Pharmaceutical Point of View on Parenteral Nutrition

Abstract

Parenteral nutrition—a form of administering nutrients, electrolytes, trace elements, vitamins, and water—is a widely used mode of therapy applied in many diseases, in patients of different ages both at home and in hospital. The success of nutritional therapy depends chiefly on proper determination of the patient's energetic and electrolytic needs as well as preparation and administration of a safe nutritional mixture. As a parenterally administered drug, it is expected to be microbiologically and physicochemically stable, with all of the components compatible with each other. It is very difficult to obtain a stable nutritional mixture due to the fact that it is a complex, two-phase drug. Also, the risk of incompatibility between mixture components and packaging should be taken into consideration and possibly eliminated. Since parenteral nutrition is a part of therapy, simultaneous use of drugs may cause pharmacokinetic and pharmacodynamic interactions as well as those with the pharmaceutical phase. The aim of this paper is to discuss such aspects of parenteral nutrition as mixture stability, methodology, and methods for determining the stability of nutritional mixtures and drugs added to them.

The Interactions between Ciprofloxacin and Parenteral Nutrition Admixtures

“…PN admixtures are the most complex drugs used in modern medicine. Up to 50 different substances are mixed together in one package, which raises the possibility of physicochemical interactions [9,10]. Administering a PN admixture simultaneously with another infusion drug or adding a drug to the PN admixture carries a high risk of physical or chemical incompatibility.…”

Development, Validation, and Stability Assessment Application of RP-HPLC-DAD Method for Quantification of Ampicillin in Total Parenteral Nutrition Admixtures

“…For this purpose, it is evaluated whether the studied TPN admixture undergoes any changes in the pH, osmolarity, zeta potential, and particle size of the lipid emulsion. It seems reasonable to determine not only the parameters characterizing the TPN admixture, but also changes in the content of the added drug, because TPN admixture might affect its stability, leading to degradation [8].…”

“…This is particularly dangerous for critically ill patients, in whom TPN admixtures are very often administered for maintaining adequate nutritional status and alleviating inflammatory reactions. Such patients also belong to a group of patients receiving many drugs at the same time and who are particularly endangered by an incompatibility of TPN admixture and the drug [8][9][10][11].…”

Lipid peroxidation in parenteral nutrition admixtures - prooxidative and antioxidative factors, as well as their clinical significance

“…terapii, jak i stanowić zagrożenie dla pacjenta [3]. Efektem interakcji może być wytrącenie osadu wodorofosforanu wapnia, inaktywacja witamin, śmietankowanie emulsji tłuszczowej, flokulacja jej kropel prowadząca do koalescencji i rozdzielenia faz emulsji.…”