MOH/S/FAR/11.

20(GU)-e

PHARM AC EUT IC AL SERVICES PRO G R AM M E

MINISTRY OF HEALTH, MALAYSIA

DILUTION GUIDELINE
FOR INJECTABLE DRUGS
 DILUTION GUIDELINE
FOR INJECTABLE DRUGS
(Part I – Antimicrobial)
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

TABLE OF CONTENT

PAGE
CONTENT NUMBER

Disclaimer 4
Preface 4
Foreword 5
Ac k nowledgem ent 6
Reviewers 6
Accreditors 7
Editorial Board 8
Abbreviations & Acronyms 9
List of Drugs
■ Acyclovir Injection 10
■ Am ik acin Injection 11
■ Amoxicillin & Clavulanate Injection 12
■ Am photericin B Injection 13

2 ■ Am picillin Injection 14
■ Am picillin & Sulbactam Injection 15
■ Anidulafungin Injection 16
■ Artesunate Injection 17
■ Azithrom ycin Injection 18
■ Benzathine Penicillin Injection 19
■ Benzylpenicillin Injection 20
■ Caspofungin Acetate Injection 21
■ Cefazolin Injection 23
■ Cefepime Injection 24
■ Cefoperazone Injection 25
■ Cefoperazone & Sulbactam Injection 26
■ Cefotaxime Injection 27
■ Ceftazidime Injection 28
■ Ceftriaxone Injection 29
■ Cefuroxime Injection 31
■ Clindamycin Injection 32
■ Cloxacillin Injection 33
■ Ertapenem Injection 34
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

PAGE
CONTENT NUMBER

■ Erythrom ycin Lactobionate Injection 35

■ Ganciclovir Injection 36
■ Gentamicin Injection 37
■ I m i p e n e m & Cilastatin Injection 38
■ Mer openem Injection 39
■ Micafungin Injection 40
■ Netilm icin Injection 41
■ Pentam idine Isethionate Injection 42
■ Piperacillin & Tazobactam Injection 43
■ Sulphamethoxazole –T rim ethoprim Injection 44
■ Vancomycin Injection 45
■ Voriconazole Injection 46
■ Zidovudine Injection 48
Appendices 49
3
References 55
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

ACKNOWLEDGEMENT
Special thanks dedicated to everyone who were involved directly or indirectly in the establishment of
this guideline.

This guideline consumes enormous amount of work, time efforts and dedication. Thus,
Pharmaceutical Services Programme, Ministry of Health would like to extend our utmost gratitude to
all individuals and organizations that had provided valuable input, advice and information for this
guideline.

We are also grateful for the provision of expertise and technical support in the development of this
guideline. Hopefully, the information provided can lead to the improvements in quality and safe
medication practice.

REVIEWERS

◆ Mdm Phan Hui Sieng ◆ Mdm Norafidah Binti Idris

Senior Principal Assistant Director Pharmacist
Pharmacy Practice & Development Division Serdang Hospital
Sarawak State Health Department
6

◆ Mdm Poh Wei Yoon ◆ Mdm Nor Mazni Binti Mohamad Tamyes
Pharmacist Pharmacist
Selayang Hospital Tengku Am puan Rahimah Hospital

◆ Mdm Noor Liyana Binti Yusup ◆ Mr. Muhammad Faizal Bin Maarof
Pharmacist Pharmacist
Rantau Panjang Health Clinic Tuanku Am puan Najihah Hospital

◆ Mdm Merina Aw Kar Ling ◆ Mdm Ong Su Hua

Pharmacist Senior Principal Assistant Director
Kuala Lum pur Hospital Pharmacy Practice & Development Division
Pharmaceutical Services Programme
Ministry of Health
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

ACCREDITORS

◆ Mdm Fajaratunur Binti A. Sani ◆ Mr. Ahmad Ridza Bin Ahmad Nizam
Pharmacist Pharmacist
Johor Bahru District Health Office Tuanku A m p u a n Najihah Hospital

◆ Mdm Nur Mariana Binti Ayub ◆ Mdm Nurul Husna Binti Sodri
Pharmacist Pharmacist
Kajang Hospital Pharmacy Practice & Developm ent Division
Selangor State Health Departm ent

◆ Mdm Wong Jern Ni ◆ Mr. Anuar Bin Mohamad

Pharmacist Pharmacist
Shah Alam Hospital Kajang Hospital

◆ Mdm Ummi Kalsum Binti Lambak ◆ Mdm Haidah Binti Ab Rahim

Pharmacist Nursing Matron
Melaka Hospital Tengku A m p u a n Rahim ah Klang Hospital

7
◆ Mdm Wong Siew Ling ◆ Mdm Kasidah Binti Kasran
Nursing Matron Nursing Sister
Selayang Hospital Shah Alam Hospital

◆ Mdm Sharina Binti Mohd Redzuan

Nursing Sister
Kajang Hospital
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

EDITORIAL BOARD

ADVISOR

◆ Mdm A’tia Binti Hashim

Director
Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e
Ministry of Health Malaysia

EDITORIAL COMMITTEE

◆ Mdm Munira Binti Muhammad ◆ Mdm Norhayati Binti Musa

Deputy Director Senior Principal Assistant Director
Pharmacy Practice & Developm ent Division Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e Pharmaceutical Services Program m e
Ministry of Health Ministry of Health

◆ Mdm Siew Lee Jin ◆ Mdm Lee Shal Ling

8 Senior Principal Assistant Director Senior Principal Assistant Director
Pharmacy Practice & Developm ent Division Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e Pharmaceutical Services Program m e
Ministry of Health Ministry of Health

◆ Mdm Noor Syuhaidah Binti Radzuan

Principal Assistant Director
Pharmacy Practice & Developm ent Division
Pharmaceutical Services Pr ogr am m e
Ministry of Health
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

ABBREVIATIONS & ACRONYMS

ABBREVIATION & ACRONYM DESCRIPTION

BW body weight

D10 10% dextrose

D5 5% dextrose

g gram

gtt drops

HCl hydrochloride

HSD5 0.45% s odium chloride + 5% dextrose

IM intram uscular

IV intravenous

kg k ilogram 9

L litre

m ax m axim um

mcg m ic rogram

mg m illigram

ml millilitre

NS 0.9% s odium chloride

NSD5 0.9% s odium chloride + 5% dextrose

RT r o o m tem perature

SC subcutaneous

w/v weight over volum e

W FI water for injection

 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Acyclovir Injection

Brand Nam e Vaxcel® Acyclovir IV For Infusion (Strength: 250m g)

Reconstitution Reconstitute 1 vial (250mg) wi t h 10ml W FI or NS to provide a solution

containing 25mg/ml.

Further Dilution IV infusion

■ Dilute the required volum e of reconstituted solution wi t h diluent
to give a concentration n o t greater than 5 m g/m l (0.5%w/v) for
adm inistration by infusion.
■ For children and neonates, where it is advisable to keep the volum e
of fluid to a m i n i m u m , dilution is on the basis of 4 m l reconstituted
solution (100mg acyclovir) added to 20m l of infusion fluid.
■ For adult, infusion bags containing 100ml of infusion fluid are used,
even wh e n this would give an acyclovir concentration substantially
below 0.5%w/v. Thus, one 100ml infusion bag m a y be used for any
dose between 250m g and 5 0 0 m g (10 and 20m l of reconstituted
solution) b u t a second bag m u s t be used for doses between 5 0 0 m g
and 1000mg.

Diluents
NS

10
Adm inistration IV infusion
Adm inister by slow IV infusion over 1 hour.

Storage & Stability RT(<25°C)

After reconstitution 48 hours
After dilution 48 hours

*Protect f r o m light.
*Reconstituted or diluted solutions SHOULD NOT BE REFRIGERATED.

Remarks ■ This infusion contains no preservative. Should visible turbidity or

crystallization appear in the solution before or during infusion, the
preparation should be discarded.
■ Do n o t give by IV bolus, IM or subcutaneous route.
■ Be aware that too-rapid infusion m ay dam age renal tubules.

References 1. Product leaflet Vaxcel® Acyclovir IV For Infusion (Kotra Pharm a (M)
Sdn. Bhd, Malaysia). Revised date: 2.4.2019.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Amikacin Injection

Brand Nam e Apalin (Strength: 500m g/2m l)

Reconstitution Not required

Further Dilution IV infusion

Add 5 0 0 m g am ik acin solution to 100 – 200ml diluent.

Diluents
NS, D5

Adm inistration IM

IV infusion
■ Adult: Adm inister slowly over 30 – 60 minutes.
■ Infants: Adm inister slowly over 1 – 2 hours.

Storage & Stability RT(25°C) Fridge (4°C)

After dilution 24 hours 60 days

Remarks ■ Slow IV infusion m ay help to avoid neurom uscular blockade.

■ Do n o t physically prem ix am ikacin injection or infusion solutions
wi t h other drugs at any point in the infusion apparatus.
11
References 1. Product leaflet Apalin (Duopharm a (M) Sdn Bhd, Malaysia). Revised
date: 16.1.2012.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Amoxicillin & Clavulanate Injection

Brand Nam e Clavam For Injection BP (Strength: 1. 2 g).

Contains: Amoxicillin 1 g as s odium salt, Clavulanic acid 2 0 0 m g as the

potassium salt.

Reconstitution Reconstitute 1 vial (1. 2 g) wi t h 20m l W FI (Final volum e 20.9ml).

Further Dilution IV infusion

Dilute the reconstituted solution to 100ml diluent.

Diluents
NS, W FI

Adm inistration Slow IV bolus

■ Adm inister slowly over 3 – 4 m inutes and wi t hin 20 m inutes of
reconstitution.
■ It m ay be injected directly into the vein or via a drip tube.

IV infusion
Adm inister over 30 – 40 m inutes and com plete wi th i n the t i m e
stated.

Storage & Stability RT (25°C) Fridge (5°C)

12 After reconstitution 20 m inutes -
After dilution 4 hours 8 hours

*Any residual antibiotic solutions should be discarded.

Remarks ■ The colour of the reconstituted solution m a y range f r o m a cream

coloured solution to slight yellow/pale straw-coloured solution.
■ Not suitable for intram uscular administration.
■ Injection solution is less stable in infusions containing glucose,
dextrose or bicarbonate.
■ Should no t be m ixed w i t h blood products, other proteinaceous
fluids such as protein hydrolysates or w i t h intravenous lipid
emulsions.
References Product leaflet Clavam For Injection BP (Alkem Laboratories Limited,
India). Revised date: April 2016.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Amphotericin B Injection

Brand Nam e Photericin B For Injection USP (Strength: 50m g)

Reconstitution ■ Reconstitute 1 vial (50mg) wi t h 10ml of WFI.

■ Shake the vial im m ediately until the colloidal solution is clear.

Further Dilution IV infusion

■ Further dilute wi t h diluent to produce the rec om m ended
concentration of 0.1mg/ml.
■ Final concentration should n o t exceed 0.1m g / m l for peripheral
infusion or 0.25m g / m l for central infusion.

Diluent
D5

Adm inistration IV infusion

■ Adm inister by slow IV infusion over 2 to 6 hours (depending on the
dose).
■ A single IV test dose (1mg in 20m l of D5) administered over 20 to
30 m inutes m ay be preferred.

Storage & Stability RT (25°C) Fridge

After reconstitution 24 hours 7 days
After dilution 24 hours 2 days 13
*Protected f r o m light

Remarks ■ The patient’s temperature, pulse, respiration, and blood pressure

should be recorded every 30 m inutes for 2 to 4 hours.
■ Rapid IV infusion, over less than 1 hour, particularly in patients w i t h
renal insufficiency, has been associated w i t h hyperkalemia and
arrhythmias and should therefore be avoided.
■ The infusion solution (0.1mg/ml) is obtained by further dilution w i t h
D5 of p H above 4.2. The p H of each container of dextrose injection
should be ascertained before used.
■ Do n o t reconstitute wi t h saline solutions.
■ An in-line m e m b r a n e filter m a y be used for IV infusion of
am photericin B (the m ean pore diameter of the filter should n o t be
less than 1 micron).

References 1. Product leaflet Photericin B For Injection USP (Cipla LTD, India).
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

* The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Ampicillin Injection

Brand Nam e Kam pibiotic Injection (Strength: 500m g)

Reconstitution IV
Dissolve 1 vial (500m g) in 10 ml WFI.

IM
Dilute 1 vial (500m g) wi t h 1.5 ml WFI.

Further Dilution IV infusion

Dilute wi t h 50 to 100 ml NS ( m a x i m u m concentration: 30mg/ml).

Diluent
NS

Adm inistration Slow IV bolus

■ Adm inister slowly over 3 to 4 minutes.
■ Do n o t exceed 100mg/minute.

Intermittent IV infusion
Adm inister over 15 – 30 minutes.

IM
14

Storage & Stability Use im m ediately

Remarks ■ Be aware that too-rapid infusion m ay cause seizures.

■ Extemporaneous admixtures of beta-lactam antibacterials and
aminoglycosides m a y result in substantial m u t u a l inactivation. If
these adm inistered concurrently, adm inistered in separate sites at
least 1 hour apart. Do no t m ix t h e m in the same intravenous bag,
bottle or tubing.
■ If ampicillin is prescribed concurrently w i t h an aminoglycoside, the
antibiotics should n o t be m ixed in the syringe, intravenous fluid
container or giving set because loss of activity of the aminoglycoside
can occur under these conditions.

References 1. Product leaflet Kampibiotic Injection (Karnataka Antibiotics &

Pharmaceuticals Limited, India). Revised date: 25.7.2017.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
3. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Ampicillin & Sulbactam Injection

Brand Nam e Am subac Injection (Strength: 1. 5 g)

Contains: Am picillin 1000mg, Sulbactam 5 0 0 m g

Reconstitution IV
■ Reconstitute 1 vial (1. 5 g) wi t h 3.2 m l WFI.
■ To ensure com plete dissolution, allow f oam ing to dissipate to p e rm it
visual inspection.

IM
Reconstitute wi t h 3.2 m l W FI or 0.5% lignocaine HCl.

Further Dilution IV infusion

Further dilute to 50 – 100ml diluent.

Diluent
NS

Adm inistration Slow IV bolus

Adm inister slowly over a m i n i m u m of 3 minutes.

IV infusion
Adm inister over 15 – 30 minutes. 15

IM
Adm inister by deep IM injection.

Storage & Stability Not available

Remarks ■ Do n o t m ix or give t h r ou g h same I.V. line w i t h aminoglycosides, as

this inactivates ampicillin/sulbactam.
■ Rapid infusion m ay cause seizures.

References 1. Product leaflet Amsubac Injection (Karnataka Antibiotics &

Pharmaceuticals Limited, India). Revised date: 23.1.2018.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Anidulafungin Injection

Brand Nam e Eraxis (Strength: 100mg)

Reconstitution Reconstitute 1 vial (100mg) wi t h 30m l W FI to provide a concentration of

3.33mg/ml. The reconstitution t i m e can be u p to 5 minutes.

Further Dilution & IV infusion

Adm inistration
Dilution Requirements For Anidulafungin Administration
Of Water For Injection Presentation

Reconstituted

Total Infusion

Duration of
Number of

Minimum
Required

Required

Infusion

Infusion

Infusion
VolumeA

VolumeB

Rate of
Volume
Dose

Vials

Total

100mg 1 30ml 100ml 130ml 1.4ml/minute 90 minutes

200mg 2 60ml 200ml 260ml 1.4ml/minute 180 minutes

A
Either 9 m g / m l (0.9%) s odium chloride for infusion or 5 0m g /m l (5%)
glucose for infusion.
B
Infusion solution concentration is 0.77m g/m l.

Diluents
NS, D5
16
IV infusion ONLY
The rate of infusion should n o t exceed 1.1mg/minute (equivalent to
1.4ml/minute or 84m l/hour wh e n reconstituted and diluted per
instructions).

Storage & Stability RT (25°C) Fridge (Frozen)

After reconstitution 24 hours -
After dilution 48 hours 72 hours

*For single use only

Remarks ■ Anaphylactic reactions, including shock, have been reported;

discontinue use and appropriate tr eatm ent administered.
■ Infusion-related adverse events have been reported w i t h
anidulafungin, inc luding rash, urticaria, flushing, pruritus, dyspnea,
bronchospasm and hypotension.
■ Infusion-related adverse events are infrequent wh e n the rate of
anidulafungin infusion does n o t exceed 1.1mg/minute.
■ Do n o t give as IV bolus.

1. Product leaflet Eraxis (Pharmacia and Upjohn Company, USA).

References
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Artesunate Injection

Brand Nam e Artesun Powder For Injection (Strength: 60m g)

Reconstitution ■ Reconstitute 1 vial (60mg) w i t h provided diluent (5% s odium

bicarbonate solution).
■ Shake the vial for 2– 3 minutes and wait until completely dissolved
and a clear solution should emerge.

Further Dilution Dilute the reconstituted solution (1 ml) w i t h diluent to produce the
required concentration.

Route of Diluent Total Volume Final

Administration (NS or D5) Concentration

IV 5m l 6ml 10mg/ml
IM 2m l 3m l 20m g/m l

Adm inistration Slow IV bolus

Adm inister the required dose slowly at a rate of 3 – 4 m l/m inute.

IM

Storage & Stability Use im m ediately

17
Remarks ■ Do n o t use in intravenous drip.
■ Discard if solution n o t clear.

References Product leaflet Artesun Powder For Injection (Guilin Pharmaceutical

Co. Ltd, China).

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Azithromycin Injection

Brand Nam e Vaxcel® Azithrom ycin IV For Infusion (Strength: 500m g)

Reconstitution Reconstitute 1 vial (500mg) wi t h 4.8m l WFI to obtain a final

concentration of 100mg/ml.

Further Dilution IV infusion

Dilute the reconstituted solution to the required concentration as
below:

Amount of Final infusion solution Amount of diluent

reconstituted concentration (ml)
solution (ml) (mg/ml)

5 1 500

5 2 250

Diluents
NS, D5

Adm inistration IV infusion

Concentration (mg/ml) Rate of infusion
18 1 over 3 hours
2 over 1 hour

An IV dose of 5 0 0 m g azithrom ycin should be infused for a m i n i m u m

duration of 1 hour.
Storage & Stability
RT Fridge ( 2°C- 8°C)
After reconstitution 24 hours (25±2○C) -
After dilution 24 hours (<25○C) 7 days

Remarks ■ Do n o t adm inister as an IV bolus or an IM injection.

■ Other intravenous substances, additives or m edications should n o t
be added to intravenous azithrom ycin or infused simultaneously
t h r o u g h the same IV line.

References Product leaflet Vaxcel® Azithrom ycin IV For Infusion, (Kotra Pharm a
(M) Sdn. Bhd, Malaysia).

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Benzathine Penicillin Injection

Brand Nam e Benzapen Sterile Penicillin G Benzathine USP (Strength: 2.4 Mega
Units)

Reconstitution Reconstitute wi t h 8 m l of WFI.

Further Dilution Not required

Adm inistration IM only

*To avoid sciatic nerve damage, infants and small children should n o t
be injected into the upper outer quadrant of the buttock except in
special cases e.g. in the presence of extensive burns.

Storage & Stability Use im m ediately

Remarks ■ Patient should be alerted to the potential occurrence of allergic

reactions and instructed to report them .
■ Patient should be observed for 30 m inutes after d r u g adm inistration
for any allergic reactions.
■ Must n o t be injected subcutaneously, intravenously or intrathecally
or instilled into body cavities.

References Product leaflet Benzapen Sterile Penicillin G Benzathine USP 2.4MU

(Karnataka Antibiotics & Pharmaceuticals Limited, India). Revised date:
13.7.2009.
19
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Benzylpenicillin Injection

Brand Nam e Bepen Injection (Strength: 1 MU (600mg), 5 MU (3g))

Reconstitution ■ Reconstitute 1 MU vial ( 600m g) wi t h 2 m l or m ore W FI immediately

before use.
■ Reconstitute 5 MU vial (3g) w i t h 10 m l or m or e W FI im m ediatel y
before use.

Further Dilution Intermittent IV infusion

Further dilute in 50 – 100m l diluent.

Continuous IV infusion
Further dilute in 1000 – 2000m l diluent.

Diluent
NS

Adm inistration IM
Alternate sites should be used for repeated injections.

Intermittent IV infusion
■ Adm inister over 1 – 2 hours (adults).
■ Adm inister over 15 to 30 m inutes (children and infants).
20 Continuous IV infusion
■ Adm inister over 24 hours.
■ Preferred for adm inistration of large doses.

Storage & Stability RT (30°C±2°C) Fridge ( 2°C- 8°C)

After reconstitution 2 days 6 days

*Reconstituted solutions of benzylpenicillin s odium BP are intended

for im m ediate administration.

Remarks ■ Should be administered separately w i t h solutions that contain

m etal ions.
■ Too-rapid infusion m ay cause electrolyte im balance or seizures.

References 1. Product leaflet Bepen Injection (Karnataka Antibiotics &

Pharmaceuticals Limited, India). Revised date: 14.2.2017.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Caspofungin Acetate Injection

Brand Nam e Cancidas ® For Injection (Strength: 50m g, 70m g)

Reconstitution Bring the refrigerated vial to r o o m temperature.

50mg vial
Reconstitute 1 vial (50mg) w i t h 10.5ml of NS or W FI to obtain a
concentration of 5.2mg/ml.

70mg vial
Reconstitute 1 vial (70mg) w i t h 10.5ml of NS or W FI to obtain a
concentration of 7.2mg/ml.

Further Dilution Depends on dose required

Preparation of the Patient Infusion Solutions in Adults:

Dose* Volume of Typical

reconstituted preparation
solution for (reconstituted
transfer to IV solution added
bag/bottle to 100ml) final
concentration

7 0 m g (from one 7 0 m g vial) 5m l in each 0.33m g / m l

(Dilute in t wo bags of 100ml) ** 100ml IV bag/
bottle

5 0 m g (from one 5 0 m g vial) 10m l 0.45m g / m l 21

35mg for moderate hepatic 5m l 0.33m g / m l

insufficiency (from one 7 0 m g vial)

35mg for moderate hepatic 7m l 0.33mg/ml

insufficiency (from one 5 0 m g vial)

* 10.5ml should be used for reconstitution of all vials.

** Dilute 5m l of the reconstituted vial in a 100ml IV bag/bottle and the
other 5m l in a second 100ml IV bag/bottle.

Note:
Paediatric patients (≥ 12 months old): Dilute reconstituted solution
(volume equal to the calculated dose) to an IV bag or bottle containing
250m l of diluent or a reduced volum e of diluent, no t to exceed a final
concentration of 0.5mg/ml.

Diluents
NS or 0.45% Sodium Chloride (Paediatric patients)
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Adm inistration IV infusion ONLY

■ Adm inister by slow IV infusion over approximately 1 hour.
■ For a 7 0 m g dose, adm inister each of the bags or bottles sequentially
over 30 minutes, for a total infusion t i m e of approximately 1 hour.

Storage & Stability RT (<25°C) Fridge (2°C- 8°C)

After reconstitution 24 hours -
After dilution 24 hours 48 hours

*The lyophilized c om pac t powder in vials should be stored at 2○C – 8○C.

Remarks ■ Do n o t use any diluents containing dextrose ( -D-glucose).

■ Do n o t m ix or co-infuse wi t h any other medications.
■ Visually inspect the reconstituted solution for particulate m atter or
discoloration during reconstitution and prior to infusion. Do no t use
if the solution is cloudy or has precipitated.

Product leaflet Cancidas ® For Injection (Laboratories Merch Sharp &

References
Dohme-Chibret, France). Revised date: September 2014.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.

22
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cefazolin Injection

Brand Nam e Cefazolin Sandoz ® Dry Substance For Infusions (Strength: 1 g)

Reconstitution Slow IV or IV infusion

Reconstitute 1 vial (1 g) wi t h 4 m l NS or WFI.

IM
Reconstitute 1 vial (1 g) wi t h 4 m l 0.5% lidocaine solution.

Further Dilution IV infusion

Dilute in 50 – 100m l diluent.

Diluent
NS

Adm inistration Slow IV bolus

Adm inister slowly over 3 – 5 minutes. (Up to a dose 1 g cefazolin).

IV infusion
Adm inister doses > 1 g over 20 – 30 minutes.

IM
Inject into a m ajor m uscle mass.
23
Storage & Stability Use im m ediately

Remarks Do n o t m ix in same infusion w i t h aminoglycoside, because b o t h drugs

m ay be inactivated.

References 1. Product leaflet Cefazolin Sandoz ® Dry Substance For Infusions

(Biochemiestr, Austria).
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cefepime Injection

Brand Nam e Cefmex Powder For Injection (Strength: 1 g)

Reconstitution IV
Reconstitute 1 vial (1 g) w i t h 10ml of diluent (approximate concentration
90mg/ml).

IM
Reconstitute 1 vial (1 g) w i t h 3m l of diluent (approximate concentration
230mg/ml).

Diluents
WFI, D5, NS

Further Dilution IV infusion

Dilute to a volum e of 50 – 100ml of diluent.

Diluents
D5, NS

Adm inistration Slow IV bolus

Adm inister slowly over 3 – 5 minutes.

24 IV infusion
Adm inister over 30 minutes.

IM
Adm inister t h r ou gh deep IM injection into a large m uscle mass.

Storage & Stability Fridge (2°C- 8°C)

After reconstitution 48 hours
After dilution 48 hours

* Intravenous: Cefepime is com patible at concentration of 1– 40m g / m l

wh e n m ixed wi t h diluents.

Remarks Parenteral drugs should be inspected visually for particulate m atter

before administration, and n o t used if particulate m atter is present.

References Product leaflet Cefmex Powder For Injection (Duopharm a (M) Sdn. Bhd,
Malaysia). Revised date: 14.10.2014.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cefoperazone Injection

Brand Nam e Bicafar (Strength: 1 g)

Reconstitution IV
■ Reconstitute 1 vial (1 g) wi t h 5m l of D5, NSD5, NS or WFI.
■ For continuous IV infusion, dissolve each g r a m in 5m l WFI.

IM
W FI m a y be used to prepare cefoperazone for IM injection. However,
w h e n concentrations of ≥250m g / m l to be administered, a lidocaine
solution should be used. A 2-STEP dilution process is recom m ended.

Vial Final Step 1: Step 2: Withdrawable

(g) Cefoperazone Volume Volume of 2% Volume (ml)
Concentration of WFI Lidocaine
(mg/ml) (ml) (ml)

1 250 2.6 0.9 4

333 1.8 0.6 3

*There is sufficient excess present to allow for withdrawal and

adm inistration of the stated volume.

Further Dilution IV (maximum dose of 2 g/day)

Dilute in appropriate diluent to give a final concentration of 100mg/ml.
25
Intermittent IV infusion
Dilute the reconstituted solution wi t h 20 – 100ml of diluent.

Diluents
D5, NSD5, NS

Adm inistration Slow IV bolus

Adm inister slowly over a period of no less than 3 – 5 minutes.

Intermittent IV infusion
Adm inister over a period of 15 m inutes – 1 hour.

IM
Deep IM injection into t he large m uscle mass of gluteus m a x i m u m or
anterior thigh.

Storage & S tability RT (15°C- 25°C) Fridge ( 2°C- 8°C)

After reconstitution 24 hours 5 days

*A solution of 300m g/m l

Remarks Solution of cefoperazone and aminoglycoside should n o t be directly

m ixed since there is a physical incom patibility between them .

References Product leaflet Bicafar (Duopharm a (M) Sdn Bhd, Malaysia). Revised
date: 14.8.2012.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cefoperazone & Sulbactam Injection

Brand Nam e Vaxcel® Cefobactam Injection (Strength: 1 g)

Contains: Cefoperazone 5 0 0 m g and Sulbactam 5 0 0 m g

Reconstitution & IV
Further Dilution
Equiv. Dosage of
Total Volume of Maximum Final
Sulbactam +
Dosage (g) diluent Conc. (mg/ml)
Cefoperazone (g)
1 0.5 + 0.5 3.4 125 + 125

■ Reconstitute 1 vial (1g) wi t h 3.4 m l WFI, D5 or NS.

Intermittent IV infusion
Dilute the reconstituted solution to 20m l wi t h the same solution.

IM
Reconstitute 1 vial (1g) with 3.4ml sterile WFI and further dilute with
2% lidocaine to obtain solutions containing u p to 125mg cefoperazone
and 125mg sulbactam/ml in approximately a 0.5% lidocaine
hydrochloride solution.

Adm inistration Slow IV bolus

Adm inister slowly over a minimum of 3 minutes.
26
Intermittent IV infusion
Adm inister over 15 – 60 minutes.

IM

Storage & Stability RT (<25°C)

After reconstitution 24 hours

Remarks Solutions of sulbactam/cefoperazone and aminoglycosides should

n o t be directly mixed, since there is a physical incompatibility
between them .

References Product leaflet Vaxcel® Cefobactam Injection (Kotra Pharm a (M) Sdn.
Bhd, Malaysia).

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cefotaxime Injection

Brand Nam e Rekaxime Injection (Strength: 500m g, 1 g)

Reconstitution ■ Reconstitute 1 vial (500mg) wi t h 2m l of WFI.

■ Reconstitute 1 vial (1000mg) wi t h 4 m l of WFI.

Further Dilution IV infusion

■ Short infusion
Dilute in 4 0 m l of W FI or 10% glucose solution.

■ Continuous drip
Dilute in 100ml of isotonic saline or glucose solution.

Diluents
NS, D5, D10 (for short infusion)

Adm inistration Slow IV bolus

Adm inister slowly over a period of 3 – 5 minutes.

Short infusion
Infused in approximately 20 minutes.

Continuous drip
Infuse over 50 – 60 minutes.

IM
27
Inject deep into the gluteus muscle. Not to inject >4m l into either side.
If daily dose exceeds 2 g, IV injection is preferred.

Storage & Stability RT (<25°C)

Cefotaxime Solutions 24 hours

*Cefotaxime solutions should be adm inistered as soon as they have

been prepared.

Remarks ■ Incom patible w i t h alkaline solutions such as sodium bicarbonate

and also incom patible wi t h hetastarch s odium chloride.
■ Adm ixture of ß-lactam antibacterials, aminoglycosides and
metronidazole m a y result in substantial inactivation. Should n o t
be adm inistered concurrently/mixed/injected at the same site as
cefotaxime.
■ A pale yellowish solution does n o t m ean an i m pa i rm en t of the
antibiotic efficacy.
■ IV bolus given over less than 1 m i n u t e have caused life- threatening
arrhythmias.

References 1. Product leaflet Rekaxime Injection (Duopharm a (M) Sdn Bhd,

Malaysia). Revised date: 19.11.2013.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Ceftazidime Injection
Brand Nam e Cefatum Injection (Strength: 1 g , 2 g)

Reconstitution May be constituted wi t h W FI or, for IM injection, wi t h 0.5% lignocaine.

Vial Size Diluent Amount of Approximate
diluent to be Concentration
added (mg/ml)

1g (10ml vial) IM 0.5% lignocaine 3m l 260

IV W FI 10ml 90
2g (20ml vial) IV W FI 10ml 170

Further Dilution Intermittent IV infusion

Dilute in 100ml of diluent.

Diluents
NS, D5

Adm inistration Slow IV bolus

Adm inister slowly over 3 – 5 minutes.
Intermittent IV infusion
Infuse over 30 minutes.
IM
Adm inister by deep IM into a large mass muscle.
28
Storage & Stability
Diluent RT Fridge
(<25°C) ( 2°C - 8°C)

After reconstitution W FI 12 hours 7 days

0.5% lignocaine 6 hours 4 days
After dilution - *12 hours *7 days
*At concentration 1-40 m g / m l

Remarks ■ Sodium bicarbonate injection is n o t rec om m ended as a diluent.

■ Solutions range f r o m light yellow to am ber depending on
concentration, diluent and storage conditions used. W ithin the
stated recommendations, produc t potency is n o t adversely affected
by such colour variations.
■ Individual doses in excess of 1g should be adm inistered intravenously.
■ The adm ixture of beta-lactam antibacterials (penicillins and
cephalosporins) and aminoglycosides m a y result in substantial
m u t u a l inactivation.

References 1. Product leaflet Cefatum Injection (Duopharm a (M) Sdn Bhd,

Malaysia). Revised date: 21.6.2014.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
3. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Ceftriaxone Injection

Brand Nam e Unocef Injection (Strength: 500m g, 1 g)

Reconstitution IM
■ WFI, NS, D5, 1% lidocaine solution (without ephinephrine)

Vial Dosage Size Amount of Diluent to be Added

250mg/ml 350mg/ml
500mg 1.8ml 1 ml
1g 3.6ml 2.1 ml

*If required, m ore dilute solutions could be utilized.

*A 350m g/m l concentration is n o t r ec om m ended for the 250m g vial
since it m ay n o t be possible to withdra w the entire contents.

IV
■ WFI, NS, D5
Vial Dosage Size Amount of Diluent to be
Added
500mg 4.8m l
1g 9.6ml

Further Dilution IV infusion

Dilute the reconstituted solution to 50 or 100ml diluent. 29

Diluents
NS, D5

Adm inistration IV infusion

Adm inister over a period of 30 minutes. Concentration betwee n
10 - 4 0 m g / m l are recomm ended, lower concentration m a y be used if
desired.

IM (for Gonorrhoea, Chancroid)

■ Adm inister deep IM into large m uscle mass.
■ Doses >1 g should be distributed between t wo injection sites.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Storage & Stability After reconstitution, protection f r o m norm al light is n o t necessary.

Stability varies w i t h concentration and diluents used: The colour of
solutions ranges f r o m light yellow to amber, de pending on the length
of storage, concentration and diluent used.

IM
Concentration
Diluent (mg/ml) RT (25○C) Fridge (4○C)

W FI 100 3 days 10 days

250, 350 24 hours 3 days
NS 100 3 days 10 days
250, 350 24 hours 3 days
D5 100 3 days 10 days
250, 350 24 hours 3 days
1% Lidocaine solution 100 24 hours 10 days
( without ephinephrine)
250, 350 24 hours 3 days

IV solutions stored in glass or PVC containers

Diluent Concentration RT (25°C) Fridge (4°C)

(mg/ml)
30
W FI 10,20,40 3 days 10 days
NS 10,20,40 3 days 10 days
D5 10,20,40 3 days 10 days

Remarks ■ Diluents containing calcium, such as Ringer’s solution or

Hartmann’s solution, are n o t to be used to reconstitute
ceftriaxone vials or to further dilute a reconstituted vial for
intravenous adm inistration because a precipitate can form.
■ Ceftriaxone m u s t n o t be adm inistered simultaneously w i t h calcium -
containing intravenous solutions, including c ontinuous calcium -
containing infusions such as parenteral nutrition via Y-site.
■ In patients other than neonates, ceftriaxone and calcium -containing
solutions m a y be adm inistered sequentially to one another if the
infusion lines are thoroughl y flushed between infusions w i t h
com patible fluid.

References 1. Product leaflet Unocef Injection (Duopharm a (M) Sdn Bhd, Malaysia).
Revised date: 2.10.2013.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cefuroxime Injection

Brand Nam e Pharm aniaga Cefuroxime Injection (Strength: 750mg, 1. 5 g)

Reconstitution IM
Reconstitute 750m g vial wi t h 3 m l of WFI.

IV
■ Reconstitute 750m g vial wi t h 8m l of WFI.
■ Reconstitute 1. 5 g vial wi t h 16 m l of WFI.

Further Dilution Intermittent IV infusion

W ithdr aw the required dose and add to 50 – 100ml of diluent.

Diluents
NS, D5

Adm inistration Slow IV bolus

Adm inister slowly over 3 – 5 minutes.

Intermittent IV infusion
Adm inister over 30 minutes.

IM
Inject deep IM into large m uscle mass (such as gluteus or lateral
part of the thigh). 31

Storage & Stability RT Fridge (2°C –8°C)

After reconstitution - 2 hours
After dilution 24 hours -

Remarks ■ Do n o t m ix wi t h s odium bicarbonate.

■ Do n o t m ix in same infusion w i t h aminoglycoside, because b o t h
drugs m ay be inactivated.
■ Before injecting intramuscularly, aspiration is necessary to avoid
inadvertent injection into a blood vessel.

References 1. Product leaflet Pharm aniaga Cefuroxime Injection (Pharmaniaga

Manufacturing Berhad, Malaysia).
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Dr ug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Clindamycin Injection
Brand Nam e Tidact Injection (Strength: 300m g/2m l)
Reconstitution Not required
Further Dilution ■ Must be DILUTED prior to IV administration.
■ To prepare initial dilution for IV use:

Dose (mg) Diluent (ml) Duration of Administration

300 50 10 m inutes
600 50 20 m inutes
900 100 30 m inutes
1200 100 4 0 m inutes
*Max im um final concentration: 18 m g / m l
*Infusion rates should n o t exceed 30 m g / m i n u t e

Diluents
NS, D5
Adm inistration IV infusion
■ Do n o t adm inister m or e than 1200mg in a single 1 hour infusion.
■ May be adm inistered as a single rapid infusion on the first dose and
followed by continuous IV infusion, as follows:
To Maintain Serum Rapid Infusion Rate Maintenance
Clindamycin Levels Infusion Rate

Above 4 m c g / m l
32
Above 5 m c g / m l
Above 6 m c g / m l
10 m g / m i n u t e 0.75 m g / m i n u t e
for 30 m inutes
15 m g / m i n u t e 1 mg/minute
for 30 m inutes
20 m g / m i n u t e 1. 25 m g / m i n u t e
for 30 m inutes

IM
■ Single IM Injection should n o t exceed 600 m g.

Storage & Stability Not available

Remarks ■ Clindam ycin is physically incom patible with ampicillin,

diphenyldantoin, barbiturates, aminophylline, calcium gluconate
and m agnes ium sulphate.
■ IV adm inistration should n o t be given undiluted or as IV bolus.
■ Rare instances of cardiopulm onary arrest and hypotension have
been reported following too rapid intravenous administration.
■ Contains benzyl alcohol, should be avoided in children under 2 years
of age and n o t to be used in neonates.

1. Product leaflet Tidact Injection (Yung Shin Pharmaceutical Ind. Co., Ltd,
References Taiwan).
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs Guide.
Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Cloxacillin Injection

Brand Nam e Cloxabiotic Injection (Strength: 250mg, 500m g)

Reconstitution The reconstituted solution m u s t be shaken well before use.

Fill Size Volume of Withdrawable Nominal
(mg) Diluent Added Volume Concentration
(ml) (ml) (mg/ml)

IM (Use WFI)
250 1. 9 2 125
500 1.7 2 250
IV Injection (Use WFI)
250 4.9 5 50
500 4.8 5 100
IV infusion
Reconstitute 1 vial in 5m l of WFI.
Further Dilution IV infusion
Dilute the reconstituted solution in 125ml to 250m l of diluent to obtain
a final concentration of 1 – 2mg/ml.

Diluent
NS
Adm inistration Slow IV bolus
■ Adm inister into a vein either directly or via a drip-tube over a period 33
of 3 to 4 minutes.
■ More rapid adm inistration m ay result in convulsive seizures.

IV infusion
Infused over 30 to 4 0 minutes.

IM

Storage & Stability RT (≤25°C) Fridge (2°C- 8°C)

After reconstitution Use within 30 m inutes Up to 48 hours
of preparation
* Solution for injection should be freshly prepared.
* Discard unused portion.

Remarks ■ If cloxacillin is prescribed concurrently w i t h an aminoglycosides,

the t wo antibiotics should n o t be m ixed in the same syringe,
intravenous fluid container or giving set because of loss of activity
of the aminoglycosides can occur under these conditions.
■ Cloxacillin injection should n o t be m ixed w i t h proteinaceous fluids
such as protein hydrolysates, blood or plasma, or w i t h intravenous
lipid emulsions.

Product leaflet Cloxabiotic Injection (Karnataka Antibiotics &

References
Pharmaceuticals Limited, India). Revised Date: 12.2.2018.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Ertapenem Injection

Brand Nam e Invanz ® Injection (Strength: 1 g)

Reconstitution IV infusion
Reconstitute 1 vial (1 g) wi t h 10ml sterile WFI, NS or bacteriostatic WFI.

IM
■ Reconstitute 1 vial (1 g) w i t h 3.2ml of 1% or 2% lidocaine HCl injection
( without epinephrine).
■ The reconstituted solution should n o t be adm inistered intravenously.

Further Dilution IV infusion

Patients 13 years of age and older
Dilute reconstituted d r u g to 50m l of NS.

Patients 3 months to 12 years of age

W ithdr a w a volum e equal to 15mg/kg of body we i ght (not to exceed
1g/day) and dilute in 0.9% Sodium Chloride Injection to a final
concentration of 20m g/m l or less.

Diluent
NS

Adm inistration IV infusion

Adm inister the diluted solution over 30 m inutes and com plete the
34 infusion within 6 hours of reconstitution.

IM
Adm inister the reconstituted solution by deep IM injection into a large
m uscle mass (e.g. gluteal m uscle or lateral part of the thigh).

Storage & Stability RT (25°C) Fridge (5°C)

After reconstitution IV: 6 hours 24 hours and use within
IM: use within 4 hours after
1 hour removal f r o m refrigeration
After dilution IV: 6 hours 24 hours and use within
4 hours after
removal f r o m refrigeration

Remarks ■ Must be reconstituted and diluted prior to administration.

■ Do n o t use diluents containing dextrose.
■ Do n o t m ix or co-infuse Invanz ® wi t h other medications.
■ The diluted solution of Ertapenem should n o t be frozen.

References 1. Product leaflet Invanz ® Injection (Laboratories Merck Sharp &

D o h m e - Chibret). Revised date: August 2015.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Erythromycin Lactobionate Injection

Brand Nam e Eritrotex Injection (Strength: 500m g)

Reconstitution Reconstitute 1 vial (500mg) wi t h 10 m l W FI to obtain final concentration

50m g/m l.

Further Dilution IV infusion

Dilute the reconstituted solution w i t h n o t l e s s t h a n 1 0 0 m l o f diluent
to a final concentration of 1 – 5 m g/m l.

Diluents
NS, D5

Adm inistration Intermittent IV infusion

Adm inister the diluted solution over 60 m inutes every 6 hours.

Continuous IV infusion
Adm inister the diluted solution over 24 hours.

Storage & Stability The injection should be freshly prepared and unused portion should be
discarded.

Remarks ■ Er ythrom ycin should n o t be reconstituted w i t h inorganic salt

solution. Use only WFI.
■ Do n o t adm inister IV push or bolus.
35
■ Rapid infusion is m ore likely to be associated w i t h arrhythmias or
hypotension.

References 1. Product leaflet Eritrotex Injection (Fisiopharma S.r.L, Italy). Revised

date: Novem ber 2008.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Ganciclovir Injection

Brand Nam e Cymevene ® (Strength: 500m g)

Reconstitution ■ Reconstitute 1 vial (500mg) wi t h 10 m l WFI.

■ The vial should be shaken to dissolve the drug.
■ Reconstituted solution should be inspected for particulate m atter
prior to proceeding wi t h adm ixture preparation.

Further Dilution IV infusion

■ W ithdr aw the required dose and dilute to 50 – 250m l of com patible
infusion fluid.
■ The final concentration m u s t n o t exceed 10mg/ml.

Diluents
NS, D5

Adm inistration IV infusion

■ Adm inister over 60 m inutes via a large peripheral or central vein
(adequate blood flow is essential to ensure rapid dilution and
distribution).
■ Infusion concentration greater than 10mg/ml are n o t recom m ended.

Storage & Stability RT Fridge (2°C- 8°C)

After reconstitution 12 hours It should n o t be
36
refrigerated
After dilution Use im m ediately 24 hours

Remarks ■ Do n o t use bacteriostatic water for injection containing parabens in

solution since these are incom patible and m ay cause precipitation.
■ The prepared solution should n o t be m ixed wi t h other IV products.
■ It is a potential teratogen and carcinogen in humans, caution should
be observed in the handling of ganciclovir. Avoid inhalation or direct
contact of the powder contained in the vials or direct contact of the
reconstituted solution wi t h the skin or m uc ous m embranes.
■ Do n o t give by IV bolus or by IM or SC route.

References 1. Product leaflet Cymevene ® (F. Hoffm an-La Rocge Ltd. Basel).
Revised date: June 2010.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Gentamicin Injection

Brand Nam e Garasent (Strength: 80m g/2m l)

Reconstitution Not required

Further Dilution IV infusion

■ Dilute the prescribed dose in 100 – 200ml of diluent.
■ Final infusion concentration should n o t exceed 1mg/ml.

Diluents
NS, D5

Adm inistration IM

Slow IV bolus
Adm inister slowly over 2 to 3 minutes.

IV infusion
Adm inister the diluted solution over 20 – 30 minutes.

Storage & Stability Fridge (2°C- 8°C)

After dilution 24 hours

Remarks ■ Should be used w i t h caution in patients w i t h im paired renal function

(including elderly and prem ature infants).
37
■ IV adm inistration is generally reserved for special indications and
m a y be used wh e n the IM route is n o t feasible, e.g. patients in shock,
wi t h haem orrhagic disorders, severe burns or reduced m uscle mass.

References 1. Product leaflet Garasent (Duopharm a (M) Sdn Bhd, Malaysia).

Revised date: 16.1.2012.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Imipenem & Cilastatin Injection

Brand Nam e I m i p e n e m /Cilastatin Kabi Powder For Solution For Infusion

Contains: 5 0 0 m g I m i p e n a m and 5 0 0 m g Cilastin

Reconstitution ■ Reconstitute 1 vial wi t h 10ml of diluent to the container.

■ Shake well and transfer the resulting m ix ture to the infusion solution
container.
■ Repeat w i t h an additional 10ml of infusion solution to ensure
com plete transfer of container contents to the infusion solution.
■ The resulting m ixture should be agitated until a clear solution is
obtained.

Further Dilution ■ Dilute the reconstituted solution to 100ml of diluent.

■ Final infusion concentration is approximately 5m g/ml.

Diluents
NS, D5

Adm inistration IV infusion ONLY

■ Doses ≤ 500m g/500m g:
Adm inister diluted solution over 20 – 30 minutes.
■ Doses > 500m g/500m g:
Adm inister diluted solution over 4 0 – 60 minutes.

38
Storage & Stability RT (30°C) Fridge (5°C)
After reconstitution 4 hours 24 hours
After dilution 4 hours 24 hours

Remarks ■ Should n o t be reconstituted in diluents containing lactate.

■ In patients w h o develop nausea during the infusion, the rate of
infusion m ay be slowed.
■ Do n o t give by direct IV injection.

References 1. Product leaflet Im i pe nem /Cilastatin Fresenius Kabi Powder For

Solution For Infusion (Facta Farmaceutical S.p.A, Italy). Revised date:
Novem ber 2015.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Dr ug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Meropenem Injection

Brand Nam e Nur onem Inj ec tion (Strength: 500m g, 1 g)

Reconstitution Reconstitute 1 vial (500mg) wi t h 10ml W FI (5ml W FI per 250m g

m er openem ) to obtain a final concentration of 50m g/ml.

Further Dilution IV infusion

Dilute reconstituted solution wi t h 50 – 200m l of diluents.

Diluents
NS, D5

Adm inistration Slow IV bolus

Adm inister slowly over 5 minutes.

IV infusion
Adm inister over 15 – 30minutes.

Storage & Stability RT (25°C) Fridge (4°C)

After dilution 8 hours (NS) 48 hours (NS)
3 hours (D5) 14 hours (D5)

* Reconstituted and diluted solution of m e ro pe n em should n o t be

frozen.
39
Remarks ■ Should n o t be m ixed wi t h or added to other drugs.
■ All vials for single use only.

References 1. Product leaflet Nurone m Injection (Ranbaxy Lab. Limited, India).

Revised date: August 2009.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3 . Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Micafungin Injection
Brand Nam e Mycam ine ® Powder For Solution For Infusion (Strength: 50m g)

Reconstitution ■ Reconstitute 1 vial (50mg) w i t h 5m l of NS or D5 (taken f r o m a 100 m l

bag/bottle) by slowly injected into each vial along the side of the
inner wall.
■ Rotate the vial gently. Do n o t shake.
■ Minim ize the a m o u n t of foam generated.

Further Dilution ■ All of the reconstituted concentrate should be withd ra wn f r o m

each vial and returned to the infusion bag/bottle f r o m whic h it was
originally taken.

Preparation Of Solution For Infusion:

Dose Vials to be Volume Volume Final

used of NS or (concentration) concentration
D5 to be of reconstituted of standard
added powder infusion
per vial (made up to
100ml)
50mg 1 x 50mg 5ml Approx. 5m l 0.5mg/ml
(10mg/ml)
100mg 2 x 50mg 5ml Approx. 10ml 1m g / m l
(10mg/ml)
150mg 3 x 50mg 5ml Approx. 15ml 1.5mg/ml
40 (10mg/ml)
200mg 4 x 50mg 5ml Approx. 20m l 2 mg/ml
(10mg/ml)
■ The infusion bag/bottle containing the diluted infusion solution should
be inserted into a closable opaque bag for protection f rom light.

Diluents
NS, D5
Adm inistration IV infusion ONLY
■ An existing IV line should be flushed wi t h NS prior to infusion.
■ Administer the reconstituted and diluted solution over approximately
one hour.

Storage & Stability

RT (30°C)
After reconstitution 24 hours
6 hours
(In transfusion bag wi t hout light protection)
After dilution
24 hours
(In transfusion bag wi t h light protection)
*when reconstituted with NS or D5
Remarks The concentrate should be used im m ediatel y for further dilution. This
pr oduc t is for single use in one patient only. Discard any residue.
References Product leaflet Mycamine® Powder For Solution For Infusion
(Astellas Pharma Tech Cp. Ltd, Japan). Revised date: July 2013.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer
to the current pr oduc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Netilmicin Injection

Brand Nam e Lotifar Injection (Strength: 150mg/2ml, 100mg/2ml)

Reconstitution Not required

Further Dilution IV infusion

Dilute single dose in 50 to 200m l of diluent.

Diluents
NS, D5

Adm inistration Slow IV bolus

Adm inister slowly over a period of 3 to 5 minutes.

IV infusion
Adm inister the diluted solution over 1.5 to 2 hours.

Storage & Stability RT (<25°C)

After dilution 7 days*
* wh e n diluted wi t h com patible diluent at concentration of 3m g / m l .

Remarks Should n o t be physically prem ixed w i t h other drugs, b u t should

adm inistered separately in accordance w i t h the rec om m ended route
of adm inistration and dosage schedule.
41
References Product leaflet Lotifar Injection ( Duopharm a (M) Sdn Bhd, Malaysia).
Revised date: 15.12.2004.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Pentamidine Isethionate Injection

Brand Nam e DBL TM Pentam idine Isethionate For Injection (Strength: 300m g)

Reconstitution Reconstitute 1 vial (300mg) wi t h 3 to 5m l WFI.

Further Dilution Dilute the required dose in 50 – 250m l of diluent.

Diluents
NS, D5

Adm inistration IV infusion

Adm inister over at least 60 minutes.

Storage & Stability RT (21 ±2°C) Fridge (2°C- 8°C)

After reconstitution 48 hours 48 hours
After dilution 24 hours* 24 hours
*W hen diluted to 1mg/ml and 2.5mg/ml in diluent.

Remarks ■ Direct bolus IV injection or rapid adm inistration m u s t n o t be used.

■ Keep patient supine during adm inistration to m inim ize hypotension.

References 1. Product leaflet DBL TM Pentam idine Isethionate For Injection

(Hospira Australia Pty Ltd, Australia). Revised date: 1.12.2012.
42 2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide. Pharmaceutical Press.
3. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Piperacillin & Tazobactam Injection

Brand Nam e Tapicin Powder For Injection (Strength: 4.5 g)

Contains: Piperacillin 4 g and Tazobactam 0.5 g

Reconstitution Reconstitute 1 vial (4.5 g) wi t h 20m l of diluent.

Diluents
WFI, NS, D5

Further Dilution IV infusion

Dilute reconstituted solution wi t h 50 – 150ml of diluent.

Diluents
NS, D5

Adm inistration Slow IV bolus

Adm inister over 3 – 5 minutes.

IV infusion
Adm inister over 20 – 30 minutes.

Storage & Stability RT (25°C) Fridge (2°C- 8°C)

After reconstitution 24 hours 7 days
43
Remarks ■ This pr oduc t do no t contain preservative, therefore appropriate
aseptic technique should be perform ed during preparation.
■ W henever this produc t is used concurrently w i t h another antibiotic,
the d r u g m u s t be adm inistered separately.
■ This pr oduc t should n o t be used w i t h solution containing only
s odium bicarbonate and should n o t be added to blood products or
album in hydrolysates.

References 1. Product leaflet Tapicin Powder For Injection (Yung Shin

Pharmaceutical Ind. Co, Ltd, Taiwan, ROC).
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Sulphamethoxazole -Trimethoprim Injection

Brand Nam e DBL T M Sulfamethoxazole 4 0 0 m g and Trim ethoprim 8 0 m g Concentrate

Injection BP (5ml per am poule)

Reconstitution Not required

Further Dilution Dilution Options:

1. Dilute 1 am poule (5 ml) to 125 ml of diluent.
2. Dilute 2 am poules (10 ml) to 250 m l of diluent.
3. Dilute 3 am poules (15 ml) to 500 m l of diluent.

Diluents
D5, NS, D10

Adm inistration IV infusion

■ Adm inister slowly over 60 – 90 minutes.

■ Duration of infusion should n o t exceed 1.5 hours.

Storage & Stability RT

After dilution 24 hours
*Do n o t refrigerate the prepared solution.

Remarks ■ Must be diluted prior to administration.

■ Must be adm inistered intravenously only in the form of an infusion
44
solution, and m ay n o t be injected undiluted either intravenously or
direct into infusion tube.
■ The prepared infusion should be shaken well to ensure thorough
mixing. Should visible turbidity or crystallisation appear in the
solution dur ing its preparation or infusion, it m u s t be discarded and
replaced by a freshly prepared solution.

References 1. Product leaflet DBL T M Sulfamethoxazole 4 0 0 m g and Trim ethoprim

8 0 m g Concentrate Injection BP (ham eln pharmaceuticals GmbH,
Germany). Revised date: 1.12.2012.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Vancomycin Injection

Brand Nam e Celovan Powder For Solution For Injection/Infusion (Strength: 500m g)

Reconstitution Dissolve 5 0 0 m g in 10 ml of W FI to obtain final concentration 50mg/ml.

Further Dilution Intermittent IV infusion

■ Dilute reconstituted solutions wi t h at least 100ml of diluent.
■ Max concentration= 5m g/ml.
■ For fluid restricted patients, a concentration of u p to 10m g / m l m ay
be used.

Diluents
NS, D5

Adm inistration Intermittent IV infusion

■ Adm inistered the desired dose over a period of at least 60 minutes.
■ Max rate = 10 m g/m inute.
■ 1 g dose is usually given over 2 hours.

Storage & Stability RT (<25°C) Fridge (2°C - 8°C)

After dilution 48 hours 48 hours

Remarks ■ Not for IM administration.

■ W atch for “red-m an” syndrome, a nonallergic histam ine reaction 45
caused by rapid IV infusion. Signs and s ym ptom s include
hypotension, pruritus, and maculopapular rash on face, neck, t ru nk
and limbs.

References 1. Product leaflet Celovan Vancomycin Powder For Solution For

Injection/Infusion (Mylan Laboratories Limited, India). Revised
date: January 2018.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.
3. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs
Guide, Pharmaceutical Press, 2011.
*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Voriconazole Injection

Brand Nam e Vfend ® (Strength: 200m g)

Reconstitution Reconstitute 1 vial (200mg) w i t h 19 m l of W FI (Concentration: 10 m g / m l

and extractable volume: 20ml).

Further Dilution Further dilute the required volum e of reconstituted solution according
to patient’s B W to a final concentration of 0.5 – 5m g/ml.

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

Weight
(kg) 3mg/kg 4mg/kg 6mg/kg 8mg/kg 9mg/kg dose
dose (no. dose (no. dose (no. dose (no. (no. of vials)
of vials) of vials) of vials) of vials)

10 - 4 m l (1) - 8 m l (1) 9 m l (1)

15 - 6 m l (1) - 12ml (1) 13.5ml (1)
20 - 8 m l (1) - 16ml (1) 18ml (1)
25 - 10ml (1) - 20m l (1) 22.5ml (2)
30 9 m l (1) 12ml (1) 18ml (1) 24m l (2) 27ml (2)
35 10.5ml (1) 14ml (1) 21ml (2) 28m l (2) 31.5ml (2)
40 12ml (1) 16ml (1) 24m l (2) 32ml (2) 36m l (2)
45 13.5ml (1) 18ml (1) 27ml (2) 36m l (2) 40.5ml (3)
46
50 15ml (1) 20m l (1) 30m l (2) 4 0 m l (2) 45m l (3)
55 16.5ml (1) 22ml (2) 33ml (2) 4 4 m l (3) 49.5ml (3)
60 18ml (1) 24m l (2) 36m l (2) 4 8 m l (3) 54m l (3)
65 19.5ml (1) 26m l (2) 39m l (2) 52ml (3) 58.5ml (3)
70 21ml (2) 28m l (2) 42m l (3) - -
75 22.5ml (2) 30m l (2) 45m l (3) - -
80 24m l (2) 32ml (2) 4 8 m l (3) - -
85 25.5ml (2) 34m l (2) 51ml (3) - -
90 27ml (2) 36m l (2) 54m l (3) - -
95 28.5ml (2) 38m l (2) 57ml (3) - -
100 30m l (2) 4 0 m l (2) 6 0 m l (3) - -

Diluents
NS, HSD5, D5

Adm inistration IV infusion ONLY

■ Adm inister over 1– 2 hours.
■ M a x i m u m rate: 3m g/k g/hour.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Storage & S tability Fridge (2°C- 8°C)

After reconstitution 24 hours
*The pr oduc t m u s t be used immediately.

Remarks ■ Voriconazole m u s t n o t be infused concom itantl y w i t h any blood

pr oduct or any short-term infusion of concentrated electrolytes,
even if the t wo infusions are running in separate intravenous line.
■ Not r ec om m ended for IV bolus administration.
■ Must n o t be diluted wi t h 4.2% s odium bicarbonate infusion.

References Product leaflet Vfend ® (Pharmacia & Upj ohn Company, USA). Revised
date: April 2014.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.

47
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

Zidovudine Injection

Brand Nam e Retrovir TM

(Strength: 200m g/20m l)

Reconstitution Not required

Further Dilution ■ Add and m ix the required dose wi t h diluent to obtain a final
concentration of either 2m g / m l or 4m g/m l.
■ Dilution m u s t be carried o u t under full aseptic conditions.

Diluent
D5

Adm inistration IV infusion

■ Adm inister slowly over 1 hour.
■ Avoid rapid infusion or bolus injection.

Storage & Stability RT (25°C) Fridge (5°C)

After dilution 48 hours 48 hours
*Any unused portion of the vial should be discarded.

Remarks ■ Do n o t adm inister as IM injection.

■ Must be DILUTED prior to administration.
■ Discard if any visible tur bidit y appears in the produc t either before
or after dilution or during infusion.
48
References 1. Product leaflet Retrovir™ (Glaxo W ellcome Operations, UK). Revised
date: 11.4.2012.
2. Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill
Professional.

*The inform ation provided in this guideline m ay be used as general reference only. Please refer to
the current produc t inserts for relevant brand used in facility.
 APPENDICES
Appendix 1 Glossary
49
Appendix 2 Best practices for injection
Appendix 3 Storage conditions
Appendix 4 Conversions & calculations
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

APPENDIX 1: GLOSSARY

No. Name Definition

1. Injection Use of a syringe and needle to push fluids or

drugs into the body; often called a “shot.”
2. Intravenous (IV) Into or wi th in a vein. Intravenous usually refers to a
way of giving a d r u g or other substance through
a needle or tube inserted into a vein.

3. Intravenous (IV) bolus ■ A m e t h o d of adm inistering concentrated

m edic ation (diluted or undiluted) directly into
the vein using a syringe t h r ou gh a needleless
por t on an existing IV line or a saline lock.
■ A discrete dose of m edication or solution given
slowly over at least 1 m inute.
■ It is usually adm inistered in a small volum e of
fluid/ m edic ine (max 20ml) that is pushed
manually into the vein slowly over at least
1 m inute.

4. Intravenous (IV) push Intravenous push is c o m m on l y used wh e n rapid

adm inistration of a m edic ation is needed such as
50 in em ergency (less than 30 seconds).

5. Continuous intravenous (IV) The adm inistration of a fluid into a blood vessel,
infusion usually over a prolonged period of time.

6. Interm ittent intravenous (IV) ■ This is the technique used to adm inister an
infusion injectable d r ug in an intravenous infusion over
a period of t i m e ranging f r o m 20 m inutes to
several hours. Repeated doses or single doses
are given in this way.
■ The infusion m ay be connected to the prim ary
intravenous giving set or to a secondary
adm inistration set via a Y-connector.
■ The volum e of intravenous fluid used to dilute
the d r ug ranges f r o m 50m l (the smallest
intravenous fluid bag) u p to 500ml. In clinical
practice m os t drugs are given in 100ml and
are set to infuse over 20-30 minutes.

7. Intramuscular (IM) injection ■ Intramuscular injections are adm inistered into

the m uscle beneath the subcutaneous tissue.
■ They are m os t c o m m onl y given into the t h i g h
or the gluteal muscle, and occasionally into
the deltoid muscle (which attaches the upper
a r m to the shoulder).
■ The volum e given at any one site is usually
lim ited to 5m l for the t h i g h (or 4 m l if it is a
depot injection because depots can be m ore
irritant), and 2m l for the deltoid muscle.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

No. Name Definition

8. Subcutaneous (SC) injection ■ Subcutaneous injections are given by injecting

a fluid or a solid pellet into the subcutis (the
fatty layer of tissue just under the skin).
■ Appropriate sites for subcutaneous injection
include:
• The outer aspect of the upper a r m
• The anterior aspect of the upper a r m
• The a bd om e n below t he costal m argins to
the iliac crests
• The anterior aspect of the t h i g h

9. Reconstitute The act of adding diluent to powder to create a

solution.

10. Dilution To add a diluent (e.g., norm al saline, sterile water)

to a solution of m edication in order to m ak e it less
concentrated or to provide additional solution for
ease of adm inistration and titration or to decrease
tissue irritation. 51

References:
1. Ministry of Health, Malaysia, 2017. Safe Operating Procedure for Adm inistration of Intravenous
(Bolus), Nursing Division.
2. Gray, A., W right, J., Goodey, V. and Bruce, L., 2011. Injectable Drugs Guide. Pharmaceutical Press.
3. https://www.cancer.gov/publications/dictionaries/cancer -terms/search [online]
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

APPENDIX 2: BEST PRACTICES FOR INJECTION

General Information:
■ All preparations should be done using aseptic technique.
■ Do NOT use the initial concentrate or the infusion solution if there is any sign of precipitation
and presence of foreign m atter in either one.
■ Do NOT m ix other drugs to the infusion solution to avoid any possible d r u g interactions.
■ Any unused portion should be discarded after the rec om m ended period of use.
■ For m ultiple use vials, reconstituted solution m us t be labelled w i t h t i m e and date im m ediatel y
after preparation and m u s t be placed under rec om m ended storage condition.
■ Flush IV line before and after administration. The m os t c o m m o n fluid adm inistered as an IV
flush is s odium chloride 0.9%. In some instances, glucose 5% m ay be used if it is m ore suitable
for use due to com patibility wi t h the IV m edicine being administered.
*This general inform ation m a y n o t be applicable to all the medications stated in this guideline.
Please refer to the pr oduc t inserts or consult your pharm acist for further information.

Table 1: Infection prevention and control practices

Do Do Not
DO carry out hand hygiene (use soap and DO NOT forget to clean your hands.
water or alcohol rub), and wash carefully,
including wrists and spaces between the
fingers, for at least 30 seconds.
52
(follow WHO’s ‘My 5 m om ents for hand
hygiene')

DO use one pair of non-sterile gloves per ■ DO NOT use the same pair of gloves for
procedure or patient. m ore than one patient.
■ DO NOT wash gloves for reuse.

Do disinfect the skin at the venepuncture site. DO NOT touch the punc ture site after
disinfecting it.

DO discard the used device (a needle and DO NOT leave an unprotected needle lying
syringe is a single unit) immediately into a outside the sharps container.
robust sharps container.

DO seal the sharps container with a DO NOT overfill or decant a sharps container.
tamper-proof lid.

DO immediately report any incident or DO NOT delay PEP after exposure to

accident linked to a needle or sharp injury, potentially contaminated material; beyond
and seek assistance; start Post-Exposure 72 hours, PEP is NOT effective.
Prophylaxis (PEP) as soon as possible,
following protocols.

References:
1. W orld Health Organization, 2010. W HO best practices for injections and related procedures
toolk it (No. WHO/EHT/10.02). W orld Health Organization.
2. Pharmaceutical Services Division, Penang State Health Departm ent, 2016. Antim icrobial
Dilution Protocol.
 D I L U T I O N G U I D E L I N E FOR I N J E C T A B L E D R U G S

APPENDIX 3: STORAGE CONDITIONS

The storage conditions for materials and/or products and/or cosmetics should follow the required
storage specification of the materials and/or products and/or cosmetics.

W here tem perature is n o t stated (in term s of range) on the labels of the materials and/or products
and/or cosmetics the following definitions should be followed:

ON THE LABEL MEANS

Freezer The tem perature is thermostatically controlled between

-20°C and -10°C

Refrigerator The tem perature is thermostatically controlled between 2°C

and 8°C

Cold place The tem perature does n o t exceed 8°C

Cool place The tem perature is between 8°C and 15°C

Room tem perature The tem perature is between 15°C and 30°C

W ar m The tem perature is between 30°C and 40°C

Excessive heat The tem perature is above 40°C

Do n o t store over 30°C The tem perature is between 2°C and 30°C 53

Do n o t store over 25°C The tem perature is between 2°C and 25°C

Do n o t store over 15°C The tem perature is between 2°C and 15°C

Do n o t store over 8°C The tem perature is between 2°C and 8°C

Do n o t store below 8°C The tem perature is between 8°C and 25°C

Dry place No m ore than 75 ± 5% relative h um id it y in norm al storage

conditions; to be provided to the user in a m oisture
resistant container.

Protect f r o m light To be provided to the user in a light resistant container.

Reference:
Ministry of Health Malaysia, 2nd Edition 2013. Guidelines on Good Distribution Practice (GDP).
 D IL U T IO N G U I D E L I N E FOR I N J E C T A B L E D R U G S

APPENDIX 4 : CONVERSIONS & CALCULATIONS

Accurate conversions and calculations of m edication dosages are crucial to ensure safe d r u g
administration.

1. Metric measures

1 m illigram (m g) = 1,000 m icrogram s (m cg)

1 g r a m (g) = 1,000 m g

1 k ilogram (kg) = 1,000 g

1 liter (L) = 1,000 milliliter (ml)

2. Calculating dosages & adm inistration rates

Concentration of solution in m g / m l = m g of d r u g
m l of solution

Infusion rate in m g / m i n u t e = m g of d r u g
x flow rate (ml/hour) ÷ 60 m inutes
m l of solution

Concentration of solution in m c g / m l = m g of d r u g x 1,000

m l of solution

Infusion rate in m c g /m i n u te = m g of d r u g x 1,000 x flow rate (ml/hour) ÷ 60 m inutes

m l of solution
54
Infusion rate in
m c g/k g/m inute = m g of d r u g x 1,000 x flow rate (ml/hour) ÷ 60 minutes ÷ weight in k g
m l of solution

Infusion rate in m l/hour = m l of solution ÷ 60 m inutes

Infusion rate in gtt/m inute = m l of solution x drip factor (gtt/ml)

t i m e in m inutes

Reference:
Schull, P.D., 2009. McGraw-Hill’s IV Drug Handbook. McGraw Hill Professional.