IV Injections: Stability, compatibility, Incompatibility and Mode of Administration
Table 1: Securon 2.5mg/ml Verapamil Hydrochloride
Name | Securon 2.5mg/ml aqueous solution for injection Verapamil Hydrochloride |
Stability | SINGLE USE |
Incompatibility | Acetylsalicylic acid, alpha blockers, Antiarrhythmics, Alkaline Solutions |
Compatibility | Water for injections; Sodium chloride (8.5mg/ml); Hydrochloric acid 10% as pH adjuster. |
Administration | Slow INTRAVENOUS INJECTION (Gray et al., 2016). |
Table 2: Acetylcysteine Injection 200mg/ml Acetylcysteine
Name | Acetylcysteine Injection 200mg/ml Acetylcysteine |
Stability | SINGLE USE |
Incompatibility | RUBBER AND METALS (iron, copper and Nickel) Change of color to light purple |
Compatibility | Disodium Edetate Glucose 5% Nitrogen Gas Water for Injection Sodium Chloride 0.9%; Sodium Hydroxide for PH adjustment (Gray et al. 2016). |
Administration | INTRAVENOUS infusion. |
Table 3: Adenocor 3mg/mL solution for injection: Adenosine
Name | Adenocor 3mg/mL solution for injection Adenosine |
Stability | SINGLE USE |
Incompatibility | NOT known. DO NOT MIX WITH OTHER MEDICINAL |
Compatibility | Water for Injection; Sodium Chloride 0.9% |
Administration | RAPID IV Injection (Gray et al., 2016). |
Table 4: Diltiazem Hydrochloride Injection
Name | Diltiazem Hydrochloride Injection |
Stability | SINGLE USE |
Incompatibility | DO NOT mix with other drugs in the administration container. DO NOT co-infuse in the same IV line with other drugs. VISUALLY inspect the drug for particulate matter and discoloration |
Compatibility | Dextrose 5% injections Sodium Chloride 0.9% Injection Normal saline Dextrose 5% + Sodium Chloride 0.9% injection (Gray et al., 2016). |
Administration | RAPID IV INJECTION (preferable) and CONTINOUS IV INFUSION |
Table 5: Gentamicin Sandoz
Name | Gentamicin Sandoz 40 mg/80 mg ampoules |
Stability | SINGLE USE |
Incompatibility | DO NOT MIX WITH OTHER DRUGS before injection DO NOT COADMINSTER with other drugs |
Compatibility | Sodium metabisulphite Sodium hydroxide Disodium edetate Methyl; hydroxybenzoate Sulphuric acid (2.5N) Propryl hydroxybenzoate Water for Injections (Trissel & American Society of Health-system Pharmacists, 2011). |
Administration | IM INJECTION (preferable) or SLOW IV (when IM is not feasible). |
Table 6: Ephedrine Hydrochloride
Name | Ephedrine Hydrochloride 30mg in 1ml Solution for Injection |
Stability | SINGLE USE. |
Incompatibility | Anionic salts such as carbonates, phosphates and acetates. |
Compatibility | Water for Injections |
Administration | SLOW INTRAVENOUS INJECTION. |
Table 7: Metronidazole Fresenius solution for infusion
Name | Metronidazole Fresenius solution for infusion (1ml contains 5mg metronidazole; each 100ml vial contains 500mg metronidazole) |
Stability | Discard after SINGLE USE. |
Incompatibility | DO NOT mix with other medical |
Compatibility | Disodium phosphate dodecahydrate Citric acid monohydrate Glucose/sodium chloride 0.9% Sodium chloride solution 5% Glucose solution Potassium Chloride solutions (20mmol and 40mmol) Ringer’s solution |
Administration | INTRAVENOUS INFUSION at an approximate rate of 5 ml/min (Trissel & American Society of Health-system Pharmacists, 2011). |
Table 8: Flolan: Epoprostenol Sodium
Name | Flolan: Epoprostenol Sodium |
Stability | SINGLE USE. Refrigerate reconstituted solutions at 2-80C for not more than 40hrs |
Incompatibility | DO NOT mix with other medicinal |
Compatibility | Powder for solution for infusions: NaOH for pH adjustment; Glycine; Sodium chloride; Mannitol Solvent for parenteral use: Water for injection Sodium hydroxide for pH adjustment Sodium chloride |
Administration | CONTINOUS INTRAVENOUS INFUSION via a central venous catheter using an AMBULATORY Fusion PUMP. DO NOT administer as a BOLUS INJECTION (Gray et al., 2016). |
Table 9: Meronem IV
Name | Meronem IV |
Stability | Each vial is for SINGLE USE ONLY |
Incompatibility | Do NOT mix with or add other medicinal |
Compatibility | Anhydrous sodium carbonate 5% Glucose with 0.15% Potassium Chloride solution 5% Glucose solution + 0.02 Sodium bicarbonate 0.9% sodium chloride solution 5% or 10% Glucose solution 5% Glucose solution + 0.9% Sodium Chloride Mannitol 2.5% or 10% solution 5% glucose with 0.225% Sodium Chloride Solution. |
Administration | INTREAVENOUS INFUSION over 15-30mins (preferable) IV INJECTION up to 1g doses over approximately 5 minutes |
Table 10: ARIXTRA Fondaparinux Sodium (Fondaparinux)
Name | ARIXTRA Fondaparinux Sodium (Fondaparinux) |
Stability | SINGLE USE. Store for up to 24hrs at room temperatures. |
Incompatibility | Do NOT mix with other medicinal products. |
Compatibility | Physiologic sodium chloride (0.9%) Water for Injection Hydrochloric acid or Sodium Hydroxide for pH adjustment if necessary |
Administration | SUBCUTANEOUS administration and INTRAVENOUS administration |
Table 11: Rocephin
Name | Rocephin |
Stability | SINGLE USE |
Incompatibility | Hartmann’s or Ringer’s solution (calcium containing solutions) Do not mix or co-administer with other medicinal |
Compatibility | Water for Injections Sodium chloride 0.45% + Glucose 2.5% Sodium chloride 0.9% Glucose 5% or 10% Dextran 6% in glucose 5% Hydroxyethyl starch 6-10% (Gray et al., 2016). |
Administration | INTRAMUSCULAR injection or INTRAVENOUS injection or INTRAVENOUS infusion (Gray et al., 2016). |
Table 12: Esmeron
Name | Esmeron: Esmeron 10mg/ml, solution for injection |
Stability | SINGLE USE |
Incompatibility | The FOLLOWING drugs: Prednisolone sodium succinate, hydrocortisone sodium succinate, Amoxicillin, Amphotericin, azathioprine, cefazolin, cloxacillin, dexamethasone, diazepam, erythromycin, famotidine, furosemide, insulin, methohexital, methylprednisolone, enoximone, thiopental, trimethoprim, vancomycin, and Intralipid (Trissel & American Society of Health-system Pharmacists, 2011). If the drug is to be administered with other drugs using the same IV line, the line must be adequately flushed (using 0.9% NaCl). |
Compatibility | Sodium acetate (for pH adjustment) Sodium chloride Water for Injection Acetic acid (for pH adjustments) |
Administration | IV BOLUS injection or INTRAVENOUS continuous infusion |
Table 13: Intratect
Name | Intratect 100g/l solution for infusion |
Stability | SINGLE USE |
Incompatibility | Do NOT mix with other medicinal products |
Compatibility | Glycine; Water for Injections |
Administration | INTRAVENOUS infusion. |
Table 14: Keppra
Name | Keppra 100mg/ml concentrate for solution for infusion |
Stability | SINGLE USE |
Incompatibility | NOT indicated |
Compatibility | Levetiracetam 500mg Water for Injection Physiological NaCl Sodium acetate trihydrate Glacial Acetic Acid as a 10% (v/v) Solution |
Administration | INTRAVENOUS use only |
Table 15: Trandate Labetalol
Name | Trandate Labetalol |
Stability | SINGLE USE. |
Incompatibility | Sodium bicarbonate injection BP 4.2% W/V |
Compatibility | Beta-blocking drugs Compound Sodium Lactate BP 0.18% Sodium Chloride + 4% Dextrose 5% Dextrose BP Water for Injection 0.3% Potassium Chloride + 5% Dextrose BP. |
Administration | INTRAVENOUS bolus Injection or INTRAVENOUS Infusion |
Table 16: Phenytoin Hikma
Name | Phenytoin Hikma 50mg/ml solution for injection (phenytoin sodium) |
Stability | SINGLE use ONLY |
Incompatibility | Do NOT mix with other Medicinal |
Compatibility | Propylene glycol Ethanol (96%) Sodium Hydroxide for pH adjustment Water for Injection |
Administration | SLOW INTRAVENOUS infusion (Gray et al., 2016). |
Table 17: Aggrastat Concentrate solution
Name | Aggrastat Concentrate solution for IV infusion equivalent to 0.25mg/ml Tirofiban base |
Stability | SINGLE USE. Storage should NOT exceed 24hrs at 2-80C. |
Incompatibility | Diazepam |
Compatibility | Sodium citrate dihydrate Sodium chloride Citric acid anhydrous Hydrochloric acid or Sodium hydroxide for pH adjustment Water for injection |
Administration | SHOULD only be administered INTRAVESOUSLY with unfractionated heparin (recommended). |
Table 18: Mikacin
Name | Mikacin: Amikacin Sulphate for parenteral use |
Stability | SINGLE USE. |
Incompatibility | Do NOT MIX or Co-administer with contraindicated antibiotics |
Compatibility | Sodium metabisulphite; Sodium citrate; Sodium chloride injection; 5% Dextrose; Compound Sodium Lactate |
Administration | INTRAMUSCULAR route (preferred) INTRAVENOUS slow bolus (2-3mins) INTRAVENOUS infusion (0.25% over 30min) IRRIGATION solution (Trissel & American Society of Health-system Pharmacists, 2011). |
Table 19: Dopamine
Name | Dopamine 40mg/ml sterile concentrate |
Stability | SINGLE USE. Store for up to 48hrs |
Incompatibility | Alkaline IV solutions. Admixtures containing or oxacillin sodium, cephalothin sodium neutral, gentamicin sulfate, or cephalothin sodium. Ampicillin + Dopamine in 5% glucose solution Dopamine + amphotericin B in glucose 5% solution |
Compatibility | Sodium metabisulphite Water for injections |
Administration | INTRAVENOUS administration. |
Table 20: Levobupivacaine
Name | Levobupivacaine |
Stability | SINGLE USE. |
Incompatibility | Alkaline solutions; Other medications NOT specified |
Compatibility | Water for Injections; Sodium hydroxide Sodium chloride; Hydrochloric acid |
Administration | EPIDURAL bolus or Continuous slow EPIDURAL INFUSION or IV BOLUS. |
Table 21: Bactrim for infusion
Name | Bactrim for infusion |
Stability | SINGLE use. |
Incompatibility | Products that lower the pH below 8. Levulose 5%, Hartmann’s solution and Sodium bicarbonate 1.4% |
Compatibility | Propylene Glycol, Trometahmine Sodium chloride 0.9%, Dextrose 5% and 10% Sodium chloride 0.45% + Dextrose 2.5%, Ringer’s solution (USP XVIII) Sodium Hydroxide, Sodium Metabisulphate, Ethanol, Water for Injection Xylitol 10%, Macrodex (dextran 70.6% in dextrose 5%), |
Administration | INTRAVENOUS administration. |
Table 22: Piperacillin/Tazobactam Sandoz
Name | Piperacillin/Tazobactam Sandoz 4.5g powder for solution for injection or infusion |
Stability | SINGLE USE. |
Incompatibility | Aminoglycosides; SHOULD NOT be mixed with other medicinal in the infusions; Ringer’s solution and Hartmann’s solution; Blood products or albumin hydrolysates |
Compatibility | Water for Injection; Sodium Chloride 9mg/ml (0.9%) solution Glucose 50mg/ml (5%) solution in Water for Injection Glucose 50mg/ml (5%) solution in NaCl 9mg/ml (0.9%) solution Dextran (grade 40) 60mg/ml (6%) solution of Sodium Chloride 0.9% solution (Gray et al., 2016). |
Administration | INTRAVENOUS BOLUS (3-5mins) or IV INFUSION (20-30mins). |
Table 23: Vancomycin Hydrochloride for Injection
Name | Vancomycin Hydrochloride for Injection, USP. Fliptop Vial for IV |
Stability | FOR SINGLE USE. |
Incompatibility | Do NOT mix with other medicinal because of its low Ph |
Compatibility | Sterile Injection Water 5% Dextrose + Lactated Ringer’s Injection 5% Dextrose Injection USP 5% Dextrose + 0.9% Sodium Chloride Injection, USP 0.9% Sodium Chloride injection, USP Lactated Ringer’s Injection, USP Normosol-M and 5% Dextrose ISOLYTE E |
Administration | INTRAVENOUS administration OR ORAL use. |
Table 24: Lanoxin Injection (digoxin)
Name | Lanoxin Injection (digoxin) |
Stability | SINGLE USE |
Incompatibility | NOT Known. DO NOT mix or co-administer with other medicinal. |
Compatibility | Ethanol; Propylene Glycol; Citric acid Minohydrate; Sodium phosphate anhydrous or sodium phosphate; Water for Injections Sodium Chloride IV infusion, BP 0.9% w/v; Sodium Chloride NaCl (0.18% w/v) + Glucose (4% w/v) IV Infusion, BP |
Administration | For INTRAVENOUS USE only. |
Table 25: ZOFRAN (Ondansetron)
Name | ZOFRAN (Ondansetron) |
Stability | SINGLE IV DOSE. |
Incompatibility | DO NOT mix or co-administer with other medicinal unless specified. |
Compatibility | Sodium chloride, Citric acid monohydrate, Water for injections, and Sodium citrate dihydrate Glucose IV infusion BP 5% w/v Potassium chloride 0.3% w/v + Sodium chloride 0.9% w/v IV infusion BP Sodium Chloride IV infusion BP 0.9% w/v Mannitol IV infusion BP 10% w/v Ringer’s IV infusion Potassium Chloride 0.3% w/v + Glucose 5% w/v Infusion BP Compatible drugs include: Cisplatin, 5-flourouracil, carboplatin, etoposide, ceftazidime, cyclophosphamide, doxorubicin, dexamethasone (Gray, 2009). |
Administration | SLOW INTRAVENOUS injection or INTRAVENOUS infusion |
Table 26: NovoSeven
Name | NovoSeven 1mg, 2mg, 5mg and 8mg powder and solvent for solution for injection |
Stability | SINGLE USE. |
Incompatibility | NEVER MIX with other infusion solutions. Do NOT give in a drip. |
Compatibility | Powder Sodium Chloride, Methionine, Mannitol, calcium chloride dehydrate, Glycylglycine, Polysorbate 80, Sucrose, Sodium hydroxide and hydrochloric acid for adjusting pH Solvent Water for injections, Histidine Sodium hydroxide or hydrochloric acid for adjusting pH |
Administration | BOLUS INJECTION (recommended) and CONTINOUS Infusions |
Table 27: Nimbex: Cisatracurium besylate
Name | Nimbex: Cisatracurium besylate |
Stability | SINGLE USE |
Incompatibility | Lactated Ringer’s injection Drugs: Ketorolac tremetamol or propofol injectable emulsion |
Compatibility | Water for Injections Benzene sulfonic acid Dextrose (5% w/v) IV infusion Sodium Chloride (0.9% w/v) IV infusion Sodium chloride (0.18% w/v) + dextrose (4% w/v) IV infusion Sodium Chloride (0.45% w/v) + dextrose (2.5% w/v) IV infusion. Drugs: droperidol, midazolam hydrochloride, alfentanil hydrochloride, fentanyl citrate, sufentanil citrate |
Administration | INTRAVENOUS infusion and INTRAVENOUS bolus injection |
Table 28: Fentanyl-Hameln 50mcg/ml Injection
Name | Fentanyl-Hameln 50mcg/ml Injection |
Stability | SINGLE USE. Stability for 24hrs at 250C after dilution. |
Incompatibility | NOT to be mixed with other medicinal. Check compatibility before administration with other drugs. Drugs: Pentobarbital sodium, methohexal sodium, thiopental sodium and nafcillin |
Compatibility | Water for injections Physiologic sodium chloride Hydrochloric acid or Sodium Hydroxide for pH adjustment |
Administration | SLOW IV BOLUS injection and BOLUS INTRAVENOUS injection |
Table 29: Curam
Name | Curam 1.2g IV- powder for solution for injection/infusion |
Stability | SINGLE USE only |
Incompatibility | Amino acid solutions; Lipid emulsions; Blood and glucose solutions |
Compatibility | NOT indicated |
Administration | INTRAVENOUS Injection and INTRAVENOUS infusion |
References
Gray, A. H. (2009). Injectable drugs pocket companion. London: Pharmaceutical; Press.
Gray, A. H., Wright, J., Bruce, L., & Oakley, J. (2016). Clinical pharmacy: pocket companion. London: Pharmaceutical Press. Print Book: English
Trissel, L. A., & American Society of Health-system Pharmacists. (2011). Handbook on injectable drugs. Bethesda, M.D.: American Society of Health-System Pharmaceutical