Stability of nitroglycerin solutions in polyolefin and glass containers

Wagenknecht, Dietmar M.; Baaske, David M.; Alam, Abu S.; Carter, James E.; Shah, Jatin

doi:10.1093/ajhp/41.9.1807

Cited by 5 publications

(4 citation statements)

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“…Polyethylene infusion sets are relatively inflexible but satisfactory results have been obtained using a combination polyvinyl chloridepolyethylene administration set (Schaber et al 1985). Glyceryl trinitrate in common intravenous solutions was found to be stable, under various storage conditions, in polyolefin and glass containers (Wagenknecht et al 1984). For routine clinical purposes, there should be no insurmountable problems.…”

Section: Loss From Intravenous Solutionsmentioning

confidence: 99%

Clinical Pharmacokinetics of Glyceryl Trinitrate Following the Use of Systemic and Topical Preparations

Bogaert

1987

Clinical Pharmacokinetics

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Glyceryl trinitrate has been used for more than a century for the treatment of angina pectoris and, more recently, for the treatment of congestive heart failure. The introduction of transdermal delivery systems has renewed the controversy regarding the efficacy of the drug, mainly in the light of the development of tolerance. With concentrations of the order of 1 microgram/L or less, the measurement of glyceryl trinitrate in plasma is not easy: gas chromatography with electron capture detection has been used widely but recently gas chromatography-mass spectrometry has provided satisfactory results. Assay problems are most likely to be responsible for some of the unexpected results reported. Further factors which may confound the results of the study of plasma concentrations are the rapid metabolism of glyceryl trinitrate in blood in vitro, adsorption to containers and infusion sets, and the uptake and/or metabolism in vessel walls. From the intravenous infusion data, the large interindividual variability in plasma concentrations of glyceryl trinitrate is apparent. The plasma half-life is about 2 to 3 minutes; plasma clearance values reported vary from 216 to 3270 L/h, indicating extensive non-hepatic metabolism. With transdermal administration, mainly with the transdermal controlled delivery systems, plasma concentrations of glyceryl trinitrate appear to be maintained for up to 24 hours, with large interindividual variations. Despite the ability to maintain, for example with the transdermal delivery systems, relatively constant concentrations of glyceryl trinitrate, it has not been possible to find a relationship between plasma concentrations and pharmacological or clinical effects. This is in part due to the attenuation of the effects with time; from the available data it is clear that this attenuation occurs at a pharmacodynamic level (reflex adaptation and tolerance) and not at the pharmacokinetic level.

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Section: Loss From Intravenous Solutionsmentioning

confidence: 99%

Clinical Pharmacokinetics of Glyceryl Trinitrate Following the Use of Systemic and Topical Preparations

Bogaert

1987

Clinical Pharmacokinetics

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“…A total of 2961 publications via search of databases and 35 publications from additional sources were assessed, and 35 manuscripts were identified for inclusion (Figure 1). Six studies were adjudicated as high risk of bias 20-25 and excluded from further analysis, for a final inclusion of 29 studies 26-54 (Supplementary Figures 1 and 2). Full characteristics of all included studies can be found in Supplementary Table 3.…”

Section: Resultsmentioning

confidence: 99%

Physical and Chemical Compatibility of Medications Commonly Used in Critically Ill Patients With Balanced Crystalloids: A Systematic Review

et al. 2023

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Objective: Evaluate available evidence of physical and/or chemical compatibility of commonly used medications in critically ill patients with balanced crystalloids. Data sources: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were queried from inception to September 2022. Study selection and data extraction: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English-language studies reporting physical and/or chemical compatibility data between 50 selected medications and balanced crystalloids were included. A previously designed tool to assess risk of bias was adapted for use. Data synthesis: Twenty-nine studies encompassing 39 (78%) medications and 188 unique combinations with balanced crystalloids were included. Combinations included 35 (70%) medications with lactated Ringer’s, 26 (52%) medications with Plasma-Lyte, 10 (20%) medications with Normosol, and one (2%) medication with Isolyte. Studies commonly evaluated physical and chemical compatibility (55.2%). More medications were evaluated via Y-site than admixture. Incompatibilities were identified in 18% of combinations comprising 13 individual drugs. Relevance to patient care and clinical practice: This systematic review evaluates the compatibility of select critical care medications with balanced crystalloid solutions. Results may be used as a tool to guide clinicians on balanced crystalloid compatibility, potentially increasing ubiquitous use and reducing patient exposure to normal saline. Conclusion and relevance: Data are limited regarding chemical/physical compatibility of commonly used medications in critically ill patients with balanced crystalloids. Additional compatibility studies are warranted, particularly methodologically rigorous studies assessing Plasma-Lyte, Normosol, and Isolyte. Of the evaluated medications, there was a low frequency of incompatibilities with balanced crystalloids.

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“…Polyethylene [31] Solution of 2, 4, and 6 mg/ml precipitated within 2 h. Solutions from 1-8 mg/ml lost more than 10% of the initial concentration within 24 h. [31] Etoposide phosphate [36] Nitroglycerine will undergo substantial loss from aqueous solutions due to sorption to PVC containers and administration sets.…”

Section: Docetaxel (2-vials)mentioning

confidence: 99%

Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide

Maraiki

Farooq

Ahmed

2016

International Journal of Pharmacy Practice

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Stability of nitroglycerin solutions in polyolefin and glass containers

Cited by 5 publications

References 0 publications

Clinical Pharmacokinetics of Glyceryl Trinitrate Following the Use of Systemic and Topical Preparations

Clinical Pharmacokinetics of Glyceryl Trinitrate Following the Use of Systemic and Topical Preparations

Physical and Chemical Compatibility of Medications Commonly Used in Critically Ill Patients With Balanced Crystalloids: A Systematic Review

Eliminating the use of intravenous glass bottles using a FOCUS-PDCA model and providing a practical stability reference guide

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