Abstract
<jats:p>Intravenous medicines expose patients not only to the intended active drug but also to product-intrinsic and administration-system components. We define the intravenous formulation exposome as patient-day co-exposure to fluid, electrolytes, medication-associated energy and excipients delivered with intravenous pharmacotherapy. This narrative review integrates targeted PubMed searches, citation chaining and product-specific regulatory sources. A descriptive evidence landscape is used only as a structured aid to narrative synthesis, not as an exhaustive evidence-and-gap map. Direct intensive-care evidence indicates that medicine preparation and delivery can contribute materially to fluid intake, while product labels and clinical studies demonstrate clinically relevant variation in sodium and chloride, propofol lipid, dextrose, citrate, propylene glycol, ethanol, benzyl alcohol and cyclodextrins. We propose a source-linked product–preparation–patient-day ledger that retains manufacturer, jurisdiction, concentration, diluent, carrier and flush identity and reports the four domains as a vector rather than an unvalidated composite score. Generic equivalence should not be assumed to imply formulation equivalence, and unknown quantities should not be converted to zero. Matching the vector to renal, hepatic, metabolic and fluid-balance susceptibility can support safer prescribing, product-specific monitoring and multidisciplinary review. Evidence linking cumulative multidomain exposure or ledger-guided care to patient-important outcomes remains limited; prospective validation is required.</jats:p>