Friday , October 7 2022

IV Bolus vs IV Infusion of Parenteral Drug Product

You have to know IV bolus vs IV infusion to remove your ambiguity between IV bolus injection and IV infusion. IV bolus or IV bolus injection and IV infusion both are the dosage form or method or ways of administering medicine via parenteral routes.  The word ”parenteral” originates from the roots ‘para’ means beyond, outside of and ‘enteral’ means intestinal. The parenteral administration introduces drugs directly into the systemic circulation or other vascular tissue across the body’s barrier defenses.

Parenteral routes are used for emergencies, for uncooperative or unconscious or vomiting patients, Rapid onset of action, for drugs that are poorly absorbed from the GIT (for example heparin), and for drugs that are unstable in the GIT (for example, insulin). Examples of parenteral routes of administration include intravenous, subcutaneous, intra-arterial and intramuscular etc. Intravenous (IV) drug products may be given either as a bolus dose or slowly infused [1].  You may also read: Side effect and Toxic effect, Poison and Toxin

Definition of IV Bolus vs IV Infusion 

IV is the short form of Intravenous means “within a vein.” It is a parenteral route of drug administration. The word “bolus” comes from Latin bolus means ball. In biopharmaceutics or medicine, a bolus refers to the administration of a discrete amount of medication, drug, or other agents within a short time generally 1–30 minutes [2]. A bolus is a single, large, discrete dose of a drug product. IV bolus and IV bolus injection indicate the same meaning. An injection is a small volume of sterile preparation intended for parenteral administration of drug or liquid by using a hypodermic needle and a syringe.  An injection is also known as “jab” (UK English), “shot” (US English), and “jag” (Scottish English) [3].

When a sterile, single, discrete amount dose of drug product, medication, or solution is administered all at once over a short period of time generally within a short time 1–30 minutes by using a hypodermic needle and a syringe is called IV bolus.

When a sterile, large volume of drug product, medication, or solution is administered through a vein into the blood slowly and continuously at a constant or zero-order rate over a long period of time generally more than 30 minutes to several hours is called IV infusion. Intravenous infusion also known as an IV drip, IV inf.

Total Time of Administration 

IV bolus is given within a short period of time generally within 1–30 minutes [4]. Whereas IV infusion is given within a long period of time generally more than 30 minutes to several hours.

Rate of Administration of IV Bolus vs IV Infusion 

IV bolus is given at an inconstant rate and expressed by mg/min. Whereas IV infusion is given at constant rate and expressed by mg/hr. Aminophylline is administered by IV infusion at a rate of 34 mg/hr. So, total daily dose of aminophylline is 34 mg/hr x 24 hr = 816 mg. The IV infusion rate may be estimated after assessment of the patient’s clearance, ClT.

Fashion of Administration of IV Bolus and IV Infusion 

IV bolus drug administration is rapid. Whereas in the case of IV infusion, drug administration is slow and given either intermittently or continuously.

Onset of action of IV Bolus vs IV Infusion 

In general, IV bolus administration of a drug provides the most rapid onset of drug action. Thus providing a fast-acting therapeutic effect. Whereas IV infusion administration of a drug provides the slow onset of drug action. Thus providing a delayed therapeutic effect.

Duration of action of IV Bolus vs IV Infusion 

Duration of action of IV bolus administration of a drug is short. On the other hand, Duration of action of IV infusion administration of a drug is long.

Purpose of Use of IV Bolus vs IV Infusion 

  • Drug is given as IV bolus for an emergency such as cardiac arrest or narcotic overdose to get an immediate effect.
  • IV bolus is given as loading dose to achieve the desired plasma level rapidly.

On the other hand, Purpose of Use of IV infusion are:

  • IV infusion is necessary when continuous and prolonged plasma drug concentration is required.
  • An IV infusion is given as a maintenance dose to maintain the steady-state by abolishing wide fluctuations of plasma drug concentration.
  • IV infusion allows control of plasma drug levels more precisely.
  • The duration of drug therapy may control or dismiss as needed using IV infusion.
  • IV infusion may give to estimate total body clearance if the steady-state level and infusion rate are known.
  • Slow IV infusion of a drug product may administer to avoid side effects.

Volume of IV Bolus vs IV Infusion 

Volume of IV bolus drug product, medication, liquid is smaller than IV infusion. Whereas Volume of IV bolus drug product, medication, liquid is larger than IV bolus.

Control of Drug delivery by IV Bolus and IV Infusion 

Drug delivery is not controlled in case of IV bolus because they are injected all at once. On the other hand, IV infusion allows precise control of plasma drug concentrations to fit the individual needs of the patient by infusion rate.

Adverse effect of medication of IV Bolus vs IV Infusion 

Chance of anaphylaxis or adverse effect is more in the case of IV bolus. The rapid IV bolus injection of many drugs (for example lidocaine) may cause an adverse response due to the initial high drug concentration in the plasma before slow equilibration with the tissues.

 On the other hand, Chance of anaphylaxis or adverse effect is less in case of IV infusion. The IV infusion of many drugs (for example lidocaine) may cause less adverse response due to slow and continuous infusion.

Discomfort during application of IV Bolus vs IV Infusion 

There is minimal or no long-time discomfort for the patient due to short-time drug product administration. Whereas the patient feels discomfort due to long-time administration.

Precaution of IV Bolus vs IV Infusion 

Inject IV bolus medications after confirmation with more precaution and proper knowledge about drug product, its dose, drug-drug interaction because once injected you can’t control. On the other hand, IV infusion should administer with less precaution but proper knowledge about the drug product, its dose, and drug-drug interaction because you can stop infusion at any time. Tissue damage may frequently occur at the site of infusion.

Operation of IV Bolus vs IV Infusion 

Administration of IV bolus is easier and requires only the skill of insertion of hypodermic needle. Administration of IV infusion is less easy than bolus and requires skill in insertion and ascending of infusion equipment.

Plasma level time Curve of IV Bolus vs IV Infusion 

After an IV bolus injection, the drug is rapidly perfused to tissue and then drug concentration declines with time from the body.

Plasma level time curve for IV bolus

Figure: Plasma level time curve for IV Bolus

On the other hand, after an IV infusion, the drug is slowly infused into plasma and gradually increase plasma drug concentration with time and attain steady-state, plateau and after discontinue of infusion drug concentration decline with time from the body. Efficacy vs Potency

Plasma level time curve for IV infusion

Figure: Plasma level time curve for IV infusion

Types of IV Bolus vs IV Infusion 

According to Fashion of administration, IV infusion is two types:

  1. Intermittent IV infusion: It is a method of successive infusions of the drug for a short period of time after the drug elimination period of previously IV infusion.
  2. Continuous IV infusion: An intravenous infusion is the infusion of a parenteral drug product over several hours (continuous drip) to days continuously.

According to the rate of administration, IV infusion is two types:

  1. High rate of infusion
  2. Low rate of infusion

According to frequency of administration, IV bolus is two types:

  1. Single IV bolus: injected the drug rapidly at once.
  2. Multiple IV bolus: injected repeatedly at regular intervals to achieve a steady plasma concentration.

Equipment for IV Bolus vs IV Infusion 

Equipment of IV bolus: Hypodermic needle and syringe.

Whereas Equipment of Intravenous Infusion:  IV bag, peripheral cannula, Tourniquet, Drip set (Insertion spike, drip chamber, Screw clamp, Extension Tube with secondary port, hollow needle, Y-Set or T-Set or V connector sets) as well as infusion pump for digital infusion equipment.

Examples of IV Bolus vs IV Infusion 

Example of IV bolus: Edrophonium IV bolus injection and Morphine IV bolus injections etc. On the other hand, Example of IV infusion: Dextrose solutions, Succinylcholine infusion. Epinephrine IV infusion, Dopamine IV infusion, and Nicardipine intravenous infusion etc.

Summary of IV Bolus vs IV Infusion 

Features IV Bolus IV Infusion
Definition When a sterile, single, discrete amount dose of drug product, medication, or solution is administered all at once over a short period of time generally within a short time 1–30 minutes by using a hypodermic needle and a syringe is called IV bolus. When a sterile, large volume of drug product, medication, or solution is administered through a vein into the blood slowly and continuously at a constant or zero-order rate over a long period of time generally more than 30 minutes to several hours is called IV infusion.
Administration Time Within 1–30 minutes More than 30 minutes to several hours
Administration Rate Inconstant rate and express by mg/min Constant rate and express by mg/hr
Fashion of Administration Rapid Slow and Continuous
Onset of action Rapid Slow
Duration of action Short Prolonged
Purpose of Use For an emergency and to achieve the desired plasma level rapidly. For continuous and prolonged plasma drug concentration and control of plasma drug levels more precisely
Volume Small Large
Control of Drug delivery No precise control. Precise control.
Adverse effect Chance of anaphylaxis or adverse effect is more. Chance of anaphylaxis or adverse effect is less.
Discomfort Less More
Precaution More precaution. Less precaution.
Operation Easier Less easier than IV bolus
Types of IV Bolus vs IV Infusion A. Intermittent IV infusion and

B. Continuous IV infusion.

A. High rate of infusion and

B. Low rate of infusion

A. Single IV bolus and

B. Multiple IV bolus

Equipment Hypodermic needle and syringe. IV bag, peripheral cannula, Tourniquet, Drip set (Insertion spike, drip chamber, Screw clamp, Extension Tube with secondary port, hollow needle, Y-Set or T-Set or V connector sets)
Plasma level time Curve of IV Bolus vs IV Infusion Plasma level time curve for IV ibolus Plasma level time curve for IV infusion of drug
Examples Edrophonium IV bolus injection and Morphine IV bolus injections Epinephrine IV infusion, Dopamine IV infusion

References

  1. Shargel, Leon, and Andrew B. C. Yu. Applied Biopharmaceutics & Pharmacokinetics, 2016.
  2. “intravenous bolus”. Farlex dictionary, in turn citing Mosby’s Medical Dictionary, 9th edition.
  3. “injection”. Cambridge dictionary.
  4. Bolger, Gordon T. Reference Module in Biomedical Sciences. Routes of Drug Administration, 2018.

Keywords: IV bolus vs IV infusion; bolus vs infusion; bolus injection vs IV infusion; IV infusion vs IV bolus, Difference between injection and infusion, Difference between IV bolus and IV infusion.

Question: Which one is better between IV bolus and IV Infusion?

Answer: Both ways are better, choice of ways are depended on purpose of use of medication.

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