Infusions, intravenous

Commercially available containers for use with parenteral products include single-dose ampuls that are heat sealed and opened by snapping at the point of least diameter, vials for multidose use, and botdes and pHable bags that are used for large volumes such as needed in intravenous infusions. Container size can vary from 1 mL to 1 L. Generally volumes up to 100 mL are available as ampuls or vials. 

The principal arninoglycoside toxicides are neuromuscular paralysis, ototoxicity, and nephrotoxicity. Neuromuscular paralysis is a relatively rare complication resulting from high aminoglycoside concentrations at the neuromuscular junctions following, for example, rapid bolus intravenous injection or peritoneal instillation, rather than the normal intravenous infusion. The mechanism apparentiy involves an inhibition of both the presynaptic release of acetylcholine and the acetylcholine postsynaptic receptors (51). 

Reproductive System. The primary PGs are intimately involved in reproductive physiology (67). PGE2 and PGP2Q, are potent contractors of the pregnant utems and intravenous infusion of either of these compounds to pregnant humans produces a dose-dependent increase in frequency and force of uterine contraction. PGI2 and TXA2 have mild relaxant and stimulatory effects, respectively, on uterine tissue. The primary PGs also play a role in parturition, ovulation, luteolysis, and lactation and have been impHcated in male infertility. 

Miconazole. Miconazole (Fig. 2, 7a) is also available as a sterile solution for intravenous infusion. Miconazole has a therapeutic effect on systemic mycoses due to C albicans A.spergillusfumigatus Cyptococcus neoformans Blastomyces dermatitidis Histoplasma capsulatum Coccidioides immitis Paracoccidioides brasiliensis and Petriellidum boydii. 

Curative treatment involves counteracting the paralytic effect of the Ba " ion on the muscle by intravenous infusion of a potassium salt. 

Compared to streptokinase, urokinase has been less extensively studied because of its high cost, ie, about 10 times that of a comparable treatment with streptokinase. In addition to the indications described for streptokinase, urokinase is indicated for use in patients with prior streptokinase treatment, or prior Streptococcal infection. Urokinase is commonly used at a loading dose of 4400 units /kg, with a maintenance intravenous infusion dose of 4400 units/kg/h for thromboses other than acute myocardial infarction. In the latter case, a much larger dose, ie, 0.5—2.0 million units/h or a bolus dose of 1.0 million units followed by a 60-min infusion with 1.0 million units, has been found optimal (106). An intracoronary dose of 2000 units/min for two hours was used in one comparative study with intracoronary streptokinase (107). In this study, urokinase exhibited efficacy equivalent to streptokinase with fewer side effects. Other studies with intracoronary urokinase have adrninistered doses ranging from 2,000 to 24,000 units/min with a reperfusion efficacy of 60—89% (108—112). In another urokinase trial, 2.0 million units were adrninistered intravenously, resulting in a thrombolytic efficacy of 60% (113). Effectiveness in terms of reduction in mortaUty rate has not been deterrnined because of the small number of patients studied. 

Intravenous infusion of epinephrin 0.1-0.5 mg epinephrin dissolved in plasma replacement, this can be repeated after 5 min. 

The recommended dose of pemetrexed is 500 mg/m2 administered as an intravenous infusion over 10 min on Day 1 of each 21-day cycle. Pemetrexed is not metabolized to an appreciable extent and is primarily eliminated in the urine, with 70-90% of the dose recovered unchanged within the first 24 h following administration. Pemetrexed has a steady-state volume of distribution of 16.1 L. Pemetrexed is highly bound (approximately 81%) to plasma proteins. Binding is not affected by the degree of renal impairment. Plasma... 

Irinotecan (CPT-11) is approved for colorectal tumors. It is given by intravenous infusion. The most severe side effect is diarrhea, which can be severe and needs to be treated by a physician. Temporary liver dysfunction is generally asymptomatic. The other side effects are the same as those produced by topotecan. 

Approximately 2% of all COPD patients suffer from homozygous al-AT deficiency. Intravenous infusion of replacement protein twice weekly in patients with established al-AT deficiency is approved in the US but not in Europe. The effectiveness of this extremely expensive treatment is not yet known. 

The dangers of shock are avoided or treated by intravenous infusion of large volumes of a salt-containing solution that is isotonic with blood (has the same osmotic pressure as blood), usually one known as lactated Ringer s solution. The added liquid increases blood volume and blood flow, thereby improving oxygen delivery. The HCO / H2C03 ratio then increases toward normal and allows the severely injured person to survive. 

Little is known regarding the pharmacokinetic properties of volatile nitrites in humans, particularly isobutyl nitrite and its primary metabolite, isobutyl alcohol. In rodents, after an intravenous infusion of isobutyl nitrite, blood concentrations peaked rapidly and then declined, with a half-life of 1.4 minutes and blood clearance rate of 2.9 L/min/kg (Kielbasa and Fung 2000). Approximately 98% of isobutyl nitrite is metabolized rapidly to isobutyl alcohol, concentrations of which also decline rapidly, with a half-life of 5.3 minutes. Bioavailability of inhaled isobutyl nitrite at a concentration of 300-900 ppm is estimated to be 43%. 

Sculier, J. P., Coune, A., Brassine, C., Laduron, C., Atassi, G., Ruysschaert, J. M., and Fruhling, H. (1986). Intravenous infusion of high doses of liposomes containing NSC 251635, a water-insoluble cytostatic agent. A pilot study with pharmacokinetic data, J. Clin. Oncol., 4, 789-797. 

Histamine H,-antagonists For intravenous infusion diphenhydramine, dimetindene and ciemastine are avaiiabie. There are no controiied studies for the new non-sedating antihistamines in the treatment of anaphyiaxis... 

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

Anaphylactic patients with impending shock, for example, those with incontinence, sudden loss of hearing or vision, dizziness, or collapse, and those with profound or persistent hypotension, require slow intravenous infusion of a dilute epinephrine solution [0.1 mg in 1 ml (1 10,000)]. Continuous hemodynamic monitoring and dose titration by trained and experienced healthcare professionals are essential. Maximum infusion rates of 5-15 ig/min are recommended in adults [2,18,22]. 

Meers P.D., Calder M.W., Mazhar M.M. Lawrie G.M. (1973) Intravenous infusion of contaminated dextrose solution the Devonport incident. Lancet, ii, 1189-1192. 

Most injections are formulated as aqueous solutions, with Water for Injections BP as the vehicle. The formulation of injections depends upon several factors, namely the aqueous solubility of the active ingredient, the dose to be employed, thermal stability of the solution, the route of injection and whether the product is to be prepared as a multidose one (i.e. with a dose or doses removed on different occasions) or in a singledose form (as the term suggests, only one dose is contained in the injection). Nowadays, most injections are prepared as single-dose forms and this is mandatory for certain routes, e.g. spinal injections such as the intrathecal route and large-volume intravenous infusions (section 2.2). Multidose injections may require the inclusion of a suitable... 

Some types of injections must be made iso-osmotic with blood serum. This applies particularly to large-volume intravenous infusions if at all possible hypotonic solutions cause lysis of red blood corpuscles and thus must not be used for this purpose. Conversely, hypertonic solutions can be employed these induce shrinkage, but not lysis, of red cells which recover their shape later. Intraspinal injections must also be isotonic, and to reduce pain at the site of injection so should intramuscular and subcutaneous injections. Adjustment to isotonicity can be determined by the following methods. 

A small range of intravenous infusions, e.g. those containing amino acids or... 

A sensitive method for detecting low levels of eontamination in intravenous infusion fluids involves the addition of a concentrated eulture medium to the fluid in its original container, such that the resultant mixture is equivalent to single strength culture medium. In this way, sampling of the entire volume is aehieved. 

Amino acids, e.g. glutamate, lysine Corynebacterium glutamicum Brevibacterium flavum Supplementation of feeds/food intravenous infusion fluid constituents... 

Suarez Jl, Zaidat OO, Sunshine JL, Tarr R, Selman WR, Landis DM. Endovascular administration after intravenous infusion of thrombolytic agents for the treatment of patients with acute ischemic strokes. Neurosurgery 2002 50 251-259 [discussion 259-260]. 

---