DILUTION PROTOCOL 2017 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

CONTENTS
Foreword from TPKN (Farmasi)……………………… 2
Foreword from Director of HTAN…………………….. 3
Message from Head of Pharmacy Department…….. 4
Preface………………………………………………….. 5
Acknowledgements……………………………………. 6
Editorial Board…………………………………………. 7
Abbreviations…………………………………………... 8
A-B………………………………………………………. 9-25
C-D…………………………………………………….... 26-41
E-F………………………………………………………. 42-48
G-H……………………………………………………... 49-56
I-J……………………………………………………….. 57-62
K-L………………………………………………………. 63-66
M-N……………………………………………………… 67-76
O-P……………………………………………………… 77-90
Q-R……………………………………………………… 91-94
S-T………………………………………………………. 95-105
U-V………………………………………………………. 106-109
W-X……………………………………………………… 110
Y-Z………………………………………………………. 111-113
Appendix 1-5…………………………………………… 114-118
Index by Trade Names………………………………... 119-121

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

FOREWORDS FROM
TPKN(Farmasi)

I am very glad that we finally established our own dilution protocol for hospital setting in Negeri
Sembilan, with the initiative from Pharmacy Department of Hospital Tuanku Ampuan Najihah,
being the lead hospital in HTAN cluster hospital programme. This will be a benchmark for more
publication activities under Bahagian Perkhidmatan Farmasi, Jabatan Kesihatan Negeri, Negeri
Sembilan. Ensuring correct preparation and administration of injectable medicines is essential
for the safety and efficacy of medicines provided to our patients and I am sure this will be
helpful tool as guidance, in such scope of quality use of medicines in hospital in-patients. I
sincerely hope that all pharmacists, especially in Negeri Sembilan, to actively participate in
publication like this, that will be beneficial to all health care providers.

I wish to congratulate the Dilution Protocol HTAN 2017 editorial committee who has contributed
to the publication of this dilution protocol. I truly hope this combined effort will help in improving
the well-being of the patients entrusted to our care.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

FOREWORDS FROM
DIRECTOR OF HTAN

Hospital Tuanku Ampuan Najihah has always being actively involved in medication safety
activities as patient‟s safety is our main priority, which is in line with the Ministry of Health
vision.

The publication of this protocol shows the commitment and hard work of the Pharmacy
Department to improve our current procedure of preparation and administration of injectable
medicines. Therefore, I would like to thank the Dilution Protocol HTAN 2017 editorial committee
who has taken the initiative to update this protocol. A big appreciation to the pharmacists who
had put in great effort in compiling and updating this protocol, which is not an easy task. Again,
congratulations to all of you.

Last but not least, I hope all relevant healthcare personnel in our hospital can gain access to
this publication and fully utilize it.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

MESSAGE FROM HEAD OF

PHARMACY DEPARTMENT

Bismillahirrahmanirrahim,

Alhamdulillah, thanks to Allah SWT, whom at His willingness allows the editorial committee and
the contributors the opportunity to complete and publish this HTAN Dilution Protocol 2017.

Ensuring the right concentration and stability of diluted medicines is important to prevent
unwanted adverse effects, which is an essential part to ensure patients receiving safe, quality
and effective therapy. This is in line with the objectives of our National Medicines Policy (NMP).

This protocol aims to provide prescribers, pharmacists, nurses, medical assistants and other
healthcare professionals with sound up-to-date, comprehensive information on the preparation
and administration of injectable medicines which are available in this hospital.

I hope all the healthcare professionals from various levels will use this protocol as a guide in
prescribing, dispensing and administration effectively. Once again, I would like to thank the
editorial committee and the contributors for their hard work in developing this protocol and
making it a reality.

Last but not least, congratulations to all HTAN pharmacists for their diligent effort to complete
and publish this HTAN Dilution protocol 2017.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

PREFACE
This Protocol has been designed for rapid reference and the information presented has been
carefully selected to aid decision on preparation and administration of medicines. It compiles
the method of preparations and administration for injectable medicines products with different
brands that had been and are currently being used in our hospital. Every effort is made to
ensure the accuracy of the content of this dilution protocol. However, readers are strongly
advised to counter check the information provided with the respective Product Inserts. The
editorial team shall not hold responsibility for errors, omissions or inaccuracies in this
publication.
.
Although the edition represents a considerable advance in the content and presentation of
information on the dilution of medicines, further improvement will be necessary. Comments
from healthcare professionals are therefore very welcome and should be sent to:

Dilution Protocol Editorial Committee,

Pharmacy Department,
Hospital Tuanku Ampuan Najihah, Kuala Pilah.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

ACKNOWLEDGEMENTS
We are grateful to individuals and organisations that have provided valuable
advice, assistance and information to the HTAN Dilution Protocol 2017 as listed
below:
i. Head of Pharmacy Department, Puan Wan Noor Hayati binti Wan Abdullah for
her encouragement and continuous advice
ii. All Dilution Protocol editorial committee members for their endless contributions
and support in developing this protocol.
iii. All Dilution Protocol committee team 2013 for their contributions in Dilution
Protocol 2013, as a reference to the publication of this protocol.
iv. Bahagian Perkhidmatan Farmasi, Jabatan Kesihatan Negeri, Negeri Sembilan
for supporting us in publishing.

v. Numerous pharmacists, nurses and others for all contributions, comments and
suggestions given either directly or indirectly in making sure this publication a
reality.

The Editorial Committee Team

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

EDITORIAL BOARD
ADVISOR
Wan Noor Hayati binti Wan Abdullah

EDITORIAL COMMITTEE
Marzirah binti Ibrahim
Muhammad Faizal bin Maarof
Siti Mariam binti Saha
Asiah binti Addenan
Siti Maryam Shafiyah binti Abas
Teo Kui Yuan
Lim Kah Von
Ong Yin Sin
Nurul Sakinah binti Azman
Nur Amalina binti Mat Nawi
Lee Wai Han
Thamarai Chelvi a/p Balachandaran
Kong Lai San
Adibah binti Murayadi

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

ABBREVIATIONS

ABBREVIATION DESCRIPTION
amp Ampoule
D5 Dextrose 5%
DS Dextrose saline
HAM High Alert Medication
IM Intramuscular
INJ Injection
kg Kilogram
KPK Ketua Pengarah Kesihatan
mcg Microgram
mg Miligram
min Minute
ml Mililiter
NS Normal saline
ROF Restriction of fluids
RT Room Temperature
SC Subcutaneous

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

A
B

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

ACETAZOLAMIDE 500MG INJ [ DIAMOX]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute vial with 5ml provided solvent (WFI).
Further dilution Not required.
Administration Slow IV: Administer reconstituted solution over 3min.
STORAGE & STABILITY
Intact vial Store below 25°C.
Reconstituted solution 24hrs at 2°C-8°c, 12hrs at < 25°C.
CAUTIONS  IM: Preferably avoided because of alkalinity leads to pain.
 Should not be taken by patients with intolerance to sulphonamide and
history of nephritic colic.
REFERENCE(S): 1. Product Insert, Diamox

ACETYLCYSTEINE 2G/10ML (DBL HOSPIRA)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration
Administration IV infusion:
 PCM poisoning case (D5 is preferred):
Initial infusion 150mg/kg in 200ml D5 or NS over 60min. Second infusion
50mg/kg in 500ml D5 or NS over 4hrs. Third infusion 100mg/kg in 1000ml
D5 or NS over 16hrs.

 Contrast-induced nephropathy:
Initial infusion 150 mg/kg in 500 ml NS or D5 over 60 min immediately
before contrast, followed by 50 mg/kg in 500 ml NS or D5 over 4 hrs
immediately after contrast.
*if fluid restriction, minimum volume is 200mL with prolonged (doubled) the
infusion duration. However, PO NAC is preferred unless unavoidable
emergency scan.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Reconstituted solution Discard any unused portion.
CAUTIONS  Anaphylactic reaction with high dose & rapid rate.
 Caution in patient with bronchial asthma or history with peptic ulceration.
REFERENCE(S): 1. Product Insert, DBL Hospira

ACYCLOVIR 250MG (ZOVIRAX®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1 vial with 10ml WFI or NS to give 25mg/ml.
Further dilution The reconstituted solution may further diluted to produce concentration of
5mg/ml (0.5%w/v) for administration by infusion.
 Dose of 250-500mg: in 100ml infusion bag.
 Dose of 500-1000mg: a second bag of 100ml must be used.
*Infusions fluid that can be used: Sodium chloride (0.45% and 0.9%), Sodium
chloride (0.18%) and glucose (4%), Sodium chloride (0.45%) and glucose
(2.5%), Hartmann‟s solution.
Dilution must be done: under full aseptic conditions.
Administration Slow IV infusion: Administer over at least 1hr period.
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STORAGE & STABILITY

Intact vial Store below 25°C.
Reconstituted solution Do not refrigerate reconstituted or diluted solutions. Use immediately.
Discard any unused portion.
Diluted solution Stable for up to 12 hours after reconstitution at room temperature (15-25°C).
CAUTIONS  Reconstituted IV for infusion has a pH of approximately 11.0 and should
not be administered by mouth.
REFERENCE(S): 1. Product Insert, Zovirax

ADENOSINE 6MG/2ML (ADENOCOR®) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Rapid IV bolus injection: The required dose should be injected directly into
a central or large peripheral vein over 2sec1.
If peripheral IV site is used, administer as proximal as possible to trunk (not
in lower arm, hand, lower leg, or foot); follow each bolus with a rapid NS flush
(≥5mL). Use of 2 syringes (one with Adenosine dose and the other with NS
flush) connected to a T-connector or stopcock is recommended2.
STORAGE & STABILITY
Intact vial Store below 30°C. Do not refrigerate
Used vial Discard any unused portion.
CAUTIONS  During administration, continuous ECG monitoring is necessary as life-
threatening arrhythmia might occur.
 May precipitate or aggravate bronchospasm in COPD.
 Compatibility with medicines is unknown.
REFERENCE(S): 1. British National Formulary 2010, 60th Edition
2. Drug Information Handbook, 19th Edition: ACLS, 2005
3. Product Insert, Adenocor

ADRENALINE 1MG/ML (CCM) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM or SC (brochodilator/ Anaphylactic reactions/ Anaphylactic shock*):
Use undiluted (1:1000 solution).
* SC administration results in slower absorption and is less reliable. IM
administration in the anterolateral aspect of the thigh is preferred in the
setting of anaphylaxis. IM administration into buttocks should be avoided1.

Slow IV: Central line is preferred. However, if peripheral line is used, it must
be flushed with at least 20mL NS to aid entry into central circulation. Diluted
to 1:10,000 solution (i.e. 1mL dilute in 10mL NS).

IV infusion (CENTRAL LINE): Central line is preferred. However, if

peripheral line is used, it must be flushed with at least 20mL NS to aid entry
into central circulation2.

 Syringe pump: 10mg in 50mL NS, Infusion pump: 1mg in 250mL NS3
 Dilute 5mg in 500mL NS or D54

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

 Dilute 1mg in 250mL NS or 1mg in 100mL NS5

 Dilute 3mg in 50mL NS6
 Dilute 3mg in 50mL or 500mL NS7

Compatible with NS; and stability in D5 decreases when the pH is >5.5.

Usual IV infusion rate: 1-4mcg/min.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Used vial Discard any unused portion.
CAUTIONS  Contains sodium Metabisulphite that may cause serious allergic type
reactions in certain susceptible patients.
 Unstable in any solution with a pH over 5.5
 Do not use if discoloured (pink or brown) or contains precipitate.
 For cardiac arrest, use LARGE VEIN or CENTRAL LINE ONLY
 Mixing with Sodium Bicarbonate will form polymer and affect drug
potential
 Rapid IV administration may cause death from cerebrovascular
haemorrhage or cardiac arrhythmias (however rapid IV administration is
necessary in pulseless arrest)
REFERENCE(S): 1. Drug Information Handbook, 19th Edition: ACLS, 2005
2. British National Formulary 2010, 60th Edition
3. HUKM Drug Formulary 2010, 5th Edition
4. Sarawak Handbook of Medical Emergencies 2nd Edition
5. Micromedex Healthcare Series Vol. 155
6. MOH, 2011, Dilution Guide for High Alert Medications
7. Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5th version. Royal
Flying Doctors Service of Australia
8. Product Insert, CCM

ALBUMIN (HUMAN) SOLUTION,12.5G IN 50ML (OCTAPHARMA, ALBUTEIN)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV infusion: Albumin 25% can be given diluted or undiluted. Dilute Albumin
25% into 5% with NS or D5 (i.e. 1 vial diluted with 200mL NS or D5).
 5%: used in hypovolemic pts or intravascularly-depleted pts,
≤2-4mL/min if normal plasma volume; ≤5-10mL/min if hypoproteinemia.
 25%: used in pts in whom fluid and sodium intake must be minimized 1.

The infusion rate should be adjusted according to individual and the

indication. In emergencies, may administer as rapidly as necessary to
improve clinical condition.
After initial volume replacement: The rate of infusion should not exceed
1ml/min in patients with normal plasma volume, should not exceed
0.25ml/min in children2 and should not exceed 2-3ml/min in patients with
hypoproteinemia1.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Do not freeze.
Diluted solution Discard any unused portion. Do not begin administration more than 4 hours
after the container has been entered.

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CAUTIONS  Must not be diluted WFI as this may cause haemolysis and acute renal
failure in recipients.
 If dilution is required, acceptable diluents are NS or D5.
 If large volumes are administered, product should be warmed to room
temperature before use.
 Rapid infusion may cause vascular overload with resultant pulmonary
edema.
 May give in combination or through the same administration set as saline
or carbohydrates.
 Do NOT use with Ethanol or protein hydrolysates, precipitation may form.
REFERENCE(S): 1.Drug Information Handbook, 19th Edition: ACLS, 2005
2.Product Insert, Albutein

ALPROSTADIL 500MCG/ML (PROSTIN VR PEDIATRIC®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Further dilute in NS or D5. See administration.
Administration IV infusion (CENTRAL LINE or through umbilical artery catheter placed
at the ductal opening):

Add 1amp Concentration Infusion

(500mcg) in (mcg/ml) rate(ml/min/kgBW)
250 2 0.05
100 5 0.02
50 10 0.01
25 20 0.005

Add the appropriate volume of NS or D5 into the chamber first. Then only add
Alprostadil into the solution to avoid any contact of drug with the plastic
chamber).
For baby 2.8kg with dose of 0.1mcg/kgBW/min: using a solution of 1amp in
100ml - infusion rate is 0.02 x 2.8kg = 0.056ml/min or 3.36ml/hr.
STORAGE & STABILITY
Intact vial Store at 2-8°C
Diluted solution 24 hours after dilution. Discard any unused portions after opening.
CAUTIONS  Alprostadil may interact with the plastic sidewalls of volumetric infusion
chambers causing a change in the appearance of the chambers and
creating a hazy solution. If this occurs, the chamber and the solution
should be replaced.
 Apnea is experienced by ~10-12% of neonates with congenital heart
defects treated with Alprostadil. Apnea is most often seen in neonates
weighing less than 2kg at birth and usually appears during the first hour of
drug infusion. Therefore, respiratory status should be monitored
throughout treatment, and Alprostadil should be used where ventilator
assistance is immediately available.
REFERENCE(S): 1.Product Insert, Prostin VR Pediatric®

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

AMIKACIN 500MG/2ML (APALIN®¹AMICIN®²AMIKOZIT®³)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Further dilute each 500mg in 100-200ml NS or D5. Concentration allowed at
2.5-5mg/ml.
Administration IM
IV Bolus: Over 2-3 min².
IV infusion:
-Adult& Paediatric: Diluted solution to be given over 30-60 min.1,2,3
-Infant: Diluted solution to be given over 1-2 hrs1,2,3.
STORAGE & STABILITY
Intact vial Below 30°C.
Away from light.
Do not freeze.
Diluted solution Used immediately. Discard any unused portion2,3.
24hr at room temperature1.
CAUTIONS  This preparation contains sodium metabisulphite may cause anaphylactic
symptoms and life threatening or less severe asthmatic episode.
 If both Penicillin &Amikacin are required, separate the administrations to
avoid incompatibilities (c.f. Gentamicin).
REFERENCE(S): 1.Product lnsert, Apalin
2.Product Insert, Amicin
3.Product Insert, Amikozit

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

AMINOPHYLLINE 250MG/10ML(DBL AMINOPHYLLINE®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IV infusion: Dilute dose with NS to a concentration of 1mg/ml and infuse over
20-30min. Max concentration is 25mg/ml (undiluted) and max rate of infusion
is 0.36mg/kg/min and no greater than 25mg/min¹.

Loading Dose: 1-2 amp in 100mL NS.

Maintenance Dose: 1 amp in 500mL NS or 1 amp in 200-250mL NS.

*ROF patients:
Variety concentration from 2mg/mL (i.e. 250mg in 125mL) to 25mg/mL (i.e.
undiluted)².
@
Dilute to 10mg/mL (i.e. 500mg or 2amp in 50mL)³.

Administration IV infusion:
Loading dose is over 20-30 min, followed by maintenance which should be
continuous.
Maximum infusion rate: 0.36mg/kg/min, and no greater than 25mg/min. (i.e.
LD of 250-500mg for at least 30min)¹.
NEVER used as bolus!!!
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
CAUTIONS  Maintenance dose (continuous infusion) should be administered around-
the-clock rather than 4 times/day, 3 times/day, etc. (i.e. 12-6-12-6, not 9-
1-5-9) to promote less variation in peak and trough serum levels.
REFERENCE(S): 1. HUKM Drug Formulary 2010, 5th Edition
2. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical Pharmacy
Association
3. Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5th version. Royal
Flying Doctors Service of Australia
4. Product Insert, DBL Aminophylline®

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

AMIODARONE 150MG/3ML(CORDARONE®)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Use only isotonic glucose solution.
Continuous IV infusion:
Do not use concentrations of <2ampoules in 500mL D5 (must be
≥0.6mg/ml).
Common dilution:
Loading Dose: 300mg (2amp) in 250-500mL D5.
Maintenance Dose: 900mg (6amp) in 500mL D5.

*If fluid restriction¹

1) Peripheral: up to 2mg/mL (min vol. in LD: 100mL, min vol. in MD:
450mL).
2) Central: up to 6mg/mL.
(min vol. in Loading Dose: 50mL, min vol. in Maintenance Dose: 150mL)
*NOTES:
The more concentrated it is, the more stable it is; BUT availability of line
(peripheral or central) limits it, as higher concentration cause higher
thrombophlebitis risk in peripheral line.

Administration IV infusion: Initial treatment (loading dose) - Further dilute in 20 ml D5 and

administer over 20min to 2hr (usually in 1hr). Maintenance treatment
(maintenance dose) - Further dilute in 250 ml of D5 over a few days
(usually in 23H). NEVER used as bolus!!!
STORAGE & STABILITY
Intact vial Below 25°C.
Diluted solution Used immediately. Dilution to be prepared prior to infusion using equipment
that does not contain any DEHP, i.e. use those made of DEHP-free PVC,
polyolefins (polyethylene, polypropylene) or glass, due to release of DEHP
(to minimize patient‟s exposure).
CAUTIONS  NOT compatible in NS due to oxidation.
 Administer via a large or central vein whenever possible. Otherwise, use
the largest peripheral vein with the highest flow possible for peripheral
administration (e.g. femoral vein).
 Administration through peripheral line may cause local effects, e.g.
superficial phlebitis.
 Administer with continuous ECG and BP monitoring.
 Conc. >3mg/mL will cause peripheral thrombophlebitis.
 For infusion >1hour, conc. of ≤2mg/mL is recommended unless a
central vein is used.
 For CPR VF / Pulseless VT resistant to defibrillation, do not repeat
injection with less than 15 min due to possible irreversible collapse.
 Do NOT mix or inject other preparations in the same syringe or line.

WARNING:
 IV injection may increase risk of haemodynamics (severe hypotension,
circulatory collapse), induce torsade de pointes, cause pulmonary and
hepatic toxicities which lead to fatal incidence. Therefore, IV infusion is

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preferable.

REFERENCE(S): 1. Adult & Intravenous Medications, standard and maximum allowable

concentrations, Guidelines for continuous or titrated infusions. Revised
2008. The University of Hospital Kansas.
2. Product lnsert, Cordarone
3. Drug Information Handbook, 19th Edition.

AMOXICILLIN 1G + CLAVULANIC ACID 200MG (CLAVICIN®¹, CLAVAM®² )

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute the 1.2g vial with 20ml WFI.
Further dilution See administration.
Administration IV bolus: Inject the reconstituted solution over a period of 3-4min.
IV infusion: Further dilute the reconstituted solution in 100ml NS. Infuse
over 30-40min.
STORAGE & STABILITY
Intact vial Below 25°C.
Protected from light.
Reconstituted solution Use within 20min of reconstitution¹.
Stable for 8hr at 5°C², 4hr at 25°C².

CAUTIONS  Should not mix with infusion containing glucose, dextran or bicarbonate.
 Should not be mixed with blood products, proteinaceous fluids (protein
hydrates or IV lipid emulsions).

REFERENCE(S): 1. Product Insert, Clavicin

2. Product Insert, Clavam

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

AMPHOTERICIN B 50MG(AMPHOTRET®)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1 vial with 10ml WFI to prepare 5mg/ml solution.
Further dilution Further dilute dose with D5 to get final concentration of 0.1mg/ml (eg.
50mg vial need to further dilute in 500ml D5).
Administration IV infusion: To be infused over 2-6 hrs (depending on the dose and
reactions). Notes: Rapid infusion has been associated with several acute
reactions. Administration of IV corticosteroids just prior to the infusions
may help to reduce the febrile reactions.
Protect from light during administration.
* Test dose: 1mg in 20ml of D5, administer over 20-30 minutes.
STORAGE & STABILITY
Intact vial 2°C-8°C.
Protect from light.
Reconstituted solution 5mg/ml solution:
RT: 24 hrs (in dark).
Refrigerated: 7 days.
Diluted solution 0.1mg/ml solution: Used promptly after dilution. Discard unused portion.
CAUTIONS  Do not dilute with saline solutions (precipitation of Ampho B).
 Protect from light when administering.
 Strictly use aseptic technique during handling and administration.
 For the test dose, vital signs should be recorded every 30 min for 2-4
hrs.
 Rapid IV infusion has been associated with hypoK, hypotension,
arrhythmias and shock.
 Monitoring of renal and liver functions, blood counts.
 Pre-medication given before each administration:
- T. Paracetamol1g
- IV Promethazine25mg
- IV Pethidine 25mg
- IV hydrocortisone 100mg
REFERENCE(S): 1. Product Insert, Amphotret

AMPICILLIN 500MG (STANDACILLIN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1 vial with 5ml of WFI.
Further dilution See administration.
Administration IM: Inject the reconstituted solution through IM.
IV bolus: Inject the reconstituted solution over at least 3-5min.
IV infusion: Add the reconstituted solution to any amount of NS and
infuse over 15-20min.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Reconstituted solution Use immediately.
CAUTIONS  Should not be mixed with blood products, proteinaceous fluids, lipid
emulsions, inverted sugars or dextran.
REFERENCE(S): 1. Product Insert, Standacillin

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

AMPICILLIN + SULBACTAM 1.5G (SULBACIN®¹Ampicillin + Sulbactam 1.5g Averroes²)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: 1.5g vial should be reconstituted with 3ml WFI¹.
Slow IV: 1.5 g vial should be reconstituted with 3-5 ml WFI and further dilute in
50-100ml NS (to get a concentration of 15-30mg/ml). Diluted solution should
be given over 15-30min¹.
IM / IV bolus:
- Add 3.2ml WFI. Maximum final concentration 125-250 mg/ml².
IM: Deep IM injection².
IV bolus: Over >3 min².
IV infusion: Over 15-30 min².
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from moisture.
Diluted solution Stable for 8hr at 25°C and 72hr at 4°C¹.
Use immediately².
CAUTIONS  If pain is experienced during deep IM injection, 0.5% sterile solution for
injection of Lignocaine HCl anhydrous may be used for reconstitution.
REFERENCE(S): 1. Product Insert, Sulbacin ®
2. Product Insert, Ampicillin + Sulbactam 1.5g Averroes

ANIDULAFUNGIN 100MG (ERAXIS®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1vial with 30ml of WFI to provide a concentration of 3.33mg/ml.
Further dilution Further dilute the 30ml of the reconstituted solution into 100ml NS or D5 to
provide a concentration of 0.77mg/ml (i.e. 100mg in 130ml).
Administration IV infusion: Infuse the diluted solution at a rate of 1.4ml/ min (≤1.1mg/min).
Minimum duration of infusion is 90min for each vial.
STORAGE & STABILITY
Intact vial Store at 2-8°C. DO NOT freeze.
Reconstituted solution 24 hr at 25°C.
Diluted solution 25°C: for up to 48 hours.
CAUTIONS  Watch out for drug-drug interactions (Ciclosporin, Voriconazole,
Liposomal Amphotericin B, Rifampicin).
REFERENCE(S): 1.Product Insert, Eraxis

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

ARTESUNATE 60MG (ARTESUN1, DUANATE2)

* contains 2 types of diluents: 1mL Na Bicarbonate 5% & 5mL NaCl 0.9%
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Inject the supplied 5% sodium bicarbonate into the injection vial. Shake the
vial for 2-3min and wait until completely dissolved & solution becomes clear.
Discard any air using syringe and needle.
Further dilution See administration.
Administration IM injection: Further add in 2ml of D5 or NS to produce 20mg/ml solution.
Withdraw the required dose and inject.
Slow IV: Further add in 5ml of D5 or NS into the solution to produce
10mg/ml solution. Withdraw the required dose from the vial and inject slowly
at a rate of 3-4ml/minutes.
It should NOT be used as IV infusion.
STORAGE & STABILITY
Intact vial Protect from light. Store below 25oC1. Store below 30°C2.
DO NOT freeze.
Diluted solution Use immediately after dilution.
CAUTIONS  DO NOT mix in IV drip.
 If solution appears cloudy or sediment occurs it should not be used.
REFERENCE(S): 1. Product Insert, Artesun
2. Product Insert, Duanate

ATRACURIUM BESYLATE 50MG/5ML INJ (TRACRIUM™1,ATRALEX2) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration For IV administration ONLY.
IV Bolus: Undiluted. Administer at dose of 0.3-0.6mg/kg over 1 minutes
IV Infusion: Dilute with diluent to produce solution of ≥0.5mg/ml (at least
50ml) and infuse at rates of 0.3-0.6 mg/kg/hr after an initial bolus.
Can be diluted to 0.5-5mg/mL (i.e. 1amp or 25mg in 5-50mL diluent)3.
Compatible with NS, D5, Ringer‟s solution, NaCl 0.18% + D4%, Hartmann‟s
solution.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Protect from light.
Diluted solution
Infusion solution Duration of stability (hrs) in
daylight &<30°C
NS 24
D5 8
Ringer‟s Injection USP 8
NaCl 0.18% + Glucose 4% 8
Hartmann‟s Solution 4

CAUTIONS  Do NOT mix with alkaline solution in the same syringe.

 Do NOT administer before unconsciousness has been induced.
 When small vein is selected as the injection site, Atracurium should be
flushed through the vein with physiological saline after injection. When
other anaesthetic drugs are administered through the same in-dwelling

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

needle or cannula as Atracurium, it is important that each drug is

flushed through with an adequate volume of physiological saline.
 Prolong action resulting in respiratory insufficiency or apnea.
REFERENCE(S): 1. Product Insert Tracrium
2. Product Insert Atralex
3. British National Formulary 2011, 61th Edition, HUKM Drug Formulary
2010, 5th Edition
ATROPINE SULPHATE 1MG/ML ( ACIPAN DUOPHARMA1)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted. Organophosphorus poisoning (as often as every 5 minutes),
bradycardia or asystole due to overdosage with parasympathomimetic
agents for gastrointestinal anticholinergic effect or preanaesthetic
medication.
SC: Undiluted. For gastrointestinal anticholinergic effect or preanaesthetic
medication.
IV (Slow IV, IV infusion):
Arrythmias, bradycardia or asystole due to overdosage with
parasympathomimetic agents, organophosphorus poisoning (as often as
every 5 minutes), for gastrointestinal anticholinergic effect or preanaesthetic
medication.
Slow IV injection: Undiluted or 1mg in 10mL NS or D5 over 15-30s.For
Organophosphate, Carbamate or mushroom poisoning:
IV infusion: Dilute 20mg up to 100mL NS or D5 to final conc. of 0.2mg/mL.
For Organophosphate, Carbamate or mushroom poisoning2.
STORAGE & STABILITY
Intact vial Below 30°C.
Protect from light.
Diluted solution Discard any unused solution after opening.
CAUTIONS  Should not be added to any IV infusion solutions before administration.
REFERENCE(S): 1. Product Insert Acipan Duopharma
2. Nova Scotia Provincial Antidote Kit Manual. 2010. IWK Regional Poison
Centre.

AZITHROMYCIN 500MG [ AZEE 1, ZITHROMAX2 ]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1 vial with 5ml of WFI (supplied in the box).
Further dilution Further dilute with 250 or 500ml NS or D5 to produce concentration of
2mg/ml or 1mg/ml solution (Diluted solution do not > 2mg/ml).
* Other diluents: NS, 0.45% NaCl, 5% Dextrose in Water, Lactated Ringer‟s
Solution, 5% Dextrose in 0.45% NaCl, 5% Dextrose in Lactated Ringer‟s
Solution, 5% Dextrose in 0.3% NaCl.
Administration IV infusion: Concentration of 1mg/ml should be infused over 3 hours and
concentration of 2mg/ml over 1 hour.
* DO NOT infuse < 60minutes.
STORAGE & STABILITY
Intact vial Store below 25°C.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

Reconstituted solution 24 hrs at room temperature1, 24 hours at 2°C-8°C2.

CAUTIONS  Do NOT administer as IV bolus or IM injection.
 Other IV substances additives or medications should NOT be added to
or infused simultaneously through the same IV line.
REFERENCE(S): 1. Product Insert, Azee
2. Product Insert, Zithromax

BENZATHINE BENZYLPENICILLIN 2.4MU [RETARPEN®1,Benzathine Benzyl Penicillin

Karnataka2)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Dissolve the content with at least 5ml of water for injection1.
Dissolve the content with at least 8ml of water for injection2.
Further dilution See administration.
Administration Deep IM Injection.
STORAGE & STABILITY
Intact vial Below 30°C.
Protect from light.
Do not freeze.
Reconstituted solution Use immediately after reconstitution. Discard unused portion.
CAUTIONS  Maximum volume tolerated at a given injection site is 5ml1.
 Because of high concentration of suspended matter, needle may be
blocked if injection is not made at slow steady rate2.
 Caution in patient with allergic diathesis or bronchiol asthma.
 Must NOT be injected SC or IV or Intrathecally or instilled into body
cavities.
 To avoid sciatic nerve damage, infants and small children SHOULD
NOT be injected into the upper outer quadrant of the buttock
REFERENCE(S): 1. Product Insert, BenzathineBenzylpenicillin 2.4MU(Retarpen®)
2. Product Insert, Benzathine Benzyl Penicillin Karnataka

BENZYL PENICILLIN 1MU (600MG)1& 5MU (3GM)2

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution 1MU.Dissolve 1 vial with 2ml or more WFI.
5MU.Dissolve 1 vial with 10ml or more WFI.
Further dilution See administration.
Administration Deep IM/ Slow IV/Intermittent IV infusion.
Deep IM: Upper outer quadrant of the buttock.
Slow IV: Infuse at rate ≤ 300mg/minutes or 0.5 MU/minutes.
Intermittent IV infusion: For dose less than 4MU, further dilute in 50ml NS
or D5. For dose more than 4MU, further dilute in 100ml NS or D5.
Administer over 30-60minutes.
STORAGE & STABILITY
Intact vial Below 25°C.
Reconstituted solution 2-8°C: 6 days.
30±2°C: 2 days.
CAUTIONS  Monitor electrolyte balance, blood counts & renal function in patient with
high dose treatment >5days.
 Alternate sites for repeated injections.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

REFERENCE(S): 1.Product Insert, Benzyl Penicillin 1MU (600mg)

2.Product Insert, Benzyl Penicillin 5MU (3gm)
BERACTANT INTRATRACHEAL SUSPENSION(200MG PHOSPHOLIPID/8ML)(SURVANTA®1)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Survanta should be warmed by standing in RT for at least 20 minutes or
warmed in the hand for at least 8 minutes. Artificial warming methods
should NOT be used.
Intratracheal ONLY.
Each dose is divided into 4 quarter doses and administered with the infants
in different position (right-left-right-left).

STORAGE & STABILITY

Intact vial 2°C-8°C.
Unopened and unused vial of Survanta that have been warmed to RT may
be returned to the refrigerator within 8 hrs of warming. Drug should not be
warmed and returned to the fridge more than once.

Reconstituted solution Single use only. Discard any unused portions after opening.
Diluted solution Single use only. Discard any unused portions after opening.
REFERENCE(S): 1. Product Insert, Beractant Intratracheal suspension (200mg Phospholipid/
8mL) (Survanta®)

BROMHEXINE HCL 4MG/2ML INJ (MUCOLEX)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM: Deep IM.
Slow IV injection: 2-3 minutes.
IV infusion: May be diluted in glucose, levulose, or Ringer‟s solution (but
volume not stated).
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Diluted solution Discard any unused solution after opening.
CAUTIONS  Contains Metabisulphite that may cause allergic reactions including
anaphylactic symptoms and life-threatening or less severe asthmatic
episodes in certain susceptible patients. More frequent in asthmatic
patients.
 Should not be mixed with alkaline solution as it may cause cloudiness
or flocculation as Bromhexine is acidic (pH 2.8).
REFERENCE(S): 1. Product Insert, Mucolex

BUPIVACAINE HCL HEAVY 20MG/4ML (MARCAINE® SPINAL HEAVY1,BUPITROY HEAVY2)

*1mL contains = 5mg Bupivacaine HCl - HAM
PREPARATION/ METHOD OF ADMINISTRATION

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

Reconstitution Not required.

Further dilution Not required.
Administration NOT FOR IV!!!
Spinal injection: Inject below L3-L4 intervertebral space.
*In the event of unsuccessful anaesthesia, a new attempt to administer the
drug should only be made by injecting at a different level and with a smaller
volume. One cause of lack of effect may be poor intrathecal distribution of
the drug, and this can be helped by altering the patient‟s position.
STORAGE & STABILITY
Intact vial 2- 25°C1.
Do not freeze.
Protect from light2.
Diluted solution Use as soon as possible after ampoule has been opened.
CAUTIONS  Addition of any solutions or fluids to spinal solutions is NOT
recommended.
 A spinal injection is given only after the subarachnoid space has been
clearly identified by means of lumbar puncture (clear CSF runs out via
the spinal needle or is seen on aspiration).
 Lowest possible dose for adequate anesthesia should be used.
 Dose should be reduced in the elderly and in patients with the late
stages of pregnancy.
 To avoid excessive dosage in obese patients, dose may need to be
calculated based on ideal body-weight.
 Inadvertent intravascular administration may cause acute CNS and
CVS toxic effects.
 Spinal anaesthesia can sometimes lead to major blocks, with paralysis
of intercostals muscle and the diaphragm, especially in pregnant
women.

REFERENCE(S): 1. Product Insert, Marcaine® Spinal Heavy.

2. Product Insert, Bupitroy Heavy

BUPIVACAINE 100MG/20M (PIVAKAN 0.5%W/V PLAIN1, MARCAINE® PLAIN2 )

*1mL = 5mg Bupivacaine HCl - HAM
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Spinal anaesthesia for surgery: Undiluted: 2-4 mL injected into the L3-L4
interspace. If the patient is in supine horizontal position, 3mL of Bupivacaine
spreads to T5-T7. If patient is in sitting position, it spreads to T4-T5.
Post-operative analgesia:
Intermittent epidural: Undiluted infuse 4-8ml at rate of 1-2mL/hr.
Continuous epidural: Dilute to 0.125% (i.e. 1mL or 5mg to 4000mL) infuse
at a rate of 15mL/hr.
Analgesia in labour: 6-12ml for moderate or complete block.
Continuous lumbar epidural infusion during labour (once epidural
block established):10–15 mg/hour of 0.1% or 0.125% solution; max. 2
mg/kg over 4 hours and total of 400 mg in 24hours.
Continuous thoracic, upper abdominal, or lower abdominal epidural

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

infusion for postoperative pain (once epidural block established):

4–15 mg/hour of 0.1% solution, or 5–15 mg/hour of 0.125% solution; max. 2
mg/kg over 4 hours and total of 400 mg in 24 hours; not recommended for
use in children3.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Diluted solution Discard any unused solution after opening. Solution should be used
immediately after opening.
CAUTIONS  Spinal injections should be made after the subarachnoid space has
been clearly identified by lumbar puncture. NO drug should be injected
until clear CSF is seen to escape from the spinal needle or it is
detected by aspiration.
 Lowest possible dose for adequate anesthesia should be used.
 Dose should be reduced in the elderly and in patients with the late
stages of pregnancy.
 The spread of anaesthesia obtained is dependent on several factors,
the most important being volume of solution injected, position of patient
and rate of injection.
 The safety and effectiveness of Bupivacaine depend on proper dosage,
correct technique and adequate precautions.

REFERENCE(S): 1. Product Insert, Pivakan 0.5%w/v Plain.

2. Product Insert, Marcaine® Plain.
3. British National Formulary 2011, 61st Edition.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

C
D

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

CALCIUM CHLORIDE 11 mEq 10ml (CALCICLO®)

Calciclo 11mEq contains Calcium dehydrate 0.8303g/10mL
Each 10ml =11mEq Ca2+=5.5mmol Ca2+ and 11Meq Cl-
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Extremely slow IV injection only!!
Inject 3.4 to 6.8 mEq (500mg to 1gm) at a speed of 0.5 to 1 ml per minutes
or 10 ml in 5 minutes.
Patient must be in supine position.
STORAGE & STABILITY
Intact vial Below 25°C.
Diluted solution Discard unused quantity.
CAUTIONS  Cardiac rhythm must be monitored.
 Forms some complexes with tetracycline, and mix of these composites
in infusion is excluded.
REFERENCE(S): 1. Product Insert, Calciclo®.

CALCITONIN (SALMON) 50IU/ML&100IU/ML SYNTHETIC SALMON CALCITONIN

(MIACALCIC®1)
*8units contains = 20mcg Calcitonin
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC injection: Undiluted.
IM injection: Undiluted.
IM is recommended over the SC route when the volume of Calcitonin to be
injected exceeds 2mL2.
Multiple injection sites are recommended for volumes greater than 2mL3.
Slow IV injection.
IV infusion: Dilute in 500ml of NS and administer over at least 6 hours.
STORAGE & STABILITY
Intact vial 2-8°C.
Do not freeze.
Diluted solution Use immediately. Discard any unused portions.
REFERENCE(S): 1. Product Insert Synthetic Salmon Calcitonin Miacalcic®1
2. Drug Information Handbook 19thEdition
3. Micromedex Healthcare Series Vol. 157

CALCIUM FOLINATE 50MG/5ML (LEUCOVORIN CALCIUM)1

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted.
IV bolus: Undiluted. Run slowly at a rate less than 160mg/minutes due to
calcium content2.
IV infusion: Over 4 hours (leucovorin rescue) or over 15minutes to 2hours2.
*Dilute in 100-1000ml NS or D5 for infusion3.

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*ROA and duration SHOULD be based on individual protocol!!!

STORAGE & STABILITY
Intact vial 2°C -8°C.
Do NOT freeze.
Protect from light.
Diluted solution Ringers, lactated Ringers, NS:24 hours at RT.
D5 & D10: 12 hours at RT.
10% dextrose saline: 6 hours at RT.
CAUTIONS  Harmful or fatal if given intrathecally.
 <160mg of leucovorin should be injected IV per min(due to Ca content).
 SrCr& methotrexate levels should be determined at least once daily.
 Should NOT be administered concurrently with Methotrexate
(commonly 24hours after the dose of MTX)2.
REFERENCE(S): 1. Product Insert, Leucovorin Calcium.
2. Drug Information Handbook 19th Edition
3. HUKM Drug Formulary 2010, 5th Edition

CALCIUM GLUCONATE 10% INJECTION (B. BRAUN)1

*(940mg CaGlu in 10ml, 2.26mmol Ca2+ in 10ml)
*1ml contains = 0.226mmol Ca2+= 0.452mEq Ca2+ = 8.4mg Ca2
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV injection: Run at rate of 1.5mL/min2.Max rate 2-5ml/minutes3.
Continuous or intermittent IV infusion: Dilute with 500-1000ml of NS, D5,
NSD5; to give concentration 1-2mg/mL3.Max concentration,dilute 1:10 to a
concentration of 10mg/mL with NS or D5(i.e. 1 amp in 100mL)1.
The maximum rate is 2ml/minutes = 0.9mEq Ca/minutes (i.e. 1 amp in
500mL, run >1.5hours)3. Max rate = 50mg CaGlu/ minutes1.
Deep IM: Preferable into gluteal region.
STORAGE & STABILITY
Intact vial Below 25°C.
Diluted solution Discard any unused solution. After dilution:
48 hours if RT.
24 hours if 2-8°C.
CAUTIONS  In children, should not be injected IM but ONLY slow IV.
 Because of the risk of local irritation, IM should be given if ONLY if IV is
not possible.
 For IM, longer needle required in overweight patients in order to avoid
injecting into adipose tissue, because Calcium is insoluble in adipose
tissue and may therefore cause infiltration and subsequent abscess
formation, tissue induration and necrosis.
 Administered slowly to minimize peripheral vasodilation and cardiac
depression.
 ECG monitoring is required when IV injection.
 Incompatible with oxidizing agents, citrates, soluble carbonates,
oxalates, phosphates, tartrates and sulphates.

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REFERENCE(S): 1. Product Insert, Calcium Gluconate B. Braun

2. Drug Information Handbook 19th Edition
3. HUKM 2nd Edition

CARBOPROST TROMETHAMINE 250MG/ML (HEMABATE®1)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Deep IM injection: Undiluted. Deep into the muscle. Rotate site if multiple
injections are required2.
STORAGE & STABILITY
Intact vial 2°C-8°C.
Diluted solution Discard any unused portions after opening.
CAUTIONS  Continuous administration of Carboprost for more than 2 days is not
recommended.
 Do NOT inject IV; may result in bronchospasm, hypertension, vomiting
or anaphylaxis2.
REFERENCE(S): 1. Product Insert, Hemabate®
2. Drug Information Handbook 19th Edition

CEFAZOLIN 1 G INJECTION
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: 1 g in 4mL 0.5% LIDOCAINE solution. Inject directly into major muscle
mass.
Slow IV: Add 4mL WFI or NS to each gram of cefazolin. Further dilute 1 g in
100mL NS or D5. Infuse for 30 min.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution Use immediately.
REFERENCE(S): 1. Hospital Selayang Dilution protocol, 2015 3rd Edition

CEFOPERAZONE SODIUM 1G (BICAFAR®1)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration Slow IV injection: Over ≥ 3-5 minutes. Dissolve in diluent (D5, D10, NS,
NSD5, WFI) to final concentration 100mg/ml.
Intermittent IV infusion: Over 15-60 minutes. Initial reconstitute 1g in 5ml
WFI. Further dilute 1-2g in 20-100ml D5 / NS. If use WFI: ≤ 20ml.
IM: Deeply into the large muscle mass of gluteus maximum or anterior
thigh. Withdrawable volume: 4ml. Add 2.6ml WFI until completely dissolved
& then add 0.9ml 2% lignocaine to give final concentration of 250mg/ml.
Withdrawable volume: 3ml. Add 1.8ml WFI until completely dissolved & then
add 0.6ml 2% lignocaine to give final concentration of 333mg/ml.
STORAGE & STABILITY
Intact vial Below 25°C.

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Protect from light.

Diluted solution Solution of 300mg/ml:
RT: 24 hours.
2-8°C: 5 days.
CAUTIONS The admixture of penicillins and cephalosporins and aminoglycosides may
result in substantial mutual inactivation.
REFERENCE(S): 1. Product Insert, Bicafar®

CEFOPERAZONE / SULBACTAM 1G (SULPERAZONE®1CEFOBACTAM2).

*1g of Sulperazone contains 500mg Cefoperazone and 500mg of sulbactam
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution 1 g dissolves with 3.4ml of NS or D5 or WFI.
Further dilution See administration.
Administration IV/ IM injection: 1 g diluted with 3.4mL diluents, then further diluted with 2%
lidocaine to produce solution containing 250mg cefoperazone and 125mg
sulbactam/ml.
IV injection: Reconstitute with 3.4ml of WFI, D5 or NS and run over
>3minutes.
Intermittent infusion: Reconstitute with 3.4ml of WFI, D5 or NS. Then
dilute to 20ml with the same type of solution. Run over 15-60minutes.
STORAGE & STABILITY
Intact vial Below 25°C1.
Below30o C2.
Protect from light.
Reconstituted solution Stable for 24 hours at below 25°C.
REFERENCE(S): 1. Product Insert, Sulperazone®
2. Product Insert, Cefobactam

CEFEPIME 1G (FORPAR®1, MAXIPIME®2, MEGAPIME3)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: 1g is diluted with 3ml of diluent to produce 230mg/ml solution (final
volume = 4.4ml) administer at deep large muscle mass. Dose up to 1g may
be administered at single injection sit. Maximum dose of 2g should be
administered at 2 injection sites2.3.
1g can be diluted with 2.4mL of WFI, NS 0.9%, dextrose injection,
lidocaine0.5% or 1.0% or sterile bacteriostatic WFI with parabens or benzyl
alcohol to produce approximate concentration of 280mg/ml1.
Slow IV injection: 1g is dissolve with 10ml of WFI, D5 or NS to produce
90mg/ml solution, with final volume of 11.4ml. Administer over 3-5 mins3
IV infusion: 1g is dissolve with 10ml of WFI, D5 or NS. Further dilute with
50-100ml the same solvent and administer over 30 mins1, 2, 3.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Reconstituted solution Constituted solution for IM:
RT: 24 hours

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2-8°C: 7 days1,2,3
Diluted solution Solution of 1-40mg/ml:
RT: 24 hours
2-8°C: 7 days1,2,3
CAUTIONS  IM is indicated ONLY for mild to moderate uncomplicated or
complicated UTIs due to E. coli when the IM route is considered to be
more appropriate route of administration.1
REFERENCE(S): 1. Product Insert, Forpar®
2. Product Insert, Maxipime®
3. Product Insert, Megapime

CEFOTAXIME 1G (REKAXIME®1 , CLARAXIM®2 , PHARMANIAGA CEFOTAXIME3)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: Dissolved 1g in 4ml WFI. Inject deep into gluteus muscle (≤4ml at each
site).
IV injection: Preferred route if daily dose >2gm. Dissolved 1g in at least
4ml WFI or 2g dissolved in at least 10mL WFI and infused over 3-5 minutes.
Short IV infusion: 2 vials of 1g dissolved in 40ml WFI or D10 and infused
over 20 minutes.
Continuous IV infusion: 2 vials dissolved in 100ml isotonic saline or
glucose solution and infused over 50-60 minutes.
STORAGE & STABILITY
Intact vial Below 30°C.
Protect from light.
Reconstituted solution 2°C-8°C: 24hours1.
Single use3.
CAUTIONS  Must NOT be mixed with sodium bicarbonate.
REFERENCE(S): 1. Product Insert, Rekaxime®
2. Product Insert, Claraxim®
3. Pharmaniaga Cefotaxime

CEFTAZIDIME 1G (CEF-41, CEFTAZIDIME PHARMANIAGA2)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: Add 3ml of 0.5% or 1% lidocaine HCL injection into 1g vial to produce
approximate concentration of 260mg/ml. Not to inject >4ml into either side.
Inject into a large muscle mass such as the upper outer quadrant or the
gluteus maximus or lateral part of the thigh2.
IV bolus: 1g dissolved with 10ml of WFI to produce approximate
concentration of 90mg/mL and run over 3-5 minutes.
IV infusion: Further dilute the above solution up to 50ml of the same diluent
to produce approximate concentration of 20mg/ml and run over 30 minutes.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Reconstituted solution RT: 12 hours.

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2°C-8°C: 3 days.
CAUTIONS  Sodium bicarbonate is not recommended as diluent.
REFERENCE(S): 1. Product Insert, Cef-4
2. Product Insert, Ceftazidime Pharmaniaga

CEFTAZIDIME 2G (VAXCEL1)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IV bolus: 2g is dissolved with 10ml of diluents NS, D5 or WFI to produce
approximate concentration of solution 170mg/ml and infused over 3-5
minutes.
IV infusion: Further dilute the above solution up to 50ml of the same diluent
(40mg/ml) and infused over 30 minutes.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Reconstituted solution RT: 18 hours.
2°C-8°C: 3 days.
CAUTIONS  Sodium bicarbonate is NOT recommended as diluents
REFERENCE(S): 1.Product Insert, Vaxcel

CEFTRIAXONE 1G (UNOCEF1, PHARMANIAGA CEFTRIAXONE INJECTION2)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: 1g dissolved in 3.6ml of 1% lidocaine HCl. Not more than 1g be injected
at one site.
IV injection: 1g dissolved in 10ml WFI. Administer over 2-4 minutes.
IV infusion: Dilute 1g with 10ml of diluents, WFI, dextrose solution or NS.
Further dilute with the same diluents of 50ml or 100ml.Administer over ≥ 30
minutes.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Reconstituted solution Not required protection from light.
RT: 24hours.
2°C-8°C: 3 days.
Diluted solution RT: 3 days
2-8oC :10days
REFERENCE(S): 1. Product Insert, Unocef
2. Product Insert, Pharmaniaga Ceftriaxone Injection

CEFUROXIME 750MG (ANIKEF1, PHARMANIAGA CEFUROXIME INJECTION2)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.

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Administration Deep IM: Dilute 750mg with 3ml of WFI1,2.

Slow IV injection: Dilute 750mg with at least 6ml of WFI or 15ml for 1.5gm.
Infused slowly over 3-5 mins1. Dissolved 750mg with 8ml of WFI or 16ml for
1.5gm2.
Short IV infusion: Dissolved 1.5g in 50-100ml WFI and administer over 30
minutes.
STORAGE & STABILITY
Intact vial Below 30oC1.
Below 25°C2.
Protect from light.
Reconstituted solution RT: 5 hours.
2°C-8°C: 48 hours.
REFERENCE(S): 1. Product Insert, Anikef
2. Product Insert, Pharmaniaga Cefuroxime Injection

CHLORPHENIRAMINE 10MG/ML 10ML VIAL (PIRIMAT®1)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution Slow IV injection / IM / SC: Undiluted.
Administration Slow IV injection: Administer slowly over 1 minutes (preferable in
anaphylactic reaction).
SC: For pediatric and in the event of blood transfusion reaction.
IM: Injected separately immediately prior to injection of any other drug.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light & freezing.
Diluted solution Discard any unused portion after opening.
CAUTIONS  Any drowsiness, giddiness or hypotension followed by IV injection is
usually transitory.
 Patients undergoing treatment with this drug should NOT take charge
of vehicles, other means of transport, or machinery where loss of
attention may lead to accidents. Patients should abstain from alcohol.
REFERENCE(S): 1. Product Insert, Pirimat®

CLINDAMYCIN 300MG/2ML (TIDACT1, DALACIN C2)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Single IM doses of greater than 600mg are not recommended.
IV infusion: Must be diluted with diluents before administration NS or D5.
Administer over at least 10-60 minutes. Dose greater than 1.2g in a single
one-hour infusion is not recommended.

Dose Diluent Administration Time

300mg 50ml 10 min
600mg 50ml 20 min
900mg 50-100ml 30 min
120mg 100ml 40 min
*Concentration must NOT exceed 18mg/ml and infusion rate must NOT

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exceed 30mg/minute.
STORAGE & STABILITY
Intact vial Below 25°C. Avoid refrigeration1.
2-8oC, Refrigerate. Do not freeze2.
Diluted solution Discard any unused portion of vial after 24hours.
CAUTIONS  Never administer as bolus.
 Clindamycin phosphate contains benzyl alcohol as a preservative. Benzyl
alcohol has been associated with a fatal “Gasping Syndrome” in
premature infants. It should be avoided in children under 2 years of age2.
 Cautions should be used when prescribing Dalacin C to individuals with
history of gastro-intestinal disease, especially colitis.
 Should be used with caution in patient receiving neuromuscular blocking
agent as clindamycin has been shown to have neuromuscular blocking
properties that may enhance the action of other neuromuscular blocking
agents.
 Should not be administered concurrently with erythromycin as
antagonism has been demonstrated between these two drugs.
 Incompatible with alkaline preparations or drugs unstable at low pH since
solutions of clindamycin salts have a low pH.
REFERENCE(S): 1.Product Insert, Tidact
2.Product Insert, Dalacin C

CIPROFLOXACIN 200MG/100ML(CIPROXOL)1
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV infusion: Infused slowly over 60 minute (into large vein).
Compatible diluents: NS, Ringer solution, D5 or D10, 10% Fructose solution
Can be infused either directly or after mixing with compatible infusion.
STORAGE & STABILITY
Intact vial Between 15°C and 30°C.
Protect from light.
Do not freeze.
Reconstituted solution RT: 24 hrs.
CAUTIONS  Used with caution in epileptic patient or history of CNS disorders.
 Should be well hydrated.
 Should avoid direct exposure to excessive sunlight or UV light.
 Use cautiously as G6PD patients are prone to have hemolytic reaction.
REFERENCE(S): 1. Product Insert, Ciproxol

CLOXACILLIN 250MG, 500MG (MONOCLOX®)1

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution See administration.
Further dilution See administration.
Administration IM: 1 vial of250mg is dissolved in 1.5ml WFI or 1 vial of 500mg is dissolved
in 2.5ml WFI.
IV bolus / IV infusion: Dissolve 250mg in 5ml or 500mg in 10ml WFI
Administer slowly over 3-4 minutes. May also be added to infusion fluids or

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injected, suitably diluted into the drip tube over 3-4 minutes.
STORAGE & STABILITY
Intact vial Below 25°C.
Reconstituted solution Discard unused solution.
CAUTIONS  Do not mix with blood products of proteinaceous fluids such as protein
hydrolysates nor with lipid emulsions
REFERENCE(S): 1. Product Insert, Monoclox®

COLISTIMETHATE SODIUM 1MÜ (COLOMYCIN1)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Dissolved 1MU vial with 2ml of WFI.
Further dilution See administration.
Administration Slow IV injection: Administer over 30-60 minutes1.
Intermittent IV infusion: Administer over 30 minute.
Continuous IV infusion: One half of the total daily dose is administered by
direct IV injection over 3-5 minutes followed by 1 to 2 hours later by the
remaining one-half of the total daily dose diluted in a compatible IV solution
(NS/D5/NSD5/LR) infused over 22 to 23 hours (5-6mg/hours).The final
concentration for continuous infusion administration should be based on the
patient‟s fluid needs, infusion should be completed within 24 hours of
preparation2.
STORAGE & STABILITY
Intact vial Below 25°C.
Diluted solution 2°C-8°C: 24hours.
Below 25°C: 8hours.
Discard any remaining solution.
CAUTIONS  Use caution in patient with pre-existing renal disease.
 May increase the risk of neuromuscular blockade & apnea.
REFERENCE(S): 1. Product Insert, Colomycin.
2. Drug Info Handbook 19th Edition

CYANOCOBALAMINE 1000MCG/ML (VITAMIN B12)1

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM / Deep SC: Undiluted.
STORAGE & STABILITY
Intact vial Below 25°C.
Protect from light.
Diluted solution Discard any unused portion.
REFERENCE(S): 1. Product Insert, Cyanocobalamine 1000mcg/ml (Vitamin B12)

DESFERRIOXAMINE 500MG (DESFERAL®1)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Add 5mL of WFI into 1vial or 500mg of Desferal, becomes 500mg/5.3mL or
95mg/mL.
Further dilution * The 95mg/mL Desferal solution can be further diluted with NS, D5,

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Ringer‟s solution, Ringer‟s lactate solution or peritoneal dialysis solution.

e.g. Dianeal 137 Glucose 2.27%, Dianeal PD4 Glucose 2.27%, and
CAPD/DPCA 2 Glucose 1.5%.

Administration Chronic iron overload

Slow SC infusion:
Add 5mL of WFI into 1vial or 500mg of Desferal, producing total drug
content of 500mg/5.3mL or 95mg/mL. Further dilute with 150ml of NS or D5
and administer using SC infusion pump over 8-12 hours (may be given over
a 24 hours period). The needle should not be inserted too close to the
dermis.
IV infusion: Add 5mL of WFI into 1vial or 500mg of Desferal, producing
total drug content of 500mg/5.3mL or 95mg/mL.
IV infusion during blood transfusion: Added to the blood line by a „Y‟
adaptor located near to the venous site of injection.
Slow IV infusion, Desferal infusion test for aluminium overload in
ESRF patients: During the last 60min of the HD session.
Continuous IV infusion: Indicated for patients who are INCAPABLE of SC
infusion and who have cardiac problem secondary to iron overload.

For treatment of chronic iron overload

IV infusion: Add 5mL of WFI into 1vial or 500mg of Desferal, then further
dilute with 150ml of NS. Infuse over 8-12 hours, and rate not to exceed
15mg/kg/hour. Can be administered before or after blood transfusion but not
concurrently with transfusion. May be administered until 24 hours for
patients with severe cardiac iron deposition.

For treatment of acute iron poisoning

Infusion rate: ≤15mg/kg/hour for 1st 1000mg.
IV infusion Add 5mL of WFI into 1vial or 500mg of Desferal, then further
dilute with 150ml of NS. Infuse at rate of≤15mg/kg/hour for 1st 1000mg.
subsequent doses given at slower rate ≤125mg/hour or infuse at 4-12
hours2.
IM injection: ONLY when SC infusion is not feasible.
Add 2mL of WFI into 1vial or 500mg of Desferal, producing total drug
content of 500mg/2.35mL or 213mg/mL.
Intraperitoneal:
Add 5mL WFI into 1vial or 500mg of Desferal, producing total drug content
of 500mg/5.3mL or 95mg/mL. Dissolved Desferal can be added to the
dialysis fluid in pt on CAPD or CCPD, although Desferal can be given by IM,
slow SC infusion or slow IV infusion.

For Desferal infusion test and treatment of aluminium overload

The appropriate amount of Desferal solution is withdrawn from the vial and
added into 150mL NS.

STORAGE & STABILITY

Intact vial Below 25°C.
Reconstituted solution For single use only. After reconstitution, use immediately (initiate treatment
within 3 hours).

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Discard any unused portion.

RT: 24 hours after reconstitution under validated aseptic conditions
CAUTIONS  IV bolus may lead to acute collapse.
 No SC bolus or IV bolus.
 For continuous IV infusion, care should be given when flushing the line
in order to avoid a sudden infusion of residual Desferal which may be
present in the dead space of the line, as this may lead to circulatory
collapse.
 Incompatible with Heparin injectable solution. NS should NOT be used
as a solvent for the dry substance, but after reconstitution of the
Desferal solution with WFI, it can be employed for further dilution.
 Following rapid IV administration, urticaria, hypotension and shock have
occurred; limiting infusion rate to 15mg/kg/hour may help avoid infusion
rate-related adverse effects2.
REFERENCE(S): 1. Product Insert, Desferal®
2. Drug Information Handbook 19th Edition

DESMOPRESSIN ACETATE 4MCG/ML (MINIRIN®1)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV bolus injection:
Central diabetes insipidus:
Undiluted3.
A dose (not mentioned) diluted in 10mL NS, to be given over 10min.
*However, IV bolus is discouraged due to the potential for hypotension2.
IM injection:
Renal concentrating capacity test: Undiluted3.
SC injection:
Renal concentrating capacity test: Undiluted3.
Intermittent IV infusion:
Haemopjilia A and von Willebrand‟sDiseaese: Slowly over 15-30 mins.
- Adult and children >10kg: diluted in 50mL NS
- Children <10kg: diluted in 10mL NS1
STORAGE & STABILITY
Intact vial 2°C-8°C.
Diluted solution Discard any unused portions after opening.
CAUTIONS  This injection is NOT for intranasal use1.
 Treatment without concomitant restriction of fluid intake may lead to
water retention or hyponatremia1.
 In the signs of water retention / hyponatremia, treatment should be
interrupted and the dose should be adjusted1.
 If injection is given preoperatively, administer IV Desmopressin 30
minutes prior to surgical procedures2.
 During desmopressin infusion, pulse and blood pressure should be
monitored by an experienced nurse or doctor and the infusion rate
should be decreased upon the observance of any adverse experience2.
REFERENCE(S): 1. Product Insert, Minirin®
2. Micromedex(R) Healthcare Series Vol.156

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3. Drug Information Handbook 19th Edition

DEXAMETHASONE SODIUM PHOSPHATE 4MG/ML (2ML AMP) [PENATONE®]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Administer undiluted.
Slow IV: Administer undiluted solution slowly over 3-5min.
IV Infusion: Further dilute with 50-100ml NS or D5 and infuse over15-30min.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Reconstituted 24 hr at room temperature.
solution
CAUTIONS  In shock use only IV route.
 It contains sodium bisulphate, may cause anaphylactic symptoms.
REFERENCE(S): 1. Product Insert, Penatone®

DIAZEPAM INJECTION 10MG/2ML [DBL,DIAPINE] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IM injection: Undiluted.
IV injection: Undiluted.
Continuous IV infusion: Dilute to a solution of ≤10mg in 200mL NS or D52.
Administration IM injection: Deep into muscle.
Use IM only if IV/PO is not possible due to slow and erratic absorption2.
IV injection: Via large vein.
Adults:Rate ≤ 5mg/min2.
Infants/Children: Rate ≤ 1-2mg/min2.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light1.
Diluted solution Discard any unused portion after opening.
CAUTIONS  IV should be given into large vessel1.
 Too rapid injection or vein with too small a lumen carries the risk of
syncope, apnoea, hypotension, bradycardia or cardiac or respiratory
arrest1.
 Administration of diazepam by dilution or mixture with IV fluids or other
drugs should be avoided1.
 Contains Benzyl alcohol, should be AVOIDED in children under 2y.o. and
in neonates1.
 Avoid abrupt discontinuation after prolonged use due to
benzodiazepinewithdrawal1.
REFERENCE(S): 1. Product Insert, DBL Diapine
2. British National Formulary 2011, 61st Edition.

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DICLOFENAC SODIUM INJECTION 75MG/3ML [DICLORAN®]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IM: Undiluted.
Administration IM only: deeply into gluteal muscle.
This product is NOT for IV.
STORAGE & STABILITY
Intact vial Store below 30°C.
CAUTIONS  Should NOT be given for more than 2 days. If necessary, treatment can
be continued with oral form.
REFERENCE(S): 1. Product Insert, Dicloran®

DIGOXIN 250MCG/ML [LANOXINTM] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV infusion: Diluted with a ≥4-fold volume of diluents, otherwise it could lead
to precipitation of Digoxin.
Diluted with NS or D5 in the ratio of 1 to 250 (i.e. 1 ampoule added to 500ml)
In cases of emergency loading dose, higher dose of 0.5-1.0mg should be
administered over 2 hours.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution 48hr at room temperature.
CAUTIONS  Arrhythmias may be precipitated by digoxin toxicity. Monitoring of heart
rate necessary before, during & after the administration.
 IM route is not recommended because it is painful and associated with
muscle necrosis.
 Hypokalaemia sensitizes the myocardium to the actions of cardiac
glycosides.

WARNING:
 Rapid injection is not recommended as it may cause systemic and
coronary arteriolar constriction.
 Death has occurred in digitalized patient with hypocalcaemia when
receiving calcium. Give calcium slowly and in small amounts.
REFERENCE(S): 1. Product Insert, LanoxinTM

DOBUTAMINE 250MG/20ML [MOBITIL®] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Dilute with at least 50ml of D5 or NS.

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Administration Continuous IV infusion:

*Refer Appendix 1 for infusion rate table.

STORAGE & STABILITY

Intact vial Store below 25°C. Protect from light.
Diluted solution Use within 24 hours.
CAUTIONS  Do not:
1) Add to Sodium Bicarbonate or any other strongly alkaline solution
(thiopental, aminophylline)1.
2) Use diluent containing sodium bisulfate and ethanol1.
3) Freeze4.
 Loading dose or bolus injection is not recommended1.
 Use with caution in patients with allergies to sulfites. More frequently
seen in asthmatic patients4.
 Decrease dose gradually before discontinuation1.
 Administer into large vein1.
Warning:
May cause a marked increase in heart rate or blood pressure1.
REFERENCE(S): 1. Product Insert, Mobitil®
2. Micromedex Healthcare Series Vol. 155.
3. Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5 th version. Royal
Flying Doctors Service of Australia.
4. British National Formulary 2010, 60th Edition.

DOPAMINE 200MG/5ML[LOXIN®] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IV infusion: Add 5ml ampoule to either 250ml or 500ml NS or D5 to give a
conc. 800mcg/ml and 400mcg/ml respectively1.
Max conc.:3.2mg/mL (i.e. 4mL or 160mg in 50mL NS or D5)2.
Most centres routinely use 4mg/mL solution (i.e. 1amp or 200mg in 50mL).
No information on stronger3,4.
Administration IV infusion: Shock: 2-5 mcg/kg/min initially, increasing gradually in
increments of 5-10 mcg/kg/min up to 20-50 mcg/kg/min1.
Chronic refractory congestive heart failure: 0.5 mcg/kg/min initially, increasing
gradually to 1-3 mcg/kg/min1.
Patient with cardiac decompensation & occlusive vascular disease: 1-
2µg/kg/min and increase the rate of infusion cautiously1.

*Refer Appendix 2 for infusion rate table.

STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light1.
Diluted solution 24hr at room temperature1.
CAUTIONS  Must be DILUTED before use.
 Administer into central line or large vein to prevent the possibility of
extravasation.
 Administration into an umbilical arterial catheter is not recommended.
 Do not add to Sodium Bicarbonate or any other strongly alkaline solution
(thiopental, aminophylline).

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 Incompatible with alkaline solution or iron salts.

 Decrease dose gradually before discontinuation due to haemodynamic
effect.

Warning:
Use with caution in patients with allergies to sulfites may cause allergic-like
reactions (anaphylactic symptoms & life threatening or less severe asthmatic
episodes)

REFERENCE(S): 1. Product Insert, Loxin®

2. British National Formulary 2010, 60th Edition
3. Micromedex Healthcare Series Vol. 155
4. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical Pharmacy
Association &Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5 th
version. Royal Flying Doctors Service of Australia.

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E
F

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ENOXAPARIN SODIUM 20MG, 40MG, 60MG (CLEXANE®)- HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution SC injection: Undiluted
Slow IV bolus: Recommend to dilute as volume too little. Dilute to 3mg/mL
with NS.

Administration SC injection.
Slow IV bolus: Patients undergoing hemodialysis or patients with STEMI,
in whom IV bolus administration is required. No IV bolus for patients
≥75y.o.
STORAGE & STABILITY
Intact vial Store below 25°C. Do not freeze.
Diluted solution Discard any unused portion.
CAUTIONS  No air bubbles should be expelled before administration.
 For IV bolus administration during acute STEMI, flush the line with
sufficient amount of NS or D5 before and after administration of
Clexane.
 DO NOT administer IM.
REFERENCE(S): 1. Product Insert, Clexane®

EPHEDRINE HCL 30MG/ML [DUOPHARMA] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IM/ SC injection: Undiluted1.
IV injection: Dilute with NS to a concentration of 3mg/ml before
administration (i.e. 1amp or 30mg in 10mL NS)2,3.
Administration IM/ SC injection: 25-50mg1.
Slow IV bolus: 5-25mg. Administered slowly1.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light1
REFERENCE(S): 1. Product Insert, Ephedrine Duopharma.
2. HUKM rug Formulary 2010, 5th Edition
3. British National Formulary 2010, 60th Edition
ERGOMETRINE MALEATE 500µG/ML(A.K.A ERGONOVINE MALEATE)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1vial with 5ml of WFI (supplied in the box).
Further dilution IM injection: Undiluted2.
Slow IV injection: Dilute IV dose up to a volume of 5ml with NS before
administration2.
Administration IM injection.
Slow IV injection: Over >1 min.
(recommend only for emergencies such as excessive uterine bleeding or
any other life threatening situation)2.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Protect from light1.
Diluted solution Discard any unused portions after opening1.
CAUTIONS  IV route produce serious side effect if injections are not diluted and
administered slowly2.

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 IV: use with caution, risk of hypertension3.

 IV should be reserved for emergency use only5.
 IV use indicated for provoking coronary vasospasm in diagnostic
studies for Prinzmetal‟s angina, given during coronary arteriography4.
REFERENCE(S): 1. Product Insert,Ergometrine Maleate 500µg/ml(a.k.a Ergonovine maleate)
2. HUKM Drug Formulary 2010, 5th Edition
3. British National Formulary 2011, 61st Edition
4. Micromedex(R) Healthcare Series Vol. 156
5. Drug Information Handbook 19th Edition

ERGOMETRINE MALEATE & OXYTOCIN 500MCG/IU(SYNTOMETRINE®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM injection: 1ml undiluted.
Slow IV: 0.5ml-1ml undiluted.
STORAGE & STABILITY
Intact vial Store at 2-8°C.
REFERENCE(S): 1. Product Insert, Syntometrine®

ERYTHROMYCIN LACTOBIONATE 500MG

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 10ml of WFI.
Further dilution Dilute with NS or D5 to a final concentration of 1-5mg/ml.
Administration Continuous IV infusion: Over 24 hrs.

Intermittent IV infusion: Over 60 mins every 6 hrs.

Bolus injection NOT recommended.

STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Reconstituted solution Use immediately.
REFERENCE(S): 1. Product Insert.
ESMOLOL HYDROCHLORIDE 100MG/10ML (ESOCARD) - HAM
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IV: Administer the required loading dose over 30 sec to 1 min.
IV infusion: Administer the required maintenance dose for 4 mins.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Do not freeze.
Diluted solution 24 hrs at room temperature.
REFERENCE(S): 1. Product Insert, Esocard.

ESOMEPRAZOLE 40MG (®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Add 5ml NS into vial.
Further dilution IV infusion (20mg dose & 40mg dose): 1 vial of 40 mg reconstituted
solution is further diluted in up to 100ml NS.

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IV infusion (80mg dose): 2 vial of 40 mg reconstituted solution is further

diluted in up to 100ml NS. (Esomeprazole concentration of 0.8mg/mL).

Continuous IV infusion: c.f. IV infusion.

Administration Slow IV: At least over 3 min.
IV infusion: Over 10-30 mins (20-40mg), Over 30mins (80mg).
Continuous IV infusion: 8mg/hour for 71.5 hours.
STORAGE & STABILITY
Intact vial Store below 30°C. Protect from light. If exposed to indoor light outside the
box, vials can be stored up to 24hours only.
Reconstituted solution In-use: 12 hrs under RT (<30°C). Discard any unused portion.
CAUTIONS  The reconstituted solution should not be mixed or co-administered in
the same infusion set with any other drug.
 Flush line before and after administration with NS, LR or D5.
REFERENCE(S): 1. Product Insert, Nexium®.

FENTANYL CITRATE 0.1MG/2ML(TALGESIL) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IM: Undiluted1.
Slow IV injection: Undiluted1.
Continuous IV infusion: Dilute with NS or D5 (volume not stated)4.
For children: may be diluted to desired concentration1.
Fentanyl only in ICU HTAN:
0.3mg (3amp) dilute to 30mL NS.
Mida-Fentanyl in ICU HTAN:
0.3mg (3amp) Fentanyl & 30mg Midazolam dilute to 30mL NS.
Administration IM.
Slow IV: IV injection over at least 1-2min via peripheral or CENTRAL LINE2,3.
IV Infusion: Further dilute with NS (volume not stated).

STORAGE & STABILITY

Intact vial Store below 25°C. Protect from light1.
Diluted solution Discard any unused portion after opening1.
CAUTIONS  Muscular rigidity may occur with rapid administration2.
 To avoid excessive dosage in obese patients, dose may need to be
calculated on the basis of ideal body-weight1.
 Monitor patient for depression of respiratory1.
REFERENCE(S): 1. Product Insert, Talgesil
2. Drug Information Handbook 19th Edition
3. Micomedex Healthcare Series Vol.155
4. British National Formulary, 2011, 61th Edition

FILGRASTIM 30MU/ML INJECTION OR 30MU/0.5ML PREFILLED SYRINGE (NEUPOGEN®)

*1ML = 30MU = 300MCG
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Use D5 only. See administration.
Administration SC: May be administered undiluted.

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IV infusion: Dilute in D5 to a concentration of not less than 5mcg/ml, given

over 15-30min.
Continuous SC infusion: Over 24hrs.
STORAGE & STABILITY
Intact vial Store at 2°C - 8°C.
Reconstituted solution Discard any unused portion after opening.
Diluted solution 24hr at 2-8°C.
CAUTIONS  1st dose should not be administered < 24hrs following cytotoxic
chemotherapy but within 24hrs of bone marrow infusion
 Dilution to final conc. < 0.2MU (2µg)/ml is not recommended at any
time.
 Should NOT be diluted with saline solutions. Diluted Neupogen maybe
adsorbed to glass and plastic materials. However, when diluted in D5,
Neupogen is compatible with glass and a variety of plastic including
PVC, polyolefin and polypropylene.
REFERENCE(S): 1. Product Insert, Neupogen®.

FLUCONAZOLE 2MG/ML (DIFLUCON 100MG 1,FLUCON 100MG2)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV infusion: Infuse over 1-2hr. Do not exceed 200mg/hr via peripheral or
CENTRAL LINE.1At rate 5-10 ml/min2.
STORAGE & STABILITY
Intact vial Store below 30°C. Protect from light. Discard any unused portion1,2.
REFERENCE(S): 1. Product Insert, Diflucon
2. Product Insert, Flucon

FLUMAZENIL 0.5MG/5ML(FLUMAZENIL-HAMEIN 0.1MG/ML, ANTABENZ, ANEXATE®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV Bolus injection: Administer undiluted over 15 sec for reversal of conscious
sedation and over 30sec for benzodiazepine overdose.3
IV infusion: 0.1-0.4mg/hour with NS or D5 or lactated Ringer‟s solution. 1,2,4
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light1,2,3,4.
Diluted solution 24hr at room temperature4.
CAUTIONS  Not recommended in epileptic patient who has been receiving
benzodiazepine treatment for a prolonged period1.
 Not recommended either as treatment for benzodiazepine dependence
or for the management of protracted benzodiazepine abstinence
syndromes1.
 Rapid injection of Flumazenil should be avoided in patients with long
term exposure to BDZs ending at any time within weeks preceding
Flumazenil administration as it may produce withdrawal symptoms,
including agitation, anxiety, emotional liability as well as mild confusion
and sensory distortions1.
REFERENCE(S): 1. Product Insert, Flumazenil-hamein 0.1mg/ml.

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2. Product Insert, Antabenz.

3. Product Insert, Anexate®
4. Drug Information Handbook 19th Edition.
FLUPENTIXOL DECANOATE 20MG/ML (FLUANXOL® DEPOT) CONTAINS CIS(Z) -
FLUPENTIXOL DECANOATE
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required. Should not be mixed with other injection fluids.
Administration IM only: Into the upper outer quadrant of the buttock.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution Discard any unused portion.
REFERENCE(S): 1.Product Insert, Fluanxol® Depot

FLUPHENAZINE DECANOATE 25MG/ML (MONASAN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM: Into gluteal muscle.
(A dry syringe and needle of at least 21G should be used. Use of a wet needle
or syringe may cause the solution to become cloudy).
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Discard unused solution after opening.
CAUTIONS  Contains Benzyl alcohol, should be AVOIDED in children below 2y.o. and
NOT to be used in neonates.
 Avoid contact of injection with skin (contact dermatitis)2.
 Watch for hypotension when administering IM2.
REFERENCE(S): 1. Product Insert, Monasan®
2. Drug Information Handbook 19th Edition

FONDAPARINUX 2.5 & 7.5MG (ARIXTRA) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required
Further dilution SC: Undiluted.1
Slow IV injection: Only for STEMI, add requisite dose to 25-50mL NS2.
Administration SC injection.
Slow IV injection: Over 1-2min (only for STEMI)2.
STORAGE & STABILITY
Intact vial Store below 25°C. Do not freeze.
Diluted solution Discard any unused portion.
CAUTIONS  Do not expel the air bubbles from the syringe before injection.
REFERENCE(S): 1. Product Insert, Arixtra
2. British National Formulary 60th Edition

FRUSEMIDE 20MG/2ML (FUSIX®, AKOSET®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IV infusion: Dilute to 1-2mg/mL, max 10mg/mL (i.e. 1 amp with 10-20mL)1.
Compatible with NS. (D5 NOT suitable)1,2.

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Administration IM: Undiluted1,2.

Slow IV: Undiluted and for doses up to 40mg, can be given slowly for 1-
2min4.
IV Infusion: Dilute to desired volume (usually 1mg/ml) and infuse at a max
rate of 4mg/min or max 10mg/ml over 15min1.
Children, max rate 1.5mg/kg/day. Max 20mg daily4.
Compatible with NS. D5 NOT suitable3.
* Common practice: undiluted.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light1,2.
Diluted solution Discard any unused solution. IV infusion solution is stable for 24hours at
RT1,2,3.
CAUTIONS  IV administration rate >4mg/min increases the risk of ototoxicity1,2.
REFERENCE(S): 1. Product Insert Fusix®
2. Product Insert Akoset®
3. British National Formulary 60th Edition
4. Drug Information Handbook 19th Edition

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G
H

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GENTAMICIN SULPHATE 80MG/2ML (GARASENT®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Dilute in 100-200ml of NS or D5.
Administration IM.
IV bolus: 2-3minutes into vein/ IV tubing
IV infusion: 20-30 minutes (concentration should not exceed 1mg/ml).
STORAGE & STABILITY
Intact vial Store below 30°C.
Diluted solution Not stated. Suggest discard any unused portion.
CAUTIONS  In paralyzed patient, patient in shock, with hemorrhagic disorder,
severe burns or ↓ muscle mass, use IV instead of IM.
 This preparation contains sodium metabisulphite may cause
anaphylactic symptoms and life threatening or less severe asthmatic
episode.
 Gentamicin is inactivated by Penicillins. Both should NOT be
administered simultaneously NOR combined in the IV fluid.
 For patient with renal failure, separate each infusion several hours
apart.
REFERENCE(S): Product Insert, Garasent®.

GLUCAGON HCL 1MG (GLUCAGEN®)

*1MG CORRESPONDING TO 1 IU.
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Add 1ml of WFI into vial containing powder of Glucagon1.
Further dilution Continuous IV infusion: 2-10mg in D5 (volume not mentioned)3.
Administration IM/IV/SC: For hypoglycaemia: Administer IM/IV bolus/SC undiluted1.

UNLABELED USE: For Beta-Blocker or Calcium Channel Blocker induced

myocardial depression: Administer bolus over 3-5 min, followed by infusion
of 70mcg/kg/hr (max: 5mg/hr) for children and 1-5mg/hr for adolescents2,3.

STORAGE & STABILITY

Intact vial Store at 2°C-8°C. Do not freeze. Protect from light1.
Reconstituted solution Use immediately1.
CAUTIONS  IV bolus may be associated with nausea and vomiting3.
REFERENCE(S): 1. Product Insert, Glucagen®.
2. Drug Information Handbook 19th Edition.
3. HUKM Drug Formulary 2010, 5th Edition.

GLYCERYL TRINITRATE 5MG/ML INJ (GITRINIL) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Dilute 50mg in 50-250mL of NS or D5 (100-200mcg/mL)1.
* For ROF patient: dilute 50mg in 50mL of NS or D52.
* Maintenance dilution: Concentration should NOT exceed 100mg in 250mL
(400mcg/ml).
* GTN initial dose: 5mcg/min; can be increased up to 200mcg/min.

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Dilution: 50mg in 50 ml diluent

Diluent: D5, NS
Formula: Rate (ml/hr) = dose (mcg/min) x 0.06

Administration IV Infusion: Administer via a syringe pump and titrate according to

patient‟s response.
STORAGE & STABILITY
Intact vial If stored in glass container: Store below 25°C. Protect from light1.
Reconstituted solution: 7 days under refrigeration, 40 hours if stored below
25°C1.
* But to use immediately after recons if using non-glass container1.

REFERENCE(S): 1. Product Insert, Gitrinil.

2. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical Pharmacy
Association & Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5th
version. Royal Flying Doctors Service of Australia

GLYCOPYRROLATE 200MCG/ML INJECTION USP

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IV or IM.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.

CAUTIONS  Incompatible with drugs with more alkaline pH (>6.0) such as

Barbiturates, Diazepam.
REFERENCE(S): 1. Product Insert, Glycopyrrolate 200mcg/mL USP.

GRANISETRON 3MG (VIATRINIL®, KYTRIL®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required1,2.
Further dilution See administration1,2.
Administration Adult
IV Bolus: Dilute 3mg in 15ml of NS. Infuse at least 30 sec1,2,3.
IV Infusion: Dilute in 20-50ml in NS or D5. Administer over 5-10 min1,2,3.
Children
IV Infusion: Dilute in 10-30ml of D5 or NS and administer over 5 min1,3.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Discard unused portion 1,2,3.
Reconstituted solution 24 hours at 15-25°C.1
REFERENCE(S): 1. Product Insert, Viatrinil®.
2. Product Insert, Kytril®.
3. British National Formulary 60th Edition.

HALOPERIDOL 5MG/ML (MANACE)

PREPARATION/ METHOD OF ADMINISTRATION

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Reconstitution Not required.

Further dilution See administration.
Administration IM injection: Undiluted.
Slow IV injection: Undiluted.

STORAGE & STABILITY

Intact vial Store below 30°C. Protect from light.
CAUTIONS  IV bolus may be associated with nausea and vomiting.
 Rate is not well established and has been associated with QT
prolongation and ECG monitoring recommended.
REFERENCE(S): 1. Product Insert, Manace.

HEPARIN SODIUM 5000IU/ML INJ (HEPARINOL)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC: Administer undiluted.
IV Bolus: Administer undiluted. Administer undiluted with loading dose over
10 minutes2.
IV Infusion: Dilute 5mL (25,000units) with D5 or NS up to 50ml (final conc.
500IU/ml)2.
Paediatrics:
<10kg: Dilute 1000 units in 50ml NS.
10kg - 40kg: Dilute 5000 units in 50ml.
> 40kg: 25000 units in 50ml3.
Note: 1mL of Heparin Sodium 5000 units/ml diluted in 500mL NS produces
Heparinised Saline 10 units/mL.
*Refer Appendix 3 for Heparin Infusion Protocol.

STORAGE & STABILITY

Intact vial Store below 30°C. Protect from light.
CAUTIONS  Heparinol contains benzyl alcohol: should be avoided in children below
2 years old and should not be used in neonates.
 Monitor APTT, signs and symptoms of bleeding regularly.
 Moderately high doses can cause excessive internal bleeding that may
lead to paralyzing or lethal strokes.
REFERENCE(S): 1. Product Insert, Heparinol
2. MOH Quick Guide on Heparin Use.
3. Hospital Selayang Dilution protocol, 2015 3rd Edition 3rd Edition.

HEPARINISED SALINE 10UNIT/ML (50UNITS/5ML) INJECTION (ISOTONIC AND

PRESERVATIVE-FREE SOLUTION)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Use undiluted.
Administration IV injection.

STORAGE & STABILITY

Intact vial Store below 30°C. Protect from light.

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REFERENCE(S): 1. Product Insert, Heparinised Saline B Braun.

HEPATITIS B IMMUNOGLOBULIN 200IU/1ML (HUMAN) INJ (HEPABIG)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM only. Anterolateral of the thigh is preferred. Avoid gluteal administration.
In neonates who are administered one dose of 1mL, Hepabig is injected at
two different sites (0.5mL/site).

STORAGE & STABILITY

Intact vial Store below 10°C. Do not freeze.
Used immediately. Discard any unused portion after opening.
CAUTIONS  Not for IV.
 Should be administered carefully to patients with Ig A deficiency
syndrome.
 Hepatitis B vaccine may be administered at the same site, but at a
different injection site, without interfering with the immune response.
REFERENCE(S): 1. Product Insert, Hepabig

HUMAN NORMAL IMMUNOGLOBULIN 3.0G/50ML [INTRAPURETM, INTRAGAM® P]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution May be infused undiluted. For further dilution, it can be diluted up to 2 parts
of NS or D5.
Administration IV infusion: Infusion rate is 1ml/min. After 15min, the rate may be gradually
increased to a max of 3-4ml/min over 15min.
* monitor vital signs throughout the infusion to avoid anaphylaxis.
* withhold infusion if anaphylaxis or adverse effects occurs. May restart with
the previous lower infusion rate.
* reduce the infusion in elderly & in patient with pre-existing renal disease.
* administer separately from other IV fluids or medications.

STORAGE & STABILITY

Intact vial Store at 2-8°C. Do not freeze. Protect from light.
Use immediately after opening. Discard any unused portion.
Once removed from fridge, store <25°C and use within 3 months3.
CAUTIONS  Should only be administered IV.
 May cause precipitous fall in blood pressure and clinical picture of
anaphylaxis.
 Patient should be adequately hydrated prior to the initiation of IVIG
infusion & recommended dose should not be exceeded.
 Monitor patient‟s vital signs & general status regularly throughout
infusion.
 The line for human normal immunoglobulin should not be used for other
drug‟s administration.
REFERENCE(S): 1. Drug Information Handbook 19th Edition.
2. Product Insert, IntrapureTM
3. Product Insert, Intragam ®

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HUMAN ANTITETANUS IMMUNOGLOBULIN 250IU/ML OR 500IU/2ML [ IGANTET ®]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IM injection only: If total doses (≥5mL) are required, it is advisable
to administer them in divided doses at different sites.
Administer in the anterolateral aspects of the upper thigh or the deltoid
muscle of the upper arm. Avoid gluteal region due to risk of injury to sciatic
nerve; if gluteal region is used, administer only in the upper quadrant.
SC injection: Only if IM injection is contraindicated.

STORAGE & STABILITY

Intact vial Store between 2-8°C. Used immediately. Discard any unused portion 2.
Product should be warmed to RT before use.
CAUTIONS  Do NOT give this product intrravascularly (risk of shock).
 True allergic responses from IM injection is rare but should be taken
into account.
 Intolerance of immunoglobulins is likely to develop in the very rare
cases of IgA deficiency.
 Patients should be observed for at least 20min after administration.
 Antitetanus immunoglobulin and vaccine should be administered using
different syringe and needles and injection sites.
 Should not be administered to those with febrile illness.
 A solution of 1 in 1000 adrenaline should be readily administered for
immediate injection in case of anaphylactic reaction.
REFERENCE(S): 1. Drug Information Handbook 2011, 19th Edition
2. Product Insert, Igantet ®

HUMAN ANTI-D IMMUNOGLOBULIN / ANTI RHD GAMMA GLOBULIN 1250IU/2ML

(250MCG/2ML) (RHESONATIV®)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM injection only: Into deltoid muscle of the upper arm or anterolateral
aspect of the upper thigh; avoid gluteal region due to risk of sciatic nerve
injury. If large doses (>5mL) are needed, administration in divided doses at
different sites is recommended.

STORAGE & STABILITY

Intact vial Store at 2°C-8°C. Protect from light.
CAUTIONS  Should be at room or body temperature prior to use.
 The solution should be clear to semi-translucent. Do not use solution
that is cloudy, contains particles or has deposits.
REFERENCE(S): 1. Product Insert, Rhesonativ ®.

HUMAN ANTI-D IMMUNE GLOBULIN LYOPHILIZED 1500 IU (WINRHO SDF)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1 vial with 2.5 ml of the supplied diluent to provide a
concentration of 600IU (120mcg)/ml.
Further dilution Not required.

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Administration IM: Injections are made into the deltoid muscle of the upper arm or the
anterolateral aspects of the upper thigh. Due to risk of sciatic nerve injury,
the gluteal region should not be used as routine injection site. If the gluteal
region is used, use only the upper, outer quadrant.
IV bolus: Administer the reconstituted solution at a rate of 5 -15sec.
IV infusion: If required to be given as infusion, further dilute the
reconstituted solution with NS only.

STORAGE & STABILITY

Intact vial Store at 2°C-8°C.
Reconstituted solution  Stable for 4 hours at RT.
REFERENCE(S): 1. Product Insert, WinRho SDF

HYDRALAZINE HCL 20MG/ML [CIRON DRUGS & PHARMACEUTICALS, APRESOLINE®]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Add 1ml of WFI OR NS.
Further dilution See administration.
Administration Direct slow IV bolus: Further dilute with 10ml of NS and administer slowly
over 3-5min. Max rate: 5mg/min3,5.
IV intermittent infusion: Dilute in 50mls NS run over 15 mins2.
Continuous IV infusion: Further dilute the one for IV bolus with 500mL NS
1,4 OR further dilute to 1mg/mL (i.e. 20mg in 20mL NS)3.

Initial: 200-300mcg/min, Maintenance: 50-150mcg/min4.

(Loading dose : 0.1mg/kg followed by 1.5-5mcg/kg/min)

STORAGE & STABILITY

Intact ampoule Store below 30°C. Protect from light.
Diluted solution Used immediately. Discard any unused portion.
CAUTIONS  Should not be stored under refrigeration because of possible
precipitation or crystallization2.
REFERENCE(S): 1. Product Insert, Ciron drugs & Pharmaceuticals
2. Product Insert, Apresoline®
3. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical
Pharmacy Association
4. British National Formulary 2010, 60th Edition
5. Drug Information Handbook 2011, 19th edition

HYDROCORTISONE SODIUM SUCCINATE 100MG INJ [DHARTISONE-100 , SOLU-CORTEF® ,

SM PHARMACEUTICALS SDN BHD ]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Dilute in 2ml of WFI or NS.
Further dilution See administration.
Administration Slow IV: Administer over 30 sec (for 100mg) or 10min (for doses more than
500mg)1-4.
IV Infusion: Further dilute with 100-1000ml of NS or D5 or 0.45% saline+
D5 (0.1-1mg/ml) and administer over 20-30min 4-5. Fluid restricted, up to
60mg/mL5.

STORAGE & STABILITY

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Intact vial Store below 30°C. Protect from light.

Reconstituted solution Stable at room temperature for up 24hrs. After reconstituted, protect from
light & freezing.
Unused solution should be discarded after 3 days2.
CAUTIONS  Following intra-articular injection, the injected joints should not be
overused if pain is relieved, because of the increased risk of joint
damage or deterioration. It is recommended that the weight-bearing
joints be rested for 24-48 hours post-injection.
REFERENCE(S): 1. Product Insert, Dhartisone
2. Product Insert, Solu-Cortef
3. Product Insert, SM Pharmaceuticals Sdn Bhd
4. Drug Information Handbook 19th Edition
5. HUKM Drug Formulary 2010, 5th Edition

HYDROXYPROGESTERONE CAPROATE 250MG/ML [PROLUTON DEPOT, JENAPROGON®]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IM injection.

STORAGE & STABILITY

Intact vial Store below 25°C. Protect from light.
Discard any unused portions after opening.
REFERENCE(S): 1. Product Insert, Proluton Depot
2. Product Insert, Jenaprogon ®

HYOSCINE N-BUTYL BROMIDE 20MG/ML INJ (COPAN)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM. Undiluted.
Slow IV: Dilute required dose to 10mL with NS or D5 and inject slowly over
3-5 mins2.

STORAGE & STABILITY

Intact ampoule Store below 25°C. Protect from light.
REFERENCE(S): 1. Product Insert, Copan
2. Paul Young, 2010, ICU and Critical Care Drug Manual

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I
J

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IMIPENEM 500MG + CILASTATIN 500MG INJ (TIENAM)

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Reconstituted with 10ml of NS or D5.
Further dilution Further dilute with the same diluents up to 50ml for 250mg (5mg/ml) OR 100ml for
500mg (5mg/ml).
Administration IV Infusion: Dose < 500mg infuse over 20-30min. Dose >500mg infuse over
40-60min.
STORAGE& STABILITY
Intact vial Store below 25°C.
Reconstituted 4hrs at room temperature or 24hrs at 4°C.
solution
CAUTIONS  TIENAM should not be mixed with or physically added to other antibiotics.
However, TIENAM may be administered concomitantly with other
antibiotics, such as aminoglycosides.
 Chemically incompatible with lactate.
REFERENCE(S): Product Insert, Tienam

INFLUENZA VACCINE [VAXIGRIP1, INTANZA2]

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM1, Intradermal: At the deltoid region2.
STORAGE& STABILITY
Intact prefilled Store at 2-8°C. Do not freeze. Protect from light.
syringe
REFERENCE(S): 1) Product Insert, Vaxigrip
2) Product Insert, Intanza

INSULIN BIPHASIC ISOPHANE 3ML (MIXTARD 30 PENFILL, INSUMAN COMBO 30, HUMULIN
30/70) - HAM
PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE& STABILITY
Intact penfill Store at 2-8°C. Do not freeze. Protect from light.
In use penfill Do not refrigerate. Store below 30°C. Stable up to 4 weeks.
REFERENCE(S): 1.Product Insert, Mixtard
2.Product Insert, Insuman Combo 30
3.Product Insert, Humulin 30/70

INSULIN ISOPHANE PENFILL 100IU/ML INJ (INSULATARD PENFILL, INSUMAN BASAL,

HUMULIN N) - HAM
PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
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Intact penfilled Store at 2-8°C. Do not freeze. Protect from light.

In use penfilled Do not refrigerate. Store below 30°C. Stable up to 4 weeks.
REFERENCE(S): 1.Product Insert, Insulatard
2.Product Insert, Insuman Basal
3.Product Insert, Humulin N

INSULIN ASPART 100IU/ML INJ (NOVORAPID FLEXPEN) - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact penfilled Store at 2-8°C. Do not freeze. Protect from light.
In use penfill Store below 30°C. Protect from light. Stable up to 4 weeks.
REFERENCE (S) Product Insert, Novorapid Flexpen

INSULIN ASPART 30% + PROTAMINE ASPART 70% INJ (NOVOMIX 30 FLEXPEN) - HAM
PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact penfill Store at 2-8°C. Do not freeze. Protect from light.
In use penfill Store below 30°C. Protect from light. Stable up to 4 weeks.
REFERENCE (S) Product Insert, Novomix Flexpen

INSULIN DETEMIR 100IU/ML INJ PREFILLED SYRINGE (LEVEMIR FLEXPEN) - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact penfill Store at 2-8°C. Do not freeze. Protect from light.
In use penfill Store below 30°C. Stable up to 6 weeks.
REFERENCE (S) Product Insert, Levemir Flexpen

INSULIN GLARGINE 300IU/3ML (LANTUS SOLOSTAR) - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact penfill Store at 2-8°C. Do not freeze. Protect from light.
In use penfilled Store below 25°C up to 4 weeks and do not refrigerate.
REFERENCE (S) Product Insert, Lantus Solostar

INSULIN HM 100IU/ML IN 3ML (ACTRAPID PENFILL, INSUMAN RAPID PENFILL, HUMULIN R)

- HAM

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PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact penfill Store at 2-8°C. Do not freeze. Protect from light.
In use penfill Store below 25°C up to 4 weeks and do not refrigerate.
REFERENCE (S) 1. Product Insert, Actrapid
2. Product Insert, Insuman Rapid
3. Product Insert, Humulin R

INSULIN HUMAN REGULAR100IU/ML INJ (ACTRAPID VIAL) - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC: Use undiluted.
IV infusion: Refer Appendix 4 for IV Insulin Infusion Protocol.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Do not freeze. Protect from light.
Opened vial Do not refrigerate. Stable for 6 weeks below 30°C
REFERENCE (S) 1. Product Insert, Actrapid

INSULIN ISOPHANE SUSPENSION HM 100IU/ML INJ (INSULATARD VIAL) - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Do not freeze. Protect from light.
Opened vial Do not refrigerate. Stable for 6 weeks below 30°C.
REFERENCE (S) 1. Product Insert, Insulatard

INSULIN 25% LISPRO + 75% LISPRO PROTAMINE 3ML INJ (HUMALOG MIX 25 KWIKPEN) -
HAM
PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact pen Store at 2-8°C. Do not freeze. Protect from light.
In used pen 4 week at room temperature.
REFERENCE (S) 1. Product Insert, Humalog Mix 25

IRON (III)-HYDROXIDE DEXTRONE COMPLEX 100MG/2ML INJ (COSMOFER)

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV Infusion: Dilute doses of 100-200mg into 100ml NS or D5. Run the first

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25mg over 15min and if there are no adverse reactions, run the remaining
portion of the infusion at a not more than 100ml in 30min.
Slow IV: Dilute doses of 100-200mg into 10-20ml NS or D5. Give the first
25mg over 1-2min and if there are no adverse reactions within 15min, the
remaining portion of injection may be given slowly.
Deep IM: Administer undiluted in doses of up to 100mg in the upper outer
quadrant of the buttocks, never into the arm or other exposed areas.
Total dose infusion: Add total amount of the required dose to 500mL NS or
D5. Infuse the first 25mg over 15 mins and if there are no adverse reactions,
infuse the remaining portion over 4-6 hours. The infusion rate may be
increased progressively to 45-60 drops/min.
Injection into dialyser: Administered during a HD session directly into the
venous limb of the dialyser under the same procedures as outlined for slow IV
injection.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution Use immediately. Discard any unused portions after opening.
After dilution, stable for 24hours at 2-8°C.
CAUTIONS  Test dose should be given before administering the first dose to a new pt.
if no adverse reactions are seen after 60min, the remaining dose can be
given. If any signs of a hypersensitivity reaction or intolerance are
detected, administration must be stopped immediately.
 Observe patient during the infusion & for at least 1 hour after completion.
 IV infusion is preferred as this may help to reduce the risk of hypotensive
episodes.
REFERENCE (S) 1. Product Insert, Cosmofer

IRON SUCROSE 100MG/5ML INJ (VENOFER)

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required
Further dilution See administration
Administration Slow IV injection: Administer undiluted (100mg over 5 mins; 200mg over 10
mins) – ref: Product Insert.
IV Infusion: Dilute with NS to a final concentration of 1mg/mL. Administer test
dose before giving therapeutic dose.
Test dose: Administer the test dose over 15 min.
Adult and children > 14kg : 20mg
Children < 14kg: Half the daily dose
Therapeutic dose:
Dose Infusion time
100mg 15 min
200mg 30 min
300mg 90 min
400mg 150 min
500mg (max) 210 min

STORAGE& STABILITY
Intact vial Store below 25°C.
Diluted solution Use immediately.

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REFERENCE(S): Product Insert, Venofer

ISOPRENALINE HCL 0.2MG/ML INJ [SALF, ISUPREL , ISOLIN] -KPK

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Start at lowest recommended dose and gradually increase rate of
administration while carefully monitoring the patient.

Heart block, Adams-Stokes attack, cardiac arrest:

IV bolus: Dilute 1ml (0.2mg) to 10ml NS or D5.
IV infusion: Dilute 10ml (2mg) in 500ml D5 with a rate of 5 mcg/min.
IM / SC / Intracardiac: Administer undiluted.

Shock and hypoperfusion states:

IV infusion: Dilute 5ml (1mg) in 500ml D5 with a rate of 0.5-5 mcg/min.

Bronchospasm occurring during anesthesia:

IV bolus: Dilute 1ml (0.2mg) to 10ml NS or D5.
STORAGE& STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution 24hr at 25°C1.
CAUTIONS  Rarely be given intracardiacally.
 The solution gradually darkens on exposure to air and light and heat; must
therefore be stored in tightly closed containers. The air in the vials was
replaced by nitrogen.
 Contains sodium metabisulfite, and may cause allergic reactions and
serious asthmatic attacks in certain pts, especially asthmatic pts.
REFERENCE(S): 1. Product Insert, Salf
2. Product Insert, Isuprel
3. Product Insert, Isolin

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K
L

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KETAMINE HCL 10MG/ML INJ [KETAMAX, KETAMINE-FRESENIUS] , 50MG/ML [KETAVA,

KANOK] – HAM
PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required
Further dilution See administration.
Administration Slow IV injection: Dilute to ≤50mg/mL conc.(undiluted if 50mg/mL
solution is used)5 and administer over at least 1 min to avoid respiratory
depression 1-4,7. Do not exceed 0.5mg/kg/min6.
Continuous IV infusion: Dilute to a 1mg/mL conc. with NS or D5 1-5. If
augmented with Diazepam, maintained at 0.1-0.5mg/min 1-4,7.
*Patient with restriction of fluid (ROF): Dilute to a 2mg/mL conc. with NS
or D5 1-4,6.
IM injection: Administer undiluted.
STORAGE& STABILITY
Intact vial Store below 30°C. Protect from light.
Diluted solution Use immediately. Discard any unused portions after opening.
CAUTIONS  More rapid administration may result in respiratory depression and
enhanced pressor response.
 Barbiturate and ketamine are chemically incompatible due to
precipitate formation, should NOT be injected from the same syringe.
 Do NOT mix ketamine and diazepam together.
 Because of rapid induction following IV injection, the patient should be
in a supported position during administration.
REFERENCE(S): 1. Product Insert, Ketamax
2. Product Insert, Ketamine-Fresenius
3. Product Insert, Ketava
4. Product Insert, Kanok
5. British National Formulary 2011, 61st Edition
6. Drug Information Handbook 19th Edition
7. Micromedex Healthcare Series Vol. 156

LABETALOL HCL 25MG/5ML INJ (TRANDATE) - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required
Further dilution See administration
Administration IV bolus: Administer undiluted (max 50mg) over at least 1min.
IV infusion: Dilute with NS or D5 to final concentration of 1mg/ml and
infuse according to prescribed dose. (i.e 200mg or 8amp diluted to 200ml,
2amp or 50mg diluted to 50mL). *In fluid restricted patients, can be
undiluted2.
* IVI labetalol dose: 0.5 – 2mg/min (max total dose: 300mg)
Dilution: 50mg (2 ampules) in 50 ml diluent
Diluent: D5
Formula: Rate (ml/hr) = dose (mcg/min) x 60
STORAGE& STABILITY
Intact ampoule Store below 25°C. Protect from light.
Diluted solution 24hr at 25°C. Discard any unused solution after opening.
CAUTIONS  Should not be used in patients with asthma or a history of obstructive

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airways disease.
 When peripheral vasoconstriction suggests low cardiac output, the
use of labetalol to control hypertensive episodes following acute MI is
contraindicated.
 Incompatible with sodium bicarbonate 4.2%.
REFERENCE(S): 1. Product Insert, Trandate
2. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted Critically
Ill Patients. 2006. 3rd Edition. United Kingdom Clinical Pharmacy Association

LEUPROLIDE ACETATE 3.75MG INJ (LUCRIN DEPOT)

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 1ml of given diluent.
Further dilution Not required.
Administration IM or SC.
STORAGE& STABILITY
Intact vial Store at room temperature. Do not freeze.
Diluted solution Use immediately. Stable up to 24hr at 25°C. Protect from light.
CAUTIONS  Contains no preservative.
 Patients treated with Leuprolide should use non-hormonal methods of
contraception.
 Due to different release characteristics, a fractional dose of the 3-
month depot formulation is not equivalent to the same dose of the
monthly formulation and should not be given.
 As with other drugs administered by injection, the injection site should
be varied periodically.
REFERENCE(S): 1. Product Insert, Lucrin Depot

LEVOBUPIVACAINE 0.5% INJ (CHIROCAINE)

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution May be given undiluted OR diluted to make 0.625mg to 2.5 mg per mL in
NS depending on indication.
Administration Surgical Anaesthesia: Epidural, intrathecal, peripheral nerve block, local
infiltration, peribulbar block in ophthalmic surgery.
Pain Management: Continuous epidural infusion, single or multiple bolus
administration.
STORAGE& STABILITY
Intact vial Store below 25°C. Protected from light.
Reconstituted solution 24 hrs at room temperature.
REFERENCE(S): 1. Hospital Selayang Dilution protocol, 2015

LIGNOCAINE HCL 200MG/10ML 2% [LAKAN INJ] - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM only: Into deltoid muscle or the vastus lateralis.
STORAGE& STABILITY
Intact vial Store below 30°C. Protect from light.
REFERENCE(S): 1. Product Insert, Lakan

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LIGNOCAINE HCL 100MG/5ML INJ (INJECSOL LIG 2) - Preservative free - HAM

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV: Use in cardiac arrhythmias, dose may be injected at a rate of 25-50mg
per minute. Following IV infusion, lignocaine may be administered at a
rate of 1-4mg/min.
STORAGE& STABILITY
Intact plastic ampoule Store below 30°C.
REFERENCE(S): 1. Product Insert, Injecsol

LINEZOLID 600MG/300ML INJ (ZYVOX)

PREPARATION/METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV infusion: Infuse over 30-120min.
STORAGE& STABILITY
Intact bags Store below 25°C. Protect from light.
CAUTIONS  Do not use the IVI bag in series connection.
 If linezolid infusion were to be given concomitantly with another drug,
each drug should be given separately in accordance with the
recommended dosage and route of administration of each product.
REFERENCE(S): 1. Product Insert, Zyvox

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M
N

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MAGNESIUM SULFATE 49.3% 5ML [DBL HOSPIRA] - HAM

2.465g MgSO4in 5ml, 1ml = 493mg MgSO4 / 2mmol = 4mEq Mg+/2mmol= 4mEq SO42-
1g MgSO4=98.6mg Mg2+/ 8.12mEq Mg2+
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV infusion: Add at least 7.5ml D5 or NS for 5ml ampoule to get a
concentration of ≤20% MgSO4 (i.e20g MgSO4 in 100mL or 1g MgSO4 in
5mL). OR
Peripheral IV line: Dilute 1 amp (10mmol) with at least 250ml NS or D5
(min 100ml in fluid restricted patients) and run 4-6hrs.
Central IV line: Dilute 1 amp (10mmol) with 20ml NS or D5 and run over
2hr using a syringe pump. Max: 150mg/min, i.e. 1 amp over at least
20mins.
Common ICU practice: 1amp or 5mL in 50mL NS over 30-60min OR 2g in
20mL NS over 20min.

In fluid restricted patients,

 Peripheral infusion: ≤10% (i.e. 4mmol Mg in 10mL NS or D5).(i.e.
1amp or 5mL MgSO4 in 25mL NS or D5).
 Central infusion: 25-50% (i.e. 1-2mmol Mg in 1mL NS or D5). (i.e.
1amp or 5mL MgSO4 in 5-10mL NS or D5).

IM:
Adult: diluted to a conc. of 25-50% Mg.
(i.e. 1 amp of 5mL diluted with 5mL D5 or NS)
Infants & Children: diluted to a conc. of ≤20% MgSO4 (i.e. 1g MgSO4 in
5mL D5 or NS).
STORAGE & STABILITY
Intact vial Below 25°C, protect from light.
Diluted solution Below 25°C: 24 hrs at concentration up to 15g/L.
Discard any unused portions after opening.
CAUTIONS  Rapid administration may cause hypotension and asystole.
 Contraindicated in patient with renal failure (CrCl < 20ml/min).
 After IM, irritation & pain at injection site may result.
 To avoid precipitation, DO NOT mix calcium salts & magnesium
sulphate in the same IV solution.
 It is reported to be incompatible with alkali carbonates & bicarbonates &
soluble phosphates.
 Refrigeration may result in precipitation or crystallization.
 Urine output should be monitored & should be at least 100ml during the
4hours preceding dose, to ensure adequate excretion of magnesium.
 IV preparation of calcium salt (IV Calcium 5-10mEq: 1-2g Calcium
Gluconate) should be readily available to avoid hypermagnesaemia.
 Respiratory rate should be at least 16/min to each dose of magnesium
sulphate. In extreme cases, PD or HD may be required.
Warning:
 Levels above 12mEq/L can lead to respiratory paralysis & heart block
and can be fatal.

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REFERENCE(S): 1. Product Insert, DBL Hospira

2. British National Formulary 2010, 60th Edition
3. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical
Pharmacy Association
4. Drug Information Handbook 19th Edition
5. Hospital Selayang Dilution protocol, 2015

MEDROXYPROGESTERONE ACETATE 150MG/3ML [DEPO-PROVERA1, CONDEP2]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM injection only: Undiluted. Shake the product vigorously prior to
administration. Deep into the gluteal or deltoid muscle.
(If larger volume is to be given, i.e. greater than 2.5mL, the divided
administration into several sites is recommended.)1,2.
STORAGE & STABILITY
Intact vial Below 25°C, protect from light.
Diluted solution Discard any unused portions after opening.
CAUTIONS  A suspension injection.
 The vial should be vigorously shaken just before use to assure that the
dose being administered represents a uniform suspension.
 Gluteal infiltration and abscess formation may occur with IM
administration, which is particularly related to the volume administered
and careful injection technique should be observed.
REFERENCE(S): 1. Product Insert, Depo-Provera
2. Product Insert, Condep
3. Hospital Selayang Dilution protocol, 2015
MEROPENEM 500MG, 1G [MERONEM]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution IV Bolus: 500mg: Add 10ml WFI OR 1g: Add 20ml WFI.
Further dilution IV Infusion: Add 50-200ml diluents (refer to table below) to achieve
concentration 1-20mg/ml).
Administration IV bolus: Over 5 mins.
IV infusion: 15-30 mins.
STORAGE & STABILITY
Intact vial Below 30°C, do not freeze.
Diluted solution Refer to table below:
Stability (hours)
Meropenem
Diluents 15 –
Conc. 4°C
25°C
Water for injection 8 48
0.9% NaCl 8 48
5% Dextrose 3 14
5% Dextrose & 0.225% NaCl 3 14
5% Dextrose & 0.9% NaCl 1 – 20 3 14
5% Dextrose & 0.15% Potassium Chloride mg/ml 3 14
2.5% OR 10% Mannitol 3 14
10% Dextrose 2 8
5% Dextrose & 0.02% Sodium Bicarbonate 2 8

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CAUTIONS  Discard any unused portions after opening.

REFERENCES 1. Hospital Selayang Dilution protocol, 2015
2. Product Insert, Meronem

METHYLENE BLUE 1% 10MG/1ML [METIBLO1, AMERICAN REAGENT INC2, BLUEJECT3]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IV bolus: Undiluted over 5mins (for drug-induced
methemoglobinemia)1
Inject very slowly over period of several minutes2.
IV use for staining: 5mg/kg diluted in 500mL D5. Over 1 hr1
STORAGE & STABILITY
Intact vial 20-25˚C1,2
Diluted solution Discard any unused portions after opening.
CAUTIONS  Should not be given by SC (risk of necrosis) or intrathecal (nerve
damage).
 Intra-spinal is contraindicated.
 Intra-amniotic injection during amniocentesis is contraindicated.
 Contraindicated in G6PD, may cause hemolysis.
 May cause methemoglobinemia if administered too rapid or in excess
dose.
REFERENCE(S): 1. Product Insert, Metiblo
2. Product Insert, American Regent INC
3. Product Insert, Blueject
4. British Drug Formulary 2010, 5th Edition
5. Hospital Selayang Dilution protocol, 2015
6. HUKM Drug Formulary 2010, 5th Edition
7. IWK Regional Poison Centre
8. Nova Scotia Provincial Antidote Kit Manual. 2010.

METOCLOPRAMIDE HCL 10MG/2ML [H-PERAN, PULIN INJ. “YUNG SHIN”]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM / IV bolus: Undiluted if dose ≤10mg. Over 1-2 mins.

Slow IV Infusion: For doses >10mg, diluted in 50mL NS. Infuse over 15-
30 mins.

Continuous Infusion:
Loading Dose: Dilute with 50-100mL NS or D5 over 15-20min.
Maintenance Dose: Dilute with 500mL NS or D5 over 8-12hours.
STORAGE & STABILITY
Intact vial Below 25˚C, protect from light.
Diluted solution Discard any unused portions after opening.
CAUTIONS  Rapid IV administration may be associated with a transient (but
intense) feeling of anxiety and restlessness, followed by drowsiness.
 Avoid doses exceeding 0.5mg/kg/day.

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 Not recommended for the first trimester of pregnancy.

 Avoided in children < 2 yrs old and not to be used in neonates, as it
contains Benzyl Alcohol.
REFERENCE(S): 1. British Drug Formulary 2010, 5th Edition
2. Drug Information Handbook 19th edition
3. Hospital Selayang Dilution protocol, 2015
4. Product Insert, H.Peran, Pulin

METHYLPREDNISOLONE 500MG [SOLU-MEDROL]

METHYLPREDNISOLONE SODIUM SUCCINATE
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Slow IV: Reconstituted with the provided diluents (7.8mL), produces
500mg/8mL.
Further dilution IV Infusion: Further dilute with at least 50ml D5, NS or D5NS (i.e. 500mg
in ≥50mL) OR 2g in 50ml or 500ml OR Dilute in 50-100ml.
Administration Adjunctive therapy in life-threatening conditions
IV Bolus: 30mg/kg over a period of at least 30 mins (repeated every 4-6
hrs for 48 hrs depending on clinical necessity).

Prevention of nausea and vomiting associated with cancer

chemotherapy
 Mild to moderate emetogenic chemotherapy: Slow IV 250mg over
atleast 5 mins one hour before chemotherapy.
 Severely emetogenic chemotherapy: Slow IV 250mg over at least
5mins.

Rheumatoid Arthritis:
1g/day (D1-D4) or 1g/month (6months). IV infusion over at least 30min
(may be repeated).
.
Acute Spinal Cord Injury:
IV bolus 30mg/kg over 15min. After 45min, followed by continuous
infusion 5.4mg/kg /hr for 23hrs.

Other indications
 Slow IV: ≤ 250mg: over at least 5 mins.
 IV Infusion: > 250mg: over at least 30 mins.
OR
 Low dose (≤1.8mg/kg or ≤125mg/dose):3-15min.
 Moderate dose (≥2mg/kg or 250mg/dose): 15-30min.
 High dose (15mg/kg or ≥1g/dose): 60min.

Infusion pump: One should preferably choose another intravenous site

than for the bolus injection.
Intact vial Below 25˚C.
Reconstituted solution Below 25˚C: 48hrs.
CAUTIONS  The administration of IV bolus >500mg over <10mins may cause
arrhythmias, circulatory collapse and cardiac arrest.

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REFERENCE(S): 1. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical
Pharmacy Association
2. Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5th version. Royal
Flying Doctors Service of Australia
3. Drug Information Handbook 19th edition
4. Hospital Selayang Dilution protocol, 2015
5. HUKM Drug Formulary 2010 5TH Edition
6. Product Insert, Solu-Medrol

METRONIDAZOLE 0.5% W/V [METRONOL]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV Infusion:
To be infused slowly over 20-30 mins every 8 hrs.
 Administration can also be performed in diluted form by adding the
product to an IV carrier such as 0.9% sodium Chloride or 5% dextrose
injection in sterile condition.
STORAGE & STABILITY
Intact vial 15-30˚C. Protect from light.
Diluted solution Discard any unused portions after infusion.
CAUTIONS  Simultaneously prescribed antibiotics are to be administered
separately.
 Metronidazole injection should NOT be mixed with cefamandole,
cefoxitin, dextrose 10% compound sodium lactate injection, penicillin G
potassium.
REFERENCE(S): 1. Product Insert, Metronol
2. Hospital Selayang Dilution protocol, 2015

MIDAZOLAM 5MG/ML, 15MG/3ML [DORMICUM,DOMI] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted, deep into large muscle.

Slow IV: Dilute to 1-5mg/mL with NS or D5 (i.e. 1mL or 5mg in ≤5mL).

Over at least 2-3 mins at a concentration of 1-5mg/ml OR give as 2mg/min.

For induction of anesthesia: Over 20-30 seconds. Wait at least 2 mins

between doses to evaluate full effect.

For sedation/ anxiolytics/ amnesia for procedure: Over 2 mins.

Continuous IV infusion: Dilute to a conc. of 0.5mg/mL with NS or D5 (i.e.

1mL or 5mg in 10mL)

For neonates and children (cont. infusion) <15kg: Dilute to a max conc.

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of 1mg/mL (i.e. dilute 10mg in 10mL). (Some centres use undiluted)

>>Via infusion pump.
Pure Midazolam in ICU HTAN: 30mg dilute to 30mL NS.
Mida-Morphine in ICU HTAN: 30mg Midazolam & 30mg Morphine dilute
to 30mL NS.
STORAGE & STABILITY
Intact vial Below 25˚C. Protect from light.
Diluted solution Diluted solution (0.5mg/ml in continuous IV Infusion):
24hrs (in NS or D5): 2-8˚C.
CAUTIONS  For IM, should be injected deep in large muscle mass.
 Rapid administration or high dose is likely to cause life threatening
incident such as respiratory depression, apnea, respiratory arrest
and/or cardiac arrest.
 Midazolam should NOT be administered by rapid intravenous injection
in the neonatal population. Severe hypotension and seizures have
been reported following rapid intravenous administration, particularly
with concomitant use of fentanyl5.
 Midazolam MAY BE mixed in the same syringe with frequently used
premedicants, e.g. Morphine, Pethidine, Atropine or Scopolamine.
REFERENCE(S): 1. British National Formulary 60th Edition
2. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical
Pharmacy Association
3. Drug Information Handbook 19th Edition
4. Hospital Selayang Dilution protocol, 2015
5. Micromedex Healthcare Series Vol. 155
6. Product Insert, Dormicum, Domi

MORPHINE 10MG/ML [MORPHINE DUOPHARMA] - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV injection: Administer undiluted, rate 10mg/min. OR
Dilute to 1-2mg/mL with NS or WFI (i.e. to dilute 1mL or 10mg in 5-10mL).
OR Dilute 4-10mg in 4-5mL of WFI. Adult: 2mg/ml. Pediatric: over 4-5
min.

SC & IM: Undiluted.

Epidural: 1-4mg morphine diluted with 10-15ml NS.

Continuous IV injection: Dilute to 0.1-1mg/mL with NS or D5 (i.e. 1amp or

10mg up to 10-100mL NS).

Intrathecal: 0.1-1mg morphine diluted with 1-4ml NS.

Pure Morphine in ICU HTAN: 30mg Morphine dilute to 30mL NS.

Mida-Morphine in ICU HTAN: 30mg Midazolam & 30mg Morphine dilute
to 30mL NS.
STORAGE & STABILITY

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Intact vial Below 25˚C. Protect from light.

Diluted solution To be used immediately (Epidural is stable up to 4 hrs after dilution).
CAUTIONS  Use with caution in patients with impaired respiratory function or
severe hepatic dysfunction.
 May cause hypotension in patients with acute myocardial infarction.
 For slow IV injection, it is best to dilute Morphine before administration.
Warning:
 May cause respiratory depression & hypertension with circulatory
failure & deepening coma (overdose symptoms)
REFERENCE(S): 1. British National Formulary 60th Edition
2. Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5th version. Royal
Flying Doctors Service of Australia
3. Drug Information Handbook 19th Edition
4. Hospital Selayang Dilution protocol, 2015
5. HUKM Drug Formulary 2010, 5th Edition
6. Product Insert, Morphine Duopharma

MOXIFLOXACIN 400MG/250ML [AVELOX]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Intermittent IV infusion:
The solution for infusion should be infused intravenously over 60 mins. The
solution for infusion can be administered directly or via a T-Tube together
with compatible infusion solutions. The following co-infusions were found to
form stable mixtures over a period of 24 hours at RT with Moxifloxacin
solution for infusion, and can therefore be considered as compatible with
Moxifloxacin solution for infusion: WFI, NS, D5, D10, Ringer‟s solution,
Lactated Ringer‟s solution.

STORAGE & STABILITY

Intact vial Below 15-30˚C. Do not refrigerate.
Diluted solution RT: 24 hrs. Do not refrigerate.
CAUTIONS  At cool storage temperatures precipitations may occur, which will re-
dissolve at room temperature.
 If solution moxifloxacin solution for infusion is to be given with another
drugs, each drug should be given separately.
REFERENCE(S): 1. Product Insert, Avelox
2. Hospital Selayang Dilution protocol, 2015

NALOXONE HCL 0.4MG/ML [MAPIN]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV Bolus, SC, IM: Undiluted at dose of 0.4mg-2mg of naloxone, maybe
repeated at 2-3min intervals.

Continuous IV infusion: Dilute 0.4mg or 1mL in 100mL (or 2mg in 500mL)

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NS or D5, final conc. 4mcg/mL OR Dilute 4mg in 20mL NS or D5, final

conc. 200mcg/mL OR Standard dilution: 2mg in 500mL NS or D5 OR
Fluid restricted: 4mg in 250mL NS or D5. OR Max infusion conc.:
0.4mg/mL.

STORAGE & STABILITY

Intact vial Below 25˚C. Protect from light.
Diluted solution RT: 24 hrs.
CAUTIONS  Given by SC/ IM only if IV route is not possible.
REFERENCE(S): 1. British National Formulary 2011, 61st Edition
2. Drug Information Handbook 19th Edition
3. Hospital Selayang Dilution protocol, 2015
4. HUKM Drug Formulary 2010, 5th Edition
5. IWK Regional Poison Centre.)
6. Micromedex Healthcare Series Vol. 155
7. Nova Scotia Provincial Antidote Kit Manual. 2010
8. Product Insert, Mapin

NEOSTIGMINE METYLSULPHATE 2.5MG/ML,

NEOSTIGMINE METHYLSULPHATE-FRESENIUS [SETISIN]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV injection: Undiluted. Over 1 min.
SC & IM: Undiluted.
STORAGE & STABILITY
Intact vial Below 25˚C. Protect from light.
Diluted solution The solution should be freshly prepared and unused portions should be
discarded.
CAUTIONS  Neostigmine Methylsulphate should NOT be combined with other
aqueous solutions of medicines EXCEPT with WFI.
 In the diagnosis of myasthenia gravis, all anticholinesterase
medications should be discontinued at least 8 hours before
administering Neostigmine
REFERENCE(S): 1. Drug Information Handbook 19th Edition
2. Hospital Selayang Dilution protocol, 2015
3. Product Insert, Setisin

NORADRENALINE/ NOREPINEPHRINE BITARTRATE 4MG/4ML

NOREPINEPHRINE ACID TARTRATE 4MG/4ML [LEVOPHED, CARDIAMED] - HAM
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution IV infusion:
Add 1amp or 4mL to 1000mL D5 or D5NS (4mcg/mL)OR
Add 2amp or 8mg to 250mL or 500mL D5 or D5NS OR
Dilute 1amp or 4 mg up to 50 ml D5 or D5NS (80mcg/ml)OR

Suggested Minimum Dilutions:

Start with 4mg/50ml and double concentration as required (8mg/50mL), up

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to 32mg/50ml. Undiluted injection has been used.

General medical settings:

0.03mg x BW (kg), dilute in 50mL D5;
0.01mcg/kg/min = 1mL/hour.
ICU setting (with close ECG monitoring):
0.3mg x BW (kg), dilute in 50mL D5;
0.1mcg/kg/min = 1mL/hour.
Administration IV infusion: Central line only. *Refer Appendix 5 for infusion rate table.
STORAGE & STABILITY
Intact vial Store at 25°C, Protect from light.
Diluted solution Use immediately.
CAUTIONS  DO NOT dilute in NS alone due to oxidation.
 Must be diluted before use.
 Avoid contact with iron salts, alkalis @ oxidizing agents.
 Administer into central line or large peripheral vein (e.g. neck line or
femoral vein) to avoid necrosis of the overlying skin from prolonged
vasoconstriction.
 Avoid sudden discontinuation.
 Administer blood or plasma with Noradrenaline separately (e.g. by use
of a Y-tube and individual containers if given simultaneously).
 Do not administer NaHCO3 through an IV line containing
Noradrenaline.
 Contains Sodium Metabisulfite that my cause serious allergic reactions
in certain patients, especially asthmatic patients.
REFERENCE(S): 1. British National Formulary 2010, 60th Edition & Critical Manual Part 2
Drug Infusion Guidelines. 2008. 5th version. Royal Flying Doctors
Service of Australia
2. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical
Pharmacy Association)
3. Drug Information Handbook 19th Edition
4. Hospital Selayang Dilution protocol, 2015
5. HUKM Drug Formulary 2010, 5th Edition
6. Product Insert, Levophed,
7. Product Insert, Cardiamed

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O
P

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OCTREOTIDE ACETATE 0.1MG/ML, OCTREOTIDE ACETATE 20MG, [SANDOSTATIN1,

SANDOSTATIN LAR2]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC injection:
Undiluted. Use the concentration with smallest volume to deliver dose to
reduce injection pain. Rotate injection site1.

IV infusion:
Dilute the required dose in NS or D5 to provide concentration of 2mcg/ml
To infuse over 15-30 mins1.

Continuous IV infusion:
0.5mg in at least 60ml NS or D5 (NS is recommended as Octreotide can
affect glucose homeostasis). OR Dilution to a conc. of 10-50% in NS OR
Dilute to not less than 1volume:1volume, and not more than
1volume:9volume. Undiluted has been used. OR 0.1mg in 50mL NS or D5,
or 0.1mg in 500mL NS or D5. OR Dilute 0.5mcg in 100mL NS1.

Dosage for continuous infusion:

25mcg/hour or 50mcg/hour;
25-50mcg/hour for treatment of esophageal variceal bleeding;

Note:
1. Sandostatin LAR, should be given by IM Intragluteal ONLY (avoid
deltoid administration) alternate gluteal injection sites to avoid irritation.
2. This product is NOT for IM injection, for IM injection, Sandostatin Depot
suspension injection is used.
STORAGE & STABILITY
Intact vial 2°C-8°C. Do not freeze1,2.
Day-to-day use:
- Ampoules: <30ºC up to 2 wks.
- Multidose vial: <25ºC up to 2 wks.
Diluted solution <25°C: at least 24hrs, but should be used as soon as possible.
2°C-8°C: 24 hrs1.
To be administer immediately after mixing2.
CAUTIONS  Product Insert only allows for SC injection and continuous IV infusion,
no IV bolus.
 It is recommended that the solution should be at room temperature
before injections.
 Multiple injections at short intervals at the same sites should be
avoided.
 For multidose vial, it is recommended that the cap should be punctured
not more than 10 times in order to prevent contaminations.
 Sandostatin LAR, should be given by IM Intragluteal only (avoid deltoid
administration) alternate gluteal injection sites to avoid irritation.
 This product is NOT for IM injection, for IM injection, Sandostatin Depot
suspension injection is used.

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REFERENCE(S): 1. Product Insert, Sandostatin

2. Product Insert, Sandostatin LAR
3. British National Formulary 2011, 61st Edition
4. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical Pharmacy
Association
5. Critical Manual Part 2 Drug Infusion Guidelines. 2008. 5th version. Royal
Flying Doctors Service of Australia
6. Drug Information Handbook 19th Edition
7. Hospital Selayang Dilution protocol, 2015
8. Micromedex(R) Healthcare Series Volume 156
9. Nova Scotia Provincial Antidote Kit Manual. 2010. IWK Regional Poison
Centre

OMEPRAZOLE SODIUM 40MG (LYPOPHILISED INJECTION), OMEPRAZOLE SODIUM 40MG

[OMEZ1, LOMAX2, OMEZOL-LYO3]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Dissolve powder with 10ml WFI (4mg/ml)1.
Dissolve with 10ml of solvent provided (Macrogol 400BP)2,3.
Further dilution IV Bolus:
Dissolve powder with 10ml WFI1.
Dissolve with 10ml of solvent provided2.

IV Infusion:
Dilute (refer reconstitution) with 100ml NS or glucose IV infusion IP
(5%w/v)1.
Dilute with the above (refer reconstitution) 40mg in 100ml NS or D52.
Administration IV Bolus:
Over a period 5 mins1,2.
Slow IV, administer the reconstituted solution at 4ml/min3.

IV Infusion:
Over 20-30 mins1,2.
STORAGE & STABILITY
Intact vial Store below 25°C, Protect from light1,2,3.
Reconstituted solution < 25˚C: 4hrs (should not be refrigerated)1.
After reconstitution, use within 4 hrs of preparation and discard any unused
portion2,3.
Diluted solution Further dilution with NS: 12 hrs2.
Further dilution with D5: 3hrs2.
CAUTIONS  Reconstitute using only solvent provided2.
REFERENCE(S): 1. Product Insert, Omez,
2. Product Insert, Lomax,
3. Product Insert, Omezol-lyo
4. British National Formulary 2010, 60th Edition
5. Hospital Selayang Dilution protocol, 2015

OXYTOXIN [UDOXAN]
PREPARATION/ METHOD OF ADMINISTRATION

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Reconstitution Not required.

Further dilution Continuous IV infusion:
1) IV infusion pump: Dilute 10 IU in 1000mL NS or D5 or QSD1,
producing 10mU/mL.

2) IV drip infusion: Dilute 10 IU in 1000mL NS or D5 or QSD1, producing

10mU/mL.

*For abortion, adjunct: 10IU in 500mL NS or D53.

**Note:
1) Induction or stimulation oflabor: Dilute to 10mU/mL, i.e. dilute 10 IU in
1000mL NS or D5.

2) Postpartum uterine bleeding: Dilute 10-40units (max 40units) in

1000mL NS or D5 or QSD1.

IM injection: Undiluted.
Administration Continuous IV infusion:
1) IV infusion pump:
Initially at 1-4mU/min (0.1-0.4ml/min or 2-8 drops/min), may be gradually
increased at intervals not shorter than 20 min.
(Max: 20mU/min or 2mL/min or 40drops/min)

2) IV drip infusion:
Initially at 2-8 drops/min (0.1-0.4mL/min or 1-4mU/min), may be gradually
increased (Max: 40 drops/min or 2mL/min or 20mU/min)

*3rd stage of labour& puerperium: IM injection or Slow IV injection. In

pts given Oxytocin by drip to induce or stimulate labour, the infusion should
be continued during the 3rd stage.

*Caesarian section: Intramurally after delivery of fetus.

*For abortion, adjunct

At a rate of 10 to 20 milliunits (20 to 40 drops) per minute. The total dose
should Not exceed 30 units in a 12-hour period due to the risk of water
intoxication. (Micromedex(R) Healthcare Series Volume 156)

Induction or stimulation of labor:

The initial dose should be 0.5 to 1 mU per minute (equal to 3 to 6 mL per
hour). The dose should be gradually increased in increments of 1 to 2 mU
per minute at 30 to 60 minute intervals until the desired contraction pattern
has been established. Once labor has progressed to 5 to 6 centimeters
dilation, the dose may be reduced by similar increments. Higher infusion
rates should be given with great care to women at full term. Rates
exceeding 9 to 10 milliunits/minute are rarely required.

Postpartum uterine bleeding:

A total of 10 units of oxytocin may be infused at a rate of 20 to 40

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milliunits/minutes after delivery of the infant for postpartum bleeding

reduction. Oxytocin is usually not given until after delivery of the placenta.
STORAGE & STABILITY
Intact vial 2°C-8°C. Do not freeze, protect from light.
Diluted solution Discard any unused portion after opening.
CAUTIONS  IV bolus injection or > 2 I.U can cause acute hypotension.
 For the induction and enhancement of labour, Oxytocin should be
given as an infusion and NOT by SC, IM or IV bolus injection.
 Not compatible with solutions containing bisulphites and
metabisulphites as preservatives.
 NOT to be started for at least 6 hours after administration of vaginal
prostaglandin.
 Prolonged intravenous administration at high doses with large volume
of fluid (which is possible in inevitable or missed abortion or postpartum
haemorrhage) may cause water intoxication with hyponatraemia. To
avoid: use electrolyte containing diluent (i.e. not glucose), increase
oxytocin concentration to reduce fluid, restrict fluid intake by mouth;
monitor fluid and electrolytes.
REFERENCE(S): 1. British National Formulary 60th Edition
2. Hospital Selayang Dilution protocol, 2015
3. Micromedex(R) Healthcare Series Volume 156
4. Product Insert, Udoxan

OXYTOXIN 5IU/ML + ERGOMETRINE 0.5MG/ML [SYNTOMETRINE]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: 1ml undiluted.
Slow IV: 0.5-1ml undiluted.
STORAGE & STABILITY
Intact vial 2°C-8°C. Protect from light.
Diluted solution Discard any unused portion after opening.
CAUTIONS  IV administration of Syntometrine is possible but not normally
recommended, as IV administration is associated with the risk of
sudden hypertensive or cerebrovascular accident and Syntometrine
should therefore only be given by this route if absolutely necessary.
REFERENCE(S): 1. Hospital Selayang Dilution protocol, 2015
2. Product Insert, Syntometrine®

ORPHENADRINE CITRATE 60MG/2ML

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV: One ampule (2ml) Over 5 minutes.
Can also administer via IM.
STORAGE & STABILITY
Intact vial Protect from light.
Diluted solution Discard any unused portion after opening.
REFERENCE(S): 1. Product Insert, Orphenadrine Citrate

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P-TROVITE [PARENTROVITE]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution The contents of each pair of ampoules (no.1&no.2) should be mixed prior to
injection.
Further dilution Dilute with 500-1000ml NS or D5.
Administration IV Infusion: Over 6-8hrs.
STORAGE & STABILITY
Intact vial Below 25˚C.
Reconstituted solution Protect from light.

REFERENCE(S): 1. Product Insert, Parentrovite

2. Hospital Selayang Dilution protocol, 2015

PALIPERIDONE PALMITATE 75MG, 150MG [INVEGA1, SUSTENNA2]

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM: Undiluted. Deep into deltoid or gluteal region
STORAGE & STABILITY
Intact vial 15-30˚C, for single use only. Discard any unused portion.
CAUTIONS  Do NOT administer IV or SC.
 For DELTOID injection, if the patient weighs < 90 kg, use the 1-inch 23
gauge needle (needle with blue colored hub); if the patient weighs ≥ 90
kg, use the 1½-inch 22 gauge needle (needle with gray colored hub).
 For GLUTEAL injection, use the 1½-inch 22 gauge needle (needle with
gray colored hub).
 Administer the dose in a single injection; do not administer the dose in
divided injections.
REFERENCE(S): 1. Product Insert, Invega
2. Product Insert, Sustenna
3. Hospital Selayang Dilution protocol, 2015

PALIVIZUMAB 100MG INJ (SYNAGIS®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 100mg vial with 1ml WFI. Gently swirl for 30 sec to avoid
foaming. Let it stand for 20min at room temperature until solution clarifies.
Do not shake or vigorously agitate the vial.
Further dilution It is recommended that unless it is reconstituted under controlled and
validated aseptic conditions, the product should be administered within 3
hours of reconstitution.
Administration IM only.
STORAGE & STABILITY
Intact vial Store at 2-8°C.
Reconstituted solution 6 hours at room temperature.
CAUTIONS  Do NOT administer as IV infusion.
 Do NOT invert the vial during the reconstitution process. Before drawing
up the solution, invert the vial for approximately 30 seconds.
REFERENCE(S): 1. Product Insert, Synagis®
2. Hospital Selayang Dilution protocol, 2015

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PAMIDRONATE DISODIUM 30MG INJ (PAMISOL®), DISODIUM PAMIDRONATE @DISODIUM-3-

AMINO-1-HYDROXYPROPYLIDENE-1,1-BIPHOSPHATE
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Further dilute with 250-1000mL D5, NS or ½NS (final concentration not more
than 90mg in 250ml).
Administration IV Infusion: Rate not to exceed 1mg/min.
90mg in 250ml: To be infused over 2 hr
30 mg in 500ml, 90mg in 500ml: To be infused over 4 hr.
60mg or 90mg in 1000ml: To be infused over 2-24 hr.
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution 24hr at room temperature.
CAUTIONS  For single use ONLY. Discard any unused portion after opening.
 NEVER be given as IV bolus since severe local reactions and
thrombophlebitis may occur as a result of high local concentration.
 Use a large vein in order to minimize local reactions at the infusion site.
 Monitor renal function. Longer infusions (i.e., >2 hours) may reduce
the risk for renal toxicity, particularly in patients with preexisting renal
insufficiency.
 Pamidronate disodium MUST NOT be mixed with calcium-containing
infusion solutions, such as Ringer‟s solution, and should be given in a
single intravenous solution and line separate from all other drugs.
REFERENCE(S): 1. Product Insert, Pamisol®
2. Hospital Selayang Dilution Protocol, 2015

PARACETAMOL 1000MG/100ML INJ (IFIMOL)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IV infusion: Administer the required dose over 15 mins.
STORAGE & STABILITY
Intact vial Store below 30°C.
REFERENCE(S): 1. Hospital Selayang Dilution Protocol, 2015

PARECOXIB 40MG (DYNASTAT®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 40mg vial with provided solvent (2ml NS) to provide
concentration of 20mg/ml.
Further dilution Not required.
Administration V bolus or Inject into IV lines delivering NS, D5, D5½NS, Lactated Ringer
solution
IM: slowly inject and deeply into muscle.
STORAGE & STABILITY
Intact vial Store below 25°C.
Reconstituted solution Do not refrigerate or freeze. 12hr at room temperature. Discard unused
portion.
CAUTIONS  Injection of parecoxib into a line delivering 5% Dextrose in Lactated
Ringer‟s solution may cause precipitation.

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 Use should be limited to 2 days only with a maximum dose of 80mg per
day. It is recommended that patients be transitioned to alternative oral
therapy as soon as clinically indicated. This is because CV risk may
increase with dose and duration of exposure.
 Flush the line before and after administration of solution with compatible
fluid (eg, NS, D5, D51/2 NS, Lactated Ringer solution)3.
REFERENCE(S): 1. Product Insert, Dynastat®
2. Hospital Selayang Dilution Protocol, 2015
3. Micromedex Healthcare Series Vol. 156

PEGINTERFERON-ALFA-2A 180MCG/0.5ML (PEGASYS®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC only.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Do not freeze or shake. Protect from light.
REFERENCE(S): 1. Product Insert, Pegasys®
2. Hospital Selayang Dilution Protocol, 2015

PETHIDINE HCL 50MG/ML & 100MG/2ML (DUOPHARMA) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Administer undiluted.
SC: Administer undiluted.
Slow IV injection: Dilute up to 10mg/ml with NS or D5. Should be
administered very slowly, over 4-5 minutes.3
Continuous IV infusion: Dilute up to 1mg/ml with NS or D5, administer
0.5-1 mg/min.3
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Discard any unused portion after
opening.
CAUTIONS  When administering parentally, especially IV route, the patient should
be lying down.
 Rapid intravenous administration may increase incidence of respiratory
depression, apnea, hypotension & cardiac arrest.3
REFERENCE(S): 1. Product Insert
2. Hospital Selayang Dilution Protocol, 2015
3. Hospital Sultanah Bahiyah Dilution Protocol

PHENOBARBITAL SODIUM 200MG/ML (PHENOBARBITAL SODIUM BP)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC or IM: Undiluted. Do NOT exceed 5ml per injection to avoid potential
tissue irritation.
Slow IV: Dilute to 10 times its own volume with WFI (e.g. 1 vial of 1 ml

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phenobarbitone dilute to 10 ml with WFI) OR dilute 1 vial in 10ml of NS or

D5; Push over 3-5 min2.
Max rate: 2mg/kg/min (infants), 30 mg/min (children), 60mg/min
(adults)3.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Discard any unused portion after
opening.
CAUTIONS  IV Infusion (Avoid rapid IV administration).
 Parenteral solution is highly alkaline. Therefore, DO NOT administer
with other drugs, IV solutions or blood products due to incompatibilities.
REFERENCE(S): 1. Product Insert, Phenobarbital Sodium BP
2. Hospital Selayang Dilution Protocol, 2015
3. Micromedex® Solutions

PHENYLEPHRINE HCL 10MG/ML (FRENIN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC, IM: May be given undiluted.
Slow IV bolus: Dilute 1vial with 99ml of D5 or NS to yield a final
concentration of 100mcg/ml (i.e. 1 mL phenylephrine 10 mg/mL plus 99 mL
NS or D5W). Inject over 20-30 seconds.4
IV infusion: Dilute 1vial with 500ml of NS or D5 to yield a final
concentration of 20mcg/ml; titrate to response.
STORAGE & STABILITY
Intact vial Store below 15-30°C. Protect from light.
Diluted solution 4hr at 25°C.
24hr at 2-8°C.
CAUTIONS  For single use ONLY, discard unused portion after opening.
REFERENCE(S): 1. Product Insert, FRENIN®
2. Hospital Selayang Dilution Protocol, 2015
3. Micromedex® Solutions
4. GlobalRPH Intravenous Dilution Guidelines

PHENYTOIN SODIUM 250MG/5ML (DILANTIN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV Bolus: May be given undiluted with rate not exceeding 50mg/min
(adult) or 1-3mg/kg/min (neonates and children).
IV infusion: Can further diluted with 50-100ml NS (final concentration not
exceeding 10mg/ml). Administer over 1hr.
STORAGE & STABILITY
Intact vial Store 15-30°C. Protect from light.
Diluted solution Keep at room temperature and can be used as long as the solution is clear.
Do NOT refrigerate.
CAUTIONS  Flush IV catheter with NS prior to and following each IV injection to avoid
local venous irritation caused by alkalinity of solution
REFERENCE(S): 1. Product Insert, Dilantin®

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2. Hospital Selayang Dilution Protocol, 2015

3. Micromedex® Solutions

PHYTOMENADIONE 1MG/1ML (VITAMIN K) (KISAN®), No Preservative Benzyl Alcohol - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC, IM: Give undiluted.
Slow IV (when other routes are not suitable): Rate not exceeding
1mg/min.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Do not freeze. Discard any unused
portion after opening.
CAUTIONS  Preservative-free phytomenadione is recommended for neonate use.3
REFERENCE(S): 1. Product Insert, Kisan®
2. Hospital Selayang Dilution Protocol, 2015
3. Micromedex® Solution

PHYTOMENADIONE 10MG/ML (VITAMIN K) (KISAN®), With Preservative Benzyl Alcohol - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV: More than 30sec (for potentially fatal haemorrhage due to
overdosage of anticoagulants or hypoprothrombinaemia)
IM: Administer undiluted.
IV Infusion (adult): May be diluted with NS or D5.1-20mg diluted to 50ml
and infused for ≥30min; 21-50mg diluted to 100ml and infused for ≥60min,
at rate not to exceed 1 mg/min3.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light. Do not freeze.
Diluted solution Do NOT refrigerate or freeze.
12hrs at room temperature. Discard unused portion.
REFERENCE(S): 1. Product Insert, Kisan®
2. Hospital Selayang Dilution Protocol, 2015
3. Micromedex® Solution

PIPERACILLIN/TAZOBACTAM 4.5G (TAPICIN®, Y.S.P) (TAZOCIN®, WYETH)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 20ml of WFI or NS.
Further dilution 50-150ml of NS or D5.
Administration IV infusion: Administer at least 30min.
STORAGE & STABILITY
Intact vial Store below 25°C. Do not freeze
Reconstituted solution 24hrs at room temperature (20-25°C).
48hrs at 2-8°C.
CAUTIONS  Do not mix with solutions that contain sodium bicarbonate because of
chemical instability.
 Aminoglycosides and piperacillin/tazobactam must be administered
separately when concomitant therapy is indicated.3 Administer

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aminoglycosides at least 1 hour before or after a piperacillin/tazobactam

dose, and/or flush the line.2
REFERENCE(S): 1. Product Insert, Tapicin®, Y.S.P.
2. Product Insert, Tazocin®, Wyeth
3. Hospital Sultanah Bahiyah Dilution Protocol
4. Micromedex® Solutions

POTASSIUM CHLORIDE 10% W/V INJECTION (1G/10ML), (INJECSOL K10) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Each vial (10ml) contains 1g = 13.41mmol potassium ions
IV Infusion:
Peripheral line: Dilute with NS or D5 to a max concentration 100mmol/L &
infuse with max rate not exceeding 10mmol/hr.
Central Line: Dilute with NS or D5 to a max concentration 200-400mmol/L
& infused with max rate not exceeding 40mmol/hr.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution 24 hrs at 15-25°C3. Discard any unused portion after opening.
CAUTIONS  DO NOT inject undiluted or IV Bolus.
REFERENCE(S): 1. Product Insert, Injecsol K10
2. Hospital Selayang Dilution Protocol, 2015
3. Hospital Sultanah Bahiyah Dilution Protocol

POTASSIUM DIHYDROGEN PHOSPHATE CONCENTRATED INJECTION (DBL HOSPIRA) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Each vial (10ml) contains 10 mmol of potassium ions, 10 mmol of
phosphate ions and 20 mmol of hydrogen ions.

IV Infusion (adult): Dilute with 500-1000ml NS or D5. Maximum

concentration 40mmol potassium content/1000ml. Infused over at least 4hr.
* If fluid restricted, dilute in 50-100ml NS/ D5 and infuse over 90min.
IV Infusion(children): Dilute with 100-150mL NS or D5 to <0.12mmol/mL
(peripheral line) or <0.5mmol/mL (central line).3
Slow IV infusion:
Adult: Infuse up to 10mmol phosphate over 12hrs.
Children: (max dose: 0.2mmol phosphate/kg/hr, 70mmol phosphate/day)4.
Mild/moderate hypophosphatemia: Infuse over 4-6 hr at a rate of
<0.06mmol phosphate/kg/hr3;
Severe hypophosphatemia: Infuse over 8-12 hr at a rate of <0.06mmol
phosphate/kg/hr3
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution 24hr at 15-25°C3.
CAUTIONS  Incompatible with calcium- or magnesium-containing solutions3.

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

REFERENCE(S): 1. Product Insert, DBL Hospira

2. Hospital Selayang Dilution Protocol, 2015
3. Hosital Sultanah Bahiyah Dilution Protocol
4. Frank Shann 16th Edition 2014

PRALIDOXIME CHLORIDE 500MG/20ML (PAMPARA®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC / IM: Use undiluted. Use when no IV access is available.
Slow IV: Dose of 5% to 10% solution in WFI given over 5-10 mins.
IV infusion: Dilute 1-2g in 100ml NS over 15-30min.
*Max rate of administration is 200mg/min.
STORAGE & STABILITY
Intact vial Store below 28°C. Protect from light.
CAUTIONS  IV administration of pralidoxime should be carried out slowly and
preferably, by infusion, since certain side effects, such as tachycardia,
laryngospasm, and muscle rigidity, have been attributed in a few cases
to a too rapid rate of injection.
 Should be used with great caution in treating organophosphate
overdosage in cases of myasthenia gravis since it may precipitate a
myasthenic crisis.
REFERENCE(S): 1. Product Insert, Pampara®
2. Hospital Selayang Dilution Protocol 2015
3. Micromedex Healthcare Series Vol. 156

PROCYCLIDINE HYDROCHLORIDE 10MG/2ML (KEMADRIN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted.
Slow IV: Further dilute 1 amp with 10ml NS. Give over 2-5min. May also be
given undiluted over at least 5min.
STORAGE & STABILITY
Intact vial Store below 25°C.
CAUTIONS  Procyclidine should NOT be withdrawn abruptly as rebound
Parkinsonian symptoms may occur.
REFERENCE(S): 1. Product Insert, Kemadrin®
2. Hospital Selayang Dilution Protocol 2015

PROCHLORPERAZINE MESYLATE 12.5MG/ML (LARTIL®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted.
Slow IV Bolus: Dilute 1 amp in 10ml NS over 5min. Rate should NOT
exceed 5mg/min.
IV infusion: Dilute 20mg in NO less than 1L of NS, infuse over 30min.
STORAGE & STABILITY

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Intact vial Below 25°C. Protect from light.

CAUTIONS  Prochlorperazine should be AVOIDED in patients with renal
dysfunction, Parkinson‟s disease, hypothyroidism,
phaeochromocytoma, myasthenia gravis and prostate hypertrophy.
REFERENCE(S): 1. Product Insert, Lartil®
2. Hospital Selayang Dilution Protocol 2015

PROMETHAZINE HYDROCHLORIDE 50MG/2ML (FRESENIUS®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Deep IM: Undiluted.
Slow IV: Dilute 1 amp in 20ml of NS, administer over 10–15min.
*Notes: Rapid IV infusion may cause a transient fall in BP and may
increase risk of severe tissue injuries. Should NOT be given intra-arterially
or SC.
Max rate of administration NOT greater than 25mg/min.
STORAGE & STABILITY
Intact vial Below 25°C. Protect from light.
CAUTIONS  Injection should be freshly prepared and unused solution should be
discarded.
 Should NOT be combined with other aqueous solutions of medicaments
except with WFI, D5, D10, ½ NS and NS.
 Promethazine may cause drowsiness and impaired concentration,
which may be aggravated by simultaneous intake of alcohol or other
central nervous system depressant agent.
 Use with caution when following medical conditions exist: prostatic
hypertrophy, narrow angle glaucoma, emphysema or chronic bronchitis,
and porphyria.
 Should NOT be used in patients with pre-existing central nervous
system depression, bone marrow depression, liver disorders,
phaeochromocytoma or Reye‟s syndrome.
REFERENCE(S): 1. Product Insert, Fresenius®
2. Hospital Selayang Dilution Protocol 2015

PROPOFOL 1% 200MG/20ML MCT/LCT (PROPOFOL-LIPURO 1%®), (FRESOFOL®) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IV or Continuous infusion: Administer undiluted or diluted with D5
or NS in glass infusion bottles. Final concentration must not be below
2mg/mL. Maximum dilution must NOT exceed 1 part of propofol with 4
parts of D5 or NS.
STORAGE & STABILITY
Intact vial Store below 25°C. Do not freeze.
CAUTIONS  Shake the container product before use. If 2 layers can be seen after
shaking the emulsion should not be used.
 Prepare the mixture aseptically immediately before administration and
must be administered within 6 hours after preparation.

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 Discard unused emulsion.

 Duration of administration must not exceed 7 days.
 Administer propofol with caution and at a reduced administration rate in
patients with cardiac, respiratory, renal or hepatic impairment or in
elderly, debilitated, hypovolaemic or epileptic patient or patients with
disorders of consciousness.
REFERENCE(S): 1. Product Insert, Propofol-Lipuro 1%®
2. Product Insert, Fresofol®
3. Hospital Selayang Dilution Protocol 2015

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Q
R

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

QUININE DIHYDROCHLORIDE 600MG/2ML (MALAKIN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV infusion: Dilute required dose in 250 – 500ml of NS or D5 and
infused over 4hrs.
*If IV infusion not possible, may be given by IM (dose 10mg/kg).
STORAGE & STABILITY
Intact vial Store below 25°C.
Protect from light.
CAUTIONS  Discard any unused portion after opening.
 Should be used with caution in patients with AF or serious heart
disease.
REFERENCE(S): 1. Product Insert, Malakin®
2. Hospital Tuanku Ampuan Najihah Dilution Protocol 2013

RABIES VACCINES (VERORAB®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute powder with given solvent. Shake gently. Reconstituted
vaccine appears as clear liquid.
Further dilution Not required.
Administration IM only: Inject into deltoid area in adults or anterolateral aspect of the thigh
in infants and toddlers. DO NOT inject in the buttocks.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Do not freeze.
Reconstituted solution Use immediately after reconstitution.
CAUTIONS  Discard any unused portion after opening.
 NOT for IV & SC injection.
 MUST NOT be administered intradermally.
REFERENCE(S): 1. Product Insert, Verorab®
2. Hospital Selayang Dilution Protocol 2015
3. Hospital Tuanku Ampuan Najihah Dilution Protocol 2013

RANITIDINE 50MG/2ML (GASTRIL®), (ZANTAC®), (AMEKET®), (ARNETIN®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted5.
Slow IV: Dilute with 20ml NS or D5. Given over 2min5.
IV infusion: Dilute with 100ml NS or D5 over 15-120min or infuse at a rate
of 25mg/hr for 2hr5.
STORAGE & STABILITY
Intact vial Store below 25 °C. Protect from light1, 2, 4.
Store below 30 °C. Protect from light3.
Diluted solution Stable for 72hr when refrigerated (2-8°C) and 24hr at room temperature.2

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Stable for 48hr at room temperature3, 5.

Stable for 24hr at room temperature4.
CAUTIONS  Treatment with histamine H2-antagonist may mask symptoms
associated with carcinoma of the stomach and therefore may delay
diagnosis of the condition. If gastric ulcer is suspected, the possibility of
malignancy must be excluded before initiating therapy1,3,4.
REFERENCE(S): 1. Product Insert, Gastril®
2. Product Insert, Zantac®
3. Product Insert, Ameket®
4. Product Insert, Arnetin®
5. Hospital Selayang Dilution Protocol 2015

REMIFENTANIL 5MG (ULTIVA™)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 5ml of diluent to give a concentration of 1mg/mL.
Further dilution See administration.
Administration IV only: Further dilute to final concentration of 20-250mcg/mL with WFI or
D5.
Recommended dilution for:-
Adults: 50mcg/mL.
Paediatric patients aged 1 year and over: 20-25mcg/mL.
STORAGE & STABILITY
Intact vial Store at or below 25°C.
Reconstituted solution Stable for 24hr at room temperature (25°C) after reconstitution.
Diluted solution Stable for 24hr at room temperature (25°C) after dilution.
CAUTIONS  Contraindicated for epidural or intrathecal administration.
 Not recommended for use as the sole agent in general anaethesia.
REFERENCE(S): 1. Product Insert, Ultiva™
2. Hospital Selayang Dilution Protocol 2015

ROCURONIUM BROMIDE 50MG/5ML (ESMERON®) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Rapid bolus: May be given undiluted.
Continuous infusion: Further dilute with NS or D5 to final concentration of
0.5 or 1mg/ml for infusion. Loading dose of 0.6mg/kg.
Infusion rate for:
(a) maintain neuromuscular block: 0.3-0.6mg/kg/hr and
(b) under inhalation anaesthesia: 0.3-0.4mg/kg/hr.
STORAGE & STABILITY
Intact vial Store at 2-8°C. 12 weeks at room temperature (up to 30°C).
Diluted solution 24 hr at 2-8°C.
CAUTIONS  For single use ONLY.
 Use immediately after first opening and completed within 24 hours.
Discard any unused solution.
 Since rocuronium causes paralysis of the respiratory muscles,

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ventilatory support is mandatory for patients treated with this medication

until adequate spontaneous respiration is restored.
 Anaphylactic reactions can occur following the administration of
neuromuscular blocking agents. Precautions for treating such reactions
should always be taken.
REFERENCE(S): 1. Product Insert, Esmeron®
2. Hospital Selayang Dilution Protocol 2015

ROPIVACAINE HCL 7.5MG/ML (150MG/20ML) (NAROPIN)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Dilute with NS or D5.
Administration Inject slowly or in incremental dose at a rate of 25- 30mg/min.
Epidural Injection (bolus): Recommended concentration 7.5mg/ml.
Lumbar and thoracic, 100mg over 3-5min.
Analgesia: Recommended concentration 2mg/ml.
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution Used immediately. Discard unused portion.
CAUTIONS  For epidural administration.
 Contains no preservative, for single use ONLY.
 To prevent inadvertent intravascular injections, great caution should be
observed. Careful aspiration is recommended before and during
injection of the total dose.
REFERENCE(S): 1. Product Insert, Naropin

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S
T

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DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

SALBUTAMOL SULFATE 5MG/5ML (VENTOLINTM)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See Administration.
Administration SC & IM injection: Undiluted.
Slow IV injection: Dilute to 50mcg/mL (i.e. 5mg or 1amp in 100mL NS or
D5)1 and administer over 3 – 5 mins3.
Continuous IV Injection:
Dilute 5mL or 5mg in 500mL of NS or D5 or DS to a conc. of 10mcg/mL2.
1) For Status asthmaticus2:
Infuse at 3 – 20mcg/min adjusted according to response and heart rate
2) For premature labour:
Infuse at 10 – 45 mcg/min adjusted according to strength and frequency of
contraction and heart rate.
ROF: Dilute 10mg in 50mL NS or D5 (i.e. 5mg or 1amp in 25mL) to a conc.
of 200mcg/mL4.
STORAGE & STABILITY
Intact vial Store below 30°C. Protect from heat and direct light.
Diluted solution Stable for 24 hrs at room temperature.
CAUTIONS Should NOT be administered in the same syringe or infusion as any other
medications.
REFERENCE(S) 1. British National Formulary 2011, 61st Edition
2. Product Insert, VentolinTM
3. University College of London Hospital. NHS Foundation Trust. 2008.
Injectable medicines administration guide. 3rd Edition. Wiley Blackwell
4. Critical Care Group. Minimum Infusion Volumes for Fluid Restricted
Critically Ill Patients. 2006. 3rd Edition. United Kingdom Clinical
Pharmacy Association.

SNAKE (COBRA, MALAYAN PIT VIPER) ANTI-VENOM - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Gently swirl (avoid foaming) with the provided solution OR 10ml of WFI until
completely dissolved.
Further dilution Further dilute the reconstituted anti-venom with 5-10ml/kg body weight of
NS or D5 for children or 250-500ml NS or D5 for adult 2,3.
Administration IV infusion: The diluted antivenin should be given by IV infusion starting at
1-2ml/min over 10-15min. If no reaction, complete the infusion within a
period of less than one hour at a rate of 5-10ml/min. Subsequent dose can
be given every 1-2hrs (Cobra) OR 6 hours (Malayan pit viper) according to
the clinical signs & symptoms 2,3.
*Skin Test: Intradermal - 0.02ml of 1:100 antivenin dilution prior administration.1
STORAGE & STABILITY
Intact vial Store at 2-8°C. Protect from light.
Reconstituted solution Use immediately.
Diluted solution Use immediately.
CAUTION  May cause local allergic or anaphylactic reaction which may be fatal.
REFERENCE(S) 1. Product Insert, Snake anti-venom
2. Selection of Anti-venom in UKMMC 2014
3. Snakebite Management Guide for Healthcare Providers in Malaysia 2014
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SNAKE (NEUROPOLYVALENT, HEMATOPOLYVALENT) ANTI-VENOM – HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Gently swirl (avoid foaming) with the provided solution or 10ml of WFI until
completely dissolved.
Further dilution Further dilute the reconstituted anti-venom with 5-10ml/kg body weight of
NS or D5 for children or 250-500ml NS or D5 for adult 2,3.
Administration IV infusion: The diluted antivenin should be given by IV infusion starting at
1-2ml/min over 10-15min. If no reaction, complete the infusion within a
period of less than one hour at a rate of 5-10ml/min. Subsequent dose can
be given every 1-2hr (neuro-polyvalent) OR 6 hrs (hemato-polyvalent)
according to the clinical signs & symptoms.
*Skin Test: Intradermal - 0.02ml of 1:100 antivenin dilution prior administration.1
STORAGE & STABILITY
Intact vial Store at 2-8°C. Protect from light.
Reconstituted solution Use immediately.
Diluted solution Use immediately.
CAUTIONS  Anti-venom may cause local allergic or anaphylactic reaction which
may be fatal.
 Monitor patient for 2 hours.
 If there is hypotension or hemodynamic instability, IV fluids should be
given. Once patient stable, restart antivenin slowly for 10-15 min under
close monitoring. Then normal drip rate can be resumed.
REFERENCE(S) 1. Product Insert, Snake Polyvalent Anti Venom
2. Selection of Antivenom in UKMMC 2014
3. Snakebite Management Guide for Healthcare Providers in Malaysia 2014
SODIUM BICARBONATE 8.4% W/V (PHARMANIAGA)
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration SC injection: Dilute 1ml with 4.6ml of WFI (to isotonicity of 1.5%).
Slow IV injection: Can be undiluted. Administered undiluted in emergency
cases, with infusion rate ≤1mEq/kg/min5.
[Given especially during metabolic acidosis in cardiac arrest, 50mL given
undiluted, with plasma pH and electrolytes being monitored.] 1,2.
Continuous IV infusion: Infuse over 4-8 hours (adult).
1) Peripheral line:
Usually 1.26% solution, i.e. 150mL or 15amp in 1000mL NS or D5 (15mL or
1.5amp in 100mL).
2) Central line:
Can be 4.2% solution (i.e. diluted with equal volume of NS or D5) or 8.4%
solution (undiluted). 1.26% solution, i.e. 150mL or 15amp in 1000mL NS or
D5 (15mL or 1.5amp in 100mL) also can be given centrally2.
@
Neonates & child <2y.o.:
Recommended to use 4.2% or dilute to 0.5mEq/mL for slow administration
of direct IV (i.e. volume of NaHCO3 needed diluted with the equal volume of
NS or D5)3.
Max rate in infants:
(using above dilution)

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Direct slow IV: 10mEq/min.

IV infusion: 1mEq/kg/min (usually over 2hours)4.
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution Discard any unused portion.
CAUTIONS  Infusion related adverse effects: excess HCO3- may result in metabolic
alkalosis, hypokalemia and hypocalcemia2.
 Flush intravenous line before and after NaHC03 infusion.
 Incompatible with acids, acidic salts, many alkaloidal salts, aspirin,
bismuth salicylate, isoproterenol HCl, norepinephrine bitartrate,
dopamine HCl and tubocurarine Cl.
REFERENCE(S) 1. British National Formulary 2011, 61st Edition, Nova Scotia Provincial
Antidote Kit Manual. 2010. IWK Regional Poison Centre
2. University College of London Hospital. NHS Foundation Trust. 2008.
Injectable medicines administration guide. 3rd Edition. Wiley Blackwell.
3. HUKM Drug Formulary 2010, 5th Edition
4. Drug Information Handbook 19th Edition
5. Nova Scotia Provincial Antidote Kit Manual. 2010. IWK Regional Poison
Centre.

SODIUM VALPROATE 400MG (EPILIM®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 4ml of provided solvent (WFI).
Further dilution See administration.
Administration Slow IV: Administer the reconstituted solution over 3-5min.
IV infusion: Dilute the required dose with 50-100ml of NS, D5 or NSD5
infuse over 60min at < 20mg/min.
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution Stable for 24hrs at 2-8°C.
REFERENCE(S) 1. Product Insert, Epilim®

STREPTOKINASE 1.5MU (STREPTASE®) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute 1 vial with 5ml NS.
Further dilution See administration.
Administration Slow IV Injection: Local administration for acute, subacute and chronic
peripheral thrombosis and embolism: 3-5 mins (amounts up to 3 hours at a
total dose of max 120,000 IU).
IV Infusion:
Acute MI: Further dilute with 100-150ml NS or D5 and infuse over 60mins1.
PE: Further dilute with 150mL NS or D51, loading dose 250,000 IU over
30mins, followed by maintenance dose 100,000IU/hour (if for short term
lysis: over a max 6hrs)2.
For administration with an infusion pump, Ns, Ringer‟s Lactate, and D5 can
be used as diluents.
STORAGE & STABILITY
Intact vial Store at 2-25°C.

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Diluted solution Stable for 24hrs at 2-8°C.

CAUTIONS  Do NOT inject NS directly to the powder for reconstitution.
(Add NS slowly alongside of the wall) and dilute gently to avoid foaming).
Warning:
 May cause life threatening thromboembolic events in particular that of
haemorrhages.
REFERENCE(S) 1. HUKM Drug Formulary 2010, 5th Edition
2. Product Insert, Streptase®

STREPTOMYCIN 1G (STREPTIN)
Reconstitution Reconstitute with 4.2ml - 4.5ml of NS or WFI to each 1g vial.
Further dilution Not required.
Administration IM: Administer the reconstituted solution. Inject deep IM into large muscle
mass.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Reconstituted solution 1 day in a cool place (below 25°C). Protect from light and freezing
REFERENCE(S): 1. Product Insert, Streptin

SUGAMMADEX SODIUM 100MG/ML (BRIDION)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution For pediatric patient: can be diluted with NS to a concentration 10mg/ml.
Administration IV Bolus: Within 10 seconds directly into the vein or into an existing
intravenous line.
Sugammadex may be injected into the line of a running infusion of NS, D5
1/2NS, D2.5%, Ringer‟s Lactate, Ringer solution or D5NS.
STORAGE & STABILITY
Intact vial Store below 30°C.Protect from light (5days if removed from box).
Diluted solution Use immediately.
REFERENCE(S) 1. Product Insert, Bridion

SULFAMETHOXAZOLE 400MG AND TRIMETHOPRIM 80MG (CO-TRIMOXAZOLE)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IV Infusion: Further dilute with NS, D5, or D10 as below:
 1amp (5ml) into 125ml.
 2amp (10ml) into 250ml.
 3amp (15ml) into 500ml.
Administer over 90mins1,2.
*In restricted fluid patients: 1 amp (5 mL) may be diluted with 75 mL D5 and
infused over max. 60 minutes. For ≥ 2amp, it should be administer over
3hr2,3.
STORAGE & STABILITY
Intact vial Store below 30°C.
Diluted solution 24hrs at room temperature.
REFERENCE(S) 1. Product Insert, Co-trimoxazole
2. British National Formulary 2011, 61 Edition

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3. Micromedex Healthcare Series Vol. 155

SUXAMETHONIUM CHLORIDE 100MG/2ML [SUXAMETHONIUM CL-FRESENIUS

(ETHICHOLINE®), SUXAMETHONIUM, UK]
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted. May be used when IV access is not available 4,5. A dose up
to 4mg/kg body weight may be given; total dose should not be more than
150mg1.
IV bolus: Undiluted. Administer over 10 - 30seconds.
IV infusion: Dilute with NS or D5 to produce 1mg/ml (0.1%) or 2mg/ml
(0.2%) solution i.e. 1amp in 50-100ml.
Brand 1: Infuse at a rate of 2.5 – 4mg/min1.
Brand 2: Infuse at a rate of 2 – 5mg/min2.
Total dose given by repeated IV injection or continuous infusion should not
exceed 500mg/hr1.
STORAGE & STABILITY
Intact vial Store at 2-8°C .Protect from light.
Diluted solution Use immediately and discard any unused portions after opening.
CAUTIONS  Should NOT be mixed with any other medications.
REFERENCE(S) 1. Product Insert, Suxamethonium Cl-Fresenius (Ethicholine®)
2. Product Insert, Suxamethonium, UK
3. HUKM Drug Formulary 2010, 5th Edition
4. Drug Information Handbook 19th Edition
5. British National Formulary 2011, 61st Edition

SYNTHETIC SALMON CALCITONIN 100 IU (MIACALCIC®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration SC or IM. If the volume to be injected exceeds 2mls, IM is preferable and
multiple injection sites should be used1,2.
STORAGE & STABILITY
Intact vial Store at 2-8°C.
Diluted solution Use immediately and discard any unused portion.
REFERENCE(S): 1. Drug Information Handbook 19th Edition
2. Micromedex Healthcare Series Vol. 157
3. Product Insert, Miacalcic®

TENECTEPLASE 10,000 UNIT (50MG) (METALYSE) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Use the prefilled syringe of solvent (10ml of WFI) to dilute, a final volume of
10mL will be produced.
(1ml =5mg =1000unit)
Further dilution Not required.
Administration IV Bolus: Infuse over 5-10sec.
STORAGE & STABILITY

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Intact vial Store below 30°C.Protect from heat.

Reconstituted solution 24hr at 2-8°C and 8hr at 30°C.
CAUTIONS  The reconstituted preparation is a colourless to pale yellow, clear
solution. Only clear solution without particle should be used.
 Avoid use of rigid catheters, IM injections or non-essentials handling.
 Compatible with NS.
 It is incompatible with dextrose solution.
 NO other medicinal product should be added to the injection solution
or infusion line.
Warning: Thrombolytic therapy requires careful attention to all possible
bleeding sites.
REFERENCE(S) 1. Product Insert, Metalyse

TERBUTALINE SULPHATE 0.5MG/ML (BALTIC®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV injection: Dilute 1amp in 10mL NS or D51. Administer over 3-
5min.1
Continuous IV infusion: Dilute 1.5mg (3amp) to 2.5mg (5amp) in 500mL
NS or D5 to a final conc. of 3-5mcg/mL2,3.
@
For bronchodilation: Dilute 1.5mg (3amp) to 2.5mg (5amp) in 500mL NS
or D5 to a final conc. of 3-5mcg/mL. This dilution can be applied for
premature labour indication1.

For premature labour: If syringe pump is used, dilute to 100mcg/mL (i.e.

every 0.5mg or 1amp in 5mL, @ 5mg or 10amp in 50mL). If not using
syringe pump, dilute to 10mcg/mL (i.e. every 0.5mg or 1amp in 50mL).1,3
ICU HTAN practice: Dilute 3mg (6amp) in 50mL NS.
* Terbutaline infusion dose: 2.5 – 20 mcg/min.

Dilution: 30 mg (6 ampules) in 50 ml diluent

Diluent: D5, NS
Formula: Rate (ml/hr) = dose (mcg/min)

SC injection: Undiluted.1,3
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution Discard any unused portions after opening.
CAUTIONS  Contains Benzyl alcohol, should be avoided in children under 2 years
old and NOT to be used in neonates.
 Contains Sodium Metabisulphite that may cause serious allergic
reactions in certain patiennts especially those with asthma.
REFERENCE(S) 1. University College of London Hospital. NHS Foundation Trust. 2008.
Injectable medicines administration guide. 3rd Edition. Wiley Blackwell.
2. HUKM Drug Formulary 2010, 5th Edition
3. British National Formulary 2011, 61st Edition
4. Product Insert, Baltic®

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TESTOSTERONE ENANTATE 250MG/ML (JENASTERON®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM injection only: Deep into the upper outer quadrant of the gluteus
maximus.
STORAGE & STABILITY
Intact vial Store below 25°C.Protect from light.
Diluted solution Discard any unused portions after opening.
CAUTIONS  An oily injection.
REFERENCE(S) 1. Drug Information Handbook 19th Edition
2. Product Insert, Jenasteron®

TETANUS VACCINE (ADSORBED) 5ML MULTIDOSE VIAL (TT VACCINE)

EACH ML OF VACCINE CONTAINS 20LF PURIFIED TETANUS TOXOID ADSORBED ONTO 3MG
ALUMINIUM PHOSPHATE, WITH 0.1MG OF THIMEROSAL AS PRESERVATIVE.
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM injection: Inject in the area of the vastus lateralis (mid-thigh laterally) or
deltoid. Do NOT inject into gluteal area1.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Do NOT freeze.
Multidose vial Stable for 4 weeks if kept as per stated above and used aseptically.
CAUTIONS  One dose of 0.5mL has a potency of at least 40IU.
 The vaccine can be given safely and effectively at the same time as
BCG, measles, rubella, mumps, polio (OPV and IPV), hepatitis B,
hemophilius influenza type B, yellow fever vaccines and vitamin A
supplement2.
 Tetanus toxoid vaccine may be given simultaneously with antibody-
containing products (e.g. IM and IV immune globulin, varicella zoster
immune globulin, rabies immune globulin, whole blood, packed red
cells, plasma and platelet products) at different sites or at any interval
between doses.
 The vaccine MUST be shaken well to homogenize the suspension
before use2.
 Do NOT use if product does not form a suspension1.
 Discard point: when the inner square matches or darker than the colour
of outer circle.
REFERENCE(S) 1. Drug Information Handbook 2011, 19th edition
2. Product Insert, TT Vaccine

TETRACOSACTIDE ACETATE/TETRACOSACTRIN 250MCG/ML (SYNACTHEN)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Diagnostic test for adrenocortical insufficiency:
IM: Undiluted.

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Slow IV: Undiluted, administer over 3-5mins.

Therapeutic use:
Slow IV: Undiluted, administer over 3-5mins.
IV Infusion: Dilute with NS or D5. Duration of infusion must not exceed 4
hrs for stability reason.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Protect from light.
Diluted solution Use immediately.
CAUTIONS  It is NOT advisable to add Synacthen to blood or plasma transfusions,
as it may be broken down by enzymes in the blood.
REFERENCE(S) 1. Product Insert, Synacthen

THIOPENTAL SODIUM 500MG (PENTOTEX®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with WFI, NS, or D5.
Further dilution See administration.
Administration Slow IV: Dilute to a conc. of 2.5% (i.e. 500mg in 20mL) or 5% solution (i.e.
500mg in 10mL). Administer 100-150mg over 10-15sec1,2.
Continuous IV Infusion: Dilute to a conc. of 0.2% (i.e. 500mg in 250mL)
or 0.4% solution (500mg in 125mL).
PR (rectally): Dilute as per above.
STORAGE & STABILITY
Intact vial Store below 25°C in dark and cool place.
Reconstituted solution Should be refrigerated and discard unused portion after 24hrs.
CAUTIONS  Avoid extravasation or intra-arterial injection.
 Solutions of suxamethonium, tubocurarine or other drugs which have
an acid pH should NOT be mixed with thiopental solutions.
 After reconstitution, keep under refrigeration and tightly stoppered.
REFERENCE(S) 1. Product Insert, Pentotex®
2. British National Formulary 2011, 61st Edition

TRACE ELEMENTS (ADDAMEL N 10ML)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Must NOT be given undiluted. See administration.
Administration IV infusion: Must be diluted at least 20 times before administration in
200-500mL of NS or D51.
1 amp diluted in 500 mL or 1000 mL of compatible solution (NS, D5, NSD5)
to be infused over 2-3 hrs2.
1 amp diluted in 250mL NS or D5 to be infused for at least 1hr3.
ICU practice: 1 amp Addamel & 1 pair Parentrovite is added into 100mL
NS and administer over 1hr.

Note: Up to 20ml Addamel N can be added to 1000ml Vamin Glucose,

Vamin 14 Electrolyte-free, Vamin 18 Electrolyte-free and glucose solutions
50mg/ml-500mg/ml.
STORAGE & STABILITY
Intact vial Store below 25°C. Do not freeze.
Diluted solution Once opened, stable for 24 hrs below 25°C.

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REFERENCE(S) 1. Centre Hospitalier Universitaire de Liège, Nutrition Guide, 3rd Edition

2012
2. HUSM Pharmacy Drug Formulary
3. University Hospital of Geneva

TRAMADOL HCL 50MG/ML (DOMADOL®, ACUGESIC)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration IM: Undiluted, slow injection over 2-3min.
IV: Can be diluted with NS or D51 or undiluted, slow injection over 2-3min.
SC: Undiluted.
STORAGE & STABILITY
Intact vial Store below 25°C. Do not freeze.
Diluted solution In NS, stable for 4-6 hrs at room temperature.
CAUTIONS  Incompatible with injection solutions of Diclofenac, Indomethacin,
Phenylbutazone, Diazepam, Flunitrazepam, Glyceryltrinitrate.
 Contains Benzyl Alcohol, should be AVOIDED in children <2y.o. and
NOT to be used in neonates.
REFERENCE(S) 1. British National Formulary 60th Edition
2. Hospital Selayang Dilution Protocol 2015
3. Product Insert, Domadol®
4. Product Insert, Acugesic

TRANEXAMIC ACID 100MG/ML 5ML INJECTION (TREN “YUNG SHIN”) - HAM

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Slow IV: Administer undiluted over 5-10min (1ml/min).
Continuous IV Infusion: Administer over 24hrs.
STORAGE & STABILITY
Intact vial Store below 25°C.
Diluted solution Discard any unused portion after opening.
CAUTIONS  Do NOT inject >1mL/min to avoid hypotension.
REFERENCE(S): 1. British National Formulary 60th Edition
2. Product Insert, Tren “Yung Shin”

TRIAMCINOLONE ACETONIDE 40MG/ML (TRICORT,SHINCORT I.M.)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM: Deeply into the gluteal muscle.
Intra-articular/Intrabursal/Intradermal: Administer the prescribed dose.
Should not be administered IV.
STORAGE & STABILITY
Intact vial Store below 30°C. Protect from light. Do not freeze.
Diluted solution Discard any unused solution after opening.

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CAUTIONS  Shake the drug before use to ensure a uniform suspension.

 This preparation should be AVOIDED in children <2y.o and NOT to be
used in neonates, as it contains benzyl alcohol.
 Intra-articular corticosteroids injection can cause flushing and may
affect line cartilage. Each joint should be treated ≤3times a year.
 AVOID SC.
REFERENCE(S) 1. Product Insert, Tricort.
2. Product Insert, Shincort I.M.
3. HUKM Drug Formulary 2010, 5th Edition

TUBERCULIN PURIFIED PROTEIN DERIVATIVE (PPD) 5U/0.1ML

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration Intradermal (intracutaneous) injection: Into the middle third of the
forearm.
STORAGE & STABILITY
Intact vial Store at 2-8°C. Do not freeze. Protect from light.
Multidose vial Up to 4 weeks if kept as per stated above and used aseptically.
CAUTIONS Do not inject IV, IM or SC.
REFERENCE(S) 1. Product Insert, Tuberculin PPD

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U
V

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UROKINASE 6000IU INJ (UROKINASE-GCC)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with a small amount of sterile WFI.
Further dilution Dilute with NS to the desired volume of administration.
Administration DVT: Slow IV injection of loading dose 4400IU/kg BW in 15ml solution
given over 10min followed by IV infusion of 4400iu/kg/hr 12-24hr.
PE: Same as DVT. Alternatively, a 50mL bolus injection into the pulmonary
artery, repeated for up to 3 doses, at 24hr-interval may be given. The initial
dose of 15,000IU/kg BW may be adjusted necessarily for subsequent
injections.
Peripheral vascular occlusion: Dilute 500,000IU in 200mL, infuse into the
clot at 4000IU/min for 2hrs followed by repeated angiography. After
advancing the catheter into the remaining occluded segment, infuse at
4000IU/min for a further of 2hrs (may be repeated up to 4 times). After
lysing a channel through the occlusion, it is given at 1000IU/min until the
clot has completely lysed.
Hyphaema: 5000IU dissolve in 2ml NS to be used for eye procedure.
Clotted arterio-venous shunts: 5000-25000IU in 2-3ml NS is instilled into
affected limb of the shunt which is then clamped off for 2-4hr. The lysate is
then aspirated. This may be repeated if necessary. For the venous side, an
infusion of 5000IU in 200ml run over 30min is recommended.
STORAGE & STABILITY
Intact vial Store below 30°C. Protect from light. Do NOT freeze.
REFERENCE(S) 1. Product Insert, Urokinase-GCC

VANCOMYCIN HCL 500MG (HOSPIRA)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute vancomycin 500mg with 10ml sterile WFI, vancomycin 1g with
20ml sterile WFI.
Further dilution Vancomycin 500mg: Dilute with 100ml D5 or NS. Max conc: 5mg/mL.
Vancomycin 1g: Dilute with 200ml D5 or NS.
Administration IV infusion:
Doses < 1g: infuse over 60min. Doses > 1g: Infuse over 90-120min.
ROF: 10mg/mL

Notes:
Adults: rate <10mg/min or >60mins, whichever is longer.
Pediatrics & neonates: each dose over 60mins.
ROF: Longer infusion rate.
STORAGE & STABILITY
Intact vial Store 20-25°C. Protect from light.
Reconstituted solution Stable for 96 hrs at 2-8°C.
Diluted solution Stable for 96 hrs at 2-8°C.
CAUTIONS  NOT for IV bolus!
 Conc. as high as 10mg/mL may ↑ risk of infusion-related events.
 Infusion rate of ≤10mg/min is a/w fewer infusion-related events.
 Mixtures of Vancomycin& beta-lactams are physically incompatible.
 Precipitation ↑ especially if conc. >5mg/mL. MUST adequately flush
the lines between administrations of these antibiotics.
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REFERENCE(S) 1. Product Insert, Vancomycin HCl Hospira

VERAPAMIL HCL 2.5MG/ML

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Slow IV: Undiluted, administer over 1min (adults), over 2mins (elderly), or
over 5mins (infants). Dose may be repeated in 5-10mins.
IV Infusion: 5-10mg (1-2amp) can be diluted in D5 or NS and infuse for
1hr.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
CAUTIONS  Continuous ECG and BP monitoring is required during administration.
REFERENCE(S) 1. Product Insert, Verapamil

VITAMIN B COMPLEX 10ML

EACH ML CONTAINS: VIT B1 100MG, VIT B2 2MG, VIT B6 10MG, NICOTINAMIDE 100MG, D-
PANTHENOL 1MG
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM only.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution Discard any unused solution.
CAUTIONS  Should be AVOIDED in children under 2 y.o. and NOT to be used in
neonates, as it contains benzyl alcohol as preservatives.
REFERENCE(S) 1. Product Insert, Vitamin B Complex

VITAMINS, MULTIPLE INJECTION (CCM-TROVITE)

AMP NO.1 (5ML): THIAMINE HCL (VIT B1) 250MG, PYRIDOXINE HCL (VIT B6) 50MG,
RIBOFLAVINE (VIT B2) 4MG, AMP NO.2 (5ML): D-SODIUM PANTHOTHENATE 5MG,
DEXTROSE 1000MG, NICOTINAMIDE 160MG, ASCORBIC ACID AS NA SALT 500MG
PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution See administration.
Administration Mix the content of each pair prior to injection or infusion.
Slow IV injection: Administer over 10 mins.
IV infusion: Dilute the contents of both ampoules with 50ml-100ml NS or
D5 and administer over 30mins.
*ICU practice: 1amp trace elements (Addamel) and 1pair of Parentrovite
are added into 100ml NS and administer over 1hr.
STORAGE & STABILITY
Intact vial Store below 25°C. Protect from light.
Diluted solution Stable for 4hrs at 25°C.
CAUTIONS  Watch out for allergic reactions during rapid administration.
REFERENCE(S) 1. Product Insert, CCM-Trovite

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VORICONAZOLE 200MG (VFEND®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 19ml WFI to produce 20mL of concentrate 10mg/mL
Further dilution Further dilute with NS or D5 to make a concentration of 0.5-5mg/mL.
Administration IV infusion: Max rate of 3mg/kg/hr over 1-2hrs.
STORAGE & STABILITY
Intact vial Store at 15-30ºC.
Reconstituted solution 2-8ºC for 24 hrs.
CAUTIONS  NOT recommended for bolus injection.
REFERENCE(S) 1. Product Insert, Vfend®

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W
X

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Y
Z

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ZIDOVUDINE 200MG/20ML (RETROVIRTM)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Dilution is preferably immediately prior to administration. Any unused
portion should be discarded. Dilute required dose with D5 ONLY to a final
volume of 2 or 4mg/mL.
Administration IV infusion: Administer over 1hr.
STORAGE & STABILITY
Intact vial Store below 30°C. Protect from light.
Diluted solution After dilution, stable up to 48hours at both 5 ºC and 25 ºC.
CAUTIONS  Must be diluted prior to administration.
 Must NOT be given IM.
REFERENCE(S) 1. Product Insert, RetrovirTM

ZIPRASIDONE MESYLATE 20MG/ML (ZELDOX®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Reconstitute with 1.2mL of supplied WFI affording concentration of
20mg/mL. Shake until complete dissolution has occurred. Only clear
solutions, free of visible particles, should be used. *should ONLY be
compatible with WFI1.
Further dilution Not required.
Administration IM injection only: Into the gluteal muscle or lateral thigh2.
STORAGE & STABILITY
Intact vial Store below 30°C. Keep vial in original packaging until use.
Diluted solution Immediate use after reconstitution or use within 24hours at 2-8ºC.
Discard any unused portions after opening.
CAUTIONS  Do NOT administer intravenously.
 IM administration of Ziprasidone for more than 3 consecutive days has
not been studied. If long term Ziprasidone is indicated, oral Ziprasidone
should replace the IM administration as soon as clinically appropriate,
REFERENCE(S) 1. Product Insert, Zeldox® IM
2. British National Formulary 2011, 61st Edition

ZUCLOPENTHIXOL DIHCL 20MG/ML(CLOPIXOL®)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM injection only.
STORAGE & STABILITY
Intact vial Store below 15°C. Protect from light. Discard any unused portions.
REFERENCE(S): 1. Product Insert, Clopixol®

ZUCLOPENTHIXOL DECANOATE 200MG/ML (CLOPIXOL® DEPOT)

PREPARATION/ METHOD OF ADMINISTRATION
Reconstitution Not required.
Further dilution Not required.
Administration IM injection only: Into the upper outer quadrant of the buttocks.
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STORAGE & STABILITY

Intact vial Store below 25°C. Protect from light. Discard any unused portions.
CAUTIONS  Oily injection fluid.
 NOT compatible with any other drugs of fluids
REFERENCE(S) 1. Product Insert, Clopixol® Depot

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Appendix 1: Dobutamine
Infusion Rate

Dose (mcg/kg/min)
Weight 1 2 2.5 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
45 0.5 1.1 1.35 1.6 2.2 2.7 3.2 3.8 4.3 4.9 5.4 5.9 6.5 7.0 7.6 8.1 8.6 9.2 9.7 10.3 10.8
50 0.6 1.2 1.5 1.8 2.4 3.0 3.6 4.2 4.8 5.4 6.0 6.6 7.2 7.8 8.4 9.0 9.6 10.2 10.8 11.4 12.0
55 0.7 1.3 1.65 2.0 2.6 3.3 4.0 4.6 5.3 5.9 6.6 7.3 7.9 8.6 9.2 9.9 10.6 11.2 11.9 12.5 13.2
60 0.7 1.4 1.8 2.2 2.9 3.6 4.3 5.0 5.8 6.5 7.2 7.9 8.6 9.4 10.1 10.8 11.5 12.2 13.0 13.7 14.4
65 0.8 1.6 1.95 2.3 3.1 3.9 4.7 5.5 6.2 7.0 7.8 8.6 9.4 10.1 10.9 11.7 12.5 13.3 14.0 14.8 15.6
70 0.8 1.7 2.1 2.5 3.4 4.2 5.0 5.9 6.7 7.6 8.4 9.2 10.1 10.9 11.8 12.6 13.4 14.3 15.1 16.0 16.8
75 0.9 1.8 2.25 2.7 3.6 4.5 5.4 6.3 7.2 8.1 9.0 9.9 10.8 11.7 12.6 13.5 14.4 15.3 16.2 17.1 18.0
80 1.0 1.9 2.4 2.9 3.8 4.8 5.8 6.7 7.7 8.6 9.6 10.6 11.5 12.5 13.4 14.4 15.4 16.3 17.3 18.2 19.2
85 1.0 2.0 2.55 3.1 4.1 5.1 6.1 7.1 8.2 9.2 10.2 11.2 12.2 13.3 14.3 15.3 16.3 17.3 18.4 19.4 20.4
90 1.0 2.2 2.7 3.2 4.3 5.4 6.5 7.6 8.6 9.7 10.8 11.9 13.0 14.0 15.1 16.2 17.3 18.4 19.4 20.5 21.6

*Rate = ml/hr

Dilution: Formula:
250mg in 50 ml diluent Rate = dose (mcg/kg/min) x patient‟s weight (kg) x 60 (min)
Concentration of dilution
Diluent:
D5, NSD5, NS, HSD5 Concentration of dilution: 5000 mcg/ml

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Appendix 2: Dopamine
Infusion Rate

Dose (mcg/kg/min)
Weight 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
45 0.7 1.4 2.0 2.7 3.4 4.1 4.7 5.4 6.1 6.8 7.4 8.1 8.8 9.5 10.1 10.8 11.5 12.2 12.8 13.5
50 0.8 1.5 2.3 3.0 3.8 4.5 5.3 6.0 6.8 7.5 8.3 9.0 9.8 10.5 11.3 12.0 12.8 13.5 14.3 15.0
55 0.8 1.7 2.5 3.3 4.1 5.0 5.8 6.6 7.4 8.3 9.1 9.9 10.7 11.6 12.4 13.2 14.0 14.9 15.7 16.5
60 0.9 1.8 2.7 3.6 4.5 5.4 6.3 7.2 8.1 9.0 9.9 10.8 11.7 12.6 13.5 14.4 15.3 16.2 17.1 18.0
65 1.0 2.0 2.9 3.9 4.9 5.9 6.8 7.8 8.8 9.8 10.7 11.7 12.7 13.7 14.6 15.6 16.6 17.6 18.5 19.5
70 1.1 2.1 3.2 4.2 5.3 6.3 7.4 8.4 9.5 10.5 11.6 12.6 13.7 14.7 15.8 16.8 17.9 18.9 20.0 21.0
75 1.1 2.3 3.4 4.5 5.6 6.8 7.9 9.0 10.1 11.3 12.4 13.5 14.6 15.8 16.9 18.0 19.1 20.3 21.4 22.5
80 1.2 2.4 3.6 4.8 6.0 7.2 8.4 9.6 10.8 12.0 13.2 14.4 15.6 16.8 18.0 19.2 20.4 21.6 22.8 24.0
85 1.3 2.6 3.8 5.1 6.4 7.7 8.9 10.2 11.5 12.8 14.0 15.3 16.6 17.9 19.1 20.4 21.7 23.0 24.2 25.5
90 1.4 2.7 4.1 5.4 6.8 8.1 9.5 10.8 12.2 13.5 14.9 16.2 17.6 18.9 20.3 21.6 23.0 24.3 25.7 27.0

*Rate = ml/hr

Dilution: Formula:
200mg in 50 ml diluent Rate = dose (mcg/kg/min) x patient‟s weight (kg) x 60 (min)
Concentration of dilution
Diluent:
D5, NS Concentration of dilution: 4000 mcg/ml

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Appendix 3: Heparin Infusion Protocol

A) Heparin Normogram
a. For acute coronary syndrome, in place of warfarin maintainance and neuro/vascular surgery
i. Acute coronary syndrome or in place of warfarin – initial bolus: 60 units/kg over 10 minutes (with fibrinolytic: max:4000 units; without fibrinolytic: max:5000 units);
initial rate: 12 units/kg/hr (max:1000 units/hr)
ii. Neuro/vascular surgery – initial bolus: 70 units/kg over 10 minutes (max:5000 units); initial rate: 15 units/kg/hr (max:1000 units/hr)

APTT (second) Bolus (units/kg) Hold (minutes) Rate Change (unit/kg/hr) Repeat APTT
<50 60 0 +3 4-6 hours
50-64 0 0 +2 4-6 hours
65-90 0 0 Target – no change Next morning (within 24 hours)
91-100 0 0 -1 4-6 hours
101-110 0 30 -2 4-6 hours
>110 0 60 -3 4-6 hours

b. For pulmonary emboli and deep vein thrombosis – initial bolus 80 units/kg over 10 minutes (max:8000 units); initial rate: 18 units/kg/hr (max:1500 units/hr)

APTT (second) Bolus (units/kg) Hold (minutes) Rate Change (unit/kg/hr) Repeat APTT
<50 80 0 +4 4-6 hours
50-64 40 0 +2 4-6 hours
65-100 0 0 Target – no change Next morning (within 24 hours)
101-110 0 0 -2 4-6 hours
>110 0 60 -3 4-6 hours

B) Heparin Infusion Rate

Conversion of units/hr (round to the closest 50 units/hr) to ml/hr for heparin sodium 25000 units diluted in 50 ml NS (concentration of dilution: 500units/ml)
Rate (units/hr) 700 750 800 850 900 950 1000 1050 1100
Rate(ml/hr) 1.4 1.5 1.6 1.7 1.8 1.9 2.0 2.1 2.2
Rate (units/hr) 1150 1200 1250 1300 1350 1400 1450 1500 1550
Rate(ml/hr) 2.3 2.4 2.5 2.6 2.7 2.8 2.9 3.0 3.1
Rate (units/hr) 1600 1650 1700 1750 1800 1850 1900 1950 2000
Rate(ml/hr) 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 4.0

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Appendix 4: Insulin Infusion Protocol

Blood Glucose SCALE

(mmol/L) 1 (U/h) 2 3 4 5 6 7 8
>22 3 4 5 6 7 8 10 11
18- 2.5 3.5 4 5 6 6 8 9
14- 2 3 3 4 5 5 6 7
12- 1.5 2.5 2.5 3 4 4 4 5
10- 1 2 2 2 3 3 3 4
8- 1 1.5 1.5 1.5 2 2 2.5 3
6- 0.5 1 1 1 1.5 1.5 2 2
5- 0.5 0.5 0.5 0.5 1 1 1.5 1.5
<5 Stop IV insulin infusion and inform doctor.

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Appendix 5: Noradrenaline

Infusion Rate for Single Strength (4mg in 50 ml)

Dose (mcg/kg/min)
Weight 0.05 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9
45 1.7 3.4 6.8 10.1 13.5 16.9 20.3 23.6 27.0 30.4 33.8 37.1 40.5 43.9 47.3 50.6 54.0 57.4 60.8 64.1
50 1.9 3.8 7.5 11.3 15.0 18.8 22.5 26.3 30.0 33.8 37.5 41.3 45.0 48.8 52.5 56.3 60.0 63.8 67.5 71.3
55 2.1 4.1 8.3 12.4 16.5 20.6 24.8 28.9 33.0 37.1 41.3 45.4 49.5 53.6 57.8 61.9 66.0 70.1 74.3 78.4
60 2.3 4.5 9.0 13.5 18.0 22.5 27.0 31.5 36.0 40.5 45.0 49.5 54.0 58.5 63.0 67.5 72.0 76.5 81.0 85.5
65 2.4 4.9 9.8 14.6 19.5 24.4 29.3 34.1 39.0 43.9 48.8 53.6 58.5 63.4 68.3 73.1 78.0 82.9 87.7 92.6
70 2.6 5.3 10.5 15.8 21.0 26.3 31.5 36.8 42.0 47.3 52.5 57.8 63.0 68.3 73.5 78.8 84.0 89.3 94.5 99.8
75 2.8 5.6 11.3 16.9 22.5 28.1 33.8 39.4 45.0 50.6 56.3 61.9 67.5 73.1 78.8 84.4 90.0 95.6 101.3 106.9
80 3.0 6.0 12.0 18.0 24.0 30.0 36.0 42.0 48.0 54.0 60.0 66.0 72.0 78.0 84.0 90.0 96.0 102.0 108.0 114.0
85 3.2 6.4 12.8 19.1 25.5 31.9 38.3 44.6 51.0 57.4 63.8 70.1 76.5 82.9 89.3 95.6 102.0 108.4 114.8 121.1
90 3.4 6.8 13.5 20.3 27.0 33.8 40.5 47.3 54.0 60.8 67.5 74.3 81.0 87.8 94.5 101.3 108.0 114.8 121.5 128.3

*Rate = ml/hr

Dilution:
4 mg in 50ml diluent Formula:
Rate = dose (mcg/kg/min) x patient‟s weight (kg) x 60 (min)
Diluent: Concentration of dilution
D5, NSD5
Concentration of dilution:
Single strength: 80 mcg/ml
If double strength (8mg in 50 ml) = rate (as above) Double strength: 160 mcg/ml
2

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INDEX BY TRADE NAMES

ACETYLCYSTEINE DBL HOSPIRA…………… 10 CEFOBACTAM…………………………………. 30
ACIPAN DUOPHARMA…………………………. 21 CEFOTAXIME PHARMANIAGA……………… 31
ACTRAPID………………………………………... 59,60 CEFOZOLIN……………………………………. 29
ACTRAPID VIAL………………………………….. 60 CEFTAZIDNE PHARMANIAGA………………. 31,32
ACUGESIC………………………………………... 104 CEFTRIAXONE PHARMANIAGA…………….. 32
ADDAMEL…………………………………………. 103,104 CEFUROXIME PHARMANIAGA……………… 32,33
ADENOCOR®……………………………………. 11 CHIROCAINE…………………………………… 65
AKOSET®…………………………………………. 47,48 CIPROXOL………………………………………. 34
ALBUTEIN…………………………………………. 12,13 CIRON DRUGS &PHARMACEUTICALS……. 55
AMEKET®…………………………………………. 92,93 CLARAXIM®…………………………………….. 31
AMERICAN REAGENT INC…………………….. 70 CLAVAM®……………………………………….. 17
AMETIN®………………………………………….. 92,93 CLAVICIN®……………………………………… 17
AMICIN®…………………………………………… 14 CLEXANE®……………………………………… 43
AMIKOZIT®………………………………………... 14 CLOPIXOL®…………………………………….. 112
AMIPICILLIN+SULBACTAM 1.5G AVERROES.. 19 CLOPIXOL®DEPOT…………………………… 112,113
AMPHOTRET®…………………………………… 18 COLOMYCIN……………………………………. 35
ANEXATE®………………………………………... 46 CONDEP…………………………………………. 69
ANIKEF…………………………………………….. 32,33 COPAN…………………………………………… 56
ANTABENZ………………………………………... 46 CORDARONE®…………………………………. 16,17
APALIN®…………………………………………… 14 COSMOFER……………………………………… 60,61
APRESOLINE®…………………………………… 55 CO-TRIMOXAZOLE…………………………….. 99
ARIXTRA…………………………………………… 47 CYNOCOBALAMINE (VITAMIN B12)…………. 35
ARTESUN…………………………………………. 20 DALACIN C………………………………………. 33,34
ATRALEX………………………………………….. 20,21 DBL AMINOPHYLLINE®……………………….. 15
AVELOX…………………………………………… 74 DBL DIAPINE…………………………………….. 38
AZEE……………………………………………….. 21,22 DEPO-PROVERA……………………………….. 69
BALTIC®…………………………………………… 101 DESFERAL®…………………………………….. 35,36,37
BENZATHINE BENZYL PENICILLIN DHARTISONE…………………………………… 55,56
KARNATAKA………………………………………. 22 DIAMOX…………………………………………... 10
BENZYL PENICILLIN 1MU (600mg)……………. 22 DICLORAN®……………………………………... 39
BENZYL PENICILLIN 5MU (3GM)……………… 22 DIFLUCON……………………………………….. 46
BICAFAR®………………………………………… 29,30 DILANTIN®………………………………………. 85
BLUEJECT………………………………………… 70 DOMADOL®……………………………………… 104
BRIDION…………………………………………… 99 DOMI……………………………………………… 72,73
BURPITROY HEAVY…………………………….. 23,24 DORMICUM……………………………………… 72,73
CALCICLO®………………………………………. 27 DUANATE………………………………………… 20
CALCIUM GLUCONATE B.BRAUN……………. 28,29 DUOPHARMA EPHEDRINE…………………… 43
CARDIAMED……………………………………… 75,76 DYNASTAT®…………………………………….. 83,84
CCM- ADRENALINE……………………………... 11,12 EPILIM®………………………………………….. 98
CCM-TROVITE…………………………………… 108 ERAXIS®…………………………………………. 19
CEF-4………………………………………………. 31,32 ERGOMETRINE MALEATE……………………. 43,44

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ERYTHROMYCIN…………………………………. 44 ISOLIN……………………………………………. 62
ESMERON®……………………………………….. 93,94 ISUPREL…………………………………………. 62
ESOCARD………………………………………….. 44 JENAPROGON®.............................................. 56
ETHICOLINE®…………………………………….. 100 JENASTERON®……………………………….. 102
FLUANXOL®DEPOT……………………………… 47 KANOK………………………………………….. 64
FLUCON……………………………………………. 46 KEMADRIN®……………………………………. 88
FLUMAZENIL-HAMEIN…………………………… 46 KETAMAX……………………………………….. 64
FORPAR®………………………………………….. 30,31 KETAMINE-FRESENIUS……………………… 64
FRENIN®…………………………………………… 85 KETAVA…………………………………………. 64
FRESENIUS®……………………………………… 89 KISAN® 10mg/ml……………………………….. 86
FRESOFOL®………………………………………. 90 KISAN® 1mg/ml………………………………… 86
FUSIX®……………………………………………... 47,48 KYTRIL®………………………………………… 51
GARASENT®………………………………………. 50 LAKAN…………………………………………… 65
GASTRIL®………………………………………….. 92,93 LANOXIN TM……………………………………… 39
GITRINIL……………………………………………. 50,51 LANTUS SOLOSTAR………………………….. 59
GLUCAGEN®……………………………………… 50 LARTIL®…………………………………………. 88,89
GLYCOPYRROLATE USP……………………….. 51 LEUCOVORIN CALCIUM……………………… 27,28
HEMABATE®………………………………………. 29 LEVEMIR FLEXPEN……………………………. 59
HEPABIG…………………………………………… 53 LEVOPHED……………………………………… 75,76
HEPARINISED SALINE B BRAUN……………… 52,53 LOMAX…………………………………………… 79
HEPARINOL……………………………………….. 52 LOXIN®…………………………………………… 40,41
H-PERAN…………………………………………… 70,71 LUCRIN…………………………………………… 65
HUMALOG MIX 25………………………………… 60 MAGNESIUM SULFATE DBL HOSPIRA……... 68,69
HUMULIN 30/70…………………………………… 58 MALAKIN®……………………………………….. 92
HUMULIN N………………………………………… 58,59 MANACE…………………………………………. 51,52
HUMULIN R………………………………………… 59,60 MAPIN…………………………………………….. 74,75
HYDROCORTISONE SM PHARMACEUTICAL MARCAINE® PLAIN…………………………….. 24,25
SDN BHD…………………………………………… 55,56 MARCAINE® SPINAL HEAVY………………… 23,24
IFIMOL………………………………………........... 83 MAXIPIME®……………………………………… 30,31
IGANTET®…………………………………………. 54 MEGAPINE®…………………………………….. 30,31
INJECSOL K10…………………………………….. 87 MERONEM……………………………………….. 69,70
INJECSOL LIG…………………………………….. 66 METALYSE………………………………………. 100,101
INSULATARD……………………………………… 58,59 METIBLO…………………………………………. 70
INSULATARD VIAL……………………………….. 60 METRONOL……………………………………… 72
INSUMAN BASAL…………………………………. 58,59 MIACALCIC®…………………………………….. 27
INSUMAN COMBO 30……………………………. 58 MIACALCIC®…………………………………….. 100
INSUMAN RAPID………………………………….. 59,60 MINIRIN®…………………………………………. 37
INTANZA…………………………………………… 58 MIXTARD…………………………………………. 58
INTRAGAM®………………………………………. 53 MOBITIL®………………………………………… 39,40
INTRAPURETM……………………………………... 53 MONASAN®……………………………………… 47
INVEGA…………………………………………….. 82 MONOCLOX®…………………………………… 34,35

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DILUTION PROTOCOL 2017 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH
DILUTION PROTOCOL 2016 HOSPITAL TUANKU AMPUAN NAJIHAH, KUALA PILAH

MORPHINE DUOPHARMA………………………. 73,74 STREPTASE®…………………………………… 98,99

MUCOLEX………………………………………….. 23 STREPTIN………………………………………... 99
NAROPIN…………………………………………… 94 SULBACIN®……………………………………… 19
NEUPOGEN®……………………………………… 45,46 SULPERAZONE®……………………………….. 30
NEXIUM®…………………………………………... 44,45 SURVANTA®…………………………………….. 23
NOVOMIX FLEXPEN……………………………… 59 SUSTENNA………………………………………. 82
NOVORAPID FLEXPEN………………………….. 59 SUXAMETHONIUM UK………………………… 100
OCTAPHARMA……………………………………. 12,13 SYNACTHEN…………………………………….. 102,103
OMEZ……………………………………………….. 79 SYNAGIS®……………………………………….. 82
OMEZOL-LYO……………………………………… 79 SYNTOMETRINE®……………………………… 44
ORPHENADRINE CITRATE……………………... 81 SYNTOMETRINE®……………………………… 81
PAMISOL®…………………………………………. 83 TALGESIL………………………………………… 45
PAMPARA®………………………………………... 88 TAPICIN®………………………………………… 86,87
PARENTROVITE………………………………….. 82 TAZOCIN®………………………………………. 86,87
PEGASYS®………………………………………… 84 TIDACT…………………………………………… 33,34
PENATONE®……………………………………… 38 TIENAM…………………………………………… 58
PENTOTEX®……………………………………… 103 TRACRIUMTM…………………………………….. 20,21
PETHIDINE DUOPHARMA……………………… 84 TRANDATE………………………………………. 64-65
PHENOBARBITAL SODIUM BP………………… 84,85 TREN "YUNG SHIN"…………………………….. 104
PIRIMAT®………………………………………….. 33 TRICORT…………………………………………. 104,105
PIVAKAN 0.5%W/V PLAIN ……………………… 24,25 TT VACCINE…………………………………........ 102
POTASSIUM DIHYDROGEN PHOSPHATE TUBERCULIN PPD……………………………… 105
DBL HOSPIRA…………………………………….. 87,88 UDOXAN…………………………………………. 79,80,81
PROLUTON DEPOT……………………………… 56 ULTIVATM…………………………………………. 93
PROPOFOL-LIPURO 1%®………………………. 89,90 UNOCEF………………………………………….. 32
PROSTIN VR PEDIATRIC®……………………… 13 UROKINASE-GCC………………………………. 107
PULIN INJ "YUNG SHIN"…………………………. 70,71 VANCOMYCIN HCL HOSPIRA……………….... 107,108
REKAXIME®……………………………………….. 31 VAXCEL…………………………………………... 32
RETARPEN®………………………………………. 22 VENOFER………………………………………... 61,62
RETROVIRTM......................................................... 112 VENTOLINTM……………………………………... 96
RHESONATIV®……………………………………. 54 VERAPAMIL ……………………………………... 108
SALF………………………………………………… 62 VERORAB®……………………………………… 92
SANDOSTATIN……………………………………. 78,79 VFEND®………………………………………….. 109
SANDOSTATIN LAR……………………………… 78,79 VIATRINIL®………………………………………. 51
SETISIN…………………………………………….. 75 VITAMIN B COMPLEX………………………….. 108
SHINCORT I.M…………………………………….. 104,105 VIXIGRIP………………………………………….. 58
SNAKE ANTIVENOM……………………………... 96 WINRHO SDF……………………………………. 54,55
SNAKE POLYVALENT ANTIVENOM…………… 97 ZANTAC®………………………………………… 92,93
SODIUM BICARBONATE PHARMANIAGA……. 97,98 ZELDOX®IM…………………………………….... 112
SOLU-CORTEF……………………………………. 55,56 ZITHROMAX……………………………………... 21,22
SOLU-MEDROL…………………………………… 71,72 ZOVIRAX®……………………………………….. 10,11
STANDACILLIN®………………………………….. 18 ZYVOX……………………………………………. 66

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