Pharmaceutical Services Division - moh.gov.myjknpenang.moh.gov.my/jknpenang/images/JKNPP/Farmasi/...i Antimicrobial Dilution Protocol (AmDP) This is a general guide for dilution of

i

Antimicrobial Dilution Protocol (AmDP)

This is a general guide for dilution of antimicrobial injections within

MOH facilities in Penang State. Users are advised to refer to the

current practice at the respective facilities and update accordingly.

Pharmaceutical Services Division

Penang State Health Department

Ministry Of Health Malaysia

ii


ANTIMICROBIAL DILUTION PROTOCOL

First Edition 2016

This is a publication of Pharmaceutical Services Division, Penang State Health

Department. Enquiries are to be directed to the address below. Permission is hereby

granted to reproduce information contained herein provided that such reproduction

be given due acknowledgement and shall not modify the text.

This guideline can be downloaded from JKNPP website at

www.jknpenang.moh.gov.my

Pharmaceutical Services Division,

Penang State Health Department,

Aras 8, Bangunan Persekutuan,

Jalan Anson,

10400 Pulau Pinang,

Malaysia.

Tel: 04- 2292319

Fax: 04- 2280314

http://www.jknpenang.moh.gov.my/

iii


ACKNOWLEDGEMENT

.

ELEDGEMENT

This guideline is an initiative by the Medication Safety Committee of Pharmaceutical Services Division, Penang State Health Department.

The committee would like to express our heartfelt gratitude to Dato’ Dr. Sukumar Mahesan

(Director of Penang State Health Department), Puan Zubaidah Binti Che’ Embee (Deputy Director Pharmacy of Penang State Health Department), members of reviewers, contributors and all those involve for their valuable and constructive comments in the completion of this guideline.

REVIEWERS

Dr. Wong Peng Shyan, Infectious Disease Consultant, Medical Department, Hospital Pulau Pinang

Dr. Loo Lay Khoon, Medical Specialist, Medical Department, Hospital Seberang Jaya

Madam Sherene Tan Su Ann, Pharmacist, Hospital Pulau Pinang

Madam Chua Cheah Chin, Pharmacist, Hospital Kepala Batas

Madam Che Ropani Binti Talib, State Matron, Penang State Health Department

Madam Saparbee Binti Mohamad, Senior Matron, Hospital Seberang Jaya

Madam Malathi D/O Govindasamy, Medical Ward Matron, Hospital Pulau Pinang

iv


CONTRIBUTORS

EDITORS

Oiyammaal D/O Maruthan Chelliah Pharmacist, Hospital Pulau Pinang

Syazleen Binti Razak Pharmacist, Hospital Pulau Pinang

Subramaniam S/O Thanimalai Pharmacist, Hospital Seberang Jaya

Celine Choong Yen Ching Pharmacist, Hospital Bukit Mertajam

Nurul Ain’ Binti Satar Pharmacist, Hospital Kepala Batas

Ong Chiou Ting Pharmacist, Hospital Sungai Bakap

Nasira Binti Mohamed Ayub Pharmacist, Hospital Balik Pulau

Tan Huey Yih Pharmacist, PKD Timur Laut

Ng Wei Min Pharmacist, PKD Barat Daya

Afida Amir Binti Ismet Amir Mohd. Idris Pharmacist, PKD Seberang Perai Utara

Tan Yin Shan Pharmacist, PKD Seberang Perai Selatan

Nurzawani Binti Yusof Pharmacist, PKD Seberang Perai Tengah

Tan Pei Ling Senior Assistant Director Pharmacy Practice and Development Division (Penang State)

Rohaizan Binti Mohd Hanafiah Senior Principle Assistant Director Pharmacy Practice and Development Division (Penang State)

Lim Shiou Hui Pharmacist, Hospital Pulau Pinang

Nasira Binti Mohamed Ayub Pharmacist, Hospital Balik Pulau

v


The use of antimicrobial is very crucial in the treatment of infection and to prevent the

disease from spreading. Nevertheless, antimicrobial resistance in our country is at a

alarming level due to their frequent and widespread use in the health sector. Moreover,

the use of antimicrobial has been abused. Many strategies have been implemented

by Ministry of Health Malaysia to promote the appropriate use of antimicrobial and to

enhance the quality use of antimicrobial for optimum treatment outcome.

Consequently, this will control the spread of antimicrobial resistance.

Dilution of antimicrobial is one of the essential strategies to ensure the correct

reconstitution and dilution method of antimicrobial for effective, safe and optimum

result to the patient. The concentration of the final dilution of antimicrobial is important

to ensure the stability, quality and safety of the antimicrobial with minimal adverse drug

reactions. At the same time minimize the occurrence of medication errors of handling

antimicrobial in the wards.

This protocol is aim to give a quick , simple and comprehensive guide to all health care

providers especially those who handle reconstitution of antimicrobials in ward. It is a

guide to accurate and correct method in reconstitution or dilution of the antimicrobial

that is prescribed and at the same time minimize the occurrence of medication errors.

Finally, I would like to congratulate the committees who have contributed their time

and effort in establishing this protocol to ensure a safe and effective practice in Penang

state. I hope that this protocol will serve its purpose well in ensuring correct

reconstitution or dilution of antimicrobials and instilling safe medication handling in all

health care facilities in Penang state.

Thank you.

DATO’ DR. SUKUMAR MAHESAN

Director Penang State Health Department

FOREWORD

DIRECTOR PENANG STATE HEALTH DEPARTMENT

vi


Prompt antimicrobial therapy for an infection can make the difference between cure

and death or long-term disability. Unfortunately, the use and misuse of antimicrobials

has driven antimicrobial to resistance and led to a loss of efficacy of these “miracle

drugs”. Improving antimicrobial use decisions ultimately involves guiding treatment

decisions made by patients and healthcare providers and ensure the infected patients

have access to quality medicines.

Errors in reconstitution and dilution of antimicrobial are medication errors that reported

in our health care facilities. These errors will affect the patients’ treatment outcome,

increase the general health care cost and promote antimicrobial resistance. In order

to minimize this medication error, Pharmaceutical Services Division, Penang State

Health Department takes the initiative to establish a comprehensive and quick protocol

as a guide for all healthcare providers during the process of reconstitution or dilution

of antimicrobials that are available in our health care facilities.

All antimicrobials listed in this protocol are available in Malaysia market and our health

care facilities. This protocol will be useful in facilitating the health care providers in the

wards for correct reconstitution or dilution of antimicrobials. This list may be updated

from time to time if there is any new antimicrobial available in the market and edited

at the individual health care facilities.

Finally, I would like to express my appreciation to all the members in working

committee, editors and reviewers for their great effort and time in establishing this

protocol.

Thank you.

Deputy Director (Pharmacy) Of Penang State Health Department

FOREWORD

DEPUTY DIRECTOR (PHARMACY) OF PENANG

STATE HEALTH DEPARTMENT

vii


1. INTRODUCTION………………………………………………………………………………. 1

2. ABOUT AmDP………………………………………………………………………………….. 2

3. GUIDE IN USING AmDP……………………………………………………………………….. 3

4. GENERAL INFROMATION…………………………………………………………………….. 4

5. ANTIMICROBIAL DILUTION PROTOCOL

5.1 Acyclovir Inj………………………………………………………………………….. 5 - 8

5.2 Anidulafungin Inj…………………………………………………………………….. 9

` 5.3 Amikacin Inj………………………………………………………………………….. 10 - 11

5.4 Amoxycillin/ Clavulanate Inj………………………………………………………… 12 - 14

5.5 Ampicilin Inj………………………………………………………………………….. 15 - 17

5.6 Ampicillin/ Sulbactam Inj……………………………………………………………. 18 - 19

5.7 Amphotericin B Inj…………………………………………………………………… 20

5.8 Artesunate Inj………………………………………………………………………… 21

5.9 Azithromycin Inj……………………………………………………………………… 22

5.10 Benzathine Penicillin Inj…………………………………………………………….. 23

5.11 Benzylpenicillin Inj…………………………………………………………………… 24 - 25

5.12 Caspofungin Inj……………………………………………………………………… 26

5.13 Cefazolin Inj………………………………………………………………………….. 27

5.14 Cefepime Inj………………………………………………………………………….. 28 - 32

5.15 Cefotaxime Inj……………………………………………………………………….. 33 – 36

5.16 Cefoperazone Inj…………………………………………………………………….. 37

5.17 Cefoperazone/ Sulbactam Inj………………………………………………………. 38 – 40

5.18 Ceftaroline Inj………………………………………………………………………… 41

5.19 Ceftazidime Inj……………………………………………………………………….. 42 – 43

5.20 Ceftriaxone Inj……………………………………………………………………….. 44 – 45

5.21 Cefuroxime Inj……………………………………………………………………….. 46 – 47

5.22 Ciprofloxacin Inj……………………………………………………………………… 48 – 49

5.23 Clindamycin Inj………………………………………………………………………. 50 – 51

5.24 Cloxacillin Inj…………………………………………………………………………. 52

5.25 Doripenem Inj………………………………………………………………………... 53

5.26 Ertapenem Inj………………………………………………………………………... 54

5.27 Erythromycin Inj……………………………………………………………………… 55

5.28 Fluconazole Inj………………………………………………………………………. 56

5.29 Gentamicin Inj……………………………………………………………………….. 57

5.30 Imipenem/ Cilastatin Inj…………………………………………………………….. 58

5.31 Kanamycin Inj………………………………………………………………………... 59

5.32 Levofloxacin Inj………………………………………………………………………. 60 - 62

5.33 Linezolid Inj…………………………………………………………………………... 63

5.34 Meropenem Inj………………………………………………………………………. 64 – 67

5.35 Metronidazole Inj…………………………………………………………………….. 68

5.36 Moxifloxacin Inj………………………………………………………………………. 69

5.37 Netilmycin Inj………………………………………………………………………… 70 – 71

5.38 Pentamidine Inj………………………………………………………………………. 72

TABLE OF CONTENTS PAGES

viii


5.39 Piperacillin/ Tazobactam Inj……………………………………………………….. 73 – 76

5.40 Polymyxin B Inj……………………………………………………………………….. 77

5.41 Streptomycin Inj………………………………………………………………………. 78 - 80

5.42 Sulfamethoxazole/ Trimethoprim Inj……………………………………………….. 81

5.43 Vancomycin Inj……………………………………………………………………….. 82 – 83

5.44 Voriconazole Inj………………………………………………………………………. 84 – 85

5.45 Zidovudine Inj…………………………………………………………………………. 86

6. NON FORMULARY DILUTION PROTOCOL

6.1 Daptomycin Inj………………………………………………………………………… 87

6.2 Liposomal Amphotericin B Inj………………………………………………………... 88

6.3 Micafungin Sodium Inj………………………………………………………………… 89

6.4 Colistimethate Sodium (Polymyxcin E) Inj………………………………………….. 90

6.5 Tigecyclin Inj ………………………………………………………………………….. 91

6.6 Pentamidine Isothionate Inj………………………………………………………….. 92

6.7 Quinine Dihydrochloride Inj…………………………………………………………... 93

7. ABBREVIATION…………………………………………………………………………………. 94

8. REFERENCES……………………………………………………………………………………. 95 – 97

TABLE OF CONTENTS PAGES

1


Intravenous therapy is the most important form of treatment in hospitalized

patients. It is essential to achieve desired plasma drug levels fast so that these patients

could obtain immediate therapeutic effect. Hence, intravenous antimicrobials provide

quick onset of action that safe patients’ life and minimize complication due to infection.

Contrary, these injectables can cause serious harm, not effective and lead to

antimicrobial resistant if prepared and given wrongly. For example, administration

intravenous Vancomycin in less than 60 minutes can cause “Red Man Syndrome”.

Study of Injectable Medication Errors done by American Nurses Association

revealed that 99% of nurses believed medication errors related to injectable

medication can cause serious harm to patient. Errors that occurred during preparation

and administration these medications accounted for 48% of the total error. Therefore,

a guide on dilution and administration of injectable medication serves as a proper

education that promotes safer medication practice at the healthcare facilities.

Reference:

Medication Errors and Syringe Safety Are Top Concerns for Nurses According to

New National Study [press release].

http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressRele

ases/2007/

INTRODUCTION

2


Serves as a drug reference for Adult cases ONLY. Clinical

discretion is necessary tailoring to patient condition and

practice preference.

Included antibiotics, antivirals and antifungals injection listed in

Ministry of Health Formulary (Year 2015) and Non-formulary

Antimicrobial (KPK drug) available at health facilities in Penang

State.

All drugs available in Malaysia are listed with their brand names.

Healthcare providers may find the details according to brand name

if there is a change in brand.

Most of the information is based on brand and manufacturer

recommendation. Thus, may subject to change.

Drugs are listed alphabetical in orders and subclass according to

brand name.

Information might be the same for different brands. Thus there will

be more than one brand listed in one table. Example; brand Azee®

and Zitromax® for Azithromycin Injection.

ABOUT ANTIMICROBIAL DILUTION PROTOCOL (AmDP)

3


1. Check the generic name of antimicrobial injection.

2. Check the brand name of antimicrobial injection.

3. Search page number of generic and brand name at content page.

4. Read all information in the table before reconstitute or dilute the

drugs.

5. If the drug or the brand is not listed in the protocol, contact

Pharmacy Department in respective healthcare facility for further

information.

GUIDE IN USING AmDP

4


1. All preparations should be done using aseptic technique.112

2. Do NOT freeze medications.111

3. Do NOT use the initial concentrate or the infusion solution if there is any sign

of precipitation and presence of foreign matter in either one.111

4. Kindly refer to pharmacist if the medication changes in color upon

reconstitution unless stated otherwise in product insert.111

5. Do NOT mix other drugs to the infusion solution to avoid any possible drug

interactions.111

6. Any unused portion should be discarded after the recommended period of

use.111

7. For multiple use vials, reconstituted solution must be labelled with time and

date immediately after preparation112 and must be placed under

recommended storage condition.

8. Flush IV line with NS before and after administration.112

9. In general, slow intravenous injection is to be given over 3 – 5 minutes;

intravenous infusion over 30 - 60 minutes113 unless stated otherwise in

product insert.

This general information may not be applicable to all the medications

available. Please consult your pharmacist for further information.

References:

111. Intravenous Drugs Preparation & Administration Quick Reference, Medical Department &

Pharmacy Department Kuala Lumpur Hospital, 2011

112. John D & Rebecca L, 2010. Guide to the Safe Preparation and Administration of Intravenous (IV)

Antibiotics at Home. http://www.newcastle-

hospitals.org.uk/downloads/cardiothoracic/Patient_info_-_safe_prep_and_admin_of_IV_ab.pdf

113. Dilution Protocol 2010, Hospital Selayang 2nd

GENERAL INFORMATION

5


1.1 BRAND : Zovirax ®

STRENGTH 250mg Powder

RECONSTITUTION/ DILUTION

IV : Reconstitute with 10ml WFI/ NS Further dilute with:

Dose To be diluted with

250mg – 500mg 100 ml NS

500mg – 1gm 200 ml NS

ADMINISTRATION Slow IV infusion over 1 hour

STABILITY

After Reconstitution After Dilution

RT RT

Used immediately after reconstitution

12 hours

DO NOT REFRIGERATE

INCOMPATIBILITY -

REMARKS -

Reference : 1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline.

1.0 ACYCLOVIR INJECTION

6


1.2 BRAND : Medovir ®

STRENGTH 250mg powder


IV: Reconstitute

Dose Notes

250mg Reconstitute with 5ml NS/ WFI


Further dilute with NS to give concentration not greater than 5mg/ml (minimum volume can be diluted 10ml of NS to achieve concentration ≤ 5mg/ml)

ADMINISTRATION IV infusion over at least 1 hour

STABILITY


RT RT


12 hours

DO NOT REFRIGERATE

INCOMPATIBILITY

Biological or colloidal solutions (blood products, protein containing solutions), Parabens

REMARKS -

Reference : 2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie.


7


1.3 BRAND : DBL Acyclovir Intravenous Infusion ®

STRENGTH 250mg Powder


IV : Reconstitute

Dose Notes



Further dilute with NS to give concentration not greater than 5mg/ml (minimum volume can be diluted 10ml of NS to achieve concentration ≤ 5mg/ml)

ADMINISTRATION IV infusion only, to be given over a period at least 1 hour

STABILITY


RT RT


12 hours

DO NOT REFRIGERATE

INCOMPATIBILITY -

REMARKS -

Reference : 3. PRODUCT LEAFLET : DBL Acyclovir Hospira.


8


1.4 BRAND : Vaxcel Acyclovir ®

STRENGTH 250mg in 10ml


IV : Dilute 250mg with 50ml NS/ D5 Dilute 500mg with 100ml NS/ D5 - concentration not greater than 5mg/ml

ADMINISTRATION IV : Infuse over 1 hour by controlled infusion pump

STABILITY

To be diluted immediately before use.

After Dilution

RT

24 hours

Solution should not be refrigerated.

INCOMPATIBILITY -

REMARKS For intravenous infusion over at least 1 hour to prevent renal tubular damage

Reference : 4. PRODUCT LEAFLET: Vaxcel Acyclovir Kontra Pharma.


9


2.1 BRAND : Eraxis ®



IV: For 100mg: Reconstitute with 30ml WFI Further dilute with 100ml NS/ D5 For 200mg: Reconstitute with 60ml WFI Further dilute with 200ml NS/ D5

ADMINISTRATION

IV: Rate of infusion: Should not exceed 1.1mg/min (equivalent 1.4 ml/min for both 100mg and 200mg doses)

Dose Minimum Duration of Infusion

100mg 90 minutes

200mg 180 minutes

STABILITY

-This medication must be kept in fridge at 2 - 8°C


RT 2 - 8°C RT 2 - 8°C

24 hours NA 48 hours NA

INCOMPATIBILITY -

REMARKS -

Reference :

5. PRODUCT LEAFLET : Eraxis, Pfizer.

2.0 ANIDULAFUNGIN INJECTION

10


3.1 BRAND : Apalin ®



IM: Inject directly IV infusion: Add to 100 to 200ml NS/ D5 (Maximum concentration: 5mg/ml)

ADMINISTRATION IM IV Infusion over 30 - 60 minute period

STABILITY

At concentration of 0.25mg/ml and 5mg/ml


RT 2 - 8°C RT 4°C -15°C (frozen)

Information not available (recommend to use

immediately)

24 hours

60 days 30 days

INCOMPATIBILITY -

REMARKS Solutions may vary in color from colorless to light straw or very pale yellow. Discard dark-colored solutions

Reference : 6. PRODUCT LEAFLET : Apalin, CCM Duopharma Bio Tech.

3.0 AMIKACIN INJECTION

11


3.2 BRAND : Selemycin ®

STRENGTH 500ml in 2ml


IM: Inject directly IV Infusion: Add into 100 - 200ml NS/ D5 (Maximum concentration: 5mg/ml)

ADMINISTRATION IV infusion over 30 - 60 minutes

STABILITY

At concentration of 0.25mg/ml and 5mg/ml


RT 2 - 8°C RT 4°C

Information not available (recommend

to use immediately)

24 hours 60 days

INCOMPATIBILITY -

REMARKS Do not freeze

Reference : 7. PRODUCT LEAFLET : Selemycin Medochemie Ltd, Cyprus.

3.0 AMIKACIN INJECTION

12


4.1 BRAND : Augmentin Intravenous ®

STRENGTH 600mg powder 1.2g powder


Slow IV injection: i) 600mg vial: Reconstitute with 10ml WFI (Final Volume 10.5ml) ii) 1.2g vial: Reconstitute with 20ml WFI (Final Volume 20.9ml) IV infusion: i) 600mg vial: Reconstitute with10ml WFI Further dilute with 50ml WFI/ NS ii) 1.2g vial: Reconstitute with 20ml WFI Further dilute with 100ml WFI/ NS

ADMINISTRATION Slow IV bolus over 3 – 4 minutes IV infusion over 30 - 40 minutes

STABILITY

REFREGIRATED RECONSTITUTED SOLUTION MUST IMMEDIATELY USED ONCE REACHING ROOM TEMPERATURE


RT 2 - 8°C RT

20 minutes - 4 hours

INCOMPATIBILITY

Should not be mixed with blood products, proteinaceous fluids (e.g. protein hydrolysates and or IV lipid emulsions Should not be administered concurrently with aminoglycosides in syringe, IV fluid container or giving set as it may cause loss of aminoglycosides activity

REMARKS It is less stable in infusion containing glucose, dextran or bicarbonate (Do not add to such solutions)

Reference : 8. PRODUCT LEAFLET : Augmentin Intravenous GlaxoSmithKline

4.0 AMOXYCILLIN/ CLAVULANATE INJECTION

13


4.2 BRAND : Clamentin Injection ®

STRENGTH 1.2g powder


IV: Add 20ml of WFI IV Infusion: Add 20ml of WFI Further dilute to 100ml WFI/ NS

ADMINISTRATION Slow IV bolus over 3 - 4 minutes IV Infusion over 30 - 40 minutes

STABILITY

If use WFI as diluent:-

If use NS as diluent: -


RT 2 - 8°C RT

10 minutes - 4 hours


RT 2 - 8°C RT

- - 4 hours

INCOMPATIBILITY

Should not be mixed with blood products, proteinaceous fluids (e.g. protein hydrolysates and or IV lipid emulsions Should not be administered concurrently with aminoglycosides in syringe, IV fluid container or giving set as it may cause loss of aminoglycosides activity

REMARKS

It is less stable in infusion containing glucose, dextran or bicarbonate (Do not add to such solutions) Appearance: White to off white powder in vial. Solution will be a colorless to pale yellow liquid in vial without other foreign matter

Reference : 9. PRODUCT LEAFLET : Clamentin Injection, Yung Shin Pharmaceutical Ind. Co., Ltd.


14


4.3 BRAND : Co-Amoxiclav Injection ®



IV : Add 20ml of WFI IV infusion: Add 20ml of WFI Further dilute with 100ml WFI/ NS

ADMINISTRATION

Slow IV bolus over 3 - 4 minutes IV Infusion over 30 - 40 minutes

STABILITY Information not available (recommend to use immediately)

INCOMPATIBILITY

Should not be mixed with blood products, proteinaceous fluids (e.g. protein hydrolysates and or IV lipid emulsions) Should not be administered concurrently with aminoglycosides in syringe, IV fluid container or giving set as it may cause loss of aminoglycosides activity

REMARKS

It is less stable in infusion containing glucose, dextran or bicarbonate (Do not add to such solutions) Appearance: Sterile Powder for injection A transient pink coloration may appear during reconstitution. Upon completion may appear colorless or pale straw color

Reference : 10. PRODUCT LEAFLET : Co-Amoxiclav Injection Averroes Pharmaceuticals Sdn Bhd.


15


5.1 Ampicillin Sodium for Injection BP ®



IM: Reconstitute with 1.5ml of WFI IV: Reconstitute with 10ml of WFI

ADMINISTRATION IM Slow IV bolus over 3 - 4 minutes


INCOMPATIBILITY

Not to be administer concurrently with beta-lactam antibacterials and aminoglycosides. If administered concurrently, separate sites at least 1 hour.

REMARKS -

Reference : 11. PRODUCT LEAFLET : Ampicillin Sodium for Injection B, Karnataka Antibiotics &

Pharmaceuticals Limited, India; July 2009.

5.0 AMPICILIN INJECTION

16


5.2 BRAND : Pamecil®



IM: Reconstitute with 1.8ml of WFI IV: Reconstitute with 5ml of WFI (for 500 mg dose) Reconstitute with 7.4ml of WFI (for 1 g dose)

ADMINISTRATION

IM Slow IV bolus over 3 – 5 minutes (for 250 – 500 mg dose) Slow IV bolus over 10 – 15 minutes (for 1 g dose)

STABILITY Use immediately after reconstitution.

INCOMPATIBILITY -

REMARKS -

Reference :

12. PRODUCT LEAFLET : Pamecil, Medochemie Ltd, Selangor.

5.0 AMPICILLIN INJECTION

17


5.3 BRAND : Standacillin ®



IM: Reconstitute with 5ml of WFI IV Infusion: Reconstitute with 5ml of WFI, Further dilute with 50 - 500ml of NS

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes IV infusion over 15 - 20 minutes


INCOMPATIBILITY -

REMARKS -

Reference :

13. PRODUCT LEAFLET : Standacillin, Sandoz.

5.0 AMPICILLIN INJECTION

18


6.1 BRAND : Ampicillin & Sulbactam powder for injection ®



IV/ IM: Reconstitute with 3.2 ml WFI IV Infusion: Further dilute to 50 – 500 ml of NS

ADMINISTRATION

IM: Deep IM injection Slow IV Bolus over 3 - 4 minutes IV Infusion over 15 - 30 minutes


INCOMPATIBILITY -

REMARKS -

Reference : 14. PRODUCT LEAFLET : Ampicillin & Sulbactam powder for injection Karnataka

Antibiotics & Pharmaceuticals Limited, India; August 2010.

6.0 AMPICILLIN/ SULBACTAM INJECTION

19


6.2 BRAND : Sulbacin ®



IM: Reconstitute with 3ml of WFI IV : Reconstitute with 5ml of WFI IV Infusion: Reconstitute with 5ml of WFI, further dilute with 50 - 100ml NS

ADMINISTRATION

IM: Deep IM injection Slow IV bolus over 10 -15 minutes IV infusion over 15 - 30 minutes

STABILITY


RT 4°C Information not available (recommend to use

immediately)

8 hours 72 hours

INCOMPATIBILITY -

REMARKS -

Reference : 15. PRODUCT LEAFLET : Sulbacin, Unichem.

6.0 AMPICILLIN/ SULBACTAM INJECTION

20


7.1 BRAND : Amphotret ®



IV: Reconstitute with 10ml of WFI , Further dilute with 500ml D5 ( dose <50mg) or 1000ml (for dose > 50mg) Maximum concentration of 0.1mg/ml

ADMINISTRATION Slow infusion over 2 - 6 hours

STABILITY


RT 2 - 8°C Use immediately after dilution 24 hours 7days

INCOMPATIBILITY -

REMARKS

If test dose is needed: Test dose: 1mg (0.2ml) further dilute in 20ml of D5, administer over 20-30 minutes

1. Monitor patient’s temperature, pulse, respiration rate &

blood pressure every 30 minutes for 2 - 4hours 2. Infusion related immediate reaction may happen with

chills, fever, hypotension, nausea or anaphylactic reaction. Premedication (Paracetamol, Hydrocortisone/ Chlorpheniramine) given 30 minutes prior to administration

3. Prophylactic antipyretics or hydrocortisone should only

be used in patients who have previously experienced acute adverse reactions

References : 16. PRODUCT LEAFLET : Amphotret Bharat Serums And Vaccines Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,

Greenwood Village, Colorado, USA.

7.0 AMPHOTERICIN B INJECTION

http://www.micromedexsolutions.com/

21


8.1 BRAND : Artesun ®



IM: Reconstitute with 1ml of 5% sodium bicarbonate solution, Further dilute with 2 ml of NS/ D5 IV: Reconstitute with 1ml of 5% sodium bicarbonate solution, Further dilute with 5ml of NS/ D5

ADMINISTRATION IM Slow IV bolus (3 - 4 ml/min)


INCOMPATIBILITY -

REMARKS -

Reference : 17. PRODUCT LEAFLET : Artesun, Guilin Pharmaceutical Co Ltd.

8.0 ARTESUNATE INJECTION

22


9.1 BRAND : Azee ® 9.2 BRAND : Zitromax ® (Brands above have same information)



IV: Reconstitute with 4.8ml of WFI Further dilute with 250 - 500ml of NS/D5

ADMINISTRATION IV infusion 1mg/ml over 3 hrs (500ml infusion)

IV infusion 2mg/ml over 1 hr (250ml infusion)

STABILITY


RT 2 - 8°C RT 2 - 8°C

Information not available (recommend

to use immediately)

24 hours 7 Days (only for brand Zithromax®)

INCOMPATIBILITY -

REMARKS -

References : 18. PRODUCT LEAFLET : Azee, Cipla United. 19. PRODUCT LEAFLET : Zitromax, Pfizer. 105. Injectable Drugs Dilution 2010, Bahagian Perkhidmatan Farmasi Perak. 106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital

Kuala Lipis.

9.0 AZITHROMYCIN INJECTION

23


10.1 BRAND : Retarpen ®



Reconstitute with 5ml of WFI

ADMINISTRATION IM only

STABILITY Use immediately after reconstitution

INCOMPATIBILITY -

REMARKS -

References : 20. PRODUCT LEAFLET : Retarpen, Sandoz. 100. MIMS Online; http://online1.mimsgateway.com.my. 106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital

Kuala Lipis.

10.0 BENZATHINE PENICILLIN INJECTION

http://online1.mimsgateway.com.my/

24


11.1 BRAND : Penicilin G Sodium Sandoz ®

STRENGTH

One million unit powder (600mg)

Five million unit powder (3g)


IM : Reconstitute with 5 - 10ml WFI (apply to not more than 6g of dose)

IV injection/IV Infusion : 600mg vial: Reconstitute with 10ml WFI 3g vial: Reconstitute with 50ml of WFI

ADMINISTRATION IM : Up to 5ml of injectable solution per injection site IV : Information not provided

STABILITY

Use immediately after reconstitution and preparation Penicillin G rapidly disintegrate even at refrigerated temperature

INCOMPATIBILITY

Solutions contain metal ions, oxidating and reducing substances, alcohol, glycerol, macrogols and other hydroxyl compounds. Sympathomimetic amines, Dextrose, Tetracycline

REMARKS Ringer’s lactate or other solutions containing sodium should not be used to avoid electrolyte imbalance to reconstitute the solution

Reference :

52. PRODUCT LEAFLET : Penicilin G Sodium Sandoz, Sandoz GmbH

11.0 BENZYLPENICILLIN INJECTION

25


11.2 BRAND : Benzyl Penicillin For Injection ®

STRENGTH One million unit powder (600mg) Five million unit powder (3g)


600mg vial: Reconstitute with 2ml or more of WFI 3g vial: Reconstitute with 10ml or more of WFI

ADMINISTRATION IM : Up to 5ml of injectable solution IV infusion: over 1 hour (1ml/min)

STABILITY


RT 2 - 8°C RT 2 - 8°C

2 days 6 days - -

INCOMPATIBILITY

Solutions contain metal ions should be administered separately Should not be administered in the same syringe / giving set as Amphotericin B, Cimetidine, Cytarabine, Flucloxacillin, Hydroxyzine, Methylprednisolone or Promethazine

REMARKS -

Reference :

53. PRODUCT LEAFLET : Benzyl Penicillin For Injection, Karnataka Antibiotics & Pharmaceuticals Ltd.

11.0 BENZYLPENICILLIN INJECTION

26


12.1 BRAND : Cancidas ®

STRENGTH 50mg powder 70mg powder


Let refrigerated Caspofungin to room temperature before reconstitution. Reconstitute with 10.8 ml of NS or WFI

i) For 70mg (loading dose): Withdraw two separate 5 ml solution and add to two separate 100ml NS

ii) For 50mg : Take 10ml solution and dilute in 100ml NS

ADMINISTRATION

i) For 70mg (loading dose): Infuse first IV bag for 30 minutes followed by second IV bag for another 30 minutes

ii) For 50mg :Slow IV infusion over 1 hour

STABILITY


RT 2 - 8°C RT 2 - 8°C

1 hour - 24 hours 48 hours

INCOMPATIBILITY Diluents containing dextrose

REMARKS Dilution of 70mg in single 100ml IV bag not recommended Final concentration should not exceed 0.5mg/ml

References : 22. PRODUCT LEAFLET : Cancidas, Merck Sharp & Dohme. 100. MIMS Online; http://online1.mimsgateway.com.my.

12.0 CASPOFUNGIN INJECTION


27


13.1 BRAND : Cefazolin Sandoz ® 13.2 BRAND : Reflin ® (Brands above have same information))

STRENGTH 1g powder


IM: Reconstitute with 2.5ml of WFI IV: Reconstitute with 4ml WFI/ NS

IV infusion: Further dilute with 50 – 100ml NS

ADMINISTRATION Dose ≤ 1g: IM or slow infusion over 3 - 5 minutes

Dose > 1g: Infusion over 20 - 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

- 24 hours Information not available (recommend to use

immediately)

INCOMPATIBILITY -

REMARKS -

References : 23. PRODUCT LEAFLET : Cefazolin Sandoz. 24. PRODUCT LEAFLET : Reflin, Ranbaxy. 100. MIMS Online; http://online1.mimsgateway.com.my.

13.0 CEFAZOLIN INJECTION


28


14.1 BRAND : Verapime ®

STRENGTH 1g powder

RECONSTITUTION / DILUTION

IM : Reconstitute with 3ml of WFI or 1% Lidocaine IV: Reconstitute with 10ml of NS/ D5 Further dilute to 50 -100ml with NS/ D5

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes

IV infusion over 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

12 hours 24 hours Information not available (recommend to use

immediately)

INCOMPATIBILITY

Should not administered concurrently with Ampicillin (<40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site

REMARKS -

References : 25. PRODUCT LEAFLET : Verapime, Demo S.A Pharmaceutical Industry. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,

Greenwood Village, Colorado, USA. 101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc.

14.0 CEFEPIME INJECTION


29


14.2 BRAND : Vaxcel Cefepime ®

STRENGTH 1g powder


IM : i) 500mg injection : Reconstitute with 1.5ml of WFI/ NS/ D5

ii)1g injection : Reconstitute with 3ml of WFI/ NS/ D5

IV : i) 500mg injection : Reconstitute with 5ml of WFI /NS/ D5 ii) 1g injection : Reconstitute with 10ml of WFI/ NS/ D5

Further dilute to 50 - 100ml with WFI/ NS/ D5

ADMINISTRATION



STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours 7 days 24 hours 7 days

INCOMPATIBILITY

Should not administered concurrently with Ampicillin (< 40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site

REMARKS -

References : 26. PRODUCT LEAFLET : Vaxcel Cefepime Kotra Pharma (M) Sdn. Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,

Greenwood Village, Colorado, USA. 101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc.



30


14.3 BRAND : Forpar ®

STRENGTH 1g powder


IM : Reconstitute with 2.4ml of NS/ D5 IV : Reconstitute with 10ml of NS/ D5 Further dilute to 50 - 100ml with NS

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes IV infusion over 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C


INCOMPATIBILITY

Should not administered concurrently with Ampicillin (< 40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site

REMARKS -

Reference : 27. PRODUCT LEAFLET : Forpar, Cipla (M) Sdn. Bhd. 2014.


31


14.4 BRAND : Megapime ®

STRENGTH 500mg powder 1g powder


IM : i) 500mg : Reconstitute with 1.5ml of NS/ D5 ii)1g : Reconstitute with 3ml of NS/ D5 IV : i) 500mg : Reconstitute with 5ml of NS/ D5 ii)1g : Reconstitute with 10ml of NS/ D5 Further dilute to 50 -100ml with NS/ D5

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes IV infusion over approximately 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C


INCOMPATIBILITY

Should not administered concurrently with Ampicillin (<40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin If administer concurrently, should use separate site

REMARKS Concomitant administration with Probenecid prolongs renal tubular secretion of Cefepime, resulting high serum concentration

Reference : 28. PRODUCT LEAFLET : Megapime, Alkem Lab Ltd. 2006.


32


14.5 BRAND : Sefepim ®

STRENGTH 1g powder


IM : Reconstitute 1g with 3ml of NS/ D5 IV : Reconstitute 1g with 10ml of NS/ D5 Further dilute with 50-100ml NS/ D5

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes IV infusion over approximately 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C


INCOMPATIBILITY

Should not administered concurrently with Ampicillin (<40mg/mL), Aminophylline, Gentamicin, Metronidazole, Netilmicin, Tobramycin or Vancomycin. If administer concurrently, should use separate site

REMARKS IV route is preferable for severe/ life-threatening infection, particularly if shock is present

Reference : 29. PRODUCT LEAFLET : Sefepim, Hovid Sdn Bhd. 2014.


33


15.1 BRAND : Rekaxime ®



IM : i) 500mg : Reconstitute with 2ml of WFI ii)1g : Reconstitute with 4ml of WFI IV : i) 500mg : Reconstitute with 2ml of WFI ii)1g : Reconstitute with 4ml of WFI iii)2g : Reconstitute with 10ml of WFI Short infusion : Further dilute with 2g in 40ml of NS/ D10 Continuous drip : Further dilute 2g vial in 100ml of NS/ D10

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes Infusion Short infusion over 20 minutes Continuous drip over 50 - 60 minutes

STABILITY To be used immediately

INCOMPATIBILITY -

REMARKS/* If daily dose exceeds 2g, IV injection is preferred

Reference : 30. PRODUCT LEAFLET : Rekaxime, Duopharma (M) Sdn Bhd. 2011.

15.0 CEFOTAXIME INJECTION

34


15.2 BRAND : Claraxim ®



IM : 1g : Reconstitute with 4ml of WFI (Can further dilute with 4ml of 1% Lidocaine to avoid pain) IV i) 250mg & 500mg : Reconstitute with 2ml of WFI ii) 1g : Reconstitute with 4ml of WFI iii) 2g : Reconstitute with 10ml of WFI Short infusion: further dilute 2g in 40ml of NS/ D10 Continuous drip: further dilute 2g in 100ml of NS/ D10

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes Infusion Short infusion over 20 minutes Continuous drip over 50 - 60 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

- 24 hours Information not available (recommend to use

immediately)

INCOMPATIBILITY -

REMARKS If daily dose exceeds 2g or Claraxim 1g is administered more than twice daily, IV injection is preferred

Reference : 31. PRODUCT LEAFLET : Claraxim, Siam Bheasach Co. Ltd. 2006.


35


15.3 BRAND : Claforan ®



IM : 1g : Reconstitute with 4ml of WFI Further dilute with corresponding amount* of 1% Lidocaine IV : i) 500mg : Reconstitute with 2ml of WFI ii) 1g : Reconstitute with 4ml of WFI iii)2g : Reconstitute with 10ml of WFI Short infusion: further dilute 2g in 40ml of NS/ D10 Continuous drip: further dilute 2g in 100ml of NS/ D10

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes Infusion Short infusion over approximately 20 minutes Continuous drip over 50 - 60 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

12 hours 24 hours 12 hours 24 hours

INCOMPATIBILITY -

REMARKS Intravenous injection is recommended if the daily dose exceeds 2 g or if Claforan 1 g is administered more than twice daily

* Suitable volume of Lidocaine to avoid pain during IM injection

Reference : 32. PRODUCT LEAFLET : Claforan, Aventis Pharma.


36


15.4 BRAND : Vaxcel Cefotaxime ®



IM : 1g : Reconstitute with 4ml of WFI Further dilute with corresponding amount* of 1% Lidocaine IV : i) 1g : Reconstitute with 4ml of WFI ii) 2g : Reconstitute with 10ml of WFI Short infusion: further dilute 2g in 40ml of NS/ D10 Continuous drip: further dilute 2g in 100ml of NS/ D10

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes IV Infusion Short infusion over approximately 20 minutes Continuous drip over 50 - 60 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours - Information not available (recommend to use

immediately)

INCOMPATIBILITY -

REMARKS Intravenous injection is recommended if the daily dose exceeds 2g or if Cefotaxime 1g is administered more than twice daily

* Suitable volume of Lidocaine to avoid pain during IM injection

Reference : 33. PRODUCT LEAFLET : Vaxcel Cefotaxime, Kotra Pharma (M) Sdn.Bhd.


37


16.1 BRAND : Bicafar ® 16.2 BRAND : Vaxcel Cefoperazone ® (Brands above have same information)

STRENGTH 500mg powder 1g powder 2g powder


IM i) 500mg : Reconstitute with 1.3ml of WFI ii) 1g : Reconstitute with 2.6ml of WFI iii) 2g : Reconstitute with 5.2ml of WFI Further dilute i) 500mg : add 0.4ml of 2% Lidocaine ii) 1g : add 0.9ml of 2% Lidocaine iii) 2g : add 1.8ml of 2% Lidocaine Slow IV Bolus dilute with WFI/NS/D5, final concentration 100mg/ml IV 1g & 2g : Reconstitute with 5ml of WFI/ NS/ D5 Further dilute with 20 -100ml of WFI/ NS/ D5

ADMINISTRATION

IM Slow IV bolus over 3 - 5 minutes. IV Infusion over 15 - 60 minutes


INCOMPATIBILITY -

REMARKS -

References : 34. PRODUCT LEAFLET : Bicafar, Duopharma (M) Sdn Bhd. 2012. 35. PRODUCT LEAFLET : Vaxcel Cefoperazone, Kotra Pharma (M) Sdn.Bhd.

16.0 CEFOPERAZONE INJECTION

38


17.1 BRAND : Vaxcel Cefobactam ®

STRENGTH 1g powder


IV : 1g : Reconstitute with 3.4ml of NS/ D5/ WFI Further dilute with 20ml NS/ D5/ WFI

ADMINISTRATION Slow IV bolus over of 3 minutes IV Infusion: over 15 - 60 minutes

STABILITY

Dilute in D5 : Use immediately


RT 2 - 8°C RT 2 - 8°C

24 hours NA Information not available

(recommend to use immediately)

INCOMPATIBILITY Should not be directly mixed with aminoglycoside due to physical incompatibility.

REMARKS -

Reference : 36. PRODUCT LEAFLET : Vaxcel Cefobactam, Kotra Pharma (M) Sdn.Bhd.

17.0 CEFOPERAZONE/ SULBACTAM INJECTION

39


17.2 BRAND : Cefper ®

STRENGTH 1g powder


IV : 1g : Reconstitute with WFI to volume of 4ml Further dilute to 20ml with WFI

ADMINISTRATION Slow IV bolus over 3 minutes IV Infusion over 15 - 60 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours 5 days Information not available (recommend to use

immediately)

INCOMPATIBILITY -

REMARKS -

Reference : 37. PRODUCT LEAFLET : Cefper Biolab Co. LTD, 2009.


40


17.3 BRAND : Cefoperazone & Sulbactam 1.0g

STRENGTH 1g powder


IV : 1g : Reconstitute with 3.4ml of NS/ D5/ WFI Further dilute with 20ml NS/ D5/ WFI

ADMINISTRATION Slow IV bolus over of 3 minutes IV Infusion over 15 - 60 minutes


INCOMPATIBILITY -

REMARKS -

Reference :

38. PRODUCT LEAFLET : Cefoperazone & Sulbactam 1.0G, Karnataka Antibiotics & Pharmaceuticals Limited, 2010.


41


18.1 BRAND : Zinforo ®



IV : Reconstitute with 20ml of WFI

Further dilute with 50ml - 250ml NS/ D5

ADMINISTRATION Infusion over 1 hour

STABILITY


RT 2 - 8°C RT 2 - 8°C

Use immediately

NA 6 hours 24 hours

INCOMPATIBILITY -

REMARKS Protect from light

Reference : 39. PRODUCT LEAFLET : Zinforo, Facta Farmaceutici S.p.A, October 2012.

18.0 CEFTAROLINE INJECTION

42


19.1 BRAND : Cefatum ®

STRENGTH 1g powder 2g powder


IM : Reconstitute with 3ml of 0.5% lignocaine HCl


IV infusion : Further dilute with 50 - 500ml NS/ D5

ADMINISTRATION



STABILITY


RT 2 - 8°C RT 2 - 8°C

WFI- 12 hours 0.5% Lignocaine HCl- 6 hours

WFI- 7 days 0.5% Lignocaine HCl- 4 days

12 hours 7 days

INCOMPATIBILITY -

REMARKS -

Reference : 40. PRODUCT LEAFLET : Cefatum, Duopharma (M) Sdn Bhd, 6 August 2010.

19.0 CEFTAZIDIME INJECTION

43


19.2 BRAND : Fortum ®

STRENGTH 1g powder 2g powder


IM : Reconstitute with 3ml of 0.5% lignocaine HCl


Further dilute with 50 - 500ml NS/ D5

ADMINISTRATION




INCOMPATIBILITY -

REMARKS -

References : 41. PRODUCT LEAFLET : Fortum, GlaxoSmithKline. 100. MIMS Online; http://online1.mimsgateway.com.my.

19.0 CEFTAZIDIME INJECTION


44


20.1 BRAND : Unocef ®

STRENGTH 250mg powder 500mg powder 1g powder


IM : 250mg: Reconstitute with 0.9ml of WFI/ NS/ D5

500mg: Reconstitute with 1.8ml of WFI/ NS/ D5

1g : Reconstitute with 3.6ml of WFI/ NS/ D5

IV infusion : 250mg: Reconstitute with 2.4ml of WFI

500mg: Reconstitute with 4.8ml of WFI

1g : Reconstitute with 9.6ml of WFI


ADMINISTRATION IV infusion over 30 minutes

STABILITY

i) For IM :

Diluent Concentration (mg/ml)

After reconstitution

RT 2 - 8°C

WFI 100

250, 350

3 days

24 hours

10 days

3 days

NS 100

250, 350

3 days

24 hours

10 days

3 days

D5 100

250, 350

3 days

24 hours

10 days

3 days

ii) For IV :


RT 2 - 8°C RT 2 - 8°C

3 days 10 days 3 days 10 days

INCOMPATIBILITY -

REMARKS -

Reference : 42. PRODUCT LEAFLET : Unocef, Duopharma (M) Sdn Bhd, 27 July 2010.

20.0 CEFTRIAXONE INJECTION

45


20.2 BRAND : Rocephin ®

STRENGTH 250mg powder 500mg powder 1g powder


IM : 500mg: Reconstitute with 1.8ml of WFI/ NS/ D5

1g : Reconstitute with 3.6ml of WFI/ NS/ D5

IV infusion : 500mg:Reconstitute with 4.8ml of WFI

1g : Reconstitute with 9.6ml of WFI



STABILITY

i) For IM :

Diluent Concentration (mg/ml)

Storage

RT 2 - 8°C

WFI 100

250, 350

2 days

24 hours

10 days

3 days

NS 100

250, 350

2 days

24 hours

10 days

3 days

D5 100

250, 350

2 days

24 hours

10 days

3 days

ii) For IV :


RT 2 - 8°C RT 2 - 8°C

2 days 10 days 2 days 10 days

INCOMPATIBILITY -

REMARKS -

Reference : 43. PRODUCT LEAFLET : Rocephin, Roche.

20.0 CEFTRIAXONE INJECTION

46


21.1 BRAND : Zinacef ®



IM : 750mg : Reconstitute with 3ml of WFI

IV : 750mg: Reconstitute with 6ml of WFI

1.5g : Reconstitute with 15ml of WFI

Further dilute with 50 -100ml NS/ D5

ADMINISTRATION

IM

Slow IV bolus over 3 - 5 minutes


STABILITY


RT 2 - 8°C RT 2 - 8°C


immediately)

INCOMPATIBILITY -

REMARKS -

References : 44. PRODUCT LEAFLET : Zinacef, GlaxoSmithKline.

100. MIMS Online; http://online1.mimsgateway.com.my.

21.0 CEFUROXIME INJECTION


47


21.2 BRAND : Anikef ®



IM : 250mg : Reconstitute with 1ml of WFI

750mg : Reconstitute with 3ml of WFI

IV : 250mg : Reconstitute with 2ml of WFI

750mg : Reconstitute with 6ml of WFI

1.5g : Reconstitute with 15-50ml of WFI

ADMINISTRATION IM

Slow IV bolus over 3 - 5 minutes


STABILITY


RT 2 - 8°C RT 2 - 8°C


immediately)

INCOMPATIBILITY -

REMARKS -

Reference : 45. PRODUCT LEAFLET : Anikef Duopharma (M) Sdn Bhd, 2 September 2013.

21.0 CEFUROXIME INJECTION

48


22.1 BRAND : Ciproxol ®



Ready to use solution


STABILITY Remaining solution should be discarded.

INCOMPATIBILITY -

REMARKS Protect from light Do not refrigerate

Reference :

46. PRODUCT LEAFLET : Ciproxol Ain Medicare Sdn. Bhd.

22.0 CIPROFLOXACIN INJECTION

49


22.2 BRAND : Ciprobay ®

22.3 BRAND : Ufexil ®

(Brands above have same information)





STABILITY Remaining solution should be discarded.

INCOMPATIBILITY Heparin, penicillins

REMARKS Inspect for particulate matters and discoloration prior to administration. Only clear and colourless or slightly yellow solution can be used

References :

47. PRODUCT LEAFLET : Ciprobay, Bayer Co. (Malaysia) Sdn Bhd. 48. PRODUCT LEAFLET : Ufexil DEMO S.A.

22.0 CIPROFLOXACIN INJECTION

50


23.1 BRAND : Dalacin C ®



IM : Inject directly IV infusion : Final diluted concentration must be ≤18mg/ml

i) 300mg : Reconstitute with 50ml NS ii) 600mg : Reconstitute with 100ml NS iii) 900mg : Reconstitute with 150ml NS iv) 1200mg: Reconstitute with 200ml NS

ADMINISTRATION

IM : ONLY for dose ≤600mg IV Infusion :

i) Dose of 300mg : over 10 minutes ii) Dose of 600mg : over 20 minutes iii) Dose of 900mg : over 30 minutes iv) Dose of 1200mg: over 45 minutes


INCOMPATIBILITY Ampicillin, Phenytoin Sodium, Diphenyldantoin, Barbiturates, Aminophylline, Calcium Gluconate, Magnesium Sulphate, Ceftriaxone Sodium and Ciprofloxacin

REMARKS -

Reference :

49. PRODUCT LEAFLET : Dalacin C, Pfizer Inc.

23.0 CLINDAMYCIN INJECTION

51


23.2 BRAND : Tidact ®



IM : Inject directly IV infusion : Final diluted concentration must be ≤18mg/ml

i) Dose of 300mg : Reconstitute with 50ml NS. ii) Dose of 600mg : Reconstitute with 100ml NS. iii) Dose of 900mg : Reconstitute with 150ml NS. iv) Dose of 1200mg: Reconstitute with 200ml NS.

ADMINISTRATION

IM : ONLY for dose ≤600mg IV Infusion :

i) Dose of 300mg : over 10 minutes. ii) Dose of 600mg : over 20 minutes. iii) Dose of 900mg : over 30 minutes. iv) Dose of 1200mg: over 45 minutes.

Maximum Rate: <30mg/min


INCOMPATIBILITY -

REMARKS Avoid refrigerate

Reference :

50. PRODUCT LEAFLET : Tidact, Yung Shin Pharmaceutical Ind. Co., Ltd.

23.0 CLINDAMYCIN INJECTION

52


24.1 BRAND : Cloxacillin Sodium ®

STRENGTH 250mg powder 500mg powder


IM : 250mg : Reconstitute with 1.9ml WFI 500mg : Reconstitute with 1.7ml WFI IV Slow bolus : 250mg : Add 4.9ml WFI 500mg : Add 4.8ml WFI IV Infusion : Reconstitute with 5ml WFI Further dilute with 125ml to 250ml of NS Continuous infusion : Reconstitute with 5ml WFI Further dilute with 250ml NS (Dose ≤ 500mg) or 500ml NS (Dose > 500mg) Recommended concentration: 2mg/ml.

ADMINISTRATION

IM Slow IV bolus over 3 - 4 minutes IV infusion: 60 minutes Continuous IV Infusion : 6 -12 hours

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours - - -

INCOMPATIBILITY Beta lactamase antibacterials, aminoglycosides. They should be administered in separate sites at least 1 hour apart

REMARKS -

Reference :

51. PRODUCT LEAFLET : Cloxacillin Sodium, Karnataka Antibiotics & Pharmaceuticals Ltd.

24.0 CLOXACILLIN INJECTION

53


25.1 BRAND : Doribax ®



IV : Reconstitute with 10ml WFI / NS

Further dilute with 100ml NS/ D5

ADMINISTRATION IV infusion over 1 hour

STABILITY


RT 2 - 8°C RT 2 - 8°C

1 hour - 12 hours (NS) 4 hours (D5)

72 hours (NS) 24 hours (D5)

INCOMPATIBILITY -

REMARKS -

References:

54. PRODUCT LEAFLET : Doribax, Shionogi & Company Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


25.0 DORIPENEM INJECTION


54


26.1 BRAND : Invanz ®



IM : Reconstitute with 3.2ml of 2% Lignocaine HCl Injection IV : Reconstitute with 10ml NS

Further dilute with 50ml NS

ADMINISTRATION IM : Deep IM


STABILITY


RT 2 - 8°C RT 2 - 8°C


immediately)

6 hours 24 hours

INCOMPATIBILITY Do not use diluents containing dextrose

REMARKS -

Reference :

55. PRODUCT LEAFLET : Invanz, Laboratories Merck Sharp & Dohme-Chibret.

26.0 ERTAPENEM INJECTION

55


27.1 BRAND : Erythromycin 500mg Injection



IV : Reconstitute with 10 ml WFI Further dilute with 100 - 500 ml of NS/ D5 to a concentration of 1-5 mg/ml

ADMINISTRATION Intermittent infusion over 20 - 60 minutes

STABILITY Information not available (Use immediately after reconstitution)

INCOMPATIBILITY -

REMARKS Bolus injection is not recommended

References :

56. PRODUCT LEAFLET : Erythromycin 500mg Injection Fisiopharma S.r.L. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


27.0 ERYTHROMYCIN INJECTION


56


28.1 BRAND : Diflucan ®




ADMINISTRATION IV infusion over 1 - 2 hour (Maximum rate 200mg/ hour)

STABILITY Single use. Discard any unused portion

INCOMPATIBILITY -

REMARKS -

Reference : 57. PRODUCT LEAFLET : Diflucan, Pfizer.

28.0 FLUCONAZOLE INJECTION

57


29.1 BRAND : Garasent ®



IM/ IV: Inject directly without further dilution IV infusion : Further dilute with 100 – 200 ml of NS/D5 (Maximum concentration: 1 mg/ ml)

ADMINISTRATION IM Slow IV bolus over 2 - 3 minutes IV infusion over 20 - 30 minutes


INCOMPATIBILITY -

REMARKS -

Reference : 58. PRODUCT LEAFLET : Garasent, Duopharma (M) Sdn Bhd.

29.0 GENTAMICIN INJECTION

58


30.1 BRAND : Tienem ®

STRENGTH 500mg Imipenem & 500mg Cilastatin powder


IV : Reconstitute with 10 ml of NS/ D5 Further dilute to 100 ml of NS/ D5

ADMINISTRATION IV: Dose imipenem ≤ 500 mg: over 20 – 30 minutes Dose imipenem > 500 mg: over 40 – 60 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C


immediately)

INCOMPATIBILITY -

REMARKS -

Reference : 59. PRODUCT LEAFLET : Tienem Merck Sharp & Dohme.

30.0 IMIPENEM + CILASTATIN INJECTION

59


31.1 BRAND : Kanamycin Sulphate Injection Meiji

31.2 BRAND : Kanamycin Injection Yung Shin

31.3 BRAND : Kancin-L ®

(Brands above have same information)

STRENGTH 1g in 3ml


Inject directly

ADMINISTRATION IM


INCOMPATIBILITY -

REMARKS -

References :

60. PRODUCT LEAFLET : Kanamycin sulfate injection meiji, Thai Meiji Pharmaceutical Co., Ltd.

61. PRODUCT LEAFLET : Kanamycin injection “Yung Shin”, Yung Shin Pharmaceutical Ind. Co., Ltd.

62. PRODUCT LEAFLET : Kancin-L, Altantic Laboratories Corporation Ltd.

31.0 KANAMYCIN INJECTION

60


32.1 BRAND : Cravit ®



Ready to use solution.

ADMINISTRATION IV Infusion : Slowly over a period of not less than 60 - 90 minutes

STABILITY Samples containing visible particles should be discarded. To be used within 3 hours of opening (rubber stopper perforation)

INCOMPATIBILITY There is no data concerning interaction but quinolones should not be co-administered with any solution containing multivalent cations (e.g. magnesium), through the same line.

REMARKS

Avoid rapid or bolus IV infusion (may lead to hypotension) (Appearance : Sterile, clear, greenish-yellow isotonic solution)

References :

63. PRODUCT LEAFLET : Cravit, Daiichi Sankyo. 100. MIMS Online; http://online1.mimsgateway.com.my.

32.0 LEVOFLOXACIN INJECTION


61


32.2 BRAND : Levofloxol ®



Ready to use infusion solution

ADMINISTRATION

IV infusion over a period of not less than 60 or 90 minutes, depending on the dosage. The recommended infusion time at least: - 30 minutes for 250 mg - 60 minutes for 500mg

STABILITY Use immediately

INCOMPATIBILITY LEVOFLOXOL should not mixed with heparin or alkaline solutions (eg: sodium hydrogen carbonate)

REMARKS Rapid or bolus IV must be avoided

Reference :

64. PRODUCT LEAFLET : Levofloxol Ain Medicare Sdn. Bhd.


62


32.3 BRAND : Glevo I.V ®



IV : 250mg dose Dilute with NS/ D5 to final volume 50ml 500mg dose Dilute with NS/ D5 to final volume 100ml 750mg dose Dilute with NS/ D5 to final volume 150ml

ADMINISTRATION

Infuse over at least: - 30 minutes for 250mg - 60 minutes for 500mg - 90 minutes for 750mg

STABILITY

Dilution in NS/ D5:


RT 2 - 8°C RT 2 - 8°C

- - 72 hours 14 days

INCOMPATIBILITY Not to be mixed with certain other solutions ( e.g. Sodium Hydrogen Carbonate) or with heparin

REMARKS Rapid or bolus IV must be avoided

References :

65. PRODUCT LEAFLET : Glevo I.V Glenmark Pharma. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics, Greenwood Village, Colorado, USA.



63


33.1 BRAND : Zyvox ®



Withdraw required dose without further dilution

ADMINISTRATION IV Infusion over 30 - 120 minutes


INCOMPATIBILITY

All drugs below must be avoided in co-administration with Linezolid in Y-site:

- Amphotericin B

- Chlorpromazine HCl

- Diazepam

- Pentamidine Isothionate

- Phenytoin Sodium

- Erythromycin Lactobionate

- Trimethoprim-sulfamethoxazole

REMARKS - Protect from light - Do not use this infusion bag in series connections - Additives should not be introduced into this solution

References :

66. PRODUCT LEAFLET : Zyvox Pfizer Inc. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


33.0 LINEZOLID INJECTION


64


34.1 BRAND : Meronem ®



IV : i) 500mg : Reconstitute with 10ml WFI ii)1 : Reconstitute with 20ml WFI Further dilute with 50 - 500ml NS/D5

ADMINISTRATION Infusion over 15 - 30 minutes

STABILITY

If diluted in D5 : Use it immediately


RT 2 - 8°C RT 2 - 8°C

3 hours 12 hours 3 hours (NS) 24 hours (NS)

INCOMPATIBILITY -

REMARKS -

Reference : 67. PRODUCT LEAFLET : Meronem, AstraZeneca.

34.0 MEROPENEM INJECTION

65


34.2 BRAND : DBL Meropenem ®



IV : i) 500mg : Reconstitute with 10ml WFI ii)1g : Reconstitute with 20ml WFI Further dilute with 50 - 200ml NS/ D5

ADMINISTRATION Slow IV bolus over 5 minutes for reconstituted solution Infusion over 15 - 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

8 hours (WFI)

24 hours (WFI)


24 hours(NS) 14 hours (D5)

INCOMPATIBILITY -

REMARKS -

Reference :

68. PRODUCT LEAFLET : DBL TM Meropenem Hospira NZ Limited.


66


34.3 BRAND : Monem ®



IV : i) 500mg : Reconstitute with 10ml WFI ii)1g : Reconstitute with 20ml WFI Further dilute with 50 - 500ml NS/D5

ADMINISTRATION Slow IV bolus over 3 - 5 minutes for reconstituted solution Infusion over 15 - 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

2 hours (WFI)

12 hours (WFI)


18 hours(NS) 8 hours (D5)

INCOMPATIBILITY

Incompatible with drug containing solution of : (avoid the combination of both drugs in Y-site)

- Acyclovir sodium

- Calcium gluconate

- Diazepam

- Doxycycline hyclate

- Ondansetron

REMARKS -

References :

69. PRODUCT LEAFLET : Monem, Biolab. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics, Greenwood Village, Colorado, USA.



67


34.4 BRAND : Meraparon ®



IV : i) 500mg : Reconstitute with 10ml WFI ii)1g : Reconstitute with 20ml WFI Further dilute with 50 - 200ml NS/ D5

ADMINISTRATION Slow IV bolus over 5 minutes for reconstituted solution Infusion over 15 - 30 minutes

STABILITY Use immediately

INCOMPATIBILITY -

REMARKS -

Reference :

70. PRODUCT LEAFLET : Meraparon, Novartis Corporation.


68


35.1 BRAND : Metronidazole 500mg Injection 35.2 BRAND : Metronol ® 35.3 BRAND : Metrogyl ® (Brands above have same information)



Infuse directly according the dose needed

ADMINISTRATION Infusion over 20 - 60 minutes


INCOMPATIBILITY -

REMARKS -

References :

71. PRODUCT LEAFLET : Metronidazole, B. Braun Medical Industries Sdn. Bhd. 72. PRODUCT LEAFLET : Metronol Ain Medicare Sdn. Bhd. 73. PRODUCT LEAFLET : Metrogyl, Unique Pharmaceutical Laboratories.

35.0 METRONIDAZOLE INJECTION

69


36.1 BRAND : Avelox ®



Infuse directly according to the dose needed If necessary , further dilute with the NS/D5

ADMINISTRATION Infusion over 60 minutes

STABILITY Do not refrigerate – product precipitates upon refrigeration Diluted solution stable over 24 hours at room temperature

INCOMPATIBILITY -

REMARKS Only clear solutions are to be used

References :

74. PRODUCT LEAFLET : Avelox, Bayer Schering Pharma AG, Germany. 100. MIMS Online; http://online1.mimsgateway.com.my.

36.0 MOXIFLOXACIN INJECTION


70


37.1 BRAND : Lotifar ®

STRENGTH 100mg in 2ml 150mg in 2ml


IV : Dilute with 50 - 200ml NS /D5

ADMINISTRATION

IM: inject directly Infusion over 1½ to 2 hours (preferable) Slow IV bolus over 3 - 5 minutes

STABILITY

Do not freeze

After Dilution

RT 2 - 8°C

1 week at concentration of 3mg/ml


immediately)

INCOMPATIBILITY -

REMARKS

Dark yellow solutions should not be used LOTIFAR 100 MG/2 ML INJECTION is a clear, pale straw coloured solution LOTIFAR 150 MG/2 ML INJECTION is a clear, colourless to pale yellow solution

References :

75. PRODUCT LEAFLET : Lotifar, Duopharma (M) Sdn Bhd. 100. MIMS Online; http://online1.mimsgateway.com.my.

37.0 NETILMYCIN INJECTION


71


37.2 BRAND : Nelin ®

STRENGTH 100mg in 2ml 150mg in 1.5ml


IV : Dilute with 50 - 200ml NS / D5

ADMINISTRATION

IM: inject directly Infusion over 1½ to 2 hours Slow IV bolus over 3 - 5 minutes

STABILITY

After Dilution

RT 2 - 8°C

Use immediately Information not available (recommend to use

immediately)

Use within 3 days after opening

INCOMPATIBILITY -

REMARKS -

References : 76. PRODUCT LEAFLET : Nelin, Biolab Co.,LTD. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


37.0 NETILMYCIN INJECTION


72


38.1 BRAND : DBL Pentamidine Isethionate Injection ®



IM/IV : Reconstitute with 3 - 5ml WFI/ D5

IV Infusion : Withdraw required dose then further dilute with 50 - 250ml D5/ NS

ADMINISTRATION

IM: Inject directly after reconstitution

Slow IV infusion with a patient in a supine position (to reduce sudden severe hypotension. Infused over 1- 2 hour (the patient is kept lying down)

Direct IV bolus or rapid administration MUST NOT be used

STABILITY


RT 2 - 8°C RT 2 - 8°C

48 hours under fluorescent

light

48 hours for concentration

100mg/ml and 60mg/ml

48 hours under fluorescent light for concentration

1.0mg/ml and 2.5mg/ml

-

*To avoid microbial contamination, the prepared solution should be used within 24 hours

INCOMPATIBILITY -

REMARKS Any solution which are hazy, discolored or contain visible particulate matter should not be used

References : 77. PRODUCT LEAFLET : DBL Pentamidine Isethionate Injection Hospira Australia Pty

Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


38.0 PENTAMIDINE INJECTION


73


39.1 BRAND : Tazpen ®



IV : Reconstitute with 20ml WFI/ NS Further dilute with 50ml NS/ WFI/ D5

ADMINISTRATION Slow IV bolus over 3 – 5 minutes Infusion over 20 – 30 minutes

STABILITY

Vials should not be frozen after reconstitution


RT 2 - 8°C RT 2 - 8°C

24 hours 48 hours Information not available (recommend to use immediately)

INCOMPATIBILITY Aminoglycosides, Heparin, Vecuronium, Methotrexate

REMARKS -

Reference : 78. PRODUCT LEAFLET : Tazpen, Strides Arcolab Ltd.

39.0 PIPERACILLIN + TAZOBACTAM INJECTION

74


39.2 BRAND : DBL Piperacillin And Tazobactam For Injection ®



IV : Reconstitute with 10ml WFI/ NS for 2.25g vial Reconstitute with 20ml WFI/ NS for 4.5g vial

Further dilute with 50ml NS or D5

ADMINISTRATION Slow infusion over 20 - 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

-

24 hours Use immediately

INCOMPATIBILITY Lactated ringer solution, solution containing only Sodium Bicarbonate or having pH basic range

REMARKS -

Reference : 79. PRODUCT LEAFLET : DBL Piperacillin And Tazobactam For Injection Hospira NZ

Limited.


75


39.3 BRAND : Tapicin ®


BRAND NAME Tapicin®


IV : Reconstitute with 10ml WFI/ NS for 2.25g vial Reconstitute with 20ml WFI/ NS for 4.5g vial

Further dilute with 50ml - 150ml NS/ D5

ADMINISTRATION Slow IV bolus over 3 - 5 minutes IV infusion over 20 - 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours 7days Use immediately

INCOMPATIBILITY Aminoglycoside, high dose Heparin, oral anticoagulants, Vecuronium, Methotrexate, solution containing Sodium Bicarbonate

REMARKS -

Reference : 80. PRODUCT LEAFLET : Tapicin, Yung Shin Pharmaceutical (M) Sdn Bhd.


76


39.4 BRAND : Tazocin EF ®


BRAND NAME Tazocin EF Injection 4.5g


IV : Reconstitute with 20ml WFI/ NS/ D5 for 4.5g vial

Further dilute with 50ml to 150ml NS/ WFI/ D5 *Maximum recommended volume of WFI per dose is 50ml

ADMINISTRATION Slow IV bolus over 3 - 5 minutes IV infusion over 20 - 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours 48 hours Use Immediately

Not to be frozen

INCOMPATIBILITY Aminoglycoside, solutions containing Sodium Bicarbonate alone or solutions that significantly alter the pH, blood products or Albumin hydrolysates

REMARKS -

Reference : 81. PRODUCT LEAFLET : Tazocin EF Pfizer Limited.


77


40.1 BRAND : Poly-B ®

STRENGTH 500,000 units powder


IM : Reconstitute with 2ml WFI /NS

IV : Reconstitute with 5ml of D5 Further dilute with 300 – 500ml of D5 Intrathecal: Reconstitute with 10ml NS

ADMINISTRATION

IM (not recommended routinely because of severe pain at injection sites particularly in infants and children)

IV: infusion durations of 60 - 120 minutes Intrathecal (treatment of choice for Ps. Aeruginosa meningitis) : Administer 50, 000 units (1ml) intrathecally

STABILITY


RT 2 - 8°C RT 2 - 8°C

- 72 hours Information not available (recommend to use immediately)

INCOMPATIBILITY -


References:

82. PRODUCT LEAFLET : Polymyxin B for injection USP, XGen Pharmaceuticals Inc. 83. PRODUCT LEAFLET : Poly-B, Samarth Life Sciences Pt Ltd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


40.0 POLYMYXIN B INJECTION


78


41.1 BRAND : Streptin ®

STRENGTH 1g powder


IM : Reconstitute with 3.2 - 3.5ml of WFI/NS (final concentration : 250mg/ml)


STABILITY


RT 2 - 8°C RT 2 - 8°C


INCOMPATIBILITY -

REMARKS Protect from light and freezing. Exposure to light causes darkening of solution without apparent loss of potency

References :

84. PRODUCT LEAFLET : Streptin, SM Pharmaceuticals Sdn Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,


41.0 STREPTOMYCIN INJECTION


79


41.2 BRAND : Meiji ®

STRENGTH 1g powder


IM : Reconstitute with 3.2ml of WFI/NS (final concentration : 250mg/ml)

Inhalation : Reconstitute with 5ml of NS Further dilute with 25 - 50ml NS

ADMINISTRATION

IM

Inhalation: Nebulize and inhale 1 -15ml of solution every 4 to 6hrs


INCOMPATIBILITY -

REMARKS Protect from light Concomitant IM may be required in many cases for inhaled streptomycin

References :

85. PRODUCT LEAFLET : Meiji, PT Meiji Indonesian Pharmaceutical Industries. 102. Medscape : Streptomycin. Incompatibility;

http://reference.medscape.com/drug/streptomycin-342682#11.


http://reference.medscape.com/drug/streptomycin-342682#11

80


41.3 BRAND : Sterile Streptomycin Sulfate For Injection

STRENGTH 1g powder


IM : Reconstitute with 3.2ml of WFI (final concentration : 250mg/ml)



INCOMPATIBILITY

-


Reference :

86. PRODUCT LEAFLET : Sterile Streptomycin Sulfate for Injection, Karnataka Antibiotics & Pharmaceuticals Limited.


81


42.1 BRAND : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg

STRENGTH Sulfamethoxazole 400mg/ Trimethoprim 80mg


IV : Dilute : 1 ampoule to 125ml NS/ D5 2 ampoule to 250ml NS/ D5 3 ampoule to 500ml NS/ D5 In fluid restriction, dilute 1 ampoule to 75ml D5

ADMINISTRATION IV infusion should not exceed 1½ hours

STABILITY


RT 2 - 8°C RT 2 - 8°C

Information not available (recommend to use immediately)

24 hours NA

INCOMPATIBILITY -

REMARKS Do not administer IM

References :

87. PRODUCT LEAFLET : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg Hameln pharmaceuticals GmbH.

99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics, Greenwood Village, Colorado, USA.

42.0 SULFAMETHOXAZOLE + TRIMETHOPRIM INJECTION


82


43.1 BRAND : Vancomycin Hydrochloride for Injection



IV : 500mg : Reconstitute with 10ml of WFI Further dilute with at least 100 ml of NS/ D5 1g : Reconstitute with 20ml of WFI Further dilute with at least 200 ml of NS/ D5 (Maximum concentration: 5mg/ml)

ADMINISTRATION

≤1g : Infusion over a period of at least 60 minutes, or at maximum infusion rates of 10mg/min, whichever is longer

>1g: Infusion at rate 10mg/min

STABILITY


RT 2 - 8°C RT 2 - 8°C

2 days 14 days - 14 days (D5 or NS)

INCOMPATIBILITY -

REMARKS Concentrations of not more than 5mg/ml and rates of not more than 10mg/min are recommended to prevent infusion related reaction ( Red Man Syndrome)

References :

88. PRODUCT LEAFLET : Vancomycin Hydrochloride for Injection, USP, Hospira Inc. 103. http://www.globalrph.com/vancomycin_dilution.htm.

43.0 VANCOMYCIN INJECTION

http://www.globalrph.com/vancomycin_dilution.htm

83


43.2 BRAND : Vancotex Injection 500mg



IV : For 500mg : Reconstitute with 10ml of WFI Further dilute with at least 100 ml of NS/D5

ADMINISTRATION

≤1g : Infusion over a period of at least 60 minutes, or at maximum infusion rates of 10mg/min, whichever is longer

>1g: Infusion at rate 10mg/min

STABILITY Freshly prepared and discard the unused portion

INCOMPATIBILITY -

REMARKS Maximum concentration allowed is 10mg/ml for fluid restriction but increased the risk of infusion-related effects ( Red Man Syndrome)

Reference :

89. PRODUCT LEAFLET : Vancotex Injection Fisiopharma S.r.L, Nucleo Industriale.

43.0 VANCOMYCIN INJECTION

84


44.1 BRAND : Vfend ®



IV : Reconstitute with 19ml WFI (final concentration: 10mg/ml) Withdraw the required amount of 10mg/ml VFEND concentrate (Refer Table 1) Then, further dilute the concentrate with NS/ D5 up to:- i) 50ml : Dose of 25 - 250mg ii) 100ml : Dose of 251 - 500mg iii) 150ml : Dose of 501 - 600mg (final concentration should be within 0.5 - 5mg/ml)

ADMINISTRATION Infusion over 1 - 2 hours At a maximum rate of 3mg/kg/hour

STABILITY


RT 2 - 8°C RT 2 - 8°C


INCOMPATIBILITY Blood products and concentrated electrolytes MUST NOT be infused concomitantly with Voriconazole even in separate infusion lines

REMARKS Not recommended for bolus injection Refer to table 1 for required volumes of 10mg/ml VFEND Concentrate table

Reference ;

90. PRODUCT LEAFLET : Vfend, Pfizer Inc.

44.0 VORICONAZOLE INJECTION

85


Table 1

Required Volumes of 10 mg/ml VFEND Concentrate

Body Weight

(kg)

Volume of VFEND Concentrate (10mg/ml) required for:

3 mg/kg dose (number of

vials)


vials)


vials)


vials)


vials)

10 - 4.0ml (1) - 8.0 ml (1) 9.0 ml (1)

15 - 6.0ml (1) - 12.0 ml (1) 13.5 ml (1)

20 - 8.0ml (1) - 16.0 ml (1) 18.0 ml (1)

25 - 10.0ml (1) - 20.0 ml (1) 22.5 ml (2)

30 9.0ml (1) 12.0ml (1) 18.0ml (1) 24.0 ml (2) 27.0 ml (2)

35 10.5ml (1) 14.0ml (1) 21.0ml (2) 28.0 ml (2) 31.5 ml (2)

40 12.0ml (1) 16.0ml (1) 24.0ml (2) 32.0 ml (2) 36.0 ml (2)

45 13.5ml (1) 18.0ml (1) 27.0ml (2) 36.0 ml (2) 40.5 ml (3)

50 15.0ml (1) 20.0ml (1) 30.0ml (2) 40.0 ml (2) 45.0 ml (3)

55 16.5ml (1) 22.0ml (2) 33.0ml (2) 44.0 ml (3) 49.5 ml (3)

60 18.0ml (1) 24.0ml (2) 36.0ml (2) 48.0 ml (3) 54.0 ml (3)

65 19.5ml (1) 26.0ml (2) 39.0ml (2) 52.0 ml (3) 58.5 ml (3)

70 21.0ml (2) 28.0ml (2) 42.0ml (3) - -

75 22.5ml (2) 30.0ml (2) 45.0ml (3) - -

80 24.0ml (2) 32.0ml (2) 48.0ml (3) - -

85 25.5ml (2) 34.0ml (2) 51.0ml (3) - -

90 27.0 ml (2) 36.0 ml (2) 54.0 ml (3) - -

95 28.5 ml (2) 38.0 ml (2) 57.0 ml (3) - -

100 30.0 ml (2) 40.0 ml (2) 60.0 ml (3) - -

86


45.1 BRAND : Retro ®



MUST be diluted prior to administration IV : Withdraw the required dose from the vial Then, further dilute with D5 up to :- i) 50ml : Dose of ≤200mg ii) 100ml : Dose of 201 – 400mg (final concentration should NOT exceed 4mg/ml)

ADMINISTRATION

Intermittent infusion: Infused over 1 hour

Continuous infusion (Prevention of maternal - fetal HIV transmission): 2mg/kg infused over 1 hour, followed by 1mg/kg/hr until umbilical cord is clamped

STABILITY


RT 2 - 8°C RT 2 - 8°C


48 hours

INCOMPATIBILITY -


References :

91. PRODUCT LEAFLET : Retro, Glaxo Wellcome Operations, ViiV Healthcare. 107. http://www.globalrph.com/zidovudine_dilution.htm.

45.0 ZIDOVUDINE INJECTION

http://www.globalrph.com/zidovudine_dilution.htm

87


1. Daptomycin Injection

BRAND : Cubicin ®

STRENGTH 500 mg lyophilized powder


IV : Reconstitute with 10ml NS Further dilute with 50ml NS

ADMINISTRATION IV : i) IV slow bolus, Inject over 2 minutes after reconstitution ii) Infuse over 30 minutes

STABILITY


RT 2 - 8°C RT 2 - 8°C

12 hours 48 hours 12 hours 48 hours

INCOMPATIBILITY Dextrose containing diluents

REMARKS AVOID vigorous shaking of the vial during or after reconstitution

References : 92. PRODUCT LEAFLET : Cubicin, Cubist Pharmaceuticals, Inc. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,

Greenwood Village, Colorado, USA. 108. http://www.globalrph.com/daptomycin_dilution.htm.

NON-FORMULARY INJECTION


http://www.globalrph.com/daptomycin_dilution.htm

88


2. Liposomal Amphotericin B Injection

BRAND : Ampholip ®



IV : Further dilute with 40ml of D5 (1mg/ml)

ADMINISTRATION IV : Infuse at a rate of 2.5 mg/kg/hr


INCOMPATIBILITY NS

REMARKS

Protect from light

Do not use an on-line microbial filter

Desired dose should withdraw using an 18G needle

Further dilution should done using 5μ filter needle

supplied with each vial pack

Mix the contents of the bag by shaking the infusion

bag every two hours

An existing IV line should flushed with D5 before

infusion of Ampholip

An initial test dose of 1.0 mg should be infused

intravenously over 15 minutes

Reference : 93. PRODUCT LEAFLET : Ampholip Bharat Serums And Vaccines Limited


89


3. Micafungin Sodium Injection

BRAND : Mycamine ®



IV : Reconstitute with 5ml of NS/ D5 Further dilute with 100ml with NS/ D5

ADMINISTRATION IV: Infuse over 1 hour

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours NA 24 hours NA

INCOMPATIBILITY -

REMARKS

Protect from light More rapid infusions may result in more frequent histamine mediated reaction

Reference : 94. PRODUCT LEAFLET : Mycamine, Cubist Pharmaceuticals, Inc.


90


4. Colistimethate Sodium (Polymyxcin E) Injection

BRAND : Colomycin ®

STRENGTH One million units powder


IV : Reconstitute with 10ml of NS Further dilute with 50ml NS Nebusation solution : 1 million unit – add 2ml NS 2 million unit – add 4ml NS

ADMINISTRATION

IV : Infuse over 30 minutes

If Totally Implantable Venous Access Device (TIVAD) in place, bolus injection of up to 2 million units in 10ml given over a minimum of 5 minutes

STABILITY

Preparation After Reconstitution

After Dilution

RT 2 - 8°C RT 2 - 8°C

Intravenous NA 24 hours NA 24 hours

Nebulisation solution

NA 24 hours NA NA

INCOMPATIBILITY -

REMARKS -

References : 95. PRODUCT LEAFLET : Colomycin, Xellia Pharmaceuticals APS. 104. https://www.medicines.org.uk/emc/medicine/1590.


http://www.medicines.org.uk/emc/medicine/1590

91


5.1 Tigecyclin Injection

BRAND : Tygacil ®

STRENGTH 50 mg lyophilized powder


IV : Reconstitute with 5.3mL* of NS/ D5 Withdraw 5ml from reconstituted solution & further dilute with 100ml with NS/ D5

Maximum concentration per bag 1mg/ml

ADMINISTRATION IV : Infusion over 30 minutes to 1 hour

STABILITY


RT 2 - 8°C RT 2 - 8°C

24 hours

NA 24 hours 48 hours

INCOMPATIBILITY -

REMARKS -

* Each vial contains a 6% overage. Thus, 5ml of reconstituted solution is equivalent to

50mg of the drug

References : 96. PRODUCT LEAFLET : Tygacil, Wyeth Pharmaceuticals Inc. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,




92


6.0 Pentamidine Isethionate BP Injection

BRAND : Pentacarinat ®



Nebulisation solution : Add 4 - 6mL of WFI IM : Reconstitute with 3ml WFI IV infusion : Reconstitute with 3 - 5ml WFI Further dilute with 50ml - 250ml with NS /D5

ADMINISTRATION IV infusion : Infuse over 1 hour

STABILITY


RT 2 - 8°C RT 2 - 8°C


NA 24 hours

INCOMPATIBILITY -

REMARKS

Sudden, severe hypotension may occur after a single dose of Pentamidine Isethionate has been given parenterally: - Baseline blood pressure should be established - Patients should receive the drug during lying down - Blood pressure should be closely monitored

* Reserved for nebulization only.

If IV needed , use brand DBL Pentamidine (refer to 4.38 Pentamidine Inj; page 72)

References : 97. PRODUCT LEAFLET : Pentacarinat Sanofi-aventis New Zealand Limited. 109. Martidale : The Complete Drug Reference. 33th ed.


93


7. Quinine Dihydrochloride Injection

BRAND : Malakin Injection 2mL ®



IV : Dilute with 250ml - 500ml NS

ADMINISTRATION

IV :

i. 7 mg dihydrochloride salt/kg infused over 30 minutes

Followed by 10mg salt/kg over a period of 4 hours

ii. For severe malaria : 20 mg of the dihydrochloride salt (16.7

mg base)/kg infused over 4 hours

Followed by 10mg salt/kg infused over 2 - 8 hours


INCOMPATIBILITY -

REMARKS -

References : 98. PRODUCT LEAFLET : Malakin Injection Duopharma (M) Sdn Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,




94


BW : Body weight

D5 : Dextrose 5%

GA : General Anaesthesia

IM : Intramuscular

IV : Intravenous

LR : Lactate Ringer

N/A : Not Applicable

NS : Sodium Chloride 0.9%

RF : Refrigerator (2 - 8 C)

RT : Room Temperature (15 - 30 C)

SC : Subcutaneous

WFI : Water For Injection

Wt : Weight

ABBREVIATION

95


REFERENCES:

1. PRODUCT LEAFLET : Zovirax For Infusion 250mg, GlaxoSmithKline. 2. PRODUCT LEAFLET : Medovir 250mg Injectible, Medochemie. 3. PRODUCT LEAFLET : DBL Acyclovir Hospira. 4. PRODUCT LEAFLET: Vaxcel Acyclovir Kontra Pharma. 5. PRODUCT LEAFLET : Eraxis, Pfizer. 6. PRODUCT LEAFLET : Apalin, CCM Duopharma Bio Tech. 7. PRODUCT LEAFLET : Selemycin Medochemie Ltd, Cyprus. 8. PRODUCT LEAFLET : Augmentin Intravenous GlaxoSmithKline 9. PRODUCT LEAFLET : Clamentin Injection, Yung Shin Pharmaceutical Ind. Co., Ltd. 10. PRODUCT LEAFLET : Co-Amoxiclav Injection Averroes Pharmaceuticals Sdn Bhd. 11. PRODUCT LEAFLET : Ampicillin Sodium for Injection B, Karnataka Antibiotics &

Pharmaceuticals Limited, India; July 2009. 12. PRODUCT LEAFLET : Pamecil, Medochemie Ltd, Selangor. 13. PRODUCT LEAFLET : Standacillin, Sandoz. 14. PRODUCT LEAFLET : Ampicillin & Sulbactam powder for injection Karnataka

Antibiotics & Pharmaceuticals Limited, India; August 2010. 15. PRODUCT LEAFLET : Sulbacin, Unichem. 16. PRODUCT LEAFLET : Amphotret Bharat Serums And Vaccines Ltd. 17. PRODUCT LEAFLET : Artesun, Guilin Pharmaceutical Co Ltd. 18. PRODUCT LEAFLET : Azee, Cipla United. 19. PRODUCT LEAFLET : Zitromax, Pfizer. 20. PRODUCT LEAFLET : Retarpen, Sandoz. 21. PRODUCT LEAFLET : Sterile Penicillin G benzathine 2.4 mega units, Karnataka

Antibiotics & Pharmaceuticals Limited, India; August 2010. 22. PRODUCT LEAFLET : Cancidas, Merck Sharp & Dohme. 23. PRODUCT LEAFLET : Cefazolin Sandoz. 24. PRODUCT LEAFLET : Reflin, Ranbaxy. 25. PRODUCT LEAFLET : Verapime, Demo S.A Pharmaceutical Industry. 26. PRODUCT LEAFLET : Vaxcel Cefepime Kotra Pharma (M) Sdn. Bhd. 27. PRODUCT LEAFLET : Forpar, Cipla (M) Sdn. Bhd. 2014. 28. PRODUCT LEAFLET : Megapime, Alkem Lab Ltd. 2006. 29. PRODUCT LEAFLET : Sefepim, Hovid Sdn Bhd. 2014. 30. PRODUCT LEAFLET : Rekaxime, Duopharma (M) Sdn Bhd. 2011. 31. PRODUCT LEAFLET : Claraxim, Siam Bheasach Co. Ltd. 2006. 32. PRODUCT LEAFLET : Claforan, Aventis Pharma. 33. PRODUCT LEAFLET : Vaxcel Cefotaxime, Kotra Pharma (M) Sdn.Bhd. . 34. PRODUCT LEAFLET : Bicafar, Duopharma (M) Sdn Bhd. 2012. 35. PRODUCT LEAFLET : Vaxcel Cefoperazone, Kotra Pharma (M) Sdn.Bhd. . 36. PRODUCT LEAFLET : Vaxcel Cefobactam, Kotra Pharma (M) Sdn.Bhd. . 37. PRODUCT LEAFLET : Cefper Biolab Co. LTD, 2009. 38. PRODUCT LEAFLET : Cefoperazone & Sulbactam 1.0G, Karnataka Antibiotics &

Pharmaceuticals Limited, 2010. 39. PRODUCT LEAFLET : Zinforo, Facta Farmaceutici S.p.A, October 2012. 40. PRODUCT LEAFLET : Cefatum, Duopharma (M) Sdn Bhd, 6 August 2010. 41. PRODUCT LEAFLET : Fortum, GlaxoSmithKline. 42. PRODUCT LEAFLET : Unocef, Duopharma (M) Sdn Bhd, 27 July 2010. 43. PRODUCT LEAFLET : Rocephin, Roche. 44. PRODUCT LEAFLET : Zinacef, GlaxoSmithKline.

REFERENCES

96


45. PRODUCT LEAFLET : Anikef Duopharma (M) Sdn Bhd, 2 September 2013. 46. PRODUCT LEAFLET : Ciproxol Ain Medicare Sdn. Bhd. 47. PRODUCT LEAFLET : Ciprobay, Bayer Co. (Malaysia) Sdn Bhd. 48. PRODUCT LEAFLET : Ufexil DEMO S.A. 49. PRODUCT LEAFLET : Dalacin C, Pfizer Inc. 50. PRODUCT LEAFLET : Tidact, Yung Shin Pharmaceutical Ind. Co., Ltd. 51. PRODUCT LEAFLET :Cloxacillin Sodium, Karnataka Antibiotics & Pharmaceuticals

Ltd. 52. PRODUCT LEAFLET : Penicilin G Sodium Sandoz, Sandoz GmbH 53. PRODUCT LEAFLET : Benzyl Penicillin For Injection, Karnataka Antibiotics &

Pharmaceuticals Ltd. 54. PRODUCT LEAFLET : Doribax, Shionogi & Company Ltd. 55. PRODUCT LEAFLET : Invanz, Laboratories Merck Sharp & Dohme-Chibret. 56. PRODUCT LEAFLET : Erythromycin 500mg Injection Fisiopharma S.r.L. 57. PRODUCT LEAFLET : Diflucan, Pfizer. 58. PRODUCT LEAFLET : Garasent, Duopharma (M) Sdn Bhd. 59. PRODUCT LEAFLET : Tienem Merck Sharp & Dohme. 60. PRODUCT LEAFLET : Kanamycin sulfate injection meiji, Thai Meiji Pharmaceutical

Co., Ltd. 61. PRODUCT LEAFLET : Kanamycin injection “Yung Shin”, Yung Shin Pharmaceutical

Ind. Co., Ltd. 62. PRODUCT LEAFLET : Kancin-L, Altantic Laboratories Corporation Ltd. 63. PRODUCT LEAFLET : Cravit, Daiichi Sankyo. 64. PRODUCT LEAFLET : Levofloxol Ain Medicare Sdn. Bhd. 65. PRODUCT LEAFLET : Glevo I.V Glenmark Pharma. 66. PRODUCT LEAFLET : Zyvox Pfizer Inc. 67. PRODUCT LEAFLET : Meronem, AstraZeneca. 68. PRODUCT LEAFLET : DBL TM Meropenem Hospira NZ Limited. 69. PRODUCT LEAFLET : Monem, Biolab. 70. PRODUCT LEAFLET : Meraparon, Novartis Corporation. 71. PRODUCT LEAFLET : Metronidazole, B. Braun Medical Industries Sdn. Bhd. 72. PRODUCT LEAFLET : Metronol Ain Medicare Sdn. Bhd. 73. PRODUCT LEAFLET : Metrogyl, Unique Pharmaceutical Laboratories. 74. PRODUCT LEAFLET : Avelox, Bayer Schering Pharma AG, Germany. 75. PRODUCT LEAFLET : Lotifar, Duopharma (M) Sdn Bhd. 76. PRODUCT LEAFLET : Nelin, Biolab Co.,LTD. 77. PRODUCT LEAFLET : DBL Pentamidine Isethionate Injection Hospira Australia Pty

Ltd. 78. PRODUCT LEAFLET : Tazpen, Strides Arcolab Ltd. 79. PRODUCT LEAFLET : DBL Piperacillin And Tazobactam For Injection Hospira NZ

Limited. 80. PRODUCT LEAFLET : Tapicin, Yung Shin Pharmaceutical (M) Sdn Bhd. 81. PRODUCT LEAFLET : Tazocin EF Pfizer Limited. 82. PRODUCT LEAFLET : Polymyxin B for injection USP, XGen Pharmaceuticals Inc. 83. PRODUCT LEAFLET : Poly-B, Samarth Life Sciences Pt Ltd. 84. PRODUCT LEAFLET : Streptin, SM Pharmaceuticals Sdn Bhd. 85. PRODUCT LEAFLET : Meiji, PT Meiji Indonesian Pharmaceutical Industries. 86. PRODUCT LEAFLET : Sterile Streptomycin Sulfate for Injection, Karnataka

Antibiotics & Pharmaceuticals Limited. 87. PRODUCT LEAFLET : DBL Sulfamethoxazole 400mg & Trimethoprim 80mg

Hameln pharmaceuticals GmbH. 88. PRODUCT LEAFLET : Vancomycin Hydrochloride for Injection, USP, Hospira Inc. 89. PRODUCT LEAFLET : Vancotex Injection Fisiopharma S.r.L, Nucleo Industriale. 90. PRODUCT LEAFLET : Vfend, Pfizer Inc. 91. PRODUCT LEAFLET : Retro, Glaxo Wellcome Operations, ViiV Healthcare.

97


92. PRODUCT LEAFLET : Cubicin, Cubist Pharmaceuticals, Inc. 93. PRODUCT LEAFLET : Ampholip Bharat Serums And Vaccines Limited 94. PRODUCT LEAFLET : Mycamine, Cubist Pharmaceuticals, Inc. 95. PRODUCT LEAFLET : Colomycin, Xellia Pharmaceuticals APS. 96. PRODUCT LEAFLET : Tygacil, Wyeth Pharmaceuticals Inc. 97. PRODUCT LEAFLET : Pentacarinat Sanofi-aventis New Zealand Limited. 98. PRODUCT LEAFLET : Malakin Injection Duopharma (M) Sdn Bhd. 99. Micromedex® 2.0; http://www.micromedexsolutions.com/ Truven Health Analytics,

Greenwood Village, Colorado, USA. 100. MIMS Online; http://online1.mimsgateway.com.my. 101. Drug Information Handbook. 23rd ed. Vol. 2014-2015: Hudson, Ohio, Lexi-Comp, Inc. 102. Medscape : Streptomycin. Incompatibility;

http://reference.medscape.com/drug/streptomycin-342682#11. 103. http://www.globalrph.com/vancomycin_dilution.htm. 104. https://www.medicines.org.uk/emc/medicine/1590. 105. Injectable Drugs Dilution 2010, Bahagian Perkhidmatan Farmasi Perak. 106. Guidelines on Reconstitution & Administration of Injectable Drugs. 2013, Hospital

Kuala Lipis. 107. http://www.globalrph.com/zidovudine_dilution.htm. 108. http://www.globalrph.com/daptomycin_dilution.htm. 109. Martidale : The Complete Drug Reference. 33th ed. 110. Medication Errors and Syringe Safety Are Top Concerns for Nurses According to

New National Study [press release].http://www.nursingworld.org/Functional Menu Categories/ Media Resources /Press Releases/2007

111. Intravenous Drugs Preparation & Administration Quick Reference, Medical Department & Pharmacy Department Kuala Lumpur Hospital, 2011 112. John D & Rebecca L, 2010. Guide to the Safe Preparation and Administration of Intravenous (IV) Antibiotics at Home. http://www.newcastle- hospitals.org.uk/downloads/cardiothoracic/Patient_info_- _safe_prep_and_admin_of_IV_ab.pdf 113. Dilution Protocol 2010, Hospital Selayang 2nd Edition



http://reference.medscape.com/drug/streptomycin-342682#11

http://www.globalrph.com/vancomycin_dilution.htm

http://www.medicines.org.uk/emc/medicine/1590

http://www.globalrph.com/zidovudine_dilution.htm

http://www.globalrph.com/daptomycin_dilution.htm

http://www.nursingworld.org/Functional%20Menu%20Categories/%20%09Media%20Resources%20/Press%20Releases/

http://www.nursingworld.org/Functional%20Menu%20Categories/%20%09Media%20Resources%20/Press%20Releases/

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