Injectable drugs DINJACSA5V ACETYLSALICYLAT LYSINE, 0.9 g (aspirin 0.5 g), powder vial Injectable analgesic, antipyretic, anti inflammatory. Not in the WHO Essential Medicines list 2002. Action is rapid, intense and prolonged (6 hours). Used particularly in French-speaking countries. 0.9g of acetylsalicylic lysine corresponds to 500mg of acetylsalicylic acid. DINJAMIN2A AMINOPHYLLINE, 25 mg/ml, 10 ml, amp. Injectable bronchodilator. Storage: Keep cool (between 8 C and 15 C). DINJAMPI1V DINJAMPI5V AMPICILLIN, 1 g, im/iv, powder vial AMPICILLIN, 500mg, im/iv, powder vial Injectable antibacterial (antibiotic) in the penicillins group, broad spectrum. The injectable powder is the same, whatever the method of injection indicated on the vial. Some dilutants accompanying the vials contain Lidocaine for IM injections. Once the solution has been reconstituted with such a dilutant, it cannot be used for IV. If the vials of powder are reconstituted with sterile water, they may be administered either IM or IV. Dosage of ampicillin and amoxycilline by parenteral route is the same, unlike the oral doses. Injectable ampicillin is preferred because of its greater stability and lower cost. The 1g strength is preferable, since this makes the treatment less expensive. Storage: Keep cool (between 8 C and 15 C).. Once the powder has dissolved, the solution should be clear and must be used the same day. Diluted in a infusion of glucose, ampicillin remains stable for 6 hours ; 12 hours in sodium chloride. It is best to inject it directly into the drip tubing. Drugs 39
DINJATRO1A ATROPINE SULFATE, 1 mg/ml, 1 ml, amp. DINJATRO5A ATROPINE SULFATE, 0.5 mg/ml, 1 ml, amp. Injectable antispasmodic, parasympatholytic. In the WHO Essential Medicines list 2002 (1mg). Storage: No special precautions as regards temperature. DINJBUPI5V2 BUPIVACAINE 0.5%, 5 mg/ml, 20 ml, vial Injectable long action local anaesthetic Should be strictly limited to surgical missions with an anaesthetist and ophthalmological missions. Used for local/regional, plexus and epidural anaesthesia and ophthalmology. Has a longer action than lidocaine (1-3 hours). Recommended concentration: 0.5% (normobaric). Can easily be diluted to obtain a 0.25% concentration. NF (Do not freeze). See introductory remarks concerning the heat sensitive items. Do not reuse an opened vial. DINJBUPI5AH BUPIVACAINE, heavy, 0.5% (5 mg/ml), 4 ml, amp. for spinal anaesthesia Injectable local anaesthetic for epidural / spinal anaesthesia 0.5% Bupivicaine in hyperbaric glucose solution. Strictly reserved for epidural and spinal anaesthesia (longer acting time than lidocaine). 40 Drugs
DINJBUTY2A BUTYLHYOSCINE (butylscopolamine), 20 mg/ml, 1 ml, amp. Injectable parasympatholytic, antispasmodic. Not in the WHO Essential Medicines list 2002. Also called: Butylscopolamine or Hyoscine Butylbromide. Storage: No special precautions as regards temperature. DINJCALG1A CALCIUM GLUCONATE, 100 mg/ml, 10 ml, amp. Injectable calcium for emergencies Calcium supply for an emergency calcitherapy. Indications are extremely limited in the field without blood biochemistry data. 1g (2.23mmol) calcium gluconate (100mg/ml, 10 ml) corresponds to 89.41mg calcium. DINJCEFT2V CEFTRIAXONE, 250mg, powder, vial Injectable antibiotic Cephalosporine of third generation, used in meningitis and severe infections resistant to first-line antibacterials. Very expensive. Some solvents for IM injections contain lidocaïne: the prepared solution with these solvents may not be used for IV injections and can be contra-indicated for young children. See national protocols and national lists of essential drugs. Drugs 41
DINJCHLM5A CHLORPROMAZINE, 25 mg/ml, 2 ml, amp. Injectable sedative and anti-emetic neuroleptic. C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. DINJCHLO1V CHLORAMPHENICOL, 1 g, powder, vial Injectable antibiotic Once the powder has dissolved, the solution should be clear and must be used the same day. DINJCHLO5AO CHLORAMPHENICOL in oil, 250 mg/ml, 2 ml, amp. Injectable long acting antibiotic (for meningitis) Antibacterial (antibiotic) with prolonged action (several weeks), oily solution only to be given IM. Should be used only for mass treatment meningitis epidemics. Product made by a very limited number of manufacturers. Check availability before it becomes urgent Shake the suspension before use. 42 Drugs
DINJCHLQ2A CHLOROQUINE PHOSPHATE, 40 mg base/ml, 5 ml, amp. Injectable antimalarial See introductory remarks on bases and salts ; there is no confusion in the case of the injectable forms, however, since the dosages are expressed in terms of base throughout the world. N.B. There is also a 50mg base/ml strength. Used mainly in English-speaking countries. Contraindicated in children under 5. Beware of abusive prescription. Change to oral therapy as soon as possible. When malaria must be treated by injection, use Quinine if available. Storage: No special precautions as regards temperature. DINJCLOX2V DINJCLOX5V CLOXACILLIN, 250 mg, powder, vial CLOXACILLIN, 500 mg, powder, vial Injectable antibiotic Against penicillase producing staphylococci Storage: Keep cool. Once the powder has dissolved, the solution should be clear and must be used the same day. DINJDEXA4A DEXAMETHASONE PHOSPHATE, 4 mg/ml, 1 ml, amp. Injectable corticosteroid Also comes in 1ml ampoule containing Dexamethasone sodium phosphate 5mg, equivalent to Dexamethasone phosphate 4.55mg. Storage: Keep cool if possible. Drugs 43
DINJDIAZ1A DIAZEPAM, 5 mg/ml, 2 ml, amp. Injectable anxiolytic, sedative, anticonvulsant, muscular relaxant C1 (Always controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. For IV administration diazepam should be diluted (a) because of its toxicity to veins and (b) to adjust the dose in line with the effect desired. Storage: No special precautions as regards temperature. DINJDICL7A DICLOFENAC SODIUM, 25 mg/ml, 3 ml, amp. Injectable non-steroid anti-inflammatory, analgesic, antipyretic Not in the WHO Essential Medicines list 2002. For infusion in glucose 5% or sodium chloride 0.9% solution, add 0.5ml of Sodium bicarbonate 8.4% per 500ml of solution. DINJDIGO5A DIGOXIN, 0.25 mg/ml, 2 ml, amp. Injectable antiarythmicum cardiotonic Storage: No special precautions as regards temperature. 44 Drugs
DINJEPHE3A EPHEDRINE, 30 mg/ml, 1 ml, amp. Injectable sympathomimetic C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Used to treat hypotension induced by regional (spinal & epidural) anaesthesia. Should be limited to surgical missions with an anaesthetist. Supplied as 1ml ampoule containing 30mg. To be diluted in 10ml glucose 5% or sodium chloride 0.9% to obtain a solution containing 3mg ephedrine per ml. Warning: confusion between Ephedrine and Epinephrine is frequent due to similar spelling. DINJEPIN1A EPINEPHRINE (adrenaline), 1 mg/ml, 1 ml, amp. Injectable sympathomimetic Sensitive to light and heat; dispose of ampoules whose contents have turned pink or brown. Warning: confusion between Ephedrine and Epinephrine is frequent due to similar spelling. Storage: Keep cool (between 8 C and 15 C). Drugs 45
DINJERGM2A DINJERGM5A METHYLERGOMETRINE, 0.2 mg/ml, 1 ml, amp. ERGOMETRINE, 0.5 mg/ml, 1 ml, amp. Injectable uterine contraction drug C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Some makes are very sensitive and deteriorate rapidly. There is no significant difference in activity or stability between ergometrine and methylergometrine. Only one of the two dosages is sufficient. Choose Methylergometrine 0.2mg/ml, by slow IV injection. Avoid any exposure whatsoever to light. * (Slightly sensitive items). See introductory remarks concerning the heat sensitive items. Storage: Keep refrigerated between + 2 to + 8 C. Do not freeze. If the drug is kept unrefrigerated, use it during one year of its arrival. The glass of the ampoules should be coloured brown. If the colour of the solution, which normally ranges from white to pink, becomes yellow/green, the drug has deteriorated and lost its effectiveness. DINJFENT1A FENTANYL, 0.05mg/ml, 2 ml, amp. Injectable analgesic for surgical and diagnostic interventions Not in the WHO Essential Medicines list 2002. C1 (Always controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Centrally acting opioid analgesic Central analgesic: a very powerful narcotic which does not figure on the WHO list of essential drugs. Distribution should be controlled as under hospital conditions (using a narcotics register, or recording amounts in and out, and keeping it under lock and key). Should be limited strictly to surgical missions with an anaesthetist. Storage: DINJFURO2A FUROSEMIDE, 10 mg/ml, 2 ml, amp. Injectable diuretic Synonym: Frusemide. 46 Drugs
DINJGENT8A GENTAMYCINE, 40 mg/ml, 2 ml, amp. Injectable antibiotic (aminoglycosides). Supplied only in 80mg ampoules (40mg/ml, 2ml) for logistical reasons. Paediatric indications are rare and should be kept that way. A dilute solution can be kept for 24 hours in the refrigerator. Provided it is used for the same patient. When using plastic syringes, inject immediately after preparation. The solution should be clear. DINJGLUC5A2 GLUCOSE HYPER, 50%, 20 ml, amp. Intravenous glucose for energy supplementation Hypertonic solution. Do not confuse with Glucose 5% isotonic solution. DINJHYDA2A HYDRALAZINE, 20 mg, powder, amp. Intravenous antihypertensive acting on the vasodilatory system Strictly for hospital use only. For infusion, use Sodium chloride 0.9% or Ringer lactate solution, other infusion fluids inactivate Hydralazine. Do not use other forms of hydralazine, particularly solutions. The lyophilised form is more stable than the solution. Hydralazine (e.g. Apresoline ) and dihydralazine (e.g. Nepressol ) are used for the same indications and at the same dosage. Drugs 47
DINJHYDR1V HYDROCORTISONE, 100 mg, powder, vial Intravenous corticosteroid Hydrocortisone salt as phosphate, succinate or hemisuccinate to be dissolved in water for injection. Remark: Hydrocortisone acetate is a suspension insoluble in water, used as a local treatment only. DINJINSH10VI INSULIN, INTERMEDIATE ACTION, 100 IU/ml, human, 10 ml, vial Subcutaneus antidiabetic insulin Pancreatic hormone, antidiabetic. The type of insulin (short-acting, intermediate acting, long acting) used depends on the type of diabetes, patient s age and blood glucose level. Human insulins are preferred for cultural and medical reasons. Should be supplied together with calibrated syringe for 100 IU insulin. Appearance: opalescent suspension. Warning: Some countries may still be used to the former presentation: 40 IU/ml, although this presentation is not recommended anymore. Storage: To be kept refrigerated between + 2 to + 8 C. Do not freeze. DINJINSH10VR INSULIN, RAPID, 100 IU/ml, human, 10 ml, vial Intravenous / Subcutaneus antidiabetic insulin The type of insulin (short-acting, intermediate acting, long acting) used depends on the type of diabetes, patient s age and blood glucose level. Preparations of human or animal origin have generally the same hypoglycaemic effect. Human insulins are more expensive than porcine origin insulins, but they are sometimes preferred for cultural or medical reasons. Should be supplied together with calibrated syringe for 100 IU insulin. Appearance: clear suspension. Warning: Some countries may still be used to the former presentation: 40 IU/ml, although this presentation is not recommended anymore. Storage: To be kept refrigerated between + 2 to + 8 C. Do not freeze. 48 Drugs
DINJKETA5V KETAMINE, 50 mg/ml, 10 ml, vial Intramuscular, intravenous, general anaesthetic C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Basic anaesthetic in developing countries. General anaesthetic, involving risk of arterial hypertension, hallucinations and salivary hypersecretion. Preferably used with atropine sulphate and diazepam (In Guide Anesthésie Réanimation Transfusion en situation d isolement, MSF). Ketamine has no myorelaxant properties. Keep away from light. Some ketamines do not withstand heat very well, and lose their therapeutic value (but without any decrease in their side-effects!). Distribution should be controlled as under hospital conditions (using a narcotics register or recording amounts in and out and keeping it under lock and key). Should be limited strictly to surgical missions with an anaesthetist. Storage: No special precautions as regards temperature. DINJLIDO1V2 LIDOCAINE, 1%, 20 ml, vial Injectable local anaesthetic Synonym: Xylocaine. Do not buy the 50ml vials (repeated perforation can cause contamination and poor conservation). The 1% strength has been chosen because it passes into the tissues more readily. DINJLIDO2CE1 LIDOCAINE 2%, + EPINEPHRINE 1/80000, 1.8 ml, cart. Injectable local (dental) anaesthetic Syringe cartridge for use in dental anaesthesia. Storage: Keep in a cool place (8 to 15 C). Protect from light. Drugs 49
DINJLIDO2VE2 LIDOCAINE 2%, + EPINEPHRINE 1/80000, 20 ml, vial Injectable local anaesthetic Synonym: Xylocaine with Epinephrine. Do not buy the 50ml vials (repeated perforation can cause contamination and poor conservation). Epinephrine added to Lidocaine prolongs anaesthesia. Never use solutions for the anaesthesia of fingers or extremities: risk of ischemia and necrosis. Storage: Keep in a cool place (8 to 15 C). Protect from light. DINJLIDO5VH LIDOCAINE, heavy, 5%, 2 ml amp. for spinal anaesthesia Injectable local/regional anaesthetic Presentation: 100mg in 2ml ampoules (50mg/ml): 5% lidocaine in hyperbaric glucose solution, for injection into the cerebrospinal fluid. Should be limited strictly to spinal anaesthesia. Storage: Temperature below 30 C. (In Guide Essential Drugs and Anesthésie Réanimation Transfusion en situation d isolement, MSF). DINJMAGS5V MAGNESIUM SULFATE, 0.5 g/ml, 10 ml, vial Injectable anticonvulsant (only by parenteral route) especially in eclampsia 10ml ampoule (0.5g/ml) contains 5g Magnesium sulphate. 1g Magnesium sulphate contains 4mmol = 8.1 meq magnesium. To avoid fatal overdosage give Calcium gluconate by IV injection. 50 Drugs
DINJMEDR1V MEDROXYPROGESTERONE ACETATE, 150mg, vial Injectable hormone contraceptive long-acting Added when setting up birth control programmes. Follow and check with the national protocols. DINJMETO1A METOCLOPRAMIDE, 5 mg/ml, 2 ml, amp. Injectable antiemetic Do not forget that it is essential to treat the cause of the vomiting and that this drug is not without its side-effects. DINJMORP1A MORPHINE, 10 mg/ml, 1 ml, amp. Injectable strong pain killer, narcotic C1 (Always controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Central analgesic: a very powerful narcotic. Distribution should be controlled as under hospital conditions (using a narcotics register, or recording amounts in and out, and keeping it under lock and key). Should be limited strictly to surgical missions with an anaesthetist. Storage: DINJNALO4A NALOXONE, 0.4 mg/ml, 1 ml, amp. Injectable specific opioid antagonist C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Should be limited strictly to surgical missions with an anaesthetist. Storage: Drugs 51
DINJNEOS5A NEOSTIGMINE METHYLSULFATE, 0.5 mg/ml, 1 ml, amp. Injectable cholinesterase inhibitor, antidote of non-depolarising muscle relaxants Used in anaesthetic procedure Cholinesterase inhibitor, antidote of non-depolarising muscle relaxants Should be limited strictly to surgical missions with an anaesthetist. Should always be used in conjunction with atropine sulphate which enables to avoid or to reduce the cholinergic effects of neostigmine. Storage: DINJOXYT1A OXYTOCIN, 10 IU/ml, 1 ml, amp. Injectable uterine contraction stimulator Should be prescribed only by obstetricians, midwives and doctors with experience of it in a hospital situation. Storage: Keep refrigerated between + 2 to + 8 C. Do not freeze. If the drug is kept unrefrigerated, use it during one year of its arrival. DINJPENA3A PENTAZOCINE, 30 mg/ml, 1 ml, amp. Injectable analgesic Not in the WHO Essential Medicines list 2002. C1 (Always controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Centrally acting opioid analgesic. Distribution should be controlled as under hospital conditions (using a narcotics register, or recording amounts in and out, and keeping it under lock and key). Storage: Keep cool. 52 Drugs
DINJPENIB2V PENICILLIN BENZATHINE, 2.4 MIU, powder, vial Injectable antibiotic, long acting Long-acting antibacterial (antibiotic): 15 to 20 days. Not to be used for urgent cases (too low blood concentrations). For IM injection only. After preparation the suspension should be used the same day and kept in the refrigerator (between 2 C and 8 C). DINJPENIF4V PENICILLIN BENZYL 1 MIU + PROCAINE 3 MIU, (PPF), powd., vial Injectable antibiotic, long acting Not in the WHO Essential Medicines list 2002. Double-action antibacterial (antibiotic), with long action (24 hours) of procaine penicillin and immediate action of benzylpenicillin. Benzylpenicillin + procaine penicillin (= procaine penicillin fortified). For IM injection only. After preparation the suspension should be used the same day. DINJPENIG1V DINJPENIG5V PENICILLIN BENZYL (peni G cristal peni), 1 MIU, powd., vial PENICILLIN BENZYL (peni G cristal peni), 5 MIU, powd., vial Injectable antibiotic, long acting, rapid-acting antibacterial (antibiotic), eliminated rapidly (6 hours). For IM or IV injection/infusion. Choose the strength in line with the national lists. 600mg of penicillin benzyl (peni G) = 1 million international units (M IU). After preparation the suspension should be used the same day. Drugs 53
DINJPETH1A PETHIDINE, 50 mg/ml, 2 ml, amp. Injectable strong analgesic C1 (Always controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Centrally acting opioid analgesic. Distribution should be controlled as under hospital conditions (using a narcotics register, or recording amounts in and out, and keeping it under lock and key). Storage: Keep cool. DINJPOTC2A1 POTASSIUM CHLORIDE, 100 mg/ml, 10 ml, amp. Injectable substitution of potassium Prevention and treatment of severe hypokaliemia. Potassium chloride 100mg/ml = solution 10% contains 13.4mmol KCl per 10 ml ampoule. Must be used in hospital care only. Storage: No special precautions. DINJPROM5A PROMETHAZINE HYDROCHLORIDE, 25 mg/ml, 2 ml, amp. Injectable antiemetic, antihistamine, sedative DINJQUIN6A QUININE DI-HYDROCHLORIDE, 300 mg/ml, 2 ml, amp. Injectable antimalarial, second line 54 Drugs
DINJSALB5A SALBUTAMOL, 0.5 mg/ml, 1 ml, amp. Injectable bronchodilator, uterorelaxant DINJSODB8A1 SODIUM BICARBONATE, 8.4%, 1 Meq/ml, 10 ml, amp. Injectable sodium bicarbonate for acidosis correction Indicated in the rare cases of metabolic acidosis. Can carry risk of metabolic disorders. Sodium Bicarbonate solution 8.4% contains 10mmol NaHCO3 per 10 ml ampoule. DINJSPEC2V SPECTINOMYCIN, 2g, powder, vial Injectable antibiotic (exp. N. gonorrhoea) Antibacterial of the aminoside group, active against Neisseria gonorrhoea. DINJSTRP1V STREPTOMYCIN SULFATE, 1 g, powder, vial Injectable antibiotic Antitubercular antibacterial (antibiotic). Should as a rule be used only in tuberculosis programs and combination with other antituberculous drugs. Always follow WHO treatment protocols after acceptance by your medical department. Follow the recommendations of the local tuberculosis programme, if there is one, otherwise the WHO recommendations. Storage: Keep cool. After preparation the solution should be clear and keeps for a maximum of 1 hour. Drugs 55
DINJSUXC5V SUXAMETHONIUM CHLORIDE, 500 mg, powder vial Injectable muscle relaxant used during general anaesthesia = succinyl choline. Depolarising muscle relaxant of immediate action (30 to 60 seconds) and of short duration (2 to 6 minutes). Should be limited strictly to surgical missions with an anaesthetist. Powder for reconstitution to be dissolved in Sodium chloride 0.9% or Glucose 5%. Try to buy the dry powder which is easier to preserve. Solution is more easily available but needs to be refrigerated. Storage: Do not use after expiry date. DINJTHIO5V THIOPENTAL SODIUM, 500 mg, powder, vial Injectable anaesthetic (strictly intravenous) C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Anaesthetic for induction of general anaesthesia, control of convulsion. Should be limited strictly to surgical missions with an anaesthetist. Storage: Keep cool. After preparation the diluted solution can be kept for 24 hours in a cool place. After preparation the solution should be clear and without crystals. DINJTRAM1A TRAMADOL HYDROCHLORIDE, 50 mg/ml, 2 ml, amp. Injectable analgesic Not in the WHO Essential Medicines list 2002. C2 (Sometimes controlled). See introductory remarks Narcotic and psychotropic drugs Medications subject to particular international and national controls. Centrally acting opioid analgesic. Distribution should be controlled as under hospital conditions (using a narcotics register or recording amounts in and out and keeping it under lock and key). Storage: Keep cool. 56 Drugs
DINJVECB10V VECURONIUM BROMIDE, 10 mg, powder vial Injectable muscle relaxant used during anaesthesia Non depolarising muscle relaxant of short to medium duration. Should be limited strictly to surgical missions with a specialist anaesthetist. Storage: Keep cool (25 C), 4 C once solution is made up, away from light (max. 12 hours). DINJWATE1A WATER for injection, 10 ml, plastic amp. Injectable water for mixing with powder Plastic ampoules are stronger and lighter than glass but more expensive. The quantity ordered should be greater than the number of powder vials ordered (streptomycin, PPF, benzathine penicillin, chloramphenicol, acetylsalicylic acid, etc.). Drugs 57