title: Physical compatibility of isavuconazonium sulfate with select i.v. drugs during simulated Y-site administration.
abstract: OBJECTIVE
  The physical compatibility of isavuconazonium sulfate with 95 i.v. drugs during simulated Y-site administration was studied.
  
  
  METHODS
  Isavuconazonium sulfate for injection and all other drugs were reconstituted according to the manufacturer's recommendation and further diluted with 0.9% sodium chloride injection or 5% dextrose injection to a final concentration (1.5 mg/mL for isavuconazonium sulfate and standard concentrations used clinically for other drugs). A Y site was simulated in glass culture tubes by mixing 5 mL of the tested drug and isavuconazonium sulfate solutions in each diluent. Incompatibility was defined as changes in visual characteristics or increases in turbidity by greater than 0.5 nephelometric turbidity units over the 120-minute experiment.
  
  
  RESULTS
  Of the 95 drugs tested, isavuconazonium sulfate was physically compatible with 66 drugs in 0.9% sodium chloride injection and 60 drugs in 5% dextrose injection. Incompatibility was observed with albumin, amphotericin B deoxycholate, amphotericin B lipid complex, amphotericin B liposome, ampicillin-sulbactam, cefazolin, cefepime, ceftaroline fosamil, ceftazidime, ceftriaxone, cefuroxime, colistimethate sodium, cyclosporine, ertapenem, esomeprazole, filgrastim, fosphenytoin, furosemide, heparin, meropenem, methylprednisolone, micafungin, phenytoin, potassium phosphate, propofol, sodium bicarbonate, sodium phosphate, and tedizolid. Azithromycin, bumetanide, penicillin G potassium, and piperacillin-tazobactam were incompatible with isavuconazonium sulfate in 5% dextrose injection only.
  
  
  CONCLUSIONS
  Of the 95 drugs tested, isavuconazonium sulfate 1.5 mg/mL was physically compatible with 66 drugs in 0.9% sodium chloride injection and 60 drugs in 5% dextrose injection. Incompatibility was observed with 18 antimicrobials, including most cephalosporins tested, and 14 other i.v. drugs in at least 1 of the 2 tested diluents.
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT.
authors.forename: Wonhee
authors.initials: W
authors.lastname: So
authors.affiliation: Astellas Pharma Global Department, Northbrook, IL.
authors.forename: Liz
authors.initials: L
authors.lastname: Kim
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CTFaculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Abrar K
authors.initials: AK
authors.lastname: Thabit
authors.affiliation: Center for Anti-Infective Research and Development and Division of Infectious Diseases, Hartford Hospital, Hartford, CT.
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
authors.affiliation: Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT. joseph.kuti@hhchealth.org.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kuti
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000737:chemistry*; D002626:Chemistry, Pharmaceutical; D004344:Drug Incompatibility; D004355:Drug Stability; D004655:Emulsions / Q000008:administration & dosage / Q000737:chemistry; D005947:Glucose / Q000737:chemistry; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D007275:Injections, Intravenous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D000072742:Invasive Fungal Infections / Q000188:drug therapy*; D009391:Nephelometry and Turbidimetry; D009570:Nitriles / Q000008:administration & dosage / Q000737:chemistry*; D011725:Pyridines / Q000008:administration & dosage / Q000737:chemistry*; D012965:Sodium Chloride / Q000737:chemistry; D012995:Solubility; D013997:Time Factors; D014230:Triazoles / Q000008:administration & dosage / Q000737:chemistry*
chemical_list: D000935:Antifungal Agents; D004655:Emulsions; D009570:Nitriles; D011725:Pyridines; D014230:Triazoles; D012965:Sodium Chloride; C508735:isavuconazole; D005947:Glucose
keywords: antiinfective agents; azole antifungals; drug combinations