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Compatibility considerations in parenteral nutrient solutions.

P W Niemiec, T W Vanderveen

    American Journal of Hospital Pharmacy
    |May 1, 1984
    PubMed
    Summary
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    Parenteral nutrition (PN) solutions require careful compatibility assessment for nutrients and drugs. Factors like pH and additives affect calcium phosphate precipitation, while some drugs may have reduced availability or stability in PN admixtures.

    Area of Science:

    • Nutritional Science
    • Clinical Pharmacy
    • Drug Compatibility Studies

    Background:

    • Parenteral nutrition (PN) is crucial for patients unable to consume food orally.
    • Ensuring the compatibility and stability of various components within PN solutions is vital for patient safety and therapeutic efficacy.
    • Limited data exists on the stability and interaction of numerous drugs when co-administered in PN admixtures.

    Purpose of the Study:

    • To review and evaluate the compatibility of nutrients and drugs within parenteral nutrient (PN) solutions.
    • To identify factors influencing the stability of common additives in PN.
    • To assess the advantages and challenges of administering drugs via PN.

    Main Methods:

    • Literature review and evaluation of existing studies on nutrient and drug compatibility in PN solutions.

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  • Analysis of factors affecting precipitation, such as pH, concentration, and temperature.
  • Summary of findings for specific drugs commonly administered via PN.

    • Main Results:

    • Calcium phosphate precipitation is influenced by pH, amino acid concentration, temperature, and additive sequence.
    • Insulin adsorption to infusion systems can decrease its availability; vitamin A delivery may be poor.
    • Thiamine stability may be affected by sodium bisulfite in amino acid injections, requiring further clinical studies.
    • Folic acid and phytonadione appear stable; many antibiotics are likely stable via co-infusion.
    • Compatibility of electrolytes, vitamins, and trace elements needs reassessment when lipids are mixed with amino acid-dextrose solutions.

    Conclusions:

    • Drug administration via PN offers benefits in fluid restriction or limited venous access scenarios.
    • Careful consideration of potential incompatibilities, such as precipitation and adsorption, is necessary.
    • Further practical research is needed to establish specific patient population and formulation guidelines for PN additives.