Initial Observations and pH
When the 17 secondary drugs, as well as the mixture of 3.3% dextrose and 0.3% sodium chloride for injection, were admixed with pantoprazole, the mixtures remained clear and colourless except in 5 cases. The exceptions, for which mixtures of the drug with pantoprazole developed a precipitate or a colour change (or both) on mixing, were dobutamine, esmolol, midazolam, norepinephrine, and octreotide. In these combinations, the second drug was initially very acidic (2.89 to 4.46), whereas the initial pantoprazole solutions were slightly alkaline (greater than 8.00) (see Table 1). Therefore, pH may represent the underlying cause of the physical incompatibility.
For the 5 medications that were physically incompatible with pantoprazole, the range of physically incompatible concentrations was investigated further. The concentration range for physical incompatibility of pantoprazole with either midazolam or dobutamine spanned virtually all possible concentration combinations. For medications that were physically compatible with pantoprazole, no further investigations were conducted. cialis 5 mg
Figure 1. Observed compatibility of dobutamine with pantoprazole at 12 h after mixing. Because all of the initial 9 pantoprazole-dobutamine mixtures turned cloudy or slightly cloudy within 12 h of preparation (some within 15 min), a total of 50 mixtures of these 2 drugs were prepared to evaluate the range of incompatibility. Solutions of pantoprazole and dobutamine were physically incompatible over a wide concentration range. In general, the final pantoprazole concentration must be less than 0.05 mg/mL with any dobutamine concentration less than 4.0 mg/mL for the combination to be physically compatible.
Pantoprazole and Dobutamine
Four of the dobutamine combinations (pantoprazole 0.16 mg/mL with dobutamine 1.0 mg/mL, 2.5 mg/mL, or 4.0 mg/mL, and pantoprazole 0.40 mg/mL with dobutamine 1.0 mg/mL) were initially clear and colourless and then showed slight cloudiness 12 h after mixing. The mixture of pantoprazole 0.80 mg/mL and dobutamine 1.0 mg/mL was also initially clear and colourless, but it turned slightly cloudy 4 h after mixing. The other 4 mixtures tested (pantoprazole 0.40 mg/mL with dobutamine 2.5 mg/mL or 4.0 mg/mL, and pantoprazole 0.80 mg/mL with dobutamine 2.5 mg/mL and 4.0 mg/mL) turned cloudy within 15 min of preparation. canadian cialis online
Because all of the initial 9 combinations turned slightly cloudy within 12 h of preparation, a total of 50 additional mixtures were prepared, with pantoprazole concentrations ranging from 0 to 0.80 mg/mL and dobutamine concentrations ranging from 0 to 4.0 mg/mL; the resulting compatibility profile is shown in Figure 1. Solutions of pantoprazole and dobutamine were physically incompatible over a wide concentration range. In general, the final concentration of pantoprazole must be less than 0.05 mg/mL with any final concentration of dobutamine less than 4.0 mg/mL for the combination to be physically compatible (see Figure 1).
Figure 2. Observed compatibility of esmolol with pantoprazole at 12 h after mixing. Because all of the initial 9 pantoprazole-esmolol mixtures turned slightly yellow within 15 min of preparation, a total of 63 mixtures of these 2 drugs were prepared to evaluate the range of incompatibility. At room temperature, solutions of pantoprazole and esmolol produced a precipitate when the final concentration of pantoprazole exceeded 0.12 mg/mL and the final esmolol concentration exceeded 2 mg/mL. At lower concentrations of either medication, no precipitate was observed, but a colour change was observed within 12 h. ppt = precipitate.
Pantoprazole and Esmolol
All combinations of pantoprazole with esmolol were initially clear and colourless and turned slightly yellow within 15 min of preparation. Esmolol mixtures containing the lowest concentration of pantoprazole (0.16 mg/mL) turned yellow by 12 h after preparation. A reddish brown precipitate was observed after 12 hin mixtures containing higher concentrations of pantoprazole (0.40 mg/mL and 0.80 mg/mL). Esmolol mixtures containing 0.40 mg/mL of pantoprazole turned orange, and those containing 0.80 mg/mL of pantoprazole turned light brown. Apcalis Oral Jelly
Because an incompatibility was observed between pantoprazole and esmolol, a total of 63 additional mixtures, with pantoprazole concentrations ranging from 0 to 0.80 mg/mL and esmolol concentrations ranging from 0 to 20 mg/mL, were prepared; the resulting compatibility profile is shown in Figure 2. At room temperature, solutions of pantoprazole and esmolol were physically incompatible over the entire concentration range tested (see Figure 2).