ASHP® Injectable Drug Information™
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ASHP® Injectable Drug Information™ Unauthenticated | Downloaded 09/24/21 07:47 PM UTC Unauthenticated | Downloaded 09/24/21 07:47 PM UTC ASHP® Injectable Drug InformationTM A Comprehensive Guide to Compatibility and Stability 2021 Published under the Editorial Authority of ASHP® Unauthenticated | Downloaded 09/24/21 07:47 PM UTC Published under the editorial authority of ASHP®. Any correspondence regarding this publication should be sent to the publisher, American Society of Health-System Pharmacists, 4500 East-West Highway, Suite 900, Bethesda, MD 20814, attn: ASHP Injectable Drug Information or to [email protected]. The nature of drug information and its applications is constantly evolving because of ongoing research and clinical experience and is often subject to professional judgment and interpretation by the practitioner due to the uniqueness of each clinical situation and patient. While care has been taken to ensure the accuracy of the information presented, the reader is advised that the authors, editors, contributors, reviewers, and publisher cannot be responsible for the continued currency of the information, for any errors or omissions, and/or any consequences arising from the use of this information in a clinical setting. Any reader of this work is cautioned that ASHP makes no representation, guarantee, or warranty, express or implied, as to the accuracy and appropriateness of the information contained in this work and specifically dis- claims any liability to any party for the accuracy and/or completeness of the material contained in the work or for any damages arising out of the use or non-use of any of the information contained in this work. Because of the dynamic nature of drug information, readers also are advised that decisions regarding drug use and patient care must be based on the independent judgment of the clinician, changing information about a drug (e.g., as represented in the literature), and changing professional practices. Vice President, Publishing Office: Daniel J. Cobaugh, PharmD, DABAT, FAACT Assistant Editor for Injectables: Lisa M. Kohoutek, PharmD, BCPS Project Manager: Elizabeth P. Shannon, BS Production Services/Printing: Sheridan Cover Design: DeVall Advertising Cover Art: iStock-913469346 Page Design: David Wade © 2021, American Society of Health-System Pharmacists, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or me- chanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without written permission from the American Society of Health-System Pharmacists. ASHP® is a service mark of the American Society of Health-System Pharmacists, Inc.; registered in the U.S. Patent and Trademark Office. ISBN: 978-1-58528-658-4 (hardcover) ISBN: 978-1-58528-685-0 (adobe pdf) ISBN: 978-1-58528-690-4 (ePub) DOI: 10.37573/9781585286850 10 9 8 7 6 5 4 3 2 1 Unauthenticated | Downloaded 09/24/21 07:47 PM UTC TABLE OF CONTENTS v TABLE OF CONTENTS Preface......................................................................................................................................................................... vii How to Use ASHP® Injectable Drug Information™ ................................................................................................. ix AHFS® Pharmacologic-Therapeutic Classification©................................................................................................ xx Drug Monographs............................................................................................................................ 1 Appendix I: Parenteral Nutrition Formulas.........................................................................................................1603 References...............................................................................................................................................................1631 Index........................................................................................................................................................................1723 DOI: 10.37573/9781585286850.fm Unauthenticated | Downloaded 09/24/21 07:47 PM UTC Unauthenticated | Downloaded 09/24/21 07:47 PM UTC PREFACE vii PREFACE ASHP® Injectable Drug Information™ 2021 is a collec- mation to the benefit of patients. With increasingly com- tion of compatibility and stability information on par- plex drug therapy regimens, an abundance of new drug enteral drug products and is the most recent contribu- and drug formulation approvals, and ever-present drug tion to this continuing series. With its publication, all shortage issues, pharmaceutics research has important previous editions are considered out of date. implications for patient care in the inpatient, specialty One of the core focuses of ASHP as a professional pharmacy, and home infusion settings. Recent exam- and scientific society has been its long history of pub- ples of inappropriate compounding practices involving lishing internationally recognized, authoritative sources parenteral medications have resulted in increased sterile of drug information. Beginning with publication of the compounding regulation and have reinforced the impor- Society’s ground-breaking work the American Hospital tance of adherence to sterile compounding standards, Formulary Service® (AHFS®; now AHFS Drug Information®) implementation of best practices in the preparation in 1959 and continuing with the definitive works the and administration of parenteral drug products (com- Parenteral Drug Information Guide™ in 1974, the Hand- mercially available or extemporaneously compounded), book on Injectable Drugs® in 1977, and the Medication and application of principles and findings of pharmaceu- Teaching Manual® (now AHFS Patient Medication Infor- tics research to patient care. For additional information mation™) in 1978, ASHP has consistently set the stan- on sterile compounding, ASHP’s Resource Center can be dard for objective drug information focused on safe and consulted (www.ashp.org/sterilecompounding). effective drug therapy. For more than 75 years, ASHP has Beginning with the 18th edition, the Handbook on been at the forefront of efforts to improve medication Injectable Drugs® became an integral component of use and patient safety. Publication of ASHP® Injectable ASHP’s AHFS® resource collection of authoritative drug Drug Information™ 2021 is an important component of information. Applying its expansive drug information those efforts. With the 2021 edition of ASHP® Injectable and informatics expertise, ASHP’s focus with the subse- Drug Information™, ASHP marks 49 years of publishing quent editions has been on the continuing addition and such an invaluable resource on parenteral medications. revision of new and existing drug monographs as well as First published in 1977 as a key outgrowth of phar- important database enhancements to this indispensable maceutics research and pharmacy practice at the US authority on parenteral drugs. ASHP® Injectable Drug Public Health Service and National Institutes of Health Information™ 2021, which was begun to provide a single (NIH), the Handbook on Injectable Drugs® has a long leg- standardized source of the primary research on the sta- acy of translating pharmaceutics research into an essen- bility, compatibilities, and incompatibilities of injectable tial resource for practical patient-care applications. Law- drugs, continues to be the most widely recognized “Gold rence A. Trissel, who served as co-author of ASHP’s first Standard” for such information. resource on injectable drugs—the Parenteral Drug Infor- ASHP® Injectable Drug Information™ 2021 includes mation Guide™, established this legacy by serving as 18 new monographs, bringing the total in this edition the distinguished author of the Handbook on Injectable to 406 monographs on parenteral drugs available in the Drugs® for the first 17 editions. ASHP and the profession United States and in other countries. In addition, more as a whole remain grateful to Mr. Trissel for his contribu- than 500 revisions to existing monographs (affect- tion to the pharmaceutics literature and his unyielding ing nearly 60% of the existing monographs) have been dedication to the science of stability and compatibility accomplished to update information on stability, com- information on parenteral products. patibility, and safety (e.g., Food and Drug Administra- With the publication of the Mirror to Hospital Phar- tion [FDA] MedWatch alerts) and to provide more spe- macy in 1964, ASHP paved the way for a transition from cific referencing of manufacturer information and other nursing-driven to pharmacy-led sterile compounding enhancements to the more than 24,100 compatibility services and has remained an industry leader for both pairs contained in ASHP® Injectable Drug Information™ advocacy and best practices related to parenteral med- 2021. The information cited throughout the text has ications. The mission of ASHP’s reference publications been compiled from 3603 references, including 195 new on compatibility and stability of parenteral products to this edition. Because information from pharmaceuti- has always been to facilitate the use of the vast body of cal manufacturers had not been uniquely cited until the pharmaceutics research on parenteral medications in a 18th edition, the number of unique references supporting way that could enable those who prescribe, prepare, and ASHP® Injectable Drug