read the monographs
The monographs follow a standard layout, which is explained here in detail.
Active ingredient(s)
NoIDs uses generic medicine names in line with the New Zealand Universal List of Medicines (NZULM).
Medicines known as vesicant or irritant1
Applicable if a medicine is known as a vesicant or an irritant.
Extravasation refers to the leakage of a medicine from a vessel or direct infiltration into the extravascular space. Based on the severity of local toxicity if extravasated, medicines can be classified as vesicants or irritants. Irritants cause inflammation (warmth, erythema, tenderness) at the administration site and along the vein but rarely result in tissue necrosis. In contrast, vesicants have the potential to cause tissue necrosis (blistering, sloughing of tissue and varying degree of deep tissue damage) with a more severe and/or lasting injury than is typically seen with irritants.
A patient’s risk of extravasation is affected by other factors such as pH of the medicine, medicines with cytotoxic and vasoconstrictive properties, site and method of venepuncture. For example, solutions that are highly acidic (less than pH 5.5) or alkaline (more than pH 8.5) are more likely to cause tissue damage on extravasation.
Irritant or vesicant medicines should be administered through a central line where possible. If no central line is available, a large peripheral line should be used and closely monitored.
If extravasation is suspected, stop the infusion immediately and follow local guidelines for management of extravasation.
Hazardous medicine
Applicable if a medicine is known as a hazardous medicine.
Hazardous medicines require the person handling the medicine to take precautions to minimise the occupational hazard.
Cytotoxic medicines are excluded from NoIDs.
Non-cytotoxic hazardous medicines require extra precautions when handling or preparing the medicine. Standard precautions are usually sufficient when administering these medicines to patients. Refer to relevant local guidelines for handling precautions.
Monoclonal antibodies (MABs) differ considerably in their structure and pharmacological properties. Many MABs are no longer classified as hazardous. Where identified as hazardous, this is indicated in the individual monograph.
Reproductive hazardous medicines have not been specifically labelled in NoIDs, but we recommend that if pregnant or trying to conceive, refer to local policies. Guidance often refers to harm from therapeutic doses rather than the considerably limited occupational exposure.
Synonym(s)
Other names of the medicine including British Approved Name (BAN) and the salt or hydrate form.
Drug class
Therapeutic group.
Trade/brand name (Sponsor)
Brand name as marketed in New Zealand or as made available under Section 29 of the Medicines Act.
In instances where the Hospital Medicines List permits ‘Any brand’, we have included products that are available in New Zealand at the time of writing. We recognise that brand changes can occur at short notice.
Unless otherwise stated, the information provided in each monograph is not brand specific. When a brand name is used, it is to highlight that the corresponding information is brand specific e.g. sodium content.
Presentation
Strengths and dose form available in New Zealand.
Solution preparations are described as total amount of medicine and total volume.
The pH value of solution preparations or reconstituted solutions is only included if the information is available in the manufacturer’s product information, hereafter referred to as product information.
Storage
Recommended storage condition of the commercial preparations as per product information.
Administration
Five standard routes of administration are included for adults and paediatrics.
We recognise that critical care and other specialist services may administer injectable medicines outside of the recommendations in these monographs.
Paediatric information is not applicable to neonates.
Routes of administration are listed in the order of preference for each medicine.
Unless otherwise stated, polyvinyl chloride (PVC) infusion sets or consumables can be used.
Visually inspect all injectable preparations for particulate matter; do not use if present.
Administer medicines using a non-touch technique.
Off-label or unapproved use of a medicine
The off-label or unapproved use of a medicine is when an approved medicine is used outside of the approved indication, dose range or route of administration, such as stated in the manufacturer’s product information.
Unapproved use of medicines occurs commonly and may be considered as part of usual practice. Many medicines administered to children are considered unapproved.
NoIDs has not specifically identified any unapproved use in individual monographs. All monographs are extensively reviewed against best available literature and current clinical practice. Therapeutic decision making and responsibility for unapproved use lies with prescribers.
Continuous intravenous infusion
Flush the line between administration of different medicines with sufficient fluid volume (usually around 20 mL) at the same rate used to administer the original medicine.
Sodium chloride 0.9% or glucose (dextrose) 5% are commonly used to flush the line; check individual monograph for compatible fluids. For some medicines, it is not appropriate to flush the lines; consult monographs and local guidelines for more information.
Smart infusion pumps with an updated drug library allow medicines to be delivered at controlled rates and concentrations, minimising errors and adverse drug events. Smart rate-controlled infusion pumps (volumetric pumps or syringe drivers) are specifically recommended in some monographs where it is deemed essential for medication safety.
Patient-controlled analgesia (PCA) is excluded in this print.
Direct intravenous
Sometimes referred to as a bolus injection.
Given directly into vein or line over less than 10 minutes. Injection duration or rate is included in the monograph if information available.
Flush the cannula between administration of different medicines with sufficient fluid volume (usually around 5–10 mL) at the same rate used to administer the original medicine. Sodium chloride 0.9% or glucose (dextrose) 5% are commonly used to flush the line; check individual monograph for compatible fluids. For some medicines, it is not appropriate to flush the lines; check local guidelines for more information.
Intramuscular
Most commonly given into the thigh or the gluteal muscle, and occasionally into the deltoid muscle.
The vastus lateralis muscle is used most commonly in children.2
The volume of intramuscular injection and appropriate needle length in children is dependent on the age and size of the child.
| Age | Site | Recommended volume2 |
| Infant less than 18 months | Vastus Lateralis | 1–3 mL |
| Infant or child 18 months to 3 years | Vastus Lateralis or Deltoid | 1–2 mL |
| Child or adolescent 3 to 11 years | Deltoid | 1–2 mL |
| Infant, child or adolescent greater than 7 months | Ventrogluteal | Up to 3 mL |
| Infant, child or adolescent | Dorsogluteal | Up to 4 mL |
| Adults | Deltoid | 0.5–2 mL |
| Adults | Ventrogluteal | 1–4 mL |
| Adults | Dorsogluteal | 1–5 mL |
| Adults | Vastus Lateralis | 1–4 mL |
Many intramuscular formulations are oil-based injections. It is therefore important to ensure, by aspiration before injection, that inadvertent intravascular entry does not occur.
Where evidence is available to support safe administration and stability of medicines reconstituted with lidocaine for intramuscular administration, including its use in children, this has been stipulated in individual monographs.
Intermittent intravenous infusion
Administered over a set time period. Sometimes referred to as a short infusion or an extended infusion. Flush the line between administration of different medicines with sufficient fluid volume (usually around 20 mL) at the same rate used to administer the original medicine. Sodium chloride 0.9% or glucose (dextrose) 5% are commonly used to flush the line; check individual monograph for compatible fluids. For some medicines, it is not appropriate to flush the lines; check local guidelines for more information.
Smart infusion pumps with an updated drug library allow medicines to be delivered at controlled rates and concentrations, minimising errors and adverse drug events. Smart rate-controlled infusion pumps (volumetric pumps or syringe drivers) are specifically recommended in some monographs where it is deemed essential for medication safety.
Subcutaneous
Commonly given in the outer or anterior aspect of the upper arm, abdomen below the costal margins to the iliac crests, anterior aspect of the thigh, anterior chest wall or scapular area.3
Diluents are used to reduce site irritation and ease medicine administration.
For subcutaneous infusions – the minimum infusion volume recommended is 20 mL. Total volume is dependent on the total volume of medicines, infusion pump used, intended infusion time and rate of delivery. Always consult local guidelines.3
Medicines commonly given as a continuous subcutaneous infusion in palliative care are indicated as such in individual monographs.
Outpatient intravenous antimicrobial administration
Refers to the intravenous administration of antimicrobials in a community setting, usually for extended periods of time.
Some antimicrobials may also be administered in the community setting using direct IV injections, intramuscular injections or subcutaneous administration. However when referred to in NoIDs monographs the outpatient intravenous antimicrobial administration refers specifically to 24-hour continuous infusions with elastomeric (balloon) infusors.
Stability is dependent on drug concentration, temperature and diluent fluid, with/without a buffer.
Elastomeric infusors require manufacturing under sterile conditions to ensure stability greater than 24 hours. These infusors are commonly supplied by licensed manufacturers and provide extended stability at various conditions.
Unless otherwise stated, NoIDs does not specify stability, concentration or storage conditions for elastomeric infusors as this is proprietary information from licensed manufacturers.
Consult a pharmacist or a medicines information service for more information pertaining to elastomeric infusors.
Undiluted solution
For solution preparations.
Physical description of the commercial preparation and recommended storage condition for partially used product are included if the information is available in the product information.
Visually inspect all injectable preparations for particulate matter; do not use if present.
Reconstitution
Instructions for reconstituting powder preparations.
Reconstitute immediately before use.
Use aseptic non-touch technique to prepare the medicine.
Unless otherwise stated, shake the vial until the powder has dissolved.
Physical description and recommended storage condition for the reconstituted solution are provided if the information is available in the product information.
Visually inspect all injectable preparations for particulate matter; do not use if present.
Displacement volume is included to assist with calculating and preparing paediatric or part doses. In the case where the displacement volume is presumed to be negligible, the concentration of the reconstituted solution is included. Displacement volume is brand specific.
Dilution
Instructions for medicines which can or must be further diluted before administration.
Dilute immediately before use.
Use aseptic non-touch technique to prepare the medicine.
Invert the container several times to ensure thorough mixing of the solution.
The volume of intravenous fluids to be used and/or desired final concentrations provided are intended for use in general wards.
For combination products (e.g. Piperacillin + Tazobactam), the final concentration is expressed as the total amount (e.g. 15–90 mg/mL of the piperacillin/tazobactam combination), unless specifically stated.
More concentrated solutions may be permitted in certain areas; consult a pharmacist or medicines information service for more information.
Unless otherwise stated, intravenous fluids in PVC containers can be used.
Visually inspect all injectable preparations for particulate matter; do not use if present.
Recommended storage condition for the diluted solution is provided if the information is available in the Data Sheet.
Monitoring
Includes monitoring recommendations related to injection or infusion related adverse effects for a particular medicine. NoIDs users should consult relevant reference resources for full monitoring requirements before, during and after treatment.
Monitor all patients for signs and symptoms of extravasation, anaphylactic and hypersensitivity reactions.
Monitor all infusions throughout administration to ensure that the infusion is being administered at the correct rate, that the infusion pump or device is working as intended, and that the patient is responding to the infusion therapy as intended.
Other information
Incompatible drug(s) as per product information. This is not an exhaustive list; consult a pharmacist or medicines information service for more information including Y-site compatibility and compatibility with parenteral nutrition.
Sodium and potassium content per unit vial, if deemed clinically relevant.
Excipients which are likely to cause allergy or significant side effects.
Therapeutic drug monitoring, if applicable.
Non-PVC and non-DEHP information
Some medicines interact with PVC and DEHP plastic. Monographs may recommend using non-PVC or non-DEHP bags or giving sets.
PVC is a plastic that is the main component of many IV infusion bags, giving sets, syringes etc. DEHP is a plasticiser that is used to make some PVC products more flexible.
Medicines can interact with DEHP or PVC by either adsorbing onto the surface of the plastic (less medicines administered to the patient) or by leaching DEHP from the plastic into the infusion (DEHP is administered to the patient).
Many factors can affect the amount of leaching from the plastic and adsorption of the drug, including the contact time, drug concentration and the infusion time.
Note that non-PVC will also be non-DEHP; but non-DEHP may still contain PVC.
Low-sorbing infusion sets may be available, but although these address the adsorption interaction, they are not considered DEHP-free, i.e. they will not affect the leaching interaction if this is a concern.
| Example of non-PVC containers | Polyolefin |
| Polyethylene | |
| Ethylene-vinyl acetate | |
| Glass | |
| Example of non-PVC giving sets | Polyurethane |
| Polyethylene | |
| Example of DEHP-free giving sets | Polyurethane |
| Polyethylene | |
| DEHP-free PVC | |
| Examples of low-sorbing infusion sets | Polyurethane |
| PVC outer with polyethylene lining |
References
1 David, V et al. Extravasation of noncytotoxic drugs. Annals of Pharmacotherapy. 2020; 54(8): 804-814.
2 Karch, Amy Morrison. Lippincott Nursing Drug Guide. Wolters Kluwer, 2016. Print.
3 Wilcock, Andrew, Howard, Paul and Charlesworth, Sarah. Palliative Care Formulary. 8th ed. Pharmaceutical Press, 2022. Print.
| °C | degree Celsius |
| CNS | central nervous system |
| DEHP | di-2-ethylhexyl phthalate (plasticiser) |
| eGFR | estimated glomerular filtration rate |
| ECG | electrocardiography |
| EEG | electroencephalogram |
| g | gram(s) |
| IV | intravenous |
| kg | kilogram(s) |
| L | litre(s) |
| mg | milligram(s) |
| mL | millilitre(s) |
| mm | millimetre(s) |
| mmol | millimole |
| % | percentage |
| PVC | polyvinyl chloride |
| pH | scale measuring acid/alkaline nature of solution |
| v/v | volume per volume |
| VF | ventricular fibrillation |
| VT | ventricular tachycardia |
Each monograph has been developed based on a range of commonly used standard medicine information resources and pharmaceutical textbooks. The following standard references were consulted for all monographs:
- Manufacturer’s Medicine Data Sheet available from medsafe.govt.nz
- New Zealand Formulary via nzf.org.nz
- New Zealand Formulary for Children via nzfchildren.org.nz
- Martindale: The Complete Drug Reference via micromedexsolution.com
- Merative Micromedex® via micromedexsolution.com
- The Royal Children’s Hospital Melbourne Paediatric Injectable Guidelines via pig.rch.org.au
- The Australian Injectable Drugs Handbook. 9th ed. Collingwood, VIC: The Society of Hospital Pharmacists of Australia; 2023.
These standard references are not cited within the individual monograph.
Additional references consulted may include:
- AHFS Clinical Drug Information via medicinescomplete.com
- ASHP Injectable Drug Information: a comprehensive guide to compatibility and stability. Bethesda, MD: American Society of Health-System Pharmacists, 2021
- British National Formulary via medicinescomplete.com
- British National Formulary for Children via medicinescomplete.com
- Lexicomp Online, Paediatric and Neonatal Lexi-Drugs Online via uptodate.com
- PCF8 Palliative Care Formulary (8th ed.). London: Pharmaceutical Press, 2023
- Pediatric Injectable Drugs. The Teddy Bear Book (11th ed.). Bethesda, MD: American Society of Health-System Pharmacists, 2018
- Product information supplied with medicines obtained under Section 29 of the Medicines Act 1981
- VicTAG Victorian Framework for the handling of Hazardous Medicines. 2021
If consulted, these references are cited online in the reference view of the monograph.
Here is a complete listing of all the injectable drug monographs with the date when their information was last updated. You can use this at any time to check that you are looking at the current version.
Any changes made to monographs after the latest book was printed are also documented at noids.nz/updates .
This Updates webpage is freely available to everyone. Where a change is clinically significant a full copy of the revised monograph is provided there for non-subscribers. For other changes the monograph is identified and the change(s) described.
All changes made and any new monographs added since the last time the book was printed are always reflected in the monographs available online for subscribers only.
use the website
You should be able to access the Notes on Injectable Drugs website, www.noids.nz, from anywhere within your organisation through any browser, although the larger the screen you use the easier it is to read.
The first time you access the website on a device there is a check to see if you are using an IP address registered to your organisation or if your device is located at one of the addresses nominated by your organisation. If your browser asks to allow Location access for the noids.nz website, please say OK.
Sometimes this location check can’t run because of your IT policies, in which case you will be asked to enter an organisation password. You can probably get this password from your Pharmacy Department in a large organisation or from your Office Manager/Administrator.
If you are off site out of hours and don’t know the organisation password you’ll be asked for some contact information and given temporary access.
Start typing the medicine name. You need to type the first 5 letters and then you’ll see all the medicines that match and can select the one you really want.
You can use an alternate name for a medicine. For instance, if you start to type in augmentin you will be given the Amoxicillin + Clavulanic Acid monograph as the result.
The STANDARD PDF is the monograph without references, while the REF PDF is the referenced version – just select which one you want to view. As explained above in the Bibliography section, even in the referenced version the most common references are not listed, so the STANDARD and REF versions are often identical.
The website always shows the most recent version of the information for each medicine.
If you want to use the Notes on Injectable Drugs information in local protocols or in other software it is strongly recommended that you use a link to the relevant URL rather than copying information that may change later without you realising.
The URL for each injectable drug is constant and does not change when the information changes and the monograph is updated.
The URL format is www.noids.nz/drug/drugname/?pdf=standard or www.noids.nz/drug/drugname/?pdf=ref depending on whether you want the standard or referenced view of the monograph.
The drugname to use for each medicine is found in the URL master list below.
report a problem
Use the Search Index page to find the medicine you want and you should see the option there to Submit Feedback.
Please fill out this contact form and we’ll get back to you as soon as possible
find out more about Notes on Injectable Drugs
Notes on Injectable Drugs (NoIDs) is intended to assist in the preparation and safe administration of injectable medicines.
Noids.nz was launched in November 2020 to enable regular review of NoIDs content to meet user needs. During 2025, 87 monographs were updated and 12 new monographs were published online in response to user feedback or to changes in medicine supply or practice.
These monographs are not intended to replace local guidelines, nor to provide prescribing information. NoIDs users should consult local guidelines, manufacturer’s Medicine Data Sheets and New Zealand Formulary for full prescribing information.
New monographs in 2025
| Cefiderocol | Etanercept |
| Cetuximab | Icatibant |
| Denosumab | Lanreotide |
| Defibrotide | Methylnaltrexone |
| Eculizumab | Pantoprazole |
| Emicizumab | Secukinumab |
The medicines documented are ones available and in use in New Zealand.
The medicines and the uses described are relevant to adult and paediatric patients in a general medical/surgical setting.
Information on medicines that are only used within a specialised ward or in a way that only occurs in specialised circumstances is not included. This means that neonatal, oncology, ICU and Emergency Department use, along with other less common specialisations, is excluded unless that medicine or usage is more generally applied.
The current version of Notes on Injectable Drugs was created by:
Chief Editor
Tanya du Plessis BPharm MScID PGDipID PGCertPharmPres
Business Manager
Lee Miller MA AM(Harvard) MBA
Editors
Michaela Beattie BPharm PGDipClinPharm PGCertPharm
Kristin Gray BPharm PGDipClinPharm
Rebecca Greening BPharm PGDipClinPharm
Adele Harrex BPharm PGDipClinPharm PGCertPharmPres
Stephanie Murphy BPharm PGDipClinPharm
Maya Patel MPharm PGDipClinPharm
Preetika Prakash BPharm PGDipPharm
Jacqui Reynolds DipPharm PGDipClinPharm
Alanna Tan-Adams BPharm(Hons) PGDipClinPharm
Acknowledgements
We would like to acknowledge the following people and groups whose contributions have continued to shape Notes on Injectable Drugs:
- Past governance group members, editors, contributors and members of the New Zealand Hospital Pharmacy Association
- User advisory group members and users of Notes on Injectable Drugs
- Medicines information services – for sourced resources and local guidelines
- Aotearoa Pharmacists in Infectious Diseases (APhIDs) – for support in ensuring advice is consistent with current NZ practice
- Pharmaceutical companies
- Pharmaceutical wholesalers
- Pharmac
We thank the Steering Group members for sharing their time and expertise.
| Kim Brackley | Bevan Harden | Jacky Chan |
| Annie Egan | Sarah Salman | Veronica Christie |
| Vidhya Sritharan | Mary Young |
Finally, Notes on Injectable Drugs would not have been possible without the initial work of the pharmacists at Napier, Hastings Memorial and Whanganui Hospitals in 1987. Their vision and input form the basis of this and any future editions of Notes on Injectable Drugs.
