Sodium Valproate Incompatibility with Parenteral Nutrition Admixtures—A Risk to Patient Safety: An In Vitro Evaluation Study

Piwowarczyk, Ludwika; Tomczak, Szymon; Antkowiak, Patryk; Jelińska, Anna; Stawny, Maciej

doi:10.3390/pharmaceutics14020371

Cited by 5 publications

(2 citation statements)

References 52 publications

(72 reference statements)

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“…Differences depend on the added drugs: Ondansetron [ 18 ] caused a decrease in absolute value zeta potential. Contrarily, adding sodium valproate [ 33 ] to the PNAs caused its increase.…”

Section: Discussionmentioning

confidence: 99%

Antiemetic Drugs Compatibility Evaluation with Paediatric Parenteral Nutrition Admixtures

et al. 2023

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Chemotherapy-induced nausea and vomiting are defined as the most common of side effects of treatment and, at the same time, are very difficult to accept for patients’, frequently causing changes in the therapy regimen, significantly reducing its effectiveness. Thus, an antiemetic prophylactic is essential to the provision of such a therapy for the patient. Pharmacotherapy often includes various drugs, including antiemetics, with the administration of such drugs by injection through two separate catheters being the preferred method. However, the co-administration of drugs and parenteral nutrition admixtures (PNAs) requires the consideration of compatibility, stability and potential negative interactions. To meet the purposes of clinical pharmacy, a compatibility test of ondansetron, dexamethasone and hydrocortisone with paediatric PNAs was conducted. PNAs differ in the composition of amino acid source (Primene® or Aminoplasmal Paed® 10%) and the type of injectable lipid emulsion (Lipidem® 200 mg/mL, Clinoleic® 20%, SMOFlipid® 200 mg/mL, Intralipid® 20%). An in vitro evaluation was performed in a static way as a simulated co-administration through a Y-site. The drug PNA ratios were determined based on the extreme infusion rates contained in the characteristics of medicinal products. All calculations were performed for a hypothetical patient aged 7 years weighing 24 kg. As a result of this study, it can be concluded that all tested PNAs showed the required stability in the range of parameters such as pH, osmolality, turbidity, zeta potential, MDD and homogeneity. The co-administration of antiemetic drugs does not adversely affect lipid emulsion stability. This combination was consistently compatible during the evaluation period.

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“…Differences depend on the added drugs: Ondansetron [ 18 ] caused a decrease in absolute value zeta potential. Contrarily, adding sodium valproate [ 33 ] to the PNAs caused its increase.…”

Section: Discussionmentioning

confidence: 99%

Antiemetic Drugs Compatibility Evaluation with Paediatric Parenteral Nutrition Admixtures

et al. 2023

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“…While there are rare instances of intravenous lipid emulsion, use in clinical practice within intensive care units for acute valproate intoxications, limitations exist due to risks of incompatibility and drug interactions identified in certain studies [88]. Consequently, combined administration of sodium valproate and ILE via the same infusion line is not recommended.…”

Section: Effects Of Ile In Valproate Intoxicationsmentioning

confidence: 99%

Intravenous Lipid Emulsions in Anticonvulsants' Toxicity

Dimitrova,

Dragomanova,

Kehayova

2024

Preprint

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(1) Background: In recent years, an innovative approach has emerged in the field of toxicology for managing acute intoxications caused by lipophilic substances: intravenous lipid emulsions (ILE). Through numerous experiments and case reports, the efficacy of lipid emulsions in counteracting toxicities induced by lipophilic agents, including a significant number of antiepileptic drugs (AE), has become increasingly evident. (2) Methods: Data spanning a 10-year period (2010-2020) was analyzed by searching through multiple scientific publication platforms like PubMed, Science Direct, Research Gate, and Springer Link. The study focused on reviewing relevant case reports detailing successful Intravenous lipid emulsion (ILE) administration in pa-tients with acute intoxications with antiepileptics, specifically examining the impact of fat emul-sions on neurological status, Glasgow Coma Scale (GCS) scores, and corrected QT interval con-cerning hemodynamic instability. (3) Results: The typical symptoms of antiepileptic toxicity in-clude central nervous system depression, ataxia, and nystagmus. Intravenous lipid emulsion ap-plication resulted in an increase in Glasgow Coma Scale scores and enhanced recovery from drug intoxication. (4) Conclusions: This study provides a comprehensive overview of the potential utility of ILE as a component to antidote therapy in cases of acute AE poisoning involving neurotropic drugs. The process involves the engagement of various mechanisms of antitoxic activity.

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Compatibility studies of selected multichamber bag parenteral nutrition with fluconazole

Dettlaff,

Anglart,

Gruszczyńska

et al. 2024

Nutrition

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Sodium Valproate Incompatibility with Parenteral Nutrition Admixtures—A Risk to Patient Safety: An In Vitro Evaluation Study

Cited by 5 publications

References 52 publications

Antiemetic Drugs Compatibility Evaluation with Paediatric Parenteral Nutrition Admixtures

Antiemetic Drugs Compatibility Evaluation with Paediatric Parenteral Nutrition Admixtures

Intravenous Lipid Emulsions in Anticonvulsants' Toxicity

Compatibility studies of selected multichamber bag parenteral nutrition with fluconazole

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