Compatibility of remifentanil hydrochloride with selected drugs during simulated Y-site administration

The compatibility of remifentanil hydrochloride with 90 other drugs during simulated Y-site administration was studied. Five milliliters of remifentanil 25 and 250 micrograms/mL (as hydrochloride) in 0.9% sodium chloride injection or 5% dextrose injection was combined with 5 mL of each of 90 other drugs in 5% dextrose injection of 0.9% sodium chloride injection. Each combination was prepared in duplicate. The combinations were stored at approximately 23 degrees C under fluorescent light and examined with the unaided eye and in high-intensity monodirectional light during the first 15 minutes after preparation and at one and four hours. The turbidity of each combination was measured as well. Particle sizing and counting were performed for selected combinations. Most of the combinations exhibited no haze, turbidity, or color change throughout the study period. Remifentanil 25 micrograms/mL combined with chlorpromazine hydrochloride showed a small increase in haze within four hours. One of the combinations of remifentanil 250 micrograms/mL with cefoperazone sodium was unacceptably hazy within one hour. The combination of remifentanil 250 micrograms/mL with amphotericin B formed a gross precipitate upon mixing. Remifentanil 25 and 250 microgram/mL (as hydrochloride) in 0.9% sodium chloride injection was compatible for four hours at approximately 23 degrees C with all the drugs studied except chlorpromazine hydrochloride (with remifentanil 25 micrograms/mL), cefoperazone sodium (with remifentanil 250 micrograms/mL), and amphotericin B (with remifentanil 250 micrograms/mL in 5% dextrose injection).