Y-site simulation compatibility study of 10% calcium salts with various injectable solutions during toxicological resuscitation.

PURPOSE: To determine the physical compatibility of 10% calcium chloride and 10% calcium gluconate in combination with injectable solutions, administered in the paediatric and adult intensive care unit setting during toxicological resuscitation involving calcium channel blockers and beta-blockers. METHODS: Forty-eight combinations were prepared at room temperature, including the following products: calcium chloride, calcium gluconate, insulin, epinephrine, norepinephrine, highly concentrated dextrose solution, sodium chloride, Plasma-Lyte A and Ringer's lactate. A visual evaluation at times 0, 1, 4, 24, 48 and 72 hours and a particle count test with the LS-20 particle counter at times 0, 4, 24 and 72 hours were performed. The admixtures were considered incompatible if there was a precipitate, a colour change, turbidity, viscosity or a gas formation. The stability of calcium salts was also tested in empty IV bags and syringes by the particle count test. RESULTS: All drug mixtures were found to be compatible by visual evaluation and using the particle counter based on United States Pharmacopoeia chapter 788 (USP<788>) specifications. Calcium salts were compatible with insulin and vasopressors in the tested combinations. The stability of 10% calcium salts in empty IV bags and polypropylene syringes was demonstrated for up to 48 hours at room temperature. CONCLUSION: All the combinations tested were physically compatible for up to 72 hours at room temperature. Clinical use of calcium salt infusions, at an undiluted concentration, in combination with these injectable solutions in a toxicological resuscitation context is considered clinically acceptable.

Stability evaluation of compounded hydroxyurea 100 mg/mL oral liquids using a novel analytical method involving chemical derivatization.

This study assessed the stability of six extemporaneously compounded hydroxyurea oral liquids stored at room temperature. Hydroxyurea oral liquids (100 mg/mL) were prepared using three different mixing methods (mortar, mixer or QuartetRx) from either bulk powder, capsule content, or whole capsules. Two brands of capsules were tested in this study. All formulations were stored at room temperature (25°C / 60% RH) in amber plastic bottles for 90 days and amber plastic syringes for 14 days. Physical stability was assessed visually, while chemical stability was evaluated using a stability-indicating high-performance liquid chromatography method. Chemical derivatization with xanthydrol allowed the retention of hydroxyurea on a reverse-phase column. At least 93.9% and 97.0% of the initial concentration of hydroxyurea remained after 90 days in bottles and 14 days in syringes, respectively. There were no visual changes in formulations over the study period. Changes in pH up to 1.6 units were observed after 90 days of storage and were explained most likely by an ammonium generating degradation pathway. Ammonium was quantified and remained within safe levels in each HU 100 mg/mL oral preparations. Hydroxyurea oral liquids were all stable for 90 days in amber plastic bottles and 14 days in amber plastic syringes.

Stability of Compounded Digoxin Solution 0.05 mg/mL for Injection.

Background: In 2015, commercial pediatric digoxin injection 0.05 mg/mL was discontinued, leaving only one adult concentration (0.25 mg/mL) for injection on the Canadian market. No published studies have documented the chemical stability over a long period of time of a diluted solution of digoxin for injection. Objective: The aim of this study was to assess the chemical stability of 2 digoxin injection formulations 0.05 mg/mL diluted in 2 vehicles stored at 5°C or a 25°C. Methods: The compounded solution of digoxin 0.05 mg/mL for injection was prepared with digoxin 0.25 mg/mL after dilution in 2 different vehicles, normal saline, and a compounding of the commercial vehicle. Half of the compounding products were stored in 2 mL transparent glass vials at 25°C and the other half at 5°C. Chemical stability was evaluated by HPLC-UV analysis on days 0, 14, 30, 60, 90, 120, 150, 180 for each temperature conditions. In addition, samples were tested for organoleptic change, presence of particular matter as well as sterility. Results: For all tested preparations, the concentration of digoxin remained above 90.0% of the initial concentration throughout the 180-day study. Furthermore, no organoleptic change was observed; particulate matter assessment was in acceptable range; and sterility specifications were met. Conclusions: Digoxin 0.05 mg/mL obtained with a dilution of digoxin 0.25 mg/mL by normal saline or a copy of the commercial vehicle remained stable for at least 180 days at 5°C and 25°C.

Stability evaluation of compounded clonidine hydrochloride oral liquids based on a solid-phase extraction HPLC-UV method.

The present study aimed to assess the stability of clonidine hydrochloride oral liquids (20-µg/mL) prepared from two different generic tablets in Ora-Blend and stored in amber plastic bottles. Physical and chemical stabilities were evaluated over a period of 90 days at 25°C. Analytical challenges were overcome with the development of a new extraction procedure based on solid phase extraction to ensure efficient clonidine hydrochloride quantification. The absence of physical instabilities, evaluated by qualitative and quantitative measurements (static multiple light scattering), as well as the absence of chemical instabilities, evidenced by a stability-indicating HPLC-UV method, confirmed that a beyond-use date of 90 days was appropriate for these compounded oral liquids.

Stability of Extemporaneously Compounded Suspensions of Trimethoprim and Sulfamethoxazole in Amber Plastic Bottles and Amber Plastic Syringes.

BACKGROUND: Trimethoprim (TMP) and sulfamethoxazole (SMX) are widely used, in combination, to treat or prevent various infections. Unfortunately, no liquid oral formulation is currently available in Canada for patients who are unable to swallow tablets. OBJECTIVE: To evaluate the stability of suspensions of TMP and SMX (8 and 40 mg/mL, respectively) prepared in Oral Mix or Oral Mix SF vehicle (Medisca Pharmaceutique Inc) and stored for up to 90 days in amber plastic bottles or amber plastic syringes at 5°C or 25°C. METHODS: Suspensions were prepared from bulk powder and from tablets in Oral Mix and Oral Mix SF vehicles, then transferred to amber plastic (polyethylene terephthalate glycol) bottles and plastic oral syringes and stored at 5°C and 25°C. Samples were collected on predetermined study days (0, 7, 14, 23, 45, 60, 75, and 90 days) and analyzed using a validated high-performance liquid chromatography - ultraviolet detection method. A suspension was considered stable if it maintained at least 90% of its initial concentration with 95% confidence. Observations of organoleptic characteristics such as colour and odour, as well as pH, were used to assess physical stability. RESULTS: Suspensions prepared from bulk powder maintained concentrations of TMP and SMX of at least 97% of the initial concentration over the 90-day study period. No obvious changes in colour, odour, or pH were observed. However, acceptable suspensions could not be prepared from the commercial tablets. A persistent foam that developed at the surface of all suspensions prepared from tablets could result in inconsistent dosing. CONCLUSIONS: Extemporaneously compounded oral suspensions of TMP and SMX (8 and 40 mg/mL, respectively) prepared from bulk powder in Oral Mix and Oral Mix SF vehicles and stored in amber plastic bottles or syringes at 5°C or 25°C remained stable for at least 90 days. Suspensions made from tablets produced unacceptable formulations.

CONTEXTE: Le triméthoprime (TMP) et le sulfaméthoxazole (SMX) sont largement utilisés conjointement pour traiter ou prévenir diverses infections. Malheureusement, aucune formulation liquide orale n'est actuellement disponible au Canada pour les patients incapables d'avaler des comprimés. OBJECTIF: Évaluer la stabilité des suspensions de TMP et de SMX (respectivement 8 et 40 mg/mL) préparées dans un véhicule Oral Mix ou Oral Mix SF (Medisca Pharmaceutique Inc.) et stockées pendant 90 jours dans des flacons ou des seringues en plastique ambré à 5 °C ou 25 °C. MÉTHODES: Les suspensions ont été préparées à partir de poudre en vrac et de comprimés dans les véhicules Oral Mix et Oral Mix SF, puis transférées dans des flacons en plastique ambré (polyéthylène téréphtalate glycol) et dans des seringues orales en plastique et stockées à 5 °C et 25 °C. Des échantillons ont été recueillis à des jours prédéterminés (0, 7, 14, 23, 45, 60, 75 et 90 jours) et analysés à l'aide d'une méthode de détection par ultraviolet validée de chromatographie en phase liquide à haute performance. La suspension était jugée stable si elle préservait au moins 90 % de sa concentration initiale avec un seuil de confiance de 95 %. Les observations des caractéristiques organoleptiques, comme la couleur et l'odeur, ainsi que le pH, ont été faites pour évaluer la stabilité physique. RÉSULTATS: Les suspensions préparées à partir de poudre en vrac préservaient au moins 97 % de la concentration initiale de TMP et de SMX pendant la période d'étude de 90 jours. Aucun changement manifeste de couleur, d'odeur ou de pH n'a été observé. Cependant, les suspensions acceptables n'ont pas pu être préparées à partir des comprimés commerciaux. Une mousse homogène se formait à la surface de ces suspensions, ce qui pourrait entraîner un dosage incohérent. CONCLUSIONS: Les suspensions orales composées extemporanées de TMP et SMX (respectivement 8 et 40 mg/mL) préparées à partir de poudre en vrac dans des véhicules Oral Mix et Oral Mix SF et stockées dans des flacons ou des seringues en plastique ambré à 5 °C ou 25°C sont restées stables pendant au moins 90 jours. Les suspensions préparées à partir de comprimés ont donné des formulations inacceptables.

Compatibility of Lactated Ringer's Injection With 94 Selected Intravenous Drugs During Simulated Y-site Administration.

Objective: To test the compatibility of intravenous (IV) lactated Ringer's injection (LR) with 94 injectable (IV) drugs during simulated Y-site administration. Methods: Ninety-four IV drugs were investigated for compatibility with LR (Baxter). Each sample was prepared in duplicate and performed at room temperature. Two observers performed visual evaluation independently immediately upon mixing and then 15 minutes, 1 hour, 2 hours, 3 hours, and 4 hours after admixture. Another observer performed a particle counting test on 1 of the 2 duplicates of each admixture that did not immediately show incompatibility and then after 4 hours by a light obscuration particle count test. Results: Of the 94 tested drugs, 86 were found to be compatible with LR. A total of 8 drugs were found to be physically incompatible. Of these incompatible drugs, 7 were directly identified visually and 1 was confirmed by the light obscuration particle count test. Conclusion: Lactated Ringer's injection was physically compatible for 4 hours with 86 tested drugs during simulated Y-site administration. Eight drugs, ciprofloxacin, cyclosporine, diazepam, ketamine, lorazepam, nitroglycerin, phenytoin, and propofol, were found to be incompatible and should not be administered with LR.

Compatibility of Y-Site Injection of Meropenem Trihydrate With 101 Other Injectable Drugs.

Objective: The objective of the study was to establish the compatibility of injectable meropenem with 101 other drugs during Y-site administration. Methods: Meropenem (50 mg/mL, 10 mL) was combined with 101 undiluted injectable drugs (10 mL each) at room temperature. Each preparation was performed twice. The first sample underwent a visual evaluation and a particle count test by light obstruction immediately after mixing. These tests were repeated 4 hours after mixing using the second preparation. Incompatibility was defined as precipitation or other visual change (turbidity, crystal formation, gas formation, color change) or failure to meet United States Pharmacopeia (USP) <788> 1.B specifications at any time point. Results: A total of 83 of the 101 injectable drugs tested with meropenem were found to be compatible both visually and using the USP <788> particle counter. The gross incompatibility of the other 17 drugs was determined by visual observation. One mixture complied with the specifications, but showed an increase of temperature upon mixing and was removed from the study. Conclusion: Of the 101 drugs tested, 83 were found to be compatible while the remaining 17 were incompatible. One drug was removed from the study as its compatibility was unclear.

Stability of Methadone Hydrochloride for Injection in Saline Solution.

BACKGROUND: Until October 2014, methadone hydrochloride for injection (10 mg/mL) was available in Canada through Health Canada's Special Access Programme. Diluted to 5 mg/mL in saline, it was used in pediatrics for acute and cancer-related pain. More recently, the department of pharmacy of the Centre hospitalier universitaire Sainte-Justine in Montréal, Quebec, proposed compounding a solution of methadone hydrochloride for injection (5 mg/mL) from bulk powder and saline solution for pediatric administration. OBJECTIVE: To assess the stability of the proposed compounded preparation. METHODS: Solutions of methadone hydrochloride in saline were prepared from bulk powder and stored in clear glass vials for up to 180 days at room temperature (25 °C) or with refrigeration (5 °C), with testing on days 0, 7, 14, 30, 60, 90, and 180. The appearance of the solutions and presence of particulate matter were assessed. A stability-indicating high-performance liquid chromatography (HPLC) method was developed to assay the concentration of methadone over time. RESULTS: No notable changes in appearance of the methadone solution were observed, particle counts did not exceed limits specified by the United States Pharmacopeia, and no microbial growth was observed. The HPLC analysis showed that the concentration of methadone remained above 90% on all study days. CONCLUSIONS: Methadone hydrochloride for injection prepared from bulk powder in saline solution at a concentration of 5 mg/mL remained chemically stable for at least 180 days when stored in clear glass vials at 5 °C and at 25 °C.

CONTEXTE: Jusqu'en octobre 2014, le chlorhydrate de méthadone pour injection (10 mg/mL) était disponible au Canada à l'aide du Programme d'accès spécial de Santé Canada. Dilué à 5 mg/mL dans une solution saline, il était utilisé en pédiatrie contre les douleurs aigües et celles liées au cancer. Plus récemment, le département de pharmacie du Centre hospitalier universitaire Sainte-Justine de Montréal au Québec a proposé de préparer une solution de chlorhydrate de méthadone pour injection (5 mg/mL) à partir d'une poudre en vrac et d'une solution saline en vue de l'administrer en pédiatrie. OBJECTIF: Évaluer la stabilité de la préparation proposée. MÉTHODES: Les préparations de chlorhydrate de méthadone diluées dans une solution saline se font à partir d'une poudre en vrac, elles sont stockées dans des fioles en verre transparent pendant180 jours à la température ambiante (25 °C) ou réfrigérées (5 °C) et sont soumises à des tests les jours 0, 7, 14, 30, 60, 90 et 180. L'apparence des solutions et la présence de substances particulaires ont fait l'objet d'une évaluation. Une méthode de chromatographie liquide à haute performance (CLHP) indiquant la stabilité a été développée pour tester la concentration de méthadone dans le temps. RÉSULTATS: Aucun changement notable de l'apparence de la solution de méthadone n'a été observé, le nombre de particules ne dépassait pas les limites précisées par l'United States Pharmacopeia et aucune croissance microbienne n'a été observée. L'analyse CLHP a indiqué que la concentration de méthadone était demeurée au-delà de 90% durant toute la durée de l'étude. CONCLUSIONS: Le chlorhydrate de méthadone pour injection préparé à partir de poudre en vrac dans une solution saline à une concentration de 5 mg/mL est resté chimiquement stable pendant au moins 180 jours lorsqu'il était stocké dans des fioles en verre transparent à 5 °C et à 25 °C.

Compatibility of Cloxacillin Sodium with Selected Intravenous Drugs During Simulated Y-Site Administration.

BACKGROUND: Data regarding Y-site compatibility of intravenous (IV) cloxacillin sodium with other drugs are scarce and incomplete. OBJECTIVE: To establish the compatibility of IV cloxacillin with 89 injectable drugs during simulated Y-site administration. METHODS: Cloxacillin sodium (10 mL, 100 mg/mL) was combined with 89 undiluted IV drugs (10 mL, each). Tests were duplicated and performed at room temperature. Visual evaluation and a light obscuration particle count test were performed on 1 of the 2 solutions immediately after mixing. The second mixture underwent visual evaluation after 15 minutes, 1 hour, and 4 hours, followed by a particle count test at 4 hours. Drugs were considered incompatible if the mixture precipitated or became turbid within the 4-hour period or exceeded the particle count limit allowed by Test 1.B of USP <788> initially or at 4 hours. RESULTS: Of the 89 tested drugs, 64 were compatible for up to 4 hours. The remaining 25 drugs were incompatible. Of these incompatible drugs, 16 were identified visually, and 9 were identified by the light obscuration particle count test. CONCLUSIONS: Sixty-four IV drugs were found to be compatible with cloxacillin via simulated Y-site, whereas 25 drugs were found to be incompatible with the antibiotic. The light obscuration particle count test should be used to complement visual evaluation when samples do not precipitate immediately.

Stability of betaine capsules.

Betaine is used to treat homocystinuria and is not available in Canada as a formulated drug. In order to facilitate the administration of this compound to patients, a capsule formulation and an evaluation of its stability were required. Capsule formulations of betaine were developed (160 mg and 625 mg of betaine per capsule). As betaine has no chromophore, an HPLC-ELSD analytical method was also developed. The critical quality attributes of these formulations were evaluated (content assay, content uniformity, and dissolution) as well as their stability. Capsules with acceptable quality attributes were produced. These capsules remained stable for 1 year when stored in airtight containers at controlled room temperature. However, shelf life decreased dramatically in nonairtight containers at 30°C (3 months for the lactose-containing capsules of 160 mg and 6 months for the capsules of 625 mg).

Quality evaluation of extemporaneous delayed-release liquid formulations of lansoprazole.

PURPOSE: The quality attributes of extemporaneous delayed-release liquid formulations of lansoprazole for oral administration were evaluated. METHODS: A novel liquid formulation (3 mg/mL) of Prevacid FasTab in an Ora-Blend vehicle was prepared and compared with the Prevacid FasTab 30 mg and Prevacid-sodium bicarbonate 1 M formulation (3 mg/mL). The latter formulation was combined with hydrochloric acid 0.1 N, and the remaining lansoprazole content was assayed by high-performance liquid chromatography (HPLC). A batch of delayed-release liquid formulation was prepared to evaluate content uniformity. For content assay, three samples were prepared for each evaluated condition and each sample was analyzed in triplicate by HPLC. RESULTS: The lansoprazole in the sodium bicarbonate formulation was extensively degraded by quantities of hydrochloric acid 0.1 N in excess of 100 mL. Storage time and temperature had a significant effect on lansoprazole stability in the Ora-Blend formulation. The drug remained stable for seven days when the formulation was stored at 4.5-5.5 °C, but storage at 21-22 °C or the reduction of pH with citric acid accelerated lansoprazole degradation. The amount of lansoprazole released from the Ora-Blend formulation during the buffer stage of the dissolution test decreased with increases in formulation storage time, in formulation storage temperature, and in the amount of lansoprazole released and degraded during the acid stage of the test. CONCLUSION: An extemporaneous formulation consisting of lansoprazole microgranules in Ora-Blend maintained acceptable quality attributes when stored for three days at 4.5-5.5 °C.

Stability of cyclosporine solutions stored in polypropylene-polyolefin bags and polypropylene syringes.

PURPOSE: The stability of cyclosporine diluted to 0.2 or 2.5 mg/mL with 0.9% sodium chloride injection or 5% dextrose injection and stored in polypropylene-polyolefin containers or polypropylene syringes was evaluated. METHODS: Intravenous cyclosporine solutions (0.2 and 2.5 mg/mL) were aseptically prepared and transferred to 250-mL polypropylene-polyolefin bags or 60-mL polypropylene syringes. Chemical stability was measured using a stability-indicating high-performance liquid chromatography (HPLC) assay. Physical stability was assessed by visual inspection and a dynamic light scattering (DLS) method. RESULTS: After 14 days, HPLC assay showed that the samples of i.v. cyclosporine stored in polypropylene-polyolefin bags remained chemically stable (>98% of initial amount remaining); the physical stability of the samples was confirmed by DLS and visual inspection. The samples stored in polypropylene syringes were found to contain an impurity (attributed to leaching of a syringe component by the solution) that could be detected by HPLC after 1 day; on further investigation, no leaching was detected when the syringes were exposed to undiluted i.v. cyclosporine 50 mg/mL for 10 minutes. CONCLUSION: Samples of i.v. cyclosporine solutions of 0.2 and 2.5 mg/mL diluted in 0.9% sodium chloride injection or 5% dextrose injection and stored at 25 °C in polypropylene-polyolefin bags were physically and chemically stable for at least 14 days. When stored in polypropylene syringes, the samples were contaminated by an impurity within 1 day; however, the short-term (i.e., ≤10 minutes) use of the syringes for the preparation and transfer of i.v. cyclosporine solution is considered safe.

Room temperature stability of injectable succinylcholine dichloride.

The purpose of this study was to determine the room temperature stability over a period of several months of commercially available intravenous succinylcholine dichloride (Quelicin, 20 mg/mL) in vials. A previously validated electro-spray tandem mass spectrometry method developed for the determination of succinylcholine dichloride in plasma was used. This method was based upon a stable isotope dilution assay using hexadeuterosuccinylcholine diiodide as the internal standard and was shown to be specific, sensitive, and reproducible. Calibration curves were plots of the ratios of intensities of the major product ions in the collision-induced dissociation spectrum for known concentration ratios of succinylcholine dichloride and hexadeuterosuccinylcholine diiodide in solutions. The concentration of succinylcholine dichloride was shown to decline linearly. After 1, 3, and 6 months at room temperature, the vial contents retained approximately 98%, 95%, and 90% of their inital concentration, respectively. We suggest, therefore, that succinylcholine dichloride can be stored safely at room temperature under normal daylight for 6 months.

Stability and subjective taste acceptability of four glycopyrrolate solutions for oral administration.

The oral tablet form of glycopryrrolate has been discontinued in Canada because of declining use. Alternatives include injectable glycopyrrolate, which is still on the market, and an oral solution compounded from the injectable form. The stabilities of different oral solutions of gycopyrrolate formulated from the injectable form were studied by using a high-performance liquid chromatographic technique. The 0.2 mg/mL injectable solution of glycopyrrolate was diluted 1:1 with water, simple syrup, a Hospital for Sick Children vehicle, or Ora-Plus/Ora-Sweet vehicle. After 35 days of storage, more than 90% of the original concentration of glycopyrrolate was still present in all solutions, regardless of whether the solution was kept at room temperature or refrigerated. A simple taste test indicated that Ora-Plus/Ora-Sweet solution and simple syrup were better choices as vehicles for the glycopyrrolate oral dosage form.