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Avoiding the incompatibility of peripheral parenteral nutrition solution and midazolam injection for intravenous
Akihiko Futamura1,2, Takashi Higashiguchi2, Takeshi Chihara3
1Department of Pharmacy, Fujita Health University Nanakuri Memorial Hospital, Tsu, Mie, Japan.
Objectives:
We have observed white turbidity when a midazolam injection is administered from a lateral tube during the administration of a peripheral parenteral nutrition (PPN) solution. The aim of the current study was to determine how to avoid compound changes when co-administering a midazolam injection and a PPN solution.
Methods:
Midazolam solutions were prepared by diluting a midazolam injection with a 5% glucose intravenous infusion. We examined the formulation of the midazolam injection and a PPN solution at the concentrations used in a clinical setting for changes in appearance, pH, and midazolam content in test tubes and during administration conditions.
Results:
With a 1/4.8 dilution of midazolam in undiluted solution, clouding occurred. A strong correlation was revealed between the midazolam content as measured through high-performance liquid chromatography and the mixture's midazolam concentration (R2=0.9918). The capture rate of midazolam infused with PPN solution was 91.0% at a 1/6 dilution, whereas it decreased to <90% at a 1/4.8 dilution.
Conclusions:
Our results suggest that the administration of a midazolam injection solution diluted by ≥6-fold with glucose solution or saline from a side tube during the administration of a PPN solution did not cause changes in composition.
Insights
To prevent white turbidity, dilute midazolam injection at least 6-fold with glucose or saline when co-administering with parenteral nutrition (PPN) solution. This ensures safe co-administration without compromising drug composition.
Area of Science:
- Clinical Pharmacy
- Intravenous Drug Compatibility
- Parenteral Nutrition
Background:
- Turbidity observed during co-administration of midazolam injection and parenteral nutrition (PPN) solutions.
- Potential for compound changes impacting patient safety and drug efficacy.
Purpose of the Study:
- Determine optimal dilution to prevent incompatibility between midazolam injection and PPN solutions.
- Establish guidelines for safe co-administration of these intravenous therapies.
Main Methods:
- Prepared midazolam solutions with varying dilutions in 5% glucose.
- Assessed appearance, pH, and midazolam content via HPLC under simulated administration conditions.
- Evaluated midazolam capture rate when co-administered with PPN solution.
Main Results:
- Clouding occurred with 1/4.8 midazolam dilution.
- High correlation (R²=0.9918) between HPLC and mixture concentration.
- Midazolam capture rate was 91.0% at 1/6 dilution, decreasing below 90% at 1/4.8 dilution.
Conclusions:
- Diluting midazolam injection by ≥6-fold with glucose or saline prevents composition changes during PPN co-administration.
- Safe co-administration is achievable with appropriate dilution protocols.
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