra-arterial, intrathecal, or epidural.
i) Avoid extravasation, it can cause tissue damage and necrosis.

MULTIVITAMINS
Vitamins

PRESENTATION

Vial with powder. See specific information on vitamin amounts on the label.

PREPARATION

Soluciones compatibles:Cloruro de sodio 0.9%, cloruro de sodio 0.45%, dextrosa 5%, dextrosa 10%.

Reconstitution and dilution:

IV: For IV infusion, reconstitute the vial with 5 mL of injectable water. In adult patients, dilute the solution.
reconstituted with no less than 500 mL and in pediatric patients with no less than 100 mL of compatible solution. The
the solution is bright yellow.
 137

STABILITY

a) Keep the unopened vial at room temperature (no more than 30°C) and protect from light.
b) After reconstitution, the solution is stable for 4 hours at room temperature (no more than
30°C) before the final dilution.
c) After diluting with the infusion solution, it must be used within 24 hours when it
Store at room temperature (no more than 30°C) or in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Do not administer by this method. It can
Direct IV
to produce vertigo and irritation of the tissue.
Intermittent IV According to medical advice.
According to medical indication. Do not administer if the solution has
IV continues
crystallized.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Do not manage by this method. It can
Direct IV
producir vértigo e irritación tisular.
intermittent IV According to medical instruction.
IV continues According to medical indication. Dilute in at least 100 mL of solution.
I am Do not administer by this method.
SC Do not administer using this method.

COMPATIBILITY

Site Y
["Sodium acyclovir","amikacin sulfate","aminophylline","atropine sulfate","sodium bicarbonate","buprenorphine hydrochloride"]
["gluconate calcium","cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","dexamethasone"]
["sodium phosphate","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride"]
(adrenaline), esmolol hydrochloride, streptokinase, fentanyl citrate, phytonadione (vitamin K1), fluconazole
furosemide, sodium heparin, sodium succinate hydrocortisone, ketorolac trometamol, lidocaine hydrochloride
magnesium sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride, midazolam
hydrochloride, morphine sulfate, nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate (noradrenaline)
ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride, ranitidine hydrochloride,
succinylcholine chloride, glycerol trinitrate, vancomycin hydrochloride, verapamil hydrochloride.

Mix
Sodium bicarbonate, metoclopramide hydrochloride, norepinephrine bitartrate (noradrenaline), verapamil
hydrochloride.
138

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with the medication.

b) Tener precaución de no administrar directamente a la vía sin diluir.

NALBUFINE
Opioid analgesic

PRESENTATION

Vial with 1 mL of injectable solution containing 10 mg of nalbuphine (10 mg/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose in 0.9% sodium chloride, 10% dextrose.

Reconstitution and dilution:

It can be administered undiluted at a concentration of 10 mg/mL.
SC: No dilution required at a concentration of 10 mg/mL.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30 °C). Protect from light.
b) The opened ampoule and/or the diluted solution must be used within 48 hours when
keep at room temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Administer every 10 mg in 2-3 Concentration: 10 mg/mL.
Direct IV
minutes.
IV intermittent Administer for 10-15 minutes.
IV continues Do not administer by this method.
Suck back first to avoid injecting into a vessel
IM
sanguine
SC Concentration: 10 mg/mL.
 139

Pediatric
Method Use Speed Comment
direct IV Administer for 2-3 minutes. Concentration: 10 mg/mL.
intermittent IV Administer for 10-15 minutes.
IV continues Do not administer by this method.
Aspirate first to avoid injecting into a vessel
I am
sanguine.
SC Concentration: 10 mg/mL.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, buprenorphine sulfate, calcium gluconate,
["cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","cisatracurium besilate","clindamycin phosphate","dexamethasone"]
["sodium phosphate","dexmedetomidine hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine"]
sulfate, epinephrine hydrochloride (adrenaline), ertapenem sodium, esmolol hydrochloride, fentanyl citrate, filgrastim
["phytomenadione (vitamin K1)","fluconazole","sodium heparin","levofloxacin","lidocaine hydrochloride","linezolid","magnesium"]
sulfate, mannitol, metoclopramide hydrochloride, metronidazole, midazolam hydrochloride, morphine sulfate
multivitamins, sodium nitroprusside, norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin
["paracetamol (acetaminophen)","sodium penicillin G","potassium chloride","ranitidine hydrochloride","succinylcholine"]
["chloride","tigecycline","glycerin trinitrate","vancomycin hydrochloride","vecuronium bromide","verapamil hydrochloride"]
zoledronic acid.

Mix
Do not mix with other medications.

Syringe
Atropine sulfate, lidocaine hydrochloride, midazolam hydrochloride, paracetamol (acetaminophen), ranitidine hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) The accidental overdose of opioid analgesics has resulted in death. Before administering,
clarify all the instructions; ensure the double review of the original order, dose calculations and
dilutions.
b) Before administration, it is recommended that an opioid antagonist (for example, naloxone) be administered.
easily available, as well as cardiopulmonary resuscitation and ventilation equipment
mechanics.
c) Do not use the medication in children under 1 year old.
140

Nimodipine
Calcium channel blocker

PRESENTATION

Vial with 50 mL of injectable solution containing 10 mg of nimodipine (0.2 mg/mL, 0.02%).

PREPARATION

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV:The solution at a concentration of 0.2 mg/mL (0.02%) requires no dilution or additional preparation.
Visually inspect for particles or discoloration before administration and discard if
this is presented.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30ºC).
b) The medication is light sensitive and should be stored in the cardboard packaging it comes with.
provided.
c) Nimodipine should not be added to containers or vials with solutions or mixed with others
medications.
d) Protect the infusion and the administration line from direct sunlight.
The medication is stable in diffuse daylight and artificial light for up to 10 hours at temperature.
environment (no more than 30°C). Prepare a new infusion if required once the 10 hours have passed
elapsed.
Nimodipine is incompatible with some plastics used in infusion packaging, equipment for
administration and filters, for example, PVC. Avoid using these materials.

ADMINISTRATION

Adult
Método Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
Administer at 0.5-2 mg/hour (2.5-10). Monitor for medication tolerance.
IV continues
mL/hour recommend a central route.
IM Do not administer by this method.
SC Do not administer by this method.
 141

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

Continuous cardiac monitoring is recommended.

b) Use only the container of the solution and the infusion line provided by the manufacturer.
c) The administration of nimodipine must be done through a central venous catheter.
d) The solution for nimodipine infusion contains ethanol.
Nimodipine should be administered simultaneously, using a three-way tap with
solutions for infusion, such as 5% dextrose, 0.9% sodium chloride, Ringer lactate, Ringer lactate with
magnesium (Hartmann) or 40% dextran at a volume ratio of 1:4 (40 mL/hour) through a route
nimodipine and on the other hand the solution; for example, 5 mL/hour of nimodipine and 20 mL/hour of the solution
co-administered. It can also be administered simultaneously with mannitol, human albumin and
blood.

Sodium Nitroprusside
Antihypertensive
Vasodilator

PRESENTATION

Vial containing 2 mL of injectable solution that contains 50 mg of sodium nitroprusside (25 mg/mL).

Preparation

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: Dilute the sodium nitroprusside solution (25 mg/mL) with 5% dextrose: 50 mg in 250 mL (concentration
final: 200 micrograms/mL), 50 mg with 500 mL (final concentration: 100 micrograms/mL) or dilute 50 mg
with 1000 mL (final concentration: 50 micrograms/mL). The recommended concentration is 50-200
142

mcg/mL. In patients with fluid restriction, a final concentration of 800 mcg/mL has been used in
5% dextrose. Immediately after mixing, wrap the solution container with opaque material.
(for example, aluminum foil) to protect it from light.

STABILITY

a) Store the unopened ampule at room temperature (no more than 25 °C). Do not freeze.
b) Infusion solution: Protect from light. The solution diluted in 5% dextrose or 0.9% sodium chloride.
that is stored at room temperature (no more than 25 °C) or refrigeration (2-8°C) should be used
within 24 hours, if properly protected.
c) Wrap the solution container with aluminum foil or another opaque material; use amber IV line.
preference. The freshly prepared solutions may have a slight brown coloration.
Discard the solution if it has a strong brown, orange, blue, green, or red coloration, as this
indicates severe degradation in the presence of light.
d) 5% Dextrose is the recommended solution for mixing and diluting the concentrated solution due to its
stability.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
Administer at 0.3-8 mcg/kg/minute. Use infusion pump. Speed
IV continues and evaluate the response. maximum: 10 mcg/kg/minute.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
0.2-0.5 mcg/kg/minute Maximum speed: 10 mcg/kg/minute.
IV continues
Concentration: 50-500 mcg/mL.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, calcium gluconate,
cefotaxime, sodium ceftriaxone, cefuroxime, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine
hydrochloride, digoxin, dopamine hydrochloride, sulfate ephedrine, epinephrine hydrochloride (adrenaline), sodium ertapenem
["esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione (vitamin K1)","fluconazole","furosemide"]
["sodium heparin","sodium hydrocortisone succinate","ketorolac trometamol","lidocaine hydrochloride","linezolid"]
magnesium sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride, metronidazole
midazolam hydrochloride, morphine sulfate, multivitamins, nalbuphine hydrochloride, norepinephrine bitartrate
(norepinephrine), ondansetron hydrochloride, oxytocin, penicillin G sodium and potassium, potassium chloride, ranitidine
 143

["hydrochloride, succinylcholine chloride, tigecycline, glyceryl trinitrate, vancomycin hydrochloride, vecuronium bromide"]
verapamil hydrochloride, zoledronic acid.

Mix
Ranitidine hydrochloride, verapamil hydrochloride.

Syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Continuous monitoring of blood pressure is essential. A small increase in speed of

infusion can lead to excessive reduction in blood pressure and may cause headache, dizziness,
diaphoresis, palpitations, and nausea. If this occurs, decrease the infusion rate. Hypotension.
Nitroprusside-induced is self-limiting within 1 to 10 minutes after stopping the infusion.
b) The patient must remain lying down during the infusion of sodium nitroprusside.
c) Extravasation can cause irritation, rash, and redness of the skin at the injection site.
d) High-dose or rapid prolonged infusions can produce clinically relevant levels.
significant cyanide, monitor for potential toxicity.
e) Use an infusion pump for the administration of sodium nitroprusside.

NOREPINEPHRINE (NORADRENALINE)
Vasopressor

PRESENTATION

Vial with 4 mL of injectable solution containing norepinephrine bitartrate equivalent to 4 mg of

norepinephrine (1 mg/mL).

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose, 5% dextrose in 0.9% sodium chloride, dextrose
5% in sodium chloride 0.45%.

Reconstitution and dilution:

IV: Dilute before use (2 mg of norepinephrine bitartrate is equivalent to 1 mg of norepinephrine). Dilute in
100-1000 mL of solution compatible according to the patient's requirements. The solution is usually
prepare by adding 4 mg of norepinephrine to 1 L of compatible solution to obtain a concentration of 4
mcg/mL; a more diluted or more concentrated solution can be prepared. Alternatively, it can be
dilute according to the following: Add 4 mg of norepinephrine to 250 mL or 500 mL of compatible solution,
resulting in a concentration of 16 mcg/mL and 8 mcg/mL of norepinephrine, respectively.
144

STABILITY

a) Keep the unopened ampoule at room temperature (not exceeding 30°C). Do not freeze and protect from
the light.
b) The open ampoule and the solution diluted in 5% dextrose and 0.9% sodium chloride are stable for up to
24 hours at room temperature (no more than 30°C) or refrigerated (2-8°C). Protect from light.
c) Norepinephrine should be diluted with dextrose, as these solutions protect against oxidation.
excessive and the subsequent loss of power. The administration of sodium chloride alone is not
recommended.
d) Norepinephrine is easily degraded by iron salts, oxidants, and alkaline solutions.
Protect from light. Do not infuse and discard if the solution is pink, dark brown (more than
slightly yellowish) or if there is a precipitate.
e) Do not administer sodium bicarbonate (or any alkaline solution) through an IV line that
It contains norepinephrine as medication inactivation may occur.

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Do not administer by this method.
intermittent IV Do not administer by this method.
IV continues According to medical advice. Adjust according to response.
IM Do not administer by this method.
SC Do not administer by this method.
Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
IV continues As per medical indication. Concentration: 4-16 mcg/mL
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefotaxime, ceftazidime,
ceftriaxone, cefuroxime, cisatracurium besilate, clindamycin phosphate, dexamethasone sodium phosphate
["dexmedetomidine hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine"]
hydrochloride (adrenaline), ergonovine maleate, sodium ertapenem, esmolol hydrochloride, streptokinase, fentanyl
["citrate","phytonadione (vitamin K1)","fluconazole","sodium heparin","hydrocortisone sodium succinate","ketorolac"]
["trometamol","lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol","meropenem","methylprednisolone succinate"]
["sodium, metoclopramide hydrochloride, metronidazole, midazolam hydrochloride, morphine sulfate, multivitamins"]
nalbuphine hydrochloride, nimodipine, sodium nitroprusside, ondansetron hydrochloride, oxytocin, sodium penicillin and
["potassium","potassium chloride","ranitidine hydrochloride","succinylcholine chloride","tigecycline","glycerin trinitrate"]
vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
 145

Amikacin sulfate, calcium gluconate, ciprofloxacin, dobutamine hydrochloride, dopamine hydrochloride, sodium heparin
sodium hydrocortisone succinate, magnesium sulfate, meropenem, sodium methylprednisolone succinate
multivitamins, potassium chloride, succinylcholine chloride, verapamil hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Confirmar que la dosis sea expresada como norepinefrina (noradrenalina) base, 1 mg de

Norepinephrine (noradrenaline) base is equivalent to 2 mg of norepinephrine (noradrenaline)
bitartrate.
b) Continuous cardiac monitoring is required during the administration of norepinephrine.
c) Infuse norepinephrine via central venous catheter using an infusion pump.
d) If blood or plasma is indicated, they should be administered separately.
e) Monitor the infusion site for signs of extravasation or vein irritation. Avoid
extravasation as it can cause tissue necrosis.
f) Norepinephrine is a vesicant medication; ensure proper placement of the needle or catheter.
before and during the infusion; prevent extravasation. If extravasation occurs, stop the infusion
immediately and disconnect (leave the cannula/needle in place); gently aspirate the solution
extravasation (do not wash the line); remove the needle/cannula; elevate the limb. Start antidote
As per medical advice. Apply dry heat compresses.

OMEPRAZOLE
Antiulcer

PRESENTATION

Vial ampule with powder containing 40 mg of sodium omeprazole.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose.

Reconstitution and dilution:

IV: Reconstitute the omeprazole 40 mg ampoule with the volume of diluent (10 mL) provided by the
manufacturer. Shake well and mix thoroughly to ensure complete dissolution. Do not use any other
diluent for reconstitution. Once reconstituted with its diluent, the resulting solution can be diluted.
with 100 mL of compatible solution.
146

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C). Protect from light.
b) The reconstituted solution with the diluent provided by the manufacturer is stable for up to 4 hours at
ambient temperature (no more than 30°C).
c) The diluted solution should be used within the first 12 hours when diluted with chloride.
0.9% sodium and within the first 6 hours when diluted with 5% dextrose, stored at
ambient temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Manage in 5 minutes.
intermittent IV Administer in 20-60 minutes.
IV continues Administer at 8 mg/hour (10 mL/hour). Concentration: 80 mg/100 mL
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Manage in 5 minutes.
intermittent IV Administer for 20-30 minutes.
IV continues According to medical indication.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions to the medication.

b) Visually inspect for particles or discoloration before administration and
discard if present. The solution must be clear and colorless.
c) The specific diluent provided by the manufacturer contains monohydrated citric acid and macrogol.
400, check label.
 147

ONDANSETRON
Antiemetic

PRESENTATION

Vial with 4 mL of injectable solution containing ondansetron hydrochloride equivalent to 8 mg of

ondansetron (2 mg/mL).

PREPARATION

["Compatible solutions: Dextrose 5%, dextrose 5% in sodium chloride 0.9%, dextrose 5% in sodium chloride"]
0.45%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: Dilute the indicated dose of ondansetron ranging from 4-16 mg in 50-100 mL. For rapid IV injection, dilute in
20 mL of compatible solution.
IM: Administer without diluting to a concentration of 2 mg/mL.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C), do not refrigerate or freeze.
Protect from light.
b) The opened ampoule and/or the diluted solution must be used within 24 hours of storage.
ambient temperature (no more than 30°C).
c) Shake vigorously to redissolve if a precipitate forms in the ampoule. The power and
safety is not affected by the formation of this precipitate.

ADMINISTRATION

Adult
Method Use Speed Comment
Manage in 2-5 minutes. The rapid injection can cause dizziness.
Direct IV
and visual alterations.
Manage for at least 15
intermittent IV minutes.
IV continues 1 mg/hour for 24-48 hours. Only by medical indication.
Suck in first to avoid injecting into a vessel
IM
sanguine
SC Do not administer by this method.
148

Pediatric
Método Use Speed Comment
Administer for 2-5 minutes. The rapid injection can cause dizziness.
Direct IV
and visual disturbances.
Administer for at least 15 Dilute with 10-50 mL of solution.
Intermittent IV
minutes.
IV continues Only by medical indication.
IM Concentration: 2 mg/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amikacin sulfate, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefotaxime,
cefuroxime, ciprofloxacin, cisatracurium besilate, clindamycin phosphate, dexamethasone sodium phosphate
dexmedetomidina clorhidrato, digoxina, dobutamina clorhidrato, dopamina clorhidrato, efedrina sulfato, epinefrina
hydrochloride (epinephrine), esmolol hydrochloride, streptokinase, fentanyl citrate, filgrastim, phytonadione (vitamin
K1), fluconazole, sodium heparin, hydrocortisone succinate and sodium phosphate, ketorolac trometamol, levofloxacin,
["lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol","metoclopramide hydrochloride","metronidazole","midazolam"]
["hydrochloride, morphine sulfate, multivitamins, nalbuphine hydrochloride, sodium nitroprusside, norepinephrine bitartrate"]
["norepinephrine","oxytocin","paracetamol (acetaminophen)","sodium and potassium penicillin G","potassium chloride","ranitidine"]
["chloride, succinylcholine chloride, tigecycline, glycerin trinitrate, vancomycin hydrochloride, vecuronium bromide"]
verapamil hydrochloride, zoledronic acid.

Mix
Fluconazole, mannitol, morphine sulfate, potassium chloride, ranitidine hydrochloride, tramadol hydrochloride.

Syringe
Atropine sulfate, fentanyl citrate, metoclopramide hydrochloride, midazolam hydrochloride, morphine sulfate.
Paracetamol (acetaminophen).

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions to the medication.

b) The total dose in 24 hours (administered in divided doses) should not exceed 32 mg in adults.
c) In patients aged 75 years or older, the intravenous dose of ondansetron per administration does not
It must exceed 8 mg and should not be administered at an interval of less than 4 hours.
d) Individual doses greater than 16 mg are not recommended due to the potential for prolongation of
cardiac QT interval.
 149

OXYTOCIN
Hormone
Antihemorrhagic

PRESENTATION

Vial with 1 mL of injectable solution containing 5 units of oxytocin.

PREPARATION

["Compatible solutions: Sodium chloride 0.9%, Sodium chloride 0.45%, Dextrose 5%, Dextrose 10%, Dextrose"]
5% sodium chloride in 0.9%, 5% dextrose in 0.45% sodium chloride.

Reconstitution and dilution:

IV: Dilute 10-40 units in 500 mL or 1000 mL of compatible solution. Rotate the container of the solution to
ensure complete mixing. Alternatively, add 5-10 units to 1000 mL of solution
compatible to obtain a concentration solution of 5-10 milli units/mL.

STABILITY

a) Store the unopened ampoule in refrigeration (2-8 °C), but do not freeze.
b) Oxytocin should not be used if it has any discoloration or precipitate.
c) The opened ampoule and/or the diluted solution must be used within 24 hours when stored in
refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Manage in 2-5 minutes. Only by medical indication.
Intermittent IV Do not administer by this method.
0.5-40 milli units/minute of Concentration maximum 40
IV continues
agreement with medical indication. units/1000 mL.
Only by medical indication. Inhale beforehand.
I am
to inject.
SC Do not administer by this method.
150

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride,
gluconate calcium, cephalotin, cefepime hydrochloride, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime
["ciprofloxacin","cisatracurium besilate","clindamycin phosphate","sodium dexamethasone phosphate","dexmedetomidine"]
digoxin, dobutamine hydrochloride, dopamine hydrochloride, ephedrine sulfate, epinephrine hydrochloride (adrenaline)
["ergonovine maleate","sodium ertapenem","esmolol hydrochloride","streptokinase","fentanyl citrate","phytomenadione"]
(vitamin K1), fluconazole, furosemide, sodium heparin, sodium succinate hydrocortisone, ketorolac tromethamine,
["levofloxacin","lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol","meropenem","methylprednisolone"]
["sodium succinate","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine sulfate"]
["multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)","ondansetron"]
hydrochloride, paracetamol (acetaminophen), sodium and potassium penicillin G, potassium chloride, ranitidine hydrochloride
["succinylcholine chloride","tigecycline","glycerol trinitrate","vancomycin hydrochloride","verapamil hydrochloride"]
zoledronic acid.

Mix
Sodium bicarbonate, sodium thiopental, verapamil hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) The dose is determined by the uterine response and should be individualized and started at a low level.
b) The frequency, intensity, and duration of contractions, as well as the fetal heart rate
They must be carefully monitored during the infusion.
c) Oxytocin must be connected via site 'Y' to a 0.9% sodium chloride solution for use during
adverse reactions or complications.
Rapid IV administration in bolus is associated with cardiovascular collapse.
e) Infuse using an infusion pump for more precise dosing.
f) Do not administer oxytocin simultaneously through more than one route.
g) Magnesium sulfate should be readily available if myometrial relaxation is needed.
h) Visually inspect the injectable product for particles or discoloration before
the administration.
i) IM administration to increase or induce labor is not recommended because the
the effects it produces are unpredictable and difficult to control; but it can be managed to
reduce postpartum uterine bleeding.

PARACETAMOL (ACETAMINOPHEN)
Antipyretic
Non-opioid synthetic analgesic derived from p-aminophenol

PRESENTATION

Vial with 100 mL of injectable solution containing 1 g of paracetamol (acetaminophen) (10 mg/mL).
 151

Preparation

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: Does not require reconstitution or additional dilution. In some cases, it can be diluted up to 1 mg/mL with
compatible solution.

STABILITY:

a) Store the unopened jar at room temperature (no more than 30°C), do not refrigerate or freeze.
Protect from light.
b) Use within 6 hours after opening the vial or after transferring the injectable solution to
another container at room temperature (not more than 30°C). Do not refrigerate.
c) If the solution is diluted with 5% dextrose or 0.9% sodium chloride, it must be used within 1
preparation time including administration at room temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer for at least 15 doses with at least 4 hours of separation
Intermittent IV minutes. or at least 6 hours if the patient has
renal or hepatic damage.
IV continues Do not manage by this method.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer at least 15 doses at least 6 hours apart.
Intermittent IV
minutes.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Buprenorphine hydrochloride, sodium ceftriaxone, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine
["hydrochloride","esmolol hydrochloride","fentanyl citrate","sodium heparin","sodium succinate hydrocortisone","ketorolac"]
152

tromethamine, lidocaine hydrochloride, magnesium sulfate, mannitol, methylprednisolone sodium succinate

metoclopramida clorhidrato, midazolam clorhidrato, morfina sulfato, nalbufina clorhidrato, ondansetrón
["hydrochloride","oxytocin","potassium chloride","ranitidine hydrochloride","vancomycin hydrochloride"]

Mix
Ketamine hydrochloride, tramadol hydrochloride.

Syringe
Buprenorphine hydrochloride, sodium ceftriaxone, clindamycin phosphate, sodium dexamethasone phosphate, fentanyl citrate
sodium heparin, sodium succinate hydrocortisone, trometamol ketorolac, sodium succinate methylprednisolone
metoclopramida clorhidrato, midazolam clorhidrato, morfina sulfato, nalbufina clorhidrato, ondansetrón
hydrochloride, ranitidine hydrochloride, vancomycin hydrochloride.

OBSERVATIONS AND PRECAUTIONS

a) Check that no other forms of paracetamol (e.g., oral or rectal) are prescribed and that the dosage
maximum total is not to be exceeded for adults and children.
Higher doses than recommended can cause serious liver damage.

PENICILLIN G (CRYSTALLINE SODIUM)

Penicillin antibiotic

PRESENTATION

Vial ampoule with powder containing crystalline sodium benzylpenicillin equivalent to 1,000,000 units of
benzylpenicillin

Ampule bottle with powder containing crystalline sodium benzylpenicillin equivalent to 5,000,000 units
of benzylpenicillin.

PREPARATION

Compatible solutions: Sodium chloride 0.9%, dextrose 5%.

Reconstitution and dilution:

IV: For intermittent IV infusion, reconstitute the vial of 5 million with 3 or 8 mL of compatible solution that
results in a concentration of 1 million or 500,000 units/mL, respectively. Dose of 3 million of
units or less should be diluted in at least 50 mL of compatible solution; doses of more than 3 million
Units should be diluted with 100 mL. For continuous IV infusion, dilute in 1-2 L of compatible solution.
Reconstitute with a minimum volume of compatible solution (maximum 5 mL).

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30°C).
 153

b) After reconstitution, the solution must be stored in refrigeration (2-8°C) and used
within 24 hours. Do not freeze.
c) The diluted solution can be stored at room temperature (no more than 30°C) and must be
Used within 24 hours. After this time, if not used, the solution must be discarded.
d) Visually inspect the solution to observe particles or colorations before the
administration. Discard if this is present.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
IV intermittent Administer for 1-2 hours.
IV continues Administer within 24 hours.
Suck back first to avoid injecting a vessel
IM
sanguine
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 15-60 minutes. Concentration: 25,000 - 500,000
Intermittent IV
units/mL.
IV continues Administer within 6-24 hours.
. Concentration maximum 100 000
IM
units/mL.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium Penicillin G data: atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride, calcium
{"gluconato":"gluconate","cefotaxima":"cefotaxime","ceftazidima":"ceftazidime","ceftriaxona sódica":"sodium ceftriaxone","cefuroxima":"cefuroxime","clindamicina fosfato":"clindamycin phosphate","dexametasona fosfato":"dexamethasone phosphate"}

sodium, digoxin, dopamine hydrochloride, ephedrine sulfate, epinephrine hydrochloride (adrenaline), ergonovine maleate
esmolol hydrochloride, streptokinase, fentanyl citrate, phylloquinone (vitamin K1), fluconazole, furosemide
["sodium heparin","sodium hydrocortisone succinate","ketorolac trometamol","levofloxacin","lidocaine hydrochloride"]
magnesium sulfate, mannitol, methylprednisolone sodium succinate, metoclopramide hydrochloride, midazolam
["hydrochloride","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate"]
(norepinephrine), ondansetron hydrochloride, oxytocin, penicillin G potassium, potassium chloride, ranitidine hydrochloride
glycerin trinitrate, verapamil hydrochloride.

Mix
Sodium Penicillin G data: Calcium gluconate, clindamycin phosphate, furosemide, hydrocortisone succinate
sodium, potassium chloride, ranitidine hydrochloride, verapamil hydrochloride.
154

Syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions to the medication.

b) Do not confuse aqueous penicillin G (potassium/sodium salts) with procaine or benzathine penicillin G.
c) For IV infusions, use potassium penicillin G or sodium penicillin G.
d) Administer benzathine penicillin G, procaine penicillin G, or the fixed combination of penicillin G
benzathine and procaine penicillin only by deep IM injection. Do not inject these medications
by intravenous route or add to other IV solutions; the inadvertent IV administration of penicillin G
Benzathine has been associated with cardiorespiratory arrest and death.
e) Take special precautions to avoid intravascular or intra-arterial administration or injection
of these medications in or near peripheral nerves or blood vessels, as such
Injections can cause severe and/or permanent neurovascular damage.
f) Administer high doses (more than 10 million units) slowly to avoid imbalances.
electrolytic.
Sodium penicillin contains 1.68 mEq (38.6 mg) of sodium per 1 million units.

Piperacillin/Tazobactam
Penicillin antibiotic plus beta-lactamase inhibitor

PRESENTATION

Vial ampoule with powder containing sodium piperacillin equivalent to 4 grams of piperacillin and
sodium tazobactam equivalent to 0.5 g of tazobactam.

PREPARATION

Compatible solutions: Sodium chloride 0.9%, dextrose 5%.

Reconstitution and dilution:

IV: Reconstitute the 4/0.5 g ampule with 20 mL of 0.9% sodium chloride or injectable water. If only
requires a part of the dose, reconstitute the ampule bottle of 4.5 g with 17 mL (volume of powder: 4.5 g = 3.2
mL of 0.9% sodium chloride or injectable water to obtain a concentration of 200 mg/mL of
piperacillin. Rotate the vial to dissolve, this may take up to 10 minutes depending on the
formulation. The solution must be clear and colorless. Once the powder is reconstituted, dilute the dose with the
less than 50-150 mL of compatible solution. For patients with fluid restriction, the solution
Reconstituted (4.5 g/20 mL) has been administered without further dilution.
 155

STABILITY

a) Store the unopened ampule at room temperature (not exceeding 30°C), do not refrigerate or
freeze.
b) The reconstituted and/or diluted solution is stable for 24 hours when kept at room temperature (not
more than 30°C) or 48 hours in refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
direct IV Administer in 3-5 minutes. Not recommended.
Administer for 20-30 minutes. Maximum concentration: 200 mg/mL
Intermittent IV
(piperacillin).
IV continues Administer within 4-24 hours.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer using this method.
Administer for at least 30 Maximum concentration: 200 mg/mL
Intermittent IV
minutes. (piperacillin).
IV continues Administer for 4-24 hours.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with the medication.

156

b) Contraindicated in patients with severe hypersensitivity to penicillins, carbapenems and

cephalosporins.
c) Administer aminoglycosides separately in time and IV line.
d) Do not mix with Hartmann solution.
e) If injectable water is used as a diluent, do not exceed a final maximum volume of 50 mL.
Piperacillin/tazobactam should not be mixed with other medications and should not be added to
blood products or hydrolyzed albumin.

POTASSIUM CHLORIDE
Electrolyte

PRESENTATION

Vial with 10 mL of injectable solution containing 1.49 g of potassium chloride (KCl) equivalent to 20 mEq
of potassium chloride.

Preparation

Compatible solutions: 5% dextrose, 10% dextrose, 5% dextrose in 0.9% sodium chloride, 5% dextrose in
sodium chloride 0.45%, sodium chloride 0.9%, sodium chloride 0.45%.

Reconstitution and dilution:

IV: The concentrated solution must be diluted before administration. Generally, the concentrations
Potassium in solution should not exceed 40 mEq/L. However, higher potassium concentrations (for
example, 60-80 mEq/L) can be used. For continuous IV infusion, the indicated dose can be diluted in
100-1,000 mL of compatible solution. Concentration commonly limited to 80 mEq/L via peripheral line and
200 mEq/L via central line. A concentration of 10 mEq/100 mL can be used for peripheral infusion and
from 20 to 40 mEq/100 mL for central infusions.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C). Do not freeze. Avoid the
excessive heat.
b) The open ampoule and/or the diluted solution must be used within 24 hours when stored at
ambient temperature (no more than 30°C). Use only clear solutions.
c) The addition of KCl to 20% mannitol can cause precipitation of mannitol.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
IV intermittent Administer 10-20 mEq/hour. Do not exceed 40 mEq/hour.
IV continues Administer at 20 mEq/hour.
 157

I am Do not administer by this method.

SC Do not administer by this method.

Pediatric
Method Use Speed Comment
direct IV Do not administer by this method.
intermittent IV Administer at 0.3-0.5 mEq/kg/hour; Maximum dose/speed: 1 mEq/kg/hour.
Administer at 20 mEq/hour. Maximum concentration: 60-80 mEq/L.
IV continues Maximum speed: 1 mEq/kg/hour or 40
mEq/hour.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, atropine sulfate, sodium bicarbonate, buprenorphine hydrochloride
gluconate calcium, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime, ciprofloxacin, cisatracurium besilate
["clindamycin phosphate","sodium dexamethasone phosphate","dexmedetomidine hydrochloride","digoxin","dobutamine"]
hydrochloride, dopamine hydrochloride, sulfate ephedrine, epinephrine hydrochloride (adrenaline), ergonovine maleate
sodium ertapenem, esmolol hydrochloride, streptokinase, fentanyl citrate, filgrastim, phytonadione (vitamin K1)
fluconazole, furosemide, sodium heparin, sodium hydrocortisone succinate, ketorolac tromethamine, levofloxacin
["lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol","meropenem","metoclopramide hydrochloride"]
["metronidazole","midazolam hydrochloride","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside"]
norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin, paracetamol (acetaminophen)
sodium and potassium penicillin G, ranitidine hydrochloride, succinylcholine chloride, tigecycline, glycerin trinitrate
vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Aminophylline, amiodarone hydrochloride, sodium bicarbonate, calcium gluconate, cefepime hydrochloride, ceftazidime,
ceftriaxona sódica, cefuroxima, ciprofloxacino, clindamicina fosfato, digoxina, dopamina clorhidrato, esmolol
["chloride, fluconazole, furosemide, heparin, hydrocortisone sodium succinate, levofloxacin, lidocaine hydrochloride"]
magnesio sulfato, metilprednisolona succinato sódico, metoclopramida clorhidrato, norepinefrina bitartrato
(norepinephrine), ondansetron hydrochloride, penicillin G sodium and crystalline, ranitidine hydrochloride, tigecycline,
vancomycin hydrochloride, verapamil hydrochloride.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) NEVER administer potassium by intravenous bolus. Medication errors involving the

administration of infusions that are too fast or KCl boluses have resulted in death.
b) Cardiorespiratory monitoring and plasma potassium concentrations are essential
during the administration of potassium.
c) The administration of potassium chloride at excessive rates can result in fatal arrhythmias.
158

d) The maximum concentration for the central infusion line is 200 mEq/L.
e) Blistering medication; severe pain and tissue necrosis may occur; ensure proper placement
appropriate placement of the needle or catheter before and during the IV infusion. Avoid extravasation. If it occurs
extravasation, stop the infusion immediately and disconnect (leave the needle/cannula in place)
place); gently aspirate the extravasated solution (do not flush the line); initiate antidote of
agreement with medical indication; remove the needle/cannula; apply cold dry compresses; elevate the
extremity.

PROPOFOL
Anesthetic
Sedative

PRESENTATION

Vial with 20 mL of injectable emulsion containing 200 mg of propofol (10 mg/mL, 1%) (Formulation with
EDTA.

PREPARATION

Compatible solutions: 5% Dextrose.

Reconstitution and dilution:

IV: The 10 mg/mL concentration solution does not require dilution for administration. Just shake well.
before use. If dilution is required, use 5% dextrose, do not dilute to less than 2 mg/mL.

STABILITY

a) Keep the unopened ampule at room temperature (not exceeding 25°C). Do not refrigerate or freeze.
Protect from light.
b) The open ampule and once the solution has been transferred to another container must be used
within 6 hours at ambient temperature (no more than 25°C).
c) Do not use the emulsion if it shows separation of its phases or discoloration.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer in 10-30 seconds.
Intermittent IV Do not administer by this method.
5-50 mcg/kg/minute (or 0.3 to 3 Concentration: 2-10 mg/mL.
IV continues
mg/kg/hour.
I am Do not administer by this method.
SC Do not administer by this method.
 159

Pediatric
Method Use Speed Comment
Direct IV Manage in 10-30 seconds Only by medical indication.
IV intermittent Do not administer by this method.
IV continues According to medical advice. Concentration: 2-10 mg/mL.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Administer the medication using an infusion pump and a central line.

b) Continuous cardiorespiratory monitoring is required for its administration. It must be available
cardiopulmonary resuscitation team.
c) Do not administer propofol through the same IV line or catheter with blood or plasma.
d) The propofol emulsion may contain soybean oil, egg lecithin, and glycerol as additives.
which can cause hypersensitivity reactions.
e) Contraindicated in patients allergic to soy, peanuts, or eggs.
f) Propofol products are not identical. Much information on compatibility for propofol with
Other medications have been developed using Diprivan and cannot be automatic.
extrapolated to other products due to differences in their formulation.

Ranitidine
Antiulcer

PRESENTATION

Vial with 2 mL of injectable solution containing ranitidine hydrochloride equivalent to 50 mg of ranitidine

(25 mg/mL)
160

PREPARATION

Compatible solutions: Sodium chloride 0.9%, dextrose 5%, dextrose 10%, dextrose 5% in sodium chloride
0.45%

Reconstitution and dilution:

IV: For direct IV injection, dilute each 50 mg in 20 mL of compatible solution (concentration not greater than
2.5 mg/mL). For intermittent IV infusion, dilute 50 mg in 100 mL (concentration less than or equal to 0.5 mg/mL)
of compatible solution. For continuous IV infusion, dilute 150 mg in 250 mL (no more than 2.5 mg/mL) of
compatible solution.
IM: Does not require dilution at a concentration of 25 mg/mL.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C), protect from light and do not
freeze. Its content may acquire a slightly yellowish coloration that does not affect the
potency of the medication.
b) The opened ampoule and/or the diluted solution must be used within 48 hours if stored at
ambient temperature (no more than 30°C).
c) Do not use solutions that show strong coloring or precipitates.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Manage in at least 5 minutes Risk of bradycardia and hypotension.
Administer the dilution of 50 Maximum concentration: 0.5 mg/mL.
Intermittent IV mg/100mL at 5 –7 mL/minute, is
say, for 15-20 minutes.
Administer dilution of 150 mg/250 Maximum concentration: 2.5 mg/mL.
IV continues
mL to 6.25 mg/hour.
Aspirate first to avoid injecting into a vessel
I am
sanguine
SC Do not administer by this method.
Pediatric
Method Use Speed Comment
Manage for at least 5 minutes. Risk of bradycardia and hypotension.
direct IV
Intermittent IV Administer for 15-30 minutes. Usual concentration: 0.5, 1, 2, 2.5 mg/mL.
IV continues Según indicación médica. Maximum concentration: 0.5 mg/mL.
Aspirate first to avoid injecting into a vessel
IM
sanguine
SC Do not administer by this method.
 161

COMPATIBILITY

Site Y
["Sodium acyclovir","amikacin sulfate","aminophylline","atropine sulfate","sodium bicarbonate","buprenorphine hydrochloride"]
["gluconate calcium","cefepime hydrochloride","cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","ciprofloxacin"]
cisatracurium besilate, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine hydrochloride, digoxin
["dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)","ertapenem"]
["sodium","esmolol hydrochloride","streptokinase","fentanyl citrate","filgrastim","phytonadione (vitamin K1)","fluconazole"]
furosemide, sodium heparin, sodium succinate hydrocortisone, ketorolac trometamol, levofloxacin, lidocaine
["hydrochloride","linezolid","magnesium sulfate","mannitol","sodium methylprednisolone succinate","metoclopramide hydrochloride"]
["metronidazole","midazolam hydrochloride","morphine sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside"]
norepinephrine bitartrate (noradrenaline), ondansetron hydrochloride, oxytocin, paracetamol (acetaminophen)
sodium and potassium penicillin G, potassium chloride, succinylcholine chloride, tigecycline, sodium thiopental, trinitrate of
glycerol, vancomycin hydrochloride, vecuronium bromide, verapamil hydrochloride, zoledronic acid.

Mix
Amikacin sulfate, aminophylline, sodium bicarbonate, ciprofloxacin, sodium dexamethasone phosphate, digoxin
["dobutamine hydrochloride","dopamine hydrochloride","epinephrine hydrochloride (adrenaline)","fluconazole","furosemide"]
["sodium heparin","ketorolac trometamol","lidocaine hydrochloride","meropenem","methylprednisolone sodium succinate"]
metoclopramide hydrochloride, midazolam hydrochloride, sodium nitroprusside, ondansetron hydrochloride, penicillin G
sodium and potassium, potassium chloride, tramadol hydrochloride, vancomycin hydrochloride.

Syringe
Atropine sulfate, sodium dexamethasone phosphate, dobutamine hydrochloride, dopamine hydrochloride, fentanyl citrate,
sodium heparin, metoclopramide hydrochloride, morphine sulfate, nalbuphine hydrochloride, paracetamol (acetaminophen).

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with the medication.

Iron Saccharate
Hematinic
Iron supplement
Antianemic

PRESENTATION

Vial with 5 mL of injectable solution containing iron(III) saccharate equivalent to 100 mg of iron
elemental (20 mg/mL).
162

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Do not dilute to a concentration less than 1 mg/mL. Add the dose to 50-250 mL of 0.9% sodium chloride;
The final concentration range is 1-2 mg of elemental iron/mL. The solution should be brown and clear.
Inspect the solution for particles or other discolorations before administration and discard if present.
presents.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 25°C), do not freeze. Protect from
the excessive light and heat.
b) The opened ampoule and/or the diluted solution must be used within 24 hours when stored at
ambient temperature (no more than 25 °C) or refrigeration (2-8 °C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer for 2-5 minutes. Only by medical indication.
Dose 100-200 mg: 1 hour. Monitor adverse reactions.
Dose 300 mg: 1.5 hours.
Intermittent IV
Dose 400 mg: 2.5 hours.
Dose 500 mg: 3.5-4 hours.
IV continues Only by medical indication.
IM Do not administer by this method.
SC Do not administer in this way.

Pediatric
Method Use Speed Comment
IV direct Administer for 5 minutes. Only by medical prescription.
Manage during 30-120 Concentration: 1-2 mg/mL. Speed
Intermittent IV
minutes. maximum: 3.3 mg/minute.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mixture
 163

Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with the medication.

b) Severe hypersensitivity reactions, some fatal, may occur with administration of
parenteral iron. These reactions can occur even when previous doses have been tolerated.
For this reason, cardiac resuscitation equipment must be available. If reactions occur
hypersensitivity and/or signs or symptoms of intolerance during administration, stop the
immediate infusion.
c) The patient must be monitored for adverse reactions for at least 30 minutes after
complete the administration of the medication.
d) There are various formulations with parenteral iron that must be differentiated.
e) Monitor the injection site. Stop the infusion if signs of extravasation occur.
f) The solution of ferric saccharate should not be mixed with other medications.
g) The patient may be premedicated prior to the administration of parenteral iron according to
medical indication.

SUCCINYLCHOLINE (SUXAMETHONIUM)
Neuromuscular blocker

PRESENTATION

Vial with 2 mL of injectable solution containing 40 mg of succinylcholine chloride (succinylcholine) (20)

mg/mL.

PREPARATION

Compatible solutions: Dextrose 5%, dextrose 10%, sodium chloride 0.9%, dextrose 5% in sodium chloride
0.9%.

Reconstitution and dilution:

IV: It can be administered undiluted. Alternatively, it can be diluted to a concentration of 1-2 mg/mL with
compatible solution.
164

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C), protect from light and the
excessive heat.
b) The open ampoule and/or the diluted solution must be used within 24 hours if stored at
ambient temperature (no more than 30°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Manage during 10-30 Rinse the line after each dose.
seconds.
intermittent IV Do not administer by this method.
IV continues Administer 2.5 mg/minute (range: Only by medical indication.
0.5-10 mg/minute.
IM Not recommended. Do not inject more than 150
mg.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Inject for 10-30 seconds. Rinse the line after each dose.
Intermittent IV Do not administer by this method.
IV continues Only by medical indication.
I am Only by medical prescription.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, atropine sulfate, buprenorphine hydrochloride
["gluconate calcium","cefotaxime","ceftazidime","sodium ceftriaxone","cefuroxime","clindamycin phosphate","dexamethasone"]
["sodium phosphate","dexmedetomidine hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine"]
["sulfate","epinephrine hydrochloride","ergonovine maleate","ertapenem sodium","esmolol hydrochloride","streptokinase"]
["fentanyl citrate","phytomenadione (vitamin K1)","fluconazole","furosemide","sodium heparin","hydrocortisone succinate"]
sodium, ketorolac trometamol, levofloxacin, lidocaine hydrochloride, linezolid, magnesium sulfate, mannitol
["sodium methylprednisolone succinate","metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine"]
["sulfate","multivitamins","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate (noradrenaline)"]
ondansetron hydrochloride, oxytocin, potassium chloride, ranitidine hydrochloride, tigecycline, glyceryl trinitrate
vancomicina clorhidrato, vecuronio bromuro, verapamilo clorhidrato, zoledrónico ácido.

Mix
Amikacin sulfate, morphine sulfate, norepinephrine bitartrate.

Syringe
Sodium heparin.
 165

OBSERVATIONS AND PRECAUTIONS

a) Monitor heart rate and blood pressure during succinylcholine administration.

b) Paralytic agent, causes respiratory arrest. Equipment to maintain the airway must be available.
air and a reversion agent.
c) The incidence of bradycardia is higher with repeated doses of succinylcholine. Pre-treatment with
Anticholinergic agents (for example, atropine) can reduce the occurrence of bradyarrhythmias.
d) Due to the risk of rhabdomyolysis and fatal hyperkalemia that has occurred in pediatric patients
with myopathies, succinylcholine should be limited to emergency situations.

TERLIPRESSIN
Vasopressin analogue

PRESENTATION

Vial ampoule with powder containing 1 mg of terlipressin acetate equivalent to 0.86 mg of terlipressin.

PREPARATION

Compatible solutions: Sodium chloride 0.9%.

Reconstitution and dilution:

IV: Reconstitute the vial with 5 mL of 0.9% sodium chloride. Once reconstituted, the solution can be
diluted with 20-50 mL of 0.9% sodium chloride.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C), protect from light, and avoid
the excessive heat.
b) The reconstituted and/or diluted solution must be stored under refrigeration (2-8°C) and must be
to be used within 12 hours.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer for 3-4 minutes.
intermittent IV Administer for 30 minutes.
IV continues Do not administer by this method.
166

I AM Do not administer by this method.

SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor blood pressure, heart rate, and fluid balance.

Tigecycline
Glycylcyclines antibiotic

PRESENTATION

Vial ampoule with powder containing 50 mg of tigecycline.

PREPARATION

Compatible solutions: 0.9% sodium chloride, 5% dextrose, 5% dextrose in 0.9% sodium chloride.

Reconstitution and dilution:

IV: Reconstitute the vial with 5.3 mL of compatible solution to obtain a concentration of 10 mg/mL.
Gently swirl the bottle to dissolve. Immediately dilute with 100 mL of compatible solution to a
maximum concentration of 1 mg/mL. The solution should be clear yellowish to orange in color.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25°C).
b) The reconstituted and/or diluted solution must be used within 24 hours when stored at temperature
ambient (no more than 25°C) and up to 48 hours when stored in refrigeration (2-8°C).
 167

MANAGEMENT

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
intermittent IV Administer for 30-60 minutes.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reaction data during the administration of the medication.

b) If the same IV line is used for sequential infusions of several medications, flush the line.
with 0.9% sodium chloride or 5% dextrose before and after the administration of tigecycline.
c) The safety and efficacy of tigecycline have not been established in patients under 18 years of age.

TRAMADOL
Opioid analgesic

PRESENTATION

Vial with 2 mL of injectable solution containing 100 mg of tramadol hydrochloride (50 mg/mL).

PREPARATION

Compatible solutions: 0.9% Sodium chloride, 5% dextrose.

168

Reconstitution and dilution:

IV: For intermittent IV infusion, dilute the prescribed dose in 50-100 mL of compatible solution. For infusion
IV continue, dilute the prescribed dose in 500 mL of compatible solution.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 30°C). Protect from light.
b) The open ampoule and/or the diluted solution must be used within 24 hours stored in
refrigeration (2-8°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer in 30-60 minutes.
IV continues According to medical advice.
Suck first to avoid injecting into the vessel
IM
sanguine
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer in 30-60 minutes.
IV continues As per medical instruction.
Aspire first to avoid injecting into a vessel.
I am
sanguine.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Amiodarone hydrochloride, midazolam hydrochloride.

Mix
Sodium bicarbonate, butylscopolamine, sodium dexamethasone phosphate, haloperidol lactate, sodium heparin, ketamine
["ketorolac tromethamine","mannitol","metoclopramide hydrochloride","midazolam hydrochloride","ondansetron"]
hydrochloride, paracetamol (acetaminophen), ranitidine hydrochloride.

Syringe
Butilhioscina, sodium dexamethasone phosphate, haloperidol lactate, sodium heparin, ketorolac tromethamine,
paracetamol (acetaminophen).
 169

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions related to the medication.

b) The daily dosage in adults by any route is 400 mg/day.
It is recommended to monitor respiratory rate and consciousness for 30 minutes in patients.
who receive an initial dose, especially in elderly patients or those of low weight.

TRIMETHOPRIM/SULFAMETHOXAZOLE
Sulfonamide-derived antibiotic

PRESENTATION

Vial with 3 mL of injectable solution containing 160 mg of trimethoprim and 800 mg of sulfamethoxazole.

PREPARATION

Compatible solutions: Sodium chloride 0.9%, sodium chloride 0.45%, dextrose 5%, dextrose 5% in chloride
sodium 0.45%.

Reconstitution and dilution:

IV: For intermittent IV infusion, the dose should be diluted in 100-250 mL of compatible solution. Inspect
the solution for the presence of cloudiness or precipitation before administration. The dilution must
to be carried out immediately before use.

STABILITY

a) Keep the unopened vial at room temperature (no more than 30°C), do not refrigerate and protect.
of the light.
b) The opened ampoule and/or the diluted solution must be used within 6 hours when stored at
ambient temperature (no more than 30°C), do not refrigerate.
c) Do not use if the diluted solution shows turbidity or precipitation.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 1-2 hours. Maintain hydration suitable.
IV intermittent
Maximum concentration: 1.06 mg/mL.
IV continues Do not administer by this method.
170

I am Do not administer by this method.

SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer in 1-2 hours. Dilute each 16 mg of trimethoprim/80 mg of
sulfamethoxazole in 20 or 25 mL. Range of
Intermittent IV
concentration: 0.6-1 mg/mL (based on
trimethoprim
IV continua Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions related to the medication.

b) Maintain hydration to prevent crystalluria and stone formation.
c) It is contraindicated in children under 3 months.
d) Wash the IV line before and after administration.

Glycerol trinitrate
Antianginal
Antihypertensive
Vasodilator

PRESENTATION

Vial with 50 mL of 5% dextrose containing 50 mg of glyceryl trinitrate (1 mg/mL).

 171

PREPARATION

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: The concentration solution of 1 mg/mL must be diluted before administration. The solution must be
clara e incolora a ligeramente amarillenta. Inspeccionar visualmente para observar partículas u otras
Colorations before administering the solution. Discard if this occurs. Example of dilution: For
obtain a solution of glycerol trinitrate at a concentration of 100 mcg/mL, add 50 mL of
solution of glyceryl trinitrate (containing 50 mg of glyceryl trinitrate) in 450 mL of solution
compatible to obtain a final volume of 500 mL (with this dilution, a dosage of 100 mcg/minute
It can be obtained by administering 60 mL per hour of the solution). The maximum recommended concentration
for patients with fluid restriction it is 400 mcg/mL.

STABILITY

a) Store the unopened ampule at room temperature (no more than 20°C), do not refrigerate or
freeze. Protect from light and excessive heat.
b) The ampule vial and/or the dilution must be used within 48 hours kept at temperature
environment (no more than 20°C).

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
IV continues Administer at 5-200 mcg/minute. Adjust according to the response.
IM Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Do not administer by this method.
IV continues According to medical indication. Concentration: 50-400 mcg/mL.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Do not mix with other medications.
172

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions associated with the medication.

Administer nitroglycerin with an infusion pump.
It is recommended to have continuous cardiorespiratory monitoring.
d) Only 5% dextrose and 0.9% sodium chloride should be used as diluents. All mixtures
They must be carried out in glass containers. Many filters will adsorb glycerol trinitrate; their use
it is not recommended.
e) Glycerol trinitrate rapidly absorbs to many plastics; therefore, it is recommended to use
glass containers and management equipment without PVC.
f) The administration of blood in the same IV line can result in pseudoagglutination and hemolysis.
g) Handle glycerol trinitrate carefully as it can explode due to percussion or heat
excessive.
h) Avoid the abrupt discontinuation of the medication to prevent rebound effects.

Valproic acid
Anticonvulsant

PRESENTATION

Vial ampoule with 5 mL of injectable solution containing sodium valproate equivalent to 500 mg of
valproic acid (100 mg/mL).

PREPARATION

Compatible solutions: Dextrose 5%, sodium chloride 0.9%.

Reconstitution and dilution:

IV: Dilute the dose in at least 50 mL of compatible solution.

STABILITY

a) Keep the unopened ampule at room temperature (no more than 30°C), protect from light
and the excessive heat.
b) The open ampoule bottle and/or the diluted solution must be used within 24 hours if stored.
the ambient temperature (no more than 30°C).
 173

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Administer for 5-10 minutes. Only by medical indication.
IV intermittent Administer for 60 minutes. Maximum speed: 20 mg/minute.
IV continues As per medical indication. Only by medical prescription.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method To use Speed Comment
Direct IV Administer for 5-10 minutes. Only by medical prescription.
Administer for 60 minutes. Maximum speed: 15-20 mg/minute or 1-6
intermittent IV
mg/kg/minute.
IV continues Administer 1-6 mg/kg/hour. Diluted to 2-4 mg/mL
I am Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Cefepime, ceftazidime.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions to the medication.

b) Monitor the IV administration site for local reactions.
c) Dizziness may occur a few minutes after administration, but it will resolve within
a few minutes.
174

VANCOMYCIN
Glycopeptide antibiotic

PRESENTATION

Ampoule vial with powder containing vancomycin hydrochloride equivalent to 500 mg of vancomycin.

PREPARATION

{"compatible_solutions":["Dextrose 5%","Dextrose 10%","Sodium chloride 0.9%","Dextrose 5% in sodium chloride"]}

0.9%.

Reconstitution and dilution:

IV: Reconstitute 500 mg or 1 g of the powder with 10 or 20 mL, respectively, of injectable water to obtain a
Concentration solution 50 mg/mL. DILUTION REQUIRED LATER. For intermittent IV infusion.
perform an additional dilution of the reconstituted solutions of 500 mg or 1 g with at least 100 mL or to
less than 200 mL, respectively, with a compatible solution. Concentration solutions are recommended.
of 5 mg/mL. For continuous IV infusion administration, it usually starts after an initial dose
loading and doses of 1-2 g of vancomycin can be added to 1000 mL of compatible solution. In
adult patients with a need for fluid restriction, a concentration of up to 10 can be used.
mg/mL, but the risk of infusion-related reactions increases.

STABILITY

a) Keep the unopened jar at room temperature (no more than 30°C).
b) The reconstituted and/or diluted solution must be used within 24 hours stored at temperature
ambient (no more than 30°C) or in refrigeration (2-8°C).
c) Do not freeze the reconstituted or diluted solution.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Manage for 2 hours or more. Monitor adverse reactions.
IV continues Administer for 24 hours. Dosage as per medical indication.
I AM Do not administer by this method.
SC No administrar por este método.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Intermittent IV Administer for 2 hours or more. Monitor adverse reactions.
IV continues Administer for 24 hours. Dose as per medical advice.
IM Do not administer by this method.
SC Do not administer by this method.
 175

COMPATIBILITY

Site Y
Sodium acyclovir, alteplase, amikacin sulfate, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate,
buprenorphine hydrochloride, calcium gluconate, ciprofloxacin, cisatracurium besilate, clindamycin phosphate
sodium phosphate dexamethasone, dexmedetomidine hydrochloride, digoxin, dobutamine hydrochloride, dopamine
["hydrochloride","ephedrine sulfate","epinephrine hydrochloride (adrenaline)","ertapenem sodium","esmolol hydrochloride","fentanyl"]
["citrate","filgrastim","phytonadione (vitamin K1)","fluconazole","ketamine hydrochloride","levofloxacin","lidocaine"]
["chloride","linezolid","magnesium sulfate","mannitol","meropenem","metoclopramide hydrochloride","metronidazole"]
midazolam clorhidrato, morfina sulfato, multivitamínicos, nalbufina clorhidrato, nitroprusiato sódico, norepinefrina
["bitartrate (norepinephrine)","ondansetron hydrochloride","oxytocin","paracetamol (acetaminophen)","potassium chloride"]
["ranitidine hydrochloride","succinylcholine chloride","tigecycline","glyceryl trinitrate","vecuronium bromide","verapamil"]
zoledronic acid hydrochloride.

Mix
Amikacin sulfate, calcium gluconate, sodium succinate hydrocortisone, potassium chloride, ranitidine hydrochloride,
verapamil hydrochloride.

Syringe
Paracetamol (acetaminophen).

OBSERVATIONS AND PRECAUTIONS

a) Rapid IV infusion should be avoided and patients must be monitored for any
reaction associated with the infusion. These reactions usually involve a severe decrease and
sudden increase in blood pressure and may be accompanied by flushing and/or erythematous rash or
maculopapular on face, neck, trunk, and upper extremities ("red man syndrome"). This
reaction often starts a few minutes after the infusion has begun and the
reaction usually disappears in 30 to 60 minutes, the administration of antihistamines
just before the infusion can prevent or minimize this reaction.
b) To minimize the risk of reaction from IV infusion, administer the solution over a longer period or
equal to 1 hour using a speed of less than or equal to 10 mg/minute and monitor frequently
the patient's blood pressure.
c) Irritating medication; closely monitor the administration site; ensure proper placement.
adequate positioning of the needle or catheter before and during the infusion. Avoid extravasation. If it occurs
extravasation, stop the infusion immediately and disconnect (leave the cannula/needle in its
place); gently aspirate extravasation solution (do not flush the line); remove the needle/cannula; elevate
the extremity. The information varies considering the use of hot or cold dry compresses; without
embargo, dry heat compresses can be beneficial by increasing local blood flow
to improve the removal of the medication from the extravasated site.
176

VERAPAMIL
Antianginal agent
Antiarrhythmic
Antihypertensive

PRESENTATION

Vial with 2 mL of injectable solution containing 5 mg of verapamil hydrochloride (2.5 mg/mL).

PREPARACIÓN

Compatible solutions: Dextrose 5%, sodium chloride 0.45%, sodium chloride 0.9%, dextrose 5% in chloride
0.9% sodium, 5% dextrose in 0.45% sodium chloride.

Reconstitution and dilution:

IV: For direct IV administration, no additional dilution is required at a concentration of 2.5 mg/mL.
Alternatively, you can dilute the dose with 10-50 mL of compatible solution.

STABILITY

a) Store the unopened ampoule at room temperature (no more than 30 °C). Do not freeze. Protect from
the light.
b) The open ampoule and/or the diluted solution must be used within 24 hours when stored at
ambient temperature (no more than 30°C).

ADMINISTRATION

Adult
Method To use Speed Comment
Manage for at least 3. Lay the patient down for at least 1 hour.
Direct IV
minutes. after the administration.
Intermittent IV Do not administer by this method.
IV continues According to medical indication. Only by medical indication.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Usar Speed Comment
Direct IV Administer in 2-4 minutes. Concentration: 0.5-2.5 mg/mL.
IV intermittent Do not administer by this method.
IV continues According to medical advice. Concentration: 0.4 mg/mL.
I am Do not administer by this method.
SC Do not administer by this method.
 177

COMPATIBILITY

Site Y
Amikacin sulfate, atropine sulfate, buprenorphine hydrochloride, calcium gluconate, cefotaxime, sodium ceftriaxone,
cefuroxime, ciprofloxacin, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine hydrochloride
digoxin, hydrochloride dobutamine, hydrochloride dopamine, sulfate ephedrine, hydrochloride epinephrine (adrenaline)
esmolol clorhidrato, estreptoquinasa, fentanilo citrato, fitomenadiona (vitamina K1), fluconazol, heparina sódica,
["sodium succinate hydrocortisone","ketorolac trometamol","levofloxacin","lidocaine hydrochloride","linezolid","magnesium"]
["sulfate","mannitol","methylprednisolone sodium succinate","metoclopramide hydrochloride","metronidazole","midazolam"]
["hydrochloride","sulfate morphine","multivitamin supplements","nalbuphine hydrochloride","sodium nitroprusside","norepinephrine bitartrate"]
ondansetron hydrochloride, oxytocin, sodium and potassium penicillin G, potassium chloride, ranitidine hydrochloride
["succinylcholine chloride","glycerin trinitrate","vancomycin hydrochloride","vecuronium bromide","zoledronic acid"]

Mix
Amikacin sulfate, amiodarone hydrochloride, atropine sulfate, sodium bicarbonate, calcium gluconate, cefotaxime,
["clindamycin phosphate","sodium dexamethasone phosphate","digoxin","dopamine hydrochloride","epinephrine hydrochloride"]
(adrenaline), sodium heparin, hydrocortisone phosphate and sodium succinate, lidocaine hydrochloride, magnesium sulfate
["mannitol","methylprednisolone sodium succinate","metoclopramide hydrochloride","morphine sulfate","multivitamins"]
sodium nitroprusside, norepinephrine bitartrate (noradrenaline), oxytocin, sodium and potassium penicillin G, potassium
chloride, glycerin trinitrate, vancomycin hydrochloride.

syringe
Sodium heparin.

OBSERVATIONS AND PRECAUTIONS

a) Monitor adverse reactions to the medication.

b) Continuous cardiopulmonary monitoring is recommended.

ZOLEDRONIC ACID
Antihypercalcemic
Bone resorption inhibitor

PRESENTATION

Vial with 100 mL of injectable solution containing 5 mg of zoledronic acid.

Ampoule vial with 5 mL of injectable solution containing hydrated zoledronic acid equivalent
4 mg of zoledronic acid.
178

PREPARATION

Soluciones compatibles:Dextrosa 5%, cloruro de sodio 0.9%.

Reconstitution and dilution:

IV: The ready-to-infuse solution does not require additional dilution. The concentrated presentation is 4 mg/5 mL.
It must be diluted with 100 mL of compatible solution.

STABILITY

a) Keep the unopened ampoule at room temperature (no more than 25°C).
b) Once the bottle is opened or the dilution is made, the solution must be used within 24 hours.
kept refrigerated (2-8°C).
c) If refrigerated beforehand, allow the solution to reach room temperature before
start the administration.

ADMINISTRATION

Adult
Method Use Speed Comment
Direct IV Do not administer by this method.
Manage for at least 15
Intermittent IV
minutes.
IV continues Do not administer by this method.
I am Do not administer by this method.
SC Do not administer by this method.

Pediatric
Method Use Speed Comment
Direct IV Do not administer by this method.
Administer for at least 15 Maximum concentration: 0.05 mg/mL.
Intermittent IV
minutes.
IV continues Do not administer by this method.
IM Do not administer by this method.
SC Do not administer by this method.

COMPATIBILITY

Site Y
Sodium acyclovir, amikacin sulfate, aminophylline, amiodarone hydrochloride, sodium ampicillin, sodium bicarbonate
buprenorphine hydrochloride, cefepime hydrochloride, cefotaxime, ceftazidime, sodium ceftriaxone, cefuroxime
["ciprofloxacin, cisatracurium besilate, clindamycin phosphate, sodium dexamethasone phosphate, dexmedetomidine"]
["hydrochloride","digoxin","dobutamine hydrochloride","dopamine hydrochloride","ephedrine sulfate","epinephrine hydrochloride"]
["adrenaline","sodium ertapenem","esmolol hydrochloride","fentanyl citrate","fluconazole","furosemide","haloperidol lactate"]
["sodium heparin","hydralazine hydrochloride","sodium succinate hydrocortisone","ketorolac trometamol","levofloxacin"]
["lidocaine hydrochloride","linezolid","magnesium sulfate","mannitol","meropenem","methylprednisolone sodium succinate"]
["metoclopramide hydrochloride","metronidazole","midazolam hydrochloride","morphine sulfate","nalbuphine hydrochloride"]
["sodium nitroprusside","norepinephrine bitartrate (noradrenaline)","ondansetron hydrochloride","oxytocin","potassium chloride"]
 179

["ranitidine hydrochloride","succinylcholine chloride","sodium thiopental","tigecycline","glycerin trinitrate","vancomycin"]

hydrochloride, vecuronium bromide, verapamil hydrochloride.

Mix
Do not mix with other medications.

Syringe
Do not mix with other medications.

OBSERVATIONS AND PRECAUTIONS

a) Patients must be properly hydrated before and after administration. For

many patients this can be achieved by drinking two glasses of liquid before and after the
administration.
b) Symptoms similar to the common flu including fever and headache may occur after the
infusion and usually resolve within 3 days. Paracetamol after administration
can reduce the incidence of these symptoms.
c) Rinse the line IV with 10 mL of 0.9% sodium chloride after finishing the infusion.
d) Do not mix with solutions that contain calcium or other divalent cations.
180

REFERENCES
1. IBM Micromedex DRUGDEX [Internet]. IBM Watson Health, Greenwood Village, Colorado, USA. [cited
2018 Jul 07]. Available at[Link]

2. Ebell MH, editor. Essential Evidence Plus & AHFS DI Essentials [Internet]. Hoboken (NJ): Wiley
Subscription Services. STAT!Ref Online Electronic Medical Library. [cited 2018 Jun 20]. Available
en: [Link]

3. Lexicomp Online, Pediatric and Neonatal Lexi-Drugs Online [Internet]. Hudson, Ohio: Wolters Kluwer
Clinical Drug Information, Inc. 2013; [cited 2018 Jun 30]. Available at:
[Link]

4. Lexicomp Online [Internet]. Hudson, Ohio: Wolters Kluwer Clinical Drug Information, Inc.; 2013 [cited
2018 Jun 30]. Available at[Link]

5. Elsevier/Gold Standard. Clinical pharmacology [Internet]. New York: Elsevier [2017 Nov 08].
Available in[Link]

6. Clinical key [Internet] Amsterdam: Elsevier. [2017 Nov 08]. Disponible en:
[Link]

7. Vallerand AH, Sanoski CAeds. Davis's Drug Guide for Nurses [Internet]. 16 ed. Philadelphia (PA). F.A.
Davis Company. Wiley Subscription Services. STAT!Ref Online Electronic Medical Library. 2018
[quoted 2018 Ene 10 Available en:
[Link]

8. McEvoy GK, editor Handbook on Injectable Drugs [Internet] 19 ed. Bethesda (MD): American Society
of Health-System Pharmacists. Wiley Subscription Services. STAT!Ref Online Electronic Medical
Library. 2018 [quoted 2018 May 15]. Available en:
[Link]

9. Thompson A, Lee K, Phelps S, Hagemann T. Teddy Bear Book: Pediatric Injectable Drugs. [Internet]. 11
ed. Bethesda (MD). American Society of Health-System Pharmacists. Wiley Subscription Services.
STAT!Ref Online Electronic Medical Library. 2018 [cited 2018 May 15.
[Link]

10. Lexi-comp Inc. King guide to parenteral admixtures. [Internet]. Hudson, Ohio: Lexi-comp; 1978, [2012].
Available in: [Link]

11. McEvoy GK, editor. AHFS Drug Information [Internet]. 60 ed. Bethesda (MD). American Society of
Health-System Pharmacists. Wiley Subscription Services. STAT! Ref Online Electronic Medical
Library. 2018 [quoted 2018 May 15].
[Link]

12. UpToDate [Internet]. Waltham (MA): Wolters Kluwer UpToDate Inc. 2018 [cited 2018 May 15].
Available in: [Link]

13. Facts and comparisons [Internet]. Hudson (OH): Wolters Kluwer Clinical Drug Information, Inc.; 2018
[cited May 15, 2018]. Available at: [Link]
 181

14. Medscape [Internet]. New York (NY): Medscape LLC. 2018 [cited 2018 May 18]. Available at:
[Link]

15. Dynamed [Internet]. Ipswich (MA): EBSCO Information Services. 2018 [cited 2018 May 18]. Available
in[Link]

16. The electronic Medicines Compendium (eMC) [Internet]. Leatherhead (UK): Datapharm
Communications Limited. 2018 [quoted 2018 May 18]. Available en:
[Link]

17. Kao H. [Link]. [Internet]. Mississauga (ON): [Link]. 2014 [cited 2018 Jun 06].
Available in[Link]

18. David McAuley. [Link] [Internet]. Detroit (MI): GlobalRPh. 2018 [cited 2018 Jun 06].
Available in[Link]

19. Winemaker Jean, Stabilis [Internet]. Infostab. 2018 [cited 2018 Jun 06]. Available at:
[Link]

20. Accesspharacy [Internet]. Nueva York (NY): McGraw-Hill Education. 2018 [citado 2018 Abr 12].
Available in[Link]

21. Australian Injectable Drugs Handbook [Internet]. 7th ed. Victoria, Australia: Society of Hospital
Pharmacists of Australia. 2018 [cited 2018 Aug 25]. Available at:[Link]

22. Jones & Bartlett Learning. 2011 Nurse's drug handbook. 10th ed. Sudbury: Jones & Bartlett Learning;
2011.

23. Dwyer P. Nursing spectrum drug handbook. New York: McGraw-Hill; 2010.

[Link] A. “et al”. Injectable drugs guide. London: Pharmaceutical Press; 2011.

25. Reina Sofía University Hospital; Nursing Division. Guide for the safe administration of
medications. Córdoba (Spain): Reina Sofía University Hospital; 2001.

26. Amboage C, Agüera M. Guide to Intravenous Drug Administration in Emergencies. Madrid:

Arán Ediciones S.L.; 2003.

27. Shulman R, “et al”. UCL Injectable Drug administration guide. London: Blackwell Science; 1998.

28. Martínez I. Guide to parenteral medication administration HUSD. 6th ed. Mallorca (Spain):
Son Dureta University Hospital; 2004.

29. Young TE, Mangum B. Neofax 2009. 22th ed. Montvale (NJ): Thomson Reuters; 2009.

30. Gahart BL, Nazareno AR. Intravenous medications: a handbook for nurses and allied health
professionals. 45 ed. St. Louis (MO): Mosby; 2017.
182

31. Son Dureta University Hospital; Pharmacy Service. Administration of medications via
parenteral. Mallorca (Spain): Son Dureta University Hospital; 2001.

32. Fernández JL. Manual of medication administration. Badajoz (Spain): Center of

Medication Information, Health Management of Badajoz; 2003.

33. Sweetman SC, editor. Martindale: the complete drug reference. 36th ed. London: Pharmaceutical
Press; 2009.

34. British National Formulary. BNF for children 2016-2017. London: BMJ Group and the Royal
Pharmaceutical Society of Great Britain; 2015.

35. British National Formulary. BNF 71. London: BMJ Group and the Royal Pharmaceutical Society of
Great Britain; 2016.

36. Lacy CF, Armstrong LL, Goldman MP, "et al" editors. Drug information handbook 2009-2010. 18th ed.
USA: Lexi-Comp; 2009.

37. Karch AM. 2012 Lippincott's nursing drug guide. Philadelphia (PA): Lippincott Williams & Wilkins;
2012.

38. Burghardt JC. Nursing 2012 drug handbook. 32nd ed. Philadelphia (PA): Lippincott Williams & Wilkins;
2012.

39. Barberio JA. Nurse´s pocket drug guide 2010. New York: McGraw-Hill; 2010.

40. Dwyer P. McGraw-Hill's I.V. drug handbook. New York: McGraw-Hill; 2009.

41. Pinel J, Weiss F, Henkens M. Essential drugs: practical guidelines. Paris: Doctors Without Borders;
2010.

42. Sánchez E. Guide for the safe administration of medications via parenteral route. Huelva (Spain):
Juan Ramón Jiménez Hospital; 2011.

43. Taketomo CK, Hodding JH, Kraus DM. Pediatric Prescription Manual. 14th ed. USA: Lexi-Comp;
2008.