Table 7.
CHS intravenous medication guidelines (selected examples)
| Medication | Usual adult dose and rate | A | B | C | D | E | F | G | Comments and precautions |
| Fosaprepitant (Emend) | 150 mg IV over 20 to 30 minutes | 150 mg/150 mL NS | NA | + | + | + | + | + | ￭ Immediate hypersensitivity may occur during infusion. Per the manufacturer, patients generally respond to discontinuation and it is not recommended to reinitiate infusion |
| Lacosamide (Vimpat) | Initial dose: 50 mg IV bid titrated weekly up to 200 mg IV bid | All doses/50 mL NS | NA | + | + | + | + | + | ￭IV therapy may be substituted on a mg-per-mg basis for patients who are temporarily unable to receive oral therapy. |
| ￭ Infuse over 30 to 60 minutes. | |||||||||
| ￭ Maximum dose of 400 mg/day (300 mg/day recommended for patients with CLcr ≤30 mL/min). | |||||||||
| ￭ May cause dose-dependent PR interval prolongation; consider an EKG prior to initiation and following titration to steady state for patients with cardiac conduction problems. | |||||||||
| Nitroglycerin | 5-200+ mcg/min | 50 mg/250 mL D5W (glass only) | 100 mg/250 mL D5W (glass only) | +(no titration | +(no titration) | + | ￭ Monitor BP, HR | ||
| ￭ Titrating: Adjust rate by 5 mcg/min every 5 min up to 20 mcg/min; if no response, increase by 10 mcg/min every 5 min. | |||||||||
| ￭ Weaning: Reduce rate by 5 mcg/min every 5 min.. | |||||||||
| Rasburicase (Elitek) | 4.5 mg IV ONCE over 30 minutes | All doses in 50 mL NS | NA | + | + | + | + | + | ￭ Contraindicated in patients with known glucose-6-phosphate dehydrogenase deficiency. |
| ￭ Uric acid blood sample collection after administration of rasburicase must be collected in a pre-chilled tube, placed on ice, and run within 4 hours of sample collection | |||||||||
Note: Heading abbreviations: A = standard concentration; B = fluid restriction concentration; C = medical/surgical/ rehab bed; D = monitored (noncardiac unit); E = monitored (cardiac unit); F = progressive care bed; G = emergency department, intensive care unit, postanesthesia care unit bed. bid = twice daily; BP = blood pressure; CHS = Carolinas HealthCare System; CLCR = creatinine clearance; D5W = 5% dextrose in water; HR = heart rate; IV = intravenous; NA = not applicable; NS = normal saline.