title: Inhalation solutions--which ones may be mixed? Physico-chemical compatibility of drug solutions in nebulizers--update 2013.
abstract: Many patients suffering from chronic respiratory diseases rely on inhalation therapy with nebulizers. About 25% of patients who need to inhale several different drugs per day save time by mixing them for simultaneous inhalation. This review presents a comprehensive overview of the available data concerning physico-chemical compatibility of commonly mixed nebulizer solutions and suspensions. Information is based on our in vitro studies and a thorough literature search. Results indicate that many nebulizer solutions/suspensions are mixable without provoking incompatibilities. However, certain excipients contained in some of the tested drug products could be identified as a reason for incompatibilities, e.g. impaired activity of dornase alfa. Studies assessing the aerosol characteristics of compatible mixtures nebulized with commonly used nebulizers are limited and should be encouraged. The clinical efficacy of simultaneous inhalation of duplicate, tripartite or quadripartite mixtures must be evaluated in clinical studies before final recommendations for the inhalation regimens can be made.
authors.affiliation: Pediatric Department, Lutheran Hospital Hamm, Hamm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kamin
authors.affiliation: Department of Pharmacy, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Erdnüss
authors.affiliation: Department of Pharmacy, University Medical Center, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Krämer
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002908:Chronic Disease; D004338:Drug Combinations; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy*; D009330:Nebulizers and Vaporizers
chemical_list: D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D004338:Drug Combinations
keywords: Aerosol; Compatibility; Mixture; Nebulizer solution/suspension; Review