title: Visual compatibility of defibrotide with selected drugs during simulated Y-site administration.
abstract: OBJECTIVE
  The visual compatibility of a solution of defibrotide (the only drug recommended for treatment and prophylaxis of hepatic venoocclusive disease) with solutions of various drugs commonly administered in bone marrow transplant procedures was studied.
  
  
  METHODS
  Solutions of 43 drug products in concentrations typically used in clinical practice were evaluated in 1:1 mixtures with defibrotide solution in glass tubes kept at room temperature. The evaluated products included antiinfectious, corticoid, sedative, analgesic, and cardiovascular agents widely used for hematopoietic stem cell transplantation and other marrow transplant procedures; in most cases, test solutions were prepared via dilution in or reconstitution with sterile water, 0.9% sodium chloride injection, or 5% dextrose injection. The mixtures were visually observed immediately after manual mixing and at specified time points (60, 150, and 240 minutes). Visual compatibility was defined as the absence of color change, haze, fibers, particles, gas generation, and precipitate formation. The effect of mixing order on visual compatibility was ascertained.
  
  
  RESULTS
  Of the 43 tested drug solutions, 36 were found to be visually compatible with the defibrotide solution over the entire four-hour study period. Solutions of 7 drugs (amikacin, furosemide, midazolam, mycophenolate mofetil, nicardipine, tobramycin, and vancomycin) were visually incompatible with defibrotide solution. In some cases, evidence of incompatibility was observed intermittently or was dependent on mixing order.
  
  
  CONCLUSIONS
  Defibrotide solution was found to be visually compatible with solutions of 36 i.v. products that are likely to be coadministered with the drug in a bone marrow transplant unit. Seven drug solutions were visually incompatible with defibrotide solution.
authors.affiliation: Florian Correard is Pharmacy Intern; Amandine Savry, Pharm.D., Ph.D., is Pharmacist; and Laurence Gauthier-Villano, Pharm.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital, Marseille, France. Pascale Pisano, Pharm.D., Ph.D., is Pharmacist, Pharmacology Laboratory and Faculty of Pharmacy, Aix Marseille University, Marseille. Bertrand Pourroy, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital.
authors.forename: Florian
authors.initials: F
authors.lastname: Correard
authors.affiliation: Florian Correard is Pharmacy Intern; Amandine Savry, Pharm.D., Ph.D., is Pharmacist; and Laurence Gauthier-Villano, Pharm.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital, Marseille, France. Pascale Pisano, Pharm.D., Ph.D., is Pharmacist, Pharmacology Laboratory and Faculty of Pharmacy, Aix Marseille University, Marseille. Bertrand Pourroy, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital.
authors.forename: Amandine
authors.initials: A
authors.lastname: Savry
authors.affiliation: Florian Correard is Pharmacy Intern; Amandine Savry, Pharm.D., Ph.D., is Pharmacist; and Laurence Gauthier-Villano, Pharm.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital, Marseille, France. Pascale Pisano, Pharm.D., Ph.D., is Pharmacist, Pharmacology Laboratory and Faculty of Pharmacy, Aix Marseille University, Marseille. Bertrand Pourroy, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gauthier-Villano
authors.affiliation: Florian Correard is Pharmacy Intern; Amandine Savry, Pharm.D., Ph.D., is Pharmacist; and Laurence Gauthier-Villano, Pharm.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital, Marseille, France. Pascale Pisano, Pharm.D., Ph.D., is Pharmacist, Pharmacology Laboratory and Faculty of Pharmacy, Aix Marseille University, Marseille. Bertrand Pourroy, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital.
authors.forename: Pascale
authors.initials: P
authors.lastname: Pisano
authors.affiliation: Florian Correard is Pharmacy Intern; Amandine Savry, Pharm.D., Ph.D., is Pharmacist; and Laurence Gauthier-Villano, Pharm.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital, Marseille, France. Pascale Pisano, Pharm.D., Ph.D., is Pharmacist, Pharmacology Laboratory and Faculty of Pharmacy, Aix Marseille University, Marseille. Bertrand Pourroy, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital. bertrand.pourroy@ap-hm.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Pourroy
mesh_terms: D061605:Administration, Intravenous; D016026:Bone Marrow Transplantation; D002626:Chemistry, Pharmaceutical; D004344:Drug Incompatibility; D004355:Drug Stability; D004356:Drug Storage; D006801:Humans; D019999:Pharmaceutical Solutions; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000737:chemistry*; D011089:Polydeoxyribonucleotides / Q000008:administration & dosage* / Q000737:chemistry*
chemical_list: D019999:Pharmaceutical Solutions; D010975:Platelet Aggregation Inhibitors; D011089:Polydeoxyribonucleotides; C036901:defibrotide