Stability of procainamide hydrochloride in neutralized 5% dextrose injection.

The stability of procainamide hydrochloride in neutralized 5% dextrose injection was studied. Sixty-four admixtures were prepared by adding either 2 mL (for 0.4% admixtures) or 4 mL (for 0.8% admixtures) of procainamide hydrochloride to 250 mL of 5% dextrose injection in plastic containers. The pH of 32 of these admixtures (16 of each type) was adjusted to 7.5. These 32 admixtures represented the neutralized group, and the remaining 32 represented the control group. The admixtures were stored at either 23-25 degrees C (room temperature) or 5 degrees C (refrigeration) for 24 hours. Procainamide hydrochloride concentrations in each sample were determined by high-performance liquid chromatography immediately after the admixtures were prepared and at various intervals during storage. Procainamide concentrations decreased over time in 5% dextrose injection. The decrease was significantly less for admixtures in neutralized 5% dextrose injection, those stored under refrigeration, and those with an 0.8% concentration of drug. Decreases in procainamide hydrochloride concentrations in the control admixtures might have been caused by procainamide-dextrose complexation. Initial concentrations of procainamide hydrochloride in 5% dextrose injection can be adequately maintained over a 24-hour storage period by neutralizing the 5% dextrose injection or storing the admixture at 5 degrees C. However, because it is impractical to maintain the necessary temperature condition during a 24-hour infusion, neutralization might be the most viable alternative when extended stability of procainamide hydrochloride in 5% dextrose injection is required.

Purchasing premixed products.

When comparing the cost of a product that requires labor-intensive manufacturing processes (e.g., IV admixtures) with the cost of the same product in a ready-to-use form (e.g., premixed, small-volume, parenteral drugs), all costs and potential savings associated with both forms of the product must be taken into consideration. An additional consideration in determining whether finished products should be purchased requires an analysis of the savings achieved in the pharmacy department in relation to the hospital's cost-reduction strategy. Little purpose would be served if the pharmacy pursued options that benefited only the pharmacy but not the hospital in general. It is time that all hospital departments challenge their staffs to maximize their efforts not only to control costs, but to reduce them as well. The greatest yield in the hospital pharmacy is derived through efforts directed at reducing supply expenditures. One reduction method worthy of analysis is use of premixed, small-volume, parenteral drugs. If it can be shown that the overall cost reduction will result from a decrease in waste, clinical pharmacy intervention through the pharmacy and therapeutics committees, targeted drug programs, quality assurance activities, and reduced operating expenses associated with premixed products, their acquisition price can be justified.