FH Pharmacy Department ACYCLOVIR 3 (PPC) AMIKACIN 2,3 AMPHOTERICIN B 1,4 (Fungizone ) AMPHOTERICIN B 1.3 Lipid Complex (Abelcet ) AMPHOTERICIN B 1.3 Liposomal (Ambisome ) AMPICILLIN 1,3 (Teva, PPC) ARGATROBAN 1 (Pfizer) DRUG 50 mg 10 SWFI 5 mg/ peripheral:0.1 mg/ max central: 1 mg/ Use 100 mg/20 5 mg/ 1-2 mg/ 10 days F 50 mg 12 SWFI 4 mg/ 0.2-2 mg/ 11 days F 250 mg (NOVO; PPC) 500 mg (NOVO; PPC) (reconstituted or ed commercial vial / amp) 0.9 SWFI 1.8 SWFI 1 g (NOVO) 3.5 SWFI 1 g (PPC) 3.4 SWFI 250 mg/ 2 g (NOVO) 6.8 SWFI 100 250 mg/2.5 100 mg/ COMPOUNDED STERILE PREPARATIO RECOTITUTION, DILUTION AND STABILITY CHART (ADULT) 500 mg/10 50 mg/ 500 mg/2 250 mg/ 1 hr RT 10 mg/ 100 Fluid Restn: 25 (central line) 250 mg/2 48 hr F 72 hr F 250 mg/ 500 mg/ 500 mg/100 1 g/100 250 mg/ 500 mg/ 1 g/ 1 g/ 1 g/ 1 g/ 2 g/100 2 g/100 do not refrigerate minibags; discard if precipitated; same BUD for dilution in pale yellow does not indicate loss of potency; dark solutions should be discarded; same BUD for dilution in vials stored in fridge; dilution in only; protect from light during storage (vials and solutions) vials stored in fridge; use 5 micron filter to add dose to infusion bag; dilution in only vials stored in fridge; use 5 micron filter to add dose to infusion bag; dilution in only >20 mg/ = 48 hr; BUD for dilution in : 2 hr RT or 4 hr F bag stable for in ambient indoor light and 48 hr F and protected from light Page 1
DRUG AZITHROMYCIN 1,6 (Zithromax ) AZTREONAM 1,3 (Azactam ) 500 mg (reconstituted or ed commercial vial / amp) 4.8 SWFI 100 mg/ 500 mg 1.5 SWFI 500 mg/ use entire 1 g 3 SWFI 1 g/50 ml vial 2 g 6 SWFI 2 g/100 Use 7 days F 1-2 mg/ 500 mg/2 7 days F 250-500 250 mg/2 500 mg/2 do not use Cornwall Syringe max concentration for administration: 20 mg/; Special Access drug CALCIUM CHLORIDE 5 g/ 100 mg/ 7 g/1000 7 g/1000 CALCIUM GLUCONATE (Abbott, PPC) CASPOFUNGIN 1 (Cancidas ) CEFAZOLIN 7 Teva, Sandoz, Apo) CEFAZOLIN / METRONIDAZOLE 2 (METCEF / CEFMET) CEFOTAXIME 1,3 (Claforan ) CEFOXITIN 3 (Teva, Apo) 1000 mg/10 (10%) 100 mg/ 50-100 7 days F 100-2 35 mg/100 50 mg 10.5 SWFI 5 mg/ Fluid Restn: 1 hr RT 48 hr F 50 mg/2 100 for doses 50 mg 70 mg 10.5 SWFI 7 mg/ 70 mg/2 500 mg 2.3 SWFI 200 mg/ 500 mg/ 1 g - 1 g 4.5 SWFI 200 mg/ >1 g - 100 1 g/ 10 g 45 SWFI 200 mg/ 2 g/100 10 of 10% = 1g Ca Glu =93 mg Ca=2.3 mmol=4.6 meq; re-dissolve crystals by warming; same BUD in Cefaz/Metronidazole see Cefazolin add Cefazolin dose to 100 1 g/500 mg 12 days F reconstitution Metronidazole bag Cefaz/Metronidazole 2 g/500 mg 500 mg 2.3 SWFI 1 g - 500 mg/ 1 g 4.6 SWFI 200 mg/ >1 g - 100 1 g/ 2 g 9 SWFI 2 g/100 1 g 4.7 SWFI 1 g/ 1 g - 2 g 9 SWFI 200 mg/ 13 days F 2 g/100 >1 g - 100 10 g 45 SWFI vials stored in fridge; for 35 mg dose: use 70 mg vial for two doses; do not use reconstitution device; reconst. overfill -dose in 10 ; dilution in only reconstitution volumes for 500 and 1 g vials differ from the manufacturer vol; same BUD for dilution in reconstitution volumes differ from the manufacturer vol ; same BUD for dilution in Page 2
CEFTAZIDIME 3 (Ceftaz, Fortaz, PPC) CEFTRIAXONE 3 (Rocephin, Sandoz) CEFUROXIME 2,3 (Zinacef, PPC) CHLORAMPHENICOL 2 (Chloromycetin ) CIPROFLOXACIN (Hospira) CLINDAMYCIN 3 CLOXACILLIN 8 (Teva) (reconstituted or ed commercial vial / amp) 1 g (Ceftaz) 4.8 SWFI 1 g (PPC) 4.4 SWFI 2 g (Ceftaz) 8 SWFI 2g (PPC,Fortaz) 8.8 SWFI 6 g (Fortaz) 26 SWFI 200 mg/ Use 250 mg 2.4 SWFI 250 mg/ 1 g 9.6 SWFI 1 g - 500 mg/ 100 mg/ >1 g - 100 14 days F 2 g 19.2 SWFI Fluid Restn: 25 1 g/ 10 g 95 SWFI 2 g/100 750 mg 5.7 SWFI 1.5 g - 500 mg/ 1.5 g 11.3 SWFI 125 mg/ >1.5 g - 100 14 days F 750 mg/ 7.5 g 58 SWFI 1.5 g/ 1g vial 10 SWFI 100 mg/ 1 g - >1 g - 100 7 days F 200 mg/100 400 mg/200 1 g/ 2 g/100 14 days F or 200 mg/100 RT out of wrap or 400 mg/200 ml RT out of wrap 300 mg/2 300 mg/ 600 mg/4 600 mg - 450 mg/ 150 mg/ >600 mg -100 900 mg/6 max:18 mg/ 600 mg/ 9 g/60 900 mg/100 500 mg 1.7 SWFI 1 g - 500 mg/ 1 g 3.4 SWFI 250 mg/ >1 g in 100-250 14 days F 1 g/ 2 g 6.8 SWFI 2 g/100 reconstitution volumes differ from the manufacturer vol; Fortaz, PPC - vent vials Ceftaz - reduced vial pressure; (vials and solutions); light darkens soln without affecting potency; Page 3
DRUG COTRIMOXAZOLE 2,8,9 (Septra ) DAPTOMYCIN 18 (Cubicin ) (reconstituted or ed commercial vial / amp) 5 16 mg TMP/80 mg SMX/ 5 + 125 (1:25 diln) 5 + 75 (1:15 diln) 5 + (1:10 diln) Use 3 hr RT 1.5 hr RT 500 mg 10 50 mg/ 10 days F because of the short stability, Pharmacy sends vials; same BUD for dilution in vials are stored in fridge; do not shake vial during reconstitution, gently swirl contents; dilute in only DOXYCYCLINE 3 contains LATEX (APP) DROTRECOGIN (Xigris ) ERTAPENEM 3 (Invanz ) ERYTHROMYCIN LACTOBIONATE 2,3 (Erythrocin IV ) FENTANYL PCA 100 mg 10 SWFI 10 mg/ 2 0.1-1 mg/ 5 mg 2.5 SWFI 2 mg/ 3 hr RT 20 mg 10 SWFI 100 1 g 72 hr F 100 mg/2 500 mg/ 1 g/ 500 mg 10 SWFI 500 mg -2 500 mg/2 50 mg/ >500 mg -500 max: 5 mg/ 1 g 20 SWFI 1 g/500 1000 mcg/20 12 hr F + 14 hr RT (24 hr total) 10 SWFI 100 mg/ 5 days F 50 mcg/ 2000 mcg/100 1 g/ 20 mcg/ - 100 IPUMP BAG and infusion; Special Access; same BUD for in vials stored in fridge; minimise agitation during preparation; do not tube dilute in only dilute in only; BUD of minibags can be extended to 10 days F by adding Na Bicarb 8.4% 0.2 to, 0.4 to 100, 1 to 2 or 2 ml to 500 bag Page 4
FENTANYL / BUPIVACAINE EPIDURAL FLUCONAZOLE (Baxter) FOMEPIZOLE (Antizol ) FUROSEMIDE 2,3 (Abbott) FUSIDATE SODIUM 1,8 (Fucidin Leo ) GANCICLOVIR GENTAMICIN 1,8 (reconstituted or ed commercial vial / amp) 1000 mcg/20 (fentanyl) 100 mg/20 (bupivacaine) 1500 mg/1.5 0.0625% bupivac 2 0.08% bupivac 2 0.1% bupivac 250 0.125% bupivac 100 Use 1000 mg/ 100 40 mg/4 10 mg/ 500 mg 10 diluent 50 mg/ 80 mg/2 800 mg/20 50 mcg/ (fentanyl) 5 mg/ (bupivac) prepared in Biological Safety Cabinet 50-100 usual: 1 mg/ max: 5 mg/ >50 kg: 250-500 (1-2 mg/) <50 kg: 0.1-0.2 mg/ 80 mg - 40 mg/ 28 days RT >80 mg - 100 200 mg/100 400 mg/200 out of wrap 0.0625% bupivac 2 0.08% bupivac 2 0.1% bupivac 2 0.125% bupivac 100 solution in vial is clear to yellow; do not refrigerate; do not use if yellow discolouration; same BUD for dilution in 3 days F Special Access drug see Cytotoxic Medication Reconstitution Chart 60 mg/50 ml 80 mg/ 100 mg/100 out of wrap 120 mg/100 do not refrigerate; BUD for doses transferred to empty viaflex bags - same BUD for dilution in Page 5
HEPARIN 1,3 (PPC; BBraun) HYDROCORTISONE SODIUM SUCCINATE 2 (Teva) (reconstituted or ed commercial vial / amp) 10,000 units/ 10,000 units/ 28 days F or RT Use 500 100 mg 1.8 SWFI 50 mg/ 100-1000 250 mg 1.8 SWFI 125 mg/ 250-1000 500 mg 3.8 SWFI 125 mg/ 500-1000 max 1 mg/ HYDROMORPHONE PCA 50 mg/5 10 mg/ 40 mg/100 HYDROMORPHONE EPIDURAL IMIPENEM / CILASTATIN 5,8 (Merk, Omega) INFLIXIMAB (Remicade ) LEUCOVORIN LEVOFLOXACIN 9 (Levaquin ) LEVOTHYROXINE 14 (PPC) 50 mg/5 (hydromorph) 100 mg/20 (bupivacaine) 250 mg 500 mg 100 mg 10 see additional info 10 SWFI allow to stand for 5 min 10 mg/ (hydromor) 5 mg/ (bupivac) 50 mg/ may be prepared in CIVA LAFH or BSC 10 mg/ 0.5 mg 5 0.1 mg/ 20 mcg/ hydromorphone 0.1% bupivacaine 2 500 mg-100 >500 mg-2 max: 5 mg/ 2 0.4-4 mg/ 48 hr F 3 months RT 25,000 units/500 or F out of Excel bag wrap 250 mg/100 500 mg/100 250 mg/ 500 mg/100 750 mg/1 see Cytotoxic Medication Reconstitution Chart or F out of wrap 0.4 mg/ - 100 IPUMP BAG 20 mcg/ hydromorphone 0.1% bupivacaine 250 250 mg/100 500 mg/100 1 g/2 using reconstitution device and minibag add 10 ; shake and add suspension to the bag; repeat; second rinsing of vial required to transfer entire dose; colorless to yellow without affecting potency; BUD in - 6 hrs vial may be reconstituted with removed from final bag; do not use if opaque or discolored; dilution in only stable in syringes for 7 days F and administered IV push Page 6
LINEZOLID 3 (Zyvoxam IV ) MAGNESIUM SULFATE 2 MEROPENEM 3 (Merrem ) MESNA METHYLPREDNISOLONE (Solumedrol, Teva) METOCLOPRAMIDE (Maxeran ) METRONIDAZOLE (Flagyll ) MICAFUNGIN 17 (Micamine ) 5 g /10 (50%) (reconstituted or ed commercial vial / amp) 500 mg 10 SWFI 1 g 20 SWFI Use 600 mg/300 out of wrap 500 mg/ 50-500 50 mg/ may be prepared in CIVA LAFH or BSC 500 mg 7.8 SWFI 62.5 mg/ 1 g 15.6 SWFI 10 mg/2 5 mg/ 100 mg 5 20 mg/ 50 mg - >50 mg - 100 50-150 mg in 100 500 mg/ 1 g/100 500 mg/ 1 g/100 7 days F MORPHINE PCA 500 mg/10 50 mg/ 200 mg/100 10 mg/ Fluid Restn:20 mg/ >250 mg in 50-250 max: 50 mg/ 5 days F 500 mg/100 see Cytotoxic Medication Reconstitution Chart 48 hr F out of wrap 250 mg/ 2 mg/ - 100 IPUMP BAG BUD in - do not refrigerate; protect from light during storage; BUD for doses transferred to empty viaflex bags - and infusion; mix vials genlty; MORPHINE EPIDURAL 15 mg/ (morphine) 100 mg/20 (bupivacaine) 15 mg/ (morphine) 5 mg/ (bupivac) 50 mcg/ morph 0.08% bupivacaine 2 50 mcg/ morphine 0.08% bupivacaine 2 MOXIFLOXACIN 10 (Avelox,) 400 mg/2 NaCl 0.8% 28 days RT out of wrap do not refrigerate; yellow solution Page 7
ONDAETRON 3 (Zofran ) PAMIDRONATE 11 (Mayne) PANTOPRAZOLE 15 (Pentaloc, Sandoz)) PENICILLIN G 8 (Teva) PENTAMIDINE ISETIONATE 1,8 (Mayne) PHENYTOIN (Dilantin ) PHYTONADIONE 2 vitamin K1 PIPERACILLIN 8 (Mayne) (reconstituted or ed commercial vial / amp) 4 mg/2 8 mg/4 40 mg/20 30 mg/10 3 mg/ 60 mg/10 6 mg/ 90 mg/10 9 mg/ Use 40 mg 10 4 mg/ 100 28 days F 40 mg/100 40 mg/100 1 million units 1.8 SWFI 1 MU/ 5 million units 8.2 SWFI 5 MU - 500,000 6-10 MU - 100 14 days F units/ >10 MU - 2 2 MU/ 10 million units 16.2 SWFI 2.5 MU/ 300 mg 3 SWFI 100 mg/ 100 mg/2 250 mg/5 2 mg/ 50 mg/ 10 mg/ 10 mg/ 6 mg - >6 mg - 100 max: 0.14 mg/ 90 mg - 2 50-500 max: 2 mg/ 14 days F 28 days RT 6 days F 5 MU/ 10 MU/100 3 g 6 SWFI 3 g - 3 g/ >3 g - 100 400 mg/ 21 days F Fluid Restn: 4 g 8 SWFI 120 mg/ 4 g/100 do not refrigerate; note specific protocols (vials and solutions); BUD for dilution in : 4 days F short stability in solution, send vials short stability in solution, send ampoules Page 8
PIPERACILLIN / TAZOBACTAM 3 (reconstituted or ed commercial vial / amp) Use 2.25 g 8.4 SWFI 2.25 g/ 2.25 g/ 3.375 g/100 3.375 g 12.6 SWFI 100 3.375 g/100 225 mg/ 30 daysf 4.5 g 16.9 SWFI 100 4.5 g/100 4.5 g/100 (Tazocin ) POTASSIUM CHLORIDE POTASSIUM PHOSPHATE 12 RANITIDINE 3 (Zantac ) SODIUM BICARBONATE (Abbott) SODIUM PHOSPHATE (Sandoz) STREPTOMYCIN 13 (Sterimax ) THIAMINE 2 Vit B1 TICARCILLIN / CLAVULANATE 3 (Timentin ) 13.5 g 52 SWFI 20 mmol/10 40 mmol/20 30 mmol/10 150 mmol/ 10 mmol/100 20 mmol/ 50 mg/2 50 mg/ 25 mg/ 2 mg/ 1.25 g/ 50 mmol/ 1 mmol/ 50-1000 30 mmol/10 3 mmol P 4 mmol Na/ 100-500 1 g 4.2 SWFI 200 mg/ 100 100 mg/ 100 mg/ 1,000 mg/10 3 g/100 mg 13 SWFI 2 mmol/ 3 mmol P 4.4 mmol K/ 100 mg/ 200 mg/ ticarcillin 6.7 mg/ clavulanate 28 days F or RT max peripheral: 60 mmol/l max central: 80 mmol/l 250-500 100 28 days F 7 days F 30 days out of wrap 15 mmol/2 3,100 mg/100 same BUD for and dextrosesaline combinations consult Parenteral Drug Therapy Manual max for peripheral line: 15 mmol/2; same BUD for and dextrosesaline combinations light darkens solution without affecting potency BUD for dilution in : 3 days F Page 9
TIGECYCLINE (Tigecyl ) TOBRAMYCIN 8 VANCOMYCIN 3 (PPC, Hospira) 50 mg (reconstituted or ed commercial vial / amp) 5.3 or 80 mg/2 1.2 g/30 10 mg/ 40 mg/ 28 days F or RT 50 mg - 100 mg - 100 max: 1 mg/ 80 mg - >80 mg - 100 Use 48 hr F 500 mg 5 SWFI 500 mg/100 1 g 10 SWFI 750 mg/250 100 mg/ 500 mg -100 5 g 48 SWFI 500 to 1250 mg - 1,000mg/250 10 g 95 SWFI 2 1,250mg/250 >1250 mg-500 1,500mg/500 max: 5 mg/ 1,750mg/500 2,000mg/500 vial contains overage, do not use recon device; same BUD for dilution in reconstitution volumes differ from the manufacturer vol; same BUD for dilution in VOLUME ADDITIO TO COMMERCIAL IV BAGS: Follow Table for Selection of appropriate Syringe IV bag size may add up to maximum volume range of acceptable maximum volume for final syringe size allowed measurable volume dispensing 25 25 1 0.5-1 0.75 25 75 3 0.6-3 2.3 100 1 5 1-5 3.6 2 300 6 1.2-6 4.5 500 5 10 2-10 7.5 1000 100 1100 12 2.4-12 9 20 4-20 15 30 6-30 22.5 For addition of larger volumes: 35 7-35 26 Withdraw sufficient volume from bag in order to not exceed maximum 60 12-60 volume allowed. Use one syringe to measure total dose For infusions administered in standard concentrations: consult the admixing instructions indicated on the infusion chart page, in the Parenteral Drug Therapy Manual. Select smallest syringe for best accuracy Measure a maximum of 5 doses in a single syringe Page 10
Minibags stored at Room Temperature (reconstituted or ed commercial vial / amp) minibags with listed BUD under Refrigeration could be stored at Room Temperature for up to 24 hours. Use Needles and dispensing pins used maximum 5 times. Needle selection determined by viscosity of soln and stopper - generally 18 to 21G Once the vial is removed from the hood dispensing pin cannot be transferred to another vial. Maximum 5 punctures to bag port if needle gauge is 19 to 25G Maximum 1 puncture to bag port if needle gauge is 18G or less REFERENCES: 1. Product Monograph 2. L.A. Trissel - Handbook on Injectable Drugs, 14th edition, 2007 3. Caryn M. Bing - Extended Stability for Parenteral Drugs, Third Edition, 2005 4. Kintzel PE and Smith GH - Practical Guidelines for Preparing and Administering Amphotericin B, AJHP Vol 49 May 1992 5. www.baxter.ca - Minibag stability outside outerwrap 6. Garey KW and Amsden GW - Intravenous Azithromycin, Annals of Pharmacotherapy Vol 33 Feb 1999 7. Baxter - CIVA Batch Preparations Listing 8. Sunnybrook Hospital Stability Information accessed online 9. VGH PDTM 10. Letter from Bayer Healthcare regarding "Moxifloxacin Stability", June 4, 2004 11. Letter from Faulding regarding "Pamidronate Stability", October 11, 2002 12. Stroup JW & Mghton Eryou LM. - Expiry Guidelines for CIVA Service, CJHP Vol 30, 3 1988 13. Vaillancourt R & Foisy MM. - Can the intramuscular Formulation of Streptomycin be given intravenously?, CJHP Vol 49 No3 June 1996 14. Das GuptaV. - Stability of levothyroxine Sodium Inj in Polypropylene syringes, International Journal of Pharmaceutical Compounding Vol 4 No 6 Nov/Dec 2000 15. Scott E. Walker, John Iazzetta, Shirley Law - Stability of Pantoprazole in /ji 37/ August 2007 16. Sandoz Compatibility and Stability of Ciprofloxacin with and in PVC IV bags, January 2008 17. Caryn M. Bing - Extended Stability for Parenteral Drugs, Third Edition, 2009 18. Letter from Sepracor Pharmaceuticals, January 6, 2010 Page 11