Editors: Susla, Gregory M.; Suffredini, Anthony F.; McAreavey, Dorothea; Solomon, Michael A.; Hoffman, William D.; Nyquist, Paul; Ognibene, Frederick P.; Shelhamer, James H.; Masur, Henry
Title: Handbook of Critical Care Drug Therapy, 3rd Edition
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Appendices
Appendix 1: Intravenous Medication Administration Guidelines

Intravenous Medication Administration Guidelines
Drug Usual Dose Rangea Standard Dilution Maximum Concentration Adjust for Renal or Hepatic Failure Infusion Times/Comments/Drug Interactions
Abciximab
• Bolus dose: 0.25 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
The dose must be filtered with a 0.22 µm filter prior to injection
• Infusion dose: 10 µg/min for 12 h 9 mg in 250 ml (D5W or 0.9% NaCl) 0.036 mg/ml Renal: no
Hepatic: no		 Continuous infusion
The dose must be filtered with a 0.22 µm filter prior to dilution
Acetazolamide 5 mg/kg/24h or 250 mg qid-qd Undiluted 100 mg/ml Renal: no
Hepatic: no		 Infuse at 500 mg/min
Acyclovir 5 mg/kg q8h 100 ml (D5W) 7 mg/ml Renal: yes
Hepatic: no		 Infuse over at least 60 min
Adenosine 6 mg initially, then 9 mg, then 12 mg Undiluted 3 mg/ml Renal: no
Hepatic: no		 Inject over 1–2 s
Drug interactions: theophylline (1), dipyridamole (2)
Alfentanil
• Bolus dose: 10–25 µg/kg Undiluted 500 µg/ml Renal: no
Hepatic: yes		 Inject over 60 s
• Infusion dose: 0.5–3 µg/kg/min 10,000 µg in 250 ml (D5W) 500 µg/ml Renal: no
Hepatic: yes		 Continuous infusion
Amikacin 7.5 mg/kg q12h 50 ml (D5W) 50 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Drug interaction: neuromuscular blocking agents (3)
Therapeutic levels: peak, 20–40 mg/L; trough, <8 mg/L
• High dose extended interval: 20 mg/kg 50 ml (D5W) 50 mg/ml Renal: yes
Hepatic: no		 Infuse over 60 min
Trough level 0 mg/L before next dose
Peak levels unnecessary
Aminocaproic acid 4 g initially, then 1 g/h 20 g in 1000 ml (D5W) 250 mg/ml Renal: no
Hepatic: no		 Rapid injection is not recommended, infuse initial dose over 60 min
Aminophylline
• Loading dose: 6 mg/kg 50 ml (D5W) 25 mg/ml Renal: no
Hepatic: no		 Infuse loading dose over 30 min
Maximum loading infusion rate 25 mg/min
Theophylline dose = 80% of aminophylline dose
Drug interactions: cimetidine, ciprofloxacin, erythromycin, clarithromycin (4); see Table 4.6
• Infusion dose:
  CHF:
  normal:
  smoker:
0.3 mg/kg/h
0.6 mg/kg/h
0.9 mg/kg/h		 500 mg in 500 ml (D5W) 10 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Therapeutic levels: 10–20 mg/L
Amiodarone
• First rapid loading infusion: 15 mg/min over first 10 min 150 mg in 100 ml (D5W) 6 mg/ml Renal: no
Hepatic: no		 Infuse over 10 min
• Followed by slow loading infusion: 1 mg/min over next 6 h 900 mg in 500 ml (D5W) 6 mg/ml Renal: no
Hepatic: no		 Infuse at 33.3 ml/h
• Maintenance infusion: 0.5 mg/min over next 18 h 900 mg in 500 ml (D5W) 6 mg/ml Renal: no
Hepatic: no		 Infuse at 16.6 ml/h
• Supplemental infusion: 15 mg/min over 10 min 150 mg in 100 ml (D5W) 6 mg/ml Renal: no
Hepatic: no		 Infuse over 10 min
Ammonium chloride mEq of H+ = 0.5 × body weight (kg) × (103 - serum Cl-) 100 mEq in 500 ml (0.9% NaCl) 0.2 mEq/ml Renal: no
Hepatic: avoid		 Maximum infusion rate is 5 ml/min of a 0.2 mEq/ml solution
Correct 1/3 to 1/2 of H+ deficit while monitoring pH
Amphotericin B 0.5–1.5 mg/kg q24h 250 ml (D5W) 1.4 mg/ml Renal: no
Hepatic: no		 Infuse over 2–6 h
Do not mix in electrolyte solutions (e.g., 0.9% NaCl, Ringer's lactate)
Amphotericin B Lipid Complex (ABLC) 5 mg/kg/d D5W to a final concentration of 1 mg/ml D5W to a final concentration of 2 mg/ml Renal: no
Hepatic: no		 Infuse at 2.5 mg/kg/h
If the infusion time exceeds 2 h, mix the contents by shaking the bag every 2 h
Ampicillin 0.5–3 g q4–6h 100 ml (0.9% NaCl) 50 mg/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
Ampicillin-sulbactam 1.5–3 g q6h 100 ml (0.9% NaCl) 50 mg/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
Anidulafungin
• Candidemia and candida infections 200 mg IV on day 1, followed by 100 mg qd D5W or 0.9% NaCl to a final concentration of 0.5 mg/ml 0.5 mg/ml Renal: no
Hepatic: no		 Maximum infusion rate 1.1 mg/min
• Esophageal candidasis 100 mg IV on day 1, followed by 50 mg qd D5W or 0.9% NaCl to a final concentration of 0.5 mg/ml 0.5 mg/ml Renal: no
Hepatic: no		 Maximum infusion rate 1.1 mg/min
Argatroban Discontinue all parenteral anticoagulants before administering argatroban
• HIT/HITTS 2 µg/kg/min 250 mg in 250 ml (D5W) 1 mg/ml Renal: no Continuous infusion
• PCI in HIT/HITTS       Hepatic: yes Maintain aPTT 1.5–3 times baseline values, not to exceed 100 s
• Bolus dose: 350 µg/kg 250 mg in 250 ml (D5W) 1 mg/ml Renal: no
Hepatic: no		 Infuse over 3 to 5 min
Check ACT 5–10 min after bolus dose is completed
Proceed with procedure if ACT is >300 s
• Infusion: 25 µg/kg/min 250 mg in 250 ml (D5W) 1 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Atenolol 5 mg IV over 5 min, 5 mg IV 10 min later Undiluted 0.5 mg/ml Renal: no
Hepatic: no		 Inject 1 mg/min
Atracurium
• Intubating dose: 0.4–0.5 mg/kg Undiluted 10 mg/ml Renal: no
Hepatic: no		 Inject over 60 s to prevent histamine release
• Maintenance dose: 0.08–0.1 mg/kg Undiluted 10 mg/ml Renal: no
Hepatic: no		 Drug interactions: aminoglycosides (3), anticonvulsants (5)
Monitor train-of-four stimulation
• Infusion dose: 5–9 µg/kg/min 1000 mg in 150 ml (D5W) 10 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Final volume = 250 ml
Concentration = 4 mg/ml
Monitor train-of-four stimulation
Azithromycin 500 mg qd for 1–2 d, then convert to oral therapy 1 mg/ml 2 mg/ml Renal: no
Hepatic: no		 Infuse the 1 mg/ml final concentration over 3 h and the 2 mg/ml final concentration over 1 h
250 PO = 100 mg IV
Aztreonam 0.5–2 g q6–12h 100 ml (D5W) 200 mg/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
Bivalirudin
• Bolus dose: 0.75 mg/kg 50 ml (D5W) 5 mg/ml Renal: yes
Hepatic: no		  
• Initial infusion: 1.75 mg/kg/h for the duration of the PCI procedure 50 ml (D5W) 5 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
The ACT should be determined 5 min after the bolus dose; an additional 0.3 mg/kg should be given if needed
• Optional post procedure infusion (up to 4 h): 0.2 mg/kg/h 500 ml (D5W) 0.5 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
After 4 h the infusion may be continued for up to 20 h post procedure
Bumetanide
• Bolus dose: 0.5–1 mg Undiluted 0.5 mg/ml Renal: no
Hepatic: no		 Infusion over 3–5 min
Maximum rate of injection is 1 mg/min
• Infusion dose: 0.08–0.3 mg/h 2.4 mg in 100 ml (0.9% NaCl) 0.5 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Monitor electrolytes
Calcium (elemental) 100–200 mg of elemental calcium IV over 15 min followed by 100 mg/h 1,000 mg in 1,000 ml (0.9% NaCl) 1.5 mg/ml Renal: no
Hepatic: no		 Ca chloride 1 g = 272 mg (13.6 mEq) of elemental calcium
Ca gluconate 1 g = 90 mg (4.65 mEq) of elemental calcium
Caspofungin
• Day 1 loading dose: 70 mg 250 ml (0.9% NaCl) 0.5 mg/ml Renal: no
Hepatic: yes		 Infuse over 60 min
• Maintenance dose: 50 mg qd 250 ml (0.9% NaCl) 0.5 mg/ml Renal: no
Hepatic: yes		 Infuse over 60 min
Cefazolin 0.5–1 g q6–8h 50 ml (D5W) 1 g in 10 ml sterile water IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Cefepime 0.5–2 g q12h 50 ml (D5W) 40 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Cefotaxime 1–2 g q4–6h 50 ml (D5W) 1–2 g in 10 ml sterile water IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Cefoxitin 1–2 g q4–6h 50 ml (D5W) 1–2 g in 10 ml sterile water IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Ceftazidime 0.5–2 g q8–12h 50 ml (D5W) 1–2 g in 10 ml sterile water IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Ceftriaxone 0.5–2 g q12–24h 50 ml (D5W) 40 mg/ml Renal: no
Hepatic: no		 Infuse over 15–30 min
Cefuroxime 0.75–1.5 g q8h 50 ml (D5W) 0.75 g in 10 ml sterile water IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Chloramphenicol 0.5–1 g q6h 50 ml (D5W) 100 mg/ml Renal: yes
Hepatic: yes		 Infuse over 30 min
Therapeutic levels: peak, 10–25 mg/L; trough, 5–10 mg/L
Chlorothiazide 0.5–1 g bid-qid 1 g in 18 ml (sterile water) 1 g in 18 ml Renal: no
Hepatic: no		 Inject over 3–5 min
Chlorpromazine 10–50 mg q4–6h Dilute with 0.9% NaCl to a final concentration of 1 mg/ml 1 mg/ml Renal: no
Hepatic: yes		 Infuse at 1 mg/min
Cidofovir Induction: 5mg/kg q wk × 2 wk
Maintenance: 5 mg/kg q2wk		 100 ml (0.9% NaCl) Unknown Renal: yes
Hepatic: no		 Infuse over 60 min
Cidofovir is contraindicated in patients with a SCr >1.5 mg/dl or CrCl <55 ml/min or urine protein >100 mg/dl
Cimetidine Drug interactions: theophylline, warfarin, phenytoin, lidocaine, benzodiazepines (6)
• IVPB: 300 mg q6–8h 50 ml (D5W) 15 mg/ml IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
• Infusion dose: 37.5 mg/h 900 mg in 250 ml (D5W) 9 mg/ml Renal no
Hepatic: no		 Continuous infusion
Ciprofloxacin 200–400 mg q12h Premixed solution 2 mg/ml 2 mg/ml Renal: yes
Hepatic: no		 Infuse over 60 min
Drug interactions: theophylline, warfarin (7)
Cisatracurium
• Intubating dose: 0.15–0.2 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Maintenance dose: 0.03 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Monitor train-of-four stimulation
• Infusion dose: 3 µg/kg/min Add 200 mg (20 ml) to D5W 180 ml 10 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Final concentrations is 1 mg/ml
Monitor train-of-four stimulation
Clindamycin 150–900 mg q8h 100 ml (D5W) 12 mg/ml Renal: no
Hepatic: yes		 Infuse over 30–60 min
Conjugated estrogens 0.6 mg/kg/d × 5 d 50 ml (0.9% NaCl) 5 mg/ml Renal: no
Hepatic: no		 Infuse over 30 min
Cosyntropin 0.25 mg Undiluted 0.25 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Cyclosporine 5–6 mg/kg q24h 100 ml (D5W) 2.5 mg/ml Renal: no
Hepatic: no		 Infuse over 2–6 h
Drug interactions: digoxin (8), erythromycin (9), amphotericin B, nonsteroidal anti-inflammatory drugs (10)
IV dose = 1/3 PO dose
Therapeutic levels: See Table 13.1
Dantrolene
• Bolus dose: 1–2 mg/kg (maximum dose 10 mg/kg) 60 ml sterile water (not dextrose or electrolyte solutions) 0.33 mg/ml Renal: no
Hepatic: no		 Administer as rapidly as possible
• Maintenance dose: 2.5 mg/kg q4h × 24 h 60 ml sterile water 0.33 mg/ml Renal: no
Hepatic: no		 Infuse over 60 min
Daptomycin 4 mg/kg q24h 100 ml (0.9% NaCl) 5 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Do not mix with dextrose-containing solutions
Desmopressin 0.3 µg/kg 50 ml (0.9% NaCl) 4 µg/ml Renal: no
Hepatic: no		 Infuse over 15–30 min
Dexamethasone 0.5–20 mg q6–24h 50 ml (0.9% NaCl) 4 mg/ml Renal: no
Hepatic: no		 May give doses ≤10 mg undiluted IV over 60 s
Dexmedetomidine
• Loading dose: 1 µg/kg over 10 min 100 µg in 48 ml (0.9% NaCl) 2 µg/ml Renal: no
Hepatic: yes		 Infuse over 10 min
• Maintenance dose: 0.2–0.7 µg/kg/h 100 µg in 48 ml (0.9% NaCl) 2 µg/ml Renal: no
Hepatic: yes		 Continuous infusion
Continuous infusion not to exceed 24 h
Diazepam 2.5–10 mg q2–4h Undiluted 5 mg/ml Renal: no
Hepatic: yes		 Inject at 2–5 mg/m
Diazoxide 50–150 mg q5–15 min Undiluted 15 mg/ml Renal: no
Hepatic: no		 Inject over 30 s
Maximum 150 mg/dose
Digoxin
• Loading dose: 1–1.25 mg over 8–24 h Undiluted 0.25 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
• Maintenance dose: 0.125–0.375 mg q24h Undiluted 0.25 mg/ml Renal: yes
Hepatic: no		 Inject over 3–5 min
Drug interactions: amiodarone, cyclosporine, quinidine, verapamil (8)
Therapeutic levels: 0.5–2 ng/ml
Diltiazem
• Bolus dose: 0.25–0.35 mg/kg Undiluted 5 mg/ml Renal: no
Hepatic: no		 Inject over 2 min
• Infusion dose: 5–15 mg/h 125 mg in 100 ml (D5W) 1 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Diphenhydramine 25–100 mg q2–4h Undiluted 50 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
Competitive histamine antagonist, doses >1,000 mg/24h may be required
Dobutamine 2.5–20 µg/kg/min 500 mg in 250 ml (D5W) 8 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Dolasetron May prolong QT interval
Administer with caution in patients with conduction system abnormalities or electrolyte abnormalities
• Post-op nausea and vomiting: 12.5 mg 15 min before cessation of surgery or as soon as nausea and vomiting present 12.5 mg IVP 12.5 mg Renal: no
Hepatic: no		 Inject over 30 seconds
• Chemotherapy induced nausea and vomiting: 100 mg 30 min before chemotherapy 100 mg IVP 100 mg Renal: no
Hepatic: no		 Inject over 30 s
Dopamine 2.5–20µg/kg/min 400 mg in 250 ml (D5W) 8 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Doxacurium
• Intubating dose: 0.025–0.08 mg/kg Undiluted 1 mg/ml Renal: no
Hepatic: no		 Inject over 5–10 s
• Maintenance dose: 0.005–0.01 mg/kg Undiluted 1 mg/ml Renal: yes
Hepatic: no		 Inject over 5–10 s
Dose based on lean body weight
Drug interactions: aminoglycosides (3), anticonvulsants (5)
Monitor train-of-four stimulation
• Infusion dose: 0.25 µg/kg/min 10 mg in 100 ml (D5W) 1 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
Dose based on lean body weight
Drug interactions: aminoglycosides (3), anticonvulsants (5)
Monitor train-of-four stimulation
The 1:10 dilution is only stable for 8 h after preparation
Doxycycline 100–200 mg q12–24h 250 ml (D5W) 1 mg/ml Renal: no
Hepatic: yes		 Infuse over 60 min
Droperidol
• Bolus dose: 0.625–10 mg q1–4h Undiluted 2.5 mg/ml Renal: no
Hepatic: yes		 Inject over 60 s
• Infusion dose: 1–20 mg/h 50 mg in 100 ml (D5W) 2.5 mg/ml (D5W) Renal: no
Hepatic: yes		 Continuous infusion
Monitor QT interval and electrolytes
Drotrecogin alfa 24 µg/kg/h × 96 h 50–250 ml (0.9% NaCL) 0.2 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Avoid in patients with single organ dysfunction and recent surgery
Edrophonium 500–1,000 µg/kg Undiluted 10 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Rapid onset, not useful for deep blocks
Enalaprilat 0.625–5 mg q6h Undiluted 1.25 mg/ml Renal: yes
Hepatic: no		 Inject over 5 min
Initial dose for patients on diuretics is 0.625 mg
Epinephrine 1–4 µg/min 1 mg in 250 ml (D5W) 0.05 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Epoetin α 50–100 U/kg 3 × /wk Undiluted 20,000 U/ml Renal: no
Hepatic: no		 Inject over 3–5 min
Maintenance doses range between 12.5–252 U/kg 3 × /wk
Eptifibatide
• Acute coronary syndrome: 180 µg/kg bolus, then 2 µg/kg/min Undiluted bolus dose 2 mg/ml
Infusion 0.75 mg/ml		 Undiluted bolus dose 2 mg/ml
Infusion 0.75 mg/ml		 Renal: yes
Hepatic: no		 Withdraw bolus dose from 2 mg/ml, 10 ml vial
Continuous infusion
• PCI without ACS: 180 µg/kg bolus × 2, then 2 µg/kg/min   2nd bolus dose administered 10 min after 1st bolus dose
Ertapenem 1 g q24h 1 g in 50 ml (0.9% NaCl) 20 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Erythromycin 0.5–1 g q6h 250 ml (0.9% NaCl) 20 mg/ml Renal: no
Hepatic: yes		 Infuse over 60 min
Drug interactions: theophylline (4), cyclosporine (9)
Esmolol
• Bolus dose: 500 µg/kg Undiluted 10 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Use 100 mg vial for bolus dose
• Infusion dose: 50–300 µg/kg/min 5g in 500 ml (D5W) 10 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Esomeprazole 20–40 mg q24h 50 ml (0.9% NaCl) 8 mg/ml
(IV Bolus)		 Renal: no
Hepatic: yes		 Infuse over 10–30 min
Inject IV bolus over at least 3 min
Etomidate 0.3–0.4 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Famotidine 20 mg q12h 100 ml (D5W) 20 mg/5ml 0.9% NaCl IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Inject IVP dose over 3–5 min
Fenoldopam 0.01–1.6 µg/kg/min 10 mg in 500 ml (D5W) 40 µg/ml Renal: no
Hepatic: no		 Do not use a bolus dose
Continuous infusion
Titrate infusion no more frequently than every 15 min
Recommended increments for titration are 0.05–0.1 µg/kg/min
Fentanyl
• Bolus dose: 25–75 µg q1–2h Undiluted 50 µg/ml Renal: no
Hepatic: no		 Inject over 5–10 s
• Infusion dose: 50–100 µg/h 50 µg/ml 50 µg/ml Renal: no
Hepatic: no		 Continuous infusion
Filgastrim (GCSF) 5–10 µg/kg × 2–4 wk Dilute in D5W to a final concentration of 5–15 µg/ml 15 µg/ml Renal: no
Hepatic: no		 Infuse over 15–30 min
Preferred route of administration is SC
To protect against adsorption to plastic materials, albumin must be added to a final concentration of 2 mg/ml
Do not dilute with saline at any time; product may precipitate
Fluconazole 100–800 mg q24h Premixed solution 2 mg/ml 2 mg/ml Renal: yes
Hepatic: no		 Maximum infusion rate 200 mg/h
Flumazenil
• Reversal of conscious sedation: 0.2 mg initially, then 0.2 mg q1min to a total of 1 mg Undiluted 0.1 mg/ml Renal: no
Hepatic: no		 Inject over 15 s
Maximum dose of 3 mg in any 1 h period
• Benzodiazepine overdose: 0.2 mg initially, then 0.3 mg × 1 dose, then 0.5 mg q30s up to a total of 3 mg Undiluted 0.1 mg/ml Renal: no
Hepatic: no		 Maximum dose of 3 mg in any 1 h period
• Infusion dose: 0.1–0.5 mg/h 5 mg in 1,000 ml (D5W) 0.1 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Foscarnet
• Induction dose: 60 mg/kg q8h Undiluted 24 mg/ml Renal: yes
Hepatic: no		 Infuse over 1 h
• Maintenance dose: 90–120 mg/kg q24h Undiluted 24 mg/ml Renal: yes
Hepatic: no		 Infuse over 2 h
Fosphenytoin
• Status epilepticus loading dose: 15–20 mg PE/kg Dilute to a final concentration from 1.5 to 25 mg PE/ml with D5W or 0.9% NaCl 25 mg PE/ml Renal: no
Hepatic: no		 Fosphenytoin 75 mg/ml = phenytoin 50 mg/ml
Infusion rate 100–150 mg PE/min
Continuous monitoring of ECG, BP, respiration
Peak phenytoin levels occur approximately 2 h after end of infusion
• Nonemergent loading and maintenance dose: 10–20 mg PE/kg Dilute to a final concentration from 1.5 to 25 mg PE/ml with D5W or 0.9% NaCl 25 mg PE/ml Renal: no
Hepatic: yes		 Should not be administered IM for the treatment of status epilepticus
• Initial daily maintenance dose: 4–6 mg PE/kg/d Dilute to a final concentration from 1.5 to 25 mg PE/ml with D5W or 0.9% NaCl 25 mg PE/ml Renal: no
Hepatic: yes		 Phenytoin therapeutic levels: 10–20 mg/L
• IM/IV substitution for oral phenytoin therapy: Substitute with same total daily dose Dilute to a final concentration from 1.5 to 25 mg PE/ml with D5W or 0.9% NaCl 25 mg PE/ml Renal: no
Hepatic: yes		  
Furosemide
• Bolus dose: 20–40 mg q1–2h Undiluted 10 mg/ml Renal: no
Hepatic: no		 Maximum injection rate 40 mg/min
Up to 400–800 mg/dose may be required in some patients
• Infusion dose: 2–20 mg/h 100 mg in 100 ml (0.9% NaCl) 10 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Monitor electrolytes
Ganciclovir 2.5 mg/kg q12h 100 ml (D5W) 10 mg/ml Renal: yes
Hepatic: no		 Infuse over 1 h
Gatifloxacin 400 mg qd 250 ml (D5W) 2 mg /ml Renal: yes
Hepatic: no		 Infuse over 60 min
Gentamicin
• Loading dose: 2–3 mg/kg 50 ml (D5W) 40 mg/ml Renal: no
Hepatic: no		 Infuse over 30 min
• Maintenance dose: 1.5–2.5 mg/kg q8–24h 50 ml (D5W) 40 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Critically ill patients have an increased volume of distribution requiring increased doses
Drug interaction: neuromuscular blocking agents (3)
Therapeutic levels: peak, 4–10 mg/L, trough <2 mg/L
• High dose extended interval: 5–8 mg/kg 50 ml (D5W) 40 mg/ml Renal: yes
Hepatic: no		 Infuse over 60 min
Trough level 0 mg/L before next dose
Peak levels unnecessary
Glucagon 0.5–3 mg followed by 1–20 mg/h 100 mg in 100 ml (D5W) 10 mg/ml Renal: no
Hepatic: no		 Continuous infusion
May cause hypokalemia, hyperglycemia, and tachycardia
Glycopyrrolate 5–15 µg/kg Undiluted 0.2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Granisetron
• Chemotherapy-induced nausea and vomiting resistant to standard antiemetic therapy 10 µg/kg IVP starting 30 min before the emetogenic drug Undiluted 1 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Postoperative nausea and vomiting 20–40 µg/kg as a single dose Undiluted 1 mg/ml Renal: no
Hepatic: no		 Infuse over 5 min
Haloperidol lactate
• Bolus dose: 1–10 mg q2–4h Undiluted 5 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
In urgent situations, the dose may be doubled every 20–30 min until an effect is obtained
Decanoate salt is only for IM administration
• Infusion dose: 1–10 mg/h 200 mg in 160 ml (D5W) (1 mg/ml) Pure drug: 5 mg/ml
D5W: 3 mg/ml;
0.9% NaCl: 0.75 mg/ml		 Renal: no
Hepatic: yes		 Continuous infusion
Monitor QT interval and electrolytes
Hydralazine 5–20 mg q4–6h Undiluted 20 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Hydrochloric acid H+ deficit in mEq = 0.5 × (body weight in kg) × (103-serum Cl-) 1 mEq/10 ml (sterile water) 1 mEq/10 ml Renal: no
Hepatic: no		 Maximum infusion rate = 0.2 mEq/kg/h
Hydrocortisone 12.5–100 mg q6–12h Undiluted 50 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Hydromorphone 1–4 mg q4–6h Undiluted 4 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Dilaudid-HP available as 10 mg/ml
Ibutilide >60 kg: 1 mg
<60 kg: 0.01 mg/kg		 50 ml (D5W) Undiluted 1 mg/10 ml Renal: no
Hepatic: no		 Infuse over 10 min
If arrhythmia does not terminate within 10 min after initial dose, a second dose may be administered over 10 min, 10 min after the completion of the first dose
Continuous ECG monitoring for at least 4 h following infusion or until QTc has returned to baseline
Imipenem 0.5–1 g q6–8h 100 ml (D5W) 5 mg/ml Renal: yes
Hepatic: no		 Infuse over 30–60 min
Isoniazid 300 mg qd 50 ml (D5W) Unknown Renal: yes
Hepatic: yes		 Infuse over 15–30 min
IM preparation is used for IV administration
Isoproterenol 1–10 µg/min 2 mg in 500 ml (D5W) 0.2 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Ketamine
• Bolus dose: 1–2 mg/kg Undiluted 100 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Infusion dose: 9–45 µg/kg/min 200 mg in 500 ml (D5W) 100 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Labetalol
• Bolus dose: 20 mg q15min Undiluted 5 mg/ml Renal: no
Hepatic: no		 Inject over 2 min
• Infusion dose: 1–4 mg/min 200 mg in 160 ml (D5W) 1 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Lansoprazole 30 mg qd 30 mg in 50 ml (D5W) 0.6 mg/ml Renal: no
Hepatic: no		 Administer over 30 min
Must administer through the in-line filter provided
Lepirudin
• Bolus dose: 0.4 mg/kg 5 mg/ml 5 mg/ml Renal: yes
Hepatic: no		 Inject over 15 sec
In patients weighing >110 kg, do not exceed the dose for a 110 kg patient
• Infusion dose: 0.15 mg/kg/h 100 mg in 500 ml (D5W) 0.4 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
Adjust aPTT to 1.5–2.5 times control
Levofloxacin 250–750 mg qd Premixed solution 5 mg/ml 5 mg/ml Renal: yes
Hepatic: no		 Infuse over 60 min
Levorphanol 2 mg q4–6h Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Levothyroxine 25–200 µg q24h Undiluted 100 µg/ml Renal: no
Hepatic: no		 Inject over 5–10 s IV dose = 75% of PO dose
Lidocaine
• Bolus dose: 1 mg/kg Undiluted 10 mg/ml Renal: no
Hepatic: yes		 Inject over 60 s
Drug interaction: cimetidine (6)
• Infusion dose: 1–4 mg/min 2 g in 500 ml (D5W) 16 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Therapeutic levels: 1.5–5.0 mg/L
Linezolid 600 mg q12h Undiluted 2 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Lorazepam
• Bolus dose: 0.5–2 mg q1–4h Undiluted 1 mg/ml Renal: no
Hepatic: no		 Inject 2 mg/min
Dilute 1:1 with 0.9% NaCl before administration
• Infusion dose: 0.02–0.1 mg/kg/h 20–40 mg in 250 ml (D5W) 2 mg/ml
Dilute 1:1 with 0.9% NaCl before administration		 Renal: no
Hepatic: no		 Continuous infusion
Lorazepam should be diluted in glass IV containers because it may be adsorbed onto plastic IV containers
Magnesium (elemental) Magnesium sulfate 1 g = 8 mEq = elemental magnesium 98 mg
• Magnesium deficiency: 25 mEq over 24 h followed by 6 mEq over the next 12 h 25 mEq in 1,000 ml (D5W) 1 mEq/ml Renal: yes
Hepatic: no		  
• Ventricular arrhythmias: 16 mEq over 1 h followed by 40 mEq over 6 h 40 mEq in 1,000 ml (D5W) 1 mEq/ml Renal: yes
Hepatic: no		 16 mEq (2 g) may be diluted in 100 ml D5W and infused over 1 h
Mannitol
• Diuretic: 12.5–100 g over 1–2 h Undiluted 250 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
• Cerebral edema: 0.25–0.5 g/kg q4h Undiluted 250 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
Meperidine 25–100 mg q2–4h Undiluted 100 mg/ml Renal: yes
Hepatic: yes		 Inject over 60 s
Avoid in renal failure
Neurotoxic metabolite, normeperidine causes seizures
Meropenem 1 g q8h 100 ml (D5W) 1 g/30 ml IVP Renal: yes
Hepatic: no		 Infuse over 15–30 min
Injection over 3–5 min
Methadone 5–20 mg qd Undiluted 10 mg/ml Renal: yes
Hepatic: yes		 Inject over 3–5 min
Accumulation with repetitive dosing
Methyldopa 250–1,000 mg q6h 100 ml (D5W) 10 mg/ml Renal: yes
Hepatic: yes		 Infuse over 30–60 min
Methyl-prednisolone 10–250 mg q6h Undiluted 62.5 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Metoclopramide
• For intubation of small intestine: 10 mg × 1 dose Undiluted 5 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
Metoprolol 5 mg q2min × 3 Undiluted 1 mg/ml Renal: no
Hepatic: yes		 Inject over 60 s
Metronidazole 500 mg q6h Premixed solution 5 mg/ml 5 mg/ml Renal: yes
Hepatic: yes		 Infuse over 30 min
Micafungin
• Treatment: 150 mg qd 100 ml (0.9% NaCl) 1.5 mg/ml Renal: no
Hepatic: no		 Infusion over 1 h
• Prophylaxis: 50 mg qd 100 ml (0.9% NaCl) 1.5 mg/ml Renal: no
Hepatic: no		 Infusion over 1 h
Midazolam
• Bolus dose: 0.025–0.35 mg/kg q1–2h Undiluted 5 mg/ml Renal: no
Hepatic: yes		 Inject 0.5 mg/min
• Infusion dose: 0.5–5 µg/kg/min 50 mg in 100 ml (D5W) 5 mg/ml Renal: yes
Hepatic: yes		 Continuous infusion
Unpredictable clearance in critically ill patients
Active metabolites accumulate in renal failure and contribute to pharmacologic effect
Milrinone
• Loading dose: 50 µg/kg Undiluted 0.4 mg/ml Renal: no
Hepatic: no		 Infuse over 10 min
The loading dose may be given undiluted, but diluting to a rounded total volume of 10 or 20 ml may simplify the visualization of the injection rate
• Maintenance dose: 0.375–0.75 µg/kg/min Premixed solution 0.2 mg/ml 0.4 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
Mivacurium
• Intubating dose: 0.15–0.25 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Rapid injection associated with histamine release
• Maintenance dose: 0.01–0.1 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Monitor train-of-four-stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
• Infusion dose: 9–10 µg/kg/min 50 mg in 100 ml (D5W) 0.5 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Monitor train-of-four stimulation
Morphine
• Bolus dose: 2–10 mg q1–2h Undiluted 15 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Infusion dose: 2–5 mg/h 100 mg in 100 ml (D5W) 15 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
Active metabolites accumulate in renal failure and contribute to pharmacologic effect
Moxifloxacin 400 mg qd Premixed solution 1.6 mg/ml 1.6 mg/ml Renal: no
Hepatic: no		 Infuse over 60 min
Mycophenolate
• Renal or hepatic transplant: 1 g q12h D5W final concentration 6 mg/ml 6 mg/ml Renal: yes
Hepatic: no		 Infuse over 2 h
• Cardiac transplant: 1.5 g q12h D5W final concentration 6 mg/ml 6 mg/ml Renal: yes
Hepatic: no		 Infuse over 2 h
Nafcillin 0.5–2 g q4–6h 100 ml (D5W) 250 mg/ml Renal: no
Hepatic: yes		 Infuse over 30–60 min
Nalmefene 0.25 µg/kg q2-5min up to a max dose of 1 µg/kg IVP
May dilute 1:1 with saline or sterile water		 100 µg/ml Renal: no
Hepatic: no		 Infuse over 60 s
In cases in which the patient is at increased cardiovascular risk, the incremental dose should be 0.1 µg/kg
In patients with renal failure, incremental doses should be infused over 60 s to prevent adverse effects, such as hypertension and dizziness
Naloxone
• Bolus dose: 0.4–2 mg (maximum 10 mg) Undiluted 1 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Infusion dose: 4–5 µg/kg/h 2 mg in 250 ml (D5W) 1 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Neostigmine 25–75 µg/kg Undiluted 1 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Nesiritide Prime IV tubing with an infusion of 25 ml prior to connecting to patient's vascular access port and prior to administering the bolus dose
Do not administer through a central heparin-coated catheter
• Bolus dose: 2 µg/kg IV push 6 µg/ml Renal: no
Hepatic: no		 Withdraw from infusion bag administer over 60 seconds through an IV port in the tubing
• Infusion dose: 0.01 µg/kg/min 1.5 mg in 250 ml (D5W) 6 µg/ml Renal: no
Hepatic: no		 Continuous infusion
Nicardipine 5–15 mg/h 25 mg in 250 ml (D5W) 0.1 mg/ml Renal: yes
Hepatic: no		 Continuous infusion
Infusion site should be changed every 12 h if administered by peripheral vein
Nitroglycerin 20–300 µg/min 50 mg in 250 ml (D5W) 1.6 mg/ml Renal: no
Hepatic: no		 Drug interaction: heparin (11)
Nitroprusside 0.5–10 µg/kg/min 50 mg in 250 ml (D5W) 0.8 mg/ml Renal: yes
Hepatic: no		 Maintain thiocyanate <10 mg/dl
Norepinephrine 4–35 µg/min 4 mg in 250 ml (D5W) 0.08 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Octreotide
• Continuous infusion: 50–100 µg bolus, followed by continuous infusion at 25–100 µg/h for 24–48 h 500 mg in 250 ml (D5W) 1000 µg/ml Renal: no
Hepatic: no		 Continuous infusion:
Ondansetron 16–32 mg 30 min before chemotherapy 50 ml (D5W) 1 mg/ml Renal: no
Hepatic: no		 Infuse over 15–30 min
• Postoperative nausea and vomiting: 4 mg IV × 1 Undiluted 2 mg/ml Renal: no
Hepatic: no		 Infuse over 2–5 min
Oxacillin 0.5–2 g q4–6h 100 ml (D5W) 250 mg/1.5 ml Renal: no
Hepatic: yes		 Infuse over 30 min
Pamidronate 60–90 mg × 1 dose 1,000 ml (D5W) Dilute in at least 1,000 ml Renal: no
Hepatic: no		 Infuse over 24 h
Pancuronium
• Intubating dose: 0.06–0.1 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Maintenance dose: 0.01–0.015 mg/kg Undiluted 2 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Active metabolite accumulates in renal failure and contributes to pharmacologic effect
Monitor train-of-four stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
• Infusion dose: 1 µg/kg/min 25 mg in 250 ml (D5W) 2 mg/ml Renal: yes
Hepatic: yes		 Active metabolite accumulates in renal failure and contributes to pharmacologic effect
Monitor train-of-four stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
Pantoprazole          
• 2 min infusion: 40 mg qd 10 ml (0.9% NaC) 4 mg/ml Renal: no
Hepatic: no		 Infuse over 2 min
• 15 min infusion: 40 mg qd 100 ml (D5W) 0.4 mg/ml Renal: no
Hepatic: no		 Infuse over 15 min
Penicillin G 8–24M U divided q4h 100 ml (D5W) 100,000 U/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
Pentamidine 4 mg/kg q24h 50 ml (D5W) 100 mg/ml Renal: yes
Hepatic: no		 Infuse over 60 min
Pentobarbital
• Bolus dose: 20 mg/kg 100 ml (0.9% NaCl) 20 mg/ml Renal: no
Hepatic: no		 Infuse over 2 h
• Infusion dose: 1 mg/kg/h initially, then 0.5–4 mg/kg/h 250 ml (0.9% NaCl) 10 mg/ml Renal: no
Hepatic: yes		 Therapeutic levels: 20–50 mg/L
Phenobarbital 20 mg/kg Undiluted 130 mg/ml Renal: no
Hepatic: yes		 Maximum infusion rate 50 mg/min
Therapeutic levels: 15–40 mg/L
Phentolamine
• Bolus dose: 5–10 mg Undiluted 5 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
• Infusion dose: 1–5 mg/min 100 ml (D5W) 5 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Phenylephrine 20–30 µg/min 15 mg in 250 ml (D5W) 6.4 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Phenytoin 15–20 mg/kg Undiluted 50 mg/ml Renal: no
Hepatic: yes		 Maximum infusion rate 25 to 50 mg/min
Drug interactions: cimetidine (6), neuromuscular blocking agents (5)
Therapeutic levels: 10–20 mg/L
Phosphate (potassium) 0.16–0.64 mmol/kg Function of K+ concentration Function of K+ concentration Renal: yes
Hepatic: no		 Infuse over 6–8 h
1 mmol of PO4 = 31 mg of phosphorus
Maximum infusion rate 10 mmol/h
Piperacillin 2–4 g q4–6h 100 ml (D5W) 200 mg/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
Pipercillin and tazobactam 3.375 g q6h 100 ml (D5W) 60 mg of piperacillin/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Potassium chloride 5–40 mEq/h 40–80 mEq in 1000 ml (0.9% NaCl, D5W, etc.) 0.4 mEq/ml Renal: yes
Hepatic: no		 Cardiac monitoring should be used with infusion rates >20 mEq/h
Prednisolone 4–60 mg q24h Undiluted 20 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Procainamide
• Loading dose: 15 mg/kg 50 ml (D5W) 20 mg/ml Renal: no
Hepatic: no		 Maximum infusion rate 25–50 mg/min
• Infusion dose: 1–4 mg/min 2 g in 500 ml (D5W) 8 mg/ml Renal: yes
Hepatic: no		 Therapeutic levels: Procainamide, 4–10 mg/L, NAPA, 10–20 mg/L
Propofol
• Bolus dose: 0.25–2 mg/kg Undiluted 10 mg/ml Renal: no
Hepatic: no		 Infuse over 1–2 min
• Infusion dose: 5–50 µg/kg/min Undiluted 10 mg/ml Renal: no
Hepatic: no		 Dilute only with 0.9% NaCl to no less than 2 mg/ml
Avoid infusion rates >80 µg/kg/min
Propranolol 0.5–1 mg q5–15 min Undiluted 1 mg/ml Renal: no
Hepatic: yes		 Inject over 60 s
• Infusion dose: 1–3 mg/h 50 mg in 500 ml (D5W) 1 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Protamine <30 min: 1–1.5 mg/100 U heparin
30–60 min: 0.5–0.75 mg/100 U heparin
>120 min: 0.25–0.375 mg/100 U heparin		 50 mg in 5 ml sterile water 10 mg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
Do not exceed 50 mg in 10 min
Pyridostigmine 100–300 µg/kg Undiluted 5 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
Use to reverse long-acting neuromuscular blocking agents
Quinidine gluconate 600 mg initially, then 400 mg q2h
Maintenance 200–300 mg q6h		 800 mg in 50 ml (D5W) 16 mg/ml Renal: no
Hepatic: yes		 Infusion rate 1 mg/min
Therapeutic levels: 1.5–5 mg/L
Quinupristin/dalfopristin 7.5 mg/kg q8–12h 250 ml (D5W) (approx. 2 mg/ml) 100 ml (D5W) (approx. 5 mg/ml) Renal: no
Hepatic: yes		 Infuse over 1 h
Infusion volume of 100 ml may be used for central line infusions
Not compatible with saline containing solutions
Ranitidine
• IVPB: 50 mg q6–8h 50 ml (D5W) 2.5 mg/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
IVP dose should be injected over at least 5 min
• Infusion dose: 6.25 mg/h 150 mg in 150 ml (D5W) 2.5 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Rasburicase 0.15–0.2 mg/kg qd × 5 d Achieve a final total volume of 50 ml (0.9% NaCl) Achieve a final total volume of 50 ml (0.9% NaCl) Renal: no
Hepatic: no		 Infuse over 30 min
Remifentanil
Continuation in the immediate postoperative period 0.0125–0.025 µg/kg/min 2 mg in 80 ml (D5W) 250 µg/ml Renal: no
Hepatic: no		 Continuous infusion
Bolus doses to treat postoperative pain are not recommended
Infusion rates should not exceed 0.025 µg/kg/min
Failure to clear IV tubing of residual drug has been associated with respiratory depression, apnea, and muscle rigidity upon administration of additional fluids through the same IV tubing
Reteplase 10 U followed by a second 10 U dose 30 min later Diluted with sterile water to a final concentration of 1 U/ml Diluted with sterile water to a final concentration of 1 U/ml Renal: no
Hepatic: no		 Inject over 2 min
RhOD Immune Globulin Intravenous 20–250 µg/kg Undiluted 120 µg/ml Renal: no
Hepatic: no		 Inject over 3–5 min
Rifampin 300–600 mg q24h 100 ml (D5W) 3 mg/ml Renal: no
Hepatic: yes		 Infuse over 30 min
Rocuronium
• Bolus dose: 0.6–1.2 mg/kg Undiluted 10 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Maintenance dose: 0.1–0.2 mg/kg Undiluted 10 mg/ml Renal: no
Hepatic: yes		 Inject over 60 s
Monitor train-of-four stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
• Infusion dose: 4–16 µg/kg/min 50 mg in 50 ml (D5W) 10 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Monitor train-of-four stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
RSV Immune Globulin 750 mg/kg q month 50 mg/ml 50 mg/ml Renal: no
Hepatic: no		 Infuse 1.5 ml/kg/h 0–15 min
Infuse 3 ml/kg/h 15–30 min
Infuse 6 ml/kg/h 30 min to end of infusion
Sargramostim (GM-CSF) 250 mg/M2/d × 21 d 50 ml (NS) Should be diluted to >10 µg/ml Renal: no
Hepatic: no		 Infuse over 2 h
If final concentration is <10 µg/ml, albumin should be added to a final concentration of 0.1%
Sodium bicarbonate HCO-3 deficit in mEq = 0.4 × (body weight in kg) × (desired HCO-3 - measured HCO-3) Premixed solution 0.6 mEq/ml 150 mEq in 1,000 ml SW or D5W Renal: no
Hepatic: no		 Continuous infusion
Sodium bicarbonate syringes contain 1 mEq/ml
Many incompatibilities; flush IV line before and after use
Streptomycin 0.5–1 g qd–q12h 100 ml (0.9% NaCl) 100 ml (0.9% NaCl) Renal: yes
Hepatic: no		 Infuse over 30 min
IM product is used for IV administration
Succinylcholine 1–2 mg/kg Undiluted 100 mg/ml Renal: no
Hepatic: no		 Infuse over 60 s
Sufentanil
• Bolus dose: 0.2–0.6 µg/kg Undiluted 50 µg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Infusion dose: 0.01–0.05 µg/kg/min Undiluted 50 µg/ml Renal: no
Hepatic: no		 Continuous infusion
Tacrolimus 50–100 µg/kg/day 100 ml (D5W) 0.02 mg/ml Renal: yes
Hepatic: yes		 Infuse over 24 h
Thiamine 100 mg qd × 3 50 ml (D5W) 2 mg/ml Renal: no
Hepatic: no		 Infuse over 15–30 min
Thiopental 3–4 mg/kg Undiluted 4 mg/ml Renal: no
Hepatic: yes		 Infuse over 3–5 min
Ticarcillin-clavulanic acid 3.1 g q4–6h 100 ml (D5W) 100 mg/ml Renal: yes
Hepatic: no		 Infuse over 15–30 min
Tigecycline 100 mg initially, then 50 mg q12h 100 ml (D5W) 1 mg/ml Renal: no
Hepatic: yes		 Reconstituted solution should be yellow to orange in color
Infuse over 30–60 min
Tirofiban 0.4 µg/kg/min for 30 min, then 0.1 µg/kg/min 25 mg in 500 ml (D5W) 50 µg/ml Renal: yes
Hepatic: no		 Continuous infusion
Can be administered through the same IV catheter as heparin
Tissue Plasminogen Activator (rtPA)          
• Myocardial infarction: 100 mg 100 mg in 100 ml (sterile water) 1 mg/ml Renal: no
Hepatic: no		 Accelerated infusion: 15 mg bolus, followed by 50 mg over 30 min, then 35 mg over the next 60 min
3 hour infusion: 60 mg in the first h, 20 mg over the second h, and 20 mg over the third h
• Acute ischemic stroke: 0.9 mg/kg (to maximum 90 mg) Appropriate volume of a 1 mg/ml solution 1 mg/ml Renal: no
Hepatic: no		 Infuse over 60 min with 10% of total dose administered as an initial bolus over 1 min
• Pulmonary embolism: 100 mg 100 mg in 100 ml (sterile water) 1 mg/ml Renal: no
Hepatic: no		 Infuse over 2 h
Tobramycin          
• Loading dose: 2–3 mg/kg 50 ml (D5W) 40 mg/ml Renal: no
Hepatic: no		 Infuse over 30 min
• Maintenance dose: 1.5–2.5 mg/kg q8–24h 50 ml (D5W) 40 mg/ml Renal: yes
Hepatic: no		 Infuse over 30 min
Critically ill patients have an increased volume of distribution requiring increased doses
Drug interaction: neuromuscular blocking agents (3)
Therapeutic levels: peak, 4–10 mg/L, trough <2 mg/L
Torsemide          
• Bolus dose: 5–40 mg qd 10 mg/ml 10 mg/ml Renal: no
Hepatic: no		 Inject over 2 min
• Infusion dose: 25 mg bolus dose followed by 3 mg/h 100 mg in 100 ml (0.9% NaCl) 10 mg/ml Renal: no
Hepatic: no		 Continuous infusion
Monitor electrolytes
Tranexamic acid  
• Presurgical: 10 mg/kg immediately prior to surgery 100 ml (D5W) Unknown Renal: no
Hepatic: no		 Infuse over 30 min
• Postsurgical: 10 mg/kg q6–8h for 2–8 d 100 ml (D5W) Unknown Renal: yes
Hepatic: no		 Infuse over 30 min
• Bladder irrigation: 1 g in 1,000 ml (0.9% NaCl) at 1 ml/min for 2–5 d 1 g in 1,000 ml (0.9% NaCl) 1 g in 1,000 ml (0.9% NaCl) Renal: no
Hepatic: no		 Not for IV use
Instill in bladder at 1 ml/min
Trimethoprim-sulfamethoxazole (TMP-SMX)          
• General: 4–5 mg/kg q12h TMP 16 mg-SMX 80 mg per 25 ml (D5W) TMP 16 mg-SMX 80 mg per 10 ml (D5W) Renal: yes
Hepatic: yes (SMX)		 Infuse over 60 min
• For pneumocystis carinii: 5 mg/kg q6h TMP 16 mg-SMX 80 mg per 25 ml (D5W) TMP 16 mg SMX 80 mg per 10 ml (D5W) Renal: yes
Hepatic: yes (SMX)		 Infuse over 60 min
Therapeutic levels (SMX): <150 mg/L
Trimetrexate 22–45 mg/m2 q24h 100 ml (D5W) 2 mg/ml Renal: no
Hepatic: no		 Infuse over 60–90 min
Trimetrexate must be given with leucovorin 20–40 mg/m2 q6h to avoid serious or life-threatening toxicities
Valproate sodium IV dose = PO dose 50 ml (D5W) 10 mg/ml Renal: no
Hepatic: yes		 Maximum infusion rate = 20 mg/min
Vancomycin 1 g q12h 250 ml (D5W) 20 mg/ml Renal: yes
Hepatic: no		 Infuse over at least 1 h to avoid “red-man” syndrome
Therapeutic levels: peak, 20–40 mg/L, trough, <10 mg/L
Vasopressin          
Upper GI bleed: 0.2–0.3 U/min 100 U in 250 ml (D5W) 1 U/ml Renal: no
Hepatic: no		 Maximum infusion rate 0.9 U/min
Septic shock: 0.01–0.04 U/min 100 U in 100 ml (D5W) 1 U/ml Renal: no
Hepatic: no		 Continuous infusion
Vecuronium          
• Bolus dose: 0.1–0.28 mg/kg Undiluted 1 mg/ml Renal: no
Hepatic: no		 Inject over 60 s
• Maintenance dose: 0.01–0.15 mg/kg Undiluted 1 mg/ml Renal: yes
Hepatic: yes		 Inject over 1–2 min
Active metabolite accumulates in renal failure and contributes to pharmacologic effect
Monitor train-of-four stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
• Infusion dose: 1 µg/kg/min 20 mg in 100 ml (D5W) 1 mg/ml Renal: yes
Hepatic: yes		 Continuous infusion
Active metabolite accumulates in renal failure and contributes to pharmacologic effect
Monitor train-of-four stimulation
Drug interactions: aminoglycosides (3), anticonvulsants (5)
Verapamil          
• Bolus dose: 5–10 mg Undiluted 2.5 mg/ml Renal: no
Hepatic: no		 Inject over 1–2 min
Drug interaction: digoxin (8)
• Infusion dose: 0.1–5 µg/kg/min 40 mg in 250 ml (D5W) 2.5 mg/ml Renal: no
Hepatic: yes		 Continuous infusion
Voriconazole          
• Loading dose: 6 mg/kg q12h × 24 h 100 ml (D5W) ≤5 mg/ml Renal: no
Hepatic: no		 Infuse over 1–2 h
Maximum infusion rate 3 mg/kg/h
• Maintenance dose: 4 mg/kg q12h 100 ml (D5W) ≤5 mg/ml Renal: no
Hepatic: no		 Infuse over 1–2 h
Maximum infusion rate 3 mg/kg/h
Zidovudine 1 mg/kg q4h D5W (50 ml) 4 mg/ml Renal: yes
Hepatic: no		 Infuse over 1 h
1 mg/kg IV q4h is the equivalent to the oral dose of 100 mg q4h
Zoledronic acid 4 mg IV × 1 D5W (100 ml) 0.04 mg/ml Renal: yes
Hepatic: no		 Infuse over 15 min
ACT, activated clotting time; APPT, activated partial thromboplastin time; BP, blood pressure; D5W, dextrose 5% in water; ECG, electrocardiogram; HF, heart failure; IM, intramuscular; INP, intravenous push; IV, intravenous; NAPA, N-acetylprocainamide; PE, phenytoin equivalents; PO, by mouth; SC, subcutaneous; SMX, sulfamethoxazole; TMP, trimethoprim
aUsual dose ranges are listed, refer to appropriate disease state for specific dose.
Drug interactions: (1) antagonizes adenosine effect; (2) potentiates adenosine effect; (3) potentiates effect of neuromuscular blocking agents; (4) inhibits theophylline metabolism; (5) antagonizes effect of neuromuscular blocking agents; (6) metabolism inhibited by cimetidine; (7) metabolism inhibited by ciprofloxacin; (8) increased digoxin concentrations; (9) metabolism inhibited by erythromycin; (10) increased nephrotoxicity; (11) increased heparin requirement.
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Appendix 2: Intravenous to Oral Conversions
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P.319

P.320

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Intravenous to Oral Conversions
IV Product Oral Conversion Product Comments
Acyclovir Acyclovir:
Herpes simplex: 200 mg PO q4h (5 × /d)
Herpes zoster acute treatment: 800 mg PO q4h (5 × /d)
Varicella zoster: 800 mg PO qid × 5 d
Valacyclovir:
Herpes zoster: 1 g PO tid × 7 d		 Valacyclovir is rapidly and nearly completely converted to acyclovir
Allopurinol Allopurinol 100–300 mg PO qd Oral dose = IV dose
Aminocaproic acid 1–1.25 g/h for 8 h or until bleeding is controlled  
Aminophylline infusion dose
  1. Multiply the hourly aminophyl-line infusion rate (mg/h) by 24 to determine the total daily dose.
  2. Multiply the total daily dose by 0.80 to convert aminophylline to theophylline.
  3. Divide the total daily theophyl-line dose by the number of dosing intervals appropriate for the oral theophylline product selected (q24h: 1; q12h: 2; q8h: 3; q6h: 4).
  4. Select the closest available dose strength of the product selected.
  5. Stop the IV infusion with the first administered oral dose.
  6. Monitor theophylline concentration 24–48 h after switching to oral product.
 Theophylline = 0.80 × aminophylline
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Amiodarone maintenance infusion Duration of IV amiodarone infusion
<1 wk
1–3 wk
>3 wk		 Initial oral daily
dose


800–1,600 mg
600–800 mg
400 mg		 Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Ampicillin Ampicillin 250–500 mg PO qid or amoxicillin 250–500 mg tid  
Ampicillin-sulbactam Amoxicillin-Clavulanic acid250–500 mg PO q8h
Argatroban Warfarin
Initiate oral anticoagulation only after substantial recovery of platelet counts (i.e., >100 × 109/L)
Do not use a warfarin loading dose
Initiate therapy with expected daily dose of warfarin
Overlap argatroban and warfarin therapy for 4–5 d to avoid prothrombotic effect
Atenolol Postmyocardial infarction: 50 mg POafter last IV dose, 50 mg PO 12 h later, then 50 mg PO bid for 6–9 days or until discharge from the hospital
Azithromycin 250 mg PO qd for 5–10 d
Cefazolin Cefadroxil 500 mg PO q12h, cephalexin 500 mg PO q6h, or cefaclor 500 mg PO q8h Cefaclor provides gram (-) coverage similar to cefazolin that is not provided by cefadroxil or cephalexin
Cefepime Ceftibuten 400 mg PO qd The spectrum of ceftibuten closely approximates the spectrum of cefepime except for Ps. aeruginosa
Cefotaxime Cefpodoxime 100–200 mg PO q12h, cefixime 400 mg PO qd, or ceftibuten 400 mg PO qd Ceftibuten may provide additional gram (-) coverage not provided by cefpodoxime or cefixime
Cefoxitin Cefuroxime 250–500 mg PO bid, cefixime 400 mg PO qd, or ceftibuten 400 mg PO qd PLUS metronidazole 250–500 mg PO q6–8h The spectrum of cefuroxime, cefixime, and ceftibuten closely approximates the gram (+) and gram (-) spectrums of cefoxitin; metronidazole covers the anaerobic organisms not covered by the cephalosporins
Ceftazidime Ceftibuten 400 mg PO qd The spectrum of ceftibuten closely approximates the spectrum of ceftazidime except for Ps. aeruginosa
Ceftriaxone Cefpodoxime 100–200 mg PO q12h, cefixime 400 mg PO qd, or ceftibuten 400 mg PO qd Ceftibuten may provide additional gram (-) coverage not provided by cefpodoxime or cefixime
Cefuroxime Cefuroxime 250–500 mg PO q12h  
Chloramphenicol Convert IV dose to equivalent oral dose The oral formulation has increased bioavailability compared to IV formulation
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Cimetidine 300 mg PO qid, 400 mg PO bid, or 800 mg PO qhs Oral dose = IV dose
Ciprofloxacin 250–750 mg PO q12h  
Clindamycin 150–450 mg PO q6h  
Cyclosporine Oral dose equals 3 × IV dose Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Digoxin maintenance dosage Convert IV dose to equivalent oral dose Oral dose approximately equal to IV dose
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Diltiazem continuous infusion 3 mg/h = diltiazem CD 120 mg PO qd
5 mg/h = diltiazem CD 180 mg PO qd
7 mg/h = diltiazem CD 240 mg PO qd
11 mg/h = diltiazem CD 300 mg PO qd		 After constant IV infusion, diltiazem exhibits nonlinear pharmacokinetics over the infusion range of 5–13 mg/h
The oral conversions are expected to produce approximately equivalent steady-state plasma concentrations to the IV dose
Doxycycline 50–100 mg PO bid  
Enalaprilat CrCl >30 ml/min: 5 mg PO qd
CrCl <30 ml/min: 2.5 mg PO qd		  
Erythromycin Tab: 250 mg PO q6h, 333 mg PO q8h, 500 mg PO q12h
Susp.: 400 mg PO q6h, 800 mg PO q12h
Legionnaire's disease:250–1,000 mg PO qid		 Multiple erythromycin salts and products are available; refer to hospital formulary for available products
Esomeprazole 20–40 mg PO qd Oral dose = IV dose
Famotidine 10–20 mg PO bid or 40 mg PO qhs Oral dose = IV dose
Fluconazole 50–400 mg PO qd Oral dose = IV dose
Fosphenytoin Switch to Dilantin brand of phenytoin at same total daily dose Monitor phenytoin serum concentrations after conversion to oral therapy and adjust oral Dilantin dose as needed
Ganciclovir CMV retinitis maintenance dosing: 1,000 mg PO tid with food or 500 mg PO 6 × /d(q3h while awake) with food  
Gatifloxacin 400 mg PO qd Oral dose = IV dose
Granisetron 1 mg PO bid, with the first dose given up to 1 h before highly emetogenic chemotherapy, and the second dose given 12 h after the first dose  
Hydralazine 10–50 mg PO qid  
Hydrocortisone 25–100 mg PO q8h Oral dose equals IV dose
Isoniazid 300 mg PO qd Oral dose = IV dose
Ketamine 10 mg/kg PO  
Ketorolac 10 mg PO qid Maximum combined duration of therapy is 5 d
Labetalol 100–400 mg PO bid  
Lansoprazole 15–30 mg PO qd Oral dose = IV dose
Levofloxacin 250–750 mg PO qd Oral dose = IV dose
Levothyroxine Oral dose equals 1.33 timesIV dose  
Linezolid 400–600 mg PO bid Oral dose = IV dose
Methyldopa 250–500 mg PO bid-qid  
Methylprednisolone 4–20 mg qd Oral dose equals IV dose
Metoclopramide 5–15 mg PO qid  
Metoprolol Tab: 25–200 mg PO bid
SR-tab: 50–100 mg PO qd		  
Metronidazole 250–500 mg PO tid  
Midazolam 0.5–1 mg/kg PO  
Moxifloxacin 400 mg PO qd Oral dose = IV dose
Nafcillin Dicloxacillin 250–500 mg PO qid  
Nicardipine continuous infusion 0.5 mg/h = 20 mg PO q8h
1.2 mg/h = 30 mg PO q8h
2.2 mg/h = 40 mg PO q8h		  
Ondansetron Administer first dose (4–8 mg) 30 min before start of chemotherapy, with subsequent doses 4 h and 8 h after first dose, then 4–8 mg PO tid for 1–2 d after completion of chemotherapy  
Oxacillin Oxacillin 250–1,000 mg PO q4–6h or dicloxacillin 250–500 mg PO qid  
Pantoprazole 20–40 mg PO qd Oral dose = IV dose
Penicillin G Penicillin VK 250–500 mg PO qid  
Phenobarbital 15–60 mg PO qd Oral dose equals IV dose
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Phenytoin Convert IV dose to equivalent oral dose Oral dose approximately equal to IV dose
Only Dilantin brand of phenytoin may be given as a single daily dose
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Phosphate 1 g (228 mg or 7.4 mmol) PO qid with meals and at bedtime
Must be thoroughly dissolved in 180–240 ml water		  
Potassium chloride Oral dose equals IV dose Oral powder or elixir must be diluted in at least 120 ml of fluid before administration to prevent osmotic diarrhea
Procainamide continuous infusion
  1. Multiply the hourly procainamide infusion rate (mg/h) by 24 to determine the total daily dose.
  2. Divide the total daily procainamide dose by the number of dosing intervals appropriate for the oral procainamide product selected (q12h: 2; q6h: 4; q3h: 8).
  3. Select the closest available dose strength of the product selected.
  4. Stop the IV infusion with the first administered oral dose.
  5. Monitor procainamide concentration 24–48 h after switching to oral product.
 Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Quinidine gluconate continuous infusion
  1. Multiply the hourly quinidine gluconate infusion rate (mg/h) by 24 to determine the total daily dose.
  2. Multiply the total daily quinidine gluconate dose by 1.4 to determine the equivalent oral quinidine gluconate dose.
  3. Divide the total daily dose by the number of dosing intervals appropriate for the oral quinidine gluconate product selected (q6h: 4; q8h: 3).
  4. Select the closest available dose strength of the product selected.
  5. Stop the IV infusion with the first administered oral dose.
  6. Monitor quinidine concentration 24–48 h after switching to oral product.
 The bioavailability of oral quinidine gluconate is approximately 70%
Quinidine gluconate delivers 62% quinidine alkaloid
Quinidine gluconate is available as a 324 mg sustained release tablet; this formulation may be broken in half for administration
Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Ranitidine 150 mg PO bid or 300 mg PO qd  
Rifampin 300–600 mg PO qd Oral dose = IV dose
Tacrolimus 0.15–0.3 mg/kg/d PO in q12h divided doses; administer initial dose no sooner than 6 h after transplantation; if IV therapy was initiated, begin 8–12 h after discontinuing IV therapy Monitor serum concentrations after conversion to oral therapy and adjust oral dose as needed
Tranexamic acid 25 mg/kg PO tid-qid starting 1 d before surgery and continued for 2–8 d postsurgery  
Trimethoprim-sulfamethoxazole (TMP-SMX) 1 Septra or 1 Septra DS tab (or equivalent susp. volume) PO q12h  
Verapamil Tab: 40–120 mg PO q8h
SR-tab/cap: 120–240 mg PO qd		  
Voriconazole Maintenance dose: 200 mg PO q12h  
IV, intravenous; PO, by mouth
The patient, degree of organ impairment, severity of infection or disease state, and duration of IV therapy at time of switch are important in determining the most appropriate oral dose. Many hospitals with switch programs have predetermined the most appropriate oral dose for the switch.
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Appendix 3: Selected Oral Drug Doses
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Selected Oral Drug Doses
Generic Name (Trade Name) Therapeutic Category Preparation Usual Adult Dose/Comments
Abacavir (Ziagen) Antiretroviral Tab: 300 mg
Soln: 20 mg/ml		 300 mg PO bid
Acarbose (Precose) Hypoglycemic Tab: 50, 100 mg Initial: 25 mg PO tid at the start of each main meal
Maintenance: Increase dose as needed at 4- to 8-wk intervals
Maximum: ≤60 kg: 50 mg PO tid; >60 kg: 100 mg PO tid
Not recommended in diabetics with SCr >2 mg/dl
Acebutolol (Sectral) Antihypertensive, antiarrhythmic Cap: 200, 400 mg HTN: 400–800 mg PO qd
Arrhythmias: 200 mg PO bid; maximum: 600–1,200 mg/d
Acyclovir (Zovirax) Antiviral Cap: 200 mg
Tab: 400, 800 mg
Susp: 200 mg/5 ml		 Herpes simplex: Initial treatment genital herpes: 200 mg PO q4h (5 × /d)
Herpes zoster: Acute treatment: 800 mg PO q4h (5 × /d)
Varicella zoster: 20 mg/kg (up to 800 mg) PO qid × 5d
Albuterol (Proventil, Ventolin) Bronchodilator Tab: 2, 4 mg
SR-Tab: 4 mg
Syr: 2 mg/5 ml		 Tab/Syr: 2–4 mg PO tid-qid, maximum 16 mg/d
SR-Tab: 4–8 mg PO q12h
Allopurinol (Zyloprim) Antigout Tab: 100, 300 mg Mild gout: 200–300 mg PO qd
Moderate-severe gout: 400–600 mg PO qd
Alprazolam (Xanax) Antianxiety Tab: 0.25, 0.5, 1, 2 mg 0.25–0.5 mg PO tid
Amantadine (Symmetrel) Antiparkinsonian, antiviral Cap: 100 mg
Syr: 50 mg/5 ml		 Influenza: 200 mg PO qd or 100 mg PO bid
Amiloride (Midamor) Potassium-sparing diuretic Tab: 5 mg 5–10 mg PO qd
Aminocaproic acid (Amicar) Hemostatic Tab: 500 mg
Syr: 250 mg/ml		 5 g PO during the first hour, then by 1–1.25 g/h for 8 h or until bleeding is controlled
Amiodarone (Cordarone) Antiarrhythmic Tab: 200 mg Loading: 800–1,600 mg PO qd for 1–3 wk
Maintenance: 600–800 mg PO qd for 1 mo, then 200–400 mg PO qd
Amlodipine (Norvasc) Antihypertensive, antianginal Tab: 2.5, 5, 10 mg HTN: 2.5–5 mg PO qd
Angina: 5–10 mg PO qd
Amoxicillin (multiple) Antibiotic Cap: 250, 500 mg
Tab: 125, 250 mg
Susp: 125, 250 mg/5 ml
 250–500 mg PO tid
Ampicillin (multiple) Antibiotic Cap: 250, 500 mg
Susp: 125, 250,500 mg/5 ml		 250–500 mg PO qid
Amprenavir (Agenerase) Antiretroviral Cap: 50 mg
Soln: 15 mg/ml		 1,200 mg PO bid
Atazanavir (Reyataz) Antiretroviral Cap: 100, 150, 200 mg 300–400 mg PO qd
Atenolol (Tenormin) Antihypertensive, antianginal Tab: 25, 50, 100 mg HTN, angina: 25–100 mg PO qd
Postmyocardial infarction: 50 mg PO after last IV dose, 50 mg PO 12 h later, then 50 mg PO bid for 6–9 d or until discharge from the hospital
Azathioprine (Imuran) Immunosuppressant Tab: 50 mg Organ transplant: maintenance after IV therapy 1–3 mg/kg/d
Azithromycin (Zithromax) Antibiotic Tab: 250, 500, 600 mg
Susp: 100 mg/5 ml, 200 mg/5 ml
1 g packs		 500 mg on day one, then 250 mg PO qd × 4 d
MAC: 1,200 mg q wk
Oral tablets and suspension may be taken with or without food
The 1 g packet should be mixed thoroughly with 60 ml water before administration
Bacitracin Antibiotic Inj: 50,000 units Clostridium difficile: 20,000–25,000 units PO q6h for 7–10 d
Benazepril (Lotensin) Antihypertensive Tab: 5, 10, 20, 40 mg 10–40 mg PO qd in 1 or 2 doses
Betaxolol (Kerlone) Antihypertensive Tab: 10, 20 mg 10–20 mg PO qd
Bisacodyl (multiple) Laxative Tab: 5 mg
Suppos: 10 mg		 PO: 5–15 mg qd prn
PR: 10 mg qd prn
Bumetanide (Bumex) Loop diuretic Tab: 0.5, 1, 2 mg 0.5–2 mg PO qd
Candesartan (Atacand) Antihypertensive 4, 8, 16, 32 mg 2–32 mg PO qd
Captopril (Capoten) Antihypertensive, heart failure, postmyocardial infarction Tab: 6.25, 12.5, 25, 50, 100 mg HTN, CHF: 6.25–100 mg PO bid-tid
Postmyocardial infarction: 6.25 mg initially increasing up to 50 mg PO tid
Carbamazepine (Tegretol) Anticonvulsant Tab: 100, 200 mg
Susp: 100 mg/5 ml		 200 mg PO qid up to 1,200 mg/d
Adjust dose monitoring serum concentrations
Carvedilol (Coreg) Antihypertensive, HF Tab: 3.125, 6.25, 12.5, 25 mg 3.125–25 mg PO bid
Cefaclor (Ceclor) Antibiotic Cap: 250, 500 mg
Susp: 125, 250, 375 mg/5 ml		 125–500 mg PO q8h
Cefadroxil (Duricef) Antibiotic Cap: 500, 1000 mg
Susp: 125, 250, 500 mg/5 ml		 500–1000 mg PO bid
Cefixime (Suprax) Antibiotic Tab: 200, 400 mg
Susp: 100 mg/5 ml		 400 mg PO qd or 200 mg PO bid
Cefpodoxime (Vantin) Antibiotic Tab: 100, 200 mg
Susp: 50, 100 mg/5 ml		 100–200 mg PO q12h
Cefprozil (Cefzil) Antibiotic Tab: 250, 500 mg
Susp: 125, 250 mg/5 ml		 500 mg PO q24h to 250–500 mg PO q12h
Ceftibuten (Cedax) Antibiotic Cap: 400 mg
Susp: 90, 180 mg/5 ml		 400 mg PO qd for 10 d
The bioavailability of ceftibuten is decreased with food, therefore it should be administered at least 2 h before or 1 h after meals
Cefuroxime (Ceftin) Antibiotic Tab: 125, 250, 500 mg
Susp: 125 mg/5 ml		 125–500 mg PO bid
Cephalexin (Keflex) Antibiotic Cap: 250, 500 mg
Tab: 250, 500,1,000 mg
Susp: 125, 250 mg/5 ml		 250–1,000 mg PO qid
Chloral Hydrate (multiple) Sedative-hypnotic Cap: 250, 500 mg
Syr: 250, 500 mg/5 ml
Suppos: 324, 500, 648 mg		 Sedative: 250 mg PO tid
Hypnotic: 500–1,000 mg PO hs
Chloramphenicol (Chloromycetin) Antibiotic Cap: 250 mg
Susp: 150 mg/5 ml		 50 mg/kg/day divided q6h
The oral preparations have a bioavailability greater than the intravenous preparation
Chlorpromazine (Thorazine) Antipsychotic Tab: 10, 25, 50, 100, 200 mg
Syr: 2 mg/ml
Liquid conc.: 30,100 mg/ml
SR-Cap: 30, 75, 150, 200, 300 mg
Suppos: 25, 100 mg		 Psychosis: 10–25 mg PO tid up to 1–2 g/d
Hiccups: 25–50 mg PO tid-qid
Chlorthalidone (Hygroton) Thiazide diuretic Tab: 15, 25, 50,100 mg 15–100 mg PO qd
Cimetidine (Tagamet) H2-antagonist Tab: 100, 200, 300, 400, 800 mg
Liq: 300 mg/5 ml		 300 mg PO qid,400 mg PO bid, or 800 mg PO qhs
Ciprofloxacin (Cipro) Antibiotic Tab: 100, 250, 500, 750 mg
XR Tab: 500,1,000 mg
Susp: 250, 500 mg/5 ml		 250–750 mg PO q12h
XR: 500–1,000 mg PO qd (urinary tract infections only)
Oral doses should be at least 2 h before or after antacids containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamins containing zinc
Clarithromycin (Biaxin) Antibiotic Tab: 250, 500 mg
SR-Tab: 500 mg
Susp: 125, 250 mg/5 ml		 250–500 mg PO q12h
SR-Tab: 1,000 mg PO qd
Clindamycin (Cleocin) Antibiotic Cap: 75, 150,300 mg
Susp: 75 mg/5 ml		 150–450 mg PO q6h
Clonidine (Catapres) Antihypertensive Tab: 0.1, 0.2, 0.3 mg 0.1–1.2 mg PO bid
Clopidogrel (Plavix) Antiplatelet agent Tab: 75 mg Recent MI, stroke, peripheral vascular disease: 75 mg qd
Acute coronary syndrome: 300 mg PO loading dose followed by 75 mg PO qd
Codeine (multiple) Opiate analgesic Tab: 15, 30, 60 mg 15–60 mg POq3–6h prn
Cyclosporine (Sandimmune, Neoral) Immunosuppressant Sandimmune
  Cap: 25, 50 100 mg
  Liq: 100 mg/ml
Neorol
  Cap: 25, 100 mg
  Liq: 100 mg/ml		 15 mg/kg PO 4–12 h before transplant, then taper to maintenance of 5–10 mg/kg/d monitoring cyclosporine concentrations
Delavirdine (Rescriptor) Antiviral Tab: 100, 200 mg 400 mg PO tid on empty stomach
Dexamethasone (multiple) Corticosteroid Tab: 0.25, 0.5, 0.75, 1.5, 2, 4, 6 mg
Elixir: 0.1 mg/ml, 0.5 mg/0.5 ml		 0.75–10 mg PO qd-qid depending on condition being treated
Diazepam (Valium) Sedative-hypnotic Tab: 2, 5, 10 mg
SR-Cap: 15 mg
Liq: 5 mg/5 ml,5 mg/ml		 2–10 mg PO bid-qid
SR-Cap: 15 mg PO qd
Dicloxacillin (multiple) Antibiotic Cap: 250, 500 mg
Susp: 62.5 mg/5 ml		 250–500 mg PO qid
Didanosine (Videx) Antiviral Tab: 25, 50, 100, 150 mg
Pwd: 100, 167, 250, 375 mg		 Tab: <60 kg: 125 mg PO q12h; >60 kg: 200 mg PO q12h
Take 2 tablets at each dose for adequate buffering to prevent degradation by gastric acid; chew or crush and disperse2 tablets in >1 oz water prior to consumption; take on empty stomach
Pwd: <60 kg: 167 mg PO q12h; >60 kg: 250 mg PO q12h
Dissolve contents of packet in 4 oz water and drink on empty stomach
Digoxin (Lanoxin, Lanoxicaps) Heart failure, antiarrhythmic Tab: 0.125, 0.25,0.5 mg
Cap: 0.05, 0.1,0.2 mg
Elixir: 0.05 mg/ml		 0.125–0.5 mg PO qd
Adjust dose monitoring serum concentrations
Diltiazem (Cardizem, Dilacor) Antihypertensive, antianginal Tab: 30, 60, 90,120 mg
SR-Cap:
Cardizem SR 60, 90, 120 mg
Cardizem CD 120, 180, 240, 300 mg
Dilacor XR 120, 180, 240 mg		 Tab: 30–90 mg PO qid
Cardizem SR: 60–120 mg PO bid up to 360 mg/d
Cardizem CD: 120–480 mg PO qd
Dilacor XR: 120–480 mg PO qd
Diphenhydramine (Benadryl) Antihistamine, hypnotic Tab/Cap: 25, 50 mg
Liq: 12.5 mg/5 ml		 25–50 mg PO q4–6h prn
Hypnotic: 25–50 mg PO hs
Dipyridamole (Persantine) Antiplatelet Tab: 25, 50, 75 mg 25–100 mg PO qid
Disopyramide (Norpace, Norpace CR) Antiarrhythmic Cap: 100, 150 mg
SR-Cap: 100,150 mg		 Cap: 100–150 mg PO q6h
SR-Cap: 100–300 mg PO q12h
Adjust dose monitoring serum concentrations
Divalproex (Depakote) Anticonvulsant SR-Tab: 125, 250, 500 mg
SR-Cap: 125 mg sprinkle caps		 125–500 mg PO qid
Adjust dose monitoring serum concentrations
Dofetilide (Tikosyn) Antiarrhythmic Cap: 125, 250,500 µg Starting dose: 125–500 µg bid based on renal function; maintenance dose: 125 µg qd to 250 µg bid based on renal function
Dolasetron (Anzemet) Antiemetic Tab: 50 mg, 100 mg Chemotherapy induced nausea and vomiting (CINV): 100 mg 1 h PO before chemotherapy
Post-operative nausea and vomiting (PONV): 100 mg 2 h PO before surgery
Doxazosin (Cardura) Antihypertensive, BPH Tab: 1, 2, 4, 8 mg 1–16 mg PO qd
Doxycycline (Vibramycin) Antibiotic Tab: 100 mg
Cap: 50, 100 mg
Syr: 50 mg/5 ml		 50–100 mg PO bid
Efavirenz (Sustiva) Antiretroviral Cap: 50, 100,200 mg
Tab: 600 mg		 600 mg PO qd
Emtricitabine (Emtriva) Antiretroviral Cap: 200 mg 200 mg PO qd
Enalapril (Vasotec) Antihypertensive, heart failure Tab: 2.5, 5, 10, 20 mg 2.5 mg PO qd to20 mg PO bid
Eplerenone (Inspra) Antihypertensive, heart failure Tab: 25, 50 mg HTN: 50 mg PO qd
CHF: 25–50 mg PO qd
Eprosartan (Teveten) Antihypertensive Tab: 400, 600 mg 400–600 mg PO qd
Erythromycin (multiple) Antibiotic Tab: 250, 500 mg
SR-Tab: 250, 333, 500 mg
SR-Cap: 250 mg
Susp: 200, 400 mg/5 ml		 Tab: 250 mg PO q6h, 333 mg PO q8h,500 mg PO q12h
Susp: 400 mg PO q6h, 800 mg PO q12h
Legionnaire's Disease: 250–1000 mg PO qid
Esomeprazole Proton pump inhibitor SR-Cap: 20, 40 mg 20–40 mg PO qd
Eszopiclone (Lunesta) Hypnotic Tab: 1, 2, 3 mg Nonelderly adults:2 mg PO hs
Elderly: 1 mg PO hs
Ethambutol (Myambutol) Antituberculous Tab: 100, 400 mg Initial: 15 mg/kg PO qd
Retreatment: 25 mg/kg PO qd, after 60 d, decrease to 15 mg/kg PO qd
Famciclovir (Famvir) Antiviral Tab: 125, 250,500 mg 500 mg PO q8h for 7 d
Famotidine (Pepcid) H2-antagonist Tab: 10, 20, 40 mg
Pwd: 40 mg/5 ml		 10–20 mg PO bid or 40 mg PO qhs
Felodipine (Plendil) Antihypertensive SR-Tab: 2.5, 5,10 mg 2.5–10 mg PO qd
Flecainide (Tambocor) Antiarrhythmic Tab: 50, 100, 150 mg Initially 100–150 mg PO bid, increasing by 50 mg PO bid increments every 4 d
Adjust dose monitoring serum concentrations
Fluconazole (Diflucan) Antifungal Tab: 50, 100, 150, 200 mg
Susp: 10, 40 mg/ml		 200 mg initially, then 100 mg PO qd
Fosamprenavir (Lexiva) Antiretroviral Tab: 700 mg 700–1,400 mg PO qd with or without ritonavir
Fosinopril (Monopril) Antihypertensive, HF Tab: 10, 20, 40 mg HTN/HF: 10–40 mg/d in 1 or 2 doses
Furosemide (Lasix) Loop diuretic Tab: 20, 40, 80 mg
Liq: 10 mg/ml,40 mg/5 ml		 10–80 mg PO bid
Gabapentin (Neurontin) Anticonvulsant Cap: 100, 300,400 mg 300 mg PO on day 1; 300 mg PO bid on day 2; 300 mg PO tid on day 3; up to 1,800 mg/d divided tid
Ganciclovir (Cytovene) Antiviral Cap: 250 mg Cytomegalovirus retinitis maintenance dosing: 1,000 mg PO tid with food or 500 mg PO 6 × /d (q3h while awake) with food
Gatifloxacin (Tequin) Antibiotic Tab: 200, 400 mg 200–400 mg PO qd
Oral doses should be at least 2 h before or after antacids containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamins containing zinc
Gemifloxacin (Factive) Antibiotic Tab: 320 mg 320 mg PO qd
Glimepiride (Amaryl) Hypoglycemic Tab: 1, 2, 4 mg 1–4 mg PO qd
Glipizide (Glucotrol, Glucotrol XL) Hypoglycemic Tab: 5, 10 mg
SR-Tab: 5, 10 mg		 Tab: 5 mg PO q AM before breakfast, increasing to 15 mg/d divided bid prn
SR-Tab: 5 mg PO q AM with breakfast, increasing to 10 mg PO q AM prn
Glyburide (Diabeta, Micronase) Hypoglycemic Tab: 1.25, 2.5, 5 mg Tab: Initial: 1.25–5 mg PO q AM with breakfast
Glyburide micronized (Glynase PresTab)  PresTab: 1.5, 3, 6 mg Maintenance: 1.25 to 20 mg/d in single or divided doses
PresTab: Initial: 0.75 to 3 mg PO q AM with breakfast. Maintenance: 0.75 to 12 mg PO in single or divided doses
Granisetron (Kytril) Antiemetic Tab: 1.12 mg (1 mg as the base) 1 mg PO bid, with the first dose given up to 1 h before highly emetogenic chemotherapy, and the 2nd dose given 12 h after the first dose
Haloperidol (Haldol) Antipsychotic Tab: 0.5, 1, 2, 5, 10, 20 mg
Liq: 2, 5 mg/ml		 0.5–5 mg PO bid-tid
Hydralazine (Apresoline) Antihypertensive Tab: 10, 25, 50,100 mg 10–50 mg PO qid
Hydrochlorothiazide (multiple) Thiazide diuretic Tab: 25, 50, 100 mg
Liq: 50 mg/5 ml,100 mg/ml		 25–100 mg PO qd
Hydrocortisone (multiple) Corticosteroid Tab: 5, 10, 20 mg 10–240 mg/d depending on disease being treated
Hydromorphone (Dilaudid) Opioid analgesic Tab: 1, 2, 3, 4, mg
Liq: 1 mg/ml		 1–2 mg PO q4–6h prn titrating dose to severity of pain
Hydroxyzine (Atarax, Vistaril) Antihistamine, sedative, antianxiety Tab/Cap: 10, 25, 50, 100 mg
Syr: 10 mg/5 ml
Susp: 25 mg/5 ml		 Pruritis: 25 mg PO tid-qid
Sedation/antianxiety: 10–100 mg PO qid
Ibuprofen (Motrin, Advil) NSAID Tab: 200, 300, 400, 600, 800 mg
Susp: 100 mg/5 ml		 Analgesia: 200–600 mg PO qid
Arthritis: 300–800 mg PO tid-qid
Indapamide (Lozol) Thiazide-like diuretic Tab: 1.25, 2.5 mg 1.25–5 mg PO qd
Indinavir (Crixivan) Antiviral Cap: 100, 200, 333, 400 mg 800 mg PO tid on empty stomach or with light low fat meals; drink plenty of water
Indomethacin (Indocin) NSAID Cap: 25, 50 mg
Susp: 25 mg/5 ml
Suppos: 50 mg		 25–50 mg PO bid-qid
Irbesartan (Avapro) Antihypertensive Tab: 75, 150, 300 mg 150–300 mg PO qd
Isoniazid (multiple) Antituberculous Tab: 50, 100, 300 mg
Liq: 50 mg/5 ml		 300 mg PO qd
Isosorbide dinitrate (Isordil, Sorbitrate, Dilatrate SR) Antianginal Tab: 5, 10, 20, 30, 40 mg
SL-Tab: 2.5, 5,10 mg
SR-Tab: 40 mg		 Tab: 5–40 mg PO q6h
SL-Tab: 2.5–10 mg SL q2–3h
SR-Tab: 20–80 mg PO q8–12h (40 mg tablets are scored and may be broken in half)
SR-Cap: 40–80 mg PO q8–12h
Isosorbide mononitrate (Ismo, Monoket, Imdur) Antianginal Tab: 10, 20 mg
SR-Tab: 60 mg		 Tab: 20 mg PO bid with the two doses given 7 h apart
SR-Tab: 30–120 mg PO qd
Isradipine (Dynacirc) Antihypertensive Cap: 2.5, 5 mg 2.5–10 mg PO bid
Itraconazole (Sporanox) Antifungal Cap: 200 mg
Liq: 50 mg/5 ml		 Cap: 200–400 mg PO qd with meals
Liq: 200–400 mg PO qd on empty stomach
Ketoconazole (Nizoral) Antifungal Tab: 200 mg 200–400 mg PO qd
Ketorolac (Toradol) NSAID Tab: 10 mg Indicated only as continuation therapy to parenteral ketorolac; maximum combined duration of use (parenteral and oral) 5 d
10 mg PO q6h not to exceed 40 mg/d
Labetalol (Normodyne, Trandate) Antihypertensive Tab; 100, 200,300 mg 100–400 mg PO bid
Lactulose (Cephulac, Chronulac) Laxative Syr: 10 g/15 ml 15–60 ml/dose qd-tid
Lamivudine (Epivir) Antiviral Tab: 100, 150,300 mg
Liq: 5, 10 mg/ml		 >50 kg; 150 mg PO bid in combination with zidovudine
<50 kg; 2 mg/kg PO bid in combination with zidovudine
Lamotrigine (Lamictal) Anticonvulsant Tab: 25, 50, 150, 200 mg Patients on enzyme-inducing agents but not valproate: 50 mg PO qd for 2 wk, then 50 mg PO bid for 2 wk, then 300–500 mg/d divided bid
Patients on enzyme-inducing agents including valproate: 25 mg PO qod for 2 wk, then25 mg PO qd for 2 wk, then 100–150 mg/d divided bid
Lansoprazole (Prevacid) Proton pump inhibitor SR-Cap; 15, 30 mg
SR-Tab, orally disintegrating: 15, 30 mg
SR-granules for oral suspension: 15, 30 mg		 15–60 mg PO qd
Levofloxacin (Levaquin) Antibiotic Tab: 250, 500,750 mg
Oral soln: 25 mg/ml		 250–750 mg PO qd
Oral doses should be at least 2 h before or after antacids containing magnesium or aluminum, as well as sucralfate, metal cations such as iron, and multivitamins containing zinc
Levothyroxine (Synthroid, Levothroid) Thyroid hormone Tab: 25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 µg Initial dose: 25–50 µg/d increasing to 100–200 µg/d with monitoring of T4 and TSH levels
Linezolid (Zyvox) Antibiotic Tab: 400, 600 mg
PWD for Susp:100 mg/5 ml		 400–600 mg PO bid
Liothyronine (Cytomel) Thyroid hormone Tab: 5, 25, 50 µg 25 µg initially, increase up to 25–75 µg qd
Lisinopril (Prinivil, Zestril) Antihypertensive, heart failure Tab: 2.5, 5, 10, 20, 40 mg 2.5–40 mg PO qd
Loperamide (Imodium) Antidiarrheal Cap/Tab: 2 mg
Liq: 1 mg/5 ml		 4 mg PO initially, then 2 mg PO after each loose stool to a maximum of 8 mg/d
Lorazepam (Ativan) Sedative-hypnotic Tab: 0.5, 1, 2 mg
Liq: 2 mg/ml		 Antianxiety: 0.5–3 mg PO bid-tid
Hypnotic: 0.5–4 mg PO hs
Losartan (Cozaar) Antihypertensive Tab: 25, 50, 100 mg 25–100 mg PO qd
Initial dose for patients on diuretics 25 mg PO qd
Meperidine (Demerol) Opioid analgesic Tab: 50, 100 mg
Syr: 50 mg/5 ml		 50–150 mg PO q3–4h prn
Metformin (Glucophage) Hypoglycemic Tab: 500, 850 mg 500 mg: PO bid with morning and evening meals up to 2,500 mg/d divided bid
850 mg: PO q AM with morning meal up to 2,550 mg/d divided bid
Should not be used in patients with renal disease or dysfunction and should be avoided in patients with clinical or laboratory evidence of hepatic disease
Methadone (Dolophine) Opioid analgesic Tab: 5, 10 mg
Liq: 5, 10 mg/5 ml, 10 mg/ml, 10 mg/10 ml		 2.5–10 mg PO q3–4h prn
Methyldopa (Aldomet) Antihypertensive Tab: 125, 250,500 mg
Susp: 250 mg/5 ml		 250–500 mg PO bid-qid
Methylprednisolone (Medrol) Corticosteroid Tab: 2, 4, 8, 16, 24, 32 mg 4–48 mg/d depending on disease being treated
Metoclopramide (Reglan) GI motility, antiemetic Tab: 5, 10 mg
Syr: 5 mg/5 ml		 5–15 mg PO qid
Metolazone (Zaroxolyn) Thiazide-like diuretic Tab: 0.5, 2.5, 5,10 mg 2.5–20 mg PO qd
Metoprolol (Lopressor, Toprol XL) Antihypertensive antianginal Tab: 50, 100 mg
SR-Tab: 50, 100, 200 mg (equal to 47.5, 95, 190 mg of metoprolol)		 Tab: 25–200 mg PO bid
SR-Tab: 50–200 mg PO qd
Metronidazole (Flagyl) Antibiotic Tab: 250, 500 mg 250–500 mg PO tid
Mexiletine (Mexitil) Antiarrhythmic Cap: 150, 200,250 mg 200 mg PO q8h with food
Adjust dose monitoring serum concentrations
Minoxidil (Loniten) Antihypertensive Tab: 2.5, 10 mg 5–40 mg PO qd in single or divided doses bid
Moexipril (Univasc) Antihypertensive Tab: 7.5, 15 mg 7.5–30 mg/d in 1 or2 doses 1h before meals
Montelukast (Singulair) Leukotriene receptor antagonist Tab: 10 mg
Chew tab: 4, 5 mg
Granules: 4 mg		 10 mg PO qd
Moricizine (Ethmozine) Antiarrhythmic Tab: 200, 250,300 mg 200–300 mg PO q8h
Morphine
Morphine sustained-release (MS-Contin, Kadian, Oramorph-SR)		 Opiate analgesic Tab: 15, 30 mg
Liq: 2, 4, 20 mg/ml, 10, 20 mg/5 ml
SR-Tab: 15, 30, 60, 100, 200 mg
SR-Cap: 20, 50,100 mg
Suppos: 5, 10, 20,30 mg		 Tab/Liq/Suppos: 10–30 mg PO/PR q4h prn
SR-Tab: 15–30 mg PO q12h initially, then adjust dose and interval according to the requirements of individual patient
SR-Cap: 20 mg PO qd initially, then adjust dose and interval according to the requirements of individual patient
Moxifloxacin (Avelox) Antibiotic Tab: 400 mg 400 mg PO qd
Mycophenolate (CellCept, Myfortic) Immunosuppressive Cap: 250 mg
Tab: 500 mg
SR-Tab: 180 mg
Pwd for susp:200 mg		 1,000–1,500 mg PO bid
SR-Tab: 720 mg PO bid
Nadolol (Corgard) Antihypertensive, antianginal Tab; 20, 40, 80, 120, 160 mg 20–160 mg PO qd
Nelfinavir (Viracept) Antiviral Tab: 250, 625 mg
Pwd: 50 mg/g		 750 mg PO tid with food or 1250 mg PO bid
Nevirapine (Viramune) Antiviral Tab: 200 mg
Susp: 10 mg/ml		 200 mg PO qd × 14 d, then 200 mg PO bid
Nicardipine (Cardene) Antihypertensive, antianginal Cap: 20, 30 mg
SR-Cap: 30, 45,60 mg		 Cap: 20–40 mg PO tid
SR-Cap: 30–60 mg PO bid
Nifedipine (Adalat Procardia) Antihypertensive, antianginal Cap: 10, 20 mg
SR-Tab: 30, 60,90 mg		 Cap: 10–30 mg PO tid
SR-Tab: 30–90 mg PO qd
Nifedipine sustained release (Adalat CC, Procardia XL)  
Nimodipine (Nimotop) Subarachnoid hemorrhage Cap: 30 mg 60 mg PO q4h, beginning within96 h after a subarachnoid hemorrhage and continuing for 21 d
Nitroglycerin (Multiple) Antianginal SL-Tab: 0.15, 0.3, 0.4, 0.6 mg
SL-spray: 0.4 mg/dose
SR-Cap: 2.5, 6.5, 9, 13 mg
SR-Tab: 2.6, 6.5,9 mg
SR-buccal Tab: 1, 2, 3 mg
Top: 2% ointment (NTG 15 mg/in)
Patch: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/h		 SL-Tab: 0.15–0.6 mg under tongue q5min as needed for relief of chest pain
SL-spray: 0.4–0.8 mg on or under tongue q5min as needed for relief of chest pain
SR-Cap: 2.5–9 mg PO q8–12h
SR-Tab: 1.3–6.5 mg PO q8–12h
SR-buccal Tab: 1–3 mg dissolved in place on oral mucosa q5h while awake
Top: 0.5–2 in q6–8h
Patch: 0.1–0.8 mg/h patch q24h, removing the patch for a 10–12 h nitrate free period before applying the next patch
Olmesartan (Benicar) Antihypertensive Tab: 5, 20, 40 mg 20–40 mg PO qd
Omeprazole (Prilosec) Proton pump inhibitor SR-Tab: 20 mg
SR-Cap: 10, 20,40 mg
Powder for oral susp: 20, 40 mg		 20 mg PO qd up to80 mg/d divided bid
Ondansetron (Zofran) Antiemetic Tab: 4, 8 mg Administer first dose (4–8 mg) 30 min before start of chemotherapy, with subsequent doses 4 h and 8 h after first dose, then 4–8 mg PO tid for 1–2 d after completion of chemotherapy
Opium, tincture, deodorized Antidiarrheal Liq: 10% (morphine 6 mg/0.6 ml) 0.2–0.6 ml qd-qid
Oseltamivir(Tamiflu) Antiviral Cap: 75 mg
Powder for Susp:12 mg/ml		 75 mg PO bid for 5 d
Oxacillin (multiple) Antibiotic Cap: 250, 500 mg
Susp: 250 mg/5 ml		 500–1,000 mg PO q4–6h
Oxazepam (Serax) Sedative-hypnotic Cap: 10, 15, 30 mg
Tab: 15 mg		 Sedative: 10–30 mg PO tid-qid
Hypnotic: 10–30 mg PO hs
Oxybutynin (Ditropan) Urinary antispasmodic Tab: 5 mg
Syr: 5 mg/5 ml		 5 mg PO tid
Oxycodone (multiple) Opioid analgesic Tab: 5 mg
Liq: 5 mg/5 ml,20 mg/ml		 10–30 mg PO q4h prn
Pantoprazole (Protonix) Proton pump inhibitor SR-Tab: 20, 40 mg 20–40 mg PO qd
Paregoric Antidiarrheal Liq: morphine 2 mg/5 ml 5–10 ml PO qd-qid
Penicillin VK (Multiple) Antibiotic Tab: 125, 250, 500 mg
Susp: 125, 250 mg/5 ml		 250–500 mg PO qid
Pentobarbital (Nembutal) Hypnotic Cap: 50, 100 mg
Elixir: 20 mg/5 ml
Suppos: 30, 60, 120, 200 mg		 Cap/elixir: Hypnotic: 100 mg PO qhs
Pre-op: 100 mg PO 1–2 h preprocedure
Suppos: 120–200 mg PR qhs
Perindopril (Aceon) Antihypertensive Tab: 2, 4, 8 mg 2–16 mg PO qd
Phenazopyridine (Pyridium) Urinary analgesic Tab: 100, 200 mg 100–200 mg PO tid
Phenobarbital (multiple) Anticonvulsant, sedative Tab: 15, 30, 60,100 mg
Elixir: 15, 20 mg/5 ml		 Sedative: 30–100 mg/d divided in 3 doses
Hypnotic: 30–200 mg PO hs
Anticonvulsant: 30–200 mg/d in single or divided doses
Adjust dose monitoring serum concentrations
Phenoxybenzamine (Dibenzyline) Antihypertensive Cap: 10 mg 10 mg PO bid up to40 mg bid-tid
Phenytoin (Dilantin) Anticonvulsant Cap: 30, 100 mg
Tab: 50 mg
Susp: 25 mg/ml		 100 mg PO tid
Only the Dilantin brand of phenytoin sodium may be given in a single daily dose
Adjust dose monitoring serum concentrations
Phosphate, potassium phosphate (K-Phos Original, Neutra-Phos-K), potassium and sodium phosphate (K-Phos M.F., Neutra-Phos) Electrolyte replacement Potassium phosphate:
Tab: K-Phos Original: PO4 114 mg (3.7 mmol), K 3.7 mEq
Cap: Neutra-Phos-K: PO4 250 mg(8 mmol), K 14.25 mEq
Potassium and sodium phosphate:
Cap: Neutra-Phos: PO4 250 mg(8 mmol), K 7.125 mEq, Na 7.125 mEq
Tab: K-Phos M.F.: PO4 125.6 mg (4 mmol), K 1.14 mEq, Na 2.9 mEq		 1 g (228 mg or7.4 mmol) PO qid with meals and at bedtime
Must be thoroughly dissolved in 180–240 ml water
Pindolol (Visken) Antihypertensive Tab: 5, 10 mg 5 mg PO bid up 60 mg/d divided bid
Potassium chloride (multiple) Electrolyte replacement SR-Tab: 6, 8, 10,20 mEq
SR-Cap: 8, 10 mEq
Liq: 10, 20, 30,40 mEq/15 ml
Packets: 10, 15, 20, 25 mEq		 Hypokalemia (treatment or prophylaxis): 10–40 mEq PO qd-qid, with titration as needed
Oral solution and powder must be diluted and stirred in 60–180 ml water before swallowing; these dosage forms may also be added to orange, tomato, or apple juice
Sustained-release tablets without a wax matrix may be swallowed whole or broken
Sustained-release capsules may be opened and sprinkled on food
Some sustained-release products utilize a wax matrix from which the drug is slowly leached out as it passes through the GI tract; the expended wax matrix may appear intact in the stool
Prazosin (Minipress) Antihypertensive Cap: 1, 2, 5 mg 1 mg PO bid-tid up to20 mg/d divided tid
Prednisolone (multiple) Corticosteroid Tab: 5 mg
Syr: 15 mg/5 ml		 5–60 mg/day depending on disease being treated
Prednisone (Multiple) Corticosteroid Tab: 1, 2.5, 5, 10, 20, 50 mg
Liq: 5 mg/5 ml,5 mg/ml		 5–60 mg/day depending on disease being treated
Primidone (Mysoline) Anticonvulsant Tab: 50, 250 mg
Susp: 250 mg/5 ml		 250 mg PO tid
Adjust those monitoring serum concentrations
Procainamide (Pronestyl), Procainamide sustained-release (Procan-SR, Pronestyl-SR) Antiarrhythmic Tab/cap: 250, 375, 500 mg
SR-Tab: 250, 500, 750, 1,000 mg		 Cap: up to 50 mg/kg/d in divided doses q3h
SR-Tab: 50 mg/kg/day in divided doses q6–12h
Some sustained-release products utilize a wax matrix from which the drug is slowly leached out as it passes through the GI tract; the expended wax matrix may appear intact in the stool
Adjust dose monitoring serum concentrations
Prochlorperazine (Compazine) Antiemetic Tab: 5, 10, 25 mg
Syr: 5 mg/5 ml
SR-Cap: 10, 15,30 mg
Suppos: 2.5, 5,25 mg		 Tab/Syr: 5–10 mg PO tid-qid
SR-Cap: 10–30 mg PO q12h
Suppos: 25 mg PR q12h
Promethazine (Phenergan) Antiemetic Tab: 12.5, 25, 50 mg
Syr: 6.25, 25 mg/5 ml
Suppos: 12.5, 25,50 mg		 Tab/Syr/Suppos: 12.5–50 mg PO/PR q4–6h prn
Propafenone (Rythmol) Antiarrhythmic Tab: 150, 225,300 mg
SR-Cap: 225, 325, 425 mg		 150–300 mg PO q8h
SR: 225–425 mg q12h
Propoxyphene HCl (Darvon) Opioid analgesic Cap: 32, 65 mg 32–65 mg PO q4h prn
Propranolol (Inderal, Inderal LA) Antihypertensive, antianginal Tab: 10, 20, 30, 40, 80, 90 mg
SR-Cap: 60, 80, 120, 160 mg
Liq: 4, 8, 80 mg/ml		 Tab/Liq: 10–40 mg PO tid-qid up to 240 mg/d divided tid-qid
Postmyocardial infarction: 180–240 mg/d divided tid-qid
SR-Cap: 60–240 mg PO qd
Pyrazinamide (Multiple) Antituberculous Tab: 500 mg 15–30 mg/kg up to 2 g PO qd
Pyrimethamine (Daraprim) Antiparasitic Tab: 25 mg Toxoplasmosis: 50–75 mg PO qd with 1–4 g of sulfadiazine, continued for 1–3 wk, decrease by 50% and continued for an additional 4–5 wk
Quinidine gluconate (Quinaglute) Antiarrhythmic SR-Tab: 324 mg 324–648 mg PO q6–12h
Adjust dose monitoring serum concentrations
Contains 62% quinidine alkaloid
Quinidine polygalacturonate (Cardioquin) Antiarrhythmic Tab: 275 mg 275 mg PO bid-tid
Adjust dose monitoring serum concentrations
Contains 60% quinidine alkaloid
Quinidine sulfate (multiple), Quinidine sulfate sustained-release (Quinidex) Antiarrhythmic Tab: 200, 300 mg
SR-Tab: 300 mg		 Tab/SR-Tab: 200–600 mg PO q6–8h
Adjust dose monitoring serum concentrations
Contains 83% quinidine alkaloid
Quinapril (Accupril) Antihypertensive, heart failure Tab: 5, 10, 20, 40 mg HTN: 10–80 mg/d in1 or 2 doses
HF: 5 mg PO bid to 40 mg/d in 1 or2 doses
Rabeprazole (Aciphex) Proton pump inhibitor SR-Tab: 20 mg 20 mg PO qd
Ramipril (Altace) Antihypertensive, HF, MI Cap: 1.25, 2.5, 5,10 mg HTN: 2.5–20 mg/d in 1 or 2 doses
HF: 2.5 mg PO bid to 5 mg PO bid
MI: 1.25 mg PO qd to 2.5 mg PO bid
Ranitidine (Zantac) H2-antagonist Tab: 75, 150, 300 mg
Cap: 150, 300 mg
Syr: 75 mg/5 ml
Effervescent tab:150 mg
Effervescent granules: 150 mg/packet		 150 mg PO bid or300 mg PO qd
Rifabutin (Mycobutin) Antituberculous Cap: 150 mg 300 mg PO qd
Rifampin (Rifadin) Antituberculous Cap: 150, 300 mg 300–600 mg PO qd
Rifapentine (Priftin) Antituberculous Tab: 150 mg Intensive phase: 600 mg PO twice weekly for 2 mo
Continuation phase: 600 mg PO once weekly for 4 mo
Rimantadine (Flumadine) Antiviral Tab: 100 mg
Syr: 50 mg/5 ml		 Influenza:
Prophylaxis: 100 mg PO bid
Treatment: 100 mg PO bid starting within 48 h of symptoms and continuing for7 d
Ritonavir (Norvir) Antiviral Cap: 100 mg
Liq: 80 mg/ml		 600 mg PO bid
Salsalate (Disalcid) NSAID Tab: 500, 750 mg
Cap: 500 mg		 1,500 mg PO bid or 1,000 mg PO tid
Saquinavir (Invirase) Antiviral Cap: 200 mg 600 mg PO tid within 2 h of food and in combination with zidovudine or zalcitabine
Simethicone (Mylicon, Phazyme, Mylanta Gas) Antiflatulent Tab: 60, 95 mg
Chewable tab: 40, 80, 125 mg
Gelcap: 62.5, 125 mg
Liq: 40 mg/0.6 ml		 40–125 mg PO qd after meals
Sirolimus (Rapamune) Immunosuppressive Tab: 1, 2 mg
Soln: 1 mg/ml		 6 mg loading dose followed by 2 mg PO qd
Sodium polystyrene sulfonate (Kayexalate) Potassium removing resin Pwd: 10–12 g/heaping teaspoon
Susp: 15 gm/60 ml		 15–60 g PO, repeat as necessary to lower serum potassium level
Sotalol (Betapace) Antiarrhythmic Tab: 80, 160, 240 mg 80–160 mg PO bid
Spironolactone (Aldactone) Potassium sparing diuretic Tab: 25, 50, 100 mg 25–100 mg PO qd or in divided doses
Stavudine (Zerit) Antiviral Cap: 15, 20, 30,40 mg
Pwd for soln: 1 mg/ml
SR-Cap: 37.5, 50, 75, 100 mg		 40 mg PO q12h
50 mg PO qd
Sucralfate (Carafate) Antiulcer Tab: 1 g
Susp: 1 g/10 ml		 1 g PO qid on empty stomach
Tacrolimus (Prograf) Immunosuppressant Cap: 0.5, 1, 5 mg 0.15–0.3 mg/kd/d PO in q12h divided doses; administer initial dose no sooner than 6 h after transplantation; if IV therapy was initiated, begin 8–12 h after discontinuing IV therapy
Telithromycin (Ketek) Antibiotic Tab: 400 mg 800 mg PO qd
Telmisartan (Micardis) Antihypertensive Tab: 20, 40, 80 mg 20–80 mg PO qd
Temazepam (Restoril) Hypnotic Cap: 7.5, 15, 30 mg 7.5–30 mg PO hs
Terazosin (Hytrin) Antihypertensive Cap: 1, 2, 5, 10 mg 1–10 mg PO qhs
Terbutaline (Brethine, Bricanyl) Bronchodilator Tab 2.5, 5 mg 2.5–5 mg PO tid
Tetracycline (multiple) Antibiotic Cap: 250, 500 mg
Syr: 125 mg/5 ml		 250–500 mg PO qid
Theophylline (Elixophyllin, Slo-phyllin, Theolair), sustained-release (Slo-Bid, Theo-Dur, Theo-24, Uni-Dur) Bronchodilator Theophylline
Cap: 100, 200,300 mg
Tab: 100, 125, 200, 250, 300 mg
Liq: 27 mg/5 ml
SR-Tab: 100, 200, 250, 300, 400, 450, 500, 600 mg
SR-Cap: 50, 75, 100, 125, 200, 250, 260, 300, 400 mg		 Initially 300 mg/d; if tolerated, the dose may be increased after 3 d to 400 mg/d; and then if necessary after 3 d to 600 mg/d; depending on product selected, dosing interval may be 6, 8, or 12 h; dose and interval should be adjusted using serum levels
Ticlopidine (Ticlid) Antiplatelet Tab: 250 mg 250 mg PO bid with meals
Contraindicated in patients with liver disease
Timolol (Blocadren) Antihypertensive myocardial Tab: 5, 10, 20 mg 10–20 mg PO bid
Postmyocardial infarction: 100 mg PO bid
Topiramate (Topamax) Anticonvulsant Tab: 25, 100, 200 mg 200 mg PO bid
Torsemide (Demadex) Loop diuretic Tab: 5, 10, 20,100 mg 5–20 mg PO qd to maximum 200 mg/d
Tramadol (Ultram) Analgesic Tab: 50 mg 50–100 mg PO q4–6h up to 400 mg/d
Trandolapril (Mavik) Antihypertensive Tab: 1, 2, 4 mg 1–8 mg PO qd
Tranexamic acid (Cyklokapron) Hemostatic Tab: 500 mg 25 mg/kg PO tid-qid starting 1 d before surgery and continued for 2–8 d postsurgery
Triamterene (Dyrenium) Potassium sparing diuretic Cap: 50, 100 mg 50–100 mg PO bid
Trimethobenzamide (Tigan) Antiemetic Cap: 100, 250 mg
Suppos: 200 mg		 100–250 mg PO tid-qid
Suppos: 200 mg PR tid-qid
Troglitazone (Rezulin) Hypoglycemic Tab: 200, 400 mg 400–600 mg PO qd
Valacyclovir (Valtrex) Antiviral Tab: 500 mg 1000 mg PO tid for 7 d
Valganciclovir (Valcyte) Antiviral Tab: 450 mg 900 mg PO qd-bid
Valproic acid (Depakene) Anticonvulsant Cap: 250 mg
Syr: 250 mg/5 ml		 15 mg/kg/day divided bid-tid to maximum 60 mg/kg/d
Adjust dose monitoring serum concentrations
Valsartan (Diovan) Antihypertensive Cap: 40, 80, 160, 320 mg 80–320 mg PO qd
Vancomycin (Vancocin) Antibiotic Cap: 125, 250 mg
Liq: 125, 250 mg/5 ml		 Clostridium difficile: 125 mg PO q6h for 7–10 d
Oral solution may be prepared using the injection dose form
Verapamil (Calan, Isoptin), Verapamil sustained release (Calan-SR, Isoptin-SR) Antihypertensive, antianginal Tab: 40, 80, 120 mg
SR-Tab/Cap: 120, 180, 240 mg		 Tab: 20–120 mg PO qid
SR-Tab: 120 mg PO qd up to 240 mg PO q12h
Voriconazole (Vfend) Antifungal Tab: 50, 200 mg
Oral Susp: 40 mg/ml		 100–300 mg PO q12h
Warfarin (Coumadin) Anticoagulant Tab: 1, 2, 2.5, 4, 5, 7.5, 10 mg 5 mg PO qd × 3, then individualize dose based on PT or INR results
Zaleplon (Sonata) Hypnotic Cap: 5, 10 mg 5–10 mg PO hs
Avoid doses >5 mg in the elderly
Zanamivir (Relenza) Antiviral Pwd for inhalation:5 mg 10 mg inhaled bid × 5 days
Zidovudine (Retrovir) Antiviral Cap: 100, 300 mg
Syr: 50 mg/5 ml		 100 mg PO q4h(5–6 × /d)
Zafirlukast (Accolate) Leukotriene receptor antagonist Tab: 10, 20 mg 20 mg PO bid
Zolpidem (Ambien) Hypnotic Tab: 5, 10 mg 2.5–10 mg PO hs
P.344

P.345

Selected Combination Oral Drug Products
Brand Name (Ingredients) Therapeutic Category Preparation Usual Adult Dose
Aggrenox (extended-release dipyridamole, aspirin) Antiplatelet Cap: Extended-release dipyridamole 200 mg, aspirin 25 mg Stroke: 1 tablet bid
Augmentin (amoxicillin, clavulanic acid) Antibiotic Tab: Amoxicillin250 mg, clavulanic acid 125 mg
Amoxicillin 500 mg, clavulanic acid 125 mg
Amoxicillin 875 mg, clavulanic acid 125 mg
SR-Tab: Amoxicillin 1,000 mg, clavulanic acid 62.5 mg
Chew Tab: Amoxicillin 125 mg, clavulanic acid 32.5 mg
Amoxicillin 200 mg, clavulanic acid28.5 mg
Amoxicillin 250 mg, clavulanic acid62.5 mg
Amoxicillin 400 mg, clavulanic acid 57 mg
Susp (per 5 ml):
Amoxicillin 250 mg, clavulanic acid62.5 mg
Amoxicillin 400 mg, clavulanic acid 57 mg
Amoxicillin 600 mg, clavulanic acid42.9 mg		 Augmentin 250–500 PO q8–12h
Augmentin-XR2 tablets q12h
Avandamet (rosiglitazone, metformin) Antidiabetic agent Tab: Rosiglitazone 1 mg, metformin 500 mg
Rosiglitazone 2 mg, metformin 500 mg
Rosiglitazone 2 mg, metformin 1,000 mg
Rosiglitazone 4 mg, metformin 500 mg
Rosiglitazone 4 mg, metformin 1,000 mg		 1 mg/500 mg PO qdup to 8 mg/2,000 mg qd
Bactrim, Septra (sulfamethoxazole, trimethoprim) Antibiotic Tab:
Sulfamethoxazole400 mg, trimethoprim 80 mg
DS Tab:
Sulfamethoxazole800 mg, trimethoprim 160 mg
Susp (per 5 ml):
Sulfamethoxazole200 mg, trimethoprim 40 mg		 1 Bactrim to 1 Bactrim DS tab (or equivalent susp volume) PO q12h
P. carinii pneumonia treatment: 20 mg/kg/d trimethoprim divided q6h
P. carinii pneumonia prophylaxis: 1 DS tablet or 20 ml of susp PO q24h
Bicitra (sodium citrate, citric acid) Electrolyte replacement, systemic alkalinizer Liq (per 5 ml):
Sodium citrate 500 mg, citric acid 334 mg
(Each 1 ml delivers1 mEq of Na and the equivalent of 1 mEq of bicarbonate)		 Systemic alkalinizer: 10–30 ml diluted in 30–90 ml water qid, after meal and at bedtime, the dose being titrated as needed
Neutralizing buffer; 15–30 ml as a single dose; may be diluted in 15–30 ml water
Darvocet-N (propoxyphene napsylate, acetaminophen) Analgesic Tab:
Darvocet-N 50:
Propoxyphene napsylate 50 mg, acetaminophen325 mg
Darvocet-N 100:
Propoxyphene napsylate 100 mg, acetaminophen650 mg		 1–2 tabs PO q4–6h prn pain
Dyazide (triamterene, hydrochlorothiazide) Diuretic, antihypertensive Cap:
Triamterene 37.5 mg, hydrochlorothiazide 25 mg		 1–2 cap PO qd
Fansidar (pyrimethamine, sulfadoxine) Antimalarial Tab:
Sulfadoxine 500 mg, pyrimethamine 25 mg		 Treatment of acute attack of malaria: 2–3 tablets with or without quinine
Malaria prophylaxis:1 tablet PO weekly or 2 tablets once every 2 wk
Glucovance (glyburide, metformin) Antidiabetic agent Tab: Glyburide1.25 mg, metformin 250 mg
Glyburide 2.5 mg, metformin 500 mg
Glyburide 5 mg, metformin 500 mg		 1.25/250 mg PO qd-bid up to20 mg/2,000 mg/d
Lomotil (diphenoxylate, atropine) Antidiarrheal Tab:
Diphenoxylate 2.5 mg, atropine 0.025 mg
Liq (per 5 ml):
Diphenoxylate 2.5 mg, atropine 0.025 mg		 Tab: 2 tabs PO qid until control of diarrhea is achieved
Liq: 10 ml PO qid until control of diarrhea is achieved
Maxzide (triamterene, hydrochlorothiazide) Diuretic, antihypertensive Tab:
Maxzide-25:
Triamterene 37.5 mg, hydrochlorothiazide 25 mg
Maxzide:
Triamterene 75 mg, hydrochlorothiazide 50 mg		 Maxzide-25: 1–2 tabs PO qd
Maxzide: 1 tab PO qd
Metaglip (glipizide, metformin) Antidiabetic agent Tab: Glipizide 2.5 mg, metformin 250 mg
Glipizide 2.5 mg, metformin 500 mg
Glipizide 5 mg, metformin 500 mg		 2.5 mg/250 mg PO once daily with a meal up 20 mg/2,000 mg/d
Percocet (oxycodone HCl, acetaminophen) Analgesic Tab:
Oxycodone HCl 5 mg, acetaminophen325 mg		 1 tab PO q6h prn pain
Percodan (oxycodone HCl, oxycodone terephthalate, aspirin) Analgesic Tab:
Oxycodone HCl4.5 mg, oxycodone terephthalate0.038 mg, aspirin325 mg		 1 tab PO q6h prn pain
Polycitra (sodium citrate, potassium citrate, citric acid) Electrolyte replacement, systemic alkalinizer Liq (per 5 ml):
Sodium citrate 500 mg, potassium citrate500 mg, citric acid 334 mg
(Each 1 ml delivers 1 mEq of Na, 1 mEq of K, and the equivalent of 2 mEq of bicarbonate)		 Systemic alkalinizer: 10–30 ml diluted in 30–90 ml water qid, after meals and at bedtime, the dose being titrated as needed
Neutralizing buffer: 15–30 ml as a single dose; may be diluted in 15–30 ml water
Trilisate (choline magnesium salicylate, magnesium salicylate) NSAID Tab:
500 mg tablet:
Choline salicylate293 mg, magnesium salicylate 362 mg
750 mg tablet:
Choline salicylate400 mg, magnesium salicylate 544 mg
1,000 mg tablet:
Choline salicylate587 mg, magnesium salicylate 725 mg
Liq:
500 mg/5 ml:
Choline salicylate293 mg, magnesium salicylate 362 mg		 1,000–1,500 mg PO bid or 3,000 mg PO qhs
Tylenol with codeine (acetaminophen, codeine) Analgesic Tab:
Tylenol #2:
Acetaminophen 300 mg, codeine 15 mg
Tylenol #3:
Acetaminophen 300 mg, codeine 30 mg
Tylenol #4:
Acetaminophen 300 mg, codeine 60 mg
Elixir (per 5 ml):
Acetaminophen 120 mg, codeine 12 mg		 Tylenol #2: 2–3 tabs PO q4h prn pain
Tylenol #3: 1–2 tabs PO q4h prn pain
Tylenol #4: 1 tab PO q4h prn pain
Elixir: 15 ml PO q4h prn pain
Vicodin, Vicodin ES (hydrocodone, acetaminophen) Analgesic Tab:
Hydrocodone 5 mg, acetaminophen500 mg
ES tab:
Hydrocodone 7.5 mg, acetaminophen750 mg		 Vicodin: 1–2 tabs PO q4h prn pain
Vicodin ES: 1 tab PO q4h prn pain
BPH, benign prostatic hypertrophy; Cap, capsule; HF, heart failure; HTN, hypertension; Inj, injection; INR, international normalized ratio; Liq, liquid; MI, myocardial infarction; PO, by mouth; PR, per rectum; PT, prothrombin time; Pwd, powder; NSAID, nonsteroidal anti-inflammatory drug; NTG, nitroglycerin; SCr, serum creatinine; SL, sublingual; soln, solution; SR, sustained-release; Suppos, suppository; Susp, suspension; Syr, syrup; Tab, tablet; Top, topical