Compatibility and stability of telavancin and vancomycin in heparin or sodium citrate lock solutions

Abstract

Telavancin 2 and 5 mg/mL was physically compatible in combination with heparin 2500 units/mL and with sodium citrate 2.2% and 4% over 72 hours. Vancomycin 2 and 5 mg/mL initially precipitated in the sodium citrate 2.2% formulation, but no precipitation was noted after 10 minutes of incubation at 37 °C. Telavancin and vancomycin 2 and 5 mg/mL retained over 90% of the initial concentration after incubation at 37 °C over 72 hours.

Stability and compatibility of antimicrobial lock solutions

“…7 Vancomycin at concentrations of 2 and 5 mg/mL in combination with TSC at concentrations of 22 and 40 mg/mL is reported to be physically and chemically stable for 72 hours. 52 Solutions of vancomycin 5 mg/mL plus TSC 22 mg/mL initially precipitated, but after 10 minutes of incubation at 37 °C, no precipitation was noted. Vancomycin 5 mg/ mL in combination with TPA 1 mg/ mL and vancomycin 50 mg/mL with urokinase 1250 units/mL have been used, with no reports of incompatibilities, but further stability studies are needed.…”

“…Telavancin (2 or 5 mg/mL) has been studied as an ALT agent in combination with TSC (22 or 40 mg/mL) or heparin sodium (2500 units/mL); the stability and compatibility of all evaluated comAm J Health-Syst Pharm-Vol 70 Dec 15, 2013 binations were confirmed over 72 hours, with limited variability. 52 However, clinical effectiveness data on this lock solution are lacking, and supply issues have limited its use in the United States.…”

“…Consistent compatibility has been demonstrated with solutions of vancomycin, at concentrations ranging from 0.1 to 10 mg/ mL, and heparin sodium 100-5000 units/mL for ALT. 33,[35][36][37]47,[52][53][54][55] There are anecdotal reports of visual haze with the use of higher concentrations of vancomycin (≥5 mg/mL) and heparin sodium (≥5000 units/ mL) in solution, but agitation appears to alleviate this concern; the clinical significance of these findings is unknown, and the phenomenon may be manufacturer specific. Vancomycin and heparin sodium at lower concentrations (0.025-0.5 mg/mL and 10-100 units/mL, respectively) have been evaluated, with no reported incompatibilities, but this research entailed less wellvalidated methodologies.…”

Antimicrobial lock therapy in central-line associated bloodstream infections: a systematic review

“…However, to our knowledge, no consistent data have been published at present regarding its efficacy. LaPlante et al [46] showed that Telavancin 2 5 and 5 mg/ml were physically compatible with heparin 2,500 units/ml and citrate 2.2 and 4 % over 72 h for lock solutions.…”

Stability and compatibility of vancomycin for administration by continuous infusion

“…1 -4 To safely implement this mode of administration in a routine hospital setting it is, however, essential to ensure that vancomycin remains stable over the whole process and that incompatibilities with other medications co-administered by the intravenous route are avoided. Vancomycin has been repeatedly reported to be stable in various media for several days (see Nornoo and Elwell, 5 LaPlante et al 6 and Dotson et al 7 ), but few studies have been performed in the actual conditions of its clinical use, including potentially accidental exposure to high temperatures. Concerning compatibility, vancomycin is notorious for being incompatible with several b-lactams, 8 -10 but few studies have examined other antibiotics or other commonly used drugs that are administered by the intravenous route in routine clinical practice.…”