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American Journal of Health-System Pharmacy, Vol. 66, Issue 8, 727-729
Copyright © 2009. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00

Note

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

David Canann, Linda S. Tyler, Brian Barker and Chad Condie

DAVID CANANN, PHARM.D., is Clinical Pharmacist, Department of Pharmacy Services, University of Utah Health Care (UUHC), Salt Lake City. LINDA S. TYLER, PHARM.D., FASHP, is Director, Drug Information Service, UUHC, and Professor (Clinical), Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City. BRIAN BARKER, B.S.PHARM., is Clinical Pharmacist; and CHAD CONDIE, PHARM.D., is Clinical Pharmacist, UUHC.

Address correspondence to Dr. Canann at the Department of Pharmacy Services, Room A-050, University of Utah Health Care, 50 North Medical Drive, Salt Lake City, UT 84132 (david.canann{at}hsc.utah.edu).

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

 

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