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De Silva DTN, Petrovski M, Strunk T, Mukadam N, Page-Sharp M, Moore BR, Batty KT. Physicochemical compatibility of caffeine citrate and caffeine base injections with parenteral medications used in neonatal intensive care settings. Eur J Clin Pharmacol 2024; 80:1079-1087. [PMID: 38546840 PMCID: PMC11156738 DOI: 10.1007/s00228-024-03678-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/19/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE To investigate the physicochemical compatibility of caffeine citrate and caffeine base injections with 43 secondary intravenous (IV) drugs used in Neonatal Intensive Care Unit (NICU) settings. METHODS Caffeine citrate (20 mg/mL or 10 mg/mL) or caffeine base injection (10 mg/mL) were mixed in a volume ratio of 1:1 with the secondary drug solution to simulate Y-site co-administration procedures in NICUs. Physical compatibility was evaluated based on visual observation for 2 h, against a black and white background and under polarised light, for changes in colour, precipitation, haze and evolution of gas. Chemical compatibility was determined from caffeine concentration measurements, using a validated high-performance liquid chromatography assay. RESULTS Six of the 43 secondary drugs tested (aciclovir, amphotericin (liposomal), furosemide, hydrocortisone, ibuprofen and ibuprofen lysine) were physically incompatible with caffeine citrate undiluted injection (20 mg/mL), at their high-end, clinically relevant concentrations for NICU settings. However, when tested at lower concentrations, hydrocortisone (1 mg/mL) was physicochemically compatible, whereas furosemide (0.2 mg/mL) was physically incompatible with caffeine citrate. The six drugs which showed physical incompatibility with caffeine citrate 20 mg/mL injection were also physically incompatible with caffeine citrate 10 mg/mL solution. All 43 secondary drugs tested were physicochemically compatible with caffeine base injection. CONCLUSIONS Most secondary test drugs, except aciclovir, amphotericin (liposomal), furosemide, hydrocortisone, ibuprofen and ibuprofen lysine, were physicochemically compatible with caffeine citrate injection. Caffeine base injection was physicochemically compatible with all 43 test drugs tested.
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Affiliation(s)
| | - Michael Petrovski
- Pharmacy Department, Sir Charles Gardiner Hospital, North Metropolitan Health Service, Nedlands, WA, Australia
| | - Tobias Strunk
- Medical School, The University of Western Australia, Crawley, WA, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Neonatal Directorate, King Edward Memorial Hospital, Child and Adolescent Health Service, Subiaco, WA, Australia
| | - Nabeelah Mukadam
- Pharmacy Department, King Edward Memorial Hospital, Women and Newborn Health Service, Subiaco, WA, Australia
| | - Madhu Page-Sharp
- Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Brioni R Moore
- Curtin Medical School, Curtin University, Bentley, WA, Australia
- Medical School, The University of Western Australia, Crawley, WA, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Kevin T Batty
- Curtin Medical School, Curtin University, Bentley, WA, Australia.
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia.
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Senarathna SG, Strunk T, Petrovski M, Woodland S, Batty KT. Physicochemical compatibility of pentoxifylline injection with high-concentration parenteral medications. Pediatr Investig 2023; 7:263-267. [PMID: 38050532 PMCID: PMC10693661 DOI: 10.1002/ped4.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/30/2023] [Indexed: 12/06/2023] Open
Affiliation(s)
| | - Tobias Strunk
- Medical SchoolUniversity of Western AustraliaCrawleyAustralia
- Neonatal DirectorateKing Edward Memorial Hospital, Child and Adolescent Health ServiceSubiacoAustralia
- Wesfarmers Centre for Vaccines and Infectious DiseasesTelethon Kids InstituteNedlandsAustralia
| | - Michael Petrovski
- Pharmacy DepartmentKing Edward Memorial Hospital, Women and Newborn Health ServiceWestern AustraliaAustralia
| | - Sarah Woodland
- Pharmacy DepartmentKing Edward Memorial Hospital, Women and Newborn Health ServiceWestern AustraliaAustralia
| | - Kevin T. Batty
- Curtin Medical SchoolCurtin UniversityBentleyAustralia
- Curtin Health Innovation Research InstituteCurtin UniversityBentleyAustralia
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Kleinlein M, Marschler S, Neininger MP, Hoeckel M, Bertsche T. Y-site administration of electrolyte solutions and injectable acetaminophen-A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia. Paediatr Anaesth 2023; 33:69-78. [PMID: 36214581 DOI: 10.1111/pan.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 09/28/2022] [Accepted: 09/03/2022] [Indexed: 01/20/2023]
Abstract
AIM Determination of the physical compatibility of acetaminophen and two different electrolyte solutions (an isotonic, balanced electrolyte solution and a hypotonic, glucose containing electrolyte solution) with drugs frequently used in routine pediatric intensive care. METHODS Analytical investigations for frequently used combinations without pre-existing data were performed. Visual and microscopic observations according to the European Pharmacopeia as well as pH measurements and ultraviolet visible spectrometry at wavelengths of 350, 410 and 550 nm were conducted to analyze physical compatibility. All measurements were performed immediately after mixing as well as 1, 4, and 24 h after. RESULTS In total, 42 combinations were analyzed. Visual incompatibilities were found with pantoprazole and diazepam with both electrolyte solutions. For furosemide, a particle formation in mixture with the hypotonic glucose-containing electrolyte solution and a change in pH ≥ 0.5 after 24 h with both electrolyte solutions were observed. Ampicillin, cefuroxime, diazepam, furosemide, linezolid, meropenem, and pantoprazole showed an aberration of the absorbance ≥0.04 (350 nm/410 nm) or ≥0.01 (550 nm) in the photometric measurements with the electrolyte solutions. For acetaminophen, a physical incompatibility was observed with ampicillin, diazepam, furosemide, and pantoprazole. CONCLUSION Most of the analyzed combinations showed no signs of physical incompatibility and may therefore be administered via the same Y-site. However, diazepam, furosemide, and pantoprazole should not be administered simultaneously with acetaminophen or both electrolyte solutions.
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Affiliation(s)
- Mona Kleinlein
- Gesundheit Nordhessen Holding AG - Pharmacy, Kassel, Germany
| | | | - Martina Patrizia Neininger
- Clinical Pharmacy, Leipzig University and Drug Safety Center, Medical Faculty, Institute of Pharmacy, Leipzig University and University Hospital, Leipzig, Germany
| | - Michael Hoeckel
- Gesundheit Nordhessen Holding AG - Pharmacy, Kassel, Germany
| | - Thilo Bertsche
- Clinical Pharmacy, Leipzig University and Drug Safety Center, Medical Faculty, Institute of Pharmacy, Leipzig University and University Hospital, Leipzig, Germany
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