PRINTER-FRIENDLY VERSION AVAILABLE AT PHARMACYPRACTICENEWS.COM
Compatibility of
Commonly Used IV Drugs
ll
A
LISA CAYO, PHARMD
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Co
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Clinical Pharmacy Coordinator
Garden City Hospital
Garden City, Michigan
T
he number of available IV medications continues to
expand. Many institutions have observed an increase in
patient acuity and a rise in the number of medications
administered to each patient. This increases the likelihood that
multiple IV medications will need to be administered concurrently.
medication is combined or added to an IV fluid. It is
important to recognize that compatibility is not just
a function of the drugs themselves, but also can be
dependent on a variety of factors including the concentration, temperature, storage vehicle, infusion solution,
order of mixing, and administration technique. Compatibility differences even have been reported for different
brands of the same drug.
Three types of incompatibilities are commonly discussed: physical, chemical, and therapeutic. Physical
d.
These factors contribute to the escalating complexity of IV drug administration and have resulted in an
ever-increasing number of possible incompatibilities.
The potential for serious and life-threatening adverse
drug events exists when incompatible medications are
infused together. Therefore, it is important to verify drug
compatibility prior to coadministration. A clear and concise compatibility chart can be a useful tool in helping to
deliver safe, high-quality IV therapy to patients.
A chance of incompatibility exists whenever any
Text continues on page 46
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
P H A R M AC Y P R AC T I C E N E WS S P E C I A L E D I T I O N • 2 0 1 3
39
A
Amiodarone
N C
ll
C
N
I
C C C C C
s
Anidulafungin
Azithromycin
Aztreonam
Bivalirudin
Bumetanide
C N C
I
N
I
N
I
N
C C N C N C N N
Ceftaroline
Ceftazidime
Ceftizoxime
Ceftriaxone
Ciprofloxacin
Cisatracurium
Clindamycin
Daptomycin
Dexamethasone
Dextrose 5% in water
Dexamethasone
I
C C C Acyclovir
I
C C C C C C N C N Amiodarone
C N
I
I
C C C C C
I
C C
C C C N N C C C C C C
I
C N C
I
Ampicillin
C C C N C
I
I
I
I
N C C C C C
I
N
I
I
I
C C N C C C C C C C C C C Argatroban
I
C N
N C C C C C Cefepime
I
C N N C C C C C Cefoxitin
C N
I
I
N N N C C C N C N C Ceftaroline
C C C N C C C C C Ceftazidime
N C
C N N C C C C C Ceftizoxime
C N C C N C C
N C
I
C C C C Ceftriaxone
C
I
C
N N C C N N
N C C N N C C N C C C C C C N N N N C N N C C
I
S N C C C N C C C C
I
C C C C C C C
I
I
I
I
C C C C C C C C
I
I
C
C C C C Clindamycin
C C
C C C
C C C C C C C C C C C C C C C C C C N C C C C C C C C
C C N
A C C C C C C C C
I
C C C C C C C C C C C
N C C N N C C C C C C C C C C
I
I
I
Daptomycin
C C Dexamethasone
D5W
I
C C Ciprofloxacin
C C C C C Cisatracurium
C C C C N C C C C C C C C C C C C N C C C C C C
C C N N N C C C C C C C
Caspofungin
N C
I
C C C
I
C N N C C C C C Cefotaxime
C N
I
C
I
I
C C C N C C N A C N
I
I
I
C C C N N C C C C C C C C C C N
I
C
N N N N N N
N
C C
N C N
C C Calcium gluconate
I
C N C C C N N C C C C C Cefazolin
C N C
I
I
C C
I
N N N N
I
A C C C
N
I
C C C N N C C C N C C C
C
I
I
I
N C C C C
I
I
I
C C C N N N N N C N N C C
I
C C C N C C C C C Atracurium
I
C C N N N C C C C C C C C
N N C C
I
C C C C C C C C
C C
C C N N N C C C N C C C C
H N N C C
I
C C C C N C C C C C C C C C C Bivalirudin
I
I
N N C N C A Ampicillin-sulbactam
C C C C C C C C C C N C C C C C C Bumetanide
C C N N N C C C C C C C C
I
I
C C C C C C C C N C C C C C C C C C C Aztreonam
C C C C C C C
I
N C N N N N N N
N C C C N C C N C C N C N N C N C C C C Azithromycin
C N N N C C C N
C C
I
Dexmedetomidine
Diltiazem
Dexmedetomidine
Daptomycin
Cisatracurium
N C
Clindamycin
Ciprofloxacin
Ceftriaxone
Ceftizoxime
Ceftazidime
Ceftaroline
Cefoxitin
Cefotaxime
Cefazolin
Cefepime
Caspofungin
I
N N N N N N N N N N S
C C C C C C C N C C N
C C C N N C C C C C C C
Cefoxitin
I
C C C C C C C C
C C C N N C C
N C C
Cefotaxime
C C C C C C
C C C C C C C C C C C C N C C C C C C N C C C Anidulafungin
C C N C C C
Caspofungin
Cefepime
I
C C C N N N N C
Calcium gluconate
Cefazolin
Calcium gluconate
Bivalirudin
Bumetanide
Aztreonam
Azithromycin
C C C N C
N C C N C N C N N
I
Atracurium
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C N N
Ampicillin-sulbactam
Argatroban
Atracurium
C C C C
Argatroban
Anidulafungin
Ampicillin
I
(Acyclovir through Dextrose 5% in water)
C N N C C C N C C C C C C H C C C C C C N C C C C C C Amikacin
Co
rig
Ampicillin
Amiodarone
C N C
Amikacin
Ampicillin-sulbactam
Acyclovir
Amikacin
Acyclovir
Table. Compatibility of Selected IV Drugs
C Dexmedetomidine
C C
D5W
C C C C C C C C C C C C C Diltiazem
Diphenhydramine
N C N
I
N C C C C N C C C C
I
I
I
I
C
C
I
C C C C
I
C C Diphenhydramine
Dobutamine
I
C C
I
N C C C C C N N N C
I
N
I
I
N N C
I
C C C C
I
C C Dobutamine
I
C C
I
N C C C C C C C C C
I
N C C C C C C C C C C C C C Dopamine
Dopamine
Doripenem
Doxycycline
Enalaprilat
Epinephrine
Eptifibatide
Esmolol
Famotidine
I
C C C N N C N N C N N C C C N N N N C N N N C N N C C N C Doripenem
C C C
I
I
C C C C C C C C C
C C N N N C C C C C C C C
I
I
N C
C
I
I
N
I
I
C N C C C
I
C C Doxycycline
C C C C C C N C C C C C C Enalaprilat
I
C C N N C C C C C C C C C C N C C N C C C N C C C C C C Epinephrine
I
C N C C C C C C C C C C N C C C C N C C C C C C C C N N Eptifibatide
I
C C N N C C C C C C C C C C N C C N C C C N C C C
C C C N N C C C N C C C C C N
I
I
C C Esmolol
C N C C N N N C C C C C C Famotidine
d.
KEY
A = Physically compatible for at least 2 hours
H = Physically compatible for at least 1 hour
C = Physically compatible
I = Incompatible
D = Physically compatible in dextrose 5% in water
N = Information on compatibility is not available or not adequate
E = Physically compatible for at least 5 minutes
R = Physically compatible for 24 hours under refrigeration
G = Physically compatible in glass bottle only
S = Physically compatible in 0.9% sodium chloride
40
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
Fentanyl
Dextrose 5% in water
Dexmedetomidine
Dexamethasone
Daptomycin
Clindamycin
Cisatracurium
Ciprofloxacin
Ceftriaxone
Ceftizoxime
Ceftazidime
Ceftaroline
Cefoxitin
Cefotaxime
Cefepime
Cefazolin
Caspofungin
Calcium gluconate
Bumetanide
Bivalirudin
Aztreonam
Azithromycin
Atracurium
Argatroban
Anidulafungin
Ampicillin-sulbactam
Ampicillin
Amiodarone
(Acyclovir through Dextrose 5% in water)
C C N N N C C C N C C C C C C N C C C C C C N C C C C C C Fentanyl
A
C C C
Furosemide
C C N S N C C
ll
Fluconazole
s
Hydrocortisone
Hydromorphone
N C C
I
I
N C C C C C C C N C C C N C C N C N C C N C C C C Fluconazole
I
N C C C C
I
C C C C C C C C
C
I
I
S N C C N C C C C C
C C N N
I
I
C C C C C C C N C C C C C C C C C
I
C C C C C C Hydrocortisone
C C N N C C C C C C C C C C N C C C C C C C C C C C C C C Hydromorphone
C N C N N C C N N C C C C C C H C
Lorazepam
C C Gentamicin
N C C C C C Heparin
C C
Linezolid
I
I
Insulin, regular
Levofloxacin
N C C C C C Furosemide
C C C C C C C C
Imipenem-cilastatin
Labetalol
I
N C C C N C C C C C N N N C C N C N C C C C
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Heparin
Co
rig
Gentamicin
I
N N C C C N N C C N C C C C C N C C
I
C C N N C C C C C C C C C N N
I
C
I
C C C C C N C C C C C
I
I
I
N C C
I
C C N Imipenem-cilastatin
C C C C N N C C C C C Insulin, regular
I
I
I
C N
I
C C C C N C C C C C C Levofloxacin
C C
I
N N N C
I
C C Labetalol
C C C C C C C C C C C C C C C C C C N C C N C C C C C C C Linezolid
C C C
I
I
C C C C
I
I
C C C N C C C C C C C C C C C C C C N Lorazepam
Magnesium sulfate
C C N N N
C C C C C C N C N
I
C C N C C
Mannitol
C C N C N C C C C C C C C C C
I
C C C C C C N C C C C C N Mannitol
Meropenem
C C C N
Metoclopramide
N C N N N C C C C C C C C C C
Micafungin
Midazolam
Morphine sulfate
Nicardipine
Nitroglycerin
Nitroprussidea
Norepinephrine
Octreotide
Ondansetron
Palonosetron
Pantoprazoleb
Penicillin G
Phenylephrine
Phenytoin
I
I
C C C
I
C C Magnesium sulfate
N N N N N C C N C N C N N C N N N N N N N N N N N C C C
Methylprednisolone
Metronidazole
I
C C C C C C C
C C C C C C C C C
N N
I
I
C C
I
I
I
C C
I
I
I
C C C C
I
I
C C C
I
C C N C C C
I
Meropenem
C C C C C C C C C C C C C Metoclopramide
C C C N C C C C C C C C C C C
N N N N N N N N C C N N N N N N N N N N
I
I
N C C C C N Methylprednisolone
C C C
I
I
I
C C N Metronidazole
N N N N C Micafungin
C C C C N C
I
C C Midazolam
N C C N N C C C N C C C C C C N C C C C C C N C C C C C C Morphine sulfate
I
C C
I
I
C C C
I
C C C C C C N C C N N C N C C N C
C C C N N C C C C C C C C C C N C C N C C C N C C
I
C N N N C C N C C C C C
I
C N C C N
I
I
I
C C Nicardipine
C C G Nitroglycerin
C C N N C C C C C Nitroprussidea
N C N N N C C C N C C C C C C N C C C C C C C C C C C C C Norepinephrine
C C C C C C C C C C C C C C C C C C N C C C C C C C C C C Octreotide
I
C N
I
C C C C C C C C C C C C C C C C C N C C C C C C C C C C Palonosetron
I
I
C C C C C C C C C C
N N N C C C C
I
C
I
N C N N N
I
I
C C C N C N C C C C C C C Ondansetron
I
N C N C C
I
I
N
I
I
I
C Pantoprazoleb
C C C C N N N C N C N C C N C N C C N C C C N N C N C N C Penicillin G
I
C C N N C C C C C C C C C C N C C N C C C N C C C C C C Phenylephrine
I
I
N
I
I
I
I
I
I
N
Piperacillin-tazobactam
I
C
I
N N C C N N C C C C
I
N C N N N N N N
I
N C C C C C Piperacillin-tazobactam
Potassium chloride
I
C C C N N C C C N C C C C C C C C C C C C C C C C C C C C Potassium chloride
N N
I
I
I
I
I
I
I
I
C N C N C N N
I
I
I
I
N N N N
N
I
I
I
I
I
I
I
I
Phenytoin
Potassium phosphate
I
N
I
N N N
I
N N C N C C Potassium phosphate
Propofol
C
I
N C N N N N N C N C C N C N C C C N C C
I
N C N C C C Propofol
Ringer’s, lactated
C C N N R N C
I
C C N C C C C N C C C C C
Sodium bicarbonate
C C
I
C C C C
Sodium chloride 0.9%
C C N C C C C C C C C C C C C C C C C C C C C C C C C C C Sodium chloride 0.9%
I
I
I
N
I
C
I
I
C C
C C N N C C C C C C C C C C
I
I
C
I
C C C C
I
N C C C C C Sodium bicarbonate
C C N C C Ringer’s, lactated
C C N C C C C C C C C C N Tacrolimus
Tigecycline
C C
Tobramycin
C C C N N C C C N C C C C C N N C C C C C
I
C C N C
TMP-SMX
C
I
N N
Vancomycin
C C C N N C C C C N
Vasopressin
C C C N N C C C C C C C C C C C C C C C C C C C C C C C N Vasopressin
I
I
I
I
d.
Tacrolimus
a
Amikacin
Acyclovir
Table. Compatibility of Selected IV Drugs
N
C C N C C C C C C C C C C C C N C C C C C C C C C C Tigecycline
I
I
C C N C N C
I
I
C C Tobramycin
I
C
I
C N TMP-SMX
C C C N N N N N N N N N C C
I
N C C Vancomycin
I
I
I
I
C
I
I
C
I
I
Vecuronium
I
C C C C C C N C C C C C C C
I
I
Voriconazole
C C C C C C C N C C C C C C C
I
C C C C C C C C C C C C C Voriconazole
C N C C C C N C C C C C Vecuronium
Protect from light. b Testing was performed with ethylenediaminetetra-acetic acid (EDTA)-free formulation.
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
41
A
ll
N N N N N C C
I
N
I
N N C N N N
I
S
I
I
C C
I
C C N N N C N Amiodarone
I
s
C C C C C C C C C C C C C C C C C C C C C C C C
Aztreonam
Bivalirudin
Bumetanide
Metoclopramide
N N
I
Anidulafungin
Azithromycin
Methylprednisolone
I
S
I
N C N N N Ampicillin
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C N C C C C N C N C C N C N C
N
Co
rig
C C C N C C C C C C N C C Amikacin
N N N N N
Atracurium
Meropenem
C C C C N C N Acyclovir
Mannitol
Linezolid
I
I
Ampicillin-sulbactam
Argatroban
Magnesium sulfate
Levofloxacin
I
Lorazepam
Labetalol
Insulin, regular
Imipenem-cilastatin
Hydromorphone
Hydrocortisone sod. succ.
C C C C N C C C C C
Heparin
I
Gentamicin
Famotidine
I
Furosemide
Esmolol
Fluconazole
Eptifibatide
I
Fentanyl
Epinephrine
C C C
Enalaprilat
I
Doxycycline
Doripenem
I
(Diltiazem through Metoclopramide)
C C C C C C C C C C C C C C C
Amiodarone
Ampicillin
Dopamine
N N
Amikacin
Dobutamine
Acyclovir
Diphenhydramine
Diltiazem
Table. Compatibility of Selected IV Drugs
I
N N C N N N N N N N
I
C N N N C C
I
N N N
I
I
N Ampicillin-sulbactam
C C C C Anidulafungin
C C C C N C C C C C C C C C C C C C C C C C C C C C C C C Argatroban
C C C C N C C C C C C C C
I
C N C C C N C C C C C C N C C Atracurium
C C C C C C C C C C N N C N N C C C N N C N C C C C C C C Azithromycin
C N C C N C C C C C C C C C C C C C N C C C C
I
C C N C C Aztreonam
C C N C N C C C C C C C C C C C C C C C C C C C C C C C C Bivalirudin
C C N C C C C C C C C C C C C C C C C C C C C C C C N C C Bumetanide
Calcium gluconate
C C N C C C C C C C C C N C C C N C N C C C C C N C N
I
C Calcium gluconate
Caspofungin
C C C C C C
I
I
C Caspofungin
C
I
I
C C C C N C C C N C C N C C N
I
I
N N N N
C
I
I
C N C C C C C C C N C N C C C C C
I
C
I
I
C N
I
C C N C C N C N N N C C C C C C C C N C
Cefazolin
Cefepime
Cefotaxime
Cefoxitin
Ceftaroline
Ceftazidime
Ceftizoxime
Ceftriaxone
Ciprofloxacin
Cisatracurium
Clindamycin
Daptomycin
C
N
I
I
I
N C N
I
I
C
I
C C C C C C C N C C C
I
C C N C N C C Cefazolin
N C C N C C C C H N C C C
C C C C N C C C C C C C C
I
I
N C
I
Cefepime
N C C C C N
I
C Cefotaxime
I
I
I
C Cefoxitin
I
C N C N C N C C Ceftaroline
C C C C N
N C N
I
C C C C C C N C N C C C C C C C C C C C N C C Ceftazidime
C C C C N
I
C C C C N C C C C C C C C C C C C C C C N C C Ceftizoxime
C
I
I
C N C C C C
I
I
C N C C C C C N C N C N C C C
C C C C C N N N C N N N C
I
C
I
I
C N C
I
C N C C Ceftriaxone
C N N N N C C
I
C
I
I
N N
I
C Ciprofloxacin
C C C C N C C C C C C C C N C N C C C N N C C C C C N N C Cisatracurium
C C C C N C C C C C C C N C C C C C C C N C C C C C N C C Clindamycin
C C C C C C C C C C C C C C C C C C
Dexmedetomidine
C C C C N C C C N C C C C C C C C C C C C C C C C C C C C Dexmedetomidine
D5W
C C C C C C C C N C C C C C C C C C N C C C C N C N
Epinephrine
Eptifibatide
Esmolol
Famotidine
I
C C C C
I
C C C C C
I
C C C
I
C C C C Dexamethasone
I
N C D5W
C C C C C C C C C C C
I
C N N C C
C C
Enalaprilat
C C C
C N N C C N C C C C C C C N C Diltiazem
C
Doxycycline
I
I
Dobutamine
Doripenem
C C
C C C C C C C C C C C C
Diphenhydramine
Dopamine
I
C C C C C C C C C C Daptomycin
C
Diltiazem
I
I
Dexamethasone
C C C C C C C C C C N C N
C C C
I
I
C C C C C C C
I
C Diphenhydramine
C N N C C C C N C C C C Dobutamine
C C C C C C C C C N C C C C C N C C C C C C C C C Dopamine
C C C C
N C N N C C C C C C C C C N C C C C C C C N C C Doripenem
C C C C N
C C C C C C C
C C C C C C
I
C
I
I
C C C C C C C C C N
I
C Doxycycline
C C C C C C C C C C C C C C C C C C C C C C Enalaprilat
C C C C N C C
C C C C C C C C C C C N C C C C C C N C C Epinephrine
C C C C N C C C
C C C C
I
C C C C C N C C C C C C C C C Eptifibatide
C C C
I
C C N C C C C C C C C C N N C Esmolol
C C C C C C C C C
C C C C C C C C C C
C C N C C C C C N C C C C C C N C C Famotidine
d.
KEY
A = Physically compatible for at least 2 hours
H = Physically compatible for at least 1 hour
C = Physically compatible
I = Incompatible
D = Physically compatible in dextrose 5% in water
N = Information on compatibility is not available or not adequate
E = Physically compatible for at least 5 minutes
R = Physically compatible for 24 hours under refrigeration
G = Physically compatible in glass bottle only
S = Physically compatible in 0.9% sodium chloride
42
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
Fentanyl
C C C C C C C C C C C
A
Furosemide
I
ll
C C C C C C C C C C C C
s
Hydrocortisone
Hydromorphone
I
C C
I
I
C C C C C C C C C C C C C
I
I
N N N C C
I
C C C C C C C C
N N
I
C C C N C C C C N N
I
C C
I
C C C
C C C C C C C C C C C C C C C C C
I
I
I
C C C C C C C C C C C C C
C C C N C
I
C C
I
C C C C C C C C C C C C C N C N
C
I
I
I
N C C Imipenem-cilastatin
C N N C N C C Levofloxacin
C C C C C C Linezolid
C C N C
C C C C C Lorazepam
Mannitol
C C C C C C C C C C C C C C C C C C
I
C
C C C C C N C C Labetalol
C C C C C C C C C C C C C C C C C C C C C C
C C C C C C C C C C C C C C C C C C
I
N C C C C C C C Insulin, regular
C C N C C C C C C C C C C N C C N C C C C N C C
C C
C C C C C C
I
I
C C C C N N C N C N N N C C C C N C N C N N C C C
I
N
C N
Metoclopramide
C C C C C C C C C C C C C N C C C C C C C C C C C C C C
Micafungin
Midazolam
Morphine sulfate
Nicardipine
Nitroglycerin
Nitroprussidea
Norepinephrine
Octreotide
Ondansetron
Palonosetron
Pantoprazoleb
Penicillin G
Phenylephrine
I
C C C
I
C C C N C C C C C N N C C C C C C C
I
C Magnesium sulfate
C C Mannitol
Methylprednisolone
Metronidazole
Metoclopramide
Methylprednisolone
Meropenem
Mannitol
C C C C C N C Heparin
C C C C
N N C C C N N C N C C N N C C C C
I
I
C C C N C N N C Hydrocortisone
Magnesium sulfate
Meropenem
Magnesium sulfate
Lorazepam
Levofloxacin
Linezolid
C C N C C C N Furosemide
C C C C C C C C C C C Hydromorphone
N
Lorazepam
Labetalol
N C C C N
Insulin, regular
Linezolid
I
N C C N C C C C C C C C C Gentamicin
C C N C N C C C C C C C N C C C C C
Levofloxacin
Insulin, regular
C C C C N N
I
Imipenem-cilastatin
Labetalol
Imipenem-cilastatin
Hydromorphone
Hydrocortisone sod. succ.
Heparin
Gentamicin
Furosemide
N C C C C N C C C C C C C C C C Fluconazole
N C N
ite
d.
ib
te
oh
no
pr
e
is
is
rw
on
si
he
is
ot
m
er
ss
le
tp
un ou
up
ith
ro
w
G
rt
ng
pa
hi
in
is
bl
or
Pu
le
ho
on
ah in w
cM
n
M
tio
13
uc
20
od
©
pr
ht
Re
rig ed.
py
rv
se
re
ht
Heparin
Co
rig
Gentamicin
N N C
(Diltiazem through Metoclopramide)
C C C C C C C C C C C C C C N C C Fentanyl
Fluconazole
I
Fluconazole
Fentanyl
Famotidine
Esmolol
Eptifibatide
Epinephrine
Enalaprilat
Doxycycline
Doripenem
Dopamine
Dobutamine
Diphenhydramine
Diltiazem
Table. Compatibility of Selected IV Drugs
N C Meropenem
C Methylprednisolone
Metoclopramide
C C C C C C C C C C C C C C C C C C C C C C C C C C C C C Metronidazole
I
N
I
C C N N
I
C C N N N C N C N C N
C C N C C C C C C C C C C
I
I
I
I
N C C N N N N Micafungin
C C N C N N C C C C C C N N C Midazolam
C C C C C C C C C C C C C N C N C C C N C C C C C C C C C Morphine sulfate
C C C C N C C C C C C C C
I
C N C C
I
N C C C N C C
I
C C Nicardipine
C C C C N C C C C C C C C N C C C C C C C
I
C C C C N C C Nitroglycerin
C
I
C C C C N C C Nitroprussidea
I
N C N C C C C C C C C C C C C C N C C
C C C C C C C C N C C C C N C C C C C N C N C C C C C C C Norepinephrine
C C C C N C C C C C C C C C C C C C C C C C C C C C C C C Octreotide
C C C C C C C C C C C C C
C C C C N
I
I
I
I
N C C N N N
C C
I
C N
I
I
C C C C C N C C C
C C C C C C C C C C C C
I
I
I
I
I
I
C C N N C Ondansetron
C C C C C C C C N C Palonosetron
N N N N N C N
I
I
I
I
N N
I
I
N Pantoprazoleb
C C N C C C C C C C C C C C N C N N C C N C C Penicillin G
C C C C C C C C C C C C C N C C C C C
I
C C C C C C N C C Phenylephrine
I
I
I
I
N
I
I
I
I
I
I
I
Piperacillin-tazobactam I
C
I
C N
I
C C C C
C C C N C C C N
I
I
I
C C C C N C C Piperacillin-tazobactam
Phenytoin
Potassium chloride
I
I
N N
I
I
N
I
I
I
I
I
I
I
I
N
I
I
Phenytoin
C C C C C C C C C C C C C C C C C C N C C C C C C C N N C Potassium chloride
Potassium phosphate
C N
N
I
N C N C C C N N N N N N C N N C N C
Propofol
N C N N
I
I
C C N N C C C C C
I
C C C C C C
I
I
N N N N C Potassium phosphate
N C N C N
I
I
Propofol
Ringer’s, lactated
N C C C N N N C N C C C C C C N C C
I
N C N C N C N
I
N C Ringer’s, lactated
Sodium bicarbonate
N
I
C N C C C C C
I
C C Sodium bicarbonate
I
I
I
C
I
C
I
C C C C C C C C C
I
Sodium chloride 0.9% C C C C C C C C N C C C C C C C C C R N C C C N C N R C C Sodium chloride 0.9%
C C C C C C C C N C C C C N C C C C C C C C C C C C C C C Tacrolimus
d.
Tacrolimus
Tigecycline
C C C C C N C C C C C C C C C C C C C C C C C C C C C N C Tigecycline
Tobramycin
C C C C C C C C C C C C C C C
I
TMP-SMX
C
I
I
I
I
I
Vancomycin
C C C C C C C C C C C C C
I
C
I
N C N C C C C C C C C N C Vancomycin
Vasopressin
C C C C N C C C N C C C C N C C C C C N C C C C C C C C C Vasopressin
Vecuronium
C C C C N C C C C C C C C
Voriconazole
C C C C C C C C N C C C C C C C C N C C C C C C C C C C C Voriconazole
a
I
I
I
N
I
N
I
C N
I
I
I
N C C N C C C C C C N C C Tobramycin
C
C C C C
I
I
I
N C N C N
I
N
C C C C C C C C
I
I
I
TMP-SMX
C Vecuronium
Protect from light. b Testing was performed with ethylenediaminetetra-acetic acid (EDTA)-free formulation.
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
43
ll
A
I
C
I
C C C C C
I
C C N N
I
N N N N R N C N C N
Anidulafungin
C N C C C C C C C C C C N C
I
C C
s
C N
Atracurium
Azithromycin
Aztreonam
Bivalirudin
Bumetanide
I
C Acyclovir
C C C C Amikacin
C N C C C C Amiodarone
Ampicillin-sulbactam
Argatroban
I
Voriconazole
I
C C C C C C
TMP-SMX
Pantoprazoleb
C C C N
Tigecycline
Palonosetron
I
Tacrolimus
Ondansetron
Octreotide
N N N C
N C
I
N N C C Ampicillin
ite
d.
ib
te
oh
no
pr
e
is
is
rw
on
si
he
is
ot
m
er
ss
le
tp
un ou
up
ith
ro
w
G
rt
ng
pa
hi
in
is
bl
or
Pu
le
ho
on
ah in w
cM
n
M
tio
13
uc
20
od
©
pr
ht
Re
rig ed.
py
rv
se
re
ht
Co
rig
I
I
Vecuronium
C N C N
N
I
Vasopressin
N C
I
N C
Vancomycin
I
I
Tobramycin
Propofol
N N
N N N C N
C
Sodium chloride 0.9%
Potassium phosphate
I
I
I
Sodium bicarbonate
Potassium chloride
C C C C N N C N C N C C N
I
C N
N
Ringer’s, lactated
Piperacillin-tazobactam
C
Ampicillin
I
Penicillin G Potassium
Amiodarone
Norepinephrine
I
Nitroprussidea
C C C C
Nitroglycerin
I
Nicardipine
C
C C N
Morphine sulfate
I
I
C N
Midazolam
I
C N C C C C C C C C C N C C
Acyclovir
Micafungin
I
Amikacin
Metronidazole
Phenytoin
(Metronidazole through Voriconazole)
Phenylephrine
Table. Compatibility of Selected IV Drugs
I
N
I
N N N C
I
I
N N
I
I
N N C C Ampicillin-sulbactam
C C N C C C C C C Anidulafungin
C N C C C C C C C C C C N C
I
C C C N C C C C C C C C C C C Argatroban
C N C C C C N C C C C
C C
I
N C N N
C C N C C C C N C
I
N N C N C C C C C N C C C C C Azithromycin
C N
I
I
N
I
N C C C C C C C C C
I
I
I
I
C C C C N C C N N Atracurium
C C
I
C C N C C C C C C C N N C C C Aztreonam
C N C C C C C C C C C N N C
I
C C C N N C C C C C C
I
C C N C C C C C C C C C C C
I
C C N C C C C C C C
C C C C Bumetanide
I
C C C Bivalirudin
Calcium gluconate
C C C C C C C C C C C N C C
I
C C N C C
I
C C C C
I
C C C C Calcium gluconate
Caspofungin
N N C C C C
C C C C N N C
I
I
I
C C C C
I
C C C C Caspofungin
C N C C C C C C C C C N C C
I
N C C C Cefazolin
C N
Cefazolin
Cefepime
Cefotaxime
Cefoxitin
Ceftaroline
Ceftazidime
Ceftizoxime
Ceftriaxone
Ciprofloxacin
Cisatracurium
Clindamycin
I
C
I
N C
I
N C N C C C C C C N
C
I
N N
I
C C N N N C C
C N C C C C C C C C C
I
C C
I
N C N C C
I
C C C C
I
N C
C N C C C C C C C C C N C C
I
N C N C C
I
C C C C
I
N C C C Cefoxitin
I
N N N N N C
I
C N C C N N N C N C N C N N N N C
C N
C N C
I
C N C N C
I
I
I
C Cefotaxime
Cefepime
C C C C N N C C N C N C Ceftaroline
C C N C N C C
I
N C N N C C C C C C
I
C N C C C C C C C C C C C C
I
N C N C C C C C C C
I
N C C C Ceftizoxime
C N C C N C C C C N C C C C
I
N C N C
I
I
N C C C Ceftriaxone
C N C N C N N C C C C
I
N N
I
I
I
C
I
C
I
N C N N C N N
I
N C C C C N C C N C Cisatracurium
I
I
I
I
C C C C N C C C C
C C C C N N C C C Ciprofloxacin
I
C C N C C C C C C N
I
N C
I
C C C N C C C C C C C
I
C C C C C C
I
C C
I
C C N C N C C C C
N C C C Dexamethasone
Dexmedetomidine
C N C C C C C C C C C
I
N C
I
C C C C C C C C C C C C C C C Dexmedetomidine
D5W
N C C C C G C C C C C C C C
I
C C C C C C C N C C N C N C C D5W
C
Dexamethasone
Diltiazem
I
I
I
C C C C C
Daptomycin
C N N C N C C C C C C N C C
C
C C C C
N C C C Ceftazidime
N C C C
C N
I
I
C
I
I
C C C C C C C C C
I
I
C C C C
I
C C
I
C C N C C
I
C C C C
I
C C C C Diphenhydramine
N C C C N C C C C
I
I
C
I
I
N C
I
C C C C
I
C C C C Dobutamine
C C C C C C C C C C C N C C
I
C C N N C
I
C C C C
I
C C C C Dopamine
Dobutamine
C
Doxycycline
Enalaprilat
Epinephrine
Eptifibatide
Esmolol
Famotidine
C C C Daptomycin
C C
C N C C C C
Doripenem
I
C C C C Clindamycin
I
Diphenhydramine
Dopamine
I
I
I
I
C C N N N C C C C C C C C C Diltiazem
C
C C C C N N N C N C N C N C N N C
C N C C C C C C C C
C
I
I
I
N C C C C C N C N N C Doripenem
C
I
I
C N C C C C C C C C C N C C
I
C C C C N C C C C C N C C C C Enalaprilat
C
C C C C C C C C C N C C
I
C C N N C
C C C C C C C N C C C N N C
I
C C C N N C N N C C C C N C N Eptifibatide
I
I
I
C N C N
I
I
C C N C
C C C C
I
I
C C C C Doxycycline
C C C C Epinephrine
C C C C C C C C C C C
I
C C N C C C C C C C C C C N C C C C Esmolol
C N C C C C C C C C C
I
C C N
I
C C C C C C C C C
I
C C C C Famotidine
d.
KEY
A = Physically compatible for at least 2 hours
H = Physically compatible for at least 1 hour
C = Physically compatible
I = Incompatible
D = Physically compatible in dextrose 5% in water
N = Information on compatibility is not available or not adequate
E = Physically compatible for at least 5 minutes
R = Physically compatible for 24 hours under refrigeration
G = Physically compatible in glass bottle only
S = Physically compatible in 0.9% sodium chloride
44
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
C C N C C C C N C C
I
I
C N C C C C C C C C C N C C
I
N C N
I
C C C C Gentamicin
C C C C C C
I
Voriconazole
I
I
N
Vecuronium
Vasopressin
Tobramycin
Tigecycline
Tacrolimus
Sodium chloride 0.9%
Sodium bicarbonate
Ringer’s, lactated
Propofol
Vancomycin
I
Potassium phosphate
TMP-SMX
N C N C
Potassium chloride
Piperacillin-tazobactam
s
Hydromorphone
I
C Furosemide
ite
d.
ib
te
oh
no
pr
e
is
is
rw
on
si
he
is
ot
m
er
ss
le
tp
un ou
up
ith
ro
w
G
rt
ng
pa
hi
in
is
bl
or
Pu
le
ho
on
ah in w
cM
n
M
tio
13
uc
20
od
©
pr
ht
Re
rig ed.
py
rv
se
re
ht
Hydrocortisone
C N C N
Co
rig
Heparin
N
Phenylephrine
Phenytoin
ll
Gentamicin
I
Palonosetron
C C
Ondansetron
A
C C C C Fluconazole
Furosemide
Octreotide
C C C C Fentanyl
I
Norepinephrine
I
Nitroprussidea
C C N C C C C C C C
Nitroglycerin
I
C C N C C N C C C C C C C
Nicardipine
C C
I
Morphine sulfate
I
C N C C C C C C C C C
Midazolam
C N C C C C C C C C C
Fluconazole
Micafungin
Fentanyl
Metronidazole
Penicillin G Potassium
(Metronidazole through Voriconazole)
Pantoprazoleb
Table. Compatibility of Selected IV Drugs
C C C N N C C C C C C N C C
I
C C N C N C C C C
I
I
I
C N N C C C C C C C C N C C
I
C C N C C C C C C N
I
N C C C Hydrocortisone
C C C Heparin
C C C C C C C C C C C N C C
I
C C C C C
I
C C C C C C C C N Hydromorphone
Imipenem-cilastatin
C N N C
I
N N N C
I
R C C C
I
N C
Insulin, regular
C
I
N N N C C N C N C N C
I
I
C N C N C N C C N
I
C N C C Insulin, regular
C
I
C C C C C C C C C
I
N C
I
I
C C C C N C C C C N C C C C Labetalol
C
I
C C C
N C C C
I
C C
I
I
C N
C N C C C C C C C C C
I
N C
I
C C C N C C C C C C N C C C C Linezolid
C C C C N C C C C
I
Labetalol
Levofloxacin
Linezolid
Lorazepam
I
C N C C C
I
I
I
I
C Imipenem-cilastatin
N C C C C C C C C C C Levofloxacin
N C
I
C C
I
C C N N C C C C C C N C C C C Magnesium sulfate
Mannitol
C N C C C C C C C C C N C C
I
C C N C N C N C C C
C N C N C C C C C C C C Lorazepam
C C C C Mannitol
I
N N N N N N N
I
Methylprednisolone
C N N C C C C C C N N
I
C C
I
C N N
I
N C C C N C
I
N C
Metoclopramide
C N C C C C C C C C C N C C
I
C C C
I
C C C C C C
I
C C C C Metoclopramide
I
N C N C C C C C C C C Metronidazole
Micafungin
Midazolam
N C C C C C C C C C
N
I
I
C
I
Morphine sulfate
C
I
C
Nicardipine
C
I
C C
Nitroglycerin
Nitroprussidea
Norepinephrine
Octreotide
Ondansetron
Palonosetron
Pantoprazoleb
Penicillin G
Phenylephrine
Phenytoin
I
C C C
I
I
C C C
I
N C C N C N C C N N N N C
I
I
I
C C N N C C C C C C N C C C C Morphine sulfate
C C
I
C C C C Nitroglycerin
I
C C C C C C C C C C
I
C C C
C C C N C C
I
C C N C C
I
C C C C Norepinephrine
C C C C C C C
C C N N C
N
C N C C C C C C C N
N
I
N N N N
I
I
C C C N N C C C C C C C C C C Octreotide
C C C C C
I
N C
I
C C C C N C C C C C C C C C N Palonosetron
N C
I
N C
C
I
N C N N C N C C N C
I
N C N N Penicillin G
I
C C N N C C C C C C
I
I
I
I
I
I
Piperacillin-tazobactam C N
I
C
I
C C C C C C N N C
I
Potassium chloride
C C C C C C C C C C C C C C
I
Potassium phosphate
C C N N N N C N C C C
I
I
I
I
I
I
I
I
I
C C N C C C C C
I
C N C
I
C Piperacillin-tazobactam
C
I
I
N C C C C C C C
N
I
C C
Sodium bicarbonate
C N
I
C C
C N N C
I
C C N C N
Sodium chloride 0.9% N C C C C G C C C C C C C C
I
C C C N N C
I
C C N N C
C
I
C C C C Potassium chloride
I
N N N N N Propofol
N N N C C N C N C N Ringer’s, lactated
C C C C
I
N C C N Sodium bicarbonate
N N C N C N C C Sodium chloride 0.9%
I
C C C N N C N
C N C C
C C C C C C C N C
I
C C C C C C N C
Tobramycin
C N C C C C C C C C C N C C
I
I
C N
TMP-SMX
C N
I
I
C
I
Vancomycin
C N C C C C C C C C C N N C
I
N C N N C N C C C C
Vasopressin
C C C C C C C C C C C C C C
I
C C C N N C N C C C N C
Vecuronium
C
Voriconazole
C N C C C C
a
I
I
N N
I
I
I
C
I
C N
C C C C C C C C C
I
C C C N
I
C C N C C C C Tacrolimus
d.
C C C C C C C C C C C N C C
Tigecycline
I
Phenytoin
N C C C N N N C C C Potassium phosphate
N C N
I
Pantoprazoleb
C C C C Phenylephrine
I
I
Tacrolimus
I
I
I
I
I
I
I
I
G C C N C N C C C
C
C C C C Ondansetron
I
N
I
I
I
N C N C N C N N N C
N C N C
C
C C C C
I
I
N N N C N
N N N N C C C N C C N N N
I
Ringer’s, lactated
I
Nitroprussidea
I
I
I
I
I
I
I
Propofol
I
C C C C
C C
C C C C C C C C C C C C C
I
C N C C C C Nicardipine
I
N N C C C C C C N C N N
I
I
N Micafungin
C C C C N C C
I
C C
I
C C C C Midazolam
I
C C C C C C
I
I
C C N C G C G C C C
I
I
C C C C
I
I
C N N
I
C C C C C N C C
C
I
C N N N
I
C
I
I
C C
C C C C C C C
N
C Methylprednisolone
I
C C C C C C
C C C C C C
I
I
N C
C C C C C C C N C C
C C C C C
R C C N N C C C C Meropenem
N N N C
C C C C C C C C
I
I
I
N N C C N C
Metronidazole
I
I
I
I
C C C C C C C C C C C N C C
C N N C
C
C C C
Magnesium sulfate
Meropenem
I
I
C C C C C N Tigecycline
C C C C C
N N N
I
N N C
I
I
C C C C Tobramycin
I
I
N C C TMP-SMX
C C C Vancomycin
C C Vasopressin
I
N C
I
I
C C N C C C C C C C C C
I
N C
I
C C C N N N C C N C C C C C
C Vecuronium
Voriconazole
Protect from light. b Testing was performed with ethylenediaminetetra-acetic acid (EDTA)-free formulation.
I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G
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Text continued from page 39
ll
A
incompatibilities are the most easily detected and are
evidenced by visible changes, such as particulate formation, haze, precipitation, color change, and gas evolution. Chemical incompatibilities are those that result
in decomposition of a drug. Loss of potency of greater
than 10% over the defined testing period is considered
chemical incompatibility. Most chemical incompatibilities can be detected only with a suitable analytic
method. Therapeutic incompatibilities in which a drug
combination results in undesirable antagonistic or synergistic pharmacologic activity are beyond the scope of
most compatibility references.
The purpose of this chart is to provide data in an
organized, concise format from which compatibility
information can be accessed quickly and conveniently.
Although there are differing types of incompatibilities,
the type of incompatibility or compatibility is not specified in this chart. A designation of “compatible” indicates that the combination evaluated appears to be
compatible based on the tests performed, whether
these tests measured physical, chemical, or both types
of compatibility. All conditions that may affect compatibility cannot be included in such a format and it
is not possible to predict all incompatibilities that may
arise, but it is hoped that the information provided may
help clinicians minimize their occurrence. Continuing
research adding to the existing body of knowledge on
IV compatibilities is vital.
Suggested Reading
Bertsche T, Mayer Y, Stahl R, Hoppe-Tichy T, Encke J, Haefeli WE.
Prevention of intravenous drug incompatibilities in an intensive
care unit. Am J Health Syst Pharm. 2008;65(19):1834-1840.
Cohen MR, Smetzer JL. ISMP medication error report analysis-drug
stability and compatibility; proper use of single-dose vials; what
drugs are present on nursing units?; Arixtra—not a hemostat;
Pradaxa–Plavix mix-up. Hosp Pharm. 2012;47(8):578-582.
s
ite
d.
ib
te
oh
no
pr
e
is
is
rw
on
si
he
is
ot
m
er
ss
le
tp
un ou
up
ith
ro
w
G
rt
ng
pa
hi
in
is
bl
or
Pu
le
ho
on
ah in w
cM
n
M
tio
13
uc
20
od
©
pr
ht
Re
rig ed.
py
rv
se
re
ht
Co
rig
Kanji S, Lam J, Johanson C, et al. Systematic review of physical and
chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Crit Care Med.
2010;38(9):1890-1898.
DRUGDEX® System (Internet database). Greenwood Village, CO:
Thomson Reuters (Healthcare) Inc.
Nemec K, Kopelent-Frank H, Greif R. Standardization of infusion
solutions to reduce the risk of incompatibility. Am J Health Syst
Pharm. 2008;65(17):1648-1654.
Newton DW. Crux of drug compatibility and incompatibility.
Am J Health Syst Pharm. 2010;67(2):108-112.
Singh BN, Dedhiya MG, DiNunzio J, et al. Compatibility of ceftaroline
fosamil for injection with selected drugs during simulated Y-site
administration. Am J Health Syst Pharm. 2011;68(22):2163-2169.
Trissel LA, ed. Handbook on Injectable Drugs. 16th ed. Bethesda, MD:
American Society of Health-System Pharmacists; 2011.
Dr. Cayo reports no relevant conflicts of interest.
d.
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