Compatibility of Commonly Used Intravenous Drugs

1 PRINTER-FRIENDLY VERSION AT Compatibility of Commonly Used Intravenous Drugs A. ll rig Co ht py s rig ed. re ht se LISA CAYO, PHARMD. rv . Clinical Pharmacy Coordinator 20. Garden City Hospital 11. Re Garden City, Michigan M. pr cM. od uc ah in w tio on T. n he number of available IV. Pu bl medications continues to expand. is ho hi Many institutions have observed an ng le or increase in patient acuity and a rise in the G. ro in number of medications administered to up pa un ou rt each patient. This increases the likelihood w le that multiple IV medications will need ith ss ot to be administered concurrently. he tp rw er is m e is no si on te d.

2 Is pr oh These factors contribute to the escalating complex- medication is combined or added to an IV fluid. It is ib ity of IV drug administration and have resulted in an important to recognize that Compatibility is not just ite ever-increasing number of possible incompatibilities. a function of the Drugs themselves, but also can be d. The potential for serious and life-threatening adverse dependent on a variety of factors including the concen- drug events exists when incompatible medications are tration, temperature, storage vehicle, infusion solution, infused together. Therefore, it is important to verify drug order of mixing, and administration technique.

3 Compat- Compatibility prior to coadministration. A clear and con- ibility differences even have been reported for different cise Compatibility chart can be a useful tool in helping to brands of the same drug. deliver safe, high-quality IV therapy to patients. Three types of incompatibilities are Commonly dis- A chance of incompatibility exists whenever any cussed: physical, chemical, and therapeutic. Physical Text continues on page 6. I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G P H A R M AC Y P R AC T I C E N E WS S E P T E M B E R 2 0 1 1. 1. Table. Compatibility of Selected IV Drugs (continued).

4 Ampicillin-sulbactam Dextrose 5% in water Calcium gluconate Diphenhydramine Dexamethasone Esomeprazole Anidulafungin Azithromycin Ciprofloxacin Caspofungin Amiodarone Dobutamine Clindamycin Fluconazole Epinephrine Ceftazidime Bumetanide Daptomycin Doxycycline Ceftizoxime Eptifibatide Furosemide Ceftriaxone Argatroban Cefotaxime Gentamicin Famotidine Doripenem Ceftaroline Aztreonam Enalaprilat Bivalirudin Dopamine Ampicillin Diazepam Cefepime Diltiazem Cefazolin Acyclovir Amikacin Cefoxitin Fentanyl Esmolol A. Acyclovir C N C I C C N I C C C N C I C C C C C C I C I C C I N N I I C C C I I I N C C C C N. ll Amikacin C C N N C N I C C C C C C H C C C C C C C C C C C I C C C C C C C C C C N C C C C C.

5 Rig Co Amiodarone N C N I C I N N I C C C N N N N C I C C C C C N N N C N C C C C N C N C N C C C N C. ht py Ampicillin C N N N C N N N C N N I N N N N N N I N N S C N I I N I I I N I N N C N N N N I S I. s Ampicillin-sulbactam I N I N C N N N C N N I N C I I N N N N I N C N A I N N I N N I N N C N N N N N N N. rig ed. re Anidulafungin C C C C C C C C C C C C C C C C N C C C C C N C C I C C C C C C C C C C N C C C C C. ht se Argatroban C N I N N C N N C N N N N N N N N N N N N N C N C N C C C C N N N N C N N N C N C N. rv . Azithromycin N I N N N C N I C N N N N N I N C I N I I I C N C N N C N N C N N N C N N I I N I I. 20. Aztreonam I C N N N C N I C C C C C C C C N C C C C C C C C I C N C C N C C C C C N C C C C C.

6 C C I C C C C C C C C I C C C C N C C C C C C C C I C C N C N C C C C C N C C C C C. 11. Bivalirudin Re Bumetanide C C C N N C N N C C C C C C C C C C C C N C C C C I C C N C C C C C C C N C C C C C. M. pr Calcium gluconate C C C N N C N N C C C C C C C C C C C I A C C I C I C C N C C C C C C C N C C N C C. cM. od Caspofungin N C C I I C N N C I C C I I I I I I C I C I C I N I C C C C C C I C N C N C C C I C. uc ah in w Cefazolin C C N N N C N N C C C C I N I C N C C C N C C C C I C I I I N I C C C C N N C C C N. tio I H N N C C N N C C C C I N N N N N N N I C C C C I I I N N N N I N C N N I N C C N. on Cefepime Cefotaxime C C N N I C N I C C C C I I N C N I I C N C C C C I C I N C N C C C C C N C C N C N.

7 N Pu Cefoxitin C C N N I C N N C C C C I C N C N C I C N C C C C I C I I C N I C C C C N N C C C C. bl Ceftaroline C C C N N N N C N N C C I N N N N N N N C C N C C I C C N C C N C N N N C C C C C C. is Ceftazidime C C I N N C N I C C C C I C N I C N C C C C C C C I C I N C N I C C C C N C C N C N. ho hi Ceftizoxime C C C I N C N N C C C C C C N I I N C C N C C C C I C C N C N I C C C C N N C C C C. ng le Ceftriaxone C C C N N C N I C C C I I C N C C N C C N I C C C I C I I C N C C C C C N N C N C N. or G. Ciprofloxacin I C C N I C N I C C N A C N I N N C C N N I C I C N C C C C C N N N C N N N N C I C. ro in Clindamycin C C C S N C N I C C C C I C C C C C C C I I C C C I C C N C N C C C C C N C C N C C.

8 Up Daptomycin I C C C C N C C C C C C C C C C C N C C C C C C I C C C C C C C C C C C N C C C C C. pa Dexamethasone C C N N N C N N C C C I I C C C C C C C C I C C C I C I I C C I C C C I N C C C C I. un ou rt D5W C C N I A C C C C C C C N C C C C C C C C C C I C N C C C C C C C C C C C C C C C C. w le Diazepam I I N I I I N N I I I I I I I I I I I I I N I C I N I I N I I I I I I I N I N I I I. ith ss Diltiazem N C C N N C C N C C C C C C I C C C C C C C C C C C I C C C C C C C C C N C C C I C. ot Diphenhydramine N C N I N C C C N C C C C I I I I C I C I C C C I C I C C C C C C C C C N C C C I C. he tp Dobutamine I C C I I C C N C N N N C I N N I N N N I C N C I C N C C C C C C C C C N C C C I C.

9 Rw Dopamine I C C I N C C N C C C C C I N C C C C C C C C C C C I C C C C C C C N C N C C C N C. er Doripenem C C C N N C N C N N C C C N N N N C N N N C N C C C I C C C C N C N N C C C C C C C. is m e Doxycycline C C C I I C N N C C C C C I N C I N I I C N C C I C I C C C C N C C C C N C C C I C. is no si Enalaprilat C C N N N C N N C C C C I C I C C C C C C N C C C C I C C C C C C C C C N C C C C C. on te Epinephrine I C C N N C N N C C C C C C N C C N C C C N C C C C I C C C C N C C C C N C C C C C. d. Eptifibatide I C N C C C C C C C C C N C C C C N C C C C C C C C I C C C N N C C C C N C C C I C. is Esmolol I C C N N C N N C C C C C C N C C N C C C N C C I C I C C C C C C C C C N C C C I C.

10 Pr Esomeprazole N N N N N N N N N N N N N N N N N C N N N N N N N C N N N N N C N N N N N N N N N N. oh Famotidine C C C N N C N I C C C C C N I C N C C N N N C C C C I C C C C C C C C C C N C C N C. ib Fentanyl C C C N N C C I C C C C C C N C C C C C C N C C C C N C C C C C C C C C C N C C C C. ite a Protect from light. b Testing was performed with ethylenediaminetetra-acetic acid (EDTA)-free formulation. d. KEY. A = Physically compatible for at least 2 hours H = Physically compatible for at least 1 hour C = Physically compatible I = Incompatible D = Physically compatible in dextrose 5% in water N = Information on Compatibility is not available or not adequate E = Physically compatible for at least 5 minutes R = Physically compatible for 24 hours under refrigeration G = Physically compatible in glass bottle only S = Physically compatible in sodium chloride I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G.