The Stability of Amikacin, Gentamicin, and Tobramycin in Total Nutrient Admixtures

Abstract

Amikacin (A), gentamicin (G), and tobramycin (T) were added to eight different total nutrient admixtures (TNA) with varying concentrations of dextrose, amino acid, and fat emulsion to determine drug and emulsion stability. All TNA were prepared aseptically and stored at room temperature under normal room lighting for 12 hr before drug addition. One volume of each drug was added to an equal volume of each of the eight TNAs to simulate 1:1 piggyback contact volumes. Samples were left at room temperature for 6 hr. Drug concentrations were analyzed by fluorescence polarization immunoassay. TNA/drug admixtures were pH tested and visually inspected before and after centrifugation in microhematocrit tubes, noting signs of emulsion stability at 1 and 6 hr. Emulsion particle size was determined at 1 and 6 hr using interference contrast microscopy. All three drugs retained their immunoreactivity in all TNAs for at least 6 hr. G and T were stable in all eight TNAs for at least 6 hr with no significant effect on emulsion particle size or stability after centrifugation. A was incompatible with all eight TNAs, resulting in visual breaking of all emulsions within 1 hr. Therefore, G and T, but not A, can be administered via piggyback method with the eight TNAs tested if the infusion is completed within 6 hr.

Physicochemical stability and compatibility testing of levetiracetam in all-in-one parenteral nutrition admixtures in daily practice

“…There are many studies on the compatibility and stability of different medications that are admixed in PN [8][9][10][11]. However, most of these investigations are older (>10 years) and are done with analytical methods and techniques, not more state of the art.…”

Physicochemical Stability and Compatibility Testing of Voriconazole in All-in-One Parenteral Nutrition Admixtures

“…Published data on stability of different medications admixed to AiO PN are frequently based on older analytical methods and techniques that no longer comply with the state-of-the-art requirements mainly based on mass spectrometry (MS) analysis [ 13 , 14 , 15 , 16 , 17 ]. Therefore, simple UV–spectrophotometric detection measures are less and less used, and the increased emergence of therapeutic drug monitoring (TDM) methods available in larger medicinal laboratories with MS detection enable faster and more specific substance characterization and quantification.…”