title: Physical compatibility of various drugs with neonatal total parenteral nutrient solution during simulated Y-site administration.
abstract: OBJECTIVE
  The physical compatibility of various drugs with neonatal total parenteral nutrient (TPN) solution during simulated Y-site administration was evaluated.
  
  
  METHODS
  Study drugs were selected based on the lack of compatibility data with them and neonatal TPN solution and the frequency of use in a local neonatal unit. These drugs included amiodarone, caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, midazolam, pentobarbital, phenobarbital, and rifampin. Equal volumes of neonatal TPN solution or sterile water for injection were combined with study drugs or sterile water for injection at concentrations used clinically in neonates. Each test was performed in triplicate. The samples were examined via turbidimetric analysis and visually against light and dark backgrounds immediately after mixing and at 0.25, 0.5, 1, 2, and 3 hours after mixing. Analysis of variance was used to determine statistically significant differences between the test and control solutions.
  
  
  RESULTS
  Many of the drugs studied exhibited no visual or turbidimetric evidence of incompatibility when combined with neonatal TPN solution for up to three hours in a simulated Y-site injection. Pentobarbital, phenobarbital, and rifampin formed visible precipitation immediately after mixing with the neonatal TPN solution.
  
  
  CONCLUSIONS
  Caffeine citrate, clindamycin, enalaprilat, epinephrine, fluconazole, fosphenytoin sodium, hydrocortisone, metoclopramide, and midazolam exhibited no visual or turbidimetric evidence of incompatibility when combined with a neonatal TPN solution for up to three hours in a simulated Y-site injection. Amiodarone, pentobarbital, phenobarbital, and rifampin were not compatible with the neonatal TPN solution and should not be coadministered via Y-site injection.
authors: School of Pharmacy, Presbyterian College, Clinton, SC 29325, USA. lmfox@presby.edu
authors: Laura M
authors: LM
authors: Fox
authors: Alyson G
authors: AG
authors: Wilder
authors: Jaime A
authors: JA
authors: Foushee
mesh_terms: D004347:Drug Interactions / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D009391:Nephelometry and Turbidimetry / Q000379:methods / Q000592:standards; D057947:Parenteral Nutrition Solutions / Q000008:administration & dosage* / Q000378:metabolism* / Q000592:standards; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000378:metabolism* / Q000592:standards; D019999:Pharmaceutical Solutions / Q000008:administration & dosage / Q000378:metabolism / Q000592:standards
chemical_list: D057947:Parenteral Nutrition Solutions; D004364:Pharmaceutical Preparations; D019999:Pharmaceutical Solutions