title: Physical compatibility of 4% sodium citrate with selected antimicrobial agents.
abstract: OBJECTIVE
  The physical compatibility of 4% sodium citrate with vancomycin, gentamicin, tobramycin, daptomycin, and linezolid was evaluated.
  
  
  METHODS
  Admixtures were prepared by mixing 4% sodium citrate with clinically relevant concentrations of antimicrobial agents (vancomycin 5 mg/mL, vancomycin 10 mg/mL, vancomycin 20 mg/mL, daptomycin 5 mg/mL, gentamicin 2.4 mg/mL, tobramycin 2.4 mg/mL, and linezolid 1 mg/mL). Three samples of each admixture were incubated (1) at 22-23 degrees C and exposed to light, (2) in a water bath at 37 degrees C and exposed to light, (3) at 22-23 degrees C and protected from light, and (4) in a water bath at 37 degrees C and protected from light. Visual compatibility, spectrophotometric absorbance, and pH were evaluated immediately after mixing (baseline) and at 8, 24, and 48 hours. Physical compatibility was defined as the absence of visible precipitation, a pH value at 48 hours that did not vary by more than 10% from baseline, and an absorbance value of <0.015.
  
  
  RESULTS
  There was no visual evidence of precipitation and no clinically important changes in pH observed during the 48-hour study period in any admixture. However, turbidity, based on absorbance, was noted with vancomycin 20 mg/mL at each time point.
  
  
  CONCLUSIONS
  No evidence of incompatibility was observed when vancomycin 5 mg/ mL, vancomycin 10 mg/mL, daptomycin 5 mg/mL, gentamicin 2.4 mg/mL, tobramycin 2.4 mg/mL, or linezolid 1 mg/mL was mixed with 4% sodium citrate as might occur in an antimicrobial lock. Vancomycin 20 mg/mL mixed with 4% sodium citrate displayed spectrophotometric evidence of incompatibility.
authors.affiliation: Department of Pharmacy, Harper University Hospital, Detroit, MI, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dotson
authors.forename: Scarlett
authors.initials: S
authors.lastname: Lynn
authors.forename: Katherine
authors.initials: K
authors.lastname: Savakis
authors.forename: Mariann D
authors.initials: MD
authors.lastname: Churchwell
mesh_terms: D000890:Anti-Infective Agents / Q000737:chemistry*; D000925:Anticoagulants / Q000737:chemistry*; D055499:Catheter-Related Infections / Q000517:prevention & control; D011232:Chemical Precipitation; D002951:Citrates / Q000737:chemistry*; D004344:Drug Incompatibility; D004355:Drug Stability; D004356:Drug Storage; D006863:Hydrogen-Ion Concentration; D008027:Light; D000077559:Sodium Citrate; D013053:Spectrophotometry; D013696:Temperature; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D002951:Citrates; D000077559:Sodium Citrate