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COMPATIBILITY SYMBOLS USED IN THE GRID
The special grid included on monograph pages allows for quick
reporting of compatibility (C), incompatibility (X), or conflicting
data (Ø). In some instances conflicting results have been reported
in the literature for a particular admixture. These contradictory
reports are noted with a Ø, and are described in the written
entries.
NOTE:
Absence of a notation in the grid does not imply that
the combination is compatible. Rather, it means that no information
has been reported for that particular combination. The presence of
other symbols in the grid, such as # and *, are included to help the
reader locate the specific written entry about the drug combination,
and the reference that pertains to that entry.
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X |
Evidence of incompatibility has been reported.
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| C |
Evidence of compatibility has been
reported
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| Ø |
Conflicting reports of compatibility have
been reported
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| #,* |
Symbols refer the reader to the written
comments adjacent to the grid within the monograph
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Absence of a notation in the grid does
not imply compatibility.
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TYPES OF INCOMPATIBILITY
Many studies on the compatibility of parenteral admixtures have used
precipitation, effervescence, color change, and related visual methods
as the criteria for deciding if a combination is compatible. These
changes that are detected by the unaided eye are termed physical or
visual incompatibilities. Physically incompatible combinations of
parenterals should not be administered.
Some studies on the compatibility of parenteral admixtures have
investigated the change in potency or stability of the admixed drugs.
These changes that are not visible with the unaided eye are termed
nonvisual or chemical incompatibility. Stability, per se, has been
defined as a product or combination of drugs that retain at least 90%
of its original potency during the life of the product. Therefore a
mixture is rated chemically incompatible(or unstable) if it loses more
than 10% of its original concentration. Chemically incompatible
combinations of parenterals should not be administered.
CONFLICTING REPORTS
Contradictory results have been reported over the years in research
studies on parenteral drug admixture compatibility. Some of these
conflicting reports may be attributed to the concentrations used in a
particular study, the order of mixing, adjuvants included in the
formulations, materials from which contained may be fabricated, and
unavoidable differences in various lots of the same drug product.
Variations in permissible pH ranges of some infusion fluids may also
contribute to the problem of conflicting reports. In addition some
combinations may be physically (i.e., visually) compatible yet be
chemically (i.e., nonvisually) incompatible. The symbol in the grid
for conflicting data is Ø. The reader should use caution when deciding
on the appropriateness of a given admixture if conflicting data has
been reported. |
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Spring-2008
We have added stability information for one new drug product:
PANTOPRAZOLE. We are also reporting the results of compatibility
studies for PANTOPRAZOLE in admixture with 90 parenteral products
including: CASPOFUNGIN ACETATE, CIPROPLOXACIN,
ENALAPRILAT, FLUCONAZOLE, LEVOFLOXACIN,
MEROPENEM, PROPOFOL, VASOPRESSIN, and ZIDOVUDINE.
Also included in the enclosed supplement is additional compatibility
information for CEFTRIAXONE used with calcium-containing products. Past Updates |
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