Instructions for Common Drug Dilutions

Version 1
11/3/21

Contributors: Vanessa Henke, Joyce Chang, and Linda Liu

Drug and Standard Concentration for Infusion	How supplied	Dilution Instructions
Amiodarone 1.8mg / mL (Use Losorb (non-latex, non-DEHP) tubing with 0.2micron filter)	150 mg / 3 mL (50 mg / mL)	Add 450 mg (9 mL) of concentrated amiodarone to 250 mL normal saline (Aspirate and waste 9mL of normal saline from a 250mL bag, then add amiodarone →total volume 250 mL)
Dobutamine 4000 mcg / mL (Ideally, use pre-mixed bag from pharmacy)	250mg / 20mL (12.5mg / mL)	Standard volume (250mL): Add 1000mg (80 mL) of concentrated dobutamine to 170mL normal saline (aspirate and waste 80mL of normal saline from a 250mL bag, then add 1000mg (=80mL, from 4 vials) of dobutamine to the bag→total volume 250mL) Smaller volume (62.5mL; for pediatric cardiac cases): Add 20mL (from 1 vial) dobutamine to 42.5mL normal saline (draw up 42.5mL normal saline in a 60 cc syringe, then add 250mg (=20mL, from 1 vial) of dobutamine to the syringe)
Dopamine 3200 mcg / mL (for adult cases) ____________ Dopamine 1600mcg/mL (for pediatrics)	200 mg / 5 mL (40 mg / mL) _____________ 200 mg / 5 mL (40 mg / mL)	Add 160 mg (4 mL) of concentrated dopamine to 46 mL normal saline ____________________________________________ Add 80 mg (2 mL) of concentrated dopamine to 48 mL normal saline
Epinephrine 16mcg/mL (Standard for cardiac cases) ___________________ Epinephrine 10mcg/mL	1 mg / 1 mL (1mg / mL)	Add 4mg (4 mL) of concentrated epinephrine to 250 mL normal saline _______________________________________________ Add 1 mg (1 mL) of concentrated epinephrine to 100 mL normal saline
Heparin (for SUBCUTANEOUS use) 10,000 units / mL undiluted	10,000 units / mL (5,000 units / 0.5 mL)	Confirm dose and route (intravenous versus subcutaneous) with surgeon before administering heparin
Heparin (intravenous, for BOLUS) 1,000 units / mL undiluted	10,000 units / 10 mL 1,000 units / mL	Confirm dose and route (intravenous versus subcutaneous) with surgeon before administering heparin
Insulin 1 unit / mL (for INFUSION; use Lo-sorb [non-latex, non-DEHP] Alaris tubing)	300 units / 3mL (100 units / mL)	Add 100 units (1 mL, measure using a 1mL insulin syringe) of concentrated insulin to 99 mL normal saline to administer using Alaris pump
Milrinone 200 mcg / mL (ideally, use pre-mixed bag from pharmacy)	10 mg / 10 mL (1 mg / mL)	Add 20 mg (20 mL) of concentrated milrinone to 80 mL normal saline (aspirate and waste 20mL from a 100mL bag of NS, then add 20mg (=20mL) milrinone to the bag→total volume 100mL)
Nicardipine 200 mcg / mL	25 mg / 10mL (2.5 mg / mL)	Add 20 mg (8 mL) of concentrated nicardipine to 92 mL normal saline (aspirate and waste 8 mL from a 100mL bag of NS, then add 20mg (=8mL) nicardipine to the bag→total volume 100mL)
Nitroprusside 100mcg/mL (for pediatrics) ________________ Nitroprusside 500mcg/mL (for adults)	50mg / 2mL (25mg / mL) ______________ 50mg / 2mL (25mg / mL)	Add 50 mg (2 mL) of concentrated nitroprusside to 500 mL bag of normal saline (light-sensitive: keep bag in light-protective sleeve) _______________________________________________ Add 50 mg (2 mL) of concentrated nitroprusside to 100 mL bag of normal saline (light-sensitive: keep bag in light-protective sleeve; supplied with vial)
Norepinephrine 8mcg/mL (for peripheral use) ___________________ Norepinephrine 16mcg/mL (standard for cardiac cases)	4mg / 4mL (1 mg / mL) _____________ 4mg / 4mL (1 mg / mL)	Add 4 mg (4 mL) of concentrated norepinephrine to 500 mL normal saline __________________________________________________ Add 4 mg (4 mL) of concentrated norepinephrine to 250 mL normal saline
Octreotide 10 mcg / mL	500 mcg / 1 mL (500 mcg/ mL)	Add 500 mcg (1 mL) of concentrated octreotide to 50 mL normal saline
Phenylephrine 100 mcg / mL (standard for OR) _________________ Phenylephrine 40 mcg / mL (for Alaris pump)	10mg/mL (10mg / 1mL vial) _________________ 10mg/mL (10mg / 1mL vial)	Add 10 mg (1 mL) of concentrated phenylephrine to 100 mL normal saline ____________________________________________________ Add 10 mg (1 mL) of concentrated phenylephrine to 250 mL normal saline
Vasopressin 1 unit / mL _______________ Vasopressin 0.2 unit / mL (for Alaris pump)	20units / 1mL (20 units / 1 mL vial) ______________ 20units / 1mL (20 units / 1 mL vial)	Add 20 units (1mL) of concentrated vasopressin to 19 mL normal saline _____________________________________________ Add 20units / 1mL (20 units / mL) of concentrated vasopressin to 99 mL normal saline

Drug and Standard Concentration for Infusion

How supplied

Dilution Instructions

Sample Vial

Amiodarone 1.8mg / mL

(Use Losorb (non-latex, non-DEHP) tubing with 0.2micron filter)

150 mg / 3 mL

(50 mg / mL)

Add 450 mg (9 mL) of concentrated amiodarone to 250 mL normal saline

(Aspirate and waste 9mL of normal saline from a 250mL bag, then add amiodarone →total volume 250 mL)

Dobutamine 4000 mcg / mL

(Ideally, use pre-mixed bag from pharmacy)

250mg / 20mL

(12.5mg / mL)

Standard volume (250mL): Add 1000mg (80 mL) of concentrated dobutamine to 170mL normal saline
(aspirate and waste 80mL of normal saline from a 250mL bag, then add 1000mg (=80mL, from 4 vials) of dobutamine to the bag→total volume 250mL)

Smaller volume (62.5mL; for pediatric cardiac cases): Add 20mL (from 1 vial) dobutamine to 42.5mL normal saline
(draw up 42.5mL normal saline in a 60 cc syringe, then add 250mg (=20mL, from 1 vial) of dobutamine to the syringe)

Dopamine 3200 mcg / mL

(for adult cases)

____________

Dopamine 1600mcg/mL

(for pediatrics)

200 mg / 5 mL

(40 mg / mL)

_____________

200 mg / 5 mL

(40 mg / mL)

Add 160 mg (4 mL) of concentrated dopamine to 46 mL normal saline

____________________________________________

Add 80 mg (2 mL) of concentrated dopamine to 48 mL normal saline

Epinephrine 16mcg/mL

(Standard for cardiac cases)

___________________

Epinephrine
10mcg/mL

1 mg / 1 mL

(1mg / mL)

Add 4mg (4 mL) of concentrated epinephrine to 250 mL normal saline

_______________________________________________

Add 1 mg (1 mL) of concentrated epinephrine to 100 mL normal saline

Heparin (for SUBCUTANEOUS use)
10,000 units / mL

undiluted

10,000 units / mL

(5,000 units / 0.5 mL)

Confirm dose and route (intravenous versus subcutaneous) with surgeon before administering heparin

Heparin (intravenous, for BOLUS)
1,000 units / mL

undiluted

10,000 units / 10 mL

1,000 units / mL

Confirm dose and route (intravenous versus subcutaneous) with surgeon before administering heparin

Insulin
1 unit / mL

(for INFUSION; use Lo-sorb [non-latex, non-DEHP] Alaris tubing)

300 units / 3mL

(100 units / mL)

Add 100 units (1 mL, measure using a 1mL insulin syringe) of concentrated insulin to 99 mL normal saline to administer using Alaris pump

Milrinone
200 mcg / mL

(ideally, use pre-mixed bag from pharmacy)

10 mg / 10 mL

(1 mg / mL)

Add 20 mg (20 mL) of concentrated milrinone to 80 mL normal saline

(aspirate and waste 20mL from a 100mL bag of NS, then add 20mg (=20mL) milrinone to the bag→total volume 100mL)

Nicardipine
200 mcg / mL

25 mg / 10mL

(2.5 mg / mL)

Add 20 mg (8 mL) of concentrated nicardipine to 92 mL normal saline

(aspirate and waste 8 mL from a 100mL bag of NS, then add 20mg (=8mL) nicardipine to the bag→total volume 100mL)

Nitroprusside
100mcg/mL

(for pediatrics)

________________

Nitroprusside

500mcg/mL

(for adults)

50mg / 2mL

(25mg / mL)

______________

50mg / 2mL

(25mg / mL)

Add 50 mg (2 mL) of concentrated nitroprusside to 500 mL bag of normal saline (light-sensitive: keep bag in light-protective sleeve)

_______________________________________________

Add 50 mg (2 mL) of concentrated nitroprusside to 100 mL bag of normal saline (light-sensitive: keep bag in light-protective sleeve; supplied with vial)