GGC Medicines


Adult Therapeutics Handbook

Appendix 2 - Preparation of Intravenous Medicines

Appendix 2 - Preparation of Intravenous Medicines

The UK NHS Injectable Medicines Guide (IMG) (Medusa) is an electronic resource containing information on the IV preparation and administration of over 200 injectable medicines. In each clinical area a folder containing 83 core monographs is available (entitled NHSGGC Adult Intravenous Medicine Monographs) with further monographs available via NHSGGC StaffNet or www.injguide.nhs.uk (username and password available on NHSGGC StaffNet). The monographs available on Medusa are not exhaustive.

It should be noted that monographs will not be available for every drug and it may be necessary to refer to other sources of information for advice on preparation and administration such as:

Specific information regarding intravenous dosing for the following medicines are included in this section:

  • Aminophylline
  • Amiodarone
  • Glyceryl trinitrate (GTN)
  • Salbutamol

Aminophylline

If intravenous aminophylline is required in a patient who was already taking a theophylline preparation, check the serum theophylline concentration and seek advice before giving a loading dose. If an infusion is required, monitor the patient closely for adverse effects and check the concentration within 24 hours. Contact your clinical pharmacist or Medicines Information for further advice.

Aminophylline Loading dose Maintenance infusion
Dose 5mg/kg 0.5mg/kg/hour
Preparation Add dose to 100ml glucose 5% or sodium chloride 0.9% Add 500mg (20ml) to 500ml glucose 5% or sodium chloride 0.9%
Weight (kg) Dose (volume) of 250mg / 10ml ampoule Infusion rate
40 200mg (8ml) 20ml/hour
50 250mg (10ml) 25ml/hour
60 300mg (12ml) 30ml/hour
70 350mg (14ml) 35ml/hour
80 400mg (16ml) 40ml/hour
90 450mg (18ml) 45ml/hour
100 500mg (20ml) 50ml/hour
Other

Dose (mg) = 5 x wt (kg)

Vol (ml) = (dose / 250) x 10

Maximum 500mg (20ml)

0.5 x wt (kg) = ml/hour
Infusion rate 300ml/hour (over 20 minutes) Up to 50ml/hour

Amiodarone

Give amiodarone through a central line. If this is not feasible, give the drug through as large a vein as possible (for example median cubital) or via a suitable long-line, inserted peripherally.

Amiodarone Loading Dose Infusion 1 Infusion 2
Dose 300mg over 1 hour 450mg over 12 hours 450mg over 12 hours
Preparation Add 300mg (6ml) to 250ml glucose 5% Add 450mg (9ml) to 250ml glucose 5% Add 450mg (9ml) to 250ml glucose 5%
Infusion rate 250ml/hour for 1 hour 21ml/hour for 12 hours 21ml/hour for 12 hours

Glyceryl Trinitrate (GTN) syringe driver

N.B. Extravasation may cause tissue damage.

Preparation:

  • Draw up 50mg (50ml) GTN into a 50 ml syringe. No need for further dilution.

Infusion Rate:

  • Normotensive patient: 1ml/hour (1mg/hour)
  • Hypotensive patient: 0.5ml/hour (0.5mg/hour)

Further increases should be based on clinical response.

Salbutamol (infusion solution 5mg/5ml)

N.B. There are two formulations of salbutamol available for parenteral use. The infusion formulation, NOT the IV injection formulation, should be used to prepare infusions.

Salbutamol Dose Preparation

Initially 5microgram/minute adjusted according to response and heart rate.

Usual range 3-20microgram/minute.

Dilute 5ml of solution with 500ml glucose 5% or sodium chloride 0.9%

(concentration = 10microgram/ml)

Dose (microgram/minute) Infusion Rate (ml/hour)
3 18
5 30
8 48
10 60
15 90
20 120

Content last reviewed December 2018