PRINTER-FRIENDLY VERSION AVAILABLE AT PHARMACYPRACTICENEWS.

COM/SE2016

Compatibility of
Commonly Used IV Drugs
A
ll

LISA CAYO, PHARMD

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Clinical Pharmacist Specialist

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Detroit Receiving Hospital

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Detroit, Michigan
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T
he number of available IV
tio

on

medications continues to
n

Pu
bl

expand. Many institutions

is
ho

hi

have observed an increase in patient

ng
le

acuity and a rise in the number of

or

G
ro
in

medications administered to each

up
pa

patient. This increases the likelihood

un ou
rt
w

le

that multiple IV medications will need

ith

ss
ot

to be administered concurrently.
he
tp

rw
er

is
m

e
is

These factors contribute to the escalating complex-

no
si
on

ity of IV drug administration and have resulted in an

te

ever-increasing number of possible incompatibilities.

d.
is

The potential for serious and life-threatening adverse

pr

drug events exists when incompatible medications are

oh

infused together. Therefore, it is important to verify drug

ib

compatibility before coadministration. A clear and con-

ite

cise compatibility chart can be a useful tool in helping to

d.

deliver safe, high-quality IV therapy to patients.

A chance of incompatibility exists whenever any drug
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 depend on many factors
including the concentration, temperature, storage vehi-
cle, infusion solution, order of mixing, and administration
Text continues on page 68

P H A R M AC Y P R AC T I C E N E WS .CO M /S E 2 0 1 6 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 6 61
 Table. Compatibility of Selected IV Drugs (Acyclovir through Dextrose 5% in water)

AmphoB lipid complex

Ampicillin-sulbactam

Dextrose 5% in water
Calcium gluconate

Dexmedetomidine
Calcium chloride

Dexamethasone
Anidulafungin

Cisatracurium
Azithromycin

Ciprofloxacin
Amiodaronea

Caspofungin

Clindamycin
Bumetanide

Daptomycin
Ceftriaxone
Argatroban
Atracurium

Ceftaroline
Aztreonam
Ampicillinb

Bivalirudin

Cefepime
Cefazolin
Acyclovir
Amikacin

Cefoxitin
A
ll

Acyclovir C I C C I C C C C I C C C C N C I C C C I N C I C C C Acyclovir
rig

Co

Amikacin C C I N N C C C N C C C C C C C C C C C N C C C C C C Amikacin
Amiodaronea I C C I I C N C I N I N C N C N C N C N C C C C I C C Amiodaronea
ht

py

Amphotericin B lipid C I C I I C C C C C I C I I I C C C N C I C C I C I C Amphotericin B lipid

s

rig ed.

complex (Abelcet) complex (Abelcet)

re

Ampicillinb Ampicillinb
ht
se

C N I I N C C N C N C N N N I N N N N N N N N C N C I
Ampicillin-sulbactam I N I I N C C N C N C N N N I N C N N N I N N C N C A Ampicillin-sulbactam
rv

Anidulafungin C C C C C C C C C C C C C C C C C C N C C C C N C C C Anidulafungin
20

Argatroban C C N C C C C C C C C C C C C C I C N C C C C C C C C Argatroban
16
Re

Atracurium C C C C N N C C C C C C C C C C N C N C C N C C C C C Atracurium
M
pr

Azithromycin C N I C C C C C C N C C C C N C C C C N N C N C C C C Azithromycin
cM
od

Aztreonam I C N C N N C C C N C C C C C C C C N C C C C C C C C Aztreonam
Bivalirudin C C I I C C C C C C C C C C I C C C N C C C C C C C C Bivalirudin
uc

ah in w

Bumetanide C C N C N N C C C C C C C C C C C C C C N C C C C C C Bumetanide
tio

on

Calcium chloride C C C I N N C C C C C C C C C I N C C I N N C C N C C Calcium chloride

n

Pu

Calcium gluconate C C N I N N C C C C C C C C C C C C C I A C C C N C C Calcium gluconate

Caspofungin N C C I I I C C C N C I C C C I I I I I C C I C I C I Caspofungin
bl
is

Cefazolin C C N C N N C C C C C C C I C I N C N C N N C C C C C Cefazolin
ho

hi

Cefepime I C C C N C C I N C C C C N C I N N N N I N C C C C C Cefepime
ng
le

Cefoxitin C C N C N N C C C C C C C C C I C N N C N N C C C C C Cefoxitin
or

Ceftaroline C C C N N N N N N C N N C C C I N N N N C C C N C N C Ceftaroline
G
ro

Ceftriaxone C C N C N N C C C N C C C I I I C N C N N C I C C C C Ceftriaxone
in

up

Ciprofloxacin I N C I N I C C C N C C N N A C N I N C N C I C I C C Ciprofloxacin
pa

Cisatracurium N C C C N N C C N C C C C N C C N N N C C C C C C C C Cisatracurium
un ou
rt

Clindamycin C C C C N N C C C N C C C C C I C C C C I I C C C C C Clindamycin
w

le

Daptomycin I C C I C C N C C C C C C C C C C C C N C C C C C C I Daptomycin
ith

ss

Dexamethasone C C I C N N C C C C C C C N N I C C C C C I C C C C C Dexamethasone
ot

Dexmedetomidine C C C I C C C C C C C C C C C C C C C N C C C C C C C Dexmedetomidine
he
tp

Dextrose 5% in water C C C C I A C C C C C C C C C I C C C C C C C C I C C Dextrose 5% in water

rw

Diltiazem N C C I N N C C C C C C C C C C C I C C C C C C C C C C Diltiazem
er

Diphenhydramine N C C C I N C C C C N C C C C C I I I C I C C C C I C C Diphenhydramine
is
m

e
is

Dobutamine I C N I I I C C C C C N N C N C I N I N I C C C C I C C Dobutamine
no
si

Dopamine I C C I N N C C C C C C C C C C I N C C C C C C C C C C Dopamine
on

te

Doripenem C C C N N N C N N C N N C N C C N N N C N C N N C C N C Doripenem
d.
is

Doxycycline C C C I I I C C C C C C C C C C I N I N C N C C C I C C Doxycycline
pr

Enalaprilat C C C C N N C C C C C C C C C I C I C C C N C C C C C C Enalaprilat
oh

Epinephrine I C C C N N C C C C C C C C C C C N C N C N C C C C C C Epinephrine
Eptifibatide I C N C C C C C C C C C C C C N C C C N C C C C C C N N Eptifibatide
ib

Ertapenem C C I C N N I C C C C C C C C I N N N N N C C N C C C I Ertapenem
ite

Esmolol I C C I N N C C C C C C C C C C C N C N C N C C C I C C Esmolol
d.

Famotidine C C C C N N C C C N C N C C C C N I N C N N C C C C C C Famotidine

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

62 P H A R M AC Y P R AC T I C E N E WS .CO M /S E 2 0 1 6
Table. Compatibility of Selected IV Drugs (Acyclovir through Dextrose 5% in water)

AmphoB lipid complex

Ampicillin-sulbactam

Dextrose 5% in water
Calcium gluconate

Dexmedetomidine
Calcium chloride

Dexamethasone
Anidulafungin

Cisatracurium
Azithromycin

Ciprofloxacin
Amiodaronea

Caspofungin

Clindamycin
Bumetanide

Daptomycin
Ceftriaxone
Argatroban
Atracurium

Ceftaroline
Aztreonam
Ampicillinb

Bivalirudin

Cefepime
Cefazolin
Acyclovir
Amikacin

Cefoxitin
A
ll

Fentanyl C C N C N N C C C N C C C C C C C N C C C N C C C C C C Fentanyl
rig

Co

Fluconazole C C C I I N C C C C C C C C N C C C C C N C C N C C C C Fluconazole
Furosemide C C N C N N C C I N C C C C C I C C C C C I N C C C C C Furosemide
ht

py

Gentamicin N C C I N N C C C N C C C C C C N N C C N C C C C N C C Gentamicin
s

rig ed.
re

Heparin C I I C N N C C N C C C C C C I C C C C C I N C C C C C Heparin
ht
se

Hydromorphone C C C C N C C C C C C C C C C C N C C C C C C C C C C C Hydromorphone
rv

Imipenem-cilastatin C C I I N N C C C N N C C N N C C C C N I N C C I C C N Imipenem-cilastatin
Insulin, regularc C N N C N N C C N N C C C C C C C H I C C N N C C C C C Insulin, regularc
20

Labetalol I C C I N N C C C C C N C C C C N N I I I N N N C I C C Labetalol
16
Re

Lactated Ringer’s C C N N N R N C N C C N C C C C C C C C C C I C C N C C Lactated Ringer’s

M
pr

Levofloxacin I C I I C C C C C N C C C N C C I C I C C N C C C C C C Levofloxacin
cM
od

Linezolid C C C C C C C C C C C C C C C C C C C N N C C C C C C C Linezolid
uc

ah in w

Liposomal amphoteri- C I N N I I C C N C I C C I I I C I C N C I N C C C C C Liposomal amphoteri-

cin B (AmBisome) cin B (AmBisome)
tio

on

Lorazepam C C C C I I C C C C I N C C C N C C C C C C C C C C C N Lorazepam
n

Pu

Magnesium sulfate C C N I N N I C C C C C C I N C N I C N N I C C C I C C Magnesium sulfate

Mannitol C C C C C N C C C C C C C C C C C I C C C N C C C C C N Mannitol
bl
is

Meropenem N N I I N N C C N C N C N N N C N N N N N I N N C C C I Meropenem
ho

hi

Methylprednisolone C C N C N I C C C C C C C I I I C C I C C I N C C C C N Methylprednisolone
ng
le

Metoclopramide N C C C N N C C C C C C C C C C C I C C C C C C C C C C Metoclopramide
or

Metronidazole C C C I C C C C C C I C C C C N C C C C C C C C I C C N Metronidazole
G
ro

Micafungin N N I N N N N N N N N N C C C N N N N N N N I N N N N C Micafungin
in

up

Midazolam I C C I I I C C C I C C N C C C C I C C C C C N C I C C Midazolam
pa

Morphine sulfate N C C I N N C C C N C C C C C C C N C C C N C C C C C C Morphine sulfate

un ou
rt

Mycophenolate I C C I I I C C C I I C C C I C I N I N I C C I C I C C Mycophenolate
w

le

Nicardipine I C C I I I C C C I C C C C C C C N C N C C C N C I C C Nicardipine
ith

ss

Nitroglycerin C C C C N N C C C C C C C C C C C N C N C N C C I C C G Nitroglycerin
ot

Nitroprussided I C N C N N C C N C C C C C C I C N C N C N N C C C C C Nitroprussided
he
tp

Norepinephrine N C N I N N C C C N C C C C C C C N C C C C C C C C C C Norepinephrine
rw

Octreotide 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 Octreotide
er

Ondansetron I C C I I I C C C C C C C C C C C I C C N C C C C C C C Ondansetron
is
m

Pantoprazolee C Pantoprazolee
is

N N N C C C C C I C I N C I N N N I N C C I I N I I I
no
si

Penicillin G C C C N C N N N C N C N C C C N C N C N C N N C N C N C Penicillin G
on

te

Phenylephrine I C C I N N C C C C C C C C C C C N C N C N C C C C C C Phenylephrine
d.
is

Phenytoin I I I I I I I I I I I I I I I I I I I N I I N I I I I I Phenytoin
pr

Phytonadione N C N N N N N N C N C N C C C N C N C N C N N C N C N C Phytonadione
oh

Piperacillin-tazobactam I C I C N N C C N N C C C C C I N C N N N I N C C C C C Piperacillin-tazobactam
Potassium chloride C C N N N N C C C N C C C C C C C C C C C C C C C C C C Potassium chloride
ib

Potassium phosphate I N I I N N I C N C N C N I I I N N N I N I N N C N C C Potassium phosphate

ite

Propofol C I N N H N N N N N C N C I C N C N C C C I N C N C C C Propofol
d.

Sodium bicarbonate C C I I N N I C I C C C C I I I C C I C C N N C C C C C Sodium bicarbonate

Sodium chloride 0.9% C C N I 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%
Tacrolimus I C C C N N C C C C C C C C C C C I C N C C C C C C C C Tacrolimus
Tobramycin C C C I N N C C C N C C C C C C N N C C I C C N C I C C Tobramycin
TMP-SMX C I I I I I C C N C N C I I I I I C I C I N N I C I C N TMP-SMX
Vancomycin C C C I N N C C C C N I C C C C N N N N N N C C I N C C Vancomycin
Vasopressin C C C I N N C C C C C C C C C C C C C C C C C C C C C N Vasopressin
Vecuronium I C C I C C C C N C C C C C C C C I C N C C N C C C C C Vecuronium
Voriconazole C C C I C C C C N C C C C C C C C I C C C C C C C C C C Voriconazole
a
Infusions exceeding 2 hours must be administered in glass or polyolefin containers. b Unstable in solutions containing dextrose. c Adsorbs to containers, tubing, and filters with which it comes into contact.
d
Protect from light. e T esting was performed with ethylenediaminetetraacetic acid (EDTA)-free formulation.
Table. Compatibility of Selected IV Drugs (Diltiazem through Metoclopramide)

Methylprednisolone sod. succ.

Imipenem-cilastatin

Magnesium sulfate
Diphenhydramine

Lactated Ringer’s

Liposomal amphoB
Hydromorphone

Metoclopramide
Insulin, regularc

Levofloxacin
Dobutamine

Fluconazole
Epinephrine
Doxycycline

Meropenem
Eptifibatide

Furosemide
Gentamicin
Famotidine
Doripenem

Lorazepam
Ertapenem
Enalaprilat
Dopamine
Diltiazem

Labetalol

Linezolid
Fentanyl

Mannitol
Esmolol

Heparin
A

Acyclovir N N I I C C C I I C I C C C C N C C C C I C I C C C C C N C N Acyclovir
ll

Amikacin C C C C C C C C C C C C C C C C I C C N C C C C I C C C N C C Amikacin
rig

Co

Amiodaronea C C N C C C C C N I C C N C N C I C I N C N I C N C N C I N C Amiodaronea
ht

py

Amphotericin B lipid I C I I N I C C C C I C C I C I C C I C I N I C N C I C I C C Amphotericin B lipid

s

complex (Abelcet) complex (Abelcet)

rig ed.
re

Ampicillinb N I I N N I N N C N N N N I N N N N N N N N C C I I N C N N N Ampicillinb
ht
se

Ampicillin-sulbactam N N I N N I N N C N N N N N N N N C N N N R C C I I N N N I N Ampicillin-sulbactam
rv

Anidulafungin C C C C C C C C C I C C C C C C C C C C C N C C C C I C C C C Anidulafungin
20

Argatroban 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 C C Argatroban
16
Re

Atracurium C C C C N C C C C C C C C C I C N C C N C N C C N C C C N C C Atracurium
Azithromycin C C C C C C C C C C C N N C N N C C N N C C N C C C C C C C C Azithromycin
M
pr

Aztreonam C N C C N C C C C C C C C C C C C C N C C C C C I I C C N C C Aztreonam
cM
od

Bivalirudin C C N C N C C C C C C N C C C C C C C C N N C C C N C C C C C Bivalirudin
uc

ah in w

Bumetanide 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 N C C Bumetanide
tio

on

Calcium chloride C C C C N C C C C C C C C C C C C C N C C C N C I C I C N I C Calcium chloride

n

Calcium gluconate C C N C C C C C C C C C C N C C C C N C C C C C I C N C N I C Calcium gluconate

Pu

Caspofungin C C C C C C I C N I C C C C I C I C C C C C C C I N C C C I C Caspofungin
bl

Cefazolin C I I I N I C C C N C N C C C N C N C C N C I C C C N C N C C Cefazolin
is
ho

hi

Cefepime I I N N N N I N C N N I N C C N C C C H N C C C I C I I N C I Cefepime
ng
le

Cefoxitin C I I C N I C C C N C N C C C C C C C I I C I C C C C C N I C Cefoxitin
Ceftaroline C C N C C N C N N N N C C C C C C C N C I C C N N C N C N C C Ceftaroline
or

Ceftriaxone C I I C N C C C C N C N C N C N C C I C I C C N C C N C N C C Ceftriaxone
ro
in

Ciprofloxacin C C C C C N N N C C N N N C I C I C N N N C N C I C I N I I C Ciprofloxacin
up
pa

Cisatracurium C C C C N C C C C C C C C C N C N C C N N I C C N C C C N N C Cisatracurium
un ou
rt

Clindamycin C C C C N C C C C N C C C N C C C C C C N C C C C C C C N C C Clindamycin
w

le

Daptomycin 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 C C C C C C Daptomycin
ith

ss

Dexamethasone C I I C C I C C C C I C C C C N C C C C I N C C C C I C C C C Dexamethasone
ot

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 C C Dexmedetomidine
he

Dextrose 5% in water C C C C C C C C N I C C C C C C C C N C C C C C C N C N I N C Dextrose 5% in water

tp

rw

Diltiazem C C C C C C C C C C C C C I C N C C N C N C C I C C C C N C Diltiazem
er

Diphenhydramine C C C C C C C C C C C C C I C N C C I C C C C C C C C C I C Diphenhydramine
is
m

Dobutamine C C C C C C C C I C C C C N C N C N N C C C C I C N C C C C Dobutamine
e
is

no
si

Dopamine C C C C C C C C C C C C C N C C C C N C C C C I C C C C C C Dopamine
on

Doripenem C C C C N C N N N C C C C C C C C N C C N C C N C C C N C C Doripenem
te

Doxycycline C C C C N C C C C C C C C I C I C C C C C C C I C C C N I C Doxycycline
d.
is

Enalaprilat 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 Enalaprilat
pr

Epinephrine 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 C C N C C Epinephrine
oh

Eptifibatide C C C C N C C C N C C C C I C C C C N C N C C C C C C C C C Eptifibatide
ib

Ertapenem C C I C N C C C N C C N C C C C C N C C C C C C C C C N C C Ertapenem
ite

Esmolol C C C C C C C C C C C C C I C C C C C C C C C C C C C N N C Esmolol
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

64 P H A R M AC Y P R AC T I C E N E WS .CO M /S E 2 0 1 6
Table. Compatibility of Selected IV Drugs (Diltiazem through Metoclopramide)

Methylprednisolone sod. succ.

Imipenem-cilastatin

Magnesium sulfate
Diphenhydramine

Lactated Ringer’s

Liposomal amphoB
Hydromorphone

Metoclopramide
Insulin, regularc

Levofloxacin
Dobutamine

Fluconazole
Epinephrine
Doxycycline

Meropenem
Eptifibatide

Furosemide
Gentamicin
Famotidine
Doripenem

Lorazepam
Ertapenem
Enalaprilat
Dopamine
Diltiazem

Labetalol

Linezolid
Fentanyl

Mannitol
Esmolol

Heparin
A

Famotidine C C C 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 C Famotidine
ll

Fentanyl C C C C C C C C C N C C C C C C C C C C C C C C C C C N C C Fentanyl
rig

Co

Fluconazole C C C C C C C C C C C C C N C C C N C C C C C N C C C C C C Fluconazole
ht

py

Furosemide I I N N C I C C I C I N C N N C C C N N C I C C C N C C C N Furosemide
s

rig ed.

Gentamicin C C C C C C C C C C C C C C N I C C N C C C C I C C C C C C Gentamicin
re

Heparin N N N C C I C C C C C C C C C I C C C N N I C C C C C C N C Heparin
ht
se

Hydromorphone 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 Hydromorphone
rv

Imipenem-cilastatin C C N C N C C C C N C C C N C C C C C C N C C I I C I N C C Imipenem-cilastatin
20

Insulin, regularc N I N N C C C N N C C N C C N N C C C I N N C N C C C C C C Insulin, regularc

16
Re

Labetalol C C C C C C C C C C C C C C N C N C C I C C C I C C C N C C Labetalol
M

Lactated Ringer’s N C C C N C C C N C C C C C C C N C N N C N C N N C N I N C Lactated Ringer’s

pr

cM

Levofloxacin C C C C C C C C C C C C C C I C I C C N C N C I N N C N C C Levofloxacin
od

Linezolid 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 N C Linezolid
uc

ah in w

Liposomal amphoB I C I I N I C C C C C C C N C I C C I N I N I C I I I I C I Liposomal amphoB

tio

on

(AmBisome) (AmBisome)
n

Lorazepam C C C C C C C C C C C C C C C C C C I C C N N C I C C C C C Lorazepam
Pu

Magnesium sulfate C C N C C C C C C C C C C C N C C C C C C C N C I C C C I C Magnesium sulfate

bl

Mannitol C C C C C C C C C C C C C C C C C C I C C N C C I C C I C C Mannitol
is
ho

hi

Meropenem C C C C N N C N C N N N N C C C C C N C N I N C I C C I N C Meropenem
ng
le

Methylprednisolone N I C C C I C C C C N N C C C C N C C C C N C N C C I C N C Methylprednisolone
Metoclopramide C C C C C C C C C C C C C C N C C C C C C C C C I C C C C C Metoclopramide
or

Metronidazole C C C C C C C C C C C C C C C C C C C C C N C C I C C C C C C Metronidazole
ro
in

Micafungin I N I C C N N I C N C N N N C N C C N I I C I N N C C N N N N Micafungin
up
pa

Midazolam C C N C C C C C C I C C C C N C C C N N C N C C I C C C N N C Midazolam
un ou
rt

Morphine sulfate C C C C C C C C C C C C C C N C N C C N C C C C I C C C C C C Morphine sulfate

w

le

Mycophenolate C C C C N C C C I N C C C C I C I C I C C N C C I C C C I I C Mycophenolate
ith

ss

Nicardipine C C C C N C C C C I C C C C I C N C I N C I C C I N C C I N C Nicardipine
ot

Nitroglycerin C C C C N C C C C C C C C C N C C C C C C G I C C C C C N C C Nitroglycerin
he

Nitroprussided C I N C N C C C C C C C C C C C C C N C C C I C C C C C N C C Nitroprussided
tp

Norepinephrine C C C C C C C C N C C C C C N C C C C N C C N C N C C C C C C Norepinephrine
rw
er

Octreotide C C C C N 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 Octreotide
is
m

Ondansetron C C C C C C C C C I C C C C I C C C C N C C C C I I C C N N C Ondansetron
e
is

no

Pantoprazolee I I I N C C N N N C I I I I N N N N C N I C I I C I N N I I N Pantoprazolee
si
on

Penicillin G C C I C N I C C N N C C C C C C C C C C N C N N N N C C N C C Penicillin G
te

Phenylephrine C C C C C C C C C C C C C C N C C C C I C C C C C C C C N C C Phenylephrine
d.
is

Phenytoin I I I I N I I I I I N N I N I I I I I I I I I I I I I I N I I Phenytoin
pr

Phytonadione N C N C N C C C N N C C C C C C C N C C C C N N N N I C N N C Phytonadione
oh

Piperacillin-tazobactam I C I C N I C C C N C I C C C N C C N I I C I C C C C C N C C Piperacillin-tazobactam
ib

Potassium chloride 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 N N C Potassium chloride

ite

Potassium phosphate C N I N I N C N C C C C N N N N N C N N C I N C I I N N N N C Potassium phosphate

d.

Propofol N C N N I C C N N N C C C C C I C C C C C C I N N C N C N I I Propofol
Sodium bicarbonate N I I I C I C I C C C C C C C C C I I C N N C C I C C C I C C Sodium bicarbonate
Sodium chloride 0.9% C C C C C C C C C C C C C C C C C C R C C N C C I N C N R C C Sodium chloride 0.9%
Tacrolimus C C C C C C C C N C C C C C N C C C C C C N C C C C C C C C C Tacrolimus
Tobramycin C C C C C C C C C C C C C C C C I C C N C C C C I C C C N C C Tobramycin
TMP-SMX C I I I N I N I C C N I I I I I I C I I N N C N C C N I N I I TMP-SMX
Vancomycin C C C C C C C C C C C C C C I C I C N C C C C C I C C C C I C Vancomycin
Vasopressin C C C C N C C C N C C C C C N C C C C N 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 C I C C C I C C C C C I C C C C I C Vecuronium
Voriconazole C C C C C C C C N C C C C C C C C N C C C N C C C C C C C C C Voriconazole
a
Infusions exceeding 2 hours must be administered in glass or polyolefin containers. b Unstable in solutions containing dextrose. c Adsorbs to containers, tubing, and filters with which it comes into contact. d Protect from
light. e Testing was performed with ethylenediaminetetraacetic acid (EDTA)-free formulation.
 Table. Compatibility of Selected IV Drugs (Metronidazole through Voriconazole)

Piperacillin-tazobactam
Penicillin G potassium

Sodium chloride 0.9%

Potassium phosphate

Sodium bicarbonate
Potassium chloride
Morphine sulfate

Norepinephrine
Mycophenolate

Nitroprussided
Metronidazole

Phenylephrine
Pantoprazolee

Phytonadione
Nitroglycerin

Voriconazole
Ondansetron

Vancomycin

Vecuronium
Vasopressin
Tobramycin
Nicardipine
Micafungin

Octreotide
Midazolam

Tacrolimus
Phenytoin

TMP-SMX
Propofol
Acyclovir C N I N I I C I N C I N C I I N I C I C C C I C C C C I C Acyclovir
A

Amikacin C N C C C C C C C C C N C C I C C C N I C C C C I C C C C Amikacin
ll

Amiodaronea C I C C C C C N N C C N C C I N I N I N I N C C I C C C C Amiodaronea
rig

Co

Amphotericin B lipid I N I I I I C C I C I C N I I N C N I N I I C I I I I I I Amphotericin B lipid

ht

py

complex (Abelcet) complex (Abelcet)

s

Ampicillinb N N C C Ampicillinb
rig ed.

C N I N I I N N N C I C C N I N N N N H N C N N I
re

Ampicillin-sulbactam C N I N I I N N N C I C N N I N N N N N N C N N I N N C C Ampicillin-sulbactam
ht
se

Anidulafungin C N C C C C C C C C C C N C I N C C I N I C C C C C C C C Anidulafungin
rv

Argatroban C N C C C C C C C C C C N C I N C C C N C C C C C C C C C Argatroban
20

Atracurium C N C C C C C N C C C I C C I C N C N N I C C C N C C N N Atracurium
16

Azithromycin C N I N I I C C N C C C N C I N N N C N C C C N C C C C C Azithromycin
Re

Aztreonam I N C C I C C C C C C I C C I C C C N C C C C C N N C C C Aztreonam
M
pr

Bivalirudin C N C C C C C C C C C N N C I N C C C N C C C C C I C C C Bivalirudin
cM
od

Bumetanide C C N C C C C C C C C C C C I C C C N C C C C C I C C C C Bumetanide
uc

ah in w

Calcium chloride C C C C C C C C C C C I C C I C C C I I I C C C I C C C C Calcium chloride

tio

on

Calcium gluconate C C C C I C C C C C C N C C I C C C I C I C C C I C C C C Calcium gluconate

n

Caspofungin N N C C C C C I C C C N N C I N I C I N I C C C I C C C C Caspofungin
Pu

Cefazolin C N C C I C C C C C C N C C I C N C N C C C C N I N C C C Cefazolin
bl

Cefepime C N I N N N N N N C I I N N I N C C N N C C I N C N C I I Cefepime
is
ho

hi

Cefoxitin C N C C I C C C C C C N C C I C N C N C I C C C I N C C C Cefoxitin
ng
le

Ceftaroline C N C C N N N N C N C C N N N N N C I C C C N C C N C N C Ceftaroline
Ceftriaxone C N C C I C C C C C N C C C I C N C N C C C C I I N C C C Ceftriaxone
or

Ciprofloxacin C N C N C C N N C C C I N N I N I C I I N C C C N N C C C Ciprofloxacin
ro
in

Cisatracurium C I C C C C C N C C C I N C N N N C N N N C C C N C C N C Cisatracurium
up
pa

Clindamycin C N N C I N C C C C C N C C I C C C N C C C C N I C C C C Clindamycin
un ou
rt

Daptomycin I N C C C C I C C C C I N C I N C C C N C C C C C I C C C Daptomycin
w

le

Dexamethasone C N I C I I C C C C C I C C I C C C N C C C C I I N C C C Dexamethasone
ith

ss

Dexmedetomidine C N C C C C C C C C C I N C I N C C C C C C C C C C C C C Dexmedetomidine
ot

D5W N C C C C C G C C C C C C C I C C C C C C C C C N C N C C D5W
he

Diltiazem C I C C C C C C C C C I C C I N I C C N N C C C C C C C C Diltiazem
tp

Diphenhydramine C N C C C C C I C C C I C C I C C C N C I C C C I C C C C Diphenhydramine
rw
er

Dobutamine C I N C C C C N C C C I I C I N I C I N I C C C I C C C C Dobutamine
is
m

Dopamine C C C C C C C C C C C N C C I C C C N N I C C C I C C C C Dopamine
e
is

no

Doripenem C C C C N N N N C N C C N C N N N C I I C C C C N C N N C Doripenem
si
on

Doxycycline C N C C C C C C C C C C I C I C I C N C I C C C I C C C C Doxycycline
te

Enalaprilat C N C C C C C C C C C N C C I C C C C C C C C C N C C C C Enalaprilat
d.
is

Epinephrine C I C C C C C C C C C N C C I C C C N N I C C C I C C C C Epinephrine
pr

Eptifibatide C C C C I C C C N C C N N C I N C C C N C C N C C C N C N Eptifibatide
oh

Ertapenem C N I C N I C C C C I C N C I N N C C N C C C C C C C C C Ertapenem
ib

Esmolol C C C C C C C C C C C I C C N C C C C C C C C C N C C C C Esmolol
ite

Famotidine C N C C C C C C C C C I C C N C I C C C C C C C I C C C C Famotidine
d.

Fentanyl C N C C C C C C C C C I C C I C C C N C C C C C I C C C C Fentanyl

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

66 P H A R M AC Y P R AC T I C E N E WS .CO M /S E 2 0 1 6
Table. Compatibility of Selected IV Drugs (Metronidazole through Voriconazole)

Piperacillin-tazobactam
Penicillin G potassium

Sodium chloride 0.9%

Potassium phosphate

Sodium bicarbonate
Potassium chloride
Morphine sulfate

Norepinephrine
Mycophenolate

Nitroprussided
Metronidazole

Phenylephrine
Pantoprazolee

Phytonadione
Nitroglycerin

Voriconazole
Ondansetron

Vancomycin

Vecuronium
Vasopressin
Tobramycin
Nicardipine
Micafungin

Octreotide
Midazolam

Tacrolimus
Phenytoin

TMP-SMX
Propofol
Fluconazole C N C C C C C C C C C I C C N C C C N C C C C C I C C C C Fluconazole
A

Furosemide C C N N I I N C N C I N C N I C C C N C C C N C I I N I C Furosemide
ll

Gentamicin C N C C C C C C C C C N C C I C N C N I C C C C I C C C C Gentamicin
rig

Co

Heparin C C C N I N C C C C C N C C I C C C N C C C C I I I C C C Heparin
ht

py

Hydromorphone C C C C C C C C C C C N C C I N C C C C I C C C C C C C N Hydromorphone
s

rig ed.

Imipenem-cilastatin C N N C I I C N C C C C C C I C N N N C I R C C I N C I C Imipenem-cilastatin
re

Insulin, regularc C I N N C N C C N C N N C I I C I C N C C C C N I C N C C Insulin, regularc

ht
se

Labetalol C I C C C C C C C C C I N C I C I C C C N C C C N C C C C Labetalol
rv

Lactated Ringer’s N C N C N I G C C N C C C C I C C C I C N N N C N C N C N Lactated Ringer’s

20

Levofloxacin C I C C C C I I N C C I N C I N I C N I C C C C C C C C C Levofloxacin
16
Re

Linezolid C N C C C C C C C C C I N C I N C C C N C C C C N C C C C Linezolid
Liposomal amphoB I N I I I I C C N C I C N C I N C C I N I I C I C I C I C Liposomal amphoB
M
pr

(AmBisome) (AmBisome)
cM
od

Lorazepam C C C C C N C C C C I I N C I N C C I C C N C C C C C C C Lorazepam
uc

ah in w

Magnesium sulfate C C C C C C C C C C C N C C I I C C N N C C C C N C C C C Magnesium sulfate

tio

on

Mannitol C N C C C C C C C C C N C C I C C C N C C N C C I C C C C Mannitol
n

Meropenem C N N C I I N N C C N I N N N N N N N N I R C N N C C C C Meropenem
Pu

Methylprednisolone C N N C I N C C C C N I C C I N C N N I C C C C I I C I C Methylprednisolone
bl

Metoclopramide C N C C C C C C C C C N C C I C C C C I C C C C I C C C C Metoclopramide
is
ho

Metronidazole N C C C C C C C C C I N C I N C C C I C N C C C C C C C Metronidazole
hi
ng
le

Micafungin N I I I I C C C I I N N C I N N C C N N C C N N N C I N Micafungin
Midazolam C I C C C C C C C C I C C I C I C N N I C C C I C C C C Midazolam
or

Morphine sulfate C I C C C C C C C C N C C I C C C N N C C C C N C C C C Morphine sulfate

ro
in

Mycophenolate C I C C C C I C C C I N C I N I C I N I N C C I C C C C Mycophenolate
up
pa

Nicardipine C I C C C C C C C C I C C I N I C N N I C C C N C C C C Nicardipine
un ou
rt

Nitroglycerin C C C C C C C C C C N C C I C C C N C C G C C I C C C C Nitroglycerin
w

le

Nitroprussided C C C C I C C C C C N C C I C C C C C C C C C I C C C I Nitroprussided
ith

ss

Norepinephrine C C C C C C C C C C N C C I C C C N C I C C C I C C C C Norepinephrine
ot

Octreotide C I C C C C C C C C N N C I N C C C N C C C C C C C C C Octreotide
he

Ondansetron C I C C C C C C C C I C C I C C C C C I C C C I C C C C Ondansetron
tp

Pantoprazolee I N I N I I N N N N I N C I N N C I N N C N N N N C I I Pantoprazolee
rw
er

Penicillin G N N C C N C C C C N C N C I C N C N N N C C C I N C N N Penicillin G
is
m

Phenylephrine C C C C C C C C C C C C C I C C C N N C C C C I C C C C Phenylephrine
e
is

no

Phenytoin I I I I I I I I I I I I I I I I I N I I N I I I I I I I Phenytoin
si
on

Phytonadione N N C C N N C C C N C N C C I N C N N C C N C I C C N N Phytonadione
te

Piperacillin-tazobactam C N I C I I C C C C C N N C I N C C N C C C I C N C I C Piperacillin-tazobactam
d.
is

Potassium chloride C C C C C C C C C C C C C C I C C N C C C C C I C C C C Potassium chloride

pr

Potassium phosphate C C N N I N N C N C C I N N N N C N N N C C N N N C C C Potassium phosphate

oh

Propofol I N N N N N C C C N C N N N I N N C N C N N I N N N N N Propofol
ib

Sodium bicarbonate C N I C I I C C I C I N N C I C C C N C C C C I N C C N Sodium bicarbonate

ite

Sodium chloride 0.9% N C C C N C G C C C C C C C N C C C C N C C C N C N C C Sodium chloride 0.9%

d.

Tacrolimus C C C C C C C C C C C N C C I N C C C N C C C N C C C C Tacrolimus
Tobramycin C N C C C C C C C C C N C C I C I C N I C C C I C C C C Tobramycin
TMP-SMX C N I N I N I I I C I N I I I I C I N N I N N I I N C C TMP-SMX
Vancomycin C N C C C C C C C C C N N C I C N C N N N C C C I C C C Vancomycin
Vasopressin C C C C C C C C C C C C C C I C C C C N C N C C N C C C Vasopressin
Vecuronium C I C C C C C C C C C I N C I N I C C N C C C C C C C C Vecuronium
Voriconazole C N C C C C C I C C C I N C I N C C C N N C C C C C C C Voriconazole
a b c
Infisions exceeding 2 hours must be administered in glass or polyolefin containers. Unstable in solutions containing dextrose. Adsorbs to containers, tubing, and filters with which it comes into con-
tact. d Protect from light. e Testing was performed with ethylenediaminetetraacetic acid (EDTA)-free formulation.

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 6
67
Text continued from page 61
technique. Compatibility differences even have been
reported for different brands of the same drug.
Three types of incompatibilities are commonly dis-
cussed: physical, chemical, and therapeutic. Physical
incompatibilities are the most easily detected and are
evidenced by visible changes, such as particulate for-
mation, haze, precipitation, color change, and gas evo-
lution. 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
A
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, et al. 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.

chemical incompatibility. Most chemical incompatibil-

ll

ities can be detected only with a suitable analytical DRUGDEX® System (internet database). Greenwood Village, CO:
rig

Co

Thomson Reuters (Healthcare) Inc.

method. Therapeutic incompatibilities, in which a drug
ht

py

combination results in undesirable antagonistic or syn- Kanji S, Lam J, Johanson C, et al. Systematic review of physical and
s

rig ed.

ergistic pharmacologic activity, are beyond the scope of chemical compatibility of commonly used medications adminis-
re

tered by continuous infusion in intensive care units. Crit Care Med.

most compatibility references.
ht
se

2010;38(9):1890-1898.
The purpose of this chart is to provide data in an
rv

Nemec K, Kopelent-Frank H, Greif R. Standardization of infusion

organized, concise format from which compatibility
20

solutions to reduce the risk of incompatibility. Am J Health Syst

information can be accessed quickly and conveniently. Pharm. 2008;65(17):1648-1654.
16
Re

Although there are differing types of incompatibilities,

Newton DW. Crux of drug compatibility and incompatibility.
M
pr

the type of incompatibility or compatibility is not spec- Am J Health Syst Pharm. 2010;67(2):108-112.
cM
od

ified in this chart. A designation of “compatible” indi-

Raverdy V, Ampe E, Hecq J, et al. Stability and compatibility of vanco-
cates that the combination evaluated appears to be
uc

ah in w

mycin for administration by continuous infusion. J Antimicrob

compatible based on the tests performed, whether
tio

Chemother. 2013;68(5):1179-1182.
on

these tests measured physical, chemical, or both types

n

Singh BN, Dedhiya MG, DiNunzio J, et al. Compatibility of ceftaroline

Pu

of compatibility. All conditions that may affect com- fosamil for injection with selected drugs during simulated Y-site
bl

patibility cannot be included in such a format, and it administration. Am J Health Syst Pharm. 2011;68(22):2163-2169.
is

is not possible to predict all incompatibilities that may

ho

McEvoy GK, ed. Handbook on Injectable Drugs. 18th ed. Bethesda, MD:
hi

arise, but it is hoped that the information provided may American Society of Health-System Pharmacists; 2015.
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le
or

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ro
in

up
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un ou
rt
w

le
ith

ss
ot
he
tp

rw
er

is
m

e
is

no
si
on

te
d.
is
pr
oh
ib
ite
d.

68 P H A R M AC Y P R AC T I C E N E WS .CO M /S E 2 0 1 6