Physical Compatibility of Pantoprazole with Selected Medications: DISCUSSION part 2

In the studies reported here, the solutions were not protected from light at any time. The solutions were prepared and mixed in clear glass test tubes and were continuously exposed to fluorescent light of normal intensity, conditions that closely simulate those in most patient care areas. However, visual inspection, such as that used for samples in this study, can detect only large, visible particles. Although each combination was placed in a clear glass test tube to avoid misinterpretations, the possibility exists that an incompatibility expressed as a microprecipitate was not detected because of small particle size.

The results of this study are limited to the drug products used and the conditions under which the study was conducted. Furthermore, although the range of physically compatible concentrations was carefully delineated, admixtures prepared in the clinical setting may be subject to some concentration errors, unlike solutions prepared in the controlled laboratory setting. Therefore, concentrations that approach or are close to the identified physically incompatible concentrations should be avoided.

In conclusion, pantoprazole for IV administration was physically compatible with 3.3% dextrose and 0.3% sodium chloride for injection and with 12 of 17 drugs diluted in D5W and tested for up to 12 h at 23°C during simulated Y-site administration. Precipitation occurred with mixtures containing pantoprazole and dobutamine or norepinephrine. A colour change and a coloured precipitate were observed when pantoprazole was combined with esmolol, midazolam, or octreotide. In general, mixtures of pantoprazole with esmolol, dobutamine, or midazolam were physically incompatible over concentration ranges used in the clinical setting. Octreotide and pantoprazole were physically compatible when the octreotide concentration was less than 1.5 pg/mL. Norepinephrine was physically compatible with pantoprazole when the norepinephrine concentration was less than 13 pg/mL.
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Routine Y-site administration of pantoprazole with esmolol, dobutamine, midazolam, norepinephrine, or octreotide is not recommended; however, for 4 of these drugs (dobutamine, midazolam, norepinephrine, and octreotide) co-infusion may be considered if appropriate concentrations are selected.

Category: Drugs

Tags: compatibility, dobutamine, esmolol, midazolam, norepinephrine, octreotide, pantoprazole, Y-site

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