Simulated Y-site Injection Research Articles

Compatibility of acetaminophen with central nervous system medications during simulated Y-site injection.

The critical care patient commonly receives alot of medications including acetaminophen and central nervous system (CNS) agents. However, research on compatibility between acetaminophen and CNS medication is still limited. Physical compatibility was evaluated using Y-site simulation by mixing one CNS medication with 10 mg mL-1 of acetaminophen solution under aseptic conditions with a1 : 1 ratio. The Y-site simulation mixture was subsequently kept in aclean glass tube for incompatibility investigation during 24 hours. The aliquot solutions were visually inspected with bare eyes then additionally with aTyndall light beam, microscope, and pH at 0, 1, 4, and 24 hours. Medications were considered compatible if there was no visual change (color/gas or turbidity), and no significant particles or precipitates, which referred to United States Pharmacopeia 788 (USP 788), and pH changes less than 0.5 units. During 24 hours, intravenous acetaminophen was physically compatible with haloperidol, ketamine, midazolam, pethidine, rocuronium and tramadol. Meanwhile, phenytoin, and propofol showed incompatibility with acetaminophen right away. Within four hours, five medications (dexketoprofen, fentanyl, ketorolac, diazepam and phenobarbital) showed incompatibility. Two medications (atropine sulfate and metamizole) were also found to be incompatible with acetaminophen under observation for 24 hours. Nine of 15 common CNS medications in critical care tested with acetaminophen were physically incompatible for 24 hours.

Visual compatibility of colistin injection with other antibiotics during simulated Y-site administration.

The compatibility of colistin with other antibiotics at concentrations commonly used in intensive care units was studied. A vial of colistin was dissolved in sterile water for injection. The reconstituted solution (colistin base 75 mg/mL) was then diluted in 0.9% sodium chloride injection in polyvinyl chloride (PVC) infusion bag to give a total volume of 100 mL (colistin 1.5 mg/mL). Secondary drugs, including cefoperazone-sulbactam, ceftazidime, ertapenem, fosfomycin, imipenem-cilastatin, linezolid, meropenem, piperacillin-tazobactam, and vancomycin, were reconstituted if necessary and then diluted in 0.9% sodium chloride injection in PVC infusion bags to give final study concentrations of one-hundredth of their initial concentrations. The admixtures were collected in beakers at the end of the i.v. line and stored at 26 °C under constant fluorescent light throughout the study. Compatibility was assessed visually during delivery of each drug pair at time 0 and at 1 hour after starting the infusion. Compatibility was defined as the absence of visually detected particulate formation, haze, precipitation, color change, or gas evolution. Each combination was tested in triplicate. No particulate formation or other evidence of incompatibility was found in any of the studied drug combinations when observed immediately after mixing or at 1 hour. No particulate matter was observed with the unaided eyes, during microscopic evaluation, or against black and white backgrounds. Colistin 1.5 mg/mL was visually compatible with single concentrations of 9 other antimicrobial products during simulated Y-site injection at 26 °C without light protection for at least 1 hour.

Physical compatibility of vancomycin and piperacillin sodium–tazobactam at concentrations typically used during prolonged infusions

The physical compatibility of vancomycin and piperacillin sodium-tazobactam at dosing concentrations commonly administered during prolonged infusions was studied. Concentrations of vancomycin and piperacillin sodium-tazobactam typically used in prolonged infusions were evaluated. Vancomycin hydrochloride and piperacillin sodium-tazobactam were reconstituted with 0.9% sodium chloride injection and diluted to the following concentrations: vancomycin, 4 mg/mL; piperacillin sodium 30 mg/mL plus tazobactam 3.75 mg/mL; and piperacillin sodium 40 mg/mL plus tazobactam 5 mg/mL. Combinations of vancomycin and piperacillin sodium-tazobactam were tested using simulated Y-site administration; phenytoin served as a positive control for precipitation with vancomycin. Each combination was prepared in triplicate, alternating the order of drug addition, and stored without light protection at room temperature. The resultant admixtures were microscopically observed and subjected to particle-size and turbidity analyses for five days. Statistical analyses were performed using two-way repeated measures analysis of variance with conservative Bonferroni corrections for multiple comparisons. Vancomycin was compatible with piperacillin sodium-tazobactam in the concentrations tested. No particulate matter was observed by the unaided eye. Similarly, the antibiotic admixtures displayed no differences microscopically, by particle-size analysis, or by turbidity analysis when compared with negative controls at five days. Vancomycin 4 mg/mL and piperacillin sodium 30 mg/mL plus tazobactam 3.75 mg/mL or piperacillin sodium 40 mg/mL plus tazobactam 5 mg/mL were physically compatible during simulated Y-site injection at room temperature without light protection for five days.

Physical compatibility of various drugs with neonatal total parenteral nutrient solution during simulated Y-site administration

The physical compatibility of various drugs with neonatal total parenteral nutrient (TPN) solution during simulated Y-site administration was evaluated. Study drugs were selected based on the lack of compatibility data with them and neonatal TPN solution and the frequency of use in a local neonatal unit. These drugs included amiodarone, caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, midazolam, pentobarbital, phenobarbital, and rifampin. Equal volumes of neonatal TPN solution or sterile water for injection were combined with study drugs or sterile water for injection at concentrations used clinically in neonates. Each test was performed in triplicate. The samples were examined via turbidimetric analysis and visually against light and dark backgrounds immediately after mixing and at 0.25, 0.5, 1, 2, and 3 hours after mixing. Analysis of variance was used to determine statistically significant differences between the test and control solutions. Many of the drugs studied exhibited no visual or turbidimetric evidence of incompatibility when combined with neonatal TPN solution for up to three hours in a simulated Y-site injection. Pentobarbital, phenobarbital, and rifampin formed visible precipitation immediately after mixing with the neonatal TPN solution. Caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, and midazolam exhibited no visual or turbidimetric evidence of incompatibility when combined with a neonatal TPN solution for up to three hours in a simulated Y-site injection. Amiodarone, pentobarbital, phenobarbital, and rifampin were not compatible with the neonatal TPN solution and should not be coadministered via Y-site injection.

Visual compatibility of i.v. medications routinely used in bone marrow transplant recipients

The visual compatibility of i.v. medications routinely used in bone marrow transplant recipients was studied. A total of 17 drug combinations were tested using simulated Y-site administration. Medications were prepared to the standard concentrations used at University of Utah Health Care and infused at the appropriate rate. For each combination, the two drugs had 99 cm of shared tubing. At the end of the shared tubing was a 0.8-microm filter disk. All of the drug combinations were tested in triplicate. After the infusion was complete, each filter was bubble-point tested to ensure filter integrity and to remove residual solution. The tubing and dried filter were examined by eye as well as a magnification microscope. Drug combinations were considered incompatible if a precipitate or color change was visible to the naked eye during filtration or if the number of particles observed under the microscope exceeded 12 particles of > or =10 microm in diameter per milliliter of solution or if 2 or more particles of > or =25 microm in diameter per milliliter of solution were observed, per guidelines established by the United States Pharmacopeia for large-volume injections. Of the 17 drug combinations tested, 5 combinations were observed to be visually incompatible. All of the incompatible combinations included acyclovir as the primary infusion. Acyclovir was incompatible with cyclosporine, diphenhydramine, gentamicin, granisetron, and metoclopramide. Of the 17 drug combinations tested, 5 combinations were observed to be visually incompatible during simulated Y-site injection. The combinations found to be visually incompatible included acyclovir with cyclosporine, diphenhydramine, gentamicin, granisetron, or metoclopramide.

Compatibility of ceftobiprole medocaril with selected drugs during simulated Y-site administration

The physical compatibility of the new cephalosporin ceftobiprole medocaril with 70 other drugs during simulated Y-site injection was studied. Ceftobiprole was reconstituted with sterile water for injection. Dilutions of ceftobiprole 2 mg/mL (as ceftobiprole medocaril 2.67 mg/mL) were prepared in 5% dextrose injection, 0.9% sodium chloride injection, and lactated Ringer's injection. For testing compatibility with the other drugs, a 5-mL sample of the ceftobiprole 2-mg/mL admixtures was combined with a 5-mL sample of the other drug either undiluted or diluted with one of the three vehicles. Each combination was prepared in duplicate, switching the order of drug addition, and kept at room temperature. At intervals up to four hours after preparation, samples were examined visually and with the aid of a Tyndall beam and measured with a turbidimeter and a particle sizer and counter. Compatibility with propofol was evaluated by checking for emulsion separation and particles after centrifugation. In all three vehicles, ceftobiprole was compatible with 31 other drugs and incompatible with 32. With 7 drugs, compatibility was dependent on the vehicle used. Signs of incompatibility included the presence of visible and subvisible particles, haze, and turbidity. No incompatibilities were related to the order of mixing. Of the 70 drugs evaluated for compatibility with ceftobiprole 2 mg/ mL (as medocaril) in 5% dextrose injection, 0.9% sodium chloride injection, and lactated Ringer's injection, 31 were found to be compatible and 32 were found to be incompatible in all three of the infusion solutions. For 7 of the drugs, compatibility was dependent on which infusion solution was used. Ceftobiprole medocaril should not be simultaneously administered via a Y site with drugs with which it was shown to be incompatible.

Physical Compatibility of Ibuprofen Lysine Injection with Selected Drugs During Simulated Y-site Injection

To study the physical compatibility of ibuprofen lysine injection (NeoProfen, Ovation Pharmaceuticals Inc., Deerfield, IL) with medications commonly used in the premature neonatal population during simulated Y-site administration. Commonly used intravenous medications in preterm infants were evaluated for physical compatibility with ibuprofen lysine injection. A 20-mL sample of ibuprofen lysine drug product solution was mixed with a 20-mL sample of each of the 34 medications at concentrations used clinically. The mixtures were stored at room temperature and each sample was evaluated for turbidity and physical appearance at time 0 (immediately after preparation) and at 4 hours after preparation. THE FOLLOWING DRUGS WERE DEEMED COMPATIBLE WITH IBUPROFEN LYSINE: ceftazidime, epinephrine, furosemide, heparin lock flush, diluted insulin, morphine sulfate, phenobarbital, potassium chloride, and sodium bicarbonate. Diluted dopamine was initially compatible at time 0 but showed a small precipitate at the 4-hour time point. Of the 37 drug solutions tested, 14 preparations (10 medications; several with more than one diluent) showed physical compatibility with ibuprofen lysine, 1 was compatible at time 0 and incompatible at 4 hours, and 1 could not be evaluated. The remaining preparations were considered to be incompatible.

Physical compatibility of pemetrexed disodium with other drugs during simulated Y-site administration

The physical compatibility of pemetrexed disodium with selected other drugs during simulated Y-site injection was studied. A 5 mL sample of pemetrexed disodium 20 mg/mL in 0.9% sodium chloride injection was combined with 5 mL of a solution of each of 79 other drugs. The other test drugs included antineoplastics, antiinfectives, and supportive care drugs used undiluted or diluted in 0.9% sodium chloride injection or 5% dextrose injection. Visual examinations were performed with the unaided eye in normal diffuse fluorescent light at intervals up to four hours after mixing. Combinations with no obvious incompatibility were examined further with a high-intensity monodirectional light source to enhance visualization of small particles and low-level turbidity. The combinations were also evaluated with a turbidimeter at one and four hours. All combinations without visual incompatibility were assessed with a particle sizer-counter. Of the 79 pemetrexed-secondary drug combinations, 55 were compatible for at least four hours. However,mixture with 24 drugs resulted in precipitation (including microprecipitation) and color change. Pemetrexed disodium was incompatible with 24 drugs during simulated Y-site administration and should not be administered with them.

Stability of zidovudine with oxytocin in a simulated Y-site injection.

Stability of zidovudine with oxytocin in a simulated Y-site injection.

Compatibility screening of oxaliplatin during simulated Y-site administration with other drugs

The physical compatibility of oxaliplatin (Eloxatin, Sanofi-Synthelabo, Malvern, PA) with 58 selected other drugs during simulated Y-site injection was evaluated by visual observation, turbidity measurement, and electronic particle content assessment when appropriate. Five-milliliter samples of oxaliplatin 0.5 mg/mL in 5% dextrose injection were combined with 5 mL of 58 other drugs. The other test drugs included antineoplastics, analgesics, antihistamines, diuretics, steroids, and other supportive care drugs undiluted or diluted in 5% dextrose injection. Visual examinations were performed with the unaided eye in normal diffuse fluorescent light and using a Tyndall beam (high-intensity monodirectional light beam) to enhance visualization of small particles and low-level turbidity. The turbidity of each sample was measured as well. For samples with no visible incompatibility, the particle content was measured. Evaluation of the samples was performed initially and at 1 and 4 h after preparation. Fifty-seven of the 58 test drugs were compatible with the oxaliplatin dilution during the 4 h observation period. However, diazepam resulted in precipitation. Oxaliplatin should not be administered simultaneously with diazepam.

Compatibility Screening of Gatifloxacin during Simulated Y-Site Administration with other Drugs

The physical compatibility of gatifloxacin injection (Tequin, Bristol-Myers Squibb) with 110 other drugs during simulated Y-site injection was evaluated by visual observation and turbidity measurement, and by electronic particle content assessment if appropriate. Five-milli-liter samples of gatifloxacin injection 2 mg/mL in 5% dextrose injection were combined with 5 mL samples of 110 other drugs. The secondary test drugs included anti-infectives, analgesics, antihistamines, diuretics, steroids, and other supportive care drugs. Visual examinations were performed with the unaided eye in normal diffuse fluorescent light and using a Tyndall beam. The turbidity of each sample was measured as well. Most of the test drugs were compatible with the gatifloxacin admixture during the 4-hour observation period. However, 14 drugs resulted in physical incompatibilities when combined with the admixture. Gatifloxacin admixtures should not be administered simultaneously with these incompatible drugs.

Stability and compatibility of topotecan hydrochloride with selected drugs

The physical and chemical compatibility of topotecan 56 microg/mL (as the hydrochloride) with 18 other drugs during simulated Y-site injection was studied. A vial of topotecan hydrochloride was reconstituted under aseptic conditions with sterile water for injection to yield a solution containing 1 mg of topotecan base per milliliter and further mixed with 0.9% sodium chloride injection or 5% dextrose injection. Equal volumes of topotecan solution and each secondary drug, also prepared in 0.9% sodium chloride injection or 5% dextrose injection, were mixed in sterile vials. All mixtures were stored at 20-23 degrees C under normal fluorescent light. Samples were taken initially and at four hours for analysis by high-performance liquid chromatography, visual inspection, and pH measurement. With a few exceptions, the drug combinations exhibited no visible change in color or clarity initially or after four hours, and the concentration of topotecan hydrochloride and of the secondary drugs was 95% or more of the initial concentration. The concentration of topotecan hydrochloride dropped to 88.7% of the initial concentration after four hours when the drug was mixed with ticarcillin disodium and with clavulanate potassium in 5% dextrose injection. An intense yellow color and a slight haze developed immediately after topotecan hydrochloride was mixed with dexamethasone sodium phosphate or with fluorouracil in 0.9% sodium chloride injection. The topotecan-mitomycin combination in both diluents became pale purple immediately and turned dark pink-lavender within four hours, after which analysis showed 15-20% degradation of mitomycin. During simulated Y-site injection, topotecan hydrochloride was physically and chemically compatible with 15 of 18 drug products.

Compatibility of gemcitabine hydrochloride with 107 selected drugs during simulated Y-site injection.

To evaluate the physical compatibility of gemcitabine hydrochloride (Gemzar-Eli Lilly and Company) with 107 selected drugs. Controlled experimental trial. Laboratory. Samples of 5 mL gemcitabine (as the hydrochloride salt) 10 mg/mL in 0.9% sodium chloride injection were mixed with 5 mL samples of the selected drugs diluted in 0.9% sodium chloride injection or, if necessary to avoid incompatibilities with the diluent, 5% dextrose injection. Visual examinations of the samples were performed in normal fluorescent light with the unaided eye and using a Tyndall beam (high-intensity monodirectional light) to enhance visualization of small particles and low-level haze. The turbidity of each sample was measured as well. In selected samples, electronic particle content assessment was performed. All of the samples were assessed initially and at 1 and 4 hours. Most of the drugs were physically compatible with gemcitabine hydrochloride during the 4-hour observation period. However, 15 drug combinations had incompatibilities that included color change, increase in haze or turbidity, particulate formation, and gross precipitation: acyclovir sodium, amphotericin B, cefoperazone sodium, cefotaxime sodium, furosemide, ganciclovir sodium, imipenem-cilastatin sodium, irinotecan, methotrexate sodium, methylprednisolone sodium succinate, mezlocillin disodium, mitomycin, piperacillin sodium, piperacillin sodium/tazobactam sodium, and prochlorperazine edisylate. Gemcitabine hydrochloride 10 mg/mL admixed in a compatible infusion solution is physically compatible for 4 hours at room temperature with 92 of 107 tested drugs. Simultaneous Y-site administration of gemcitabine hydrochloride with the 15 drugs resulting in incompatibilities should be avoided.

Compatibility of Medications With 3‐in‐1 Parenteral Nutrition Admixtures

The absence of drug compatibility information with 3-in-1 parenteral nutrition admixtures has been problematic. The purpose of this project was to evaluate the physical compatibility of 106 selected drugs during simulated Y-site injection into nine different 3-in-1 parenteral nutrition admixture formulations. Four-milliliter samples of each of the representative 3-in-1 parenteral nutrition admixture formulations were combined in a 1:1 ratio with 4-mL samples of each of 106 drugs, including supportive care drugs, anti-infectives, and antineoplastic drugs. Six replicate samples of each combination were prepared. Two samples were evaluated initially after mixing, two more after 1 hour, and the last two after 4 hours at 23 degrees C. At each test interval, the samples were subjected to centrifugation, causing the fat to rise to the top. The top fat layer and most of the aqueous phase were removed, and the remaining liquid was diluted with about 7 mL of particle-free, high-performance liquid chromatography-grade water to facilitate observation of any particulates that might have formed. Visual examinations were performed in normal diffuse fluorescent laboratory light and under high-intensity, monodirectional light. Most of the drugs tested were physically compatible with the 3-in-1 parenteral nutrition admixtures for 4 hours at 23 degrees C. However, 23 drugs exhibited various incompatibilities with one or more of the parenteral nutrition admixtures. Six drugs resulted in the formation of precipitate with some or all of the admixtures. Seventeen drugs caused disruption of the emulsion, usually with oiling out. Most of the test drugs were physically compatible with the nine representative 3-in-1 parenteral nutrition admixtures. However, the 23 drugs that resulted in incompatibilities should not be administered simultaneously with the incompatible parenteral nutrition admixtures via a Y injection site.

Stability of milrinone lactate in the presence of 29 critical care drugs and 4 i.v. solutions.

The stability of milrinone lactate in the presence of 29 critical care drugs during simulated Y-site injection and in 4 i.v. solutions was studied. Ten milliliters of milrinone 400 microg/mL (as the lactate salt) was combined with 10 mL of each of 29 commonly used critical care drugs in 5% dextrose injection. Also, mixtures containing milrinone 400 microg/ mL in lactated Ringer's injection, 5% dextrose injection, 0.45% sodium chloride injection, and 0.9% sodium chloride injection were prepared. All mixtures were prepared in triplicate and stored at 22-23 degrees C in glass containers or polyvinyl chloride bags under fluorescent light. Samples were withdrawn zero, one, two, and four hours after mixing for each milrinone-secondary drug mixture and at intervals up to seven days for each milrinone-i.v. diluent mixture. Samples were examined visually and analyzed by high-performance liquid chromatography, enzymatic assay, or fluorescence polarization immunoassay. No precipitation or substantial pH change was observed in any of the mixtures. In all the mixtures, milrinone retained more than 96% of its initial concentration, and the other drugs retained more than 97% of their initial concentrations. Milrinone 400 microg/mL in 5% dextrose injection and 29 critical care drugs were stable for four hours at 22-23 degrees C during simulated Y-site administration. Milrinone 400 microg/mL was stable in lactated Ringer's injection, 5% dextrose injection, 0.45% sodium chloride injection, and 0.9% sodium chloride injection for seven days at 22-23 degrees C.

Compatibility of propofol injectable emulsion with selected drugs during simulated Y-site administration.

The compatibility of a new formulation of injectable propofol with selected other drugs during simulated Y-site injection was studied. Two milliliters of undiluted propofol injectable emulsion was combined with 2 mL of each of 112 other drugs in 5% dextrose injection or 0.9% sodium chloride injection. The liquids were diluted with 6 mL of particle-free high-performance liquid chromatography (HPLC)-grade water and centrifuged for 20 minutes. A pipette connected to a vacuum line was used to remove the fat layer at the top and most of the aqueous phase. The remaining liquid was diluted with 9 mL of particle-free HPLC-grade water to facilitate visualization of any precipitate. The liquids were examined with the unaided eye in fluorescent light and with a Tyndall beam to enhance visualization of small particles. Samples were evaluated during the first 15 minutes and one hour after mixing. Propofol injectable emulsion was compatible with 98 of the 112 drugs testes. Fourteen drugs demonstrated incompatibilities, including precipitation, gel formation, and oiling out of cracked emulsions. During simulated Y-site injection, propofol injectable emulsion was compatible with most other drugs tested for one hour at approximately 23 degrees C

Stability of ondansetron and fluconazole in 5% dextrose injection and normal saline during Y-site administration

The stability of ondansetron and fluconazole in 5% dextrose injection and normal saline during simulated Y-site injection at room temperature was studied. Ondansetron 0.03, 0.1 and 0.3 mg/ml were admixed 1ratio1 with fluconazole 2 mg/ml. The solutions were stored at room temperature and samples were retrieved at time 0, 1, 2, 4 and 12 hr for immediate assay. At the time of the assay and before any dilution, each sample was visually inspected for clarity, color, precipitation, and the pH was determined. Drug concentrations were measured by a stability-indicating high performance liquid chromatograph. Ondansetron 0.03, 0.1 and 0.3 mg/ml were stable when mixed with concentration of fluconazole 2 mg/ml. There were no change in clarity and color and no precipitates in any admixture for 12 hr of inspection. The pH measurements did not have a particular trend in any direction over time.

Compatibility of thiotepa (lyophilized) with selected drugs during simulated Y-site administration.

The compatibility of lyophilized thiotepa injection with selected other drugs during simulated Y-site injection was evaluated. Five-milliliter samples of thiotepa (lyophilized) 1 mg/mL in 5% dextrose injection were combined with 5 mL each of 100 other drugs, including antineoplastics, anti-infectives, and supportive care drugs, in 5% dextrose injection or 0.9% sodium chloride injection. The combinations were stored at room temperature (approximately 23 degrees C) under constant fluorescent light. Visual examinations were performed immediately and at one and four hours with the unaided eye and, if there was no obvious incompatibility, with a high-intensity mono-directional light beam to enhance visualization of small particles and low-level turbidity. The turbidity of each combination was measured as well. Particle sizing and counting were performed on selected solutions. Most of the test drugs were compatible with thiotepa 1 mg/mL during the observation period. Two drugs exhibited incompatibilities with thiotepa. The thiotepa-cisplatin combination developed turbidity in four hours, and the thiotepa-minocycline hydrochloride combination developed a bright yellow-green discoloration in one hour. All the test drugs except cisplatin and minocycline hydrochloride were compatible with thiotepa 1 mg/mL (prepared from the lyophilized formulation) for at least four hours at room temperature.

Stability and compatibility of granisetron hydrochloride in i.v. solutions and oral liquids and during simulated Y-site injection with selected drugs.

The stability and compatibility of granisetron hydrochloride in common i.v. fluids and oral liquids and during simulated Y-site injection with selected drugs were studied. One milliliter of solution containing granisetron 1 mg (as the hydrochloride salt) was added to 50 mL of 5% dextrose injection, 5% dextrose and 0.9% sodium chloride injection, 5% dextrose and 0.45% sodium chloride injection, or 0.9% sodium chloride injection in polyvinyl chloride (PVC) bags and to 5 mL of 5% dextrose injection, 0.9% sodium chloride injection, or bacteriostatic water for injection in polypropylene syringes and stored at room temperature (20 degrees C) for 24 hours. One milliliter of the granisetron hydrochloride injection was added to 50 mL of apple juice, orange juice, cola, or an electrolyte replacement solution and stored for 60 minutes at room temperature. Twenty-nine drugs were mixed with the granisetron hydrochloride injection in 0.9% sodium chloride injection in volumes simulating Y-site injection and stored at room temperature. Finally, dexamethasone sodium phosphate injection 0.5 mL and 1 mL of the granisetron hydrochloride injection were added to 50 mL of 0.9% sodium chloride injection in a PVC bag and stored for 60 minutes. Drug concentrations were determined by high-performance liquid chromatography, and color, clarity, and pH were evaluated. Granisetron hydrochloride was stable in and compatible with all the i.v. solutions and oral liquids. Neither granisetron nor any of the drugs it was tested with during simulated Y-site injection showed any physical changes except for a slight Tyndall effect in the granisetron hydrochloride-doxorubicin hydrochloride combination; all the drugs retained at least 96% of initial concentrations. Granisetron and dexamethasone sodium phosphate were stable and compatible in the admixture. Granisetron 1 mg (as the hydrochloride salt) was stable for 24 hours in four i.v. infusion fluids in PVC bags and in 5% dextrose injection, 0.9% sodium chloride injection, and bacteriostatic water for injection in polypropylene syringes; for 1 hour in four oral liquids; for 4 hours in the presence of each of 29 drugs during simulated Y-site injection; and for 1 hour when mixed with dexamethasone sodium phosphate in 0.9% sodium chloride injection in a PVC bag.

Stability of cefpirome sulfate in the presence of commonly used intensive care drugs during simulated Y-site injection.

The stability of cefpirome sulfate during simulated Y-site injection with drugs commonly used in the intensive care unit was studied. Cefpirome sulfate was constituted and diluted to 50 mg/mL with 0.9% sodium chloride injection, 0.45% sodium chloride injection, 5% dextrose injection, and lactated Ringer's injection. Each cefpirome sulfate solution was mixed 1:1 (simulating Y-site injection) with amikacin 5.0 mg/mL (as the sulfate salt), amphotericin B 0.1 mg/mL, cefazolin 10 mg/mL (as the sodium salt), clindamycin 12.0 mg/mL (as the phosphate ester), dexamethasone phosphate 4.0 mg/mL (as the sodium salt), dopamine hydrochloride 0.8 mg/mL, epinephrine 0.1 mg/mL (as the hydrochloride salt), fluconazole 2.0 mg/mL, gentamicin 1.0 mg/mL (as the sulfate salt), and vancomycin 5.0 mg/mL (as the hydrochloride salt). All the drug combinations were prepared in triplicate and maintained at 23 degrees C. The combinations were observed visually at intervals up to eight hours, pH was measured, and samples were tested for drug concentration by high-performance liquid chromatography. Cefpirome was stable in the presence of each of the secondary drugs throughout the study period. All the secondary drugs except amphotericin B were stable in the presence of cefpirome. There were no visual phenomena indicating incompatibility. Changes in pH were minimal. Cefpirome 50 mg/mL (as the sulfate salt) in four different diluents was stable in the presence of each of 10 commonly used intensive care drugs for at least eight hours during simulated Y-site administration. Amphotericin B 0.1 mg/mL was not stable in the presence of cefpirome sulfate.