Issues in Contemporary Drug Delivery: Part V: Total Parenteral Nutrition

Abstract

Objective: To provide an overview of common compounding and administration guidelines for total parenteral nutrition (TPN). The compatibility of various drug products with TPN preparations is also discussed. Data Sources: References were selected from published bibliographies of specialized nutrition and drug-nutrient interaction articles, package inserts and manufacturer's information, and specific topic searches in MEDLINE computerized database (English language, through 1989). Study Selection: Studies that investigated stability were selected preferentially to those studying compatibility alone; when stability data were not available, compatibility studies were included. Studies using products marketed in the US were chosen preferentially to those using European products; studies and case reports using human subjects were selected in preference to animal studies. Sixty percent of the initially identified studies were selected for inclusion. Data Extraction: Studies were reviewed by the authors for internal consistency and statistical validity. Data Synthesis: Intravenous solutions can be manufactured to meet various nutritional specifications. As additional nutrients and drugs are incorporated, the risk of incompatibility and instability of the admixture increases. Stability data are relatively sparse, leading to a dependence on compatibility studies for decision making. Conclusions: A wide variety of TPN formulations can be compounded to meet the individual needs of patients of all ages and assorted disease states. Addition of specific drugs to the TPN preparation may improve the efficiency of drug delivery and improve overall therapeutic response. Care must be taken, however, to ensure that incompatible compounds are not combined in a single TPN preparation.

Management of the General Process of Parenteral Nutrition Using mHealth Technologies: Evaluation and Validation Study (Preprint)

“…In the specific case of parenteral nutrition, according to the formulations for three-chamber, two-chamber and saline bags included in the program database, together with the stability conditions that any preparation must present (Table 9) [31][32][33] , the program will generate automatically the preparation which better adjusts to said conditions. If it was decided to modify said preparation due to clinical criteria, this can be confirmed again with the aim to determine its physical-chemical stability.…”

“…En el caso específico de las nutriciones parenterales, de acuerdo con las presentaciones de las nutriciones tricamerales, bicamerales y sueros incluidos en la base de datos del programa junto con las condiciones de estabilidad que debe recoger toda preparación (Tabla 9) [31][32][33] , el programa genera automáticamente la preparación que se ajusta más a dichas condiciones. Si por criterio clínico se decidiese modificar dicha elaboración, ésta puede ser chequeada de nuevo con el fin de determinar su estabilidad físico-química.…”