Physical compatibility of cisatracurium with selected drugs during simulated Y-site administration.
OBJECTIVE
The physical compatibility of cisatracurium with selected drugs during simulated Y-site administration was studied.


METHODS
Study drugs were selected based on the lack of physical compatibility data with cisatracurium and their use in intensive care units. Test admixtures were prepared by mixing 2.5-mL samples of varying concentrations of calcium gluconate, diltiazem, esomeprazole, regular insulin, nicardipine, pantoprazole, and vasopressin with either 2.5 mL of normal saline 0.9% (control) or 2.5 mL of cisatracurium (experimental) to simulate a 1:1 Y-site ratio. Drug infusions were prepared at the maximum concentrations used clinically. Physical compatibility of the admixtures was determined by visual and turbidimetric assessments performed in triplicate immediately after mixing and at 15, 30, and 60 minutes. Visual incompatibility was defined as a change in color, the formation of haze or precipitate, the presence of particles, or the formation of gas in the experimental groups compared with the controls. Disturbances invisible to the naked eye were determined by assessing changes in turbidity of experimental admixtures compared with the controls.


RESULTS
None of the admixtures exhibited visual changes when mixed with cisatracurium. Six of the seven admixtures exhibited turbidimetric compatibility with cisatracurium. Pantoprazole admixtures demonstrated a significant difference in turbidimetric assessment between the control and experimental groups when mixed with cisatracurium (p < 0.001).


CONCLUSIONS
Calcium gluconate, diltiazem hydrochloride, esomeprazole, regular insulin, nicardipine hydrochloride, and vasopressin demonstrated physical compatibility with cisatracurium over 60 minutes during simulated Y-site administration. Cisatracurium and pantoprazole should not be coadministered due to a significant difference in turbidity between control and experimental samples.
Jaime A. Foushee, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; and Laura M. Fox, Ph.D., is Assistant Dean for Professional and Student Affairs and Professor of Pharmaceutics, School of Pharmacy, Presbyterian College, Clinton, SC. Lyndsay R. Gormley, Pharm.D., is Postgraduate Year 1 Pharmacy Practice Resident, Greenville Health System, Greenville, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College. Megan S. Lineberger, Pharm.D., is Pharmacist, Rite Aid, Woodruff, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College. jafoushee@presby.edu.
Jaime A
JA
Foushee
Jaime A. Foushee, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; and Laura M. Fox, Ph.D., is Assistant Dean for Professional and Student Affairs and Professor of Pharmaceutics, School of Pharmacy, Presbyterian College, Clinton, SC. Lyndsay R. Gormley, Pharm.D., is Postgraduate Year 1 Pharmacy Practice Resident, Greenville Health System, Greenville, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College. Megan S. Lineberger, Pharm.D., is Pharmacist, Rite Aid, Woodruff, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College.
Laura M
LM
Fox
Jaime A. Foushee, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; and Laura M. Fox, Ph.D., is Assistant Dean for Professional and Student Affairs and Professor of Pharmaceutics, School of Pharmacy, Presbyterian College, Clinton, SC. Lyndsay R. Gormley, Pharm.D., is Postgraduate Year 1 Pharmacy Practice Resident, Greenville Health System, Greenville, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College. Megan S. Lineberger, Pharm.D., is Pharmacist, Rite Aid, Woodruff, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College.
Lyndsay R
LR
Gormley
Jaime A. Foushee, Pharm.D., BCPS, is Assistant Professor of Pharmacy Practice; and Laura M. Fox, Ph.D., is Assistant Dean for Professional and Student Affairs and Professor of Pharmaceutics, School of Pharmacy, Presbyterian College, Clinton, SC. Lyndsay R. Gormley, Pharm.D., is Postgraduate Year 1 Pharmacy Practice Resident, Greenville Health System, Greenville, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College. Megan S. Lineberger, Pharm.D., is Pharmacist, Rite Aid, Woodruff, SC; at the time of writing she was Pharm.D. student, School of Pharmacy, Presbyterian College.
Megan S
MS
Lineberger
D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000737:chemistry; D002626:Chemistry, Pharmaceutical; D004339:Drug Compounding; D004344:Drug Incompatibility; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D009391:Nephelometry and Turbidimetry; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000737:chemistry*; D013997:Time Factors
D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium