Unlabeled uses of nebulized medications

Shirk, Mary Beth; Donahue, Kevin; Shirvani, Jill

doi:10.2146/ajhp060015

Cited by 31 publications

(18 citation statements)

References 70 publications

(77 reference statements)

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“…CMS is also being increasingly used via inhalation to treat infections of patients with ventilator-associated pneumonia caused by multidrug-resistant gram-negative bacteria (12,24,27). Administration of CMS via inhalation is not approved by the FDA (30) but is common in CF clinics and intensive-care units throughout the world (9,(12)(13)(14)27). The solution that is administered via nebulization to the lungs is either a solution made by reconstitution of the lyophilized parenteral formulation or a solution prepared by a hospital pharmacy department or other manufacturer specifically for inhalation that contains CMS at a concentration in the range of 40 to 200 mg/ml.…”

mentioning

confidence: 99%

Stability of Colistin Methanesulfonate in Pharmaceutical Products and Solutions for Administration to Patients

Wallace

Rayner

et al. 2008

Antimicrob Agents Chemother

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Colistin methanesulfonate (CMS) has the potential to hydrolyze in aqueous solution to liberate colistin, its microbiologically active and more toxic parent compound. While conversion of CMS to colistin in vivo is important for bactericidal activity, liberation of colistin during storage and/or use of pharmaceutical formulations may potentiate the toxicity of CMS. To date, there has been no information available regarding the stability of CMS in pharmaceutical preparations. Two commercial CMS formulations were investigated for stability with respect to colistin content, which was measured by a specific high-performance liquid chromatography method. Coly-Mycin M Parenteral (colistimethate lyophilized powder) was stable (<0.1% of CMS present as colistin) for at least 20 weeks at 4°C and 25°C at 60% relative humidity. When Coly-Mycin M was reconstituted with 2 ml of water to a CMS concentration of 200 mg/ml for injection, Coly-Mycin M was stable (<0.1% colistin formed) for at least 7 days at both 4°C and 25°C. When further diluted to 4 mg/ml in a glucose (5%) or saline (0.9%) infusion solution as directed, CMS hydrolyzed faster at 25°C (<4% colistin formed after 48 h) than at 4°C (0.3% colistin formed). The second formulation, CMS Solution for Inhalation (77.5 mg/ml), was stable at 4°C and 25°C for at least 12 months, as determined based on colistin content (<0.1%). This study demonstrated the concentration-and temperature-dependent hydrolysis of CMS. The information provided by this study has important implications for the formulation and clinical use of CMS products.

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mentioning

confidence: 99%

Stability of Colistin Methanesulfonate in Pharmaceutical Products and Solutions for Administration to Patients

Wallace

Rayner

et al. 2008

Antimicrob Agents Chemother

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“…The unlabeled use of aerosolized medications is increasing, often without previous study, 125 and it is important to recognize that aerosolization may change not only drug onset and effect but also dose. Some drugs may lose activity when nebulized, particularly with certain nebulizers, and actual delivered dose may fall short of that intended.…”

Section: Discussionmentioning

confidence: 99%

Aerosolized Surfactants, Anti-Inflammatory Drugs, and Analgesics

Willson

2015

Respir Care

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Drug delivery by aerosol may have several advantages over other modes, particularly if the lung is the target organ. Aerosol delivery may allow achievement of higher concentrations while minimizing systemic effects and offers convenience, rapid onset of action, and avoidance of the needles and sterile technique necessary with intravenous drug administration. Aerosol delivery may change the pharmacokinetics of many drugs, however, and an awareness of the caveats of aerosolized drug delivery is mandatory to ensure both safety and adequate drug delivery. This paper discusses the administration of surfactants, anti-inflammatory agents, and analgesics by the aerosol route.

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“…Studies on the use of nebulized lidocaine exist in the adult population, but they are limited and contradictory. The limited research examines the use of nebulized lidocaine for the management of cough and asthma symptoms and as an anesthesia for bronchoscopy [4].…”

Section: Discussionmentioning

confidence: 99%