Physical Compatibility of Pantoprazole with Selected Medications during Simulated Y-Site Administration

ABSTRACT Rationale: Patients receiving IV pantoprazole often require concomitant IV drugs and solutions. A review of the product monograph, a search of the MEDLINE, International Pharmaceutical Abstracts, and EMBASE bibliographic databases, and communication with the manufacturer revealed no information about compatibility between pantoprazole and other medications during Y-site administration of drugs. Objective: To complete a visual compatibility study of IV pantoprazole with 17 other IV medications, as well as with a mixture of 3.3% dextrose and 0.3% sodium chloride for injection, during simulated Y-site injection. Methods: Seventeen drugs, each at 3 different concentrations (prepared in 5% dextrose in water [D5W] for injection), as well as a mixture of 3.3% dextrose and 0.3% sodium chloride for injection, were selected for physical compatibility testing with 3 concentrations (0.16 mg/mL, 0.40 mg/mL, and 0.80 mg/mL) of pantoprazole in 0.9% sodium chloride for injection (NS). The 17 drugs were ampicillin, cefazolin, ceftriaxone, dimenhydrinate, dobutamine, dopamine, epinephrine, esmolol, furosemide, insulin, midazolam, morphine, nitroglycerin, norepinephrine, octreotide, potassium chloride, and vasopressin. To simulate Y-site administration, equal volumes of pantoprazole (at each of the 3 concentrations) and each secondary drug (at each of the 3 concentrations) were mixed in a test tube. Solutions were inspected for colour change, clarity, visible precipitate, and evolution of gas immediately after mixing and at 15 min and 1, 4, and 12 h. The pH of each test drug was measured before it was mixed with pantoprazole. For combinations found to be physically incompatible, a range of concentrations was prepared to evaluate the extent of the incompatibility. Results: Pantoprazole solutions were physically compatible with 12 of the 17 drugs tested and with the mixture of 3.3% dextrose and 0.3% sodium chloride for injection for up to 12 h at 23°C during simulated Y-site administration. Precipitation occurred with mixtures containing pantoprazole and dobutamine or norepinephrine. A colour change and a precipitate were observed when pantoprazole was mixed with esmolol, midazolam, or octreotide. In general, mixtures of pantoprazole with dobutamine, esmolol, or midazolam were physically incompatible over clinically useful concentration ranges. Octreotide and pantoprazole were physically compatible when the octreotide concentration was less than 1.5 μg/mL. Norepinephrine was physically compatible with all pantoprazole concentrations when the norepinephrine concentration was less than 13 μg/mL. Conclusions: Admixtures prepared in the clinical setting are subject to greater error than in the laboratory, and it is therefore recommended that practitioners avoid Y-site administration of pantoprazole with dobutamine, esmolol, midazolam, octreotide (at concentrations near or greater than 1.5 μg/mL), or norepinephrine (at concentrations near or greater than 13 μg/mL). RESUME Historique : Les patients qui recoivent du pantoprazole par voie intraveineuse (IV) necessitent egalement souvent l’administration concomitante d’autres medicaments et solutions par voie IV. L’etude de la monographie du pantoprazole, une recherche dans les bases de donnees bibliographiques MEDLINE, International Pharmaceutical Abstracts et EMBASE, et des echanges avec le fabricant n’ont permis d’obtenir aucune information sur la compatibilite entre le pantoprazole et d’autres medicaments pour une administration dans un raccord en Y. Objectif : Mener une etude de compatibilite visuelle entre le pantoprazole IV et 17 autres medicaments IV, ainsi qu’avec une mixture de solutions injectables de dextrose a 3,3 % et de chlorure de sodium a 0,3 %, au cours d’une administration simulee dans un raccord en Y. Methodes : On a choisi 17 medicaments, chacun prepare selon trois concentrations dans une solution injectable de dextrose a 5 % dans l’eau (D5W), ainsi qu’une mixture de solutions injectables de dextrose a 3,3 % et de chlorure de sodium a 0,3%, a des fins de tests de compatibilite avec trois concentrations de pantoprazole preparees dans une solution injectable de chlorure de sodium a 0,9 % (NS) — 0,16 mg/mL, 0,4 mg/mL et 0,8 mg/mL. Les 17 medicaments etaient les suivants : ampicilline, cefazoline, ceftriaxone, dimenhydrinate, dobutamine, dopamine, epinephrine, esmolol, furosemide, insuline, midazolam, morphine, nitroglycerine, norepinephrine, octreotide, chlorure de potassium et vasopressine. Pour simuler l’administration dans un raccord en Y, on a melange en volumes egaux dans des eprouvettes le pantoprazole (a chacune des trois concentrations) et, de facon unitaire, chacun des autres medicaments (egalement a chacune des trois concentrations). Les solutions ont ete inspectees pour un changement de couleur, la limpidite, la presence d’un precipite et l’emission de gaz immediatement apres leur preparation, puis apres 15 min, 1, 4 et 12 heures. Le pH de chacune des solutions a ete mesure avant leur preparation. Pour les melanges qui etaient physiquement incompatibles, on a prepare une serie de concentrations afin d’en evaluer le degre d’incompatibilite. Resultats : Les solutions de pantoprazole etaient physiquement compatibles avec 12 des 17 medicaments testes et avec la mixture de solutions injectables de dextrose a 3,3 % et de chlorure de sodium a 0,3 %, jusqu’a 12 heures a 23 °C au cours d’une administration simulee dans un raccord en Y. La formation d’un precipite est survenue avec les melanges de pantoprazole et de norepinephrine ou de dobutamine. On a observe un changement de couleur et la formation d’un precipite lorsque le pantoprazole etait melange a l’esmolol, au midazolam ou a l’octreotide. Regle generale, les melanges de pantoprazole et de dobutamine, d’esmolol ou de midazolam etaient physiquement incompatibles dans un eventail de concentrations cliniquement utiles. L’octreotide et le pantoprazole etaient physiquement compatibles lorsque la concentration d’octreotide etait inferieure a 1,5 μg/mL. La norepinephrine s’est revelee physiquement compatible avec toutes les concentrations de pantoprazole, lorsque ses propres concentrations etaient inferieures a 13 μg/mL. Conclusions : Les melanges prepares en milieu clinique sont sujets a une plus grande marge d’erreur que ceux prepares en laboratoire, et c’est pourquoi on recommande aux praticiens d’eviter l’administration de pantoprazole dans un raccord en Y avec la dobutamine, l’esmolol, le midazolam, l’octreotide (a des concentrations pres de ou superieures a 1,5 (g/mL), ou la norepinephrine (a des concentrations pres de ou superieures a 13 μg/mL).

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.