Compatibility of cisatracurium besylate with selected drugs during simulated Y-site administration

The compatibility of cisatracurium besylate with 91 other drugs during simulated Y-site injection was studied. Five milliliters of cisatracurium 0.1, 2, and 5 mg/mL (as besylate) in 5% dextrose injection was combined with 5 mL of each of 91 drugs in 5% dextrose injection or 0.9% sodium chloride injection. All combinations were prepared in duplicate and stored at approximately 23 degrees C. Samples were visually examined under normal laboratory fluorescent light and, if there was no obvious visual incompatibility, under high-intensity monodirectional light. Turbidity was measured as well. Particle sizing and counting was performed for selected combinations. All evaluations were performed at intervals up to four hours. Cisatracurium besylate at all three concentrations was compatible with most of the drugs tested. However, one drug (cefoperazone) was incompatible with cisatracurium besylate at all three concentrations, 14 (including many cephalosporins) were incompatible with cisatracurium besylate 2 and 5 mg/ mL, and 12 were incompatible with cisatracurium 5 mg/ mL. During simulated Y-site administration, cisatracurium 0.1, 2, and 5 mg/mL (as besylate) in 5% dextrose injection was compatible with 64 of 91 drugs for four hours at approximately 23 degrees C. Twenty-seven drugs were incompatible with cisatracurium besylate at one or more concentrations.