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PubMed2004

Stability of cefepime in icodextrin peritoneal dialysis solution.

BACKGROUND: Icodextrin is a glucose polymer used as an alternative osmotic agent in peritoneal dialysis (PD) solutions. Cefepime may be a suitable antibiotic for the treatment of PD-related peritonitis. The stability of cefepime in icodextrin PD solution has not been examined. OBJECTIVE: To determine the chemical stability of cefepime in icodextrin PD solution over a 7-day period. METHODS: Samples were prepared by adding cefepime HCl 1000 mg to commercially available 2.0-L bags of icodextrin 7.5% PD solution. Nine bags were prepared and stored in the following conditions: 3 under refrigeration (4 degrees C), 3 at room temperature (20 degrees C), and 3 at body temperature (37 degrees C). Study samples were drawn from each bag immediately after preparation and at predetermined intervals over the subsequent 7 days. Solutions were visually inspected for precipitation, cloudiness, or discoloration at each sampling interval. Total concentration of cefepime in dialysate fluid was determined by liquid chromatography-tandem mass spectrometry. RESULTS: Under refrigeration, a mean +/- SD of 95.7 +/-4.2% of the initial cefepime concentration remained at 168 hours (7 days). At room temperature, 92.0 +/- 17.9% remained at 48 hours. At body temperature, 92.2 +/- 4.7% remained at 4 hours. Beyond these respective time points, <90% of the initial cefepime concentrations remained. CONCLUSIONS: Pre-mixed cefepime-icodextrin PD solutions stored at room temperature were stable for up to 48 hours. However, it is recommended that these be kept refrigerated whenever possible. When refrigerated, cefepime-icodextrin solutions were found to be stable for up to 7 days. Solutions stored at body temperature were stable up to 4 hours, permitting the practice of pre-warming solutions prior to administration.

Anti-Bacterial Agents↗
PubMed2005

Compatibility of argatroban with abciximab, eptifibatide, or tirofiban during simulated Y-site administration.

PURPOSE: The physical and chemical compatibility of argatroban with abciximab, eptifibatide, or tirofiban during simulated Y-site administration was studied. METHODS: Test solutions of argatroban 1 mg/mL, abciximab 36 microg/mL, eptifibatide 2 mg/mL, and tirofiban 50 microg (as the hydrochloride salt) per milliliter in 5% dextrose injection (D5W) and in 0.9% sodium chloride injection (saline) were prepared in duplicate by using aseptic technique. Argatroban solution was mixed with abciximab, eptifibatide, or tirofiban solution, each at a ratio of 1:1 by volume, and at 4:1 with abciximab solution, 8:1 with tirofiban solution, and 16:1 with eptifibatide solution. Compatibility was evaluated immediately after solution preparation and after storage for four hours at 20-25 degrees C. Physical compatibility was determined with the unaided eye and with a particle counter, and chemical compatibility was measured with high-performance liquid chromatography. The chemical compatibility of argatroban and abciximab was not tested because of the poor stability or recovery of abciximab in the test diluents. RESULTS: Argatroban was physically compatible with abciximab, eptifibatide, and tirofiban in D5W at each ratio tested and in saline at a 1:1 ratio. Argatroban was chemically compatible with eptifibatide and tirofiban. No significant impurities were detected, except for a single impurity in argatroban-eptifibatide 1:1 admixtures. CONCLUSION: At concentrations commonly used in practice, argatroban was physically compatible with abciximab and physically and chemically compatible with eptifibatide and tirofiban for four hours at 20-25 degrees C.

Abciximab↗
PubMed2005

Compatibility of ondansetron hydrochloride and methylprednisolone sodium succinate in multilayer polyolefin containers.

PURPOSE: The compatibility of ondansetron hydrochloride and methylprednisolone sodium succinate in 5% dextrose injection and 0.9% sodium chloride injection was studied. METHODS: Test solutions of ondansetron hydrochloride 0.16 mg/mL and methylprednisolone sodium succinate 2.4 mg/mL were prepared in triplicate and tested in duplicate. Total volumes of 4 and 2 mL of ondansetron hydrochloride solution and methylprednisolone sodium succinate solution, respectively, were added to 50-mL multilayer polyolefin bags containing 5% dextrose injection or 0.9% sodium chloride injection. Bags were stored for 24 hours at 20-25 degrees C and for 48 hours at 4-8 degrees C. Chemical compatibility was measured with high-performance liquid chromatography, and physical compatibility was determined visually. RESULTS: Ondansetron hydrochloride was stable for up to 24 hours at 20-25 degrees C and up to 48 hours at 4-8 degrees C. Methylprednisolone sodium succinate was stable for up to 48 hours at 4-8 degrees C. When stored at 20-25 degrees C, methylprednisolone sodium succinate was stable for up to 7 hours in 5% dextrose injection and up to 24 hours in 0.9% sodium chloride injection. Compatibility data for solutions containing ondansetron hydrochloride plus methylprednisolone sodium succinate revealed that each drug was stable for up to 24 hours at 20-25 degrees C and up to 48 hours at 4-8 degrees C. CONCLUSION: Ondansetron 0.16 mg/mL (as the hydrochloride) and methylprednisolone 2.4 mg/mL (as the sodium succinate) mixed in 50-mL multilayer polyolefin bags were stable in both 5% dextrose injection and 0.9% sodium chloride injection for up to 24 hours at 20-25 degrees C and up to 48 hours at 4-8 degrees C.

Antiemetics↗
PubMed1990

Parenteral nutrition. Pharmaceutical problems of compatibility and stability.

A typical All-in-One (AIO) parenteral nutrition mixture in a 3-litre polymeric infusion bag will consist of lipid emulsion, amino acids, glucose, electrolytes, trace elements and vitamins. This varied mixture of chemical entities provides the potential for a number of chemical and physicochemical interactions that can compromise the clinical safety and efficacy of the product. The destabilisation of the lipid emulsion in the presence of electrolytes is a major problem. Although a predictive equation for the maximum concentrations of mono-, di- and trivalent ions causing instability has been proposed, it is too simplistic to be of significant value. The reasons for this are discussed as well as the stability implications of other additives to the parenteral nutrition mixture.

Drug Incompatibility↗
PubMed1992

Pharmacokinetic drug interactions with rifampicin.

Rifampicin, an antituberculosis drug, is usually administered for 4 to 12 months with other antituberculosis drugs or medications from other classes. A potential for drug interactions often exists because rifampicin is a potent inducer of hepatic drug metabolism, as evidenced by a proliferation of smooth endoplasmic reticulum and an increase in the cytochrome P450 content in the liver. The induction is a highly selective process and not every drug metabolised via oxidation is affected. Case reports and studies have demonstrated enhanced metabolism of several drugs; most of these interactions are clinically important. At the start of rifampicin treatment, and again at the end, clinicians must check the dosages of any accompanying medications with which rifampicin may potentially interact. Monitoring of clinical response and blood drug concentrations is essential to adjust the drug dosage during rifampicin therapy. Rifampicin also interacts with cholephils such as bilirubin and bromosulphthalein. Its pharmacokinetics are reported to be altered by ethambutol, p-aminosalicylic acid (through its excipient component), ketoconazole, cyclosporin, clofazimine, probenecid and phenobarbital through one or other of the following mechanisms--impaired absorption of rifampicin, competition between the drug and rifampicin for hepatic uptake and altered hepatic metabolism of rifampicin. Most interactions affecting rifampicin have been relatively minor or are not expected to alter its therapeutic efficacy.

Drug Incompatibility↗
PubMed1975

Timolol: a preliminary report of its pharmacological properties and therapeutic efficacy in angina and hypertension.

Timolol (MK 950) is a new beta-adrenergic receptor blocking drug. It has little or no membrane stabilising ('quinidine-like') or partial agonist (intrinsic sympathomimetic) activity and thus resembles sotalol. On a weight for.weight basis, timolol is more potent than sotalol or propranolol. A 2.5 mg dose of timolol causes about the same reduction in resting heart rate as 20mg of propranolol. Results of placebo-controlled and of comparative trials with other beta-adrenergic receptor blocking drugs, have shown that timolol effectively lowers blood pressure without producing orthostatic or exercise hypotension. Findings of an international multicentre trial in angina pectoris, indicate that timolol is effective in reducing the frequency of anginal attacks and the consumption of glyceryl trinitrate for their relief.

Adrenergic beta-Antagonists↗
PubMed1979

Cefoxitin: a review of its antibacterial activity, pharmacological properties and therapeutic use.

Cefoxitin is a beta-lactam antibiotic derived from cephamycin C, a naturally occurring substance produced by Streptomyces lactamdurans. Its resistance to destruction by beta-lactamases results in a broad spectrum of antibacterial activity which includes anaerobic as well as Gram-positive and Gram-negative aerobic bacteria, including many resistant to cephalothin and other cephalosporins. Given by intravenous or intramuscular injection, cefoxitin is effective against a wide variety of infections caused by Gram-positive or Gram-negative aerobes as well as by anaerobic bacteria. It is generally well tolerated, thrombophlebitis, skin rash and some degree of discomfort after intramuscular injection, being the most commonly reported side effects. Cefoxitin has not been shown to cause adverse effects on renal function.

Bacteria↗
PubMedDate not supplied

Stable insulin for implantable delivery systems: in vitro studies with different containers and solvents.

The stability of a new insulin formulation (lyophilized U100 insulin, Organon) was investigated in vitro in conditions reproducing those of in vivo implanted devices, i.e., constant horizontal agitation at 37 degrees C for 4 wk in various containers and 8 wk in different solvents. Physical stability was assessed by ultraviolet absorption, chemical stability by HPLC, and biological stability by hypoglycemia tests in mice. Insulin precipitated in glass vials but remained clear and active in polyethylene reservoirs and after passage through catheter and pumps in motion, although only 83-90% of insulin was delivered chemically intact. In acidic solvent, insulin showed a major gradual transformation into deamidized derivatives (up to 78% after 8 wk), although still fully active and clear, as expected from previously published excellent in vivo results with acidic insulins. Heparin addition to neutral insulin solution (500 IU/ml) did not alter the properties of the two compounds and might thus be tried to prevent in vivo catheter obstruction due to fibrin deposition.

Chromatography, High Pressure Liquid↗
PubMedDate not supplied

Interaction between plastic catheter tubings and regular insulin preparations used for continuous subcutaneous insulin-infusion therapy.

In search of possible interactions between plastic tubings used for insulin-pump treatment and commercial regular insulin preparations, various catheter sets made from polyvinyl chloride (PVC), polyethylene (PE), and nylon plastics were perfused at 30 degrees C in a laboratory setting for up to 72 h. The perfused insulin solutions were analyzed by high-performance liquid chromatography and atomic absorption spectroscopy. Although no plasticizer, e.g., dioctyl phthalate, or nickel or chromium ions were found in the perfusates, substantial interactions between the plastics and the insulin solutions were detected, extraction of bacteriostatic additives from the insulin solutions in particular. The PVC retained up to 88% of the bacteriostatics from the insulin preparations, whereas PE tubings retained only 10-15%. Whether the loss of preservatives during perfusion through PVC catheters predisposes to cutaneous infections during insulin-pump therapy remains to be shown.

Catheterization↗
PubMed1981

Anticoccidial efficacy of salinomycin (AHR-3096C) and compatibility with roxarsone in floor-pen experiments with broilers.

Five experiments were conducted to test the anticoccidial efficacy of salinomycin (AHR-3096C, A. H. Robins) at 66 ppm and its compatibility with roxarsone (50 ppm) under floor pen conditions Monensin (100, 121 ppm), lasalocid (75, 125 ppm), and shuttle programs of salinomycin-monensin (66/100 ppm) or monensin-salinomycin (100/66 ppm) were included for comparison. Coccidiosis exposure was provided by using the infected seeder bird technique. Salinomycin reduced the lesion scores significantly and improved the body weight and feed conversion in all the trials as compared to unmedicated groups. All three ionophores effectively reduced the lesion scores. Birds treated with salinomycin-monensin shuttle programs had lesion scores, body weight, and feed conversion that were not significantly different from the salinomycin treated birds, suggesting that this shuttle program could be used satisfactorily for control of coccidiosis. Lesion scores, body weight, and feed conversion data of the 4th and 5th trials suggested that the anticoccidial activity of salinomycin and roxarsone are additive. There was evidence of compensatory growth after withdrawal of salinomycin and monensin but not with lasalocid.

Animals↗
PubMed1991

Iatrogenesis in the elderly. Drug-related problems.

Drug reactions are generally related to the influence of age, toxicity, side effects, immunologic reactions, idiosyncratic reactions, drug-drug interactions, and drug-disease interactions. In addition to age-related changes, the elderly are susceptible to the incidence of adverse drug reactions because of polypharmacy, incorrect self-administration of drugs, omission of drugs, taking another's prescriptions, use of over-the-counter drugs, and medication errors by health-care personnel. To prevent or predict adverse drug reactions, the gerontologic nurse can obtain thorough drug histories, educate clients and health-care providers, use nursing measures to alleviate symptoms, and be astute for the potential for problems through drug review.

Aged↗
PubMed2004

Flushing an i.v. line: a simple but potentially costly procedure for both patient and health unit.

This observational study investigated the intravenous (i.v.) medication administration technique of Registered Nurses (n = 47) using the injection port of a concurrent intravenous infusion. Study findings showed that the majority of nurses adhered to the most common although debatable recommended guideline in stopping the concurrent infusion and slowly administering the medication in the syringe over 3-5 minutes, prior to flushing the line quickly. Nurses failed to account for the dead space in the i.v. line when calculating the administration rate for pre and post medication flush. Similarly, the benefits of continuing the concurrent infusion when administering intravenous medication were not taken into consideration. Based upon these study findings, we recommend changes to procedural guidelines for i.v. medication.

Clinical Competence↗
PubMed2004

Ethanol/trisodium citrate for hemodialysis catheter lock.

AIMS: The objective of this study was to confirm the compatibility of ethanol and 4% trisodium citrate (TSC) for potential use as a catheter locking solution. METHODS: Increasing concentrations of ethanol were combined with 4% TSC in glass test tubes and stored at 37 degrees C over 72 hours. Each tube was visually inspected to determine the highest compatible concentration. To confirm visual compatibility, HPLC analysis was used to compare the concentration of TSC in control solutions (n = 6) to solutions containing both TSC and the highest concentration of ethanol that was visually compatible (n = 6). Compatibility in carbothane hemodialysis catheters was then confirmed in vitro. RESULTS: Results of the compatibility tests indicated that 30% ethanol was the maximum concentration visually compatible with 4% TSC. Ethanol concentrations of 35% or above form a crystalline precipitate in the glass test tubes within 72 hours. HPLC analysis showed no difference in the concentration of TSC in the control solutions compared to the TSC/ethanol solutions when incubated in glass test tubes. A slight, but statistically significant increase in the TSC concentration (1.27%; p < 0.0001) was observed when the ethanol/TSC solution was incubated in carbothane hemodialysis catheters. This slight increase may be due to ethanol absorption into the catheter polymer. Further studies are underway to determine if an ethanol/TSC lock affects the mechanical properties of these carbothane hemodialysis catheters. CONCLUSIONS: We conclude that 30% ethanol is compatible with 4% trisodium citrate in carbothane hemodialysis catheters in vitro. Until the lock's affect on carbothane hemodialysis catheters is known, it cannot yet be recommended for clinical use.

Anti-Infective Agents, Local↗