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Compatibility of furosemide with aminoglycoside admixtures
Abstract:
The compatibility of furosemide with i.v. admixtures containing each of five different aminoglycosides was studied. Admixtures of amikacin 2 mg/ml, gentamicin 1.6 mg/ml, kanamycin 2 mg/ml, netilmicin 1.5 mg/ml, and tobramycin 1.6 mg/ml (as the sulfate salts) were prepared in both 5% dextrose injection and 0.9% sodium chloride injection in minibags. Furosemide injection 4 ml (40 mg) was then added to each admixture, and the admixtures were examined visually and microscopically for precipitate. The macroscopic and microscopic evaluations were repeated 15 minutes and 24 hours after mixing. To simulate Y-site injection of furosemide, furosemide injection 1 ml (10 mg) was added to 1 ml of each aminoglycoside admixture in a syringe. For admixtures in which precipitates formed, the pH was recorded before and after adding furosemide to subsequent admixtures and also after dropwise addition of 1N sodium hydroxide until the precipitate dissolved. Precipitates were identified using spectrophotometric analysis and melting point determinations. Addition of furosemide resulted in a precipitate only in admixtures containing gentamicin sulfate or netilmicin sulfate; the results for the simulated Y-site injection study were the same. Spectrophotometric analysis and melting point determinations revealed that the precipitate was furosemide. Because furosemide precipitates when added to admixtures containing either gentamicin sulfate or netilmicin sulfate in 5% dextrose injection or 0.9% sodium chloride injection, furosemide should be administered separately or the i.v. tubing should be flushed thoroughly before and after administering this drug via a Y-injection site.
Insights
Furosemide precipitates when mixed with gentamicin sulfate or netilmicin sulfate in intravenous admixtures. Separate administration or thorough flushing of IV lines is recommended to prevent precipitation and ensure patient safety.
Area of Science:
- Pharmacology
- Intravenous Drug Compatibility
- Clinical Pharmacy
Background:
- Intravenous admixtures are common in healthcare settings.
- Ensuring compatibility between co-administered drugs is crucial for patient safety.
- Furosemide and aminoglycosides are frequently administered intravenously.
Purpose of the Study:
- To evaluate the compatibility of furosemide with intravenous admixtures containing five different aminoglycosides.
- To identify potential precipitation issues when furosemide is mixed with amikacin, gentamicin, kanamycin, netilmicin, or tobramycin.
Main Methods:
- Furosemide was added to minibag admixtures of aminoglycosides in dextrose 5% and sodium chloride 0.9%.
- Visual and microscopic examinations for precipitate were conducted at multiple time points.
- Simulated Y-site injections were performed, and precipitate analysis included spectrophotometry and melting point determination.
Main Results:
- Precipitation occurred only when furosemide was added to admixtures containing gentamicin sulfate or netilmicin sulfate.
- The precipitate was identified as furosemide.
- Results were consistent in both dextrose 5% and sodium chloride 0.9% solutions and in simulated Y-site injections.
Conclusions:
- Furosemide is incompatible with gentamicin sulfate and netilmicin sulfate in common intravenous solutions.
- Separate administration of furosemide or thorough flushing of intravenous lines is necessary when co-administering with these aminoglycosides.
- This finding is critical for preventing adverse events related to drug precipitation.