Issues in Contemporary Drug Delivery: Part V: Total Parenteral Nutrition

Abstract

Objective:To provide an overview of common compounding and administration guidelines for total parenteral nutrition (TPN). The compatibility of various drug products with TPN preparations is also discussed.Data Sources:References were selected from published bibliographies of specialized nutrition and drug-nutrient interaction articles, package inserts and manufacturer's information, and specific topic searches in MEDLINE computerized database (English language, through 1989).Study Selection:Studies that investigated stability were selected preferentially to those studying compatibility alone; when stability data were not available, compatibility studies were included. Studies using products marketed in the US were chosen preferentially to those using European products; studies and case reports using human subjects were selected in preference to animal studies. Sixty percent of the initially identified studies were selected for inclusion.Data Extraction:Studies were reviewed by the authors for internal consistency and statistical validity.Data Synthesis:Intravenous solutions can be manufactured to meet various nutritional specifications. As additional nutrients and drugs are incorporated, the risk of incompatibility and instability of the admixture increases. Stability data are relatively sparse, leading to a dependence on compatibility studies for decision making.Conclusions:A wide variety of TPN formulations can be compounded to meet the individual needs of patients of all ages and assorted disease states. Addition of specific drugs to the TPN preparation may improve the efficiency of drug delivery and improve overall therapeutic response. Care must be taken, however, to ensure that incompatible compounds are not combined in a single TPN preparation.