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

OBJECTIVE: To evaluate the physical compatibility of gemcitabine hydrochloride (Gemzar-Eli Lilly and Company) with 107 selected drugs. DESIGN: Controlled experimental trial. SETTING: Laboratory. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: 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 etoposide phosphate with selected drugs during simulated Y-site injection

OBJECTIVE: To evaluate the physical compatibility of etoposide phosphate with 101 selected secondary drugs, including antineoplastic chemotherapy agents, anti-infectives, and supportive care drugs, during simulated Y-site injection. DESIGN: Five-milliliter samples of etoposide 5 mg/mL as phosphate in 5% dextrose injection were mixed with 5 mL of the selected drugs diluted in 5% dextrose injection or, if necessary to avoid incompatibilities with the diluent, 0.9% sodium chloride injection. Samples were examined visually in normal fluorescent light with the unaided eye and using a Tyndall beam (high-intensity monodirectional light) to enhance the visibility of small particles and low-level haze. Turbidity of each sample was measured. In selected samples, electronic particle content assessment was performed. All of the samples were assessed initially and at one and four hours. RESULTS: Most of the secondary drugs were physically compatible with etoposide phosphate during the four-hour observation period. However, seven drug combinations had incompatibilities that included color change, increase in haze or turbidity, particulate formation, and gross precipitation. The drugs that were observed to be physically incompatible with etoposide phosphate were amphotericin B, cefepime hydrochloride, chlorpromazine hydrochloride, imipenem-cilastatin sodium, methylprednisolone sodium succinate, mitomycin, and prochlorperazine edisylate. CONCLUSION: Etoposide 5 mg/mL as phosphate in 5% dextrose injection is physically compatible for four hours at room temperature during simulated Y-site administration with 94 of the 101 drugs selected. Simultaneous Y-site administration of etoposide phosphate with the seven incompatible drugs should be avoided.     

Compatibility screening of linezolid injection during simulated Y-site administration with other drugs and infusion solutions

OBJECTIVE: To evaluate the physical compatibility of linezolid injection (Zyvox-Pharmacia) during simulated Y-site administration with 8 infusion solutions and 110 selected other drugs. DESIGN: Controlled experimental trial. SETTING: Laboratory. INTERVENTIONS: Five-milliliter samples of linezolid injection 2 mg/mL were mixed with 5 mL samples of the selected infusion solutions and the selected other drugs diluted in 5% dextrose injection, or, if necessary to avoid incompatibility with the diluent, 0.9% sodium chloride injection. MAIN OUTCOME MEASURES: Visual examinations of the samples were performed in normal fluorescent light with the unaided eye and using a Tyndall beam (high-intensity monodirectional light source) to enhance visualization of small particles and low-level haze. The turbidity of each sample was measured, and for samples that did not exhibit visible precipitation, the particle content was measured, as well. All of the samples were assessed initially and at 1 and 4 hours. RESULTS: All of the infusion solutions and most of the test drugs were physically compatible with linezolid injection during the 4-hour observation period. Physical incompatibilities resulted when linezolid injection was combined with five of the drugs: amphotericin B, chlorpromazine hydrochloride, diazepam, pentamidine isethionate, and phenytoin sodium. Precipitation, turbidity formation, and/or unacceptable changes in measured haze levels were observed. CONCLUSION: Linezolid 2 mg/mL was physically compatible for 4 hours at room temperature with all 8 infusion solutions tested and 105 of the drugs tested. Simultaneous Y-site administration of linezolid injection with the five drugs resulting in physical incompatibilities should be avoided.     

Compatibility of palonosetron with cyclophosphamide and with ifosfamide during simulated Y-site administration.

PURPOSE: The physical and chemical compatibility of palonosetron with cyclophosphamide and with ifosfamide during simulated Y-site administration was studied. METHODS: Test samples were prepared in triplicate by mixing 7.5 mL of palonosetron hydrochloride 50 microg (of palonosetron) per milliliter with 7.5 mL of cyclophosphamide 10 mg/mL and with ifosfamide 20 mg/mL. Physical stability was assessed by turbidimetry, particle sizing, and visual inspection. Chemical stability was assessed by stability-indicating high-performance liquid chromatography. Evaluations were performed immediately and one and four hours after mixing. RESULTS: The samples were clear and colorless when viewed in normal fluorescent room light and when viewed with a high-intensity monodirectional light. Turbidity remained unchanged, and particulate content was low and exhibited little change. Palonosetron, cyclophosphamide, and ifosfamide remained chemically stable throughout the four-hour test period. CONCLUSION: Palonosetron hydrochloride was physically compatible with cyclophosphamide or ifosfamide during simulated Y-site administration.