Stability of Two Concentrations of Heparin Sodium Prefilled in CADD-Micro* Pump Syringes.

The purpose of this study was to determine the stability of two concentrations (1000 units/mL and 40,000 units/mL) of heparin sodium when individually prefilled in CADD-Micro pump syringes (Sims Deltec, Inc., St Paul MN) and stored at near-body (30 deg C) temperature for extended periods of time, up to 30 days. Three syringes were prepared for each sample period and each concentration. Following aseptic filling, the syringes were capped and stored under controlled temperatures for the duration of the study. The contents of each of three syringes per sample set were expelled individually into screw-cap, glass sample vials at designated sample times. Samples were immediately stored at -70 deg C until the time of analysis. The results of the study indicate that, when prefilled in CADD-Micro pump polypropylene syringes and maintained at 30 deg C for up to 30 days, both concentrations of heparin sodium studied retained greater thatn 95% of the intact drug.

Stability of cefpirome sulfate in the presence of commonly used intensive care drugs during simulated Y-site injection.

The stability of cefpirome sulfate during simulated Y-site injection with drugs commonly used in the intensive care unit was studied. Cefpirome sulfate was constituted and diluted to 50 mg/mL with 0.9% sodium chloride injection, 0.45% sodium chloride injection, 5% dextrose injection, and lactated Ringer's injection. Each cefpirome sulfate solution was mixed 1:1 (simulating Y-site injection) with amikacin 5.0 mg/mL (as the sulfate salt), amphotericin B 0.1 mg/mL, cefazolin 10 mg/mL (as the sodium salt), clindamycin 12.0 mg/mL (as the phosphate ester), dexamethasone phosphate 4.0 mg/mL (as the sodium salt), dopamine hydrochloride 0.8 mg/mL, epinephrine 0.1 mg/mL (as the hydrochloride salt), fluconazole 2.0 mg/mL, gentamicin 1.0 mg/mL (as the sulfate salt), and vancomycin 5.0 mg/mL (as the hydrochloride salt). All the drug combinations were prepared in triplicate and maintained at 23 degrees C. The combinations were observed visually at intervals up to eight hours, pH was measured, and samples were tested for drug concentration by high-performance liquid chromatography. Cefpirome was stable in the presence of each of the secondary drugs throughout the study period. All the secondary drugs except amphotericin B were stable in the presence of cefpirome. There were no visual phenomena indicating incompatibility. Changes in pH were minimal. Cefpirome 50 mg/mL (as the sulfate salt) in four different diluents was stable in the presence of each of 10 commonly used intensive care drugs for at least eight hours during simulated Y-site administration. Amphotericin B 0.1 mg/mL was not stable in the presence of cefpirome sulfate.

Stability of ramipril in water, apple juice, and applesauce.

The stability of ramipril in water, in apple juice, and in applesauce was studied. The contents of a single capsule each of ramipril 1.25, 2.5, and 5 mg were mixed in glass beakers with 120 mL of deionized and filtered water, apple juice, or applesauce. Each mixture was apportioned into 10 120-mL amber polyethylene terephthalate (PET) containers. Five of the containers in each set were stored at 23 degrees C, and samples were taken at 0, 1, 2, 6, 12, and 24 hours. The other five containers were stored at 3 degrees C, and samples were taken at 4, 8, 12, 24, and 48 hours. The samples were analyzed for ramipril concentration by stability-indicating high-performance liquid chromatography (HPLC). The quantity of drug remaining in the PET container after "administration" was determined by mixing the contents of single 5-mg ramipril capsules with 60 mL of apple juice, pouring the mixture into a waste receptacle, rinsing the PET container three separate times with 10 mL of water, and analyzing the pooled fluid from these rinses for ramipril concentration by HPLC. Under no condition did the percentage of ramipril remaining drop below 90%. No peaks for degradation products appeared in the chromatograms. The mean +/- S.D. quantity of ramipril remaining in the PET containers after draining was 0.3 +/- 0.3% for the apple juice. Ramipril from 1.25-, 2.5-, and 5-mg capsules mixed in water, in apple juice, and in applesauce was stable for 24 hours at 23 degrees C and for 48 hours at 3 degrees C.

Stability of octreotide acetate in polypropylene syringes.

The stability of octreotide acetate in polypropylene syringes was studied. Polypropylene syringes were aseptically filled with 1 mL of octreotide acetate 0.2 mg/mL and stored at 3 or 23 degrees C under light protection or light exposure. Three syringes were prepared for each condition and each sampling time. Unopened 5-mL glass vials of the drug served as controls. Samples were removed immediately and at 8, 15, 22, and 29 days and analyzed by high-performance liquid chromatography. At 3 degrees C, octreotide stored in light-protected syringes maintained more than 90% of its initial concentration for up to 29 days. However, at 22 days the concentration in the syringes stored at that temperature and exposed to light was less than 90% when the standard deviation is considered. At 23 degrees C, the drug was stable for only up to 15 days (light protection) and 22 days (light exposure) when the standard deviation is considered. Octreotide acetate in polypropylene syringes was stable for up to 29 days when stored at 3 degrees C and protected from light and for up to 22 days when stored at 23 degrees C and exposed to light.

Stability of ceftazidime (with arginine) and of cefuroxime sodium in infusion-pump reservoirs.

The stability of ceftazidime (with arginine) and cefuroxime sodium was studied after storage in infusion-pump reservoirs at freezing and refrigerated temperatures and subsequent simulated administration over 24 hours at near-body temperature. Polyvinyl chloride reservoirs and glass vials were filled with ceftazidime (with arginine) or cefuroxime sodium at various concentrations, diluted in sterile water. Three reservoirs each of ceftazidime 30 and 60 mg/mL and of cefuroxime 22.5, 30, 45, and 60 mg/mL were stored for various times and at various temperatures. Three glass vials each of ceftazidime or cefuroxime 30 and 60 mg/mL were stored for 30 days at -20 degrees C, followed by 4 days at 3 degrees C and 24 hours at 30 degrees C. Samples obtained periodically during storage and during simulated administration were analyzed with high-performance liquid chromatography. Both drugs maintained at least 90% of their initial concentration under all of the test conditions except simulated administration at 30 degrees C, during which degradation accelerated. In portable infusion-pump reservoirs, ceftazidime 30 and 60 mg/mL and cefuroxime 30 and 60 mg/mL were stable for 30 days at -20 degrees C followed by 4 days at 3 degrees C; ceftazidime 30 and 60 mg/mL was stable for 10 days at 3 degrees C; and cefuroxime 22.5 and 45 mg/mL was stable for 7 days at 3 degrees C. However, the drugs may need to be administered over less than 24 hours when the pump reservoir is worn on the patient's body.

Stability of ondansetron hydrochloride in portable infusion-pump reservoirs.

The stability of ondansetron hydrochloride 0.24 and 2 mg/mL when delivered by portable infusion pump at near-body temperature over various time periods was investigated. Nine 100-mL drug reservoirs were prepared, three containing ondansetron hydrochloride 2 mg/mL and six containing ondansetron hydrochloride diluted with 0.9% sodium chloride injection to 0.24 mg/mL. Three of the reservoirs containing the diluted solution were refrigerated for up to 30 days at 3 degrees C before being attached to portable infusion pumps and pumped over 24 hours at 30 degrees C. The remaining six reservoirs were attached to pumps immediately after being filled, and the solutions were delivered for up to 24 hours (the diluted solution; three reservoirs) or up to seven days (the concentrated solution; three reservoirs) at 30 degrees C. Samples were taken initially and periodically and analyzed by high-performance liquid chromatography and with a pH meter. Both the diluted and the concentrated solutions of ondansetron hydrochloride retained at least 95% of the initial drug concentration under all the conditions studied. There was no appreciable change in pH. Ondansetron hydrochloride 0.24 mg/mL was stable when stored for up to 30 days at 3 degrees C and infused over 24 hours at 30 degrees C. Ondansetron hydrochloride 2 mg/mL was stable when infused for up to one week at 30 degrees C.

Gas production of three brands of ceftazidime.

Two sodium carbonate formulations of ceftazidime (Tazidime and Tazicef) and a new arginine formulation (Ceptaz) were evaluated for gas production and bubble formation within the drug reservoir and extension tubing of a portable infusion pump during a 24-hour delivery cycle. Triplicate samples of each brand of ceftazidime were studied under identical conditions. All formulations were constituted and diluted with sterile water for injection to a concentration of approximately 33 mg/mL, drawn into syringes, and expelled into infusion-pump drug reservoirs. Triplicate samples of degassed Tazidime and Tazicef were evaluated in the same manner. In one set of triplicate experiments, reservoirs for each formulation were attached to portable infusion pumps immediately after filling at room (23 degrees C) temperature and were programmed to deliver 25 mL over one hour every eight hours for a 24-hour delivery cycle. In a second experiment, reservoirs containing triplicate samples of each product were refrigerated (3 degrees C) for 24 hours before they were attached to the pumps for dose delivery. Visual observations were made for all pumping devices. In addition, multiple vials of each formulation were constituted, and the headspace pressure of the various formulations was monitored to compare the pressure build-up due to carbon dioxide. The presence of carbon dioxide was confirmed by gas chromatography. Pressure build-up due to carbon dioxide formation occurred in the ceftazidime sodium carbonate vials only. The sodium carbonate formulations required degrassing to reduce gas and bubble formation to a manageable level after constitution. Additionally, drug was lost because of spewing of some samples during withdrawal from the vial.(ABSTRACT TRUNCATED AT 250 WORDS)

Stability of fentanyl citrate and bupivacaine hydrochloride in portable pump reservoirs.

The stability of fentanyl citrate and bupivacaine hydrochloride in an admixture with 0.9% sodium chloride injection in portable pump reservoirs with or without overwraps was investigated. Twelve 100-mL samples containing fentanyl 20 micrograms/mL and bupivacaine hydrochloride 1250 micrograms/mL were placed in the plastic drug reservoirs, and 1-mL quantities were withdrawn immediately after preparation and at intervals during 30 days of storage. Six reservoirs were refrigerated (3 degrees C) and six stored at room temperature (23 degrees C); three at each temperature were placed in overwraps. All samples were observed for precipitation and for change in color or pH and were analyzed for drug concentration by high-performance liquid chromatography. No precipitation or change in color or pH was observed during the 30-day storage period. No loss of fentanyl or bupivacaine was detected in either the wrapped or the unwrapped samples. Fentanyl citrate and bupivacaine hydrochloride in 0.9% sodium chloride injection appear to be compatible, and admixtures containing the two drugs at the concentrations studied can be stored without overwraps for up to 30 days at refrigerated or room temperature without any significant loss of potency.

Stability of fentanyl citrate in 0.9% sodium chloride solution in portable infusion pumps.

The stability of fentanyl citrate diluted with 0.9% sodium chloride injection for use in portable infusion pumps was studied. The commercially available injection containing 50 micrograms of fentanyl per milliliter was diluted to a concentration of 20 micrograms/mL. Twelve 100-mL portions of the dilute solution were placed in polyvinyl chloride infusion pump drug reservoirs; six were stored at 3 degrees C and six at 23 degrees C; three at each temperature were overwrapped with polypropylene-Mylar. Initially and after 5, 10, 20, and 30 days of storage, 1-mL samples were taken from each reservoir, inspected for color change and precipitation, and assayed for fentanyl concentration by high-performance liquid chromatography. Initially and on day 30, pH of the samples was checked. No precipitation or change in color or pH was observed. No substantial decrease in fentanyl concentration was found in either the wrapped or unwrapped samples at either temperature, although concentrations on day 30 in the samples at 23 degrees C were slightly lower than those at 3 degrees C. Under the conditions studied, fentanyl citrate solutions containing 20 micrograms of fentanyl per milliliter can be stored for 30 days in polyvinyl chloride reservoirs for portable infusion pumps.

Stability of fluorouracil administered through four portable infusion pumps.

The stability of fluorouracil in four portable infusion pumps under simulated infusion conditions was studied. Three commercially available fluorouracil aqueous solutions (50 mg/mL) were used. Samples adjusted to six pH levels were examined for precipitate. Drug reservoirs of four different portable infusion pumps were filled with 70 mL of each fluorouracil injection. Under conditions simulating actual use, the reservoirs were attached to the pumps and the solutions were pumped at a rate of 10 mL/24 hours over a seven-day period at 25 degrees C and 37 degrees C. Samples at the distal end of the extension tubing were collected hourly for the first 10 hours and at 12-hour intervals thereafter. Visual observations and pH determinations were made immediately. Drug concentrations were determined by reverse-phase high-performance liquid chromatography. Diethylhexylphthalate (DEHP) concentrations (the result of leaching from the plastic tubing and container) were determined by gas chromatography. In the pH study, precipitate appeared immediately in all fluorouracil injections below pH 8.52; precipitate was observed after two to four hours at pH 8.60-8.68. Under simulated infusion conditions, no apparent changes in concentration or pH were detected with any of the brands of drugs or portable infusion devices. At 25 degrees C, a fine white precipitate was observed in the extension tubing of all devices with the Roche brand of fluorouracil 48 to 96 hours after the pumping cycle began. The amount of DEHP leached from the drug reservoirs over the seven-day period was less than 1 ppm at both temperatures. All tested brands of fluorouracil injection were found to be stable under simulated infusion conditions over a seven-day period at 37 degrees C.

Stability of cefazolin sodium, cefoxitin sodium, ceftazidime, and penicillin G sodium in portable pump reservoirs.

The stability of cefazolin sodium, cefoxitin sodium, ceftazidime, and penicillin G sodium in prefilled drug reservoirs that were stored at -20 degrees C for 30 days, thawed at 5 degrees C for four days, and pumped at 37 degrees C for one day was studied. Each antimicrobial agent was diluted with sterile water for injection to a concentration representative of the most common dosage when administered via a portable infusion pump. Ten milliliters of each drug solution was placed in individual glass vials to serve as controls, and volumes appropriate to deliver the designated dosages were loaded into the drug reservoirs. Triplicate reservoirs were prepared for each drug. One-milliliter samples from all containers were taken on days 0, 30, 31, 32, 33, 34, 34.5, and 35. All solutions were observed for color change and precipitation. Drug concentrations were determined using high-performance liquid chromatography. Leaching of the plasticizer diethylhexyl phthalate (DEHP) was analyzed by packed-column gas chromatography on days 0 and 35. No color change or precipitation was observed. No DEHP concentrations above 1 ppm were detected. More than 90% of the initial concentrations of each drug remained, except penicillin G sodium, which had a mean concentration of 83.9 +/- 0.5% at the end of the study. Cefazolin sodium, cefoxitin sodium, and ceftazidime in admixtures with sterile water for injection are stable under the conditions of this study. Penicillin G sodium should not be administered for more than 12 hours after such a cycle of freezing and thawing.