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1.
Drug Des Devel Ther ; 15: 2519-2527, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34163138

RESUMO

PURPOSE: The stability of aprepitant injectable emulsion is evaluated in various admixture bags and solutions, under different storage conditions, and when combined with other antiemetics. METHODS: A volume of 18 mL aprepitant injectable emulsion was added to infusion bags (either non-di-(2-ethylhexyl) phthalate [DEHP], polyvinyl chloride [PVC]-containing bags or non-DEHP, non-PVC bags) containing 100, 130, or 250 mL of 0.9% normal saline solution (NSS) or 5% dextrose in water (D5W). Bags were stored at controlled room temperature (20-25°C) for up to 12 hours or refrigerated (2-8°C) for up to 72 hours. Compatibility/stability was also assessed in admixtures combined with either dexamethasone or palonosetron. At specified time points, bags were tested for appearance, pH, assay for aprepitant (ie, percent label claim of aprepitant) and aprepitant-related substances, Z-average particle size, globule size distribution, particulate matter, and DEHP content (PVC bags). In separate analyses to assess microbial burden, bags containing aprepitant were inoculated with seven different organisms and assessed for microbial growth. RESULTS: There was no detectable impact on the physicochemical properties or potential to promote microbial growth of aprepitant when diluted with various amounts of either NSS or D5W and when admixed with either dexamethasone or palonosetron at room temperature for at least 6 hours or during refrigeration for up to 72 hours in either PVC- or non-PVC-containing bags. CONCLUSION: Aprepitant-containing admixtures are stable under these conditions, a finding that may improve patient and provider convenience and reduce medication wastage.


Assuntos
Antieméticos/química , Aprepitanto/química , Dexametasona/química , Palonossetrom/química , Antieméticos/administração & dosagem , Aprepitanto/administração & dosagem , Dexametasona/administração & dosagem , Dietilexilftalato/química , Combinação de Medicamentos , Incompatibilidade de Medicamentos , Embalagem de Medicamentos , Estabilidade de Medicamentos , Armazenamento de Medicamentos , Emulsões , Concentração de Íons de Hidrogênio , Palonossetrom/administração & dosagem , Cloreto de Polivinila/química , Refrigeração , Temperatura , Fatores de Tempo
2.
Farm Hosp ; 45(3): 135-141, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33941057

RESUMO

OBJECTIVE: To describe and organize the current information available on  binary, ternary and/or quaternary mixtures used in opioid-free anesthesia (OFA), as well as their physicochemical stability, in order to  facilitate its correct administration, optimize its use, and prevent potential  effectiveness and safety issues. METHOD: A systematic review of the literature on OFA was conducted in  PubMed/Medline, Trissel, Micromedex, Lexicomp,  ww.ahfsdruginformation.com, ASHP's Extended Stability for Parenteral Drugs, and www.stabilis.org. Only articles published in English or Spanish until May 2020 and with  access to full text were considered. MeSH terms used included: "drug  incompatibility" AND "opioid-free anesthesia" AND "administration, intravenous" AND "dexmedetomidine" AND "lidocaine"  AND "ketamine" AND "magnesium sulphate" OR "infusions, intravenous. A  first search was carried out in PubMed/Medline that included OFA clinical cases. The results obtained were collected in a database. A second search  was carried out on the incompatibilities of intravenous mixtures.  Information was compiled on mutually-compatible/incompatible drugs,  reference concentrations, stability time at room temperature (23 ± 2 °C)  and under refrigeration (4 ± 2 ºC), type of administration recommended,  and relevant results and conclusions. Two two-dimensional tables on the  compatibility of each drug combination were created for administration as  Y-site infusion or as a mixture in a single solution. RESULTS: Seven hundred and eighty articles were identified, with the full  text of 203 being accessed. A total of 4,762 cases treated with OFA  protocols were chronologically collected from 32 different publications. Administration of two concomitant drugs was the most usual  regimen (42.4%). The most frequently drugs were dexmedetomidine (25  studies), ketamine hydrochloride (25 studies) and lidocaine (14 studies).  Compatibility/incompatibility data was collected for 11 drugs, associated to  7 pharmacological groups; compatibility with Y-site administration was  found in 43 of 55 combinations (78.18%) and with integration into one  single solution in 13 of 55 drug combinations (23.63%). None of the  sources reviewed reported any adverse results related to potential  pharmacological incompatibilities. CONCLUSIONS: Despite the availability of multiple OFA protocols, few studies analyze the compatibility between binary drug mixtures. No  information exists as yet regarding compatibilities in the context of ternary and quaternary mixtures.  Despite the availability of multiple OFA  protocols, few studies analyze the compatibility between binary drug  mixtures. No information exists as yet regarding compatibilities in the  context of ternary and quaternary mixtures.


Objetivo: Describir y estructurar la información actual disponible sobre mezclas binarias, ternarias y/o cuaternarias empleadas en una  "anestesia libre de opiáceos", así como su estabilidad fisicoquímica, para  facilitar su correcta administración, optimizar su uso y prevenir posibles  problemas de efectividad o seguridad.Método: Revisión sistemática de la literatura sobre anestesia libre de opiáceos en PubMed/Medline, Trissel, Micromedex, Lexicomp, AHFS  Drug Information, Extended Stability for Parenteral Drugs y Stabilis Web.  Artículos publicados en inglés o español hasta mayo de 2020 y con acceso  a texto completo. Se emplearon los términos MeSH: "Drug Incompatibility" AND "Opioid Free Anesthesia" AND "Administration,  Intravenous" AND "Dexmedetomidine" AND "Lidocaine" AND "Ketamine"  AND "Sulphate Magnesium" OR "Infusions, Intravenous". Se realizó una  primera búsqueda en PubMed/Medline incluyendo casos clínicos de  anestesia general tipo anestesia libre de opiáceos. Los resultados  obtenidos se estructuraron en una base de datos. La segunda búsqueda  fue sobre incompatibilidades de las mezclas intravenosas. Se recogieron  medicamentos compatibles/ incompatibles; concentraciones de referencia; tiempo de estabilidad a temperatura ambiente (23 ± 2 °C) y en  refrigeración (4 ± 2 °C); tipo de administración recomendada y resultados  y conclusiones relevantes. Se crearon phardos tablas bidimensionales de la compatibilidad de cada combinación de fármacos para la administración en Y o en mezcla en una sola solución.Resultados: Se identificaron 780 artículos; se accedió al texto completo de 203. Se recogieron de forma cronológica los 4.762 casos  tratados en 32 diferentes publicaciones con protocolos de anestesia libre de opiáceos. El uso de dos fármacos fue la asociación más frecuente (42,4%). Los fármacos más empleados fueron dexmedetomidina (25 trabajos), clorhidrato de ketamina (25 trabajos) y lidocaína (14  trabajos). Se recopiló información de compatibilidad/incompatibilidad de  11 medicamentos, asociados a 7 grupos farmacológicos, encontrándose  compatibilidad en Y en 43 de 55 combinaciones (78,18%) y en mezcla en  una sola solución en 13 de 55 combinaciones de fármacos (23,63%). En  ningún trabajo publicado se expone algún tipo de evento adverso en  relación con una posible incompatibilidad farmacológica.Conclusiones: Existen múltiples protocolos de anestesia libre de  piáceos, pero los estudios de compatibilidad entre las diferentes mezclas  de fármacos empleadas son muy limitados cuando se trata de mezclas  binarias, y no existe información en el caso de mezclas ternarias y  cuaternarias.


Assuntos
Anestesia , Preparações Farmacêuticas , Analgésicos Opioides , Combinação de Medicamentos , Incompatibilidade de Medicamentos , Humanos
3.
Am J Vet Res ; 82(5): 358-366, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33904804

RESUMO

OBJECTIVE: To evaluate physical compatibility of small animal (SAE) and large animal (LAE) injectable formulations of enrofloxacin with select IV fluids and drugs. SAMPLE: 162 admixtures containing SAE or LAE with saline (0.9% NaCl) solution, lactated Ringer solution (LRS), Plasma-Lyte A (PLA), 6% hydroxyethylstarch 130/0.4 (HES), metoclopramide, or ampicillin-sulbactam. PROCEDURES: In the first of 2 simultaneously conducted experiments, admixtures containing enrofloxacin (10 mg/kg) and a volume of IV fluid that would be administered over a 20-minute period when dosed at the maintenance infusion rate (40 mL/kg/d for saline solution, LRS, and PLA and 20 mL/kg/d for HES) were created. In the second experiment, enrofloxacin (10 mg/kg) was admixed with saline solution (40 mL/kg/d) and metoclopramide (2 mg/kg/d) or ampicillin-sulbactam (30 mg/kg). In both experiments, admixture components were infused into a flask over 20 minutes assuming patient weights of 5, 10, and 20 kg. Admixtures were created by use of undiluted SAE and SAE diluted 1:1 with saline solution and undiluted LAE and LAE diluted 1:1 and 1:10 with saline solution. Admixtures were assessed for physical incompatibility at 0, 15, 30, and 60 minutes after completion of mixing. Physical incompatibility was defined as gross precipitation, cloudiness, Tyndall effect, or change in turbidity. RESULTS: Admixtures containing undiluted SAE or LAE were physically incompatible with saline solution, PLA, LRS, and HES. Because saline solution was used to dilute SAE and LAE, all admixtures containing diluted SAE or LAE were also physically incompatible. Physical compatibility of enrofloxacin with metoclopramide or ampicillin-sulbactam could not be assessed because those admixtures also contained saline solution. CONCLUSIONS AND CLINICAL RELEVANCE: Enrofloxacin was physically incompatible with all tested solutions.


Assuntos
Preparações Farmacêuticas , Animais , Antibacterianos , Incompatibilidade de Medicamentos , Enrofloxacina , Infusões Intravenosas/veterinária
4.
Enferm. glob ; 20(62): 65-108, abr. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-202228

RESUMO

OBJETIVO: Evaluar las incompatibilidades de los medicamentos intravenosos en pacientes cardíacos ingresados en una unidad cardiointensiva, asociando posibles incompatibilidades con la gravedad y las características del evento adverso. MÉTODO: Estudio transversal, observacional y cuantitativo. Realizado en una Unidad Cardiointensiva de un Hospital Universitario en la ciudad de Rio de Janeiro. La recopilación de datos se realizó de marzo a junio de 2018. Para identificar y clasificar las incompatibilidades de medicamentos se utilizó Micromedex(R). RESULTADOS: Se analizaron 111 recetas, con un total de 1,497 medicamentos recetados, el número promedio de medicamentos recetados fue 13,49 (6 ± 24), 580 (38.74%) por vía intravenosa, de los cuales el 41.38% se administraron simultáneamente con otro medicamento. El estudio mostró 121 incompatibilidades y las clases de drogas que tuvieron el mayor número de incompatibilidades fueron diuréticos, hipnóticos y sedantes, estimulantes cardiovasculares (aminas vasoactivas), antibióticos para uso sistémico, corticosteroides para uso sistémico, vasodilatadores cardiovasculares y agentes antiarrítmicos. Destacando las incompatibilidades clasificadas como moderadas, furosemida con hidrocortisona y midazolam con omeprazol y fentanilo severo con amiodarona. CONCLUSIÓN: El estudio destaca la importancia de la programación y administración de medicamentos por parte del equipo de enfermería con base en el conocimiento farmacológico. Se espera que el cuadro de recomendaciones preparado en el estudio, con atención de enfermería relacionada con incompatibilidades con mayor potencial de gravedad y sus eventos, pueda contribuir a la seguridad de los medicamentos


OBJECTIVE: To evaluate the incompatibilities of intravenous medications in cardiac patients admitted to a cardiac intensive unit, associating possible incompatibilities with the severity and characteristics of the adverse event. METHOD: Cross-sectional, observational, and quantitative study, held in a Cardiac intensive Unit of a University Hospital in the city of Rio de Janeiro. Data collection took place from March to June 2018. Micromedex(R) identified and classified drug incompatibilities. RESULTS: We analyzed 111 prescriptions with a total of 1,497 prescription drugs, the average number of prescription drugs was 13.49 (6 ± 24), 580 (38.74%) intravenously in which 41.38% were administered simultaneously with another medicine. The study showed 121 incompatibilities and the drug classes that had the highest number of incompatibilities were diuretics, hypnotics and sedatives, cardiovascular stimulants (vasoactive amines), antibiotics for systemic use, corticosteroids for systemic use, cardiovascular vasodilators, and antiarrhythmic agents. We highlight the incompatibilities classified as moderate, furosemide with hydrocortisone, and midazolam with omeprazole, and severe fentanyl with amiodarone. CONCLUSION: The study highlights the importance of medication scheduling and administration by the nursing team based on pharmacological knowledge. We expect that the chart of recommendations prepared in the study with nursing care related to incompatibilities with greater potential for severity and its events can contribute to drug safety


OBJETIVO: Avaliar as incompatibilidades de medicações intravenosas em pacientes cardiopatas internados em uma unidade cardiointensiva, associando as possíveis incompatibilidades com a gravidade e característica do evento adverso. MÉTODO: Estudo transversal, observacional e quantitativo. Realizado em uma Unidade Cardiointensiva de um Hospital Universitário do município do Rio de Janeiro. A coleta de dados ocorreu de março a junho de 2018. Para a identificação e classificação das incompatibilidades medicamentosas, foi utilizado o Micromedex(R). RESULTADOS: Foram analisadas 111 prescrições, com um total de 1.497 medicamentos prescritos, a média de medicamentos por prescrição foi 13,49 (6 ±24), sendo 580 (38,74%) por via intravenosa, destes, 41,38% foram administrados simultaneamente com outro medicamento. O estudo apresentou 121 incompatibilidades e as classes medicamentosas que apresentaram maior número de incompatibilidades foram diuréticos, hipnóticos e Sedativos, estimulantes cardiovasculares (aminas vasoativas), antibióticos de uso sistêmico, corticoides de uso sistêmico, vasodilatadores cardiovasculares e antiarrítmicos. Destacando-se as incompatibilidades classificadas como moderadas, a furosemida com hidrocortisona e o midazolam com omeprazol e grave o fentanil com amiodarona. CONCLUSÃO: O estudo destaca a importância do aprazamento e administração de medicamentos pela equipe de enfermagem com base em conhecimentos farmacológicos. Espera-se que o quadro de recomendações elaborado no estudo, com os cuidados de enfermagem relacionados as incompatibilidades com maior potencial de gravidade e seus eventos, possa contribuir para segurança medicamentosa


Assuntos
Humanos , Incompatibilidade de Medicamentos , Unidades de Cuidados Coronarianos/métodos , Injeções Intravenosas , Fármacos Cardiovasculares/administração & dosagem , Segurança do Paciente , Erros de Medicação/prevenção & controle , Estudos Transversais , Bases de Dados como Assunto/estatística & dados numéricos , Receitas Médicas de Controle Especial , Prescrições/estatística & dados numéricos , Fármacos Cardiovasculares/efeitos adversos , Infusões Intravenosas/efeitos adversos , Vias de Administração de Medicamentos , Medicamentos sob Prescrição/administração & dosagem
5.
J Nippon Med Sch ; 88(6): 533-539, 2021 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-33692301

RESUMO

BACKGROUND: Severe coronavirus disease 2019 (COVID-19) may require continuous administration of analgesics, sedatives, and muscle relaxants. Nafamostat has recently been reported as a therapeutic agent for COVID-19. However, there is a lack of information on the compatibility of nafamostat with the aforementioned drug classes. This study evaluated the physical compatibility of nafamostat with these drug classes. METHODS: Nafamostat was combined with 1-3 target drugs (fentanyl, morphine, midazolam, dexmedetomidine, and rocuronium). Fifteen physical compatibility tests were conducted. Nafamostat was dissolved in 5% glucose solution; the final concentration was 10 mg/mL. All other medications were diluted in 0.9% sodium chloride to obtain clinically relevant concentrations. The power of hydrogen (pH) of all medications was measured during each test. Compatibility tests were conducted with 4 test solutions in which nafamostat and the target drugs were compounded at equal volume ratios (1:1, 1:1:1, or 1:1:1:1). Visual appearance, turbidity, and pH were evaluated immediately after mixing and at 1 and 3 hours. Physical incompatibilities were defined as gross precipitation, cloudiness, appearance of the Tyndall effect, or a turbidity change of ≥0.5 nephelometric turbidity units (NTU) based on nafamostat. RESULTS: The mean pH of nafamostat was 3.13 ± 0.03. The combination of nafamostat, fentanyl, and dexmedetomidine had the highest pH (3.39 ± 0.01; 3 hours after mixing). All drugs were compatible with nafamostat until 3 hours after admixture, with a mean turbidity value of ≤0.03 NTU. CONCLUSIONS: Infusions combining nafamostat with the tested sedatives, analgesics, and muscle relaxants could be safely administered.


Assuntos
Analgésicos/uso terapêutico , Benzamidinas/uso terapêutico , COVID-19/tratamento farmacológico , Incompatibilidade de Medicamentos , Fentanila/uso terapêutico , Guanidinas/uso terapêutico , Relaxantes Musculares Centrais/uso terapêutico , Dexmedetomidina/uso terapêutico , Humanos , Hipnóticos e Sedativos , SARS-CoV-2 , Resultado do Tratamento
7.
Eur J Clin Pharmacol ; 77(9): 1309-1321, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33768303

RESUMO

PURPOSE: Drug protocols in intensive care units may require the concomitant administration of many drugs as patients' venous accesses are often limited. A major challenge for clinicians is to limit the risk of simultaneously infusing incompatible drugs. Incompatibilities can lead to the formation of particles and inactivation of drugs, whose consequences on the body have already been indicated. Our objective was to assess current strategies to counter the risk of incompatible infusions and control the resulting clinical consequences. METHODS: This review was independently conducted by three investigators in respect of the PRISMA statement. Three online databases were consulted. Full-text articles, notes, or letters written in English or French, published or in press between the 1990s and the end of February 2020, with clinical study design, were eligible. Parameters of interest were mainly number and size of particles, and a number of observed/avoided incompatibilities. RESULTS: All in all, 382 articles were screened, 17 meeting all the acceptance criteria. The strategies outlined and assessed were filtration, the use of multi-lumen devices, the purging of infusion lines, incompatibility tables and databases, and the use of standard operating procedures. CONCLUSION: Although many strategies have been developed in recent years to address drug incompatibility risks, clinical data is still lacking. All studies with in vitro design were excluded although some current innovative strategies, like niosomes, should be considered and studied by means of clinical data in the future.


Assuntos
Incompatibilidade de Medicamentos , Infusões Intravenosas/métodos , Unidades de Terapia Intensiva , Protocolos Clínicos , Filtração , Humanos , Infusões Intravenosas/instrumentação
9.
Int J Pharm Compd ; 25(1): 52-61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503010

RESUMO

The physical compatibility of cefiderocol for injection (prepared as a diluted 2% cefiderocol solution) with potential co-administration drug products is presented. The compatibility of cefiderocol with a selection of 91 intravenous drugs was tested at clinically relevant concentrations using the admixed volume ratio 1:1. Compatibility of the mixtures was determined by visual observations, turbidity, and particulate-matter measurements. The mixtures were examined immediately after mixing, and then at 1 hour and 4 hours thereafter at room temperature. When using 0.9% sodium chloride or 5% dextrose injection for diluents, solutions of dobutamine hydrochloride, esomeprazole sodium, methylprednisolone acetate, propofol, rocuronium bromide, amiodarone hydrochloride, famotidine, labetalol hydrochloride, mycophenolate mofetil, acyclovir sodium, amphotericin B, caspofungin acetate, doxycycline, posaconazole, diphenhydramine hydrochloride, and phenytoin sodium were found to cause visible cloudiness upon mixing with 2% cefiderocol in both diluents. Solutions of lorazepam, tobramycin sulfate, and vancomycin hydrochloride were determined incompatible by examining the mixtures with the aid of a Tyndall light. These 19 drugs were clearly incompatible with cefiderocol for injection by visual examination. In addition, solutions of iron sucrose and albumin were incompatible with 2% cefiderocol based on sub-visual tests for turbidity and/or particulate matter. Based on sub-visual data, the 0.9% sodium chloride admixture of aminophylline and 2% cefiderocol was incompatible, while inconclusive results were obtained for the 0.9% sodium chloride admixtures of 2% cefiderocol with amikacin sulfate. Similarly, the 5% dextrose admixtures of either ciprofloxacin or polymyxin B sulfate with 2% cefiderocol were incompatible, whereas data for phenylephrine hydrochloride morphine sulfate, or undiluted sodium bicarbonate were inconclusive. Overall, the 2% cefiderocol solution was physically compatible with 63 of 91 drugs challenged at 1:1 volume ratio in both 0.9% sodium chloride and 5% dextrose diluents for at least 4 hours at the concentrations tested in this study.


Assuntos
Cefalosporinas , Preparações Farmacêuticas , Incompatibilidade de Medicamentos , Estabilidade de Medicamentos , Injeções Intravenosas
10.
J Ethnopharmacol ; 273: 113839, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-33476713

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Eighteen Incompatible Medicaments (EIM) belongs to the category of incompatibility of Traditional Chinese medicine (TCM). This theory forbids concomitant using any one of the eighteen herbal pairs such as Radix Glycyrrhizae (RG)-Radix Euphorbiae Pekinensis (REP), Radix Aconiti-Bulbus Fritiliariae Cirrhosae, and Radix et Rhizoma Veratri Nigri-Radix Ginseng. Concomitant using RG and REP could result in more serious adverse effects on major organs such as kidney, heart, and liver. AIM OF THE STUDY: To investigate the effects of RG-REP decoctions on gut microbiota and short-chain fatty acids (SCFAs) for the purpose of elucidating the mechanism of RG-REP incompatibility. MATERIALS AND METHODS: Six groups of male SD rats were intragastrically administrated with distilled water, RG decoction, REP decoction, 1:1 RG-REP decoction, 2:1 RG-REP decoction and 3:1 RG-REP decoction, respectively, twice daily for 30 consecutive days, and the feces of each rat was separately sampled for gut microbiota analysis and SCFAs assay. 16S rDNA sequencing was employed to comparatively investigate the structure and abundance of intestinal bacteria in rat feces. Gas chromatography (GC) was used to quantitatively determine the contents of SCFAs in rat feces and in vitro samples. The correlation between bacteria and the production of SCFAs was analyzed by Spearman correlation analysis. An in vitro model of human intestinal bacteria was also constructed to simulate and validate the in vivo experiment. RESULTS: The contents of butyric acid in both rat feces and in vitro samples decreased in RG-REP groups. The general structure of gut microbiota in RG-REP groups was not significantly different from that in control group. However, RG alone increased the abundance of Lactobacillus while this effect was counteracted by concomitant using with REP. REP alone decreased the abundance of two interrelated species, Akkermansia and Butyricimonas, and this effect was strengthened by concomitant using REP with RG in the ratio of 1:1. In comparison with REP alone, RG-REP combination also significantly increased the abundance of Streptococcus and Prevotella. CONCLUSION: The incompatibility of RG-REP combination is associated with its negative effect against probiotic bacteria and positive effect on conditional pathogenic bacteria as well as its inhibition on butyric acid production.


Assuntos
Medicamentos de Ervas Chinesas/efeitos adversos , Medicamentos de Ervas Chinesas/farmacologia , Microbioma Gastrointestinal/efeitos dos fármacos , Glycyrrhiza/química , Adulto , Animais , Bactérias/efeitos dos fármacos , Incompatibilidade de Medicamentos , Medicamentos de Ervas Chinesas/uso terapêutico , Euphorbiaceae/química , Ácidos Graxos Voláteis/análise , Ácidos Graxos Voláteis/química , Fezes/química , Fezes/microbiologia , Feminino , Humanos , Masculino , Raízes de Plantas/química , Análise de Componente Principal , Ratos Sprague-Dawley , Adulto Jovem
11.
Ann Pharm Fr ; 79(1): 28-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32853574

RESUMO

OBJECTIVES: The aim of the current study was to compare the physicochemical and disintegrant properties of pearl millet starch with other starches using paracetamol as model drug. METHODOLOGY: Determination of percentage yield, Physicochemical, micrometrics characteristics of starch/granules, drug excipients compatibility studies and evaluation of prepared paracetamol tablets were measured using official techniques. RESULTS: The yield of the millet starch ranged from 30 to 40%. Moisture content 8.77%, pH 5.7, Swelling capacity 1.2, Hydration capacity 1.748, Moisture uptake 11.8%, Amylose 24.6%, with poor flowability and compressibility. No significant difference in hardness, friability% & disintegration times for formulations containing millet starch to that containing potato and maize starch (P>0.05). CONCLUSION: From the study, Millet seeds locally cultivated in Sudan gave a high yield of starch, has same physicochemical properties as maize and potato starch so can be used as an alternative to those starches.


Assuntos
Acetaminofen/química , Excipientes/análise , Milhetes/química , Sementes/química , Solanum tuberosum/química , Amido/análise , Zea mays/química , Acetaminofen/administração & dosagem , Química Farmacêutica , Composição de Medicamentos , Custos de Medicamentos , Incompatibilidade de Medicamentos , Excipientes/economia , Concentração de Íons de Hidrogênio , Pós , Solubilidade , Sudão , Comprimidos
12.
Eur J Pediatr ; 180(4): 1169-1176, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33128625

RESUMO

This study aimed to determine the physical compatibility of alprostadil with 17 continuous infusion drugs commonly administered in neonatal intensive care units. Test samples were prepared in a laminar airflow hood. Alprostadil 20 mcg/ml was mixed with each drug in a 1:1 ratio, in two orders of mixing. Physical stability of the admixtures was assessed by visual examination and by measuring turbidity. Visual examination was conducted by two observers by two methods: visual examination against a black and white background under normal fluorescent light and using a high-intensity monodirectional light. pH was measured as chemical stability predictor. Evaluations were performed immediately and 4 h after mixing. An additional visual control was performed at 24 h. Visual examination was positive or doubtful for the four drug combinations not considered compatible. Turbidity values were under 0.5 NTU throughout the study in all samples. No modifications of one pH unit or more was detected in any drug pair over time.Conclusion: Alprostadil was considered physical compatible with 13 drugs (adrenalin, amiodarone, calcium gluconate, dobutamine, dopamine, fentanyl, flecainide, furosemide, heparin, ketamine, midazolam, milrinone and morphine). Incompatibility could not be ruled out for 3 drugs (cisatracurium, dexmedetomidine and noradrenalin), and insulin was considered incompatible with alprostadil. What is Known: • Y-site administration is common in neonatal intensive care units, and volume of diluents and rate of infusions in newborns were lower than in adults which might result in high concentrations and prolonged contact time at Y-site administration. • Available data about compatibility of alprostadil with other drugs was scarce. What is New: • Alprostadil was compatible with 13 drugs commonly used in neonatal intensive care units. • Insulin was considered incompatible with alprostadil, and incompatibility cannot be ruled out for cisatracurium, dexmedetomidine and noradrenalin with alprostadil.


Assuntos
Preparações Farmacêuticas , Alprostadil , Incompatibilidade de Medicamentos , Humanos , Recém-Nascido , Infusões Intravenosas , Unidades de Terapia Intensiva Neonatal
13.
Drug Des Devel Ther ; 14: 4179-4187, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33116406

RESUMO

BACKGROUND AND OBJECTIVE: The combination of naloxone hydrochloride (NH) and fentanyl citrate (FC) in patient-controlled analgesia (PCA) is examined to reduce the risk of opioid-induced nausea and vomiting. However, there are no such commercially available drug mixtures, and there is also no published evidence on the compatibility and stability of NH and FC. Thus, the primary purpose of the current research is to investigate the physical compatibility and chemical stability of NH when mixed with FC over a 72-h period in a 0.9% sodium chloride injection solution for PCA administration under storage at 4°C and 25°C. METHODS: Test solutions of 20 µg/mL FC and 4 µg/mL NH were prepared and stored in polyvinyl chloride (PVC) bags or glass bottles with a 0.9% sodium chloride injection solution as the diluent. During the 72-h storage period at 4°C or 25°C without light protection, the concentrations of the test drugs were assayed via high-performance liquid chromatography (HPLC), and the physical compatibility was determined with the naked eye. Furthermore, pH measurement of each sample was also performed with a pH meter. RESULTS: The percentages of the initial concentrations of FC and NH in the various solutions were maintained at a minimum of 98% over the 72-h study period. All of the mixtures remained clear and colourless throughout the observation period, and no precipitation or turbidity was observed in any of the batches. CONCLUSION: The 20 µg/mL FC test solution was physically compatible and chemically stable with the 4 µg/mL NH test solution when stored at 4°C or 25°C in PVC bags or glass bottles containing the 0.9% sodium chloride injection solution.


Assuntos
Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/química , Fentanila/química , Naloxona/química , Antagonistas de Entorpecentes/química , Analgésicos Opioides/administração & dosagem , Cromatografia Líquida de Alta Pressão , Incompatibilidade de Medicamentos , Embalagem de Medicamentos , Estabilidade de Medicamentos , Fentanila/administração & dosagem , Injeções Intravenosas , Naloxona/administração & dosagem , Antagonistas de Entorpecentes/administração & dosagem , Padrões de Referência , Reprodutibilidade dos Testes , Solução Salina
15.
Am J Health Syst Pharm ; 77(23): 1980-1985, 2020 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-32974650

RESUMO

PURPOSE: To determine the physical intravenous Y-site compatibility of 19 commonly used medications at pediatric concentrations with 3 different types of lipid emulsion. METHODS: Medications at commonly used pediatric concentrations were mixed in a 1:1 ratio with lipid emulsions (Intralipid, Nutrilipid, and Smoflipid) and incubated at room temperature for 4 hours to simulate Y-site administration. Each sample was then diluted with particle-free water and analyzed using the analytical technique of light obscuration recommended in United States Pharmacopeia (USP) general information chapter 729 (USP <729>). Physical compatibility was determined by measuring the percentage of fat residing in globules larger than 5 µm (PFAT5) per USP <729> recommendations. RESULTS: Most combinations tested were physically compatible based on USP <729> regulations. Incompatibilities differed for the different brands of lipid emulsion. The two combinations that met USP <729> criteria for physical incompatibility were cisatracurium 2 mg/mL with Intralipid and gentamicin 2 mg/mL with Smoflipid. CONCLUSION: Three different lipid emulsions were physically compatible at the Y site with the majority of medications tested. Data regarding Y-site compatibility for one lipid emulsion product cannot be safely extrapolated to another without additional testing.


Assuntos
Emulsões Gordurosas Intravenosas/química , Preparações Farmacêuticas/química , Química Farmacêutica , Incompatibilidade de Medicamentos , Emulsões/química , Óleos de Peixe/química , Humanos , Azeite de Oliva/química , Pediatria , Fosfolipídeos/química , Óleo de Soja/química , Triglicerídeos/química
16.
BMC Med Inform Decis Mak ; 20(1): 206, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878609

RESUMO

BACKGROUND: Multi-drug intravenous (IV) therapy is one of the most common medical procedures used in intensive care units (ICUs), operating rooms, oncology wards and many other hospital departments worldwide. As drugs or their solvents are frequently chemically incompatible, many solutions must be administered through separate lumens. When the number of available lumens is too low to facilitate the safe administration of these solutions, additional (peripheral) IV catheters are often required, causing physical discomfort and increasing the risk for catheter related complications. Our objective was to develop and evaluate an algorithm designed to reduce the number of intravenous lumens required in multi-infusion settings by multiplexing the administration of various parenteral drugs and solutions. METHODS: A multiplex algorithm was developed that schedules the alternating IV administration of multiple incompatible IV solutions through a single lumen, taking compatibility-related, pharmacokinetic and pharmacodynamic constraints of the relevant drugs into account. The conventional scheduling procedure executed by ICU nurses was used for comparison. The number of lumens required by the conventional procedure (LCONV) and multiplex algorithm (LMX) were compared. RESULTS: We used data from 175,993 ICU drug combinations, with 2251 unique combinations received by 2715 consecutive ICU patients. The mean ± SD number of simultaneous IV solutions was 2.8 ± 1.6. In 27% of all drug combinations, and 61% of the unique combinations the multiplex algorithm required fewer lumens (p < 0.001). With increasing LCONV, the reduction in number of lumens by the multiplex algorithm further increased (p < 0.001). In only 1% of cases multiplexing required > 3 lm, versus 12% using the conventional procedure. CONCLUSION: The multiplex algorithm addresses a major issue that occurs in ICUs, operating rooms, oncology wards, and many other hospital departments where several incompatible drugs are infused through a restricted number of lumens. The multiplex algorithm allows for more efficient use of IV lumens compared to the conventional multi-infusion strategy.


Assuntos
Unidades de Terapia Intensiva , Preparações Farmacêuticas , Algoritmos , Incompatibilidade de Medicamentos , Quimioterapia Combinada , Humanos , Infusões Intravenosas , Veículos Farmacêuticos
17.
Drug Deliv ; 27(1): 1176-1187, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32762483

RESUMO

Icaritin (ICT) and hydrous icaritin (HICT) are two similar flavonoids compounds isolated from Epimedium Genus. This is the first comparative study on their in vitro and in vivo antitumor effects. Nanorods (NRs) were prepared for ICT and HICT by anti-solvent precipitation method using D-alpha tocopherol acid polyethylene glycol succinate (TPGS) as a stabilizer. The prepared ICT-NRs and HICT-NRs had similar diameter (155.5 nm and 201.7 nm), high drug loading content (43.30 ± 0.22% and 41.08 ± 0.19%), excellent stability and a similar sustaining drug release manner. Nanorods improved the in vitro toxicity against 4 different cancer cells in contrast to free ICT or free HICT; however, no significant difference was observed in this regard between ICT-NRs and HICT NRs. In the in vivo study on the anticancer efficacy on MCF-7 and PLC/PRE/5 tumor-bearing mice model, HICR-NRs displayed certain advantage over ICT NRs with higher tumor inhibition rate.


Assuntos
Antineoplásicos/administração & dosagem , Antineoplásicos/farmacologia , Flavonoides/administração & dosagem , Flavonoides/farmacologia , Nanotubos/química , Animais , Linhagem Celular Tumoral , Sobrevivência Celular , Química Farmacêutica , Sistemas de Liberação de Medicamentos , Incompatibilidade de Medicamentos , Feminino , Humanos , Camundongos , Camundongos Nus , Tamanho da Partícula , Polietilenoglicóis/química , Difração de Raios X , alfa-Tocoferol/química
18.
Drug Deliv ; 27(1): 1134-1146, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32729331

RESUMO

The application of nanotechnology to drug delivery systems for cancer therapy has progressively received great attention. The most heavily investigated approach is the development of nanoparticles (NPs) utilizing biodegradable and biocompatible polymers such as poly (lactic-co-glycolic acid) (PLGA). These NPs could be further improved by surface modification utilizing a hydrophilic biodegradable polymer such as polyethylene glycol (PEG) to achieve passive targeting. Modified NPs can deliver drugs such as brucine (BRU), which has shown its potential in cancer therapy. The objective of the current investigation was to develop and evaluate the passive targeting of long-circulating PLGA NPs loaded with BRU. NPs were characterized in terms of drug-excipient compatibility studies, including FTIR and DSC; physicochemical evaluations including particle size, zeta potential, morphological evaluation, entrapment efficiency and percentage yield; total serum protein adsorbed onto NP surfaces; and in vitro release of the loaded drug. Factorial design was employed to attain optimal PLGA-loaded NPs. Finally, the in vivo anti-tumor activity of BRU-loaded PLGA NPs was evaluated in tumor-bearing mice. The NPs obtained had smooth surfaces with particle sizes ranged from 94 ± 3.05 to 253 ± 8.7 nm with slightly positive surface charge ranged from 1.09 ± 0.15 to 3.71 ± 0.44 mV. Entrapment of BRU ranged between 37.5 ± 1.8% and 77 ± 1.3% with yields not less than 70.8%. Total protein adsorbed was less than 25.5 µg total protein/1 mg NP. In vitro drug release was less than 99.1% at 168 h. Finally, significant reductions in tumor growth rate and mortality rate were observed for PEG PLGA NP formulations compared to both BRU solution and naked NPs.


Assuntos
Adjuvantes Imunológicos/administração & dosagem , Nanopartículas/química , Polietilenoglicóis/química , Copolímero de Ácido Poliláctico e Ácido Poliglicólico/química , Estricnina/análogos & derivados , Adjuvantes Imunológicos/farmacologia , Animais , Linhagem Celular Tumoral , Química Farmacêutica , Sistemas de Liberação de Medicamentos , Incompatibilidade de Medicamentos , Liberação Controlada de Fármacos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Neoplasias/tratamento farmacológico , Tamanho da Partícula , Estricnina/administração & dosagem , Estricnina/farmacologia , Propriedades de Superfície
19.
Clin Ther ; 42(8): 1580-1586.e2, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32684326

RESUMO

PURPOSE: The objective of this communication was to determine the intravenous compatibility of ceftazidime/avibactam and aztreonam using simulated and actual Y-site administration. METHODS: Ceftazidime-avibactam was reconstituted and diluted to concentrations of 8, 25, and 50 mg/mL in 0.9% sodium chloride. Aztreonam was reconstituted and diluted to concentrations of 10 and 20 mg/mL. Each combination of concentrations was tested for compatibility using visual, Tyndall beam, microscopy, turbidity, and pH assessments. Microscopy results were compared to those from sodium chloride 0.9% in water, pH was compared to that at time 0, and turbidity of combinations was compared to that of individual agents. Actual Y-site mixing was conducted over 2-h infusions with samples collected at 0, 1, and 2 h. Test results were evaluated at 0, 1, 2, 4, 8, and 12 h after mixing. All experiments were completed in triplicate. FINDINGS: Across simulated and actual Y-site experiments, no evidence of incompatibility between combinations of ceftazidime-avibactam + aztreonam was observed. Visual and microscopic tests revealed no particulate matter, color changes, or turbidity. Tyndall beam tests were negative with all combinations. No evidence of incompatibility was observed in turbidity testing. The pH values were consistent across each of the 6 combinations, from immediately after mixing until 12 h after mixing. When the addition of agents was reversed in simulated Y-site experiments, no differences in compatibility were observed. No differences in compatibility between actual and simulated Y-site administration were observed, and there was minimal variability across all replicate experiments. IMPLICATIONS: Ceftazidime-avibactam, at concentrations of 8, 25, and 50 mg/mL, appeared compatible with aztreonam at concentrations of 10 and 20 mg/mL.


Assuntos
Antibacterianos/química , Compostos Azabicíclicos/química , Aztreonam/química , Ceftazidima/química , Antibacterianos/administração & dosagem , Compostos Azabicíclicos/administração & dosagem , Aztreonam/administração & dosagem , Ceftazidima/administração & dosagem , Simulação por Computador , Combinação de Medicamentos , Incompatibilidade de Medicamentos , Infusões Intravenosas
20.
BMC Microbiol ; 20(1): 155, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527225

RESUMO

BACKGROUND: Quaternary ammonium compound based disinfectants are commonly used in pig and poultry husbandry to maintain farm hygiene. However, studies have shown that subinhibitory concentrations of these disinfectants may increase antibiotic resistance. Investigation of antibiotic susceptibility is usually assessed via the microbroth dilution method, although this conventional culture-based technique only provides information on the bacteriostatic activity of an antimicrobial agent. Therefore, experiments were performed to investigate the effect of prior benzalkonium chloride (BKC) exposure on the viability of subsequent ciprofloxacin (CIP) treated Escherichia coli. RESULTS: Following CIP treatment, bacterial cell counts were significantly higher after exposure to a subinhibitory BKC concentration than without BKC exposure. The flow cytometric results suggested a BKC-dependent onset of membrane damage and loss of membrane potential. CONCLUSION: Our results indicate a lower bactericidal effect of CIP treatment on BKC-exposed E. coli isolates compared to unexposed E. coli isolates.


Assuntos
Compostos de Benzalcônio/efeitos adversos , Ciprofloxacina/farmacologia , Desinfetantes/efeitos adversos , Escherichia coli/crescimento & desenvolvimento , Criação de Animais Domésticos , Animais , Carga Bacteriana/efeitos dos fármacos , Relação Dose-Resposta a Droga , Incompatibilidade de Medicamentos , Farmacorresistência Bacteriana , Escherichia coli/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Viabilidade Microbiana/efeitos dos fármacos , Compostos de Amônio Quaternário/efeitos adversos , Suínos
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