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

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 23; no. 2; pp. 67 - 74
• Main Authors: Trissel, Lawrence A., Gilbert, Doward L., Martinez, Juan F., Baker, Mary B., Walter, William V., Mirtallo, Jay M.
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA Sage Publications 01-03-1999; SAGE Publications; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: Amikacin - administration & dosage; Amikacin - chemistry; Amino Acids - administration & dosage; Amino Acids - chemistry; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chemical Phenomena; Chemical Precipitation; Chemistry, Physical; Drug Incompatibility; Electrolytes - administration & dosage; Electrolytes - chemistry; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Fat Emulsions, Intravenous - administration & dosage; Fat Emulsions, Intravenous - chemistry; Glucose - administration & dosage; Glucose - chemistry; Intensive care medicine; Medical sciences; Parenteral Nutrition; Pharmaceutical Preparations - administration & dosage; Pharmaceutical Preparations - chemistry; Sodium Chloride - administration & dosage; Sodium Chloride - chemistry; Solutions; Human; Drug; Drug adjuvant interaction; Electrolyte solution; Nutrient solution; Mixture; Parenteral administration; Feeding; Chemotherapy; Chemical composition; Compatibility; Comparative study; Physicochemical properties
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/014860719902300267

Background: 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. Methods: 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°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. Results: Most of the drugs tested were physically compatible with the 3-in-1 parenteral nutrition admixtures for 4 hours at 23°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. Conclusions: 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. (Journal of Parenteral and Enteral Nutrition 23:67-74, 1999)