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Using gravity infusions and bolus injections in adults

Mark Cheeseman, Professional Lead for Medicines Information, Midlands & East, Midlands and East Medicines Advice Service (East site)Published Last updated See all updates
Topics: AdministeringCOVID-19 Medicines Optimisation: Information and resources

During certain periods, it may be more necessary than normal to give some medicines by gravity infusion or bolus injection; we list suitable medicines

Contents
  1. Using gravity infusion sets
  2. Giving medicines by gravity or bolus
    1. Advice on individual medicines
  3. Acknowledgements
  4. Change history

Using gravity infusion sets

Gravity infusion sets may be used routinely in adults for:

  • Infusion fluids given alone such as sodium chloride 0.9% or glucose 5% with no added potassium
  • Infusion fluids with a medicine added where rate of administration does not need to be tightly controlled to prevent adverse effects

Giving medicines by gravity or bolus

Generally, if an IV medicine can be given safely by IV bolus injection, it should be administered as a bolus over a minimum of 3 minutes. All IV antibiotics should be given by IV bolus injection if it is safe to do so.

The table below lists medicines which may be added to infusions and given via gravity or which may be given by intravenous bolus injection; individual links to information in Medusa injectable medicines guide are also provided.

See also: National Infusion and Vascular Access Society (NIVAS) Gravity infusion and Bolus IV drug administration guidance

Advice on individual medicines

Medicine Gravity administration possible for intermittent
infusions? 		 Bolus intravenous injection possible? Notes
Amikacin Yes Yes
Amoxicillin Yes Yes
Ampicillin Yes Yes Up to 500mg may be given by IV bolus injection.
Atenolol Yes Yes
Azathioprine Yes Yes
Azithromycin Yes No
Aztreonam Yes Yes
Benzylpenicillin Yes Yes Up to 1.2g may be given by IV bolus injection over 3-5 minutes. For higher doses, the maximum rate of injection is 300mg/minute.
Betamethasone Yes Yes
Brivaracetam Yes Yes
Calcium folinate Yes Yes
Caspofungin Yes No
Cefepime Yes Yes
Cefotaxime Yes Yes
Ceftazidime Yes Yes
Ceftazidime with avibactam Yes No
Ceftobiprole Yes No
Ceftolozane with tazobactam Yes No
Ceftriaxone Yes Yes Up to 2g may be given by IV bolus injection.
Cefuroxime Yes Yes
Chloramphenicol Yes Yes
Ciprofloxacin Yes No
Clarithromycin Yes No
Clindamycin Yes No
Colistimethate sodium (Colistin) Yes Specialist use. Central line
Co-amoxiclav Yes Yes
Co-fluampicil Yes Yes
Co-trimoxazole Yes No
Daptomycin Yes Yes Manufacturer recommends IV infusion is preferable to IV injection.
Desmopressin Yes Yes Check indication to determine method of administration.
Dexamethasone Yes Yes
Diclofenac 75mg/3mL (Voltarol) Yes No Akis (diclofenac 75mg/mL) is not licensed for IV infusion.
Ertapenem Yes No
Erythromycin Yes No
Esomeprazole Yes Yes
Flucloxacillin Yes Yes Up to 2g may be given by IV bolus injection. Give doses over 1g over 6 minutes.
Fluconazole Yes No
Flucytosine Yes No
Fosaprepitant Yes No
Furosemide Yes Yes Maximum rate of administration 4mg/minute
Gentamicin Yes Yes
Hydrocortisone sodium phosphate Yes Yes
Hydrocortisone sodium succinate Yes Yes
Imipenem / cilastatin Yes No
Lacosamide Yes No
Lenograstim Yes No Subcutaneous infusion used for most indications.
Levetiracetam Yes No
Linezolid Yes No
Meropenem Yes Yes
Meropenem with vaborbactam Yes No
Methylprednisolone sodium succinate Yes Yes Up to 250mg may be given by IV bolus injection.
Metronidazole Yes No
Omeprazole Yes No
Ondansetron Yes Yes Do not give IV bolus injection to elderly for chemo- or radio-therapy induced nausea/vomiting.
Pantoprazole Yes Yes
Paracetamol Yes No
Phytomenadione Yes Yes
Piperacillin/tazobactam Yes No May be given by IV bolus injection (unlicensed) in some circumstances.
Ranitidine Yes Yes
Rifampicin Yes No
Tedizolid Yes No
Teicoplanin Yes Yes
Temocillin Yes Yes
Ticarcillin with clavulanic acid Yes No
Tigecycline Yes No
Tobramycin Yes Yes
Tramadol Yes Yes
Vitamin B with ascorbic acid (Pabrinex IV High Potency) Yes No
Zanamivir Yes No
Zidovudine Yes No

Acknowledgements

This page was developed in conjunction with colleagues from the National Injectable Guide (Medusa). We are hugely grateful for their input.

Change history

  1. Introductory text changed to remove specific reference to COVID-19
  2. Title changed to remove specific reference to COVID-19
  1. Published