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Sodium Valproate Incompatibility with Parenteral Nutrition Admixtures-A Risk to Patient Safety: An In Vitro

Ludwika Piwowarczyk1, Szymon Tomczak1, Patryk Antkowiak1

  • 1Department of Pharmaceutical Chemistry, Poznan University of Medical Sciences, 6 Grunwaldzka, 60-780 Poznań, Poland.

Pharmaceutics
|February 26, 2022
PubMed

Insights

Sodium valproate (VPA) co-administration with parenteral nutrition admixtures (PNAs) was studied. Compatibility was only met with omega-3-acid-triglyceride-based PNAs, highlighting risks of simultaneous VPA infusion.

Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Patient Safety

Background:

  • Epilepsy management often requires antiepileptic drugs like sodium valproate (VPA).
  • Intensive care units (ICUs) frequently administer VPA and parenteral nutrition admixtures (PNAs) simultaneously.
  • Drug-PNA incompatibilities are a significant risk to patient safety, yet VPA-PNA compatibility is unstudied.

Purpose of the Study:

  • To investigate the compatibility of sodium valproate (VPA) when co-administered with various parenteral nutrition admixtures (PNAs).
  • To assess the impact of PNA composition on VPA stability and safety during simultaneous infusion.

Main Methods:

  • Evaluated VPA-PNA compatibility using visual inspection, pH, osmolality, zeta potential, particle size, polydispersity index, and turbidity.
  • Tested multiple commercially available PNAs, focusing on those containing omega-3-acid-triglycerides.

Main Results:

  • PNA lipid emulsion composition significantly impacts drug-PNA compatibility.
  • Acceptance criteria for VPA compatibility were met only by PNAs containing omega-3-acid-triglycerides (Omegaflex special and peri).
  • Most tested PNAs exhibited particle fractions >1000 nm, disqualifying simultaneous administration with VPA.

Conclusions:

  • Simultaneous administration of sodium valproate (VPA) with most common parenteral nutrition admixtures (PNAs) is not recommended due to incompatibility.
  • PNAs containing omega-3-acid-triglycerides demonstrate better compatibility with VPA.
  • Further research and clear guidelines are needed to ensure safe co-administration of VPA and PNAs in clinical practice.

Keywords:
compatibilityinteractionmedical errorssafe therapysodium valproate

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