ANTIBIOTICOS COMPATIBILIDADES

INSTITUTO NACIONAL DE PEDIATRALABORATORIO DE FARMACOLOGAFRMACO: PIPERACILINA / TAZOBACTAN

Piperacilina-Tazobactam (PIP-TZ) es un frmaco compuesto por un antibitico betalactmico (PIP) y un inhibidor de betalactamasa (TZ) para tratamiento de infecciones graves producidas por grmenes Gram positivos, Gram negativos y anaerobios. Ejerce su actividad bactericida mediante la inhibicin de la sntesis de la pared celular bacteriana.El tazobactam, una sulfona cida triazolimetil penicilnica, es un inhibidor potente de muchas -lactamasas, incluyendo las enzimas mediadas por plasmidios y cromosomales que comnmente causan resistencia a las penicilinas y cefalosporinas, incluyendo las cefalosporinas de tercera generacin.

Cada gramo de piperacilina debe reconstituirse con al menos 5 ml de agua estril para inyeccin , cloruro sdico al 0,9 %, agua bacteriosttica para inyeccin o cloruro de sodio bacteriosttico 0,9 % (conservada con alcohol benclico o parabenos ) o dextrosa al 5 % y se agita bien hasta diluir .

pH :Viales : de 4.5 a 6.8Solucin premezclada congelada: de 5,5 a 6.Biodisponibilidad: 71 %

Administracin: debe administrarse por infusin intravenosa durante al menos 30 minutos despus de la dilucin con al menos 50 ml en un diluyente compatible. Tambin se puede infundir usando bombas de infusin ambulatorias Compatibilidad con antibiticos y otros frmacos: - Puede disminuir la concentracin plasmtica de aminoglucsidos. - Puede disminuir la aclaracin renal de Metotrexate (controlar nivles de MTx)- Anticoagulantes orales: Se puede producir un aumento del efecto anticoagulante, con un aumento del riesgo hemorrgico. Puede disminuir el efecto terapetico de la vacuna BCG, y la respuesta inmunolgica de la vacuna de fiebre tifoidea atenuada (Ty21a).

Estabilidad : Polvo liofilizado de color blanquecino en viales intactos que deben almacenarse a temperatura ambiente. Viales de una sola dosis de la solucin deben utilizarse inmediatamente despus de la reconstitucin. Cualquier porcin restante debe desecharse despus de 24 horas a temperatura ambiente o 48 horas bajo refrigeracin a 2 a 8 C.En las soluciones de infusin compatible, el frmaco es estable durante 24 horas a temperatura ambiente o una semana bajo refrigeracin. Vidrio y plstico (incluyendo jeringas, bolsas de solucin por va intravenosa, y tubera) no afectan estabilidad. Soluciones CongeladasLas inyecciones congeladas disponibles comercialmente se deben almacenar en 0 por debajo de -20 C . Descongelar a temperatura ambiente o bajo refrigeracin, pero no en un bao de agua caliente o por radiacin de microondas. Soluciones descongeladas no deben volver a congelarse. Despus de la descongelacin, las soluciones son estables durante 24 horas a temperatura ambiente o 14 das en refrigeracin. Bombas AmbulatoriaEl producto mostr ser estable hasta 12 horas en una bomba de infusin ambulatoria.

Solucin Observaciones Drogas en jeringa

Dextrosa al 5%Compatible Dimenhydrinate 10mg/1mlCompatible, solucin clara

Dextrosa al 5% con 20- 80 g Concentracion/LVisualmente compatible. Pequea prdida de cualquiera de los frmacos en 28 das a 5 C y luego 72 horas a 23 C a la luz

pantoprazol sdico4mg/1 mL No compatible, formacin de precipitado despus de 1 h.

Inyeccin de Ringer lactato

Compatible si se usa la formulacin con Edetato Disdico.Compatibilidad Inyeccin Y- Site

Cloruro de Sodio al 0.9%compatible

Cloruro de Sodio al 0.9%Con 40g C/L de base de drogaprdida del 10 % en 5,8 das a 7 C y 3,8 das a temperatura ambiente.

Cloruro de Sodio al 0.9%Con 40 g C /L de base de droga prdida del 10 % en 5,8 das a 7 C y 3,8 das a temperatura ambiente.

Cloruro de Sodio al 0.9%con 20- 80 g C/L de base de droga Visualmente compatible. 5 % tazobactam y 2 % de prdida de piperacilina en 28 das a 5 C y luego 72 horas a 23 C a la luz.

http://www.interactivehandbook.com/monographs/

http://www.interactivehandbook.com/monographs/a591011.htmErtapenem SodiumAHFS Class: 8:12.07.08 - CarbapenemsTradenames: InvanzProductsErtapenem is available as a lyophilized powder in 1-g vials as the sodium salt with sodium bicarbonate 175 mg and sodium hydroxide to adjust the pH. For intravenous administration, reconstitute the 1-g vial with 10 mL of sterile water for injection, bacteriostatic water for injection, or sodium chloride 0.9% and shake well, yielding a 100-mg/mL concentration. Upon dissolution, immediately transfer the reconstituted solution to 50 mL of sodium chloride 0.9% for adults. For pediatric patients, the dose of reconstituted ertapenem should be transferred to a volume of sodium chloride 0.9% to yield a final concentration of 20 mg/mL or less.1(2/08) For intramuscular injection, reconstitute the 1-g vial with 3.2 mL of lidocaine hydrochloride 1% (without epinephrine) and shake well, yielding a 280-mg/mL concentration. Upon dissolution, administer within one hour. Do NOT administer the reconstituted intramuscular injection intravenously.1(2/08) pH7.5.1(2/08) Sodium ContentApproximately 137 mg or 6 mEq.1(2/08) AdministrationErtapenem sodium diluted in sodium chloride 0.9% may be administered by intravenous infusion over 30 minutes or by deep intramuscular injection into a large muscle mass such as the gluteal muscle or the lateral part of the thigh.1(2/08) StabilityIntact vials of ertapenem sodium should be stored at controlled room temperature not exceeding 25 C. The reconstituted drug solution for intravenous administration should be diluted immediately in sodium chloride 0.9%. Dextrose-containing solutions should NOT be used to dilute ertapenem.1(2/08) 2723 . The drug diluted for infusion may be stored and used within six hours at room temperature or may be stored for 24 hours under refrigeration and used within four hours after removal from refrigeration. The drug prepared for intramuscular administration should be used within one hour. Solutions of ertapenem sodium should not be frozen.1(2/08) Compatibility Solution CompatibilityErtapenem (as sodium salt)

Test Soln NameTest Soln MfrBase Drug MfrBase Drug Conc/LRemarksRefsCompat

Dextrose 5% in sodium chloride 0.225%ABME10 and 20 gVisually compatible. 10% loss in 6 hr at 25 C. 8% loss in 32 hr and 11% loss in 48 hr at 4 C2487 I

Dextrose 5% in sodium chloride 0.9%ABME10 and 20 gVisually compatible. 11% loss in 6 hr at 25 C and 10% loss in 32 hr at 4 C2487 I

Dextrose 5%ABME10 and 20 gVisually compatible. 10% loss in 6 hr at 25 C and 5 to 8% loss in 24 hr at 4 C2487 I

Ringer's injectionABME10 and 20 gVisually compatible. 10 to 12% ertapenem loss in 20 hr at 25 C and 11% loss in 5 days at 4 C2487 Ia

Ringer's injection lactatedABME10 and 20 gVisually compatible. 18% loss in 20 hr at 25 C and 9% loss in 3 days at 4 C2487 I

Sodium chloride 0.225%ABME10 and 20 gVisually compatible. 9 to 12% loss in 20 hr at 25 C and 8 to 11% loss in 5 days at 4 C2487 Ia

Sodium chloride 0.9%ABME10 and 20 gVisually compatible. 9 to 11% loss in 20 hr at 25 C and 8 to 11% loss in 5 days at 4 C2487 Ia

Sodium chloride 0.9%b ME10 gPhysically compatible with less than 10% drug loss in 24 hr at 25 C and 7 days at 5 C2723 C

Sodium chloride 0.9%c ME10 gPhysically compatible with less than 10% drug loss in 30 hr at 25 C and 8 days at 5 C2723 C

Sodium chloride 0.9%b ME20 gPhysically compatible with less than 10% drug loss in 18 hr at 25 C and 5 days at 5 C2723 C

Sodium chloride 0.9%c ME20 gPhysically compatible with less than 10% drug loss in 24 hr at 25 C and 7 days at 5 C2723 C

Sodium lactate (1/6) MABME10 and 20 gVisually compatible. 7 to 9% loss in 6 hr at 25 C and 8 to 11% loss in 2 days at 4 C2487 I

a Incompatible by conventional standards but recommended for dilution of ertapenem with use in shorter periods of time. b Tested in the Homepump Eclipse elastomeric pump reservoirs. c Tested in Intermate elastomeric pump reservoirs.

Additive CompatibilityErtapenem (as sodium salt)

Test DrugTest Drug MfrTest Drug Conc/LBase Drug MfrBase Drug Conc/LSolutionRemarksRefsCompat

MannitolAB5%ME10 and 20 gPrecipitate in 90 min may be required if Redman syndrome develops.

a Chemical degradation was dependent on the diluent. This is the shortest time in which the drug degraded 10%. b Stable for 48 h warmed to room temperature after refrigeration. c Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Thaw at room temperature or under refrigeration. Do not force thaw. Do not refreeze. d Manufacturers extrapolated data from other sources. e pH of the undiluted solution is 3.8-6. pH of reconstituted preparation in W or NS is 3.9. pH of a 5% solution in W is 2.5-4.5.1 f Following 17 d refrigerated storage.

Compatibility Solution CompatibilityVancomycin HCl


Dextrose 5% in Ringer's injection lactated5 gStable for 96 hr refrigerated1(10/08) C

Dextrose 5% in sodium chloride 0.9%5 gStable for 96 hr refrigerated1(10/08) C

Dextrose 5% in sodium chloride 0.9%LI1 gPhysically compatible74 C

Dextrose 5%5 gStable for 14 days refrigerated1(10/08) C

Dextrose 5%LI1 gPhysically compatible74 C

Dextrose 5%LI5 gStable for 7 days at 5 and 25 C141 C

Dextrose 5%TRa LI5 gPhysically compatible and stability for 24 hr at room temperature518 C

Dextrose 5%TRb LI5 gPhysically compatible with no loss in 7 days and 5% loss in 17 days at 24 C. In glass containers, no loss in 63 days at 5 C1134 C

Dextrose 5%TRLI4 and 5 gPhysically compatible with 8% loss in 17 days at 23 C and 11% loss in 30 days at 4 C1354 C

Dextrose 5%ABe AB20 and 40 gLittle loss in 96 hr at 25 C and in 30 days at 5 C2097 C

Dextrose 5%a QLM8 gVisually compatible and no loss during a 24 hr simulated infusion at 22 C2148 C

Dextrose 5%a QLM5 gVisually compatible and no loss during a 1 hr simulated infusion at 22 C2148 C

Dextrose 5%a QLM5 gVisually compatible and no loss during storage for 48 hr at 22 C in light and 7 days at 4 C in dark2148 C

Dextrose 5%BAa LI5 and 10 gVisually compatible with less than 3% loss in 58 days at 4 C2252 C

Dextrose 5%BAf QLM2 gVisually compatible with no loss at 4 C and 4 to 6% loss at room temperature in 48 hr2278 C

Dextrose 5%BAg HOS1 and 5 gUnder 10% loss in 7 days at 23 C and 31 days at 4 C2819 C

Dextrose 10%LI5 gPhysically compatible143 C

Normosol M in dextrose 5%5 gStable for 96 hr refrigerated1(10/08) C

Ringer's injection lactated5 gStable for 96 hr refrigerated1(10/08) C

Ringer's injection lactatedLI5 gPhysically compatible143 C

Ringer's injection lactatedLI1 gPhysically compatible74 C

Sodium chloride 0.9%5 gStable for 14 days refrigerated1(10/08) C

Sodium chloride 0.9%LI5 gStable for at least 7 days at 5 and 25 C141 C

Sodium chloride 0.9%LI1 gPhysically compatible74 C

Sodium chloride 0.9%TRa LI5 gPhysically compatible and stable for 24 hr at room temperature518 C

Sodium chloride 0.9%TRb LI5 gPhysically compatible with no loss in 7 days and 5% loss in 17 days at 24 C. In glass containers, no loss in 63 days at 5 C1134 C

Sodium chloride 0.9%TRLI4 and 5 gPhysically compatible with 9% loss in 24 days at 23 C and 5 to 6% loss in 30 days at 4 C1354 C

Sodium chloride 0.9%ABc ES10 gLittle loss with 24-hr storage at 5 C followed by 24-hr simulated administration at 30 C via portable pump1779 C

Sodium chloride 0.9%a QLM8 gVisually compatible and no loss during a 24 hr simulated infusion at 22 C2148 C

Sodium chloride 0.9%a QLM5 gVisually compatible and no loss during a 1 hr simulated infusion at 22 C2148 C

Sodium chloride 0.9%a QLM5 gVisually compatible and no loss during storage for 48 hr at 22 C in light and 7 days at 4 C in dark2148 C

Sodium chloride 0.9%BAf QLM2 gVisually compatible with no loss at 4 C and at room temperature in 48 hr2278 C

Sodium chloride 0.9%HOSg HOS1 and 5 gUnder 10% loss in 7 days at 23 C and 31 days at 4 C2819 C

Sodium lactate (1/6) MLI5 gPhysically compatible143 C

TPN #95d LE400 mgPhysically compatible and no vancomycin loss for 8 days at room temperature and refrigerated1321 C

TPN #96d LE400 mgPhysically compatible and no vancomycin loss for 8 days at room temperature and refrigerated1321 C

TPN #105d LI1 and 6 gPhysically compatible with little or no vancomycin loss in 4 hr at 22 C1325 C

TPN #106d LI1 and 6 gPhysically compatible with little or no vancomycin loss in 4 hr at 22 C1325 C

TPN #107d 200 mgActivity retained for 24 hr at 21 C1326 C

TPN #202d LIa 500 mg and 1 gVisually compatible and activity retained for 35 days at 4 C plus 24 hr at 22 C1933 C

a Tested in PVC containers. b Tested in both glass and PVC containers. c Tested in portable pump reservoirs (Pharmacia Deltec). d Refer to Appendix I for the composition of parenteral nutrition solutions. TPN indicates a 2-in-1 admixture. e Tested in SIMS Deltec Medication Cassette reservoirs. f Tested in PVC, polyolefin, and glass containers. g Tested in Accufusor reservoirs.

Additive CompatibilityVancomycin HCl


Amikacin sulfateBR5 gLI2 gD5LR, D5R, D5S, D5W, D10W, LR, NS, R, SLPhysically compatible and amikacin stable for 24 hr at 25 C. Vancomycin not tested293 C

Aminophylline250 mgLI1 gD5WPhysically compatible74 C

AminophyllineSE1 gLI5 gD5WPhysically incompatible15 I

Atracurium besylateBW500 mg5 gD5WPhysically compatible and atracurium stable for 24 hr at 5 and 30 C1694 C

AztreonamSQ40 gAB10 gD5W, NSImmediate microcrystalline precipitate. Turbidity and precipitate over 24 hr1848 I

AztreonamSQ4 gAB1 gD5WPhysically compatible. Little loss of either drug in 31 days at 4 C. 10% aztreonam loss in 14 days at 23 C and 7 days at 32 C1848 C

AztreonamSQ4 gAB1 gNSPhysically compatible. Little loss of either drug in 31 days at 4 C. 8% aztreonam loss in 31 days at 23 C and 7 days at 32 C1848 C

Calcium gluconate1 gLI1 gD5WPhysically compatible74 C

Cefepime HClBR4 gLI5 gD5W, NS4% cefepime loss in 24 hr at room temperature in light and 2% loss in 7 days at 5 C. No vancomycin loss. Cloudiness in 5 days at 5 C1682 C

Cefepime HClBR40 gLI1 gD5W, NS4% cefepime loss in 24 hr at room temperature in light and 2% loss in 7 days at 5 C. No vancomycin loss and no cloudiness1682 C

Chloramphenicol sodium succinatePD10 gLI5 gD5WPhysically incompatible15 I

DimenhydrinateSE50 mgLI1 gD5WPhysically compatible74 C

FamotidineYAM200 mgAB5 gD5Wb Visually compatible. 9% vancomycin and 6% famotidine loss in 14 days at 25 C. At 4 C, 4% loss of both drugs in 14 days2111 C

Fusidate sodiumLEO500 mg25 gD-SPhysically incompatible1800 I

Heparin sodium12,000 unitsLI1 gD5WPrecipitates immediately74 I

Heparin sodiumIX1000 unitsLE400 mgTPN #95a Physically compatible and vancomycin stable for 8 days at room temperature and under refrigeration1321 C

Heparin sodiumES100,000 unitsLI25 mgNSPhysically compatible. Under 10% vancomycin loss and no heparin loss in 30 days at 28 C and 63 days at 4 C2542 C

Hydrocortisone sodium succinateUP100 mgLI1 gD5WPhysically compatible74 C

MeropenemZEN1 and 20 gLI1 gNSVisually compatible for 4 hr at room temperature1994 C

Potassium chloride3 gLI1 gD5WPhysically compatible74 C

Ranitidine HClGL100 mgDI1 gD5WPhysically compatible for 24 hr at ambient temperature in light1151 C

Ranitidine HClGL50 mg and 2 g5 gD5WPhysically compatible. Ranitidine stable for 24 hr at 25 C. Vancomycin not tested1515 C

Verapamil HClKN80 mgLI1 gD5W, NSPhysically compatible for 24 hr764 C

a Refer to Appendix I for the composition of parenteral nutrition solutions. TPN indicates a 2-in-1 admixture. b Tested in methyl-methacrylate-butadiene-styrene plastic containers.

Drugs in Syringe CompatibilityVancomycin HCl

Test DrugTest Drug MfrTest Drug ConcBase Drug MfrBase Drug ConcRemarksRefsCompat

Caffeine citrate20 mg/1 mLLI50 mg/1 mLVisually compatible for 4 hr at 25 C2440 C

Dimenhydrinate10 mg/1 mL50 mg/1 mLPrecipitate forms2569 I

Heparin sodium2500 units/1 mLLI500 mgTurbidity or precipitate forms within 5 min1053 I

Pantoprazole sodiuma 4 mg/1 mL50 mg/1 mLClear solution2574 C

a Test performed using the formulation WITHOUT edetate disodium.

Y-Site Injection Compatibility (1:1 Mixture)Vancomycin HCl


Acyclovir sodiumBW5 mg/mLa LI5 mg/mLa Physically compatible for 4 hr at 25 C1157 C

Albumin human0.1 and 1%b 20 mg/mLa Heavy turbidity forms immediately and precipitate develops subsequently1701 I

AldesleukinCHIq a Visually compatible. Aldesleukin activity retained. Vancomycin not tested1890 C

Allopurinol sodiumBW3 mg/mLb LY10 mg/mLb Physically compatible for 4 hr at 22 C1686 C

AlprostadilBED7.5 mcg/mLp e LI5 mg/mLs Visually compatible for 1 hr2746 C

AmifostineUSB10 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C1845 C

Amiodarone HClLZ4 mg/mLc LI5 mg/mLc Physically compatible for 4 hr at room temperature1444 C

Amiodarone HClWY6 mg/mLa APP4 mg/mLa Visually compatible for 24 hr at 22 C2352 C

Amiodarone HClWY6 mg/mLa APP10 mg/mLa Visually compatible for 24 hr at 22 C2352 C

Amphotericin B cholesteryl sulfate complexSEQ0.83 mg/mLa AB10 mg/mLa Gross precipitate forms2117 I

Ampicillin sodiumSKB250 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Ampicillin sodiumSKB1, 10, 50 mg/mLb AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Ampicillin sodiumSKB1b , 10b , 50b , 250d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Ampicillin sodium-sulbactam sodiumPFt 250 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Ampicillin sodium-sulbactam sodiumPFt 1, 10, 50 mg/mLb AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Ampicillin sodium-sulbactam sodiumPFt 1, 10, 50 mg/mLb AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Ampicillin sodium-sulbactam sodiumPFt 250 mg/mLd AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

AmsacrineNCI1 mg/mLa LI10 mg/mLa Visually compatible for 4 hr at 22 C1381 C

AnidulafunginVIC0.5 mg/mLa APP10 mg/mLa Physically compatible for 4 hr at 23 C2617 C

Atracurium besylateBW0.5 mg/mLa ES5 mg/mLa Physically compatible for 24 hr at 28 C1337 C

AztreonamSQ200 mg/mLb LI67 mg/mLb White granular precipitate forms immediately in tubing when given sequentially1364 I

AztreonamSQ40 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C1758 C

BivalirudinTMC5 mg/mLa AB10 mg/mLa Gross white precipitate forms immediately2373 I

Caspofungin acetateME0.7 mg/mLb HOS10 mg/mLb Physically compatible for 4 hr at room temperature2758 C

Caspofungin acetateME0.5 mg/mLb HOS4 mg/mLb Physically compatible over 60 min2766 C

Cefazolin sodiumSKB200 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Cefazolin sodiumSKB10 and 50 mg/mLa AB20 mg/mLa Gross white precipitate forms immediately2189 I

Cefazolin sodiumSKB1 mg/mLa AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefazolin sodiumSKB200 mg/mLd AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefazolin sodiumSKB50 mg/mLa AB2 mg/mLa Subvisible haze forms immediately2189 I

Cefazolin sodiumSKB1 and 10 mg/mLa AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefepime HClBMS120 mg/mLd 30 mg/mLPhysically compatible with less than 10% cefepime loss. Vancomycin not tested2513 C

Cefotaxime sodium100 mg/mLd 12.5, 25, 30, 50 mg/mLd White precipitate forms immediately1721 I

Cefotaxime sodium100 mg/mLd 5 mg/mLd No precipitate visually observed over 7 days at room temperature, but nonvisible incompatibility cannot be ruled out1721 ?

Cefotaxime sodiumHO200 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Cefotaxime sodiumHO50 mg/mLa AB20 mg/mLa White cloudiness forms immediately2189 I

Cefotaxime sodiumHO1 and 10 mg/mLa AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefotaxime sodiumHO1, 10, 50 mg/mLa AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefotaxime sodiumHO200 mg/mLd AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefotetan disodiumZEN200 mg/mLd AB20 mg/mLa Transient precipitate forms followed by white precipitate in 4 hr2189 I

Cefotetan disodiumZEN10 and 50 mg/mLa AB20 mg/mLa Gross white precipitate forms immediately2189 I

Cefotetan disodiumZEN1 mg/mLa AB20 mg/mLa Subvisible haze forms immediately. White precipitate in 4 hr2189 I

Cefotetan disodiumZEN1a , 10a , 50a , 200d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefoxitin sodiumME180 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Cefoxitin sodiumME50 mg/mLa AB20 mg/mLa Immediate gross white precipitate2189 I

Cefoxitin sodiumME10 mg/mLa AB20 mg/mLa Visible haze forms in 4 hr at 23 C2189 I

Cefoxitin sodiumME1 mg/mLa AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefoxitin sodiumME1a , 10a , 50a , 180d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Ceftazidime50 mg/mLd 10 mg/mLa Precipitates immediately873 I

CeftazidimeSKB10a , 50a , 200d mg/mLAB20 mg/mLa Gross white precipitate forms immediately2189 I

CeftazidimeSKB1 mg/mLa AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

CeftazidimeSKB1a , 10a , 50a , 200d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

CeftazidimeSKB125 mg/mL30 mg/mLPrecipitates immediately2434 I

CeftazidimeGSK120 mg/mLd 30 mg/mLPrecipitates2513 I

Ceftriaxone sodiumRC100 mg/mLLI20 mg/mLWhite precipitate forms immediately1398 I

Ceftriaxone sodiumRC250 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Ceftriaxone sodiumRC10 and 50 mg/mLa AB20 mg/mLa Gross white precipitate forms immediately2189 I

Ceftriaxone sodiumRC1 mg/mLa AB20 mg/mLa Subvisible haze forms immediately2189 I

Ceftriaxone sodiumRC1a , 10a , 50a , 250d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefuroxime sodiumGW150 mg/mLd AB20 mg/mLa Transient precipitate forms followed by a subvisible haze2189 I

Cefuroxime sodiumGW50 mg/mLa AB20 mg/mLa Gross white precipitate forms immediately2189 I

Cefuroxime sodiumGW10 mg/mLa AB20 mg/mLa Subvisible haze forms immediately2189 I

Cefuroxime sodiumGW1 mg/mLa AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cefuroxime sodiumGW1a , 10a , 50a , 150d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Cisatracurium besylateGW0.1, 2, 5 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C2074 C

ClarithromycinAB4 mg/mLa DB10 mg/mLa Visually compatible for 72 hr at both 30 and 17 C2174 C

CyclophosphamideMJ20 mg/mLa LI5 mg/mLa Physically compatible for 4 hr at 25 C1194 C

Dexmedetomidine HClAB4 mcg/mLb AB10 mg/mLb Physically compatible for 4 hr at 23 C2383 C

Diltiazem HClMMD5 mg/mLLI5 and 50 mg/mLb Visually compatible1807 C

DocetaxelRPR0.9 mg/mLa LI10 mg/mLa Physically compatible for 4 hr at 23 C2224 C

DoripenemJJ5 mg/mLa b HOS10 mg/mLa b Physically compatible for 4 hr at 23 C2743 C

Doxapram HClRB2 mg/mLa APP5 mg/mLa Visually compatible for 4 hr at 23 C2470 C

Doxorubicin HCl liposomalSEQ0.4 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C2087 C

EnalaprilatMSD0.05 mg/mLb LE5 mg/mLa Physically compatible for 24 hr at room temperature under fluorescent light1355 C

Esmolol HClDCC10 mg/mLa LE5 mg/mLa Physically compatible for 24 hr at 22 C1169 C

Etoposide phosphateBR5 mg/mLa LI10 mg/mLa Physically compatible for 4 hr at 23 C2218 C

Fenoldopam mesylateAB80 mcg/mLb APP10 mg/mLb Physically compatible for 4 hr at 23 C2467 C

FilgrastimAMG30 mcg/mLa AB10 mg/mLa Physically compatible for 4 hr at 22 C1687 C

FluconazoleRR2 mg/mLLY20 mg/mLPhysically compatible for 24 hr at 25 C1407 C

Fludarabine phosphateBX1 mg/mLa LI10 mg/mLa Visually compatible for 4 hr at 22 C1439 C

Foscarnet sodiumAST24 mg/mLLE20 mg/mLPrecipitates immediately1335 I

Foscarnet sodiumAST24 mg/mLLE15 mg/mLc Physically compatible for 24 hr at 25 C under fluorescent light1393 C

Foscarnet sodiumAST24 mg/mLLE10 mg/mLb Visually compatible for 24 hr at room temperature. No precipitate found2063 C

Gallium nitrateFUJ1 mg/mLb AB5 mg/mLb Visually compatible for 24 hr at 25 C1673 C

Gemcitabine HClLI10 mg/mLb LI10 mg/mLb Physically compatible for 4 hr at 23 C2226 C

Granisetron HClSKB0.05 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C2000 C

Heparin sodiumTR50 units/mLLI6.6 mg/mLa Visually incompatible within 4 hr at 25 C1793 I

Heparin sodiumES100 units/mLc LE10 mg/mLb Precipitate forms2063 I

Heparin sodiumLEO10 and 5000 units/mLb PHS2.5 mg/mLb Physically compatible with little change in heparin activity in 14 days at 4 and 37 C. Antibiotic not tested2684 C

Heparin sodiumLEO10 units/mLb PHS2 mg/mLb Physically compatible with little change in heparin activity in 14 days at 4 and 37 C. Antibiotic not tested2684 C

Hetastarch in lactated electrolyteAB6%LI10 mg/mLa Physically compatible for 4 hr at 23 C2339 C

Hydromorphone HClWY0.2 mg/mLa LI5 mg/mLa Physically compatible for 4 hr at 25 C987 C

Hydromorphone HClHOS2 mg/mLHOS4 mg/mLb Physically compatible2794 C

Idarubicin HClAD1 mg/mLb AD4 mg/mLa Color changes immediately1525 I

Insulin, regularLI0.2 unit/mLb LI4 mg/mLa Physically compatible for 2 hr at 25 C1395 C

Labetalol HClSC1 mg/mLa LE5 mg/mLa Physically compatible for 24 hr at 18 C1171 C

LevofloxacinOMN5 mg/mLa LI50 mg/mLVisually compatible for 4 hr at 24 C2233 C

LinezolidPHU2 mg/mLFUJ10 mg/mLa Physically compatible for 4 hr at 23 C2264 C

LorazepamWY0.33 mg/mLb LI5 mg/mLVisually compatible for 24 hr at 22 C1855 C

Magnesium sulfateIX16.7, 33.3, 66.7, 100 mg/mLa LI5 mg/mLa Physically compatible for at least 4 hr at 32 C813 C

Melphalan HClBW0.1 mg/mLb LY10 mg/mLb Physically compatible for 3 hr at 22 C1557 C

Meperidine HClWY10 mg/mLa LI5 mg/mLa Physically compatible for 4 hr at 25 C987 C

MeropenemZEN1 and 50 mg/mLb LI5 mg/mLd Visually compatible for 4 hr at room temperature1994 C

Methotrexate sodiumLEa f AB510 mgg Physically compatible during 1-hr simultaneous infusion1405 C

Methotrexate sodium30 mg/mL5 mg/mLa Visually compatible for 2 hr at room temperature. Yellow precipitate in 4 hr1788 I

Midazolam HClRC1 mg/mLa LI5 mg/mLa Visually compatible for 24 hr at 23 C1847 C

Midazolam HClRC5 mg/mLLI5 mg/mLVisually compatible for 24 hr at 22 C1855 C

Milrinone lactateSS0.2 mg/mLa OR5 mg/mLa Visually compatible for 4 hr at 25 C2381 C

Morphine sulfateWI1 mg/mLa LI5 mg/mLa Physically compatible for 4 hr at 25 C987 C

Mycophenolate mofetil HClRC5.9 mg/mLa 10 mg/mLa Physically compatible and 3% mycophenolate mofetil loss in 4 hr2738 C

Nafcillin sodiumBE250 mg/mLd AB20 mg/mLa Transient precipitate forms followed by a visibly hazy solution2189 I

Nafcillin sodiumBE10 and 50 mg/mLb AB20 mg/mLa Gross white precipitate forms immediately2189 I

Nafcillin sodiumBE1 mg/mLb AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Nafcillin sodiumBE10b , 50b , 250d mg/mLAB2 mg/mLa Subvisible measured haze forms immediately2189 I

Nafcillin sodiumBE1 mg/mLb AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Nicardipine HClDCC0.1 mg/mLa LE5 mg/mLa Visually compatible for 24 hr at room temperature235 C

Omeprazole4 mg/mL10 mg/mLa White precipitate forms within 5 min2173 I

Ondansetron HClGL1 mg/mLb LI10 mg/mLa Visually compatible for 4 hr at 22 C1365 C

PaclitaxelNCI1.2 mg/mLa 10 mg/mLa Physically compatible for 4 hr at 22 C1528 C

Palonosetron HClMGI50 mcg/mLHOS5 mg/mLa Physically compatible and no loss of either drug in 4 hr at room temperature2765 C

Pancuronium bromideES0.05 mg/mLa ES5 mg/mLa Physically compatible for 24 hr at 28 C1337 C

Pantoprazole sodiumALTr 8 mg/mLME40 mg/mLColor change after 10 hr2727 I

Pemetrexed disodiumLI20 mg/mLb AB10 mg/mLa Physically compatible for 4 hr at 23 C2564 C

Piperacillin sodium-tazobactam sodiumLEr u 40 mg/mLa AB10 mg/mLa White turbidity forms immediately and white precipitate forms in 4 hr1688 I

Piperacillin sodium-tazobactam sodiumLEr u 200 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Piperacillin sodium-tazobactam sodiumLEr u 10 and 50 mg/mLa AB20 mg/mLa Gross white precipitate forms immediately2189 I

Piperacillin sodium-tazobactam sodiumLEr u 1 mg/mLa AB20 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Piperacillin sodium-tazobactam sodiumLEr u 1, 10, 50 mg/mLd AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

Piperacillin sodium-tazobactam sodiumLEr u 200 mg/mLd AB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

PropofolZEN10 mg/mLAB10 mg/mLa Physically compatible for 1 hr at 23 C2066 C

PropofolBA10 mg/mL10 mg/mLa Emulsion disruption within 1 to 4 hr at room temperature2336 I

PropofolASZ10 mg/mL10 mg/mLa Physically compatible for up to 30 days at room temperature2336 C

Remifentanil HClGW0.025 and 0.25 mg/mLb AB10 mg/mLa Physically compatible for 4 hr at 23 C2075 C

SargramostimIMM10 mcg/mLb LI10 mg/mLb Visually compatible for 4 hr at 22 C1436 C

SargramostimIMM15 mcg/mLb LI20 mg/mLc Visually compatible for 2 hr1618 C

SargramostimIMM6 mcg/mLb h LI20 mg/mLc Haze forms within 15 min and increases due to vancomycin incompatibility with albumin human1618 1701 I

Sodium bicarbonate1.4%5 mg/mLa Visually compatible for 4 hr at room temperature1788 C

TacrolimusFUJ1 mg/mLb LI5 mg/mLa Visually compatible for 24 hr at 25 C1630 C

TeniposideBR0.1 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C1725 C

TheophyllineTR4 mg/mLLI6.6 mg/mLa Visually compatible for 6 hr at 25 C1793 C

ThiotepaIMMi 1 mg/mLa AB10 mg/mLa Physically compatible for 4 hr at 23 C1861 C

Ticarcillin disodium-clavulanate potassiumSKB206.7 mg/mLd AB20 mg/mLa Transient precipitate forms2189 ?

Ticarcillin disodium-clavulanate potassiumSKB1.034, 10.335, 51.675 mg/mLa AB20 mg/mLa Gross white precipitate forms2189 I

Ticarcillin disodium-clavulanate potassiumSKB31 mg/mLb 5 mg/mLb White precipitate formed sporadically2167 I

Ticarcillin disodium-clavulanate potassiumSKB1.034a , 10.335a , 51.675a , 206.7d mg/mLAB2 mg/mLa Physically compatible for 4 hr at 23 C2189 C

TigecyclineWY1 mg/mLb 5 mg/mLb Physically compatible for 4 hr2714 C

TNA #218j AB10 mg/mLa Visually compatible for 4 hr at 23 C2215 C









TPN #61j k LI50 mg/1 mLl Physically compatible1012 C

TPN #61j m LI300 mg/6 mLl Physically compatible1012 C

TPN #91j n LI30 mgo Physically compatible1170 C

TPN #189j DB10 mg/mLb Visually compatible for 24 hr at 22 C1767 C

TPN #212j AB10 mg/mLa Physically compatible for 4 hr at 23 C2109 C




Vecuronium bromideOR0.1 mg/mLa ES5 mg/mLa Physically compatible for 24 hr at 28 C1337 C

Vinorelbine tartrateBW1 mg/mLb LY10 mg/mLb Physically compatible for 4 hr at 22 C1558 C

Warfarin sodiumDU2 mg/mLd LI4 mg/mLa Haze forms immediately2010 I

Warfarin sodiumDU0.1 mg/mLc AB10 mg/mLc Physically compatible for 24 hr at 23 C2011 C

Warfarin sodiumDU2 mg/mLd AB10 mg/mLc Heavy white turbidity forms immediately2011 I

Warfarin sodiumDME2 mg/mLd LI4 mg/mLa Haze forms immediately2078 I

ZidovudineBW4 mg/mLa LI15 mg/mLa Physically compatible for 4 hr at 25 C1193 C

a Tested in dextrose 5%. b Tested in sodium chloride 0.9%. c Tested in both dextrose 5% and sodium chloride 0.9%. d Tested in sterile water for injection. e Tested in a 1:1 mixture of dextrose 5% and TPN #274 (see Appendix I). f Concentration unspecified. g Infused over one hour simultaneously with methotrexate. h Tested with 0.1% albumin human added. i Lyophilized formulation tested. j Refer to Appendix I for the composition of parenteral nutrition solutions. TNA indicates a 3-in-1 admixture, and TPN indicates a 2-in-1 admixture. k Run at 21 mL/hr. l Given over 30 minutes by syringe pump. m Run at 94 mL/hr. n Run at 10 mL/hr. o Given over one hour by syringe pump. p Tested in a 1:1 mixture of (1) dextrose 5% and dextrose 5% in sodium chloride 0.45% with and without potassium chloride 20 mEq/L and also in (2) dextrose 10% in sodium chloride 0.45% with and without potassium chloride 20 mEq/L. q Tested with albumin human 0.1%. r Test performed using the formulation WITHOUT edetate disodium. s Tested in either dextrose 5% or in sodium chloride 0.9%, but the report did not specify which solution. t Ampicillin sodium component. Ampicillin sodium in a 2:1 fixed-ratio concentration with sulbactam sodium. u Piperacillin sodium component. Piperacillin sodium in an 8:1 fixed-ratio concentration with tazobactam sodium.

Additional Compatibility Information Peritoneal Dialysis SolutionsThe activity of vancomycin 15 mg/L was evaluated in peritoneal dialysis fluids containing dextrose 1.5 or 4.25% (Dianeal 137, Travenol). Storage at 25 C resulted in virtually no loss of antimicrobial activity in 24 hours.515 Vancomycin hydrochloride with aztreonam admixed in Dianeal 137 with dextrose 4.25% is stated to be stable for 24 hours at room temperature.1(10/08) Vancomycin hydrochloride (Lilly) 10 and 50 mg/L in peritoneal dialysis concentrate with dextrose 50% (McGaw) retained 93 to 100% of its initial activity after 24 hours of storage at room temperature.1044 The stability of vancomycin hydrochloride (Lilly) 20 mg/L in peritoneal dialysis solutions (Dianeal 137 and PD2) with heparin sodium 500 units/L was evaluated. Approximately 95 12% activity remained after 24 hours at 25 C.1228 Vancomycin hydrochloride (Lilly) 15 mg/L to 5.3 g/L in Dianeal with dextrose 2.5 or 4.25% was physically compatible with heparin sodium (Organon) 500 to 14,300 units/L for 24 hours at 25 C under fluorescent light. However, a white precipitate formed immediately in combinations of heparin sodium with vancomycin hydrochloride 6.9 to 14.3 g/L.1322 The retention of antimicrobial activity of vancomycin hydrochloride (Lilly) 1 g/L alone and with each of the aminoglycosides gentamicin sulfate (SoloPak) 120 mg/L and tobramycin sulfate (Lilly) 120 mg/L in Dianeal PD-2 (Travenol) with dextrose 1.5% was evaluated. Little or no loss of any antibiotic occurred in eight hours at 37 C. Vancomycin hydrochloride alone retained activity for at least 48 hours at 4 and 25 C. In combination with gentamicin sulfate and tobramycin sulfate, antimicrobial activity of both vancomycin and the aminoglycosides was retained for up to 48 hours. However, refrigeration at 4 C was recommended for storage periods greater than 24 hours.1414 The stability of vancomycin hydrochloride (Lilly) 25 mg/L in Dianeal 137 (Baxter) with dextrose 1.36 and 3.86%, while protected from direct sunlight, was evaluated. At both dextrose concentrations, less than 4% vancomycin hydrochloride was lost in 42 days at 4 C. At 20 C, a 5% or less loss occurred in 28 days. At 37 C, a 10% loss occurred in six to seven days.1654 Vancomycin hydrochloride (Lilly) 1 mg/mL admixed with ceftazidime (Lilly) 0.5 mg/mL in Dianeal PD-2 (Baxter) with 1.5% and also 4.25% dextrose were evaluated for compatibility and stability. Samples were stored under fluorescent light at 4 and 24 C for 24 hours and at 37 C for 12 hours. No precipitation or other change was observed by visual inspection in any sample. No loss of either drug was found in the samples stored at 4 C and no loss of vancomycin hydrochloride and about 4 to 5% ceftazidime loss in the samples stored at 24 C in 24 hours. Vancomycin hydrochloride losses of 3% or less and ceftazidime loss of about 6% were found in the samples stored at 37 C for 12 hours. No difference in stability was found between samples at either dextrose concentration.2217 Vancomycin hydrochloride (Lederle) 0.05 mg/mL in Dianeal PD-2 with dextrose 1.5% with or without heparin sodium 1 unit/mL in PVC bags was chemically stable for up to six days at 4 C (about 3 to 5% loss) and 25 C (up to 7% loss) and five days at body temperature of 37 C.866 The addition of ceftazidime (Glaxo) 0.1 mg/mL to this peritoneal dialysis solution demonstrated a somewhat reduced stability with the ceftazidime being the defining component. The ceftazidime was chemically stable for up to six days at 4 C (about 3% loss), three days at 25 C (about 9 to 10% loss), and 12 hours at body temperature of 37 C with the vancomycin exhibiting less loss throughout.866 Vancomycin hydrochloride (Lederle) 25 mcg/mL in Delflex peritoneal dialysis solution bags with 2.5% dextrose (Fresenius) was stable with little loss occurring in 14 days refrigerated and at room temperature.2573 Gentamicin sulfate (American Pharmaceutical Partners) 8 mcg/mL with vancomycin hydrochloride (Lederle) 25 mcg/mL in Delflex peritoneal dialysis solution bags with 2.5% dextrose (Fresenius) was stable with little or no loss of either drug occurring in 14 days refrigerated and at room temperature.2573 Vancomycin hydrochloride (Abbott) 1 mg/mL in icodextrin 7.5% PD (Baxter) was tested for stability at 5, 24, and 37 C. The solutions remained clear and colorless. Little or no loss at 5 C and about 3% loss at 24 C after seven days of storage was found. At 37 C, about 6% loss occurred in 24 hours.2650 Heparin LocksVancomycin hydrochloride (Lilly) 25 mcg/mL and heparin sodium (Elkins-Sinn) 100 units/mL in 0.9% sodium chloride injection as a catheter flush solution was evaluated for stability when stored at 4 C for 14 days. The flush solution was visually clear, and the vancomycin activity and heparin activity were retained throughout the storage period. However, an additional 24 hours at 37 C to simulate use conditions resulted in losses of both agents ranging from 20 to 37%.1933 Vancomycin hydrochloride (Lilly) 25 mcg/mL and preservative-free heparin sodium (Elkins-Sinn) 100 units/mL in 0.9% sodium chloride in 2-mL glass vials for use as a central catheter flush solution were evaluated for compatibility and stability at 4 and 28 C. Visual inspection found no evidence of color change or particulate formation throughout the study. Heparin activity remained unchanged for 100 days. Acceptable vancomycin levels were maintained for 30 days at 28 C and for 63 days at 4 C. However, unacceptable losses occurred after those times. The activity of both drugs was unaffected by the presence of the other when compared to the activity of single drug controls.2279 Vancomycin hydrochloride 25 mcg/mL combined with heparin sodium (Hospira) 10 units/mL in sterile water for injection for use as a lock solution was found to be physically compatible. Little or no vancomycin loss occurred in 3 days at 4 C. However, losses of 8% occurred in 3 days at 27 C and 1 day at 40 C.2820 If ciprofloxacin (Sicor) 2 mg/mL was added to this flush solution, a white precipitate appeared within 1 day. Losses of both ciprofloxacin and vancomycin occurred as well.2820 Handbook on Injectable Drugs. Copyright, 1977-2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.Original Publication Date: October 1, 1982. Selected Revisions: May 28, 2014.

ReferencesFor a list of references cited in the text of this monograph, search the monograph titled HID references.

FRMACO: VORICONAZOL

OsmolaridadpHBiodisponibilidad

Compatibilidad con antibiticos y otros frmacos:

Estabilidad con electrolitos:

Estabilidad en Dilucin en medicamentos:

Estabilidad en infusin :

Estabilidad en refrigeracin y medio ambiente :

VoriconazoleAHFS Class: 8:14.08 - AzolesTradenames: VfendProductsVoriconazole is available as a lyophilized powder in single-use vials containing 200 mg with 3.2 g of sulfobutyl ether -cyclodextrin sodium and bearing a vacuum. Reconstitute with 19 mL of sterile water for injection and shake well to yield 20 mL of a voriconazole 10-mg/mL solution. Do not use the vial if a vacuum does not draw in the diluent for reconstitution.1(5/08) The reconstituted solution is a concentrate that must be diluted in a compatible solution to a concentration of 0.5 to 5 mg/mL before intravenous administration. The manufacturer recommends removing a volume equivalent to the volume of drug before addition to the bag.1(5/08) AdministrationVoriconazole is administered by intravenous infusion in a compatible infusion solution at a concentration between 0.5 and 5 mg/mL over one to two hours at a maximum rate of 3 mg/kg/hr.1(5/08) StabilityIntact vials should be stored at controlled room temperature. Voriconazole reconstituted as directed is chemically and physically stable for 24 hours under refrigeration. However, because no antimicrobial preservative is present, the manufacturer recommends use immediately after reconstitution. Voriconazole is intended for single use, and any remaining drug should be discarded.1(5/08) Compatibility Solution CompatibilityVoriconazole


Dextrose 5% in Ringer's injection lactatedPFCompatible and stable for 24 hr1(5/08) C

Dextrose 5% in sodium chloride 0.45%PFCompatible and stable for 24 hr1(5/08) C

Dextrose 5% in sodium chloride 0.9%PFCompatible and stable for 24 hr1(5/08) C

Dextrose 5%PFCompatible and stable for 24 hr1(5/08) C

Dextrose 5%a PF4 gVisually compatible. 3% loss in 15 days at 4 C2662 C

Dextrose 5%MACb PF2 gVisually compatible. 9% loss in 6 days at 4 C and in 5 days at 25 C2694 C

Sodium chloride 0.45%PFCompatible and stable for 24 hr1(5/08) C

Sodium chloride 0.9%PFCompatible and stable for 24 hr1(5/08) C

Sodium chloride 0.9%MACb PF2 gNo loss over 32 days at 4 C2624 C

Sodium chloride 0.9%MACb PF2 gVisually compatible. No loss at 4 C and 5% loss at 25 C in 8 days2694 C

a Tested in PVC containers. b Tested in polyolefin containers.

Additive CompatibilityVoriconazole


Sodium bicarbonate4.2%PFVoriconazole slightly decomposes at room temperature1(5/08) I

Y-Site Injection Compatibility (1:1 Mixture)Voriconazole


AnidulafunginVIC0.5 mg/mLa PF4 mg/mLa Physically compatible for 4 hr at 23 C2617 C

Caspofungin acetateME0.7 mg/mLb PF4 mg/mLb Physically compatible for 4 hr at room temperature2758 C

Caspofungin acetateME0.5 mg/mLb PF2 mg/mLb Physically compatible over 60 min2766 C

Ceftaroline fosamilFOR2.22 mg/mLa b d PF4 mg/mLa b d Physically compatible for 4 hr at 23 C2826 C

DoripenemJJ5 mg/mLa b PF4 mg/mLa b Physically compatible for 4 hr at 23 C2743 C

TigecyclineWY1 mg/mLb PF2 mg/mLb Microparticulates form2714 I

VasopressinAPP0.2 unit/mLb PF3 mg/mLc Physically compatible2641 C

a Tested in dextrose 5%. b Tested in sodium chloride 0.9%. c Tested in sodium chloride 0.45%. d Tested in Ringer's injection lactated.

Handbook on Injectable Drugs. Copyright, 1977-2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.Original Publication Date: October 1, 2008. Selected Revisions: October 1, 2012.


FRMACO: COSPOFUNGINA







Amphotericin BAHFS Class: 8:14.28 - PolyenesTradenames: FungizoneProductsAmphotericin B is available in vials containing 50 mg of drug with sodium desoxycholate 41 mg and sodium phosphates 20.2 mg. Reconstitute with 10 mL of sterile water for injection without preservatives and shake until a clear colloidal dispersion is obtained. The resultant concentration is 5 mg/mL of amphotericin B. Use only sterile water for injection without preservatives for reconstitution because other diluents, such as sodium chloride 0.9% or solutions containing a bacteriostatic agent such as benzyl alcohol, may result in the precipitation of the antibiotic. For infusion, amphotericin B must be further diluted with dextrose 5% with a pH above 4.2.1(4/07) 4 Although various lipid complex and liposomal products of amphotericin B exist, they are sufficiently different from conventional amphotericin B formulations that extrapolating information to or from the other forms would be inappropriate. pHThe pH of amphotericin B (Squibb) 100 mg/L in dextrose 5% has been reported as 5.7.149 OsmolalityThe osmolality of amphotericin B (Squibb) 0.1 mg/mL in dextrose 5% was determined to be 256 mOsm/kg.1375 AdministrationAmphotericin B is administered by slow intravenous infusion over approximately two to six hours. The recommended concentration of the infusion is 0.1 mg/mL.1(4/07) 4 The drug has also been given intra-articularly, intrathecally, intrapleurally, and by irrigation.4 CAUTION: Care should be taken to ensure that the correct drug product, dose, and administration procedure are used and that no confusion with other products occurs.StabilityStore intact vials at 2 to 8 C and protect from light.1(4/07) 4 The manufacturer indicates that a 5 to 10% potency loss occurs in one month at room temperature.1433 Amphotericin B reconstituted with sterile water for injection without preservatives and stored in the dark is stable for 24 hours at room temperature and for one week under refrigeration at 2 to 8 C.1(4/07) 4 108 One report indicates that aqueous solutions may be stable for over a week at both 5 and 28 C.352 Reconstituted amphotericin B may be added to dextrose 5% with a pH above 4.2. Buffers present in the formulation raise the pH of the admixture. If the dextrose 5% has a pH less than 4.2, additional buffer must be added.1(4/07) 4 One or 2 mL of a buffer solution composed of dibasic sodium phosphate anhydrous 1.59 g and monobasic sodium phosphate anhydrous 0.96 g in water for injection is brought to 100 mL. The buffer solution should be sterilized either by filtration or by autoclaving for 30 minutes at 121 C at 15 pounds pressure.1(4/07) Failure to sterilize this buffer solution coupled with prolonged storage at room temperature has resulted in severe infection.328 Amphotericin B was reported to precipitate when added to some evacuated containers due to a small residual amount of fluid that may have acetic acid and sodium acetate buffer or sodium chloride 0.9% solution. Only evacuated containers with residual sterile water should be used for preparing amphotericin B admixtures.1232 In an effort to reduce toxicity, amphotericin B has been admixed in Intralipid instead of the more usual dextrose 5%.1809 1810 1811 2178 However, amphotericin B 0.75 mg/kg/day administered using this approach in 250 mL of Intralipid 20% has been associated with acute pulmonary toxicities, including sudden onset of coughing, tachypnea, cyanosis, and deterioration of oxygen saturation following administration. The temporal relationship between the drug administration and respiratory symptoms suggested a causal relationship. Furthermore, no reduction in renal toxicity or other side effects was observed. It was concluded amphotericin B should not be administered in Intralipid.2177 At a concentration of 0.6 mg/mL in Intralipid 10 or 20%, amphotericin B precipitates immediately or almost immediately. The precipitate is not visible to the unaided eye because of the emulsion's dense opacity. Particle size evaluation found thousands of particles larger than 10 m per milliliter. In dextrose 5%, very few particles were larger than 10 m. Centrifuging the Intralipid admixtures resulted in rapid visualization of the precipitate as a mass at the bottom of the test tubes.1808 However, amphotericin B precipitation is observed in fat emulsion within two to four hours without centrifuging. In concentrations ranging from 90 mg to 2 g/L in Intralipid 20%, amphotericin B precipitate is easily seen as yellow particulate matter on the bottom of the lipid emulsion containers.1872 1988 Damage to the emulsion integrity with creaming has also been reported.1987 In other reports, the appearance of problems was observed in as little as 15 minutes, and actual amphotericin B precipitate formed within 20 minutes of mixing. Analysis of the precipitate confirmed its identity as amphotericin B. The authors hypothesized that amphotericin B precipitates as a consequence of the excipient desoxycholic acid, which is an anion, attracting oppositely charged choline groups from the egg yolk components of the fat emulsion. As a consequence, desoxycholic acid and phosphatidylcholine form a precipitate and insufficient surfactant remains to keep the amphotericin B dispersed.2204 2205 pH EffectsThe pH range for optimum clarity and stability is 6 to 7.148 At a pH of less than approximately 6, the colloidal dispersion may become turbid.40 148 Colloidal particles tend to coagulate rapidly at a pH of less than 5.4 Light EffectsAlthough the manufacturer recommends light protection for aqueous solutions of amphotericin B1(4/07) , several reports indicate that for short-term exposure of eight to 24 hours, little difference in potency is observed between light-protected and light-exposed solutions.150 335 353 Longer exposure periods150 or higher intensity light exposure2414 may result in unacceptable potency losses, however. Elastomeric Reservoir PumpsAmphotericin B (Lyphomed) 0.25 mg/mL in dextrose 5% was evaluated for binding potential to natural rubber elastomeric reservoirs (Baxter). No binding was found after storage for two weeks at 35 C with gentle agitation.2014 FiltrationVarious studies have assessed the effects of filtration on the amphotericin B colloidal dispersion with differing results. The use of a 0.22-m membrane filter was reported to be unacceptable with colloidal solutions adjusted to pH 4.7, 5.6, and 6.5. The concentration of amphotericin B in the filtrate decreased substantially after several hours. A 0.45-m filter was satisfactory for infusions with a pH of 6.5, but the results at pH 5.6 were inconclusive. At pH 5.6 and 6.5, 1- and 5-m filters both proved satisfactory in that they did not reduce the concentration of amphotericin B. For the turbid mixtures resulting at pH 4.7, however, all filters sharply reduced the concentration.148 A report tended to support this finding for the 0.22-m filter. At pH 5.7, fine particles of amphotericin B formed and were retained by the 0.22-m filter.149 No appreciable reduction in concentration with a 0.45-m filter was found; but with a 0.22-m filter, after one hour the concentration of amphotericin B delivered was about 30% of the initial concentration.152 When amphotericin B 50 mg/500 mL in dextrose 5% was filtered through a 0.22-m circular cellulose ester membrane (Swinnex) or a 0.22-m cylindrical cellulose ester filter (Ivex-2), the flow rate decreased dramatically after passage of as little as 30 mL. Flow ceased altogether after 100 to 200 mL. The last sample filtered contained no drug. With a 0.45-m circular cellulose ester membrane (Swinnex), no loss of activity was determined after filtration of 200 mL. However, the flow rate had decreased.598 On the other hand, no significant difference in the amount or concentration of amphotericin B in dextrose 5% with phosphate buffer was found after filtration with 0.22-, 0.45-, and 5-m filters.151 For amphotericin B infusions, only filters with a pore size not less than 1 m should be used for filtration.1(4/07) 4 148 This would allow a margin for error that would compensate for possible variations in particle size.148 Also, limiting the use of filtration to situations where it is believed to be necessary has been recommended.598 599 Compatibility Solution CompatibilityAmphotericin B


Amino acids 4.25%, dextrose 25%MGSQ100 mgTurbidity and fine yellow particles form349 I

Dextrose 5% in Ringer's injection lactatedMGa SQ100 mgPrecipitate forms in 30 min. About 50% remains in 30 min539 I

Dextrose 5% in sodium chloride 0.9%MGa SQ100 mgPrecipitate forms within 2 hr. 30 to 70% remains in 2 hr539 I

Dextrose 5%SQ70 and 140 mgBioactivity not affected over 24 hr at 25 C in light or dark335 C

Dextrose 5%MGa SQ100 mgPhysically compatible. Concentration unchanged in 48 hr539 C

Dextrose 5%SQ50 and 100 mgNo loss of bioactivity in normal light at 25 C for 24 hr540 C

Dextrose 5%MGb SQ0.9, 1.2, 1.4 gPhysically compatible with little loss in 36 hr at 6 and 25 C1434 C

Dextrose 5%MGb SQ470, 660, 750 mgVisually compatible with no loss in 24 hr at 25 C1537 C

Dextrose 5%BAc SQ100 mgVisually compatible with no loss in 24 hr at 15 to 25 C1544 C

Dextrose 5%BAc SQ100 and 250 mgVisually compatible with 4% loss in 35 days at 4 C in dark1546 C

Dextrose 5%BAc SQ0.2, 0.5, 1 gVisually compatible. Little loss in 5 days at 4 and 25 C. Normal turbidity observed at 1 g/L1728 C

Dextrose 5%ABc BMS50 mgVisually compatible. No loss protected from light and 5% loss exposed to fluorescent light in 24 hr at 24 C2093 C

Dextrose 5%ABc BMS500 mgVisually compatible. No loss protected from or exposed to fluorescent light in 24 hr at 24 C2093 C

Dextrose 5%50, 100, 150 mgVisually compatible with less than 5% loss in 24 hr at 4 and 25 C when protected from light2414 C



Ringer's injection lactatedMGa SQ100 mgPrecipitate forms within 2 hr. 80% remains in 2 hr539 I

Sodium chloride 0.9%ABSQ100 mgPhysically incompatible15 I

Sodium chloride 0.9%MGa SQ100 mgPrecipitate forms within 2 hr. 43% remains in 2 hr539 I

a Tested in both glass and polyolefin containers. b Tested in polyolefin containers. c Tested in PVC containers.

Additive CompatibilityAmphotericin B


Amikacin sulfateBR5 gSQ100 mgD5LR, D5R, D5S, D5W, D10W, LR, NS, R, SLPrecipitates immediately293 I

Calcium chlorideBP4 g200 mgD5WHaze develops over 3 hr26 I

Calcium gluconateBP4 g200 mgD5WHaze develops over 3 hr26 I

Chlorpromazine HClBP200 mg200 mgD5WPrecipitates immediately26 I

CiprofloxacinMI2 g100 mgD5WPhysically incompatible888 I

CiprofloxacinBAY2 gAPC100 mgD5WPrecipitates immediately2413 I

Diphenhydramine HClPD80 mgSQ100 mgD5WPhysically incompatible15 I

Dopamine HClAS800 mgSQ200 mgD5WPrecipitates immediately78 I

Edetate calcium disodiumRI4 g200 mgD5WHaze develops over 3 hr26 I

Fat emulsion, intravenousCL10 and 20%APC, PHT0.6 gPrecipitate forms immediately but is concealed by opaque emulsion1808 I

Fat emulsion, intravenous20%90 mgYellow precipitate forms in 2 hr. Cumulative delivery of only 56% of total amphotericin B dose1872 I

Fat emulsion, intravenousCL20%APC10, 50, 100, 500 mg, 1 and 5 gEmulsion separation occurred rapidly with visible creaming within 4 hr at 27 and 8 C1987 I

Fat emulsion, intravenousKA20%SQ500 mg, 1 and 2 gPrecipitated amphotericin noted on bottom of containers within 4 hr1988 I

Fat emulsion, intravenousCLb 20%BMS50 and 500 mgFat emulsion separates into two phases within 8 hr. Little loss protected from or exposed to fluorescent light in 24 hr at 24 C2093 I

Fat emulsion, intravenousKP20%BMS1 and 3 gPrecipitate forms immediately2518 I

Fat emulsion, intravenousKP20%BMS150 mg, 300 mg, 1.5 gD5Wc Precipitate forms immediately2518 I

FluconazolePF1 gLY50 mgD5WVisually compatible with no fluconazole loss in 72 hr at 25 C. Amphotericin B not tested1677 C

Gentamicin sulfate320 mg200 mgD5WHaze develops over 3 hr26 I

Heparin sodiumUP4000 unitsSQ100 mgD5WPhysically compatible15 C

Heparin sodiumAB4000 unitsSQ100 mgDPhysically compatible21 C

Heparin sodium2000 unitsSQ70 and 140 mgD5WBioactivity not affected over 24 hr at 25 C335 C

Hydrocortisone sodium succinateUP500 mgSQ100 mgD5WPhysically compatible15 C

Hydrocortisone sodium succinate50 mgSQ70 and 140 mgD5WBioactivity not significantly affected over 24 hr at 25 C335 C

Magnesium sulfateIMS2 and 4 gSQ40 and 80 mgD5WPhysically incompatible in 3 hr at 24 C with decreased clarity and development of supernatant1578 I

MeropenemZEN1 and 20 gSQ200 mgNSPrecipitate forms2068 I

Methyldopate HCl1 g200 mgD5WHaze develops over 3 hr26 I

Penicillin G potassiumSQ20 MUSQ100 mgD5WPhysically incompatible15 I

Penicillin G potassiumSQ5 MUSQ50 mgPrecipitate forms within 1 hr47 I

Penicillin G potassiumBP10 MU200 mgD5WHaze develops over 3 hr26 I

Penicillin G sodiumUP20 MUSQ100 mgD5WPhysically incompatible15 I

Penicillin G sodiumBP10 MU200 mgD5WHaze develops over 3 hr26 I

Polymyxin B sulfateBP20 mg200 mgD5WHaze develops over 3 hr26 I

Potassium chlorideAB100 mEqSQ100 mgD5WPhysically incompatible15 I

Potassium chlorideBP4 g200 mgD5WHaze develops over 3 hr26 I

Prochlorperazine mesylateBP100 mg200 mgD5WHaze develops over 3 hr26 I

Ranitidine HClGL100 mgSQ200 mgD5WColor change and particle formation1151 I

Sodium bicarbonateAB2.4 mEqa SQ50 mgD5WPhysically compatible for 24 hr772 C

Streptomycin sulfateBP4 g200 mgD5WHaze develops over 3 hr26 I

Verapamil HClKN80 mgSQ100 mgD5WPhysically incompatible after 8 hr764 I

Verapamil HClKN80 mgSQ100 mgNSImmediate physical incompatibility764 I

a One vial of Neut added to a liter of admixture. b Tested in glass containers. c Diluted in dextrose 5% before adding to the fat emulsion.

Drugs in Syringe CompatibilityAmphotericin B


Heparin sodium2500 units/1 mL50 mgPhysically compatible for at least 5 min1053 C

Pantoprazole sodiuma 4 mg/1 mL5 mg/1 mLOpacity within 1 hr2574 I

a Test performed using the formulation WITHOUT edetate disodium.

Y-Site Injection Compatibility (1:1 Mixture)Amphotericin B


AldesleukinCHI33800 I.U./mLa SQ1.6 mg/mLa Visually compatible for 2 hr1857 C

Allopurinol sodiumBW3 mg/mLa SQ0.6 mg/mLa Amphotericin B haze lost immediately1686 I

AmifostineUSB10 mg/mLa AD0.6 mg/mLa Turbidity forms immediately1845 I

Amiodarone HClWY6 mg/mLa BMS0.5 mg/mLa Visually compatible for 24 hr at 22 C2352 C

AmsacrineNCI1 mg/mLa SQ0.6 mg/mLa Immediate yellow turbidity, becoming yellow flocculent precipitate in 15 min1381 I

AnidulafunginVIC0.5 mg/mLa PHT0.6 mg/mLa Measured haze went up immediately2617 I

AztreonamSQ40 mg/mLa PHT0.6 mg/mLa Yellow turbidity forms immediately and becomes flocculent precipitate in 4 hr1758 I

BivalirudinTMC5 mg/mLa APO0.6 mg/mLa Yellow precipitate forms immediately2373 I

Caspofungin acetateME0.7 mg/mLb XGN0.6 mg/mLa Immediate yellow turbid precipitate forms2758 I

Ceftaroline fosamilFOR2.22 mg/mLa b c XGN0.6 mg/mLa Increased haze and microparticulates2826 I

Cisatracurium besylateGW0.1 mg/mLa PH0.6 mg/mLa Physically compatible for 4 hr at 23 C2074 C

Cisatracurium besylateGW2 mg/mLa PH0.6 mg/mLa Cloudiness forms immediately; gel-like precipitate forms in 1 hr2074 I

Cisatracurium besylateGW5 mg/mLa PH0.6 mg/mLa Turbidity forms immediately2074 I

Dexmedetomidine HClAB4 mcg/mLb APO0.6 mg/mLa Yellow precipitate forms immediately2383 I

Diltiazem HClMMD5 mg/mLSQ0.1 mg/mLa Visually compatible1807 C

DocetaxelRPR0.9 mg/mLa PH0.6 mg/mLa Visible turbidity forms immediately2224 I

DoripenemJJ5 mg/mLa XGN0.6 mg/mLa Physically compatible for 4 hr at 23 C2743 C

DoripenemJJ5 mg/mLb XGN0.6 mg/mLa Yellow precipitate forms immediately2743 I

Doxorubicin HCl liposomalSEQ0.4 mg/mLa APC0.6 mg/mLa Fivefold increase in measured particulates in 4 hr2087 I

EnalaprilatMSD1.25 mg/mLSQ0.1 mg/mLa Layered haze develops in 4 hr at 21 C1409 I

Etoposide phosphateBR5 mg/mLa GNS0.6 mg/mLa Yellow-orange precipitate forms immediately2218 I

Fenoldopam mesylateAB80 mcg/mLb APO0.6 mg/mLb Yellow precipitate forms immediately2467 I

FilgrastimAMG30 mcg/mLa SQ0.6 mg/mLa Yellow turbidity and precipitate form1687 I

FluconazoleRR2 mg/mLSQ5 mg/mLCloudiness and yellow precipitate1407 I

Fludarabine phosphateBX1 mg/mLa SQ0.6 mg/mLa Precipitate forms in 4 hr at 22 C1439 I

Foscarnet sodiumAST24 mg/mLSQ5 mg/mLCloudy yellow precipitate forms1335 I

Foscarnet sodiumAST24 mg/mLSQ0.6 mg/mLa Dense haze forms immediately1393 I

Gemcitabine HClLI10 mg/mLb PH0.6 mg/mLa Gross precipitation occurs immediately2226 I

Granisetron HClSKB0.05 mg/mLa PH0.6 mg/mLa Large increase in measured turbidity occurs immediately2000 I

Heparin sodiumSO100 units/mLb SQ0.1 mg/mLa Turbidity forms in 45 min1435 I

Hetastarch in lactated electrolyteAB6%APC0.6 mg/mLa Immediate gross precipitation2339 I

LinezolidPHU2 mg/mLAB0.6 mg/mLa Yellow precipitate forms within 5 min2264 I

Melphalan HClBW0.1 mg/mLb SQ0.6 mg/mLa Immediate increase in measured turbidity1557 I

Melphalan HClBW0.1 mg/mLa SQ0.6 mg/mLa Physically compatible but rapid melphalan loss in D5W precludes use1557 I

MeropenemZEN1 and 50 mg/mLb SQ5 mg/mLPrecipitate forms2068 I

Ondansetron HClGL1 mg/mLa SQ0.6 mg/mLa Immediate yellow turbid precipitation1365 I

PaclitaxelNCI1.2 mg/mLa SQ0.6 mg/mLa Immediate increase in measured turbidity followed by separation into two layers in 24 hr at 22 C1556 I

Pemetrexed disodiumLI20 mg/mLb PHT0.6 mg/mLa Yellow precipitate forms immediately2564 I

Piperacillin sodium-tazobactam sodiumLEh 40 mg/mLa i SQ0.6 mg/mLa Yellow precipitate forms immediately1688 I

PropofolZEN10 mg/mLAPC0.6 mg/mLa Gel-like precipitate forms immediately2066 I

Remifentanil HClGW0.025 mg/mLa PHT0.6 mg/mLa Physically compatible for 4 hr at 23 C2075 C

Remifentanil HClGW0.25 mg/mLa PHT0.6 mg/mLa Yellow precipitate forms immediately2075 I

SargramostimIMM10 mcg/mLa SQ0.6 mg/mLa Visually compatible for 4 hr at 22 C1436 C

SargramostimIMM10 mcg/mLb SQ0.6 mg/mLb Yellow precipitate forms immediately1436 I

TacrolimusFUJ1 mg/mLd LY5 mg/mLa Visually compatible for 24 hr at 25 C1630 C

Telavancin HClASP7.5 mg/mLa XGN0.1 mg/mLa Increase in measured turbidity2830 I

TeniposideBR0.1 mg/mLa SQ0.6 mg/mLa Physically compatible for 4 hr at 23 C1725 C

ThiotepaIMMe 1 mg/mLa APC0.6 mg/mLa Physically compatible for 4 hr at 23 C1861 C

TigecyclineWY1 mg/mLb 2 mg/mLa Immediate cloudiness with particulates in 1 hr2714 I

TNA #218g PH0.6 mg/mLa Yellow precipitate forms immediately2215 I









TPN #212g PH0.6 mg/mLa Precipitate forms immediately2109 I




Vinorelbine tartrateBW1 mg/mLb SQ0.6 mg/mLf Yellow precipitate forms immediately1558 I

ZidovudineBW4 mg/mLa SQ600 mcg/mLa Physically compatible for 4 hr at 25 C1193 C

a Tested in dextrose 5%. b Tested in sodium chloride 0.9%. c Tested in dextrose 5%, Ringer's injection lactated. d Tested in sterile water. e Lyophilized formulation tested. f Tested in both dextrose 5% and sodium chloride 0.9%. g Refer to Appendix I for the composition of parenteral nutrition solutions. TNA indicates a 3-in-1 admixture, and TPN indicates a 2-in-1 admixture. h Test performed using the formulation WITHOUT edetate disodium. i Piperacillin sodium component. Piperacillin sodium in an 8:1 fixed-ratio concentration with tazobactam sodium.

Handbook on Injectable Drugs. Copyright, 1977-2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.Original Publication Date: October 1, 1982. Selected Revisions: May 28, 2014.


FRMACO: ANFOTERECINA B







FRMACO: LINEZOLID







LinezolidAHFS Class: 8:12.28.24 - OxazolidinonesTradenames: ZyvoxProductsLinezolid is available as a single-use, ready-to-use solution for infusion in 100-, 200-, and 300-mL plastic (Excel) containers. Each milliliter of the ready-to-use infusion provides linezolid 2 mg along with dextrose 50.24 mg, sodium citrate 1.64 mg, and citric acid 0.85 mg in water for injection.1(7/08) pHAdjusted to pH 4.8.1(7/08) Sodium ContentThe sodium concentration is 0.38 mg/mL. The sodium content in a 100-mL bag is 1.7 mEq, in a 200-mL bag is 3.3 mEq, and in a 300-mL bag is 5 mEq.1(7/08) AdministrationLinezolid ready-to-use solution is administered only by intravenous infusion over a period of 30 to 120 minutes.1(7/08) StabilityLinezolid ready-to-use solutions may exhibit a yellow color that can intensify over time without affecting the stability of the drug. Intact containers should be kept in their protective overwrap until ready to use, and should be stored at controlled room temperature and protected from light and freezing.1(7/08) Linezolid 150, 300, and 600 mg/L in Dianeal PD-2 with 1.5 or 4.25% dextrose stored at 37, 25, and 4 C protected from light was physically compatible and exhibited no loss.2500 SorptionLinezolid was found to be compatible with common types of intravenous administration sets including diethylhexyl phthalate (DEHP) plasticized PVC, trioctyl trimellitate (TOTM) plasticized PVC, and polyolefin sets. The total dose of linezolid was fully delivered with the delivered concentration remaining constant throughout. In addition, no detectable levels of plasticizer were found in the delivered solutions.2338 Compatibility Solution CompatibilityLinezolid


Dextrose 5%PFCompatible1(7/08) C

Ringer's injection lactatedPFCompatible1(7/08) C

Sodium chloride 0.9%PFCompatible1(7/08) C

Additive CompatibilityLinezolid


AztreonamSQ20 gPHU2 ga Physically compatible with no linezolid loss in 7 days at 4 and 23 C protected from light. About 9% aztreonam loss at 23 C and less than 4% loss at 4 C in 7 days2263 C

Cefazolin sodiumAPC10 gPHU2 ga Physically compatible with 5% or less loss of each drug in 3 days at 23 C and 7 days at 4 C protected from light2262 C

CeftazidimeGW20 gPHU2 ga Physically compatible with no linezolid loss in 7 days at 4 and 23 C protected from light. Ceftazidime losses of 5% in 24 hr and 12% in 3 days at 23 C and about 3% in 7 days at 4 C2262 C

Ceftriaxone sodiumRC10 gPHU2 ga Physically compatible, but up to 37% ceftriaxone loss in 24 hr at 23 C and 10% loss in 3 days at 4 C2262 I

CiprofloxacinBAY4 gPHU2 ga Physically compatible with little or no loss of either drug in 7 days at 23 C protected from light. Refrigeration results in precipitation after 1 day2334 C

Erythromycin lactobionateAB5 gPHU2 ga Erythromycin loss of 15% in 1 hr and 30% in 4 hr at 23 C. Loss of 45% in 1 day at 4 C2333 I

Gentamicin sulfateAB800 mgPHU2 ga Physically compatible. Little linezolid loss in 7 days at 4 and 23 C in dark. Gentamicin losses of 5 to 7% in 7 days at 4 C and 8% in 5 days at 23 C2332 C

LevofloxacinOMN5 gPHU2 ga Physically compatible. Little drug loss in 7 days at 4 and 23 C in dark2334 C

Tobramycin sulfateGNS800 mgPHU2 ga Physically compatible. Little linezolid loss in 7 days at 4 and 23 C in dark. No tobramycin loss in 7 days at 4 C but losses of 4% in 1 day and 12% in 3 days at 23 C2332 C

Trimethoprim-sulfamethoxazoleES800 mgb PHU2 ga A large amount of white needle-like crystals forms immediately2333 I

a Admixed in the linezolid infusion container. b Trimethoprim component. Trimethoprim in a 1:5 fixed-ratio concentration with sulfamethoxazole.

Y-Site Injection Compatibility (1:1 Mixture)Linezolid


Acyclovir sodiumAPP7 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Alfentanil HClTAY0.5 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Amikacin sulfateAB5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

AminophyllineAB2.5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Amphotericin BAB0.6 mg/mLa PHU2 mg/mLYellow precipitate forms within 5 min2264 I

Ampicillin sodiumAPC20 mg/mLb PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Ampicillin sodium-sulbactam sodiumPF20 mg/mLb d PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

AnidulafunginVIC0.5 mg/mLa PH2 mg/mLPhysically compatible for 4 hr at 23 C2617 C

AztreonamSQ40 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Buprenorphine HClRKC0.04 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Butorphanol tartrateAPC0.04 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Calcium gluconateAMR40 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

CarboplatinBR5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Caspofungin acetateME0.7 mg/mLb PHU2 mg/mLb Physically compatible for 4 hr at room temperature2758 C

Caspofungin acetateME0.5 mg/mLb PF2 mg/mLPhysically compatible over 60 min2766 C

Cefazolin sodiumSKB20 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Cefotetan disodiumZEN20 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Cefoxitin sodiumME20 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

CeftazidimeSKB40 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Ceftriaxone sodiumRC20 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Cefuroxime sodiumGL30 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Chlorpromazine HClES2 mg/mLa PHU2 mg/mLMeasured haze level increases immediately2264 I

CiprofloxacinBAY1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Cisatracurium besylateGW2 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

CisplatinBR1 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Clindamycin phosphateUP10 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

CyclophosphamideMJ10 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

CyclosporineSZ5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

CytarabineBED50 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Dexamethasone sodium phosphateFUJ1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Dexmedetomidine HClAB4 mcg/mLb PHU2 mg/mLPhysically compatible for 4 hr at 23 C2383 C

DiazepamAB5 mg/mLPHU2 mg/mLTurbid precipitate forms immediately2264 I

DigoxinES0.25 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Diphenhydramine HClES2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Dobutamine HClAST4 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Dopamine HClAB3.2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

DoripenemJJ5 mg/mLa b PHU2 mg/mLPhysically compatible for 4 hr at 23 C2743 C

Doxorubicin HClFUJ2 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Doxycycline hyclateFUJ1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

DroperidolAMR0.4 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

EnalaprilatME0.1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Esmolol HClOHM10 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Etoposide phosphateBR5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

FamotidineME2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Fenoldopam mesylateAB80 mcg/mLb PHU2 mg/mLPhysically compatible for 4 hr at 23 C2467 C

Fentanyl citrateAB0.05 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

FluconazoleRR2 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

FluorouracilPH16 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

FurosemideAMR3 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Ganciclovir sodiumRC20 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Gemcitabine HClLI10 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Gentamicin sulfateFUJ5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Granisetron HClSKB0.05 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Haloperidol lactateMN0.2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Heparin sodiumES1000 units/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Hydrocortisone sodium succinateUP1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Hydromorphone HClAST0.5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Hydroxyzine HClES2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

IfosfamideMJ25 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Imipenem-cilastatin sodiumME10 mg/mLb PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Labetalol HClGW5 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Leucovorin calciumGNS2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

LevofloxacinORT5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Lidocaine HClAB10 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

LorazepamWY0.1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Magnesium sulfateAST100 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

MannitolBA15%PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Meperidine HClAST4 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

MeropenemZEN2.5 mg/mLb PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

MesnaMJ10 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Methotrexate sodiumIMM15 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Methylprednisolone sodium succinateAB5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Metoclopramide HClFAU5 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

MetronidazoleBA5 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Midazolam HClRC2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Mitoxantrone HClIMM0.5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Morphine sulfateAST1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Nalbuphine HClAST10 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Naloxone HClDU0.4 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Nicardipine HClWAY1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

NitroglycerinFAU0.4 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Ondansetron HClGW1 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

PaclitaxelMJ0.6 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Pentamidine isethionateFUJ6 mg/mLa PHU2 mg/mLCrystalline precipitate forms in 1 to 4 hr2264 I

Pentobarbital sodiumAB5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Phenobarbital sodiumWY5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Phenytoin sodiumES50 mg/mLPHU2 mg/mLCrystalline precipitate forms immediately2264 I

Piperacillin sodium-tazobactam sodiumLEc 40 mg/mLa e PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Potassium chlorideFUJ0.1 mEq/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Prochlorperazine edisylateSO0.5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Promethazine HClSCN2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Propranolol HClWAY1 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Ranitidine HClGW2 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Remifentanil HClGW0.5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Sodium bicarbonateAB1 mEq/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Sufentanil citrateES0.05 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

TheophyllineBA4 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

TigecyclineWY1 mg/mLb PF2 mg/mLPhysically compatible for 4 hr2714 C

Tobramycin sulfateAB5 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Vancomycin HClFUJ10 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

VasopressinAPP0.2 unit/mLb PHU2 mg/mLPhysically compatible2641 C

Vecuronium bromideOR1 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Verapamil HClAB2.5 mg/mLPHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

Vincristine sulfateLI0.05 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

ZidovudineGW4 mg/mLa PHU2 mg/mLPhysically compatible for 4 hr at 23 C2264 C

a Tested in dextrose 5%. b Tested in sodium chloride 0.9%. c Test performed using the formulation WITHOUT edetate disodium. d Ampicillin sodium component. Ampicillin sodium in a 2:1 fixed-ratio concentration with sulbactam sodium. e Piperacillin sodium component. Piperacillin sodium in an 8:1 fixed-ratio concentration with tazobactam sodium.

Handbook on Injectable Drugs. Copyright, 1977-2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.Original Publication Date: October 1, 2001. Selected Revisions: May 28, 2014.


FRMACO: IMIPENEM







FRMACO: METILPREDNISOLONA







Interferon Alfa-2bAHFS Class: 10:00 - Antineoplastic AgentsTradenames: Intron AProductsInterferon alfa-2b is available as a dry powder in vials containing 10, 18, and 50 million International Units (I.U.) packaged with bacteriostatic water for injection containing benzyl alcohol 0.9% diluent. Only the 10-million I.U. vial is recommended for intralesional use. The 50-million I.U. vials are used in malignant melanoma and AIDS-related Kaposi's sarcoma only.1(5/08) For intramuscular, subcutaneous, or intralesional use, reconstitute the appropriate-size vial contents with the bacteriostatic water for injection diluent using the requisite volume noted in Table 1. Direct the stream at the vial wall and not at the powder in the bottom of the vial. Swirl gently to dissolve the powder; do not shake.1(5/08) In addition to the drug, the reconstituted solutions also contain in each milliliter glycine 20 mg, sodium phosphate dibasic 2.3 mg, sodium phosphate monobasic 0.55 mg, and albumin human 1 mg.1(5/08) For intravenous infusion, reconstitute the appropriate-size vial contents with the diluent provided. Swirl gently to dissolve the powder; do not shake. Withdraw the appropriate dose and add it to 100 mL of sodium chloride 0.9%, ensuring that the final concentration is not less than 10 million I.U./100 mL.1(5/08) Table 1. Reconstitution of Interferon Alfa-2b Powder for Injection Vials1(5/08)

Vial Size(million I.U.)Diluent Volume(mL)Concentration(I.U./mL)

1025

10110 (for intralesional use only)

18118

50150 (for malignant melanoma and AIDS-related Kaposi's sarcoma only)

Interferon alfa-2b is also available for intramuscular or subcutaneous use as solutions in multidose vials, which contain 22.8 million I.U./3.8 mL (6 million I.U./mL), and 25 million I.U., which contain 32 million I.U./3.2 mL (10 million I.U./mL). Multidose injection pens are also available containing 3, 5, and 10 million I.U. per 0.2 mL injection with a total of 1.5 mL per pen for subcutaneous injection.1(5/08) Each milliliter of solution also contains sodium chloride 7.5 mg, sodium phosphate dibasic 1.8 mg, sodium phosphate monobasic 1.3 mg, edetate disodium 0.1 mg, polysorbate 80 0.1 mg, and metacresol 1.5 mg. The solution products are albumin-free.1(5/08) Vial size to be used and appropriate concentration are dependent on the intended use of the product. In addition to intramuscular and subcutaneous use, the 10-million I.U. vials are also for intralesional use. Interferon alfa-2b solution products are not recommended for intravenous administration in the United States labeling.1(5/08) In the Canadian labeling, intravenous infusion of the solution products is permitted with dilution in sodium chloride 0.9% immediately before administration to a concentration no lower than 0.3 million I.U./mL. These albumin-free dosage forms require this higher minimum concentration to avoid loss due to sorption to plastic bags.1(5/08) Specific ActivityApproximately 2 108 I.U./mg of protein.1(5/08) pHThe reconstituted powder for injection has a pH in the range of 6.9 to 7.5.4 TonicityReconstitution of the 10-million I.U. vial with 1 mL of water for injection results in an isotonic solution.1369 AdministrationThe administration of interferon alfa-2b is dependent on the intended use and specific dosage form. The dry powder products, reconstituted as directed, may be administered by intramuscular and subcutaneous injection or intravenous infusion. The contents of the 10-million I.U. vial, reconstituted as directed, may also be given intralesionally. For intravenous infusions, interferon alfa-2b may be diluted further to a concentration of not less than 10 million I.U./100 mL of sodium chloride 0.9% for intravenous infusion over 20 minutes.1(5/08) The solution products are administered by intramuscular or subcutaneous injection. The 5-million I.U. and 10-million I.U. vials and the 25-million I.U. multidose vials may also be used for intralesional injection. The solution products are not for use in malignant melanoma or AIDS-related Kaposi's sarcoma. In addition, the Canadian product labeling permits intravenous infusion in sodium chloride 0.9% at concentrations no lower than 0.3 million units/mL.1(5/08) StabilityInterferon alfa-2b dry powder in vials is a white to cream color.1(5/08) 4 It is not photosensitive.1369 The reconstituted solution is clear and colorless to light yellow. Intact vials should be stored under refrigeration at 2 to 8 C but are stable up to seven days at 45 C4 or 28 days at room temperature.1369 The reconstituted solution should be stored under refrigeration. In concentrations between 3 and 50 million I.U./mL, reconstituted solutions are stable for up to one month under refrigeration and up to two days at ambient temperatures up to 40 C.1(5/08) Interferon alfa-2b solution in vials is colorless. Intact vials of solution should be stored under refrigeration at 2 to 8 C. The solution products are stable for up to seven days at 35 C and up to 14 days at 30 C. Interferon alfa-2b in multidose pens is stable for up to two days at 30 C.1(5/08) Interferon alfa-2b (Schering) containing albumin human in the formulation reconstituted with the accompanying diluent and diluted further to 2 million I.U./mL with sterile water for injection was stored at 4 C for 21 days in polypropylene centrifuge tubes. Biological activity was retained throughout the study period.2022 In another study, the retention of bioactivity by albumin-free interferon alfa-2b 6 million units/mL stability was compared to samples of that product to which albumin human 1 mg/mL was added and also to the reconstituted product containing albumin human in the formulation. The solutions were packaged as 0.5 mL in polypropylene syringes and stored at 4 C for 42 days. In addition, the albumin-free product was diluted to 2 million units/mL with sterile water for injection and stored in a 60-mL polypropylene syringe under the same conditions. No substantial loss of biological activity was found in any of the samples.2188 Sodium chloride 0.9% is recommended for preparation of intravenous infusion admixtures.1(5/08) Interferon alfa-2b is stated to be compatible with sodium chloride 0.9%, Ringer's injection, and Ringer's injection lactated. It is stated to be incompatible with dextrose solutions.1369 pH EffectsReconstituted interferon alfa-2b is stable over a pH range of 6.5 to 84 , with greatest stability between pH 6.9 and 7.5.1369 Freezing SolutionsReconstituted interferon alfa-2b 10 million I.U./mL packaged in plastic syringes is stated to be stable for up to four weeks when frozen at -10 C or colder.4 Solutions frozen at -20 C are stated to be stable for 56 days including four freeze-thaw cycles. Frozen solutions stored at -80 C are stable for one year.1369 SyringesInterferon alfa-2b (Intron A, Kirby-Warwick) 3 million units was diluted in 6 mL of sterile water for injection and packaged in 10-mL polypropylene syringes. The samples were stored for 14 days under refrigeration and for 24 hours at 37 C. Analysis found changes indicating interconversion between interferon monomers and possibly oligomer formation. Dilution and packaging in polypropylene syringes was considered to be unsuitable.744 SorptionLike other interferons, interferon alfa-2b can bind to surfaces, including glass and plastics. Consequently, albumin human is incorporated into the dry powder dosage forms to minimize adsorption and permit the use of glass or plastic syringes for administration without substantial loss at concentrations not less than 0.1 million I.U./mL.1(5/08) 4 The solution dosage forms are albumin-free. Consequently, the Canadian product labeling recommends dilution of the solution products in sodium chloride 0.9% to a concentration not lower than 0.3 million I.U./mL to prevent losses.1(5/08) Handbook on Injectable Drugs. Copyright, 1977-2014. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.Original Publication Date: October 1, 1998. Selected Revisions: October 1, 2012.

ReferencesFor a list of references cited in the text of this monograph, search the monograph

ANTIBIOTICOS COMPATIBILIDADES

Documents

Transcript of ANTIBIOTICOS COMPATIBILIDADES