Co-Administration of Drugs and Parenteral Nutrition: In Vitro Compatibility Studies of Loop Diuretics for Safer Clinical Practice

Abstract

Parenteral nutrition (PN) admixtures are prone to interacting with drugs administered intravenously via a common catheter. This may cause a threat to a patient’s health and life. The literature that has been reported on the compatibility of loop diuretics with PN presents conflicting results. This work aimed to study the compatibility of furosemide and torsemide with PN used in clinical practice. Undiluted solutions of drugs were mixed with PN at various ratios determined by flow rates. In order to assess compatibility, visual control was followed by pH measurement, osmolality, mean emulsion droplet diameter (MDD), and zeta potential upon mixing and at 4 h of storage. No macroscopic changes that indicated lipid emulsion degradation were observed. After the addition of the drugs, the value of pH ranged from 6.37 ± 0.01 to 7.38 ± 0.01. The zeta potential was in reverse proportion to the drug concentration. The addition of the drugs did not affect the MDD. It may be suggested that the co-administration of furosemide or torsemide and PN caused no interaction. The absence of such signs of unwanted interactions allowed for the co-administration of the mentioned loop diuretics and PN at each of the studied ratios.

Antiemetic Drugs Compatibility Evaluation with Paediatric Parenteral Nutrition Admixtures

“…Due to the lack of guidelines for summarising the compatibility tests procedure, it was decided to establish the following acceptance criteria: no changes visible to the unaided eye during the entire test period, while during the evaluation period (4 h), pH changes no greater than 0.2, osmolality changes less than 5%, zeta potential differences lower than 5 mV, MDD below 500 nm and the absence of second fraction of lipid droplets higher than 1000 nm, and turbidity differences lower than 0.5 NTU [ 19 , 25 , 26 , 27 , 28 ].…”

Sodium Valproate Incompatibility with Parenteral Nutrition Admixtures—A Risk to Patient Safety: An In Vitro Evaluation Study

“…Until now, no official compendium or harmonized methodology has been established to evaluate PNA stability. Based on the research data and our own experience, we used different analytical methods which allowed us to detect changes in the physicochemical properties of VPA-RTU samples [15][16][17][18]31,32,[39][40][41][42][43][44][45][46]. Despite the duration of the VPA infusion of approximately a few hours and of the PNA from 16 to 24 h, the real-time contact in a common line of Y-site connector lasted only a few minutes.…”

Application of the HPLC Method in Parenteral Nutrition Assessment: Stability Studies of Ondansetron

“…The osmolality, pH, zeta potential, and size of the lipid emulsion particle, expressed as mean emulsion droplet diameter (MDD), were performed. The measurements were in accordance with the methodology described previously [34,35].…”