Typically, these reactions are detectable through a visual check. The Department of Health advises prescribers and those administering injections to check with a pharmacist, or other authoritative source, about whether it is safe to mix injectable medicines [1]. Mixing medicines is often necessary, such as when patients are on multiple infusions, but must only occur when it is essential to meet the needs of the patient. Although the causes of incompatibility reactions are mostly as a result of active drug reactions, occasionally incompatibility between the excipients in various parenteral presentations may also occur. This effect is often not visible, and a clear, colourless fluid free of precipitation is not definitive proof of compatibility between two or more substances [2] , [3]. Propofol is formulated as a lipid.

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Syringe Driver Drug Compatibility | MIMS online

Avoid electrolyte solutions e. Subscribe to our free alerts.

Changes in concentration can affect the compatibility of some drug combinations i. Integrated Pharmacy Case Studies Over 90 case studies based on real life patient-care scenarios.

Those prescribing medicines intended to be mixed should provide instructions on how to do so in writing and must satisfy themselves that the persons doing the mixing are competent to undertake the task safely and effectively. The creation of gas is a normal part of the reconstitution of some drugs, particularly those made with sodium carbonate as an excipient upon reconstitution, these formulations can generate carbon drygs. When it is mixed with too much lidocaine, the fat droplet size increases considerably and layering occurs fat and aqueous components of an emulsion separate over time into two distinct layers.

Mixing medicines: how to ensure patient safety

However, the creation of extensive amounts of incompatjble can be hazardous. Cookies are small text files stored on the device you are using to access this website. In-line filters are required for certain medicines e. Although the causes of incompatibility reactions are mostly as a result of active drug reactions, occasionally incompatibility between the excipients in various parenteral presentations may also occur.


Latest views Mark Lyonette: To find relevant articles please visit here to pick a cluster. Guidance for students or researchers undertaking a multi-centre research project in health drugw, medicines use and professional practice. Handbook on injectable drugs. This is a weak base, but is formulated at an acidic pH of 2. Healthcare professionals are often required to mix medicines together before administration to a patient.

This is caused by lidocaine disrupting the surfactant properties of the propofol vehicle [6]. Phenytoin is a weak acid and is formulated for use in intravenous preparations as a phenytoin sodium salt, with the solution adjusted to a highly basic pH of Seek advice about the compatibilities of the drug that is to be mixed.

Syringe Driver Drug Compatibility

Typically, the buffer capacity of the diluent solution will allow it to resist any small changes to the pH when the drug is added to the infusion bag or other vehicle syrings administration. It needs to be administered diluted at least fourfold to prevent precipitation. Incompatibility poses a constant risk when mixing parenteral medicines but it can be avoided by understanding the chemical reactions taking place.

Syringes are generally PVC-free and are more suitable for use with drugs that are susceptible ihcompatible adsorption. When erythromycin is reconstituted, it is degraded by hydrolysis and will lose potency after eight hours. Commonly used solvents include polyethylene glycol, propylene glycol, ethanol and glycerine [9].


The legal position with regards to mixing parenteral injections in clinical practice in the UK incompatjble documented in guidance from the Department of Health. However, this lack of reporting may be because the adverse effects caused by drug incompatibilities are difficult to identify in patients who are already seriously ill [2][3]. Now available as a 2 year print subscription to both the BNF and BNFC, ensuring you have the latest medicines information as it publishes and at a greatly reduced price.

Alcohol or lipid solvents are water-miscible organic solvents used to improve the solubility of poorly drgs soluble drugs. Over 90 case studies based on real life patient-care scenarios.

Mixing medicines: how to ensure patient safety | Learning article | Pharmaceutical Journal

However, there incompagible situations when there is syringr clinical need to mix medicines, such as when a patient is on multiple drug infusions and there is limited parenteral access, the patient has been placed on fluid inocmpatible in palliative care, and when there is an urgent clinical need for multiple medicines to be administered within a short space of time.

It also stipulates that the mixing of medicines should: Mixing of medicines prior to administration in clinical practice: Optimise drug therapy for your patients. You will be re-directed back to this page where you will have the ability to comment. According to its manufacturer, phenytoin sodium can be added to sodium chloride for infusion, but administration should start immediately after preparation and must be completed within one hour.