• Dxona = dexamethasone sodium phosphate
• Neropenam = meropenem
• Avil = pheniramine maleate

1. Sodium bicarbonate injection

• An alkalinising agent. It provides bicarbonate, which buffers excess hydrogen ions and raises blood pH.
• It also shifts potassium temporarily into cells, so it may be used as an adjunct in severe hyperkalemia with acidosis.

• Severe metabolic acidosis confirmed with ABG/electrolytes
• Specific poisonings with sodium-channel blockade, such as tricyclic-antidepressant overdose
• Selected cases of hyperkalemia with significant acidosis
• Cardiac arrest only in selected situations, not routinely

• Often 1 mEq/kg IV, reassessed using ECG, ABG, potassium, and clinical status.
• Common solution: 8.4% sodium bicarbonate = 1 mEq/mL. Thus, a 50 mL ampoule contains 50 mEq.
• This is not a routine “acidity” injection. Giving it unnecessarily can worsen outcomes.

• Can be given by slow IV injection in emergencies.
• For infusion, it must be prescribed in mEq and diluted according to the clinical protocol, often in D5W.
• Avoid mixing with calcium-containing solutions, such as Ringer’s lactate, because precipitation can occur.
• Use a separate line where possible. Check compatibility before using a Y-site.

• Metabolic or respiratory alkalosis
• Hypernatremia, fluid overload, severe heart failure
• Hypocalcemia
• Severe renal impairment unless specifically ordered
• Inadequate ventilation: bicarbonate produces CO₂ and may worsen intracellular/CNS acidosis if ventilation is poor

• Alkalosis: confusion, twitching, tetany, seizures
• High sodium/fluid overload: edema, breathlessness, raised BP
• Low potassium or low ionized calcium: weakness, cramps, arrhythmia
• Tissue damage if extravasated
• Monitor ECG, ABG, sodium, potassium, calcium, fluid balance.

2. Dexona injection: dexamethasone

• A potent corticosteroid. It suppresses inflammatory cytokines, capillary leak, and immune-mediated inflammation.

• Severe allergy or asthma exacerbation as an adjunct
• Cerebral edema due to tumor or neurosurgical causes
• Certain autoimmune/inflammatory diseases
• Some hematologic and cancer protocols
• Bacterial meningitis in selected settings, usually given before or with the first antibiotic dose
• COVID-19 requiring oxygen or ventilatory support, under a defined protocol

• Highly diagnosis-specific. Injectable initial dosing in official prescribing information ranges broadly, often 0.5 to 9 mg/day for many disorders, but emergency protocols can use different doses.
• Do not use a standard dose without knowing the diagnosis and patient details.

• Usually slow IV or IM.
• Dexamethasone sodium phosphate may be given directly by IV/IM injection or added to 0.9% sodium chloride or 5% dextrose for IV infusion, depending on the product. DailyMed prescribing information
• Do not mix in the same syringe with other medications unless compatibility is confirmed.

• Systemic fungal infection
• Known hypersensitivity
• Avoid live vaccines with immunosuppressive steroid doses
• Caution: active infection, TB exposure, diabetes, hypertension, peptic ulcer disease, glaucoma, psychiatric illness, osteoporosis.

• Increased glucose, increased BP, insomnia, agitation or mood changes
• Gastritis, GI bleeding, infection masking or worsening
• With longer/repeated courses: adrenal suppression, muscle weakness, osteoporosis, cataract/glaucoma
• Seek urgent review for black stools, severe abdominal pain, fever, confusion, vision changes, or severe mood disturbance.

3. Vancomycin injection

• Glycopeptide antibiotic. It binds the D-Ala-D-Ala terminal of bacterial cell-wall precursors, preventing cell-wall formation.
• Active mainly against serious Gram-positive infections, including MRSA.

• Serious MRSA infections: bloodstream infection/sepsis, endocarditis, pneumonia, bone/joint infection, complicated skin/soft-tissue infection
• Some severe resistant Gram-positive infections
• IV vancomycin does not treat C. difficile colitis in the gut. Oral vancomycin is used for that indication.

• Commonly 15-20 mg/kg per dose every 8-12 hours, calculated using actual body weight.
• Serious infections may need a loading dose based on local protocol.
• Dose and interval must be adjusted for kidney function and guided by serum drug monitoring, usually AUC-guided monitoring or troughs as per hospital policy.

• 500 mg vial: add 10 mL sterile water to make 50 mg/mL
• 1 g vial: add 20 mL sterile water to make 50 mg/mL
• Then dilute further:
  • 500 mg in at least 100 mL
  • 1 g in at least 200 mL
  • Compatible fluid usually 0.9% saline or 5% dextrose, based on product information.
• Infuse at no more than 10 mg/min, and generally over at least 60 minutes. A 1 g dose is often infused over at least 100 minutes if observing the 10 mg/min maximum. Vancomycin preparation guidance

• Do not give vancomycin as IV push/rapid bolus.
• Do not mix blindly with other drugs in the same bag or line.

• Known vancomycin hypersensitivity
• Renal impairment, dehydration, older age
• Concurrent nephrotoxic drugs, such as aminoglycosides, amphotericin, loop diuretics, contrast in some contexts
• Pre-existing hearing impairment

• Nephrotoxicity: reduced urine, rising creatinine, swelling
• Ototoxicity: tinnitus, hearing changes, vertigo
• Infusion reaction: flushing, itching, red face/neck/upper chest, low BP, wheeze. Slow/stop the infusion and seek medical review. This is often called vancomycin infusion reaction.
• Neutropenia, rash, rare severe skin reactions
• Monitor renal function, urine output, drug levels, CBC when prolonged therapy.

4. Meropenem injection

• A carbapenem beta-lactam antibiotic. It binds penicillin-binding proteins and blocks bacterial cell-wall synthesis.
• Broad-spectrum activity against many Gram-negative, Gram-positive, and anaerobic bacteria, including many ESBL-producing organisms and Pseudomonas.

• Severe suspected or proven bacterial infection, such as:
  • Complicated intra-abdominal infection
  • Severe hospital-acquired infection or sepsis
  • Complicated urinary infection or pyelonephritis, depending on susceptibility
  • Complicated skin/soft-tissue infection
  • Meningitis, according to protocol
• Use should be culture-guided and reviewed for de-escalation. It does not treat viral infections.

• Often 500 mg to 1 g IV every 8 hours, depending on infection and local policy.
• For meningitis/severe CNS infection, 2 g IV every 8 hours is commonly used in adults under specialist direction.
• Reduce dose/extend interval in renal impairment. The FDA-labelled adult renal schedule changes when creatinine clearance is 50 mL/min or lower. Meropenem prescribing information

• Common vial reconstitution:
  • 500 mg with 10 mL sterile water
  • 1 g with 20 mL sterile water
  • Produces about 50 mg/mL
• Then dilute in a compatible IV fluid, commonly 0.9% saline or 5% dextrose, according to the manufacturer and hospital protocol.
• Common administration: IV infusion over 15-30 minutes. Some critical-care protocols use prolonged infusion, but this is a prescriber/pharmacy decision. DailyMed meropenem guidance

• Serious allergy to meropenem/carbapenems
• Previous anaphylaxis to beta-lactam antibiotics
• Renal impairment
• History of seizures or CNS disease
• Valproate/valproic acid: meropenem can substantially lower valproate levels and trigger seizures.

• Diarrhea, nausea, rash, injection-site inflammation
• Allergy/anaphylaxis: wheeze, facial swelling, hypotension, generalized rash
• C. difficile diarrhea: persistent watery diarrhea, abdominal pain, fever
• Seizures, particularly with high doses, renal impairment, or CNS disease
• Rare severe skin reaction or rhabdomyolysis.

5. Avil injection: pheniramine maleate

• First-generation H1 antihistamine. It blocks histamine H1 receptors, reducing itching, hives, sneezing, runny nose, and allergic redness.
• It also crosses into the brain, which explains drowsiness and sedation.

• Acute allergic reactions, urticaria, drug rash, itching
• Allergic respiratory/skin symptoms
• It may be used as an adjunct in anaphylaxis after IM adrenaline and initial resuscitation measures.

• In India, Avil injection is commonly 22.75 mg/mL, supplied as 2 mL = 45.5 mg pheniramine maleate. Avil product listing
• Adult use is commonly 22.75-45.5 mg, IV slowly or IM, but the exact dose depends on the clinical situation and local protocol.
• Pediatric dose must be weight/age based and ordered by a pediatric clinician.

• May be given deep IM or slow IV by trained staff.
• There is no universal “one dilution” rule for every Avil product. Follow the vial insert and hospital compatibility chart.
• Avoid rapid IV administration because it may cause hypotension, sedation, or adverse effects.
• Do not combine it with other medicines in the same syringe unless compatibility is confirmed.

• Known hypersensitivity
• Neonates
• Symptomatic prostatic enlargement/urinary retention
• Narrow-angle glaucoma
• Caution with asthma/COPD, elderly patients, liver disease, epilepsy, pregnancy/breastfeeding
• Avoid alcohol, opioids, benzodiazepines, and other sedating drugs unless specifically prescribed.

• Drowsiness, dizziness, impaired coordination
• Dry mouth, blurred vision, constipation, urinary retention
• Fast heart rate, low BP, confusion or paradoxical agitation, especially in children/older adults
• Avoid driving or operating machinery after it. Sedation is a commonly reported adverse effect. Avil safety information

Key administration safety points

1. Check the exact diagnosis and prescription first. These medications are not interchangeable.
2. Check allergies: especially beta-lactam allergy before meropenem, and prior vancomycin reaction.
3. Before vancomycin or meropenem, obtain cultures when feasible, without delaying treatment in sepsis.
4. Check creatinine/eGFR and urine output before and during vancomycin and meropenem.
5. Give vancomycin slowly and monitor for flushing, itching, hypotension, and breathing difficulty.
6. Never IV-push vancomycin.
7. Do not mix sodium bicarbonate with calcium-containing IV fluids or medications without a compatibility check.
8. Adrenaline is first-line for anaphylaxis. Avil and dexamethasone do not replace it.
9. Use separate lines or flush thoroughly between drugs if compatibility is not documented.
10. If the patient develops wheeze, facial swelling, severe rash, low BP, confusion, seizure, reduced urine, or severe diarrhea, stop the suspected infusion and seek urgent medical help.

Injection Drug Chart - Easy Quick Reference

Critical safety reminders

Easy Injection Chart With Contraindications

Important notes

One-Page Injection Drug Chart

Assumption: “M Casin” likely means Mikacin = amikacin injection. Please check the ampoule label because brand names can vary.

Critical safety box

One-Page Injection Drug Chart

Critical administration reminders

Injection Drug Chart: Uses, Dose, Dilution, Monitoring Symptoms

Important symptoms requiring immediate action

Symptoms/Conditions That May Lead to These Drugs Being Prescribed

Quick symptom guide

Urgent red-flag symptoms

• Wheeze, throat swelling, facial swelling, fainting, low BP: treat as anaphylaxis. Give IM adrenaline immediately as per emergency protocol.
• Fever with low BP, confusion, fast breathing, reduced urine: possible sepsis. Urgent medical assessment and cultures are needed.
• Severe weakness, deep breathing, altered consciousness, abnormal ECG: possible severe acidosis or hyperkalemia. Do not give bicarbonate without urgent monitoring and tests.
• During vancomycin: flushing, itching, low BP, wheeze means slow/stop infusion and inform the doctor.
• During amikacin or vancomycin: reduced urine, dizziness/vertigo, tinnitus, or hearing loss needs urgent review.
• During meropenem: seizure, confusion, severe rash, severe watery diarrhea, muscle pain with dark urine requires urgent review.