Stability of cyclosporine in dextrose 5%, NaCl 0.9%, dextrose/amino acid solution, and lipid emulsion.
OBJECTIVE
Because of limited intravenous access in patients who have undergone bone marrow transplant (BMT), we undertook a study to determine the safety of mixing cyclosporine in intravenous preparations commonly administered to BMT patients.


METHODS
In a pilot study, we investigated the stability of intravenous cyclosporine (Sandimmune) in four types of intravenous fluids: dextrose 5%, NaCl 0.9%, dextrose/amino acid solutions, and lipid emulsion. Because the pilot study showed highly variable cyclosporine concentrations that suggested inadequate mixing, we undertook another study to determine the effect of the mixing method on cyclosporine concentrations.


METHODS
Cyclosporine was considered stable in the study solutions if concentrations remained above 90 percent of the initial concentrations.


RESULTS
Substantial variation in cyclosporine concentrations was observed in lipid emulsion and dextrose/amino acid solutions and gentle swirling of the solutions was insufficient to adequately disperse the drug. The variation was eliminated by vigorous shaking either before each sampling or once after the initial addition of cyclosporine. We used vigorous shaking methods to establish that cyclosporine is stable for up to 72 hours at room temperature in dextrose 5%, 10% amino acid solution with dextrose 50%, and Liposyn 10%, and up to 8 hours in NaCl 0.9%.


CONCLUSIONS
These data may be used to simplify cyclosporine administration in patients who have limited intravenous access.
McLeod
H L
HL
St. Jude Children's Research Hospital, Memphis, TN.
McGuire
T R
TR
Yee
G C
GC
D000596:Amino Acids / Q000032:analysis / Q000737:chemistry*; D016026:Bone Marrow Transplantation; D002626:Chemistry, Pharmaceutical; D016572:Cyclosporine / Q000008:administration & dosage / Q000032:analysis / Q000737:chemistry*; D004355:Drug Stability; D005217:Fat Emulsions, Intravenous / Q000032:analysis / Q000737:chemistry*; D005947:Glucose / Q000032:analysis / Q000737:chemistry*; D010865:Pilot Projects; D012965:Sodium Chloride / Q000032:analysis / Q000737:chemistry; D012996:Solutions
D000596:Amino Acids; D005217:Fat Emulsions, Intravenous; D012996:Solutions; D012965:Sodium Chloride; D016572:Cyclosporine; D005947:Glucose