Subcutaneous Dihydrocodeine Tartrate: Compatibility in a Syringe Pump With Other Drugs Frequently Prescribed for the Management of Symptoms Associated With Brain Tumors

2021 ◽  
pp. 082585972110527
Author(s):  
Ruth Isherwood ◽  
Amy Forsyth ◽  
Anne Wilson

Background Dihydrocodeine can be more effective in the management of headache due to brain tumor than other opioids. It can be used as a subcutaneous infusion, but at present, there is little available data to support its use in combination with other medicines in a syringe pump. Aim This project aimed to establish physical stability data for the use of dihydrocodeine with other drugs when combined in a syringe pump. Design: Dihydrocodeine was combined in a syringe pump with either cyclizine, midazolam, or hyoscine butylbromide at different doses chosen to represent routine clinical practice. Each drug combination was repeated twice—with 0.9% sodium chloride and with water for injections. Setting: The project was conducted in an independent hospice after seeking appropriate approvals to use the drugs for this purpose. Results Dihydrocodeine and midazolam appear compatible at when 0.9% sodium chloride is used as the diluent. Dihydrocodeine and cyclizine appeared compatible when either 0.9% saline or water for injections was used as the diluent. Dihydrocodeine and hyoscine butylbromide appeared compatible with either diluent at 24 hours. Conclusions Physical stability data has been described that will support the use of dihydrocodeine and other drugs that are commonly used to manage symptoms due to brain tumors at the end of life. This information will benefit patients and ensure that one syringe pump can be used where possible. Future work could expand on this data and explore the physical stability of three drug combinations in each syringe.

2003 ◽  
Vol 38 (2) ◽  
pp. 130-134
Author(s):  
Lawrence A. Trissel ◽  
Quanyun A. Xu

The objective of this study was to evaluate the physical and chemical stability of imipenem-cilastatin sodium 250 mg/100 mL and 500 mg/100 mL (of each drug component) admixed in 0.9% sodium chloride injection packaged in AutoDose Infusion System bags. Triplicate test samples were prepared by bringing the required amount of imipenem-cilastatin sodium injection to volume with 0.9% sodium chloride injection. A total of 100 mL of each of the test solutions was packaged in each of three ethylene vinyl acetate (EVA) AutoDose bags designed for use in the AutoDose Infusion System for each storage condition. Samples were protected from light and evaluated at appropriate intervals for up to three days at 23°C and 14 days at 4°C. Physical stability was assessed using a multistep evaluation procedure that included turbidimetric and particulate measurement in addition to visual inspection. Chemical stability was assessed with stability-indicating high performance liquid chromatography (HPLC) analytical techniques, based on initial drug concentrations and concentrations at appropriate intervals over the study periods. The admixtures were clear throughout the study when viewed in normal fluorescent room light and with a Tyndall beam. Measured turbidity and particulate content were low initially and exhibited little change throughout the study. HPLC analysis revealed extensive decomposition in the samples, with imipenem being the less stable component. The instability of the imipenem-cilastatin sodium admixtures is consistent with previous studies. Admixtures stored under refrigeration should be used immediately upon warming to room temperature due to the rapid rate of imipenem decomposition. The AutoDose Infusion System bags were not found to affect adversely or improve the physical and chemical stability of this drug.


2001 ◽  
Vol 36 (7) ◽  
pp. 740-745 ◽  
Author(s):  
Lawrence A. Trissel ◽  
Yanping Zhang ◽  
Michael R. Cohen

The objective of this study was to evaluate the physical and chemical stability of vincristine sulfate diluted to a variety of concentrations in 0.9% sodium chloride injection and packaged in minibags and 30 mL syringes, to help deter inadvertent intrathecal injection of the drug. Test samples were prepared by diluting vincristine sulfate quantities of 0.5 mg, 1 mg, 2, mg, and 3 mg in 0.9% sodium chloride injection. These quantities were selected to span the range of doses normally expected for this cytotoxic drug. The vincristine was diluted with 0.9% sodium chloride injection in volumes of 25 mL and 50 mL packaged in polyvinyl chloride minibags and to 20 mL packaged in 30 mL polypropylene syringes. Physical and chemical stability evaluations were performed initially and after 1, 3, and 7 days of storage at 4°C followed by an evaluation at 9 days after 2 additional days of storage at a temperature of 23°C. Physical stability was assessed using visual observation in normal light and a high-intensity monodirectional light beam. In addition, turbidity and particle content were measured electronically. Chemical stability of the drug was evaluated by using a stability-indicating high performance liquid chromatographic (HPLC) analytical technique. No physical instability was noted and no unacceptable loss of vincristine sulfate concentration was found in any sample throughout the study period. The use of vincristine sulfate doses diluted in infusion volumes of 0.9% sodium chloride injection and packaged in minibags or in 30 mL syringes to help deter inadvertent intrathecal administration may be performed with no unacceptable physical or chemical instability occurring.


2019 ◽  
Vol 72 (5) ◽  
Author(s):  
Élise D’Huart ◽  
Jean Vigneron ◽  
Alexandre Charmillon ◽  
Igor Clarot ◽  
Béatrice Demoré

ABSTRACTBackground: In severe infections, high-concentration vancomycin may be administered by continuous infusion. The dosage of vancomycin may reach 60 mg/kg per day. Objectives: To study the feasibility of preparing high-concentration vancomycin solutions (40 to 83.3 mg/mL), to study the effect of an electric syringe pump on the physical stability of high-concentration vancomycin, and to study the stability of vancomycin 62.5 and 83.3 mg/mL in 0.9% sodium chloride (0.9% NaCl) or 5% dextrose in water (D5W) with storage up to 48 h at room temperature. Methods: The following sets of syringes were prepared: (1) 4 syringes of vancomycin in 0.9% NaCl for each of 5 concentrations between 40 and 83.3 mg/mL (total 20 syringes); (2) 6 syringes at 83.3 mg/mL in 0.9%NaCl and 6 syringes at 83.3 mg/mL in D5W; and (3) 30 syringes at 83.3 mg/mL in D5W. Visual inspection was performed for all 3 syringe sets, and subvisual inspection for sets 1 and 2 (for periods of 24 h for set 1 and 48 h for sets 2 and 3). One syringe of vancomycin 83.3 mg/mL with each solvent was inserted into an electric syringe pump, and samples from the infusion line and collected after transit through the pump were inspected visually. Chemical stability was evaluated by high-performance liquid chromatography, and physical stability, pH, and osmolality were investigated. Results: For all sets of syringes, no physical modification was observed over time, nor were any changes observed after transit through the electric syringe pump. In 0.9% NaCl, vancomycin 62.5 and 83.3 mg/mL retained more than 90% of the initial concentration after 48 and 24 h, respectively; however, for the 83.3 mg/mL solution, precipitate was visible after 48 h. In D5W, vancomycin at 62.5 and 83.3 mg/mL retained more than 90%of the initial concentration after 48 h. Conclusion: It was feasible to prepare high-concentration solutions of vancomycin. The electric syringe pump did not cause any precipitation. Vancomycin in D5W at 62.5 and 83.3 mg/mL was stable over 48 h at room temperature. Precipitation occurred in 0.9% NaCl. D5W is therefore recommended as the solvent for this drug.RÉSUMÉContexte : En cas d’infection grave, de la vancomycine à forte concentration peut être administrée par perfusion continue à une dose pouvant atteindre 60 mg/kg par jour. Objectifs : Mener une étude de faisabilité portant sur la préparation de solutions de vancomycine à forte concentration (de 40 à 83,3 mg/mL); étudier l’effet d’un pousse-seringue électrique sur la stabilité physique de la vancomycine à forte concentration; et étudier la stabilité de la vancomycine (62,5 et 83,3 mg/mL) dans une solution de chlorure de sodium à 0,9 % (NaCl à 0,9 %) ou dans une solution aqueuse de dextrose à 5 % (D5W) après 48 h à la température ambiante.Méthodes : Trois ensembles de seringues ont été préparés : (1) quatre seringues de vancomycine dans une solution de NaCl à 0,9 %, à chacune des cinq concentrations comprises entre 40 et 83,3 mg/mL (20 seringues au total); (2) six seringues à 83,3 mg/mL dans une solution de NaCl à 0,9 % et six seringues à 83,3 mg/mL dans une solution de D5W; et (3) 30 seringues à 83,3 mg/mL dans une solution de D5W. Une inspection visuelle des trois ensembles de seringues et une inspection « sous-visuelle » des ensembles 1 et 2 ont eu lieu (période de 24 h pour l’ensemble 1 et de 48 h pour les ensembles 2 et 3). Une seringue contenant de la vancomycine à 83,3 mg/mL mélangée à chaque solvant a été insérée dans un pousse-seringue électrique, et les échantillons prélevés dans le tube de perfusion et ceux recueillis après leur passage dans la pompe ont été inspectés visuellement. La stabilité chimique a été évaluée par chromatographie liquide à haute performance et la stabilité physique, le pH ainsi que l’osmolalité ont eux aussi été étudiés. Résultats : Les trois ensembles de seringues n’ont présenté aucune modification physique avec le temps. Aucun changement n’a non plus été observé après le passage dans le pousse-seringue électrique. Dans la solution de NaCl à 0,9 %, la vancomycine à 62,5 et à 83,3 mg/mL a conservé plus de 90 % de sa concentration initiale respectivement après 48 et 24 h. Cependant, le précipité de la solution à 83,3 mg/mL était visible après 48 h. Dans la solution de D5W, la vancomycine à 62,5 et à 83,3 mg/mL a conservé plus de 90 % de sa concentration initiale après 48 h. Conclusion : La préparation de solutions de vancomycine à forte concentration est faisable. Le pousse-seringue électrique n’a pas causé de précipitation. La vancomycine dans la solution de D5W à 62,5 et à 83,3 mg/mL est restée stable pendant plus de 48 h à la température ambiante. Les précipitations se sont produites dans les solutions de NaCl à 0,9 %. On recommande donc la solution de D5W comme solvant pour ce médicament.


Author(s):  
Ana Carla PESSUTTO ◽  
JONKO Eliena

Background: Aluminum stands out for being a light, corrosion-resistant, and recyclable metal, achieving wide coverage in the market. When incorporated into alloying elements, it is possible to acquire other desirable characteristics. Alloy 6063, intended for architectural purposes, has aesthetic, structural, and strength functions. Anodized finishing is performed through an electrolytic process, ensuring a more resistant aluminum oxide film than that formed naturally. For decorative purposes, the anodic film coloration can be performed by several methodologies, in this case, for the coloration by organic adsorption, with the use of aniline, and the electrolytic coloration, composed of tin sulfate salts, both for obtaining the black color. Aim: Compare of two different staining methods on the surface of anodized profiles of aluminum alloy 6063. Methods: Profile samples were collected and tests were carried out to measure the thickness of the anodic layer, immersion tests with 3,5 percent sodium chloride, for 1000 hours, and neutral saline mist, for 600 hours. Results and Discussion: Both methodologies proved to be resistant to immersion tests with sodium chloride, as well as with neutral saline mist, and these tests are quite aggressive and provide corrosion of the material when not well treated. Corrosion points were only seen at the intersections performed, and in the rest of thearea, no points were detected. Conclusions: The result of both methodologies was positive, considering tht there was no corrosion in the tested samples, except in the intersections performed, as well as the maintenance of the color in both tested methodologies, which was not expected in the literature. For future work, it is suggested to deepen the study to perform electrochemical impedance spectroscopy tests for exaluate the strength of the anodic film and perform anodizing with the same parameters, however, with different anilines to analyze their behavior.


2021 ◽  
pp. 875512252110517
Author(s):  
Prapanna Bhattarai ◽  
Timothy McPherson ◽  
Marcelo Nieto ◽  
William M. Kolling

Background: Olmesartan medoxomil (OLM) is only available in the United States as tablets. The United States Pharmacopoeia (USP) has placed OLM on its priority list of preparations that require stability data to support practitioner compounding. Objective: The purpose of the study was to develop a stability-indicating assay and then determine the beyond-use date (BUD) for an extemporaneous OLM suspension. Methods: A reverse-phase high-performance liquid chromatography (HPLC) assay was developed and validated according to guidelines for USP official compounded monographs. OLM 2 mg/mL suspensions were compounded with Ora-Sweet and Ora-Plus and stored at room temperature or in a refrigerator. Suspensions were assayed periodically over 90 days for OLM concentration and observed for physical stability. The pH was measured at the beginning and end of the study. Results: The OLM concentration remained above 97% of the starting concentration for 90 days when stored in the refrigerator and above 94% of the starting concentration for 90 days when stored at room temperature. The suspension pH did not change and indicators of physical stability were unchanged for 90 days. Conclusion: OLM 2 mg/mL suspensions were chemically and physically stable at room temperature and in the refrigerator for 90 days. The BUD may be set at 90 days under either storage condition.


1986 ◽  
Vol 15 (4) ◽  
pp. 171-174 ◽  
Author(s):  
Paul Wadham

With the evolution of special care baby, intensive care, and coronary care units over the last decade, there has developed a need for greater accuracy in the control of increasingly potent infusions. The design of bedside syringe pump infusers that administer the contents of a syringe to a patient at a constant and predetermined rate will be considered in terms of their ergonomics, control, and safety. Syringe pump design has evolved over the past few years from simple mechanised forms of syringe driving to very sophisticated and precisely-controlled drive systems capable of high volumetric accuracy over a wide range of clinical conditions and sustained for long time periods. This has led to the development of new and critical forms of drug therapy. In addition, important progress has been made in the safety and reliability aspects of syringe pump design. Modern syringe pumps are expected to have fail-safe electronics to protect the patient in the event of a fault occurring. With the advent of modern microprocessor techniques, future syringe pumps can be expected to incorporate further sophisticated operational and safety enhancements, whilst remaining simple to operate. Typical safety enhancements could include the incorporation of a variable pressure sensor to protect against unwanted pressure build up in the IV line, the use of absolute linear encoding techniques for control and monitoring of the infusion, and the increasing use of self-tests and diagnostics to aid the user. Operational enhancements could include the ability to support pharmacokinetic techniques, as well as closed loop drug therapy and remote computer control. Whilst this suggests that infusion therapy might become too sophisticated for day to day use, comprehensive interactive instructions and diagnostic aids would contribute greatly to ease of use. Good user training will be of increasing importance to maximize the benefits of the advances in syringe pump design.


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