Paracetamol

http://www.drugs.com/paracetamol.html
Copyright 1996-2010 Version: 11.01. 12/07/2009

Copyright 2000-2014 Drugs.com. All rights reserved.

Pronunciation

Generic Name: paracetamol (oral/rectal) (par RA cet a MOL)

Alternate Name: acetaminophen (a SEET a MIN oh fen)

What is paracetamol ?
Paracetamol (acetaminophen) is a pain reliever and a fever reducer. The exact mechanism of action of is not known.
Paracetamol is used to treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and fevers. It
relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of the joint.
Paracetamol may also be used for other purposes not listed in this medication guide.

Important information
There are many brands and forms of paracetamol available and not all brands are listed on this leaflet.
Do not use more of this medication than is recommended. An overdose of paracetamol can cause serious harm. The maximum
amount of paracetamol for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Taking more paracetamol could
cause damage to your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking paracetamol
and never use more than 2 grams (2000 mg) per day.
Do not use this medication without first talking to your doctor if you drink more than three alcoholic beverages per day or if you have
had alcoholic liver disease (cirrhosis). You may not be able to use paracetamol .
Before using paracetamol , tell your doctor if you have liver disease or a history of alcoholism.
Do not use any other over-the-counter cough, cold, allergy, or pain medication without first asking your doctor or pharmacist.
Paracetamol is contained in many combination medicines. If you use certain products together you may accidentally use too much
paracetamol . Read the label of any other medicine you are using to see if it contains paracetamol, acetaminophen or APAP. Avoid
drinking alcohol while taking this medication. Alcohol may increase your risk of liver damage while taking paracetamol .

Before taking this medicine

Do not use this medication if you are allergic to acetaminophen or paracetamol.
Ask a doctor or pharmacist if it is safe for you to take paracetamol if you have:

liver disease; or

a history of alcoholism;

It is not known whether paracetamol will harm an unborn baby. Before using paracetamol , tell your doctor if you are pregnant. This
medication can pass into breast milk and may harm a nursing baby. Do not use paracetamol without telling your doctor if you are
breast-feeding a baby.

How should I use paracetamol ?

Use paracetamol exactly as directed on the label, or as prescribed by your doctor.
Do not use more of this medication than is recommended. An overdose of paracetamol can cause serious harm. The maximum
amount for adults is 1 gram (1000 mg) per dose and 4 grams (4000 mg) per day. Using more paracetamol could cause damage to
your liver. If you drink more than three alcoholic beverages per day, talk to your doctor before taking paracetamol and never use
more than 2 grams (2000 mg) per day. If you are treating a child, use a pediatric form of paracetamol . Carefully follow the dosing
directions on the medicine label. Do not give the medication to a child younger than 2 years old without the advice of a doctor.
Measure the liquid form of paracetamol with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a
dose-measuring device, ask your pharmacist for one. You may need to shake the liquid before each use. Follow the directions on
the medicine label.
The paracetamol chewable tablet must be chewed thoroughly before you swallow it.
Make sure your hands are dry when handling the paracetamol disintegrating tablet. Place the tablet on your tongue. It will begin to
dissolve right away. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.
To use the paracetamol effervescent granules, dissolve one packet of the granules in at least 4 ounces of water. Stir this mixture and
drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right
away.
Do not take a paracetamol rectal suppository by mouth. It is for use only in your rectum. Wash your hands before and after inserting
the suppository.
Try to empty your bowel and bladder just before using the paracetamol suppository. Remove the outer wrapper from the suppository
before inserting it. Avoid handling the suppository too long or it will melt in your hands.
For best results from the suppository, lie down and insert the suppository pointed tip first into the rectum. Hold in the suppository for
a few minutes. It will melt quickly once inserted and you should feel little or no discomfort while holding it in. Avoid using the
bathroom just after inserting the suppository.
Stop using paracetamol and call your doctor if:

you still have a fever after 3 days of use;

you still have pain after 7 days of use (or 5 days if treating a child);
you have a skin rash, ongoing headache, or any redness or swelling; or
if your symptoms get worse, or if you have any new symptoms.

Urine glucose tests may produce false results while you are taking paracetamol . Talk to your doctor if you are diabetic and you
notice changes in your glucose levels during treatment.
Store paracetamol at room temperature away from heat and moisture. The rectal suppositories can be stored at room temperature or
in the refrigerator.

What happens if I miss a dose?

Since paracetamol is often used only when needed, you may not be on a dosing schedule. If you are using the medication regularly,
use the missed dose as soon as you remember. If it is almost time for your next regularly scheduled dose, skip the missed dose and
use your next dose as directed. Do not use extra medicine to make up for a missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.
The first signs of an paracetamol overdose include loss of appetite, nausea, vomiting, stomach pain, sweating, and confusion or
weakness. Later symptoms may include pain in your upper stomach, dark urine, and yellowing of your skin or the whites of your
eyes.

What should I avoid?

Do not use any other over-the-counter cough, cold, allergy, or pain medication without first asking your doctor or pharmacist.
Paracetamol is contained in many combination medicines. If you use certain products together you may accidentally use too much
paracetamol . Read the label of any other medicine you are using to see if it contains paracetamol, acetaminophen or APAP. Avoid
drinking alcohol while taking this medication. Alcohol may increase your risk of liver damage while taking paracetamol .

Paracetamol side effects

Get emergency medical help if you have any of these signs of an allergic reaction to paracetamol: hives; difficulty breathing; swelling
of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have a serious side effect such as:

low fever with nausea, stomach pain, and loss of appetite;

dark urine, clay-colored stools; or
jaundice (yellowing of the skin or eyes).

This is not a complete list of paracetamol side effects and others may occur. Call your doctor for medical advice about side effects.
You may report side effects to FDA at 1-800-FDA-1088.
See also: Side effects (in more detail)

Paracetamol Dosing Information

Usual Adult Paracetamol Dose for Fever:
General Dosing Guidelines: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours orally or rectally.
Paracetamol 500mg tablets: Two 500 mg tablets orally every 4 to 6 hours
Usual Adult Paracetamol Dose for Pain:
General Dosing Guidelines: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours orally or rectally.
Paracetamol 500mg tablets: Two 500 mg tablets orally every 4 to 6 hours
Usual Pediatric Dose for Fever:
Oral or Rectal:
<=1 month: 10 to 15 mg/kg/dose every 6 to 8 hours as needed.
>1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5 doses in 24 hours)
Fever: 4 months to 9 years: Initial Dose: 30 mg/kg (Reported by one study (n=121) to be more effective in reducing fever than a 15
mg/kg maintenance dose with no difference regarding clinical tolerance.)

>=12 years: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours.

Usual Pediatric Dose for Pain:
Oral or Rectal:
<=1 month: 10 to 15 mg/kg/dose every 6 to 8 hours as needed.
>1 month to 12 years: 10 to 15 mg/kg/dose every 4 to 6 hours as needed (Maximum: 5 doses in 24 hours)
Fever: 4 months to 9 years: Initial Dose: 30 mg/kg (Reported by one study (n=121) to be more effective in reducing fever than a 15
mg/kg maintenance dose with no difference regarding clinical tolerance.)
>=12 years: 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 to 8 hours.

What other drugs will affect paracetamol ?

There may be other drugs that can interact with paracetamol . Tell your doctor about all your prescription and over-the-counter
medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without
telling your doctor.

Ceftriaxone Injection
http://www.nlm.nih.gov/medlineplus/druginfo/meds/a685032.html
pronounced as(sef try ax' one)
Why is this medication prescribed?How should this medicine be used?Other uses for this medicineWhat special precautions
should I follow?What special dietary instructions should I follow?What should I do if I forget a dose?What side effects can this
medication cause?What should I know about storage and disposal of this medication? In case of emergency/overdoseWhat other
information should I know?Brand names

Why is this medication prescribed?

Ceftriaxone injection is used to treat certain infections caused by bacteria such as gonorrhea (a sexually transmitted disease), pelvic
inflammatory disease (infection of the female reproductive organs that may cause infertility), meningitis (infection of the membranes that
surround the brain and spinal cord), and infections of the lungs, ears, skin, urinary tract, blood, bones, joints, and abdomen. Ceftriaxone
injection is also sometimes given before certain types of surgery to prevent infections that may develop after the operation. Ceftriaxone
injection is in a class of medications called cephalosporin antibiotics. It works by killing bacteria. Antibiotics will not work for colds, flu, or other
viral infections.

How should this medicine be used?

Ceftriaxone injection comes as a liquid to be injected intravenously (into a vein) or intramuscularly (into a muscle). It is sometimes given as a
single dose and sometimes given once or twice a day for 4-14 days, depending on the type of infection being treated. You may receive
ceftriaxone injection in a hospital or doctor's office, or you may administer the medication at home. If you are using ceftriaxone injection at
home, use it at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or
pharmacist to explain any part you do not understand. Use ceftriaxone injection exactly as directed. Do not use more or less of it or use it
more often than prescribed by your doctor.
You should begin to feel better during the first few days of your treatment with ceftriaxone injection. If your symptoms do not improve or get
worse, call your doctor.
If you will be using more than one dose of ceftriaxone injection, use the medication until you finish the prescription, even if you feel better. If
you stop using ceftriaxone injection too soon or skip doses, your infection may not be completely treated and the bacteria may become
resistant to antibiotics.

Other uses for this medicine

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Ceftriaxone injection is also sometimes used to treat endocarditis (infection of the heart lining and valves), chancroid (genital sores caused
by bacteria), Lyme disease (an infection that is transmitted by tick bites that may cause problems with the heart, joints, and nervous system),
relapsing fever (an infection that is transmitted by tick bites that causes repeated episodes of fever), shigella (an infection that causes severe
diarrhea), typhoid fever (a serious infection that is common in developing countries), salmonella (an infection that causes severe diarrhea),
and Whipple's disease (a rare infection that causes serious problems with digestion). Ceftriaxone injection is also sometimes used to prevent
infection in people who have been sexually assaulted or who have been bitten by humans or animals. Talk to your doctor about the risks of
using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Return to top

Before using ceftriaxone injection,

tell your doctor and pharmacist if you are allergic to ceftriaxone injection, other cephalosporin or penicillin antibiotics, or any other
medications.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal
products you are taking or plan to take. Be sure to mention any intravenous medications or feedings that contain calcium such as
total parenteral nutrition (TPN, a liquid feeding that is given intravenously to people who cannot eat or digest food).

tell your doctor if you have or have ever had problems with your digestive system, especially colitis (inflammation of the large
intestine), malnutrition (you do not eat or cannot digest the nutrients needed for good health), or kidney or liver disease.

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using
ceftriaxone injection, call your doctor.

What special dietary instructions should I follow?

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Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

Return to top

Use the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your
regular dosing schedule. Do not use a double dose to make up for a missed one.

What side effects can this medication cause?

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Ceftriaxone injection may cause side effects. Tell your doctor if any of these symptoms
are severe or do not go away:

pain, tenderness, hardness, or warmth in the place where ceftriaxone was injected

headache

dizziness

sweating

flushing

diarrhea

Some side effects can be serious. If you experience any of these symptoms, call your
doctor immediately:

rash

bloody, watery stools

fever

stomach cramps

stomach pain or bloating

nausea and vomiting

heartburn

chest pain

Ceftriaxone injection may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What should I know about storage and disposal of this medication?

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If you will be injecting ceftriaxone injection at home, your health care provider will tell you where you should store it and how long you may
keep it. Follow these directions carefully. Be sure to store ceftriaxone in the container it came in and out of reach of children. Throw away any
medication that is outdated or no longer needed. Talk to your health care provider about the proper disposal of your medication.

In case of emergency/overdose
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In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local
emergency services at 911.

What other information should I know?

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Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to
ceftriaxone.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well
as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if
you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

Return to top

Rocephin
Last Revised - 03/16/2011
Browse Drugs and Medicines

American Society of Health-System Pharmacists, Inc. Disclaimer

AHFS Consumer Medication Information. Copyright, 2014. The American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda,
Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Ceftriaxone
http://www.drugs.com/cdi/ceftriaxone.html
Pronunciation

Generic Name: ceftriaxone (SEF-trye-AX-one in DEX-trose)

Brand Name: Rocephin

Ceftriaxone is used for:

Treating bacterial infections.
Ceftriaxone is a cephalosporin antibiotic. It works by interfering with the formation of the bacteria's cell wall so that the wall ruptures,
resulting in the death of the bacteria.

Do NOT use ceftriaxone if:

you are allergic to any ingredient in ceftriaxone or to any other cephalosporin antibiotic (eg, cephalexin, cefprozil)

the patient is a newborn (younger than 29 days old) with high blood bilirubin (hyperbilirubinemia) or jaundice

the patient is a newborn and is receiving or is expected to receive an intravenous (IV) medicine that contains calcium

Contact your doctor or health care provider right away if any of these apply to you.

Study produces some of the most concrete findings about how to add years to your life.

Before using ceftriaxone:

Tell your health care provider if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding

if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement

if you have allergies to medicines, foods, or other substances (including corn products)

if you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to a penicillin antibiotic
(eg, amoxicillin) or other beta-lactam antibiotic (eg, imipenem)

if you have diarrhea, stomach or bowel problems (eg, colitis, inflammation, infection), a blood clotting problem, gallbladder
disease, low vitamin K levels, poor nutrition, diabetes, or if you cannot tolerate carbohydrates

if you have a history of liver or kidney problems

if you are using a medicine or supplement that contains calcium

Some MEDICINES MAY INTERACT with ceftriaxone. Tell your health care provider if you are taking any other medicines, especially
any of the following:

Calcium-containing IV medicines (eg, parenteral nutrition, Ringer's solution) because severe and sometimes fatal lung and
kidney problems may occur, especially in newborns

Aminoglycosides (eg, gentamicin), anticoagulants (eg, warfarin), cyclosporine, or heparin because the risk of their side
effects may be increased by ceftriaxone

Certain live vaccines (BCG, oral typhoid) because ceftriaxone may decrease their effectiveness

This may not be a complete list of all interactions that may occur. Ask your health care provider if ceftriaxone may interact with other
medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use ceftriaxone:

Use ceftriaxone as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ceftriaxone is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using ceftriaxone at
home, a health care provider will teach you how to use it. Be sure you understand how to use ceftriaxone. Follow the
procedures you are taught when you use a dose. Contact your health care provider if you have any questions.

Ceftriaxone is light yellow to amber in color. Do not use ceftriaxone if it contains particles, is cloudy or discolored, or if the
vial or container is cracked or damaged in any way.

To clear up your infection completely, use ceftriaxone for the full course of treatment. Keep using it even if you feel better
in a few days.

Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes,
or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.

If you miss a dose of ceftriaxone, take it as soon as possible. If it is almost time for your next dose, skip the missed dose
and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use ceftriaxone.

Important safety information:

Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may
rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor
right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with
your doctor.
Ceftriaxone only works against bacteria; it does not treat viral infections (eg, the common cold).

A severe and sometimes fatal type of anemia (hemolytic anemia) has been reported in patients using cephalosporin
antibiotics, including ceftriaxone. Discuss any questions or concerns with your doctor. Contact your doctor right away if you
experience unusual tiredness or weakness, unusually pale skin, dizziness, fever or chills, severe back or stomach pain, or
yellowing of the eyes or skin.

Be sure to use ceftriaxone for the full course of treatment. If you do not, the medicine may not clear up your infection
completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to
treat in the future.

Long-term or repeated use of ceftriaxone may cause a second infection. Tell your doctor if signs of a second infection
occur. Your medicine may need to be changed to treat this.

Ceftriaxone may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking ceftriaxone.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits
and risks of using ceftriaxone while you are pregnant. Ceftriaxone is found in breast milk. If you are or will be breast-feeding
while you use ceftriaxone, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of ceftriaxone:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most
COMMON side effects persist or become bothersome:
Mild diarrhea; mild pain, swelling, or redness at the injection site; nausea; vomiting.
Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue);
bloody or watery stools; dizziness; fever or chills; seizures; severe diarrhea; severe or persistent stomach or back pain with nausea
and vomiting; stomach pain or cramps; unusual tiredness or weakness; unusually pale skin; vaginal irritation or discharge; yellowing
of the skin or eyes.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care
provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read
the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room
immediately. Symptoms may include muscle spasms; seizures.
Proper storage of ceftriaxone:
Ceftriaxone is usually handled and stored by a health care provider. If you are using ceftriaxone at home, store ceftriaxone as
directed by your pharmacist or health care provider. Keep ceftriaxone, as well as needles and syringes, out of the reach of children
and away from pets.

General information:

If you have any questions about ceftriaxone, please talk with your doctor, pharmacist, or other health care provider.

Ceftriaxone is to be used only by the patient for whom it is prescribed. Do not share it with other people.

If your symptoms do not improve or if they become worse, check with your doctor.

Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take ceftriaxone or any other medicine. Only your health care
provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any
medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general
information about ceftriaxone. It does NOT include all information about the possible uses, directions, warnings, precautions,
interactions, adverse effects, or risks that may apply to ceftriaxone. This information is not specific medical advice and does not
replace information you receive from your health care provider. You must talk with your healthcare provider for complete information
about the risks and benefits of using ceftriaxone.
Issue Date: March 5, 2014
Database Edition 14.1.1.003
Copyright 2014 Wolters Kluwer Health, Inc.

Lactated Ringers
Lactated Ringer's Injection USP
http://www.drugs.com/pro/lactated-ringers.html
Sodium Chloride USP 0.6 g; Sodium Lactate 0.31 g
Potassium Chloride USP 0.03 g; Calcium Chloride Dihydrate USP 0.02 g
Water for Injection USP qs
pH may be adjusted with Hydrochloric Acid NF or Sodium Hydroxide NF
pH: 6.2 (6.07.5) Calculated Osmolarity: 275 mOsmol/liter
Concentration of Electrolytes (mEq/liter): Sodium 130; Potassium 4; Calcium 3; Chloride 110; Lactate (CH3CH(OH)COO) 28
Lactated Ringer's Injection USP is sterile, nonpyrogenic and contains no bacteriostatic or antimicrobial agents. This product is
intended for intravenous administration in a single dose container.
The formulas of the active ingredients are:

Ingredients

Molecular Formula

Molecular Weight

NaCl

58.44

CH3CH(OH)COONa

112.06

KCl

74.55

CaCl22H2O

147.02

Sodium Chloride USP

Sodium Lactate
Potassium Chloride USP
Calcium Chloride Dihydrate USP
The EXCEL Container is Latex-free, PVC-free, and DEHP-free.

The plastic container is made from a multilayered film specifically developed for parenteral drugs. It contains no plasticizers and
exhibits virtually no leachables. The solution contact layer is a rubberized copolymer of ethylene and propylene. The container is
nontoxic and biologically inert. The container-solution unit is a closed system and is not dependent upon entry of external air during
administration. The container is overwrapped to provide protection from the physical environment and to provide an additional
moisture barrier when necessary.
Addition of medication should be accomplished using complete aseptic technique.
The closure system has two ports; the one for the administration set has a tamper evident plastic protector and the other is a
medication addition site. Refer to the Directions for Use of the container.

Lactated Ringers - Clinical Pharmacology

Lactated Ringer's Injection USP provides electrolytes and is a source of water for hydration. It is capable of inducing diuresis
depending on the clinical condition of the patient. This solution also contains lactate which produces a metabolic alkalinizing effect.
Sodium, the major cation of the extracellular fluid, functions primarily in the control of water distribution, fluid balance, and osmotic
pressure of body fluids. Sodium is also associated with chloride and bicarbonate in the regulation of the acid-base equilibrium of
body fluid. Potassium, the principal cation of intracellular fluid, participates in carbohydrate utilization and protein synthesis, and is
critical in the regulation of nerve conduction and muscle contraction, particularly in the heart.
Chloride, the major extracellular anion, closely follows the metabolism of sodium, and changes in the acid-base balance of the body
are reflected by changes in the chloride concentration. Calcium, an important cation, provides the framework of bones and teeth in
the form of calcium phosphate and calcium carbonate. In the ionized form, calcium is essential for the functional mechanism of the
clotting of blood, normal cardiac function, and regulation of neuromuscular irritability.
Sodium lactate is a racemic salt containing both the levo form, which is oxidized by the liver to bicarbonate, and the dextro form,
which is converted to glycogen. Lactate is slowly metabolized to carbon dioxide and water, accepting one hydrogen ion and resulting
in the formation of bicarbonate for the lactate consumed. These reactions depend on oxidative cellular activity.

Indications and Usage for Lactated Ringers

This solution is indicated for use in adults and pediatric patients as a source of electrolytes and water for hydration.

Contraindications
This solution is contraindicated where the administration of sodium, potassium, calcium, lactate, or chloride could be clinically
detrimental.
Lactate administration is contraindicated in severe metabolic acidosis or alkalosis, and in severe liver disease or anoxic states which
affect lactate metabolism.

Warnings
Solutions containing lactate are not for use in the treatment of lactic acidosis.
Solutions containing lactate should be used with great care in patients with metabolic or respiratory alkalosis, and in those
conditions in which there is an increased level or an impaired utilization of lactate, such as severe hepatic insufficiency.
The administration of intravenous solutions can cause fluid and/or solute overload resulting in dilution of serum electrolyte
concentrations, overhydration, congested states or pulmonary edema. The risk of dilutional states is inversely proportional to the
electrolyte concentration. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly
proportional to the electrolyte concentration.
Solutions containing sodium ions should be used with great care, if at all, in patients with congestive heart failure, severe renal
insufficiency, and in clinical states in which there is sodium retention with edema.
Solutions containing potassium ions should be used with great care, if at all, in patients with hyperkalemia, severe renal failure, and
in conditions in which potassium ions retention is present.
In patients with diminished renal function, administration of solutions containing sodium or potassium ions may result in sodium or
potassium retention.

Solutions containing calcium ions should not be administered through the same administration set as blood because of the likelihood
of coagulation.

Precautions
General
This solution should be used with care in patients with hypervolemia, renal insufficiency, urinary tract obstruction, or impending or
frank cardiac decompensation.
Extraordinary electrolytes losses such as may occur during protracted nasogastric suction, vomiting, diarrhea or gastrointestinal
fistula drainage may necessitate additional electrolyte supplementation.
Additional essential electrolytes, minerals and vitamins should be supplied as needed.
Sodium-containing solutions should be administered with caution to patients receiving corticosteroids or corticotropin, or to other
salt-retaining patients.
Care should be exercised in administering solutions containing sodium or potassium to patients with renal or cardiovascular
insufficiency, with or without congestive heart failure, particularly if they are postoperative or elderly.
Potassium therapy should be guided primarily by serial electrocardiograms, especially in patients receiving digitalis. Serum
potassium levels are not necessarily indicative of tissue potassium levels.
Solutions containing calcium should be used with caution in the presence of cardiac disease, particularly when accompanied by
renal disease. Parenteral calcium should be administered with extreme caution to patients receiving digitalis preparations.
Solutions containing lactate should be used with caution. Excess administration may result in metabolic alkalosis.
The conversion of lactate to bicarbonate is markedly delayed in the presence of tissue anoxia and reduced capacity of the liver to
metabolize lactate. This may occur under conditions such as metabolic acidosis associated with circulatory insufficiency,
extracorporeal circulation, hypothermia, glycogen storage disease, liver dysfunction, respiratory alkalosis, shock or cardiac
decompensation.
To minimize the risk of possible incompatibilities arising from mixing this solution with other additives that may be prescribed, the
final infusate should be inspected for cloudiness or precipitation immediately after mixing, prior to administration, and periodically
during administration.
Do not use plastic container in series connection.
If administration is controlled by a pumping device, care must be taken to discontinue pumping action before the container runs dry
or air embolism may result. If administration is not controlled by a pumping device, refrain from applying excessive pressure
(>300mmHg) causing distortion to the container such as wringing or twisting. Such handling could result in breakage of the
container.
This solution is intended for intravenous administration using sterile equipment. It is recommended that intravenous administration
apparatus be replaced at least once every 24 hours.
Use only if solution is clear and container and seals are intact.

Laboratory Tests
Clinical evaluation and periodic laboratory determinations are necessary to monitor changes in fluid balance, electrolyte
concentrations, and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such
evaluation. Significant deviations from normal concentrations may require tailoring of the electrolyte pattern, in this or an alternative
solution.

Drug Interactions
Some additives may be incompatible. Consult with pharmacist. When introducing additives, use aseptic techniques. Mix thoroughly.
Do not store.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Studies with Lactated Ringer's Injection USP have not been performed to evaluate carcinogenic potential, mutagenic potential, or
effects on fertility.

Pregnancy
Teratogenic Effects
Pregnancy Category C. Animal reproduction studies have not been conducted with Lactated Ringer's Injection USP. It is also not
known whether Lactated Ringer's Injection USP can cause fetal harm when administered to a pregnant woman or can affect
reproduction capacity. Lactated Ringer's Injection USP should be given to a pregnant woman only if clearly needed.

Labor and Delivery

As reported in the literature, Lactated Ringer's Injection USP has been administered during labor and delivery. Caution should be
exercised, and the fluid balance, glucose and electrolyte concentrations, and acid-base balance, of both mother and fetus should be
evaluated periodically or whenever warranted by the condition of the patient or fetus.

Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be
exercised when Lactated Ringer's Injection USP is administered to a nursing woman.

Pediatric Use
Safety and effectiveness of Lactated Ringer's Injection USP in pediatric patients have not been established by adequate and well
controlled trials, however, the use of electrolyte solutions in the pediatric population is referenced in the medical literature. The
warnings, precautions, and adverse reactions identified in the label copy should be observed in the pediatric population.

Geriatric Use
Clinical studies of Lactated Ringer's Injection USP did not include sufficient numbers of subjects aged 65 and over to determine
whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in
responses between the elderly and younger patients.

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the
greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Adverse Reactions
Allergic reactions or anaphylactoid symptoms such as localized or generalized urticaria and pruritus; periorbital, facial, and/or
laryngeal edema; coughing, sneezing, and/or difficulty with breathing have been reported during administration of Lactated Ringer's
Injection USP. The reporting frequency of these signs and symptoms is higher in women during pregnancy.
Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site
of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation and hypervolemia.
Symptoms may result from an excess or deficit of one or more of the ions present in the solution; therefore, frequent monitoring of
electrolyte levels is essential.
Hypernatremia may be associated with edema and exacerbation of congestive heart failure due to the retention of water, resulting in
an expanded extracellular fluid volume.
Reactions reported with the use of potassium-containing solutions include nausea, vomiting, abdominal pain and diarrhea. The
signs and symptoms of potassium intoxication include paresthesias of the extremities, areflexia, muscular or respiratory paralysis,
mental confusion, weakness, hypotension, cardiac arrhythmias, heart block, electrocardiographic abnormalities and cardiac arrest.
Potassium deficits result in disruption of neuromuscular function, and intestinal ileus and dilatation.
If infused in large amounts, chloride ions may cause a loss of bicarbonate ions, resulting in an acidifying effect.
Abnormally high plasma levels of calcium can result in depression, amnesia, headaches, drowsiness, disorientation, syncope,
hallucinations, hypotonia of both skeletal and smooth muscles, dysphagia, arrhythmias and coma. Calcium deficits can result in
neuromuscular hyperexcitability, including cramps and convulsions.
Although the metabolism of lactate to bicarbonate is a relatively slow process, aggressive administration of sodium lactate may
result in metabolic alkalosis. Careful monitoring of blood acid-base balance is essential during the administration of sodium lactate.
The physician should also be alert to the possibility of adverse reactions to drug additives. Prescribing information for drug additives
to be administered in this manner should be consulted.
If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures
and save the remainder of the fluid for examination if deemed necessary.

Overdosage
In the event of a fluid or solute overload during parenteral therapy, reevaluate the patient's condition and institute appropriate
corrective treatment.
In the event of overdosage with potassium-containing solutions, discontinue the infusion immediately and institute corrective therapy
to reduce serum potassium levels.
Treatment of hyperkalemia includes the following:
1.

Dextrose Injection USP, 10% or 25%, containing 10 units of crystalline insulin per 20 grams of dextrose administered
intravenously, 300 to 500 mL per hour.

2.
3.

Absorption and exchange of potassium using sodium or ammonium cycle cation exchange resin, orally and as retention
enema.

Hemodialysis and peritoneal dialysis. The use of potassium-containing foods or medications must be eliminated. However,
in cases of digitalization, too rapid a lowering of plasma potassium concentration can cause digitalis toxicity.

Lactated Ringers Dosage and Administration

This solution is for intravenous use only.
Dosage is to be directed by a physician and is dependent upon age, weight, clinical condition of the patient and laboratory
determinations. Frequent laboratory determinations and clinical evaluation are essential to monitor changes in blood glucose and
electrolyte concentrations, and fluid and electrolyte balance during prolonged parenteral therapy.
Fluid administration should be based on calculated maintenance or replacement fluid requirements for each patient.
The presence of calcium ions in this solution should be considered when phosphate is present in additive solutions, in order to avoid
precipitation.
Some additives may be incompatible. Consult with pharmacist. When introducing additives, use aseptic techniques. Mix thoroughly.
Do not store.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever
solution and container permit.

How is Lactated Ringers Supplied

Lactated Ringer's Injection USP is supplied sterile and nonpyrogenic in EXCEL Containers. The 1000 mL containers are packaged
12 per case, the 500 mL and 250 mL containers are packaged 24 per case.

NDC

Cat. No.

Size

0264-7750-00

L7500

1000 mL

0264-7750-10

L7501

500 mL

0264-7750-20

L7502

250 mL

Lactated Ringer's Injection USP

(Canada DIN 01931636)

Exposure of pharmaceutical products to heat should be minimized. Avoid excessive heat. Protect from freezing. It is recommended
that the product be stored at room temperature (25C); however, brief exposure up to 40C does not adversely affect the product.
Rx only
Revised: December 2009
EXCEL is a registered trademark of B. Braun Medical Inc.

Directions for Use of EXCEL Container

Caution: Do not use plastic container in series connection.

To Open
Tear overwrap down at notch and remove solution container. Check for minute leaks by squeezing solution container firmly. If leaks
are found, discard solution as sterility may be impaired. If supplemental medication is desired, follow directions below before
preparing for administration.
NOTE: Before use, perform the following checks:
o
o
o

Inspect each container. Read the label. Ensure solution is the one ordered and is within the expiration date.
Invert container and carefully inspect the solution in good light for cloudiness, haze, or particulate matter. Any container
which is suspect should not be used.
Use only if solution is clear and container and seals are intact.
Preparation for Administration

1.
2.

Remove plastic protector from sterile set port at bottom of container.

Attach administration set. Refer to complete directions accompanying set.
To Add Medication
Warning: Some additives may be incompatible.
To Add Medication Before Solution Administration

1.
2.
3.

Prepare medication site.

Using syringe with 1822 gauge needle, puncture medication port and inner diaphragm and inject.
Squeeze and tap ports while ports are upright and mix solution and medication thoroughly.
To Add Medication During Solution Administration

1.
2.
3.
4.
5.
6.
7.

Close clamp on the set.

Prepare medication site.
Using syringe with 1822 gauge needle of appropriate length (at least 5/8 inch), puncture resealable medication port and
inner diaphragm and inject.
Remove container from IV pole and/or turn to an upright position.
Evacuate both ports by tapping and squeezing them while container is in the upright position.
Mix solution and medication thoroughly.
Return container to in use position and continue administration.
B. Braun Medical Inc.
Irvine, CA 92614-5895 USA
Made in USA
In Canada, distributed by:
B. Braun Medical Inc.
Scarborough, Ontario M1H 2W4
Y36-002-714

PRINCIPAL DISPLAY PANEL - 1000 mL Container Label

Lactated Ringer's
Injection USP
REF L7500
NDC 0264-7750-00
DIN 01931636
HK 22614
1000 mL
EXCEL CONTAINER
Each 100 mL contains:
Sodium Chloride USP 0.6 g
Sodium Lactate 0.31 g
Potassium Chloride USP 0.03 g
Calcium Chloride2H2O USP 0.02 g
Water for Injection USP qs
pH may be adjusted with HCl NF or NaOH NF
pH: 6.2 (6.0-7.5)
Calc. Osmolarity: 275 mOsmol/liter
Electrolytes (mEq/liter): Na+ 130
Ca++ 3

Cl 110

K+ 4

Lactate 28

Sterile, nonpyrogenic. Single dose container.

Do not administer simultaneously with blood.
Do not use in series connection.
For intravenous use only. Use only if solution is clear
and container and seals are intact.
WARNINGS: NOT FOR USE IN THE TREATMENT OF
LACTIC ACIDOSIS. Some additives may be
incompatible. Consult with pharmacist. When
introducing additives, use aseptic techniques.
Mix thoroughly. Do not store.
Recommended Storage:
Room temperature (25C). Avoid excessive heat.
Protect from freezing. See Package Insert.

Rx only

EXCEL is a registered trademark

of B. Braun Medical Inc.
B. Braun Medical Inc.
Irvine, CA 92614-5895 USA
1-800-227-2862
www.bbraun.com
Made in USA
In Canada, distributed by:
B. Braun Medical Inc.
Scarborough, Ontario M1H 2W4
Y94-003-035
LD-144-2
Do not remove overwrap until ready for use. After
removing the overwrap, check for minute leaks by
squeezing container firmly. If leaks are found,
discard solution as sterility may be impaired.
LOT
EXP

PRINCIPAL DISPLAY PANEL - 500 mL Container Label

Lactated Ringer's
Injection USP
REF L7501
NDC 0264-7750-10
DIN 01931636
HK 22614
500 mL
EXCEL CONTAINER
Each 100 mL contains: Sodium Chloride USP 0.6 g
Sodium Lactate 0.31 g; Potassium Chloride USP 0.03 g
Calcium Chloride2H2O USP 0.02 g; Water for Injection USP qs
pH may be adjusted with HCl NF or NaOH NF
pH: 6.2 (6.0-7.5)
Calc. Osmolarity: 275 mOsmol/liter
Electrolytes (mEq/liter): Na+ 130
Cl 110

K+ 4

Ca++ 3

Lactate 28

Sterile, nonpyrogenic. Single dose container.

Do not administer simultaneously with blood.
Do not use in series connection. For intravenous use only.
Use only if solution is clear and container and seals are intact.

WARNINGS: NOT FOR USE IN THE TREATMENT OF LACTIC ACIDOSIS. Some

additives may be incompatible. Consult with pharmacist. When introducing
additives, use aseptic techniques. Mix thoroughly. Do not store.
Recommended Storage: Room temperature (25C). Avoid excessive heat.
Protect from freezing. See Package Insert.

Rx only

EXCEL is a registered trademark of B. Braun Medical Inc.

B. Braun Medical Inc.
Irvine, CA 92614-5895 USA
1-800-227-2862
www.bbraun.com Made in USA
In Canada, distributed by:
B. Braun Medical Inc.
Scarborough, Ontario M1H 2W4
Y94-003-036
LD-143-2
Do not remove overwrap until ready for use. After removing the overwrap,
check for minute leaks by squeezing container firmly. If leaks are found,
discard solution as sterility may be impaired.
LOT
EXP

PRINCIPAL DISPLAY PANEL - 250 mL Container Label

Lactated Ringer's
Injection USP
REF L7502
NDC 0264-7750-20
DIN 01931636
HK 22614
250 mL
EXCEL CONTAINER
Each 100 mL contains: Sodium Chloride USP 0.6 g;
Sodium Lactate 0.31 g; Potassium Chloride USP 0.03 g;
Calcium Chloride2H2O USP 0.02 g;
Water for Injection USP qs
pH may be adjusted with HCl NF or NaOH NF
pH: 6.2 (6.0-7.5) Calc. Osmolarity: 275 mOsmol/liter
Electrolytes (mEq/liter): Na+ 130
Ca++ 3 Cl 110 Lactate 28

K+ 4

Sterile, nonpyrogenic. Single dose container.

Do not administer simultaneously with blood.
Do not use in series connection. For intravenous use only.
Use only if solution is clear and container and seals are intact.
WARNINGS: NOT FOR USE IN THE TREATMENT OF LACTIC
ACIDOSIS. Some additives may be incompatible. Consult
with pharmacist. When introducing additives, use aseptic
techniques. Mix thoroughly. Do not store.
Recommended Storage: Room temperature (25C). Avoid
excessive heat. Protect from freezing. See Package Insert.

Rx only

EXCEL is a registered trademark of B. Braun Medical Inc.

B. Braun Medical Inc.
Irvine, CA 92614-5895 USA
1-800-227-2862 www.bbraun.com
Made in USA
In Canada, distributed by:
B. Braun Medical Inc.
Scarborough, Ontario M1H 2W4
Y94-003-037
LD-142-2
Do not remove overwrap until ready for use. After
removing the overwrap, check for minute leaks by
squeezing container firmly. If leaks are found, discard
solution as sterility may be impaired.
LOT
EXP

Lactated Ringers
sodium chloride, sodium lactate, potassium chloride, and calcium chloride injection, solution
Product Information
Product Type

HUMAN PRESCRIPTION DRUG

LABEL

Item Code (Source)

Route of Administration

INTRAVENOUS

DEA Schedule

NDC:02647750

Active Ingredient/Active Moiety

Ingredient Name

Basis of Strength

Strength

SODIUM CHLORIDE (SODIUM CATION)

SODIUM CHLORIDE

0.6 g in 100 mL

SODIUM LACTATE (LACTIC ACID)

SODIUM LACTATE

0.31 g in 100 mL

POTASSIUM CHLORIDE (POTASSIUM CATION)

POTASSIUM CHLORIDE

0.03 g in 100 mL

CALCIUM CHLORIDE (CALCIUM CATION)

CALCIUM CHLORIDE

0.02 g in 100 mL

Inactive Ingredients
Ingredient Name

Strength

WATER

Packaging
#Item Code

Package Description

1NDC:0264-7750-00

12 CONTAINER (12 CONTAINER) in 1 CASE

1000 mL in 1 CONTAINER

2NDC:0264-7750-10

24 CONTAINER (24 CONTAINER) in 1 CASE

500 mL in 1 CONTAINER

3NDC:0264-7750-20

24 CONTAINER (24 CONTAINER) in 1 CASE

250 mL in 1 CONTAINER

Marketing Information

Marketing
Category

Application Number or Monograph

Citation

Marketing Start
Date

NDA

NDA019632

02/29/1988

Labeler -

B. Braun Medical Inc. (002397347)

Revised: 07/2012

B. Braun Medical Inc.

Marketing End
Date

ringers-lactated ringers solution-intravenous

http://www.medicinenet.com/ringers-lactated_ringers_solutionintravenous/article.htm
GENERIC NAME: RINGERS/LACTATED RINGERS SOLUTION - INTRAVENOUS (RING-ers; LACKtay-ted RING-ers)
Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes |Missed Dose | Storage
USES: This medication is an intravenous (IV) solution used to supply water and electrolytes (e.g., calcium, potassium, sodium,
chloride), either with or without calories (dextrose), to the body. It is also used as a mixing solution (diluent) for other IV medications.
HOW TO USE: Give this medication by vein (IV), as directed by you doctor. The dosage is based on your medical condition and
response to therapy. Follow all instructions for proper mixing with other IV medications. Ask your pharmacist if you have any
questions regarding the use of this medication. This medication should be checked visually for particles or discoloration before use.
If either is present, do not use the liquid. Learn how to store and discard needles and medical supplies safely. Consult your
pharmacist.

SIDE EFFECTS: Redness or pain at the injection site may occur. If any of these effects persist or worsen, contact your doctor or
pharmacist promptly. Tell your doctor immediately if any of these unlikely but serious side effects occur: fever, trouble breathing,
swelling. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Tell your doctor your medical history, especially of: diabetes, heart problems, kidney problems, liver problems, high
levels of potassium (hyperkalemia), high levels of sodium (hypernatremia), acid/base problems (e.g., acidosis, alkalosis), swelling
(edema), allergies (especially drug allergies). Caution is advised when using this drug in infants since they may be more sensitive to
the effects of the drug. Tell your doctor if you are pregnant before using this medication. It is unknown if this medication passes
into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Tell your doctor of all prescription and nonprescription medication you may use, especially of: water pills
(e.g., furosemide, hydrochlorothiazide), corticotropin (adrenocorticotropic hormone), corticosteroids (e.g., prednisone,
hydrocortisone), digoxin. Do not start or stop any medicine without doctor or pharmacist approval.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can
call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.
Symptoms of overdose include trouble breathing, or swelling.
NOTES: Do not share this medication with others. Laboratory and/or medical tests may be performed to monitor for side effects and
response to treatment.
MISSED DOSE: If you miss a dose, contact your doctor or pharmacist immediately to establish a new dosing schedule. If the dose
is interrupted, contact your doctor or pharmacist immediately to establish a new dosing schedule.
STORAGE: Store at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from light and moisture. Consult
your pharmacist for details about stability and storage after mixing with other IV medications. Discard any unused liquid.
Last Editorial Review: 3/2/2005

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