Auromedics Pharma Llc

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Auromedics Pharma Llc Drugs

Caffeine Citrate

Caffeine Citrate

Prior to initiation of caffeine citrate injection USP, baseline serum levels of caffeine should be measured in infants previously treated with theophylline, since preterm infants metabolize theophylline to caffeine. Likewise, baseline serum levels of caffeine should be measured in infants born to mothers who consumed caffeine prior to delivery, since caffeine readily crosses the placenta.

The recommended loading dose and maintenance doses of caffeine citrate injection USP follow.
Dose of Caffeine Citrate Injection USP Volume Dose of Caffeine Citrate Injection USP mg/kg Route Frequency Loading Dose 1 mL/kg 20 mg/kg Intravenous* (over 30 minutes) One Time Maintenance Dose 0.25 mL/kg 5 mg/kg Intravenous* (over 10 minutes) or Orally Every 24 hours**
* using a syringe infusion pump

** beginning 24 hours after the loading dose

NOTE THAT THE DOSE OF CAFFEINE BASE IS ONE-HALF THE DOSE WHEN EXPRESSED AS CAFFEINE CITRATE (e.g., 20 mg of caffeine citrate is equivalent to 10 mg of caffeine base).

Serum concentrations of caffeine may need to be monitored periodically throughout treatment to avoid toxicity. Serious toxicity has been associated with serum levels greater than 50 mg/L.Caffeine citrate injection USP should be inspected visually for particulate matter and discoloration prior to administration. Vials containing discolored solution or visible particulate matter should be discarded.

Drug Compatibility

To test for drug compatibility with common intravenous solutions or medications, 20 mL of caffeine citrate injection USP were combined with 20 mL of a solution or medication, with the exception of an Intralipid® admixture, which was combined as 80 mL/80 mL. The physical appearance of the combined solutions was evaluated for precipitation. The admixtures were mixed for 10 minutes and then assayed for caffeine. The admixtures were then continually mixed for 24 hours, with further sampling for caffeine assays at 2, 4, 8, and 24 hours.Based on this testing, caffeine citrate injection USP, 60 mg/3 mL is chemically stable for 24 hours at room temperature when combined with the following test products.• Dextrose Injection, USP 5%• 50% Dextrose Injection USP• Intralipid® 20% IV Fat Emulsion• Aminosyn® 8.5% Crystalline Amino Acid Solution• Dopamine HCI Injection, USP 40 mg/mL diluted to 0.6 mg/mL with Dextrose Injection, USP 5%• Calcium Gluconate Injection, USP 10% (0.465 mEq/Ca+2/mL)• Heparin Sodium Injection, USP 1000 units/mL diluted to 1 unit/mL with Dextrose Injection, USP 5%• Fentanyl Citrate Injection, USP 50 mcg/mL diluted to 10 mcg/mL with Dextrose Injection, USP 5%
Bhi Restore

Bhi Restore

To avoid distress to the patient, atracurium should not be administered before unconsciousness has been induced. Atracurium should not be mixed in the same syringe, or administered simultaneously through the same needle, with alkaline solutions (e.g., barbiturate solutions).Atracurium besylate should be administered intravenously. DO NOT GIVE ATRACURIUM BESYLATE BY INTRAMUSCULAR ADMINISTRATION. Intramuscular administration of atracurium besylate may result in tissue irritation and there are no clinical data to support this route of administration.As with other neuromuscular blocking agents, the use of a peripheral nerve stimulator will permit the most advantageous use of atracurium besylate, minimizing the possibility of overdosage or underdosage, and assist in the evaluation of recovery. Bolus Doses for Intubation and Maintenance of Neuromuscular Block Adults An atracurium besylate dose of 0.4 to 0.5 mg/kg (1.7 to 2.2 times the ED95), given as an intravenous bolus injection, is the recommended initial dose for most patients. With this dose, good or excellent conditions for nonemergency intubation can be expected in 2 to 2.5 minutes in most patients, with maximum neuromuscular block achieved approximately 3 to 5 minutes after injection. Clinically required neuromuscular block generally lasts 20 to 35 minutes under balanced anesthesia. Under balanced anesthesia, recovery to 25% of control is achieved approximately 35 to 45 minutes after injection, and recovery is usually 95% complete approximately 60 minutes after injection.Atracurium is potentiated by isoflurane or enflurane anesthesia. The same initial atracurium besylate dose of 0.4 to 0.5 mg/kg may be used for intubation prior to administration of these inhalation agents; however, if atracurium is first administered under steady-state of isoflurane or enflurane, the initial atracurium besylate dose should be reduced by approximately one-third, i.e., to 0.25 to 0.35 mg/kg, to adjust for the potentiating effects of these anesthetic agents. With halothane, which has only a marginal (approximately 20%) potentiating effect on atracurium, smaller dosage reductions may be considered.Atracurium besylate doses of 0.08 to 0.1 mg/kg are recommended for maintenance of neuromuscular block during prolonged surgical procedures. The first maintenance dose will generally be required 20 to 45 minutes after the initial atracurium besylate injection, but the need for maintenance doses should be determined by clinical criteria. Because atracurium lacks cumulative effects, maintenance doses may be administered at relatively regular intervals for each patient, ranging approximately from 15 to 25 minutes under balanced anesthesia, slightly longer under isoflurane or enflurane. Higher atracurium doses (up to 0.2 mg/kg) permit maintenance dosing at longer intervals. Pediatric Patients No atracurium dosage adjustments are required for pediatric patients two years of age or older. An atracurium besylate dose of 0.3 to 0.4 mg/kg is recommended as the initial dose for infants (1 month to 2 years of age) under halothane anesthesia. Maintenance doses may be required with slightly greater frequency in infants and children than in adults. Special Considerations An initial atracurium besylate dose of 0.3 to 0.4 mg/kg, given slowly or in divided doses over one minute, is recommended for adults, children, or infants with significant cardiovascular disease and for adults, children, or infants with any history (e.g., severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release.Dosage reductions must be considered also in patients with neuromuscular disease, severe electrolyte disorders, or carcinomatosis in which potentiation of neuromuscular block or difficulties with reversal have been demonstrated. There has been no clinical experience with atracurium in these patients, and no specific dosage adjustments can be recommended. No atracurium dosage adjustments are required for patients with renal disease.An initial atracurium besylate dose of 0.3 to 0.4 mg/kg is recommended for adults following the use of succinylcholine for intubation under balanced anesthesia. Further reductions may be desirable with the use of potent inhalation anesthetics. The patient should be permitted to recover from the effects of succinylcholine prior to atracurium administration. Insufficient data are available for recommendation of a specific initial atracurium dose for administration following the use of succinylcholine in children and infants.Use by Continuous Infusion Infusion in the Operating Room (OR) After administration of a recommended initial bolus dose of atracurium besylate injection (0.3 to 0.5 mg/kg), a diluted solution of atracurium besylate can be administered by continuous infusion to adults and pediatric patients aged 2 or more years for maintenance of neuromuscular block during extended surgical procedures.Infusion of atracurium should be individualized for each patient. The rate of administration should be adjusted according to the patient’s response as determined by peripheral nerve stimulation. Accurate dosing is best achieved using a precision infusion device.Infusion of atracurium should be initiated only after early evidence of spontaneous recovery from the bolus dose. An initial infusion rate of 9 to 10 mcg/kg/min may be required to rapidly counteract the spontaneous recovery of neuromuscular function. Thereafter, a rate of 5 to 9 mcg/kg/min should be adequate to maintain continuous neuromuscular block in the range of 89% to 99% in most pediatric and adult patients under balanced anesthesia. Occasional patients may require infusion rates as low as 2 mcg/kg/min or as high as 15 mcg/kg/min.The neuromuscular blocking effect of atracurium administered by infusion is potentiated by enflurane or isoflurane and, to a lesser extent, by halothane. Reduction in the infusion rate of atracurium should, therefore, be considered for patients receiving inhalation anesthesia. The rate of atracurium infusion should be reduced by approximately one-third in the presence of steady-state enflurane or isoflurane anesthesia; smaller reductions should be considered in the presence of halothane.In patients undergoing cardiopulmonary bypass with induced hypothermia, the rate of infusion of atracurium required to maintain adequate surgical relaxation during hypothermia (25° to 28°C) has been shown to be approximately half the rate required during normothermia.Spontaneous recovery from neuromuscular block following discontinuation of atracurium infusion may be expected to proceed at a rate comparable to that following administration of a single bolus dose. Infusion in the Intensive Care Unit (ICU) The principles for infusion of atracurium in the OR are also applicable to use in the ICU.An infusion rate of 11 to 13 mcg/kg/min (range: 4.5 to 29.5) should provide adequate neuromuscular block in adult patients in an ICU. Limited information suggests that infusion rates required for pediatric patients in the ICU may be higher than in adult patients. There may be wide interpatient variability in dosage requirements and these requirements may increase or decrease with time (see PRECAUTIONS: Long-Term Use in Intensive Care Unit (ICU)). Following recovery from neuromuscular block, readministration of a bolus dose may be necessary to quickly re-establish neuromuscular block prior to reinstitution of the infusion. Infusion Rate Tables The amount of infusion solution required per minute will depend upon the concentration of atracurium in the infusion solution, the desired dose of atracurium, and the patient’s weight. The following tables provide guidelines for delivery, in mL/hr (equivalent to microdrops/min when 60 microdrops = 1 mL), of atracurium solutions in concentrations of 0.2 mg/mL (20 mg in 100 mL) or 0.5 mg/mL (50 mg in 100 mL) with an infusion pump or a gravity flow device.
Table 3: Atracurium Besylate Infusion Rates for a Concentration of 0.2 mg/mL Patient Weight (kg) Drug Delivery Rate (mcg/kg/min) 5 6 7 8 9 10 11 12 13 Infusion Delivery Rate (mL/hr) 30 45 54 63 72 81 90 99 108 117 35 53 63 74 84 95 105 116 126 137 40 60 72 84 96 108 120 132 144 156 45 68 81 95 108 122 135 149 162 176 50 75 90 105 120 135 150 165 180 195 55 83 99 116 132 149 165 182 198 215 60 90 108 126 144 162 180 198 216 234 65 98 117 137 156 176 195 215 234 254 70 105 126 147 168 189 210 231 252 273 75 113 135 158 180 203 225 248 270 293 80 120 144 168 192 216 240 264 288 312 90 135 162 189 216 243 270 297 324 351 100 150 180 210 240 270 300 330 360 390 Table 4: Atracurium Besylate Infusion Rates for a Concentration of 0.5 mg/mL Patient Weight (kg) Drug Delivery Rate (mcg/kg/min) 5 6 7 8 9 10 11 12 13 Infusion Delivery Rate (mL/hr) 30 18 22 25 29 32 36 40 43 47 35 21 25 29 34 38 42 46 50 55 40 24 29 34 38 43 48 53 58 62 45 27 32 38 43 49 54 59 65 70 50 30 36 42 48 54 60 66 72 78 55 33 40 46 53 59 66 73 79 86 60 36 43 50 58 65 72 79 86 94 65 39 47 55 62 70 78 86 94 101 70 42 50 59 67 76 84 92 101 109 75 45 54 63 72 81 90 99 108 117 80 48 58 67 77 86 96 106 115 125 90 54 65 76 86 97 108 119 130 140 100 60 72 84 96 108 120 132 144 156
Compatibility and Admixtures Atracurium besylate infusion solutions may be prepared by admixing atracurium besylate injection with an appropriate diluent such as 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose and 0.9% Sodium Chloride Injection. Infusion solutions should be used within 24 hours of preparation. Unused solutions should be discarded. Solutions containing 0.2 mg/mL or 0.5 mg/mL atracurium besylate in the above diluents may be stored either under refrigeration or at room temperature for 24 hours without significant loss of potency. Care should be taken during admixture to prevent inadvertent contamination. Visually inspect prior to administration.Spontaneous degradation of atracurium besylate has been demonstrated to occur more rapidly in Lactated Ringer’s solution than in 0.9% sodium chloride solution. Therefore, it is recommended that Lactated Ringer’s Injection not be used as a diluent in preparing solutions of atracurium besylate injection for infusion.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Atracurium Besylate

Atracurium Besylate

To avoid distress to the patient, atracurium should not be administered before unconsciousness has been induced. Atracurium should not be mixed in the same syringe, or administered simultaneously through the same needle, with alkaline solutions (e.g., barbiturate solutions).Atracurium besylate should be administered intravenously. DO NOT GIVE ATRACURIUM BESYLATE BY INTRAMUSCULAR ADMINISTRATION. Intramuscular administration of atracurium besylate may result in tissue irritation and there are no clinical data to support this route of administration.As with other neuromuscular blocking agents, the use of a peripheral nerve stimulator will permit the most advantageous use of atracurium besylate, minimizing the possibility of overdosage or underdosage, and assist in the evaluation of recovery. Bolus Doses for Intubation and Maintenance of Neuromuscular Block Adults An atracurium besylate dose of 0.4 to 0.5 mg/kg (1.7 to 2.2 times the ED95), given as an intravenous bolus injection, is the recommended initial dose for most patients. With this dose, good or excellent conditions for nonemergency intubation can be expected in 2 to 2.5 minutes in most patients, with maximum neuromuscular block achieved approximately 3 to 5 minutes after injection. Clinically required neuromuscular block generally lasts 20 to 35 minutes under balanced anesthesia. Under balanced anesthesia, recovery to 25% of control is achieved approximately 35 to 45 minutes after injection, and recovery is usually 95% complete approximately 60 minutes after injection.Atracurium is potentiated by isoflurane or enflurane anesthesia. The same initial atracurium besylate dose of 0.4 to 0.5 mg/kg may be used for intubation prior to administration of these inhalation agents; however, if atracurium is first administered under steady-state of isoflurane or enflurane, the initial atracurium besylate dose should be reduced by approximately one-third, i.e., to 0.25 to 0.35 mg/kg, to adjust for the potentiating effects of these anesthetic agents. With halothane, which has only a marginal (approximately 20%) potentiating effect on atracurium, smaller dosage reductions may be considered.Atracurium besylate doses of 0.08 to 0.1 mg/kg are recommended for maintenance of neuromuscular block during prolonged surgical procedures. The first maintenance dose will generally be required 20 to 45 minutes after the initial atracurium besylate injection, but the need for maintenance doses should be determined by clinical criteria. Because atracurium lacks cumulative effects, maintenance doses may be administered at relatively regular intervals for each patient, ranging approximately from 15 to 25 minutes under balanced anesthesia, slightly longer under isoflurane or enflurane. Higher atracurium doses (up to 0.2 mg/kg) permit maintenance dosing at longer intervals. Pediatric Patients No atracurium dosage adjustments are required for pediatric patients two years of age or older. An atracurium besylate dose of 0.3 to 0.4 mg/kg is recommended as the initial dose for infants (1 month to 2 years of age) under halothane anesthesia. Maintenance doses may be required with slightly greater frequency in infants and children than in adults. Special Considerations An initial atracurium besylate dose of 0.3 to 0.4 mg/kg, given slowly or in divided doses over one minute, is recommended for adults, children, or infants with significant cardiovascular disease and for adults, children, or infants with any history (e.g., severe anaphylactoid reactions or asthma) suggesting a greater risk of histamine release.Dosage reductions must be considered also in patients with neuromuscular disease, severe electrolyte disorders, or carcinomatosis in which potentiation of neuromuscular block or difficulties with reversal have been demonstrated. There has been no clinical experience with atracurium in these patients, and no specific dosage adjustments can be recommended. No atracurium dosage adjustments are required for patients with renal disease.An initial atracurium besylate dose of 0.3 to 0.4 mg/kg is recommended for adults following the use of succinylcholine for intubation under balanced anesthesia. Further reductions may be desirable with the use of potent inhalation anesthetics. The patient should be permitted to recover from the effects of succinylcholine prior to atracurium administration. Insufficient data are available for recommendation of a specific initial atracurium dose for administration following the use of succinylcholine in children and infants.Use by Continuous Infusion Infusion in the Operating Room (OR) After administration of a recommended initial bolus dose of atracurium besylate injection (0.3 to 0.5 mg/kg), a diluted solution of atracurium besylate can be administered by continuous infusion to adults and pediatric patients aged 2 or more years for maintenance of neuromuscular block during extended surgical procedures.Infusion of atracurium should be individualized for each patient. The rate of administration should be adjusted according to the patient’s response as determined by peripheral nerve stimulation. Accurate dosing is best achieved using a precision infusion device.Infusion of atracurium should be initiated only after early evidence of spontaneous recovery from the bolus dose. An initial infusion rate of 9 to 10 mcg/kg/min may be required to rapidly counteract the spontaneous recovery of neuromuscular function. Thereafter, a rate of 5 to 9 mcg/kg/min should be adequate to maintain continuous neuromuscular block in the range of 89% to 99% in most pediatric and adult patients under balanced anesthesia. Occasional patients may require infusion rates as low as 2 mcg/kg/min or as high as 15 mcg/kg/min.The neuromuscular blocking effect of atracurium administered by infusion is potentiated by enflurane or isoflurane and, to a lesser extent, by halothane. Reduction in the infusion rate of atracurium should, therefore, be considered for patients receiving inhalation anesthesia. The rate of atracurium infusion should be reduced by approximately one-third in the presence of steady-state enflurane or isoflurane anesthesia; smaller reductions should be considered in the presence of halothane.In patients undergoing cardiopulmonary bypass with induced hypothermia, the rate of infusion of atracurium required to maintain adequate surgical relaxation during hypothermia (25° to 28°C) has been shown to be approximately half the rate required during normothermia.Spontaneous recovery from neuromuscular block following discontinuation of atracurium infusion may be expected to proceed at a rate comparable to that following administration of a single bolus dose. Infusion in the Intensive Care Unit (ICU) The principles for infusion of atracurium in the OR are also applicable to use in the ICU.An infusion rate of 11 to 13 mcg/kg/min (range: 4.5 to 29.5) should provide adequate neuromuscular block in adult patients in an ICU. Limited information suggests that infusion rates required for pediatric patients in the ICU may be higher than in adult patients. There may be wide interpatient variability in dosage requirements and these requirements may increase or decrease with time (see PRECAUTIONS: Long-Term Use in Intensive Care Unit (ICU)). Following recovery from neuromuscular block, readministration of a bolus dose may be necessary to quickly re-establish neuromuscular block prior to reinstitution of the infusion. Infusion Rate Tables The amount of infusion solution required per minute will depend upon the concentration of atracurium in the infusion solution, the desired dose of atracurium, and the patient’s weight. The following tables provide guidelines for delivery, in mL/hr (equivalent to microdrops/min when 60 microdrops = 1 mL), of atracurium solutions in concentrations of 0.2 mg/mL (20 mg in 100 mL) or 0.5 mg/mL (50 mg in 100 mL) with an infusion pump or a gravity flow device.
Table 3: Atracurium Besylate Infusion Rates for a Concentration of 0.2 mg/mL Patient Weight (kg) Drug Delivery Rate (mcg/kg/min) 5 6 7 8 9 10 11 12 13 Infusion Delivery Rate (mL/hr) 30 45 54 63 72 81 90 99 108 117 35 53 63 74 84 95 105 116 126 137 40 60 72 84 96 108 120 132 144 156 45 68 81 95 108 122 135 149 162 176 50 75 90 105 120 135 150 165 180 195 55 83 99 116 132 149 165 182 198 215 60 90 108 126 144 162 180 198 216 234 65 98 117 137 156 176 195 215 234 254 70 105 126 147 168 189 210 231 252 273 75 113 135 158 180 203 225 248 270 293 80 120 144 168 192 216 240 264 288 312 90 135 162 189 216 243 270 297 324 351 100 150 180 210 240 270 300 330 360 390 Table 4: Atracurium Besylate Infusion Rates for a Concentration of 0.5 mg/mL Patient Weight (kg) Drug Delivery Rate (mcg/kg/min) 5 6 7 8 9 10 11 12 13 Infusion Delivery Rate (mL/hr) 30 18 22 25 29 32 36 40 43 47 35 21 25 29 34 38 42 46 50 55 40 24 29 34 38 43 48 53 58 62 45 27 32 38 43 49 54 59 65 70 50 30 36 42 48 54 60 66 72 78 55 33 40 46 53 59 66 73 79 86 60 36 43 50 58 65 72 79 86 94 65 39 47 55 62 70 78 86 94 101 70 42 50 59 67 76 84 92 101 109 75 45 54 63 72 81 90 99 108 117 80 48 58 67 77 86 96 106 115 125 90 54 65 76 86 97 108 119 130 140 100 60 72 84 96 108 120 132 144 156
Compatibility and Admixtures Atracurium besylate infusion solutions may be prepared by admixing atracurium besylate injection with an appropriate diluent such as 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or 5% Dextrose and 0.9% Sodium Chloride Injection. Infusion solutions should be used within 24 hours of preparation. Unused solutions should be discarded. Solutions containing 0.2 mg/mL or 0.5 mg/mL atracurium besylate in the above diluents may be stored either under refrigeration or at room temperature for 24 hours without significant loss of potency. Care should be taken during admixture to prevent inadvertent contamination. Visually inspect prior to administration.Spontaneous degradation of atracurium besylate has been demonstrated to occur more rapidly in Lactated Ringer’s solution than in 0.9% sodium chloride solution. Therefore, it is recommended that Lactated Ringer’s Injection not be used as a diluent in preparing solutions of atracurium besylate injection for infusion.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Hydrochlorothiazide

Hydrochlorothiazide

[see Indications and Usage (1) and Clinical Pharmacology (12.3)]

2.1 Community-Acquired Pneumonia

The recommended dose of azithromycin for injection for the treatment of adult patients with community-acquired pneumonia due to the indicated organisms is 500 mg as a single daily dose by the intravenous route for at least two days. Intravenous therapy should be followed by azithromycin by the oral route at a single, daily dose of 500 mg, administered as two 250 mg tablets to complete a 7- to 10-day course of therapy. The timing of the switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response.

2.2 Pelvic Inflammatory Disease

The recommended dose of azithromycin for injection for the treatment of adult patients with pelvic inflammatory disease due to the indicated organisms is 500 mg as a single daily dose by the intravenous route for one or two days. Intravenous therapy should be followed by azithromycin by the oral route at a single, daily dose of 250 mg to complete a 7-day course of therapy. The timing of the switch to oral therapy should be done at the discretion of the physician and in accordance with clinical response.

2.3 Preparation of the Solution for Intravenous Administration

The infusate concentration and rate of infusion for azithromycin for injection should be either 1 mg/mL over 3 hours or 2 mg/mL over 1 hour. Azithromycin for injection should not be given as a bolus or as an intramuscular injection. Reconstitution Prepare the initial solution of azithromycin for injection by adding 4.8 mL of Sterile Water for Injection to the 500 mg vial, and shaking the vial until all of the drug is dissolved. Since azithromycin for injection is supplied under vacuum, it is recommended that a standard 5 mL (non-automated) syringe be used to ensure that the exact amount of 4.8 mL of Sterile Water is dispensed. Each mL of reconstituted solution contains 100 mg azithromycin. Reconstituted solution is stable for 24 hours when stored below 30°C (86°F).Parenteral drug products should be inspected visually for particulate matter prior to administration. If particulate matter is evident in reconstituted fluids, the drug solution should be discarded. Dilute this solution further prior to administration as instructed below. Dilution To provide azithromycin over a concentration range of 1 to 2 mg/mL, transfer 5 mL of the 100 mg/mL azithromycin solution into the appropriate amount of any of the diluents listed below: Normal Saline (0.9% sodium chloride)1/2 Normal Saline (0.45% sodium chloride)5% Dextrose in WaterLactated Ringer’s Solution5% Dextrose in 1/2 Normal Saline (0.45% sodium chloride) with 20 mEq KCl5% Dextrose in Lactated Ringer’s Solution5% Dextrose in 1/3 Normal Saline (0.3% sodium chloride)5% Dextrose in 1/2 Normal Saline (0.45% sodium chloride)Normosol®-M in 5% DextroseNormosol®-R in 5% Dextrose

Final Infusion Solution Concentration (mg/mL) Amount of Diluent (mL) 1 mg/mL 500 mL 2 mg/mL 250 mLOther intravenous substances, additives, or medications should not be added to azithromycin for injection, or infused simultaneously through the same intravenous line. Storage When diluted according to the instructions (1 mg/mL to 2 mg/mL), azithromycin for injection is stable for 24 hours at or below room temperature 30°C (86°F), or for 7 days if stored under refrigeration 5°C (41°F).
Oxacillin

Oxacillin

The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use.Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. Duration of therapy varies with the type of severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. Treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of oxacillin and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Penicillin-probenecid therapy is generally limited to those infections where very high serum levels of penicillin are necessary.Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious, life-threatening infections (see PRECAUTIONS-General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
RECOMMENDED DOSAGES FOR OXACILLIN FOR INJECTION Drug Adults Infants and Children<40 kg (88 lbs) Other Recommendations Oxacillin 250 to 500 mg IM or IV every 4 to 6 hours (mild to moderate infections) 50 mg/kg/day IM or IV in equally divided doses every 6 hours (mild to moderate infections) 1 gram IM or IV every 4 to 6 hours (severe infections) 100 mg/kg/day IM or IV in equally divided doses every 4 to 6 hours (severe infections) Premature and Neonates 25 mg/kg/day IM or IV
Directions for Use

For Intramuscular Use

Use Sterile Water for Injection, USP. Add 11.5 mL to the 2 gram vial. Shake well until a clear solution is obtained. After reconstitution, vials will contain 250 mg of active drug per 1.5 mL of solution. The reconstituted solution is stable for 3 days at 70°F or for one week under refrigeration (40°F).

For Direct Intravenous Use

Use Sterile Water for Injection, USP or Sodium Chloride Injection, USP. Add 20 mL to the 2 gram vial. Withdraw the entire contents and administer slowly over a period of approximately 10 minutes.

For Administration by Intravenous Drip

Reconstitute as directed above (For Direct Intravenous Use) prior to diluting with Intravenous Solution.
STABILITY PERIODS FOR OXACILLIN FOR INJECTION, USP Concentrationmg/mL SterileWater forInjection USP 0.9% SodiumChloride Injection USP (Isotonic) SodiumLactate Solution USP (M/6 Molar) DextroseInjection USP (5%) Dextroseand Sodium Chloride Injection USP(5% Dextrose and0.45% NaCl) InvertSugar Injection USP (10%) LactatedRinger’sInjection USP ROOM TEMPERATURE (25°C) 10-100 4 Days 4 Days 10-30 24 Hrs 24 Hrs 0.5-2 6 Hrs 6 Hrs 6 Hrs REFRIGERATION (4°C) 10-100 7 Days 7 Days 10-30 4 Days 4 Days 4 Days 4 Days 4 Days FROZEN (-15°C) 50-100 30 Days 250/1.5 mL 30 Days 100 30 Days 10-100 30 Days 30 Days 30 Days 30 Days 30 Days
Stability studies on oxacillin sodium at concentrations of 0.5 mg/mL and 2 mg/mL in various intravenous solutions listed below indicate the drug will lose less than 10% activity at room temperature (70°F) during a 6-hour period. IV Solution 5% Dextrose in Normal Saline10% D-Fructose in Water10% D-Fructose in Normal SalineLactated Potassic Saline Injection10% Invert Sugar in Normal Saline10% Invert Sugar Plus 0.3% Potassium Chloride in WaterTravert 10% Electrolyte #1 Travert 10% Electrolyte #2Travert 10% Electrolyte #3 Only those solutions listed above should be used for the intravenous infusion of oxacillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of oxacillin is administered before the drug loses its stability in the solution in use.If another agent is used in conjunction with oxacillin therapy, it should not be physically mixed with oxacillin but should be administered separately.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.Do not add supplementary medication to Oxacillin for Injection, USP.
Nafcillin

Nafcillin

Nafcillin for injection is available for intramuscular and intravenous use. The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use. The usual I.V. dosage for adults is 500 mg every 4 hours. For severe infections, 1 gram every 4 hours is recommended. Administer slowly over at least 30 to 60 minutes to minimize the risk of vein irritation and extravasation.
RECOMMENDED DOSAGE FOR NAFCILLIN FOR INJECTION, USP Drug Adults Infants andChildren <40 kg (88 lbs) OtherRecommendations Nafcillin 500 mg IM every 4 to 6 hours. IV every 4 hours 25 mg/kg IM twice daily Neonates 10 mg/kg IM twice daily Nafcillin 1 gram IM or IV every 4 hours (severe infections)
Bacteriologic studies to determine the causative organisms and their susceptibility to nafcillin should always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with nafcillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. The treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of the penicillinase-resistant penicillins and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Nafcillin-probenecid therapy is generally limited to those infections where very high serum levels of nafcillin are necessary.No dosage alterations are necessary for patients with renal dysfunction, including those on hemodialysis. Hemodialysis does not accelerate nafcillin clearance from the blood.For patients with hepatic insufficiency and renal failure, measurement of nafcillin serum levels should be performed and dosage adjusted accordingly.With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.Do not add supplementary medication to nafcillin.Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious life-threatening infections (see PRECAUTIONS, General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis. Directions for Use For Intramuscular UseReconstitute with Sterile Water for Injection, USP, 0.9% Sodium Chloride Injection, USP or Bacteriostatic Water for Injection, USP (with benzyl alcohol or parabens); add 6.6 mL to the 2 g vial for 8 mL resulting solution. All reconstituted vials have a concentration of 250 mg per mL.The clear solution should be administered by deep intragluteal injection immediately after reconstitution.Reconstituted StabilityReconstitute with the required amount of Sterile Water for Injection, USP, 0.9% Sodium Chloride Injection, USP or Bacteriostatic Water for Injection, USP (with benzyl alcohol or parabens). The resulting solutions are stable for 3 days at room temperature or 7 days under refrigeration and 90 days frozen.For Direct Intravenous UseThe required amount of drug should be diluted in 15 to 30 mL of Sterile Water for Injection, USP or Sodium Chloride Injection, USP and injected over a 5- to 10-minute period. This may be accomplished through the tubing of an intravenous infusion if desirable.For Administration by Intravenous Drip Reconstitute as directed above (For Intravenous Use) prior to diluting with Intravenous Solution.
STABILITY PERIODS FOR NAFCILLIN FOR INJECTION, USP* Concentrationmg/mL Sterile Water forInjection USP Sodium ChlorideInjection USP (0.9%) Sodium LactateSolution USP (M/6 Molar) Dextrose InjectionUSP (5%) Dextrose and SodiumChloride Injection USP(5% Dextrose and0.45% Sodium Chloride) Invert SugarInjection USP(10%) Lactated Ringer’sInjection USP * IMPORTANT: This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that a product should be used as soon after preparation as feasible. ROOM TEMPERATURE (25ºC) 10-200 24 Hrs 24 Hrs 30 24 Hrs 2-30 24 Hrs 24 Hrs 10-30 24 Hrs 24 Hrs REFRIGERATION (4ºC) 10-200 7 Days 7 Days 10-30 7 Days 7 Days 7 Days 7 Days 7 Days FROZEN (-15ºC) 250 90 Days 90 Days 10-250 90 Days 90 Days 90 Days 90 Days 90 Days
Only those solutions listed above should be used for the intravenous infusion of nafcillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of nafcillin is administered before the drug loses its stability in the solution in use.There is no clinical experience available on the use of this agent in neonates or infants for this route of administration.This route of administration should be used for relatively short-term therapy (24 to 48 hours) because of the occasional occurrence of thrombophlebitis particularly in elderly patients.If another agent is used in conjunction with nafcillin therapy, it should not be physically mixed with nafcillin but should be administered separately.
Nafcillin

Nafcillin

Nafcillin for injection Pharmacy Bulk Package is available for intravenous use only. The usual I.V. dosage for adults is 500 mg every 4 hours. For severe infections, 1 gram every 4 hours is recommended. Administer slowly over at least 30 to 60 minutes to minimize the risk of vein irritation and extravasation.Bacteriologic studies to determine the causative organisms and their susceptibility to nafcillin should always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with nafcillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. The treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of the penicillinase-resistant penicillins and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Nafcillin-probenecid therapy is generally limited to those infections where very high serum levels of nafcillin are necessary.No dosage alterations are necessary of patients with renal dysfunction, including those on hemodialysis. Hemodialysis does not accelerate nafcillin clearance from the blood.For patients with hepatic insufficiency and renal failure, measurement of nafcillin serum levels should be performed and dosage adjusted accordingly.With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.Do not add supplementary medication to nafcillin.Oral preparation of the penicillinase-resistant penicillins should not be used as initial therapy in serious life-threatening infections (see PRECAUTIONS, General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.

DIRECTIONS FOR PROPER USE OF A PHARMACY BULK PACKAGE

The container closure may be penetrated only one time after reconstitution using a suitable sterile transfer device or dispensing set which allows measured dispensing of the contents. Use of a syringe and needle is not recommended as it may cause leakage. Use of this product is restricted to a suitable work area, such as a laminar flow hood. The withdrawal of container contents should be accomplished without delay. However, should this not be possible, a maximum of 4 HOURS from initial closure entry is permitted to complete fluid transfer operations. This time limit should begin with the introduction of solvent or diluent into the Pharmacy Bulk Package bottle. Pharmacy Bulk Package Each nafcillin for injection, USP Pharmacy Bulk Package bottle contains nafcillin sodium as the monohydrate equivalent to 10 g nafcillin. The Pharmacy Bulk Package bottle is intended for use in a pharmacy admixture program and is restricted to the preparation of admixtures for intravenous infusion. Add 93 mL Sterile Water for Injection, USP or 0.9% Sodium Chloride Injection, USP. The resulting solution will contain 100 mg nafcillin activity per mL and will require further dilution. CAUTION: NOT TO BE DISPENSED AS A UNIT. Do not add supplementary medication to nafcillin. DIRECTIONS FOR USE For Administration by Intravenous Drip: Reconstitute as directed above (For Intravenous Use) prior to diluting with intravenous solution.
STABILITY PERIODS FOR NAFCILLIN FOR INJECTION, USP* Concentrationmg/mL SterileWater forInjection USP SodiumChloride Injection USP (0.9%) SodiumLactate Solution USP (M/6 Molar) DextroseInjection USP (5%) Dextroseand Sodium Chloride Injection USP(5% Dextrose and0.45% Sodium Chloride) InvertSugar Injection USP (10%) LactatedRinger’sInjection USP * IMPORTANT: This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that a product should be used as soon after preparation as feasible. ROOM TEMPERATURE (25ºC) 10-200 24 Hrs 24 Hrs 30 24 Hrs 2-30 24 Hrs 24 Hrs 10-30 24 Hrs 24 Hrs REFRIGERATION (4ºC) 10-200 7 Days 7 Days 10-30 7 Days 7 Days 7 Days 7 Days 7 Days FROZEN (-15ºC) 250 90 Days 90 Days 10-250 90 Days 90 Days 90 Days 90 Days 90 Days
Only those solutions listed above should be used for the intravenous infusion of nafcillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of nafcillin is administered before the drug loses its stability in the solution in use.There is no clinical experience available on the use of this agent in neonates or infants for this route of administration.This route of administration should be used for relatively short-term therapy (24 to 48 hours) because of the occasional occurrence of thrombophlebitis particularly in elderly patients.If another agent is used in conjunction with nafcillin therapy, it should not be physically mixed with nafcillin but should be administered separately.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
Goddess Garden Organics...

Goddess Garden Organics Everyday Natural Sunscreen

Table 1 (Recommended Dosages) summarizes the recommended volumes and concentrations of lidocaine hydrochloride injection, USP for various types of anesthetic procedures. The dosages suggested in this table are for normal healthy adults and refer to the use of epinephrine-free solutions. When larger volumes are required, only solutions containing epinephrine should be used except in those cases where vasopressor drugs may be contraindicated.

There have been adverse event reports of chondrolysis in patients receiving intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures. Lidocaine hydrochloride injection, USP is not approved for this use (see WARNINGS and DOSAGE AND ADMINISTRATION). These recommended doses serve only as a guide to the amount of anesthetic required for most routine procedures. The actual volumes and concentrations to be used depend on a number of factors such as type and extent of surgical procedure, depth of anesthesia and degree of muscular relaxation required, duration of anesthesia required, and the physical condition of the patient. In all cases the lowest concentration and smallest dose that will produce the desired result should be given. Dosages should be reduced for children and for the elderly and debilitated patients and patients with cardiac and/or liver disease.The onset of anesthesia, the duration of anesthesia and the degree of muscular relaxation are proportional to the volume and concentration (i.e., total dose) of local anesthetic used. Thus, an increase in volume and concentration of lidocaine hydrochloride injection, USP will decrease the onset of anesthesia, prolong the duration of anesthesia, provide a greater degree of muscular relaxation and increase the segmental spread of anesthesia. However, increasing the volume and concentration of lidocaine hydrochloride injection, USP may result in a more profound fall in blood pressure when used in epidural anesthesia. Although the incidence of side effects with lidocaine hydrochloride is quite low, caution should be exercised when employing large volumes and concentrations, since the incidence of side effects is directly proportional to the total dose of local anesthetic agent injected.

Epidural Anesthesia

For epidural anesthesia the following dosage form of lidocaine hydrochloride injection, USP is recommended:1% without epinephrine 30 mL single dose vialsAlthough this solution is intended specifically for epidural anesthesia, it may also be used for infiltration and peripheral nerve block, provided it is employed as a single dose unit.This solution contains no bacteriostatic agent.In epidural anesthesia, the dosage varies withthe number of dermatomes to be anesthetized (generally 2 to 3 mL of the indicated concentration per dermatome).

Caudal and Lumbar Epidural Block

As a precaution against the adverse experience sometimes observed following unintentional penetration of the subarachnoid space, a test dose such as 2 to 3 mL of 1.5% lidocaine hydrochloride should be administered at least 5 minutes prior to injecting the total volume required for a lumbar or caudal epidural block. The test dose should be repeated if the patient is moved in a manner that may have displaced the catheter. Epinephrine, if contained in the test dose (10 to 15 mcg have been suggested), may serve as a warning of unintentional intravascular injection. If injected into a blood vessel, this amount of epinephrine is likely to produce a transient “epinephrine response” within 45 seconds, consisting of an increase in heart rate and systolic blood pressure, circumoral pallor, palpitations and nervousness in the unsedated patient. The sedated patient may exhibit only a pulse rate increase of 20 or more beats per minute for 15 or more seconds. Patients on beta blockers may not manifest changes in heart rate, but blood pressure monitoring can detect an evanescent rise in systolic blood pressure. Adequate time should be allowed for onset of anesthesia after administration of each test dose. The rapid injection of a large volume of lidocaine hydrochloride injection, USP through the catheter should be avoided, and, when feasible, fractional doses should be administered.In the event of the known injection of a large volume of local anesthetic solution into the subarachnoid space, after suitable resuscitation and if the catheter is in place, consider attempting the recovery of drug by draining a moderate amount of cerebrospinal fluid (such as 10 mL) through the epidural catheter.
Thyrotox

Thyrotox

2.2 Sildenafil Injection

Sildenafil injection is for the continued treatment of patients with PAH who are currently prescribed oral sildenafil and who are temporarily unable to take oral medication.The recommended dose is 10 mg administered as an intravenous bolus injection three times a day. The dose of sildenafil injection does not need to be adjusted for body weight.A 10 mg dose of sildenafil injection is predicted to provide pharmacological effect of sildenafil and its N-desmethyl metabolite equivalent to that of a 20 mg oral dose.
Betamethasone Dipropion...

Betamethasone Dipropionate Ointment

NOTE: The products accompanying this insert do not contain epinephrine. The dose of any local anesthetic administered varies with the anesthetic procedure, the area to be anesthetized, the vascularity of the tissues, the number of neuronal segments to be blocked, the depth of anesthesia and degree of muscle relaxation required, the duration of anesthesia desired, individual tolerance, and the physical condition of the patient. The smallest dose and concentration required to produce the desired result should be administered. Dosages of bupivacaine hydrochloride injection should be reduced for elderly and/or debilitated patients and patients with cardiac and/or liver disease. The rapid injection of a large volume of local anesthetic solution should be avoided and fractional (incremental) doses should be used when feasible.For specific techniques and procedures, refer to standard textbooks.There have been adverse event reports of chondrolysis in patients receiving intra-articular infusions of local anesthetics following arthroscopic and other surgical procedures. Bupivacaine hydrochloride injection is not approved for this use (see WARNINGS and DOSAGE AND ADMINISTRATION).In recommended doses, bupivacaine hydrochloride produces complete sensory block, but the effect on motor function differs among the three concentrations.0.25% — when used for caudal, epidural, or peripheral nerve block, produces incomplete motor block. Should be used for operations in which muscle relaxation is not important, or when another means of providing muscle relaxation is used concurrently. Onset of action may be slower than with the 0.5% or 0.75% solutions.0.5% — provides motor blockade for caudal, epidural, or nerve block, but muscle relaxation may be inadequate for operations in which complete muscle relaxation is essential.0.75% — produces complete motor block. Most useful for epidural block in abdominal operations requiring complete muscle relaxation, and for retrobulbar anesthesia. Not for obstetrical anesthesia.The duration of anesthesia with bupivacaine hydrochloride injection is such that for most indications, a single dose is sufficient.Maximum dosage limit must be individualized in each case after evaluating the size and physical status of the patient, as well as the usual rate of systemic absorption from a particular injection site. Most experience to date is with single doses of bupivacaine hydrochloride injection up to 225 mg with epinephrine 1:200,000 and 175 mg without epinephrine; more or less drug may be used depending on individualization of each case.These doses may be repeated up to once every three hours. In clinical studies to date, total daily doses have been up to 400 mg. Until further experience is gained, this dose should not be exceeded in 24 hours. The duration of anesthetic effect may be prolonged by the addition of epinephrine.The dosages in Table 1 have generally proved satisfactory and are recommended as a guide for use in the average adult. These dosages should be reduced for elderly or debilitated patients. Until further experience is gained, bupivacaine hydrochloride injection is not recommended for pediatric patients younger than 12 years. Bupivacaine hydrochloride injection is contraindicated for obstetrical paracervical blocks, and is not recommended for intravenous regional anesthesia (Bier Block).

Use in Epidural Anesthesia

During epidural administration of bupivacaine hydrochloride injection, 0.5% and 0.75% solutions should be administered in incremental doses of 3 mL to 5 mL with sufficient time between doses to detect toxic manifestations of unintentional intravascular or intrathecal injection. In obstetrics, only the 0.5% and 0.25% concentrations should be used; incremental doses of 3 mL to 5 mL of the 0.5% solution not exceeding 50 mg to 100 mg at any dosing interval are recommended. Repeat doses should be preceded by a test dose containing epinephrine if not contraindicated. Test Dose for Caudal and Lumbar Epidural Blocks See PRECAUTIONS Unused portions of solution should be discarded following initial use.This product should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Solutions which are discolored or which contain particulate matter should not be administered.
Table 1. Recommended Concentrations and Doses of Bupivacaine Hydrochloride Injection Type ofBlock Conc. Each Dose MotorBlock1 (mL) (mg) 1With continuous (intermittent) techniques, repeat doses increase the degree of motor block. The first repeat dose of 0.5% may produce complete motor block. Intercostal nerve block with 0.25% may also produce complete motor block for intra-abdominal surgery. 2 For single-dose use, not for intermittent epidural technique. Not for obstetrical anesthesia. 3 See PRECAUTIONS. 4 Solutions with or without epinephrine. Localinfiltration 0.25%4 up tomax. up tomax. –– Epidural 0.75%2,4 10 to 20 75 to 150 complete 0.5%4 10 to 20 50 to 100 moderate to complete 0.25%4 10 to 20 25 to 50 partial to moderate Caudal 0.5%4 15 to 30 75 to 150 moderate to complete 0.25%4 15 to 30 37.5 to 75 moderate Peripheralnerves 0.5%4 5 to max. 25 to max. moderate to complete 0.25%4 5 to max. 12.5 to max. moderate to complete Retrobulbar3 0.75%4 2 to 4 15 to 30 complete Sympathetic 0.25% 20 to 50 50 to 125 — Epidural 3 Test Dose 0.5%w/epi 2 to 3 10 to 15 (10 to 15 micrograms epinephrine) ––
Everyday Clean

Everyday Clean

Ampicillin and sulbactam for injection may be administered by either the IV or the IM routes.For IV administration, the dose can be given by slow intravenous injection over at least 10 to 15 minutes or can also be delivered, in greater dilutions with 50 to 100 mL of a compatible diluent as an intravenous infusion over 15 to 30 minutes.Ampicillin and sulbactam for injection may be administered by deep intramuscular injection. (See Preparation for Intramuscular Injection.)The recommended adult dosage of ampicillin and sulbactam for injection is 1.5 g (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) to 3 g (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) every six hours. This 1.5 to 3 g range represents the total of ampicillin content plus the sulbactam content of ampicillin and sulbactam for injection, and corresponds to a range of 1 g ampicillin/0.5 g sulbactam to 2 g ampicillin/1 g sulbactam. The total dose of sulbactam should not exceed 4 grams per day. Pediatric Patients 1 Year of Age or Older The recommended daily dose of ampicillin and sulbactam for injection in pediatric patients is 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours. This 300 mg/kg/day dosage represents the total ampicillin content plus the sulbactam content of ampicillin and sulbactam for injection, and corresponds to 200 mg ampicillin/100 mg sulbactam per kg per day. The safety and efficacy of ampicillin and sulbactam for injection administered via intramuscular injection in pediatric patients have not been established. Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations, and the total dose of sulbactam should not exceed 4 grams per day. The course of intravenous therapy should not routinely exceed 14 days. In clinical trials, most children received a course of oral antimicrobials following initial treatment with intravenous ampicillin and sulbactam for injection. (See CLINICAL STUDIES section.) Impaired Renal Function In patients with impairment of renal function the elimination kinetics of ampicillin and sulbactam are similarly affected, hence the ratio of one to the other will remain constant whatever the renal function. The dose of ampicillin and sulbactam in such patients should be administered less frequently in accordance with the usual practice for ampicillin and according to the following recommendations:
TABLE 5 Ampicillin and Sulbactam for Injection Dosage Guide for Patients with Renal Impairment Creatinine Clearance (mL/min/1.73 m2) Ampicillin/Sulbactam Half-Life (Hours) Recommended Ampicillin and Sulbactam for Injection Dosage ≥30 1 1.5 to 3 g q 6 h to q 8 h 15 to 29 5 1.5 to 3 g q 12 h 5 to 14 9 1.5 to 3 g q 24 h
When only serum creatinine is available, the following formula (based on sex, weight, and age of the patient) may be used to convert this value into creatinine clearance. The serum creatinine should represent a steady state of renal function.Males weight (kg)×(140 – age) 72 × serum creatinineFemales 0.85 × above value

COMPATIBILITY, RECONSTITUTION AND STABILITY

Ampicillin and sulbactam for injection sterile powder is to be stored at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature] prior to reconstitution.When concomitant therapy with aminoglycosides is indicated, ampicillin and sulbactam and aminoglycosides should be reconstituted and administered separately, due to the in vitro inactivation of aminoglycosides by any of the aminopenicillins.

DIRECTIONS FOR USE

General Dissolution Procedures

Ampicillin and sulbactam for injection sterile powder for intravenous and intramuscular use may be reconstituted with any of the compatible diluents described in this insert. Solutions should be allowed to stand after dissolution to allow any foaming to dissipate in order to permit visual inspection for complete solubilization.

Preparation for Intravenous Use

Reconstitution of ampicillin and sulbactam for injection, at the specified concentrations, with these diluents provide stable solutions for the time periods indicated in the following table: (After the indicated time periods, any unused portions of solutions should be discarded.)
TABLE 6 Maximum Concentration (mg/mL) Diluent Ampicillin and Sulbactam for Injection Use Periods Sterile Water for Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 48 hrs at 4°C 30 (20/10) 72 hrs at 4°C 0.9% Sodium Chloride Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 48 hrs at 4°C 30 (20/10) 72 hrs at 4°C 5% Dextrose Injection 30 (20/10) 2 hrs at 25°C 30 (20/10) 4 hrs at 4°C 3 (2/1) 4 hrs at 25°C Lactated Ringer's Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 24 hrs at 4°C M/6 Sodium Lactate Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 8 hrs at 4°C 5% Dextrose in 0.45% Saline 3 (2/1) 4 hrs at 25°C 15 (10/5) 4 hrs at 4°C 10% Invert Sugar 3 (2/1) 4 hrs at 25°C 30 (20/10) 3 hrs at 4°C
Initially, the vials may be reconstituted with Sterile Water for Injection to yield solutions containing 375 mg ampicillin and sulbactam per mL (250 mg ampicillin/125 mg sulbactam per mL). An appropriate volume should then be immediately diluted with a suitable parenteral diluent to yield solutions containing 3 to 45 mg ampicillin and sulbactam per mL (2 to 30 mg ampicillin/1 to 15 mg sulbactam/per mL).

Preparation for Intramuscular Injection

1.5 g and 3 g Standard Vials: Vials for intramuscular use may be reconstituted with Sterile Water for Injection USP, 0.5% Lidocaine Hydrochloride Injection USP or 2% Lidocaine Hydrochloride Injection USP. Consult the following table for recommended volumes to be added to obtain solutions containing 375 mg ampicillin and sulbactam per mL (250 mg ampicillin/125 mg sulbactam per mL). Note: Use only freshly prepared solutions and administer within one hour after preparation.
Table 8 Ampicillin and Sulbactam for Injection Vial Size Volume of Diluent to be Added Withdrawal Volume* * There is sufficient excess present to allow withdrawal and administration of the stated volumes. 1.5 g 3.2 mL 4 mL 3 g 6.4 mL 8 mL
Sumatriptan

Sumatriptan

2.1 Dosing Information

The maximum single recommended adult dose of sumatriptan injection for the acute treatment of migraine or cluster headache is 6 mg injected subcutaneously. For the treatment of migraine, if side effects are dose limiting, lower doses (1 mg to 5 mg) may be used [see Clinical Studies (14.1)]. For the treatment of cluster headache, the efficacy of lower doses has not been established.The maximum cumulative dose that may be given in 24 hours is 12 mg, two 6 mg injections separated by at least 1 hour. A second 6 mg dose should only be considered if some response to a first injection was observed.

2.3 Administration of Doses of Sumatriptan Injection other than 4 or 6 mg

In patients receiving doses other than 4 mg or 6 mg, use the 6 mg single-dose vial. Visually inspect the vial for particulate matter and discoloration before administration. Do not use if particulates and discolorations are noted.
Oxacillin

Oxacillin

The intent of the pharmacy bulk package for this product is for preparation of solutions for IV infusion only.

The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use.Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. Duration of therapy varies with the type of severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. Treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of oxacillin and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Penicillin-probenecid therapy is generally limited to those infections where very high serum levels of penicillin are necessary.Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious, life-threatening infections (see PRECAUTIONS-General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
RECOMMENDED DOSAGES FOR OXACILLIN FOR INJECTION Drug Adults Infants and Children<40 kg (88 lbs) OtherRecommendations Oxacillin 250 to 500 mg IV every 4 to 6 hours (mild to moderate infections) 50 mg/kg/day IV in equally divided doses every 6 hours (mild to moderate infections) 1 gram IV every 4 to 6 hours (severe infections) 100 mg/kg/day IV in equally divided doses every 4 to 6 hours (severe infections) Premature and Neonates 25 mg/kg/day IV
Directions for Use

For Administration by Intravenous DripReconstitute as directed below (Pharmacy Bulk Package) prior to further dilution.
STABILITY PERIODS FOR OXACILLIN FOR INJECTION, USP* Concentrationmg/mL SterileWater forInjection USP 0.9% SodiumChloride Injection USP (Isotonic) SodiumLactate Solution USP (M/6 Molar) DextroseInjection USP (5%) Dextroseand Sodium Chloride Injection USP(5% Dextrose and0.45% NaCl) InvertSugar Injection USP (10%) LactatedRinger’sInjection USP *IMPORTANT:This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that a product should be used as soon after preparation as feasible. ROOM TEMPERATURE (25°C) 10-100 4 Days 4 Days 10-30 24 Hrs 24 Hrs 0.5-2 6 Hrs 6 Hrs 6 Hrs REFRIGERATION (4°C) 10-100 7 Days 7 Days 10-30 4 Days 4 Days 4 Days 4 Days 4 Days FROZEN (-15°C) 50-100 30 Days 250/1.5 mL 30 Days 100 30 Days 10-100 30 Days 30 Days 30 Days 30 Days 30 Days
Stability

Studies on oxacillin sodium at concentrations of 0.5 mg/mL and 2 mg/mL in various intravenous solutions listed below indicate the drug will lose less than 10% activity at room temperature (70°F) during a 6-hour period. IV Solution 5% Dextrose in Normal Saline10% D-Fructose in Water10% D-Fructose in Normal SalineLactated Potassic Saline Injection10% Invert Sugar in Normal Saline10% Invert Sugar Plus 0.3% Potassium Chloride in Water Travert 10% Electrolyte #1 Travert 10% Electrolyte #2 Travert 10% Electrolyte #3 Only those solutions listed above should be used for the intravenous infusion of oxacillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of oxacillin is administered before the drug loses its stability in the solution in use. If another agent is used in conjunction with oxacillin therapy, it should not be physically mixed with oxacillin but should be administered separately.

Pharmacy Bulk Package

This Pharmacy Bulk Package glass bottle contains 10 grams oxacillin sodium and is designed for use in the pharmacy in preparing IV admixtures. Add 93 mL Sterile Water for Injection, USP or Sodium Chloride Injection, USP 0.9%. The resulting solution will contain 100 mg oxacillin per mL and will require further dilution. CAUTION: NOT TO BE DISPENSED AS A UNIT.

Directions for Proper Use of Pharmacy Bulk Package
The container closure may be penetrated only one time after reconstitution, utilizing a suitable sterile dispensing set which allows measured distribution of the contents. Use of this product is restricted to a suitable work area, such as a laminar flow hood. Once a sterile transfer device has been inserted into the container closure withdrawal of the contents should be completed without delay. The container closure may be penetrated only one time after reconstitution if prompt fluid transfer cannot be accomplished, discard the contents no later than 4 hours after initial closure puncture. This time limit should begin with the introduction of solvent or diluent into the Pharmacy Bulk Package bottle. A plastic bail attached to the Pharmacy Bulk Package provides a suitable hanging device while dispensing contents.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.Do not add supplementary medication to Oxacillin for Injection, USP.
Oxacillin

Oxacillin

The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use.Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. Duration of therapy varies with the type of severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. Treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of oxacillin and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Penicillin-probenecid therapy is generally limited to those infections where very high serum levels of penicillin are necessary.Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious, life-threatening infections (see PRECAUTIONS-General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
RECOMMENDED DOSAGES FOR OXACILLIN FOR INJECTION Drug Adults Infants and Children<40 kg (88 lbs) Other Recommendations Oxacillin 250 to 500 mg IM or IV every 4 to 6 hours (mild to moderate infections) 50 mg/kg/day IM or IV in equally divided doses every 6 hours (mild to moderate infections) 1 gram IM or IV every 4 to 6 hours (severe infections) 100 mg/kg/day IM or IV in equally divided doses every 4 to 6 hours (severe infections) Premature and Neonates 25 mg/kg/day IM or IV
Directions for Use

For Intramuscular Use

Use Sterile Water for Injection, USP. Add 5.7 mL to the 1 gram vial and 11.5 mL to the 2 gram vial. Shake well until a clear solution is obtained. After reconstitution, vials will contain 250 mg of active drug per 1.5 mL of solution. The reconstituted solution is stable for 3 days at 70°F or for one week under refrigeration (40°F).

For Direct Intravenous Use

Use Sterile Water for Injection, USP or Sodium Chloride Injection, USP. Add 10 mL to the 1 gram vial and 20 mL to the 2 gram vial. Withdraw the entire contents and administer slowly over a period of approximately 10 minutes.

For Administration by Intravenous Drip

Reconstitute as directed above (For Direct Intravenous Use) prior to diluting with Intravenous Solution.
STABILITY PERIODS FOR OXACILLIN FOR INJECTION, USP Concentrationmg/mL SterileWater forInjection USP 0.9% SodiumChloride Injection USP (Isotonic) SodiumLactate Solution USP (M/6 Molar) DextroseInjection USP (5%) Dextroseand Sodium Chloride Injection USP(5% Dextrose and0.45% NaCl) InvertSugar Injection USP (10%) LactatedRinger’sInjection USP ROOM TEMPERATURE (25°C) 10-100 4 Days 4 Days 10-30 24 Hrs 24 Hrs 0.5-2 6 Hrs 6 Hrs 6 Hrs REFRIGERATION (4°C) 10-100 7 Days 7 Days 10-30 4 Days 4 Days 4 Days 4 Days 4 Days FROZEN (-15°C) 50-100 30 Days 250/1.5 mL 30 Days 100 30 Days 10-100 30 Days 30 Days 30 Days 30 Days 30 Days
Stability studies on oxacillin sodium at concentrations of 0.5 mg/mL and 2 mg/mL in various intravenous solutions listed below indicate the drug will lose less than 10% activity at room temperature (70°F) during a 6-hour period. IV Solution 5% Dextrose in Normal Saline10% D-Fructose in Water10% D-Fructose in Normal SalineLactated Potassic Saline Injection10% Invert Sugar in Normal Saline10% Invert Sugar Plus 0.3% Potassium Chloride in WaterTravert 10% Electrolyte #1 Travert 10% Electrolyte #2Travert 10% Electrolyte #3 Only those solutions listed above should be used for the intravenous infusion of oxacillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of oxacillin is administered before the drug loses its stability in the solution in use.If another agent is used in conjunction with oxacillin therapy, it should not be physically mixed with oxacillin but should be administered separately.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.Do not add supplementary medication to Oxacillin for Injection, USP.
Ampicillin And Sulbacta...

Ampicillin And Sulbactam

Ampicillin and sulbactam for injection is administered by the IV route.For IV administration, the dose can be given by slow intravenous injection over at least 10 to 15 minutes or can also be delivered, in greater dilutions with 50 to 100 mL of a compatible diluent as an intravenous infusion over 15 to 30 minutes.The recommended adult dosage of ampicillin and sulbactam for injection is 1.5 g (1 g ampicillin as the sodium salt plus 0.5 g sulbactam as the sodium salt) to 3 g (2 g ampicillin as the sodium salt plus 1 g sulbactam as the sodium salt) every six hours. This 1.5 to 3 g range represents the total of ampicillin content plus the sulbactam content of ampicillin and sulbactam for injection, and corresponds to a range of 1 g ampicillin/0.5 g sulbactam to 2 g ampicillin/1 g sulbactam. The total dose of sulbactam should not exceed 4 grams per day. Pediatric Patients 1 Year of Age or Older The recommended daily dose of ampicillin and sulbactam for injection in pediatric patients is 300 mg per kg of body weight administered via intravenous infusion in equally divided doses every 6 hours. This 300 mg/kg/day dosage represents the total ampicillin content plus the sulbactam content of ampicillin and sulbactam for injection, and corresponds to 200 mg ampicillin/100 mg sulbactam per kg per day. The safety and efficacy of ampicillin and sulbactam for injection administered via intramuscular injection in pediatric patients have not been established. Pediatric patients weighing 40 kg or more should be dosed according to adult recommendations, and the total dose of sulbactam should not exceed 4 grams per day. The course of intravenous therapy should not routinely exceed 14 days. In clinical trials, most children received a course of oral antimicrobials following initial treatment with intravenous ampicillin and sulbactam for injection. (See CLINICAL STUDIES section.) Impaired Renal Function In patients with impairment of renal function the elimination kinetics of ampicillin and sulbactam are similarly affected, hence the ratio of one to the other will remain constant whatever the renal function. The dose of ampicillin and sulbactam in such patients should be administered less frequently in accordance with the usual practice for ampicillin and according to the following recommendations:
TABLE 5 Ampicillin and Sulbactam Dosage Guide for Patients With Renal Impairment Creatinine Clearance(mL/min/1.73 m2) Ampicillin/SulbactamHalf-Life (Hours) RecommendedAmpicillin and Sulbactamfor Injection Dosage ≥30 1 1.5 to 3 g q 6 h to q 8 h 15 to 29 5 1.5 to 3 g q 12 h 5 to 14 9 1.5 to 3 g q 24 h
When only serum creatinine is available, the following formula (based on sex, weight, and age of the patient) may be used to convert this value into creatinine clearance. The serum creatinine should represent a steady state of renal function.Males weight (kg)×(140 – age) 72 × serum creatinineFemales 0.85 × above valueCOMPATIBILITY, RECONSTITUTION AND STABILITY Ampicillin and sulbactam for injection sterile powder is to be stored at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [see USP Controlled Room Temperature] prior to reconstitution.When concomitant therapy with aminoglycosides is indicated, ampicillin and sulbactam and aminoglycosides should be reconstituted and administered separately, due to the in vitro inactivation of aminoglycosides by any of the aminopenicillins.DIRECTIONS FOR USE General Dissolution Procedures Ampicillin and sulbactam for injection sterile powder for intravenous use may be reconstituted with any of the compatible diluents described in this insert. Solutions should be allowed to stand after dissolution to allow any foaming to dissipate in order to permit visual inspection for complete solubilization.Preparation for Intravenous Use 1.5 g and 3 g infusion bottles: Ampicillin and sulbactam for injection sterile powder in infusion bottles may be reconstituted directly to the desired concentrations using any of the following parenteral diluents. Reconstitution of ampicillin and sulbactam for injection, at the specified concentrations, with these diluents provide stable solutions for the time periods indicated in the following table: (After the indicated time periods, any unused portions of solutions should be discarded.)
TABLE 6 Maximum Concentration(mg/mL) Diluent Ampicillin and Sulbactam for Injection Use Periods Sterile Water for Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 48 hrs at 4°C 30 (20/10) 72 hrs at 4°C 0.9% Sodium Chloride Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 48 hrs at 4°C 30 (20/10) 72 hrs at 4°C 5% Dextrose Injection 30 (20/10) 2 hrs at 25°C 30 (20/10) 4 hrs at 4°C 3 (2/1) 4 hrs at 25°C Lactated Ringer's Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 24 hrs at 4°C M/6 Sodium Lactate Injection 45 (30/15) 8 hrs at 25°C 45 (30/15) 8 hrs at 4°C 5% Dextrose in 0.45% Saline 3 (2/1) 4 hrs at 25°C 15 (10/5) 4 hrs at 4°C 10% Invert Sugar 3 (2/1) 4 hrs at 25°C 30 (20/10) 3 hrs at 4°C
Animal Pharmacology While reversible glycogenosis was observed in laboratory animals, this phenomenon was dose- and time-dependent and is not expected to develop at the therapeutic doses and corresponding plasma levels attained during the relatively short periods of combined ampicillin/sulbactam therapy in man.
Acyclovir Sodium

Acyclovir Sodium

CAUTION - RAPID OR BOLUS INTRAVENOUS INJECTION MUST BE AVOIDED (see WARNINGS and PRECAUTIONS).INTRAMUSCULAR OR SUBCUTANEOUS INJECTION MUST BE AVOIDED (see WARNINGS). Therapy should be initiated as early as possible following onset of signs and symptoms of herpes infections. A maximum dose equivalent to 20 mg/kg every 8 hours should not be exceeded for any patient.

Dosage

HERPES SIMPLEX INFECTIONS MUCOSAL AND CUTANEOUS HERPES SIMPLEX (HSV-1 AND HSV-2) INFECTIONS IN IMMUNOCOMPROMISED PATIENTS Adults and Adolescents (12 years of age and older) 5 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. Pediatrics (Under 12 years of age) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. SEVERE INITIAL CLINICAL EPISODES OF HERPES GENITALIS Adults and Adolescents (12 years of age and older) 5 mg/kg infused at a constant rate over 1 hour, every 8 hours for 5 days. HERPES SIMPLEX ENCEPHALITIS Adults and Adolescents (12 years of age and older) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 10 days. Pediatrics (3 months to 12 years of age) 20 mg/kg infused at a constant rate over 1 hour, every 8 hours for 10 days. Neonatal Herpes Simplex Virus Infections (Birth to 3 months) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 10 days. In neonatal herpes simplex infections, doses of 15 mg/kg or 20 mg/kg (infused at a constant rate over 1 hour every 8 hours) have been used; the safety and efficacy of these doses are not known. VARICELLA-ZOSTER INFECTIONS ZOSTER IN IMMUNOCOMPROMISED PATIENTS Adults and Adolescents (12 years of age and older) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. Pediatrics (Under 12 years of age) 20 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. Obese Patients Obese patients should be dosed at the recommended adult dose using Ideal Body Weight. PATIENTS WITH ACUTE OR CHRONIC RENAL IMPAIRMENT Refer to DOSAGE AND ADMINISTRATION section for recommended doses, and adjust the dosing interval as indicated in Table 5.
Table 5: Dosage Adjustments for Patients with Renal Impairment Creatinine Clearance(mL/min/1.73 m2) Percent of Recommended Dose Dosing Interval (hours) >50 100% 8 25 to 50 100% 12 10 to 25 100% 24 0 to 10 50% 24
Hemodialysis

For patients who require dialysis, the mean plasma half-life of acyclovir during hemodialysis is approximately 5 hours. This results in a 60% decrease in plasma concentrations following a six-hour dialysis period. Therefore, the patient’s dosing schedule should be adjusted so that an additional dose is administered after each dialysis.

Peritoneal Dialysis

No supplemental dose appears to be necessary after adjustment of the dosing interval.

Administration

The calculated dose should be further diluted in an appropriate intravenous solution at a volume selected for administration during each 1 hour infusion. Infusion concentrations of approximately 7 mg/mL or lower are recommended. In clinical studies, the average 70 kg adult received between 60 and 150 mL of fluid per dose. Higher concentrations (e.g., 10 mg/mL) may produce phlebitis or inflammation at the injection site upon inadvertent extravasation. Standard, commercially available electrolyte and glucose solutions are suitable for intravenous administration; biologic or colloidal fluids (e.g., blood products, protein solutions, etc.) are not recommended.Once diluted for administration, each dose should be used within 24 hours.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Nafcillin

Nafcillin

Nafcillin for injection is available for intramuscular and intravenous use. The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use. The usual I.V. dosage for adults is 500 mg every 4 hours. For severe infections, 1 gram every 4 hours is recommended. Administer slowly over at least 30 to 60 minutes to minimize the risk of vein irritation and extravasation.
RECOMMENDED DOSAGE FOR NAFCILLIN FOR INJECTION, USP Drug Adults Infants andChildren <40 kg (88 lbs) OtherRecommendations Nafcillin 500 mg IM every 4 to 6 hours. IV every 4 hours 25 mg/kg IM twice daily Neonates 10 mg/kg IM twice daily Nafcillin 1 gram IM or IV every 4 hours (severe infections)
Bacteriologic studies to determine the causative organisms and their susceptibility to nafcillin should always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with nafcillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. The treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of the penicillinase-resistant penicillins and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Nafcillin-probenecid therapy is generally limited to those infections where very high serum levels of nafcillin are necessary.No dosage alterations are necessary for patients with renal dysfunction, including those on hemodialysis. Hemodialysis does not accelerate nafcillin clearance from the blood.For patients with hepatic insufficiency and renal failure, measurement of nafcillin serum levels should be performed and dosage adjusted accordingly.With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.Do not add supplementary medication to nafcillin.Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious life-threatening infections (see PRECAUTIONS, General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis. Directions for Use For Intramuscular UseReconstitute with Sterile Water for Injection, USP, 0.9% Sodium Chloride Injection, USP or Bacteriostatic Water for Injection, USP (with benzyl alcohol or parabens); add 3.4 mL to the 1 g vial for 4 mL resulting solution; 6.6 mL to the 2 g vial for 8 mL resulting solution. All reconstituted vials have a concentration of 250 mg per mL.The clear solution should be administered by deep intragluteal injection immediately after reconstitution.Reconstituted StabilityReconstitute with the required amount of Sterile Water for Injection, USP, 0.9% Sodium Chloride Injection, USP or Bacteriostatic Water for Injection, USP (with benzyl alcohol or parabens). The resulting solutions are stable for 3 days at room temperature or 7 days under refrigeration and 90 days frozen.For Direct Intravenous UseThe required amount of drug should be diluted in 15 to 30 mL of Sterile Water for Injection, USP or Sodium Chloride Injection, USP and injected over a 5- to 10-minute period. This may be accomplished through the tubing of an intravenous infusion if desirable.For Administration by Intravenous Drip Reconstitute as directed above (For Intravenous Use) prior to diluting with Intravenous Solution.
STABILITY PERIODS FOR NAFCILLIN FOR INJECTION, USP* Concentrationmg/mL Sterile Water forInjection USP Sodium ChlorideInjection USP (0.9%) Sodium LactateSolution USP (M/6 Molar) Dextrose InjectionUSP (5%) Dextrose and SodiumChloride Injection USP(5% Dextrose and0.45% Sodium Chloride) Invert SugarInjection USP(10%) Lactated Ringer’sInjection USP * IMPORTANT: This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that a product should be used as soon after preparation as feasible. ROOM TEMPERATURE (25ºC) 10-200 24 Hrs 24 Hrs 30 24 Hrs 2-30 24 Hrs 24 Hrs 10-30 24 Hrs 24 Hrs REFRIGERATION (4ºC) 10-200 7 Days 7 Days 10-30 7 Days 7 Days 7 Days 7 Days 7 Days FROZEN (-15ºC) 250 90 Days 90 Days 10-250 90 Days 90 Days 90 Days 90 Days 90 Days
Only those solutions listed above should be used for the intravenous infusion of nafcillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of nafcillin is administered before the drug loses its stability in the solution in use.There is no clinical experience available on the use of this agent in neonates or infants for this route of administration.This route of administration should be used for relatively short-term therapy (24 to 48 hours) because of the occasional occurrence of thrombophlebitis particularly in elderly patients.If another agent is used in conjunction with nafcillin therapy, it should not be physically mixed with nafcillin but should be administered separately.
Nafcillin

Nafcillin

Nafcillin for injection Pharmacy Bulk Package is available for intravenous use only. The usual I.V. dosage for adults is 500 mg every 4 hours. For severe infections, 1 gram every 4 hours is recommended. Administer slowly over at least 30 to 60 minutes to minimize the risk of vein irritation and extravasation.Bacteriologic studies to determine the causative organisms and their susceptibility to nafcillin should always be performed. Duration of therapy varies with the type and severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with nafcillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. The treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of the penicillinase-resistant penicillins and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Nafcillin-probenecid therapy is generally limited to those infections where very high serum levels of nafcillin are necessary.No dosage alterations are necessary of patients with renal dysfunction, including those on hemodialysis. Hemodialysis does not accelerate nafcillin clearance from the blood.For patients with hepatic insufficiency and renal failure, measurement of nafcillin serum levels should be performed and dosage adjusted accordingly.With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.Do not add supplementary medication to nafcillin.Oral preparation of the penicillinase-resistant penicillins should not be used as initial therapy in serious life-threatening infections (see PRECAUTIONS, General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.

DIRECTIONS FOR PROPER USE OF A PHARMACY BULK PACKAGE

The container closure may be penetrated only one time after reconstitution using a suitable sterile transfer device or dispensing set which allows measured dispensing of the contents. Use of a syringe and needle is not recommended as it may cause leakage. Use of this product is restricted to a suitable work area, such as a laminar flow hood. The withdrawal of container contents should be accomplished without delay. However, should this not be possible, a maximum of 4 HOURS from initial closure entry is permitted to complete fluid transfer operations. This time limit should begin with the introduction of solvent or diluent into the Pharmacy Bulk Package bottle. Pharmacy Bulk Package Each nafcillin for injection, USP Pharmacy Bulk Package bottle contains nafcillin sodium as the monohydrate equivalent to 10 g nafcillin. The Pharmacy Bulk Package bottle is intended for use in a pharmacy admixture program and is restricted to the preparation of admixtures for intravenous infusion. Add 93 mL Sterile Water for Injection, USP or 0.9% Sodium Chloride Injection, USP. The resulting solution will contain 100 mg nafcillin activity per mL and will require further dilution. CAUTION: NOT TO BE DISPENSED AS A UNIT. Do not add supplementary medication to nafcillin. DIRECTIONS FOR USE For Administration by Intravenous Drip: Reconstitute as directed above (For Intravenous Use) prior to diluting with intravenous solution.
STABILITY PERIODS FOR NAFCILLIN FOR INJECTION, USP* Concentrationmg/mL SterileWater forInjection USP SodiumChloride Injection USP (0.9%) SodiumLactate Solution USP (M/6 Molar) DextroseInjection USP (5%) Dextroseand Sodium Chloride Injection USP(5% Dextrose and0.45% Sodium Chloride) InvertSugar Injection USP (10%) LactatedRinger’sInjection USP * IMPORTANT: This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that a product should be used as soon after preparation as feasible. ROOM TEMPERATURE (25ºC) 10-200 24 Hrs 24 Hrs 30 24 Hrs 2-30 24 Hrs 24 Hrs 10-30 24 Hrs 24 Hrs REFRIGERATION (4ºC) 10-200 7 Days 7 Days 10-30 7 Days 7 Days 7 Days 7 Days 7 Days FROZEN (-15ºC) 250 90 Days 90 Days 10-250 90 Days 90 Days 90 Days 90 Days 90 Days
Only those solutions listed above should be used for the intravenous infusion of nafcillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of nafcillin is administered before the drug loses its stability in the solution in use.There is no clinical experience available on the use of this agent in neonates or infants for this route of administration.This route of administration should be used for relatively short-term therapy (24 to 48 hours) because of the occasional occurrence of thrombophlebitis particularly in elderly patients.If another agent is used in conjunction with nafcillin therapy, it should not be physically mixed with nafcillin but should be administered separately.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
Piperacillin And Tazoba...

Piperacillin And Tazobactam

Piperacillin and tazobactam for injection should be administered by intravenous infusion over 30 minutes.

2.1 Adult Patients

The usual total daily dose of piperacillin and tazobactam for injection for adults is 3.375 g every six hours totaling 13.5 g (12 g piperacillin/1.5 g tazobactam). The usual duration of piperacillin and tazobactam for injection treatment is from 7 to 10 days.Piperacillin and tazobactam for injection should be administered by intravenous infusion over 30 minutes.

2.2 Nosocomial Pneumonia

Initial presumptive treatment of patients with nosocomial pneumonia should start with piperacillin and tazobactam for injection at a dosage of 4.5 g every six hours plus an aminoglycoside, totaling 18 g (16 g piperacillin/2 g tazobactam). The recommended duration of piperacillin and tazobactam for injection treatment for nosocomial pneumonia is 7 to 14 days. Treatment with the aminoglycoside should be continued in patients from whom P. aeruginosa is isolated.

2.3 Renal Impairment

In patients with renal impairment (creatinine clearance ≤ 40 mL/min) and dialysis patients (hemodialysis and CAPD), the intravenous dose of piperacillin and tazobactam for injection should be reduced to the degree of actual renal function impairment. The recommended daily doses of piperacillin and tazobactam for injection for patients with renal impairment are as follows:
Table 1: Recommended Dosing of Piperacillin and Tazobactam for Injection in Patients with Normal Renal Function and Renal Impairment (As total grams piperacillin/tazobactam) Renal Function (Creatinine Clearance, mL/min) All Indications (except nosocomial pneumonia) Nosocomial Pneumonia * Creatinine clearance for patients not receiving hemodialysis ** 0.75 g (0.67 g piperacillin/0.08 g tazobactam) should be administered following each hemodialysis session on hemodialysis days >40 mL/min 3.375 q 6 h 4.5 q 6 h 20 to 40 mL/min* 2.25 q 6 h 3.375 q 6 h <20 mL/min* 2.25 q 8 h 2.25 q 6 h Hemodialysis** 2.25 q 12 h 2.25 q 8 h CAPD 2.25 q 12 h 2.25 q 8 h
For patients on hemodialysis, the maximum dose is 2.25 g every twelve hours for all indications other than nosocomial pneumonia and 2.25 g every eight hours for nosocomial pneumonia. Since hemodialysis removes 30% to 40% of the administered dose, an additional dose of 0.75 g piperacillin and tazobactam for injection (0.67 g piperacillin/0.08 g tazobactam) should be administered following each dialysis period on hemodialysis days. No additional dosage of piperacillin and tazobactam for injection is necessary for CAPD patients.

2.4 Pediatric Patients

For children with appendicitis and/or peritonitis 9 months of age or older, weighing up to 40 kg, and with normal renal function, the recommended piperacillin and tazobactam for injection dosage is 100 mg piperacillin/12.5 mg tazobactam per kilogram of body weight, every 8 hours. For pediatric patients between 2 months and 9 months of age, the recommended piperacillin and tazobactam for injection dosage based on pharmacokinetic modeling, is 80 mg piperacillin/10 mg tazobactam per kilogram of body weight, every 8 hours [see Use in Specific Populations (8.4) and Clinical Pharmacology (12.3)]. Pediatric patients weighing over 40 kg and with normal renal function should receive the adult dose. It has not been determined how to adjust piperacillin and tazobactam for injection dosage in pediatric patients with renal impairment.

2.5 Reconstitution and Dilution of Powder Formulation

Single dose vials Reconstitute piperacillin and tazobactam for injection vials with a compatible reconstitution diluent from the list provided below.2.25 g, 3.375 g, and 4.5 g piperacillin and tazobactam for injection should be reconstituted with 10 mL, 15 mL, and 20 mL, respectively. Swirl until dissolved.Compatible Reconstitution Diluents for Single Dose Vials 0.9% sodium chloride for injectionSterile water for injectionDextrose 5%Bacteriostatic saline/parabensBacteriostatic water/parabensBacteriostatic saline/benzyl alcoholBacteriostatic water/benzyl alcoholReconstituted piperacillin and tazobactam for injection solutions for single dose vials should be further diluted (recommended volume per dose of 50 mL to 150 mL) in a compatible intravenous solution listed below. Administer by infusion over a period of at least 30 minutes. During the infusion it is desirable to discontinue the primary infusion solution.Compatible Intravenous Solutions for Single Dose Vials 0.9% sodium chloride for injectionsterile water for injection‡ Dextran 6% in salineDextrose 5% LACTATED RINGER'S SOLUTION IS NOT COMPATIBLE WITH PIPERACILLIN AND TAZOBACTAM FOR INJECTION.‡Maximum recommended volume per dose of sterile water for injection is 50 mL.Piperacillin and tazobactam should not be mixed with other drugs in a syringe or infusion bottle since compatibility has not been established.Piperacillin and tazobactam is not chemically stable in solutions that contain only sodium bicarbonate and solutions that significantly alter the pH.Piperacillin and tazobactam should not be added to blood products or albumin hydrolysates. Parenteral drug products should be inspected visually for particulate matter or discoloration prior to administration, whenever solution and container permit.Stability of Piperacillin and Tazobactam Powder Formulation Following ReconstitutionPiperacillin and tazobactam for injection reconstituted from single vials is stable in glass and plastic containers (plastic syringes, I.V. bags and tubing) when used with compatible diluents.Single dose vials should be used immediately after reconstitution. Discard any unused portion after 24 hours if stored at room temperature (20°C to 25°C [68°F to 77°F]), or after 48 hours if stored at refrigerated temperature (2°C to 8°C [36°F to 46°F]). Vials should not be frozen after reconstitution.Stability studies in the I.V. bags have demonstrated chemical stability (potency, pH of reconstituted solution and clarity of solution) for up to 24 hours at room temperature and up to one week at refrigerated temperature. Piperacillin and tazobactam for injection contains no preservatives. Appropriate consideration of aseptic technique should be used.Piperacillin and tazobactam for injection reconstituted from single vials can be used in ambulatory intravenous infusion pumps. Stability of piperacillin and tazobactam for injection in an ambulatory intravenous infusion pump has been demonstrated for a period of 12 hours at room temperature. Each dose was reconstituted and diluted to a volume of 37.5 mL or 25 mL. One-day supplies of dosing solution were aseptically transferred into the medication reservoir (I.V. bags or cartridge). The reservoir was fitted to a preprogrammed ambulatory intravenous infusion pump per the manufacturer's instructions. Stability of piperacillin and tazobactam for injection is not affected when administered using an ambulatory intravenous infusion pump.

2.7 Compatibility with Aminoglycosides

Due to the in vitro inactivation of aminoglycosides by piperacillin, piperacillin and tazobactam and aminoglycosides are recommended for separate administration. Piperacillin and tazobactam and aminoglycosides should be reconstituted, diluted, and administered separately when concomitant therapy with aminoglycosides is indicated [see Drug Interactions (7.1)].In circumstances where co-administration via Y-site is necessary, piperacillin and tazobactam is compatible for simultaneous coadministration via Y-site infusion only with the following aminoglycosides under the following conditions:
Table 2: Compatibility with Aminoglycosides Aminoglycoside Piperacillin and Tazobactam Dose (grams) Piperacillin and Tazobactam Diluent Volumea (mL) Aminoglycoside ConcentrationRangeb (mg/mL) Acceptable Diluents a Diluent volumes apply only to single vialsb The concentration ranges in Table 2 are based on administration of the aminoglycoside in divided doses (10 to 15 mg/kg/day in two daily doses for amikacin and 3 to 5 mg/kg/day in three daily doses for gentamicin). Administration of amikacin or gentamicin in a single daily dose or in doses exceeding those stated above via Y-site with piperacillin and tazobactam has not been evaluated. See package insert for each aminoglycoside for complete Dosage and Administration instructions. Amikacin 2.25, 3.375, 4.5 50, 100, 150 1.75 to 7.5 0.9% sodium chloride or 5% dextrose Gentamicin 2.25 3.375 4.5 50, 100 150 0.7 to 3.32 0.9% sodium chloride or 5% dextrose
Only the concentration and diluents for amikacin or gentamicin with the dosages of piperacillin and tazobactam listed above have been established as compatible for coadministration via Y-site infusion. Simultaneous coadministration via Y-site infusion in any manner other than listed above may result in inactivation of the aminoglycoside by piperacillin and tazobactam.Piperacillin and tazobactam is not compatible with tobramycin for simultaneous coadministration via Y-site infusion. Compatibility of piperacillin and tazobactam for injection with other aminoglycosides has not been established.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Loratadine Antihistamin...

Loratadine Antihistamine

This insert is for a Pharmacy Bulk Package and is intended for preparing IV admixtures only. Dosage recommendations for intramuscular or direct intravenous injection are for informational purpose only. Infections of the respiratory tract and soft tissues.Patients weighing 40 kg (88 lbs) or more: 250 to 500 mg every 6 hours.Patients weighing less than 40 kg (88 lbs): 25 to 50 mg/kg/day in equally divided doses at 6- to 8- hour intervals.Infections of the gastrointestinal and genitourinary tracts (including those caused by Neisseria gonorrhoeae in females).Patients weighing 40 kg (88 lbs) or more: 500 mg every 6 hours.Patients weighing less than 40 kg (88 lbs): 50 mg/kg/day in equally divided doses at 6- to 8- hour intervals.In the treatment of chronic urinary tract and intestinal infections, frequent bacteriological and clinical appraisal is necessary. Smaller doses than those recommended above should not be used. Higher doses should be used for stubborn or severe infections. In stubborn infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy.Urethritis in males due to N. gonorrhoeae.Adults –Two doses of 500 mg each at an interval of 8 to 12 hours. Treatment may be repeated if necessary or extended if required.In the treatment of complications of gonorrheal urethritis, such as prostatitis and epididymitis, prolonged and intensive therapy is recommended. Cases of gonorrhea with a suspected primary lesion of syphilis should have darkfield examinations before receiving treatment. In all other cases where concomitant syphilis is suspected, monthly serological tests should be made for a minimum of four months. The doses for the preceding infections may be given by either the intramuscular or intravenous route. A change to oral ampicillin may be made when appropriate.Bacterial Meningitis Adults and children – 150 to 200 mg/kg/day in equally divided doses every 3 to 4 hours. (Treatment may be initiated with intravenous drip therapy and continued with intramuscular injections.) The doses for other infections may be given by either the intravenous or intramuscular route.Septicemia Adults and children – 150 to 200 mg/kg/day. Start with intravenous administration for at least three days and continue with the intramuscular route every 3 to 4 hours.Treatment of all infections should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. A minimum of 10-days treatment is recommended for any infection caused by Group A beta-hemolytic streptococci to help prevent the occurrence of acute rheumatic fever or acute glomerulonephritis.For Administration by Intravenous Infusion – Reconstitute as directed below (see Directions for Proper Use of Pharmacy Bulk Package) prior to diluting with an intravenous solution.IMPORTANT: This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that compounded admixtures should be administered as soon after preparation as is feasible.Stability studies on ampicillin sodium at several concentrations in various intravenous solutions indicate the drug will lose less than 10% activity at the temperatures noted for the time periods stated.
Room Temperature (25°C) Diluent Concentrations Stability Periods Sterile Water for Injection Sodium Chloride Injection USP, 0.9% 5% Dextrose in Water 5% Dextrose in Water 5% Dextrose in 0.45% NaCl Inj. Lactated Ringer’s Solution up to 30 mg/mLup to 30 mg/mL10 to 20 mg/mLup to 2 mg/mLup to 2 mg/mLup to 30 mg/mL 8 hours8 hours1 hour2 hours2 hours8 hours Refrigerated (4°C) Sterile Water for Injection Sterile Water for Injection Sodium Chloride Injection USP, 0.9% Sodium Chloride Injection USP, 0.9% Lactated Ringer’s Solution 5% Dextrose in Water 5% Dextrose and 0.45% NaCl Inj. 30 mg/mLup to 20 mg/mL30 mg/mLup to 20 mg/mLup to 30 mg/mLup to 20 mg/mLup to 10 mg/mL 48 hours72 hours24 hours48 hours24 hours1 hour1 hour
Only those solutions listed above should be used for the intravenous infusion of ampicillin for injection, USP. The concentrations should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of ampicillin is administered before the drug loses its stability in the solution in use.

Directions For Proper Use Of Pharmacy Bulk Package

This Pharmacy Bulk Package glass bottle contains ampicillin sodium equivalent 10 grams of ampicillin. It is designed for use in the pharmacy in preparing IV admixtures using aseptic technique.a) Add 94 mL Sterile Water for Injection USP. The resulting solution will contain 100 milligrams ampicillin activity per mL, and is stable up to ONE hour at room temperature.b) Dilute further within ONE hour to a concentration of 5 mg to 10 mg per mL. See Table for suitable fluid. Use promptly. This chemical stability information in no way indicates that it would be acceptable practice to use this product well after preparation time. Good professional practice suggests that compounded admixtures should be administered as soon after preparation as is feasible.c) Using aseptic technique, the closure should be penetrated only one time after reconstitution using a suitable sterile dispensing set; which allows measured dispensing of the contents. Use of a syringe and needle is not recommended as it may cause leakage.d) After entry, use entire contents of vial promptly. The entire contents of the Pharmacy Bulk Package must be dispensed within ONE hour of reconstitution. This time should begin with the introduction of solvent or diluent into the Pharmacy Bulk Package.e) A plastic ball attached to the pharmacy bulk package provides a suitable hanging device while dispensing contents.Use of this product is restricted to a suitable work area, such as a laminar flow hood. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.CAUTION: NOT TO BE DISPENSED AS A UNIT.
Oxacillin

Oxacillin

The intent of the pharmacy bulk package for this product is for preparation of solutions for IV infusion only.

The penicillinase-resistant penicillins are available for oral administration and for intramuscular and intravenous injection. The sodium salts of methicillin, oxacillin, and nafcillin may be administered parenterally and the sodium salts of cloxacillin, dicloxacillin, oxacillin, and nafcillin are available for oral use.Bacteriologic studies to determine the causative organisms and their susceptibility to oxacillin should always be performed. Duration of therapy varies with the type of severity of infection as well as the overall condition of the patient; therefore, it should be determined by the clinical and bacteriological response of the patient. In severe staphylococcal infections, therapy with oxacillin should be continued for at least 14 days. Therapy should be continued for at least 48 hours after the patient has become afebrile, asymptomatic, and cultures are negative. Treatment of endocarditis and osteomyelitis may require a longer duration of therapy.Concurrent administration of oxacillin and probenecid increases and prolongs serum penicillin levels. Probenecid decreases the apparent volume of distribution and slows the rate of excretion by competitively inhibiting renal tubular secretion of penicillin. Penicillin-probenecid therapy is generally limited to those infections where very high serum levels of penicillin are necessary.Oral preparations of the penicillinase-resistant penicillins should not be used as initial therapy in serious, life-threatening infections (see PRECAUTIONS-General). Oral therapy with the penicillinase-resistant penicillins may be used to follow-up the previous use of a parenteral agent as soon as the clinical condition warrants. For intramuscular gluteal injections, care should be taken to avoid sciatic nerve injury. With intravenous administration, particularly in elderly patients, care should be taken because of the possibility of thrombophlebitis.
RECOMMENDED DOSAGES FOR OXACILLIN FOR INJECTION Drug Adults Infants and Children<40 kg (88 lbs) OtherRecommendations Oxacillin 250 to 500 mg IV every 4 to 6 hours (mild to moderate infections) 50 mg/kg/day IV in equally divided doses every 6 hours (mild to moderate infections) 1 gram IV every 4 to 6 hours (severe infections) 100 mg/kg/day IV in equally divided doses every 4 to 6 hours (severe infections) Premature and Neonates 25 mg/kg/day IV
Directions for Use

For Administration by Intravenous DripReconstitute as directed below (Pharmacy Bulk Package) prior to further dilution.
STABILITY PERIODS FOR OXACILLIN FOR INJECTION, USP* Concentrationmg/mL SterileWater forInjection USP 0.9% SodiumChloride Injection USP (Isotonic) SodiumLactate Solution USP (M/6 Molar) DextroseInjection USP (5%) Dextroseand Sodium Chloride Injection USP(5% Dextrose and0.45% NaCl) InvertSugar Injection USP (10%) LactatedRinger’sInjection USP *IMPORTANT:This chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. Good professional practice suggests that a product should be used as soon after preparation as feasible. ROOM TEMPERATURE (25°C) 10-100 4 Days 4 Days 10-30 24 Hrs 24 Hrs 0.5-2 6 Hrs 6 Hrs 6 Hrs REFRIGERATION (4°C) 10-100 7 Days 7 Days 10-30 4 Days 4 Days 4 Days 4 Days 4 Days FROZEN (-15°C) 50-100 30 Days 250/1.5 mL 30 Days 100 30 Days 10-100 30 Days 30 Days 30 Days 30 Days 30 Days
Stability

Studies on oxacillin sodium at concentrations of 0.5 mg/mL and 2 mg/mL in various intravenous solutions listed below indicate the drug will lose less than 10% activity at room temperature (70°F) during a 6-hour period. IV Solution 5% Dextrose in Normal Saline10% D-Fructose in Water10% D-Fructose in Normal SalineLactated Potassic Saline Injection10% Invert Sugar in Normal Saline10% Invert Sugar Plus 0.3% Potassium Chloride in Water Travert 10% Electrolyte #1 Travert 10% Electrolyte #2 Travert 10% Electrolyte #3 Only those solutions listed above should be used for the intravenous infusion of oxacillin sodium. The concentration of the antibiotic should fall within the range specified. The drug concentration and the rate and volume of the infusion should be adjusted so that the total dose of oxacillin is administered before the drug loses its stability in the solution in use. If another agent is used in conjunction with oxacillin therapy, it should not be physically mixed with oxacillin but should be administered separately.

Pharmacy Bulk Package

This Pharmacy Bulk Package glass bottle contains 10 grams oxacillin sodium and is designed for use in the pharmacy in preparing IV admixtures. Add 93 mL Sterile Water for Injection, USP or Sodium Chloride Injection, USP 0.9%. The resulting solution will contain 100 mg oxacillin per mL and will require further dilution. CAUTION: NOT TO BE DISPENSED AS A UNIT.

Directions for Proper Use of Pharmacy Bulk Package
The container closure may be penetrated only one time after reconstitution, utilizing a suitable sterile dispensing set which allows measured distribution of the contents. Use of this product is restricted to a suitable work area, such as a laminar flow hood. Once a sterile transfer device has been inserted into the container closure withdrawal of the contents should be completed without delay. The container closure may be penetrated only one time after reconstitution if prompt fluid transfer cannot be accomplished, discard the contents no later than 4 hours after initial closure puncture. This time limit should begin with the introduction of solvent or diluent into the Pharmacy Bulk Package bottle. A plastic bail attached to the Pharmacy Bulk Package provides a suitable hanging device while dispensing contents.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.Do not add supplementary medication to Oxacillin for Injection, USP.
Acyclovir Sodium

Acyclovir Sodium

CAUTION - RAPID OR BOLUS INTRAVENOUS INJECTION MUST BE AVOIDED (see WARNINGS and PRECAUTIONS).INTRAMUSCULAR OR SUBCUTANEOUS INJECTION MUST BE AVOIDED (see WARNINGS). Therapy should be initiated as early as possible following onset of signs and symptoms of herpes infections. A maximum dose equivalent to 20 mg/kg every 8 hours should not be exceeded for any patient.

Dosage

HERPES SIMPLEX INFECTIONS MUCOSAL AND CUTANEOUS HERPES SIMPLEX (HSV-1 AND HSV-2) INFECTIONS IN IMMUNOCOMPROMISED PATIENTS Adults and Adolescents (12 years of age and older) 5 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. Pediatrics (Under 12 years of age) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. SEVERE INITIAL CLINICAL EPISODES OF HERPES GENITALIS Adults and Adolescents (12 years of age and older) 5 mg/kg infused at a constant rate over 1 hour, every 8 hours for 5 days. HERPES SIMPLEX ENCEPHALITIS Adults and Adolescents (12 years of age and older) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 10 days. Pediatrics (3 months to 12 years of age) 20 mg/kg infused at a constant rate over 1 hour, every 8 hours for 10 days. Neonatal Herpes Simplex Virus Infections (Birth to 3 months) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 10 days. In neonatal herpes simplex infections, doses of 15 mg/kg or 20 mg/kg (infused at a constant rate over 1 hour every 8 hours) have been used; the safety and efficacy of these doses are not known. VARICELLA-ZOSTER INFECTIONS ZOSTER IN IMMUNOCOMPROMISED PATIENTS Adults and Adolescents (12 years of age and older) 10 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. Pediatrics (Under 12 years of age) 20 mg/kg infused at a constant rate over 1 hour, every 8 hours for 7 days. Obese Patients Obese patients should be dosed at the recommended adult dose using Ideal Body Weight. PATIENTS WITH ACUTE OR CHRONIC RENAL IMPAIRMENT Refer to DOSAGE AND ADMINISTRATION section for recommended doses, and adjust the dosing interval as indicated in Table 5.
Table 5: Dosage Adjustments for Patients with Renal Impairment Creatinine Clearance(mL/min/1.73 m2) Percent of Recommended Dose Dosing Interval (hours) >50 100% 8 25 to 50 100% 12 10 to 25 100% 24 0 to 10 50% 24
Hemodialysis

For patients who require dialysis, the mean plasma half-life of acyclovir during hemodialysis is approximately 5 hours. This results in a 60% decrease in plasma concentrations following a six-hour dialysis period. Therefore, the patient’s dosing schedule should be adjusted so that an additional dose is administered after each dialysis.

Peritoneal Dialysis

No supplemental dose appears to be necessary after adjustment of the dosing interval.

Administration

The calculated dose should be further diluted in an appropriate intravenous solution at a volume selected for administration during each 1 hour infusion. Infusion concentrations of approximately 7 mg/mL or lower are recommended. In clinical studies, the average 70 kg adult received between 60 and 150 mL of fluid per dose. Higher concentrations (e.g., 10 mg/mL) may produce phlebitis or inflammation at the injection site upon inadvertent extravasation. Standard, commercially available electrolyte and glucose solutions are suitable for intravenous administration; biologic or colloidal fluids (e.g., blood products, protein solutions, etc.) are not recommended.Once diluted for administration, each dose should be used within 24 hours.Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Ondansetron

Ondansetron

2.1 Prevention of Nausea and Vomiting Associated with Initial and Repeat Courses of Emetogenic Chemotherapy

Ondansetron injection should be diluted in 50 mL of 5% Dextrose Injection or 0.9% Sodium Chloride Injection before administration.

Adults: The recommended adult intravenous dosage of ondansetron injection is three 0.15 mg/kg doses up to a maximum of 16 mg per dose [see Clinical Pharmacology (12.2)]. The first dose is infused over 15 minutes beginning 30 minutes before the start of emetogenic chemotherapy. Subsequent doses (0.15 mg/kg up to a maximum of 16 mg per dose) are administered 4 and 8 hours after the first dose of ondansetron injection. Pediatrics: For pediatric patients 6 months through 18 years of age, the intravenous dosage of ondansetron injection is three 0.15 mg/kg doses up to a maximum of 16 mg per dose [see Clinical Studies (14.1), Clinical Pharmacology (12.2, 12.3)]. The first dose is to be administered 30 minutes before the start of moderately to highly emetogenic chemotherapy. Subsequent doses (0.15 mg/kg up to a maximum of 16 mg per dose) are administered 4 and 8 hours after the first dose of ondansetron injection. The drug should be infused intravenously over 15 minutes.

2.2 Prevention of Postoperative Nausea and Vomiting

Ondansetron injection should not be mixed with solutions for which physical and chemical compatibility have not been established. In particular, this applies to alkaline solutions as a precipitate may form.Adults: The recommended adult intravenous dosage of ondansetron injection is 4 mg undiluted administered intravenously in not less than 30 seconds, preferably over 2 to 5 minutes, immediately before induction of anesthesia, or postoperatively if the patient did not receive prophylactic antiemetics and experiences nausea and/or vomiting occurring within 2 hours after surgery. Alternatively, 4 mg undiluted may be administered intramuscularly as a single injection for adults. While recommended as a fixed dose for patients weighing more than 40 kg, few patients above 80 kg have been studied. In patients who do not achieve adequate control of postoperative nausea and vomiting following a single, prophylactic, preinduction, intravenous dose of ondansetron 4 mg, administration of a second intravenous dose of 4 mg ondansetron postoperatively does not provide additional control of nausea and vomiting. Pediatrics: For pediatric patients 1 month through 12 years of age, the dosage is a single 0.1 mg/kg dose for patients weighing 40 kg or less, or a single 4 mg dose for patients weighing more than 40 kg. The rate of administration should not be less than 30 seconds, preferably over 2 to 5 minutes immediately prior to or following anesthesia induction, or postoperatively if the patient did not receive prophylactic antiemetics and experiences nausea and/or vomiting occurring shortly after surgery. Prevention of further nausea and vomiting was only studied in patients who had not received prophylactic ondansetron injection.

2.3 Stability and Handling

After dilution, do not use beyond 24 hours. Although ondansetron injection is chemically and physically stable when diluted as recommended, sterile precautions should be observed because diluents generally do not contain preservative.Ondansetron injection is stable at room temperature under normal lighting conditions for 48 hours after dilution with the following intravenous fluids: 0.9% Sodium Chloride Injection, 5% Dextrose Injection, 5% Dextrose and 0.9% Sodium Chloride Injection, 5% Dextrose and 0.45% Sodium Chloride Injection, and 3% Sodium Chloride Injection.Note: Parenteral drug products should be inspected visually for particulate matter and discoloration before administration whenever solution and container permit. Precaution: Occasionally, ondansetron precipitates at the stopper/vial interface in vials stored upright. Potency and safety are not affected. If a precipitate is observed, resolubilize by shaking the vial vigorously.

2.4 Dosage Adjustment for Patients with Impaired Hepatic Function

In patients with severe hepatic impairment (Child-Pugh score of 10 or greater), a single maximal daily dose of 8 mg infused over 15 minutes beginning 30 minutes before the start of the emetogenic chemotherapy is recommended. There is no experience beyond first-day administration of ondansetron in these patients [see Clinical Pharmacology (12.3)].
Levofloxacin

Levofloxacin

2.1 Dosage in Adult Patients with Normal Renal Function

The usual dose of levofloxacin injection is 250 mg or 500 mg administered by slow infusion over 60 minutes every 24 hours or 750 mg administered by slow infusion over 90 minutes every 24 hours, as indicated by infection and described in Table 1.

These recommendations apply to patients with creatinine clearance ≥ 50 mL/min. For patients with creatinine clearance <50 mL/min, adjustments to the dosing regimen are required [see Dosage and Administration (2.3)].

Table 1: Dosage in Adult Patients with Normal Renal Function (creatinine clearance ≥ 50 mL/min)
* Due to the designated pathogens [see Indications and Usage (1)].† Sequential therapy (intravenous to oral) may be instituted at the discretion of the physician.‡ Due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae [see Indications and Usage (1.2)]. § Due to Streptococcus pneumoniae (excluding multi-drug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae [see Indications and Usage (1.3)]. ¶ This regimen is indicated for cUTI due to Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and AP due to E. coli, including cases with concurrent bacteremia.# This regimen is indicated for cUTI due to Enterococcus faecalis, Enterococcus cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa; and for AP due to E. coli. Þ Drug administration should begin as soon as possible after suspected or confirmed exposure to aerosolized B. anthracis. This indication is based on a surrogate endpoint. Levofloxacin plasma concentrations achieved in humans are reasonably likely to predict clinical benefit [see Clinical Studies (14.9)].ß The safety of levofloxacin in adults for durations of therapy beyond 28 days or in pediatric patients for durations beyond 14 days has not been studied. An increased incidence of musculoskeletal adverse events compared to controls has been observed in pediatric patients [see Warnings and Precautions (5.10), Use in Specific Populations (8.4), and Clinical Studies (14.9)]. Prolonged levofloxacin therapy should only be used when the benefit outweighs the risk. à Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis. Higher doses of levofloxacin typically used for treatment of pneumonia can be used for treatment of plague, if clinically indicated. Type of Infection* Dosed Every 24 hours Duration (days)† Nosocomial Pneumonia 750 mg 7 to 14 Community Acquired Pneumonia‡ 500 mg 7 to 14 Community Acquired Pneumonia§ 750 mg 5   Acute Bacterial Sinusitis 750 mg 5 500 mg 10 to 14 Acute Bacterial Exacerbation of Chronic Bronchitis 500 mg 7 Complicated Skin and Skin Structure Infections (SSSI) 750 mg 7 to 14 Uncomplicated SSSI 500 mg 7 to 10 Chronic Bacterial Prostatitis 500 mg 28 Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP)¶ 750 mg 5 Complicated Urinary Tract Infection (cUTI) or Acute Pyelonephritis (AP)# 250 mg 10 Uncomplicated Urinary Tract Infection 250 mg 3 Inhalational Anthrax (Post-Exposure), adult and pediatric patients > 50 kgÞ,ß Pediatric patients < 50 kg and ≥ 6 months of ageÞ,ß 500 mg see Table 2 below (2.2) 60ß 60ß Plague, adult and pediatric patients > 50 kg à Pediatric patients < 50 kg and ≥ 6 months of age 500 mgsee Table 2 below (2.2) 10 to 1410 to 14
2.2 Dosage in Pediatric Patients

The dosage in pediatric patients ≥ 6 months of age is described below in Table 2.

                                                                Table 2:     Dosage in Pediatric Patients ≥ 6 months of age
Type of Infection* Dose Freq. Once every Duration† Inhalational Anthrax (post-exposure) ‡,§ Pediatric patients > 50 kg 500 mg 24 hr 60 days§ Pediatric patients < 50 kg and ≥ 6 months of age 8 mg/kg (not to exceed 250 mg per dose) 12 hr 60 days§    Plague¶ Pediatric patients > 50 kg 500 mg 24 hr 10 to 14 days Pediatric patients < 50 kg and ≥ 6 months of age 8 mg/kg (not to exceed 250 mg per dose) 12 hr 10 to 14 days
* Due to Bacillus anthracis [see Indications and Usage (1.13)] and Yersinia pestis [see Indications and Usage (1.14)].

† Sequential therapy (intravenous to oral) may be instituted at the discretion of the physician.

‡ Drug administration should begin as soon as possible after suspected or confirmed exposure to aerosolized B. anthracis. This indication is based on a surrogate endpoint. Levofloxacin plasma concentrations achieved in humans are reasonably likely to predict clinical benefit [see Clinical Studies (14.9)]

§ The safety of levofloxacin in pediatric patients for durations of therapy beyond 14 days has not been studied. An increased incidence of musculoskeletal adverse events compared to controls has been observed in pediatric patients [see Warnings and Precautions (5.10), Use in Specific Populations (8.4), and Clinical Studies (14.9)]. Prolonged levofloxacin therapy should only be used when the benefit outweighs the risk.

¶ Drug administration should begin as soon as possible after suspected or confirmed exposure to Yersinia pestis.

2.3 Dosage Adjustment in Adults with Renal Impairment

Administer levofloxacin injection with caution in the presence of renal insufficiency. Careful clinical observation and appropriate laboratory studies should be performed prior to and during therapy since elimination of levofloxacin may be reduced.No adjustment is necessary for patients with a creatinine clearance ≥ 50 mL/min.In patients with impaired renal function (creatinine clearance <50 mL/min), adjustment of the dosage regimen is necessary to avoid the accumulation of levofloxacin due to decreased clearance [see Use in Specific Populations (8.6)].Table 3 shows how to adjust dose based on creatinine clearance.
Table 3: Dosage Adjustment in Adult Patients with Renal Impairment (creatinine clearance <50 mL/min) Dosage inNormal RenalFunction Every24 hours CreatinineClearance20 to 49 mL/min CreatinineClearance10 to 19 mL/min Hemodialysis orChronic AmbulatoryPeritoneal Dialysis(CAPD)    750 mg       750 mg every 48 hours       750 mg initial dose, then    500 mg every 48 hours       750 mg initial dose, then      500 mg every 48 hours    500 mg       500 mg initial dose, then     250 mg every 24 hours       500 mg initial dose, then    250 mg every 48 hours       500 mg initial dose, then      250 mg every 48 hours    250 mg       No dosage adjustment required       250 mg every 48 hours.       If treating uncomplicated     UTI, then no dosage     adjustment is required      No information on       dosing adjustment is available
2.4 Drug Interaction With Chelation Agents: Antacids, Sucralfate, Metal Cations, Multivitamins

Levofloxacin injection should not be coadministered with any solution containing multivalent cations, e.g., magnesium, through the same intravenous line [see Dosage and Administration (2.6)].

2.5 Administration Instructions

Caution: Rapid or bolus intravenous infusion of levofloxacin injection has been associated with hypotension and must be avoided. Levofloxacin injection should be infused intravenously slowly over a period of not less than 60 or 90 minutes, depending on the dosage. Levofloxacin injection should be administered only by intravenous infusion. It is not for intramuscular, intrathecal, intraperitoneal, or subcutaneous administration. Hydration for Patients Receiving Levofloxacin Injection Adequate hydration of patients receiving intravenous levofloxacin injection should be maintained to prevent the formation of highly concentrated urine. Crystalluria and cylindruria have been reported with quinolones [see Adverse Reactions (6.1) and Patient Counseling Information (17.2)].

2.6 Preparation of Intravenous Product

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.Because only limited data are available on the compatibility of levofloxacin injection with other intravenous substances, additives or other medications should not be added to levofloxacin injection in single-use vials, or infused simultaneously through the same intravenous line. If the same intravenous line is used for sequential infusion of several different drugs, the line should be flushed before and after infusion of levofloxacin injection with an infusion solution compatible with levofloxacin injection and with any other drug(s) administered via this common line. Levofloxacin Injection in Single-Use Vials Single-use vials require dilution prior to administration.Levofloxacin injection is supplied in single-use vials containing a concentrated levofloxacin solution with the equivalent of 500 mg (20 mL vial) and 750 mg (30 mL vial) of levofloxacin in Water for Injection, USP. The 20 mL and 30 mL vials each contain 25 mg of levofloxacin/mL. These levofloxacin injection single-use vials must be further diluted with an appropriate solution prior to intravenous administration [see Table 4]. The concentration of the resulting diluted solution should be 5 mg/mL prior to administration.Compatible Intravenous Solutions: Any of the following intravenous solutions may be used to prepare a 5 mg/mL levofloxacin solution with the approximate pH values:
Table 4: Compatible Intravenous Solutions Intravenous Fluids Final pH ofLevofloxacin Solution    0.9% Sodium Chloride Injection, USP 4.71    5% Dextrose Injection, USP 4.58    5% Dextrose/0.9% NaCl Injection 4.62    5% Dextrose in Lactated Ringers 4.92    Plasma-Lyte® 56/5% Dextrose Injection 5.03    5% Dextrose, 0.45% Sodium Chloride, and   0.15% Potassium Chloride Injection 4.61    Sodium Lactate Injection (M/6) 5.54
Since no preservative or bacteriostatic agent is present in this product, aseptic technique must be used in preparation of the final intravenous solution. Since the vials are for single-use only, any unused portion remaining in the vial should be discarded. When used to prepare two 250 mg doses from the 20 mL vial containing 500 mg of levofloxacin, the full content of the vial should be withdrawn at once using a single-entry procedure, and a second dose should be prepared and stored for subsequent use [see Stability of Levofloxacin Injection Following Dilution].

Prepare the desired dosage of levofloxacin according to Table 5:

                                            Table 5: Preparation of Levofloxacin Intravenous Solution
Desired Dosage Strength From Appropriate Vial, Withdraw Volume Volume of Diluent Infusion Time 250 mg 10 mL (20 mL Vial) 40 mL 60 min 500 mg 20 mL (20 mL Vial) 80 mL 60 min 750 mg 30 mL (30 mL Vial) 120 mL 90 min
For example, to prepare a 500 mg dose using the 20 mL vial (25 mg/mL), withdraw 20 mL and dilute with a compatible intravenous solution to a total volume of 100 mL.

This intravenous drug product should be inspected visually for particulate matter prior to administration. Samples containing visible particles should be discarded.

Stability of Levofloxacin Injection Following Dilution: Levofloxacin injection, when diluted in a compatible intravenous fluid to a concentration of 5 mg/mL, is stable for 72 hours when stored at or below 25°C (77°F) and for 14 days when stored under refrigeration at 5°C (41°F) in plastic intravenous containers. Solutions that are diluted in a compatible intravenous solution and frozen in glass bottles or plastic intravenous containers are stable for 6 months when stored at - 20°C (- 4°F). Thaw frozen solutions at room temperature 25°C (77°F) or in a refrigerator 8°C (46°F). Do not force thaw by microwave irradiation or water bath immersion. Do not refreeze after initial thawing.
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2.1 Important Administration Instructions

Ibandronate sodium injection must be administered intravenously only by a health care professional. Care must be taken not to administer intra-arterially or paravenously as this could lead to tissue damage [see Warnings and Precautions (5.4)].
Appropriate medical support and monitoring measures should be readily available when ibandronate sodium injection is administered. If anaphylactic or other severe hypersensitivity/allergic reactions occur, immediately discontinue the injection and initiate appropriate treatment [see Warnings and Precautions (5.2)]. Visually inspect the liquid in the prefilled syringe for particulate matter and discoloration before administration. Do not use prefilled syringes with particulate matter or discoloration. Administer only with the enclosed needle. Discard any unused portion. Do not mix with calcium-containing solutions or other intravenously administered drugs. Prefilled syringes are for single use only.
2.2 Dosage Information

The recommended dose of ibandronate sodium injection for the treatment of postmenopausal osteoporosis is 3 mg every 3 months administered intravenously over a period of 15 to 30 seconds. Do not administer more frequently than once every 3 months.

2.3 Laboratory Testing and Oral Examination Prior to Administration

Prior to administration of each dose obtain a serum creatinine [see Warnings and Precautions (5.3)]. Given that bisphosphonates have been associated with osteonecrosis of the jaw (ONJ), perform a routine oral examination prior to administration of ibandronate sodium injection.

2.4 Calcium and Vitamin D Supplementation

Instruct patients to take supplemental calcium and vitamin D if their dietary intake is inadequate. [see Warnings and Precautions (5.1)].

2.5 Dosing After Missed Dose

If the dose is missed, administer as soon as it can be re-scheduled. Thereafter, ibandronate sodium injection should be scheduled every 3 months from the date of the last injection.

2.6 Dosage Modifications in Patients with Renal Impairment

Do not administer to patients with severe renal impairment (creatinine clearance less than 30 mL/minute) [see Warnings and Precautions (5.3) and Clinical Pharmacology (12.3)]. No dose adjustment is necessary for patients with mild or moderate renal impairment (creatinine clearance greater than or equal to 30 mL/min) [see Clinical Pharmacology (12.3)].

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