- Acute adrenal insufficiency, shock, acute hypersensitivity reactions, disseminated lupus erythematosus and other disorders
|
VIAL SIZE |
STERILE WATER for INJECTION REQUIRED |
FINAL CONCENTRATION |
|
100 mg |
1.8 mL |
50 mg/mL |
|
250 mg |
4.8 mL |
50 mg/mL |
|
500 mg |
9.8 mL |
50 mg/mL |
- Reconstituted solutions stable for 3 days at room temperature. Protect from light
- Infusion solutions in D5W or 0.9% NaCl stable 24 hrs at concentrations <1 mg/mL
- Act-0-Vial (self-contained powder for injection plus diluent) may be reconstituted by pressing into the center of the stopper to force diluent into the powder compartment. Following gentle agitation, solution may be withdrawn via syringe through a needle inserted into the center of the stopper.
- Reconstitution of Act-0-Vial 100 mg yields a final concentration of 50 mg/mL/ Discard any remaining contents of single-use vial.
- Solutions Compatible: dextrose up to D20W, 0.9% NaCl, 0.45% NaCl, dextrose-saline combinations, ringer's solution
- Additives/Above Cassette Compatible: amphotericin B, KCl, furosemide
- Y-site Compatible: morphine, TPN (amino acids/dextrose), ampicillin, calcium gluconate, digoxin, lidocaine, heparin
Incompatible: ciprofloxacin, phenobarbital, phenytoin
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | YES |
| IV Direct |
YES |
| IV Intermittent Infusion | YES Usual dilution: 1 mg/mL, 10 mg/mL or 50 mg/mL Infusion time: 20-30 minutes |
| IV Continuous Infusion |
YES |
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric:
- Acute adrenal insufficiency:
- 50 - 100 mg/m2 IV x 1 , then 25 mg/m2/dose IV/IM Q6H
Click here to go to Lexicomp online to calculate the Body Surface Area. From this page, type in "body surface area " in the lookup box, click on lookup tab and choose Body Surface Area: Pediatric.
- Anti-inflammatory: 1 - 5 mg/kg/day IV divided Q12-24H
- Status asthmaticus: ED Load: 8 mg/kg/dose (MAX 400 mg) IV x1.
Maintenance 5 mg/kg/dose, MAX 400 mg IV Q6H
- Shock: 2 mg/kg IV x 1, then 1 mg/kg/dose IV Q6H
Adult:
- Acute adrenal insufficiency:
- 100 mg IV bolus, then 300 mg/day IV/IM divided Q 8 hours or as a continuous infusion
- Once patient is stable, change to oral
- Anti-inflammatory: 15-240 mg IM/IV Q 12 hours
-- Shock: 0.5-2 g IV Q 2-6 hours
- Thrombophlebitis, burning, itching at IV site
- Increased blood pressure
- Psychotic reactions, seizures (rare)
- Cushing's syndrome, growth suppression, suppression of HPA function
- Hypokalemia, hyperglycemia, edema, hypernatremia, CHF
- Precipitation of diabetic ketoacidosis
- Anaphylaxis
- Monitor BP, serum glucose, electrolytes, growth (pediatric patients)
- May mask signs and dissemination of an infection
- Acute adrenal insufficiency may occur with abrupt withdrawal after long-term therapy or with stress
- Use with caution in patients with hyperthyroidism, hypertension, cirrhosis, nonspecific ulcerative colitis, hypertension, osteoporosis, thromboembolic tendencies, CHF, convulsive disorders, thrombophlebitis, peptic ulcer, diabetes, glaucoma, hepatic impairment
- 4 mg hydrocortisone = 1 mg prednisone
- 1 mg of hydrocortisone per mg of amphotericin (Max 25 mg of hydrocortisone) in buretrol is compatible