ASHP-Extended-Stability-2017.Pdf

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Any correspondence regarding this publication should be sent to the publisher, ASHP, 4500 East-West Highway, Suite 900, Bethesda, MD 20814, attention: Special Publishing. The information presented herein reflects the opinions of the contributors and advisors. It should not be interpreted as an official policy of ASHP or as an endorsement of any product. Because of ongoing research and improvements in technology, the information and its applications contained in this text are constantly evolving and are subject to the professional judgment and interpretation of the practitioner due to the uniqueness of a clinical situation. The editors and ASHP have made reasonable efforts to ensure the accuracy and appropriateness of the information presented in this document. However, any user of this information is advised that the editors and ASHP are not responsible for the continued currency of the information, for any errors or omissions, and/or for any consequences arising from the use of the information in the document in any and all practice settings. Any reader of this document 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 document and specifically disclaims any liability to any party for the accuracy and/or completeness of the material or for any damages arising out of the use or non-use of any of the information contained in this document.

Editorial Project Manager: Ruth Bloom Production Manager: Johnna Hershey Cover & Page Design: David Wade

Library of Congress Cataloging-in-Publication Data

Names: Bing, Caryn M., editor. | Nowobilski-Vasilios, Anna, editor. | American Society of Health-System Pharmacists, issuing body. Title: Extended stability for parenteral drugs / [edited by] Caryn Dellamorte Bing, Anna Nowobilski-Vasilios. Description: Sixth edition. | Bethesda, MD : American Society of Health-System Pharmacists, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2017001433 | ISBN 9781585285273 Subjects: | MESH: Drug Stability | Drug Storage | Time Factors | Home Infusion Therapy | Parenteral Nutrition | Handbooks Classification: LCC RS424 | NLM QV 735 | DDC 615.8/55--dc23 LC record available at https://lccn.loc.gov/2017001433 © 2017, 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 mechanical, 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 Trade- mark Office.

ISBN: 978-1-58528-527-3

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EXTENDED STABILITY FOR PARENTERAL DRUGS

Dedication

To the ever-growing network of colleagues who inspire and encourage us: It is impossible to recognize and thank you all appropriately for your continued support of this ongoing drug information project.

Acknowledgments

The preparation of this updated reference was a team effort that would not have been possible without the exceptional group of capable writers and reviewers. They spent many hours on what some might consider minutia but this team considers essential. The editors appre- ciate the dedication and focus that these extremely talented and very busy professionals applied to this edition, and are grateful to others who contributed extensively to prior editions.

iii Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Contents EXTENDED STABILITY FOR PARENTERAL DRUGS

Preface ...... vii Selenium ...... 38 About the Editors ...... ix Trace Elements ...... 38 Writers’ Affiliations ...... x Vitamin A ...... 39 How to Use This Reference ...... xi Vitamin B1 ...... 40 Vitamin B2 ...... 41 Part I Vitamin B3 ...... 42 Applying Stability Data in Patient Care ...... 1 Vitamin B5 ...... 42 Introduction ...... 3 Vitamin B6 ...... 43 Factors Affecting Extended Drug Stability ...... 3 Vitamin B12 ...... 43 Preparation Sterility and Quality Assurance ...... 4 Vitamin C ...... 44 Professional, Regulatory, and Accreditation Expectations ...... 5 Vitamin D ...... 45 Commercial Products and Extemporaneous Compounding ...... 6 Vitamin E ...... 46 Infusate Properties ...... 7 Vitamin K ...... 47 Vascular Access Devices and Catheters Used Zinc ...... 47 in Medication Administration ...... 8 References ...... 47 Labeling Instructions ...... 11 Part II Assigning Beyond-Use Dates ...... 11 Drug Monographs ...... 53 Patient and Site-Specific Considerations ...... 12 Acetaminophen ...... 55 Considerations in Selecting Administration Methods Acyclovir sodium ...... 56 and Infusion Devices ...... 14 ADO-Trastuzumab Emtansine ...... 58 External Factors Affecting Stability ...... 18 Aldesleukin ...... 59 Ethanol and Antibiotic Locks ...... 19 Amikacin Sulfate ...... 60 Summary ...... 19 Amiodarone Hydrochloride ...... 62 References ...... 20 Amphotericin B...... 63 Parenteral Nutrition ...... 23 Amphotericin B Lipid Complex ...... 64 Beyond-Use Dating of Parenteral Nutrition Formulations ...... 23 Amphotericin B Liposome ...... 65 Non-Formulation Factors Affecting PN Stability ...... 23 Ampicillin Sodium ...... 66 Formulation Factors Affecting PN Stability ...... 25 Ampicillin Sodium–Sulbactam Sodium ...... 68 Commercial Products and Extemporaneous Azithromycin ...... 70 Compounding ...... 29 Aztreonam ...... 71 Professional, Regulatory, and Accreditation Baclofen ...... 73 Expectations and Guidance ...... 30 Bevacizumab ...... 75 Summary ...... 31 Bleomycin Sulfate ...... 76 Parenteral Nutrition Monographs ...... 32 Blinatumomab ...... 77 Carnitine ...... 32 Bortezomib ...... 78 Chromium ...... 32 Bumetanide ...... 79 Copper ...... 33 Bupivacaine Hydrochloride...... 80 Famotidine ...... 34 Calcitriol ...... 83 Folic Acid ...... 35 Carboplatin ...... 84 Heparin ...... 36 Caspofungin Acetate ...... 86 Iron ...... 36 Cefazolin Sodium ...... 88 Manganese ...... 37 Cefepime Hydrochloride ...... 91 Ranitidine ...... 37 Cefotaxime Sodium ...... 94

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Drug Monographs, continued Cefotetan Disodium ...... 97 Epoprostenol Sodium ...... 170 Cefoxitin Sodium ...... 99 Ertapenem Sodium ...... 172 Ceftaroline Fosamil ...... 101 Erythromycin Lactobionate ...... 174 Ceftazidime ...... 102 Ethanol (Catheter Lock) ...... 175 Ceftolozane–Tazobactam ...... 105 Etoposide ...... 176 Ceftriaxone Sodium ...... 106 Etoposide Phosphate ...... 179 Cefuroxime Sodium ...... 109 Famotidine ...... 181 Chlorpromazine Hydrochloride ...... 112 Fentanyl Citrate ...... 182 Cidofovir ...... 113 Ferric Carboxymaltose ...... 185 Ciprofloxacin ...... 114 Filgrastim ...... 186 CISplatin ...... 116 Floxuridine ...... 187 Cladribine ...... 118 Fluconazole ...... 188 Clindamycin Phosphate ...... 119 Fludarabine Phosphate ...... 190 Clonidine Hydrochloride ...... 121 Fluorouracil ...... 191 Coagulation Factor VIIa Recombinant ...... 124 Foscarnet Sodium ...... 194 Coagulation Factor VIII ...... 125 Fosphenytoin Sodium ...... 196 Coagulation Factor IX ...... 129 Furosemide ...... 197 Coagulation Factor X ...... 131 Ganciclovir Sodium...... 199 Coagulation Factor XIII ...... 132 Gemcitabine Hydrochloride ...... 201 Colistimethate Sodium ...... 133 Gentamicin Sulfate ...... 202 Co-Trimoxazole (Trimethoprim–Sulfamethoxazole) ...... 135 Glycopyrrolate ...... 204 Cyclophosphamide ...... 136 Granisetron Hydrochloride ...... 205 Cyclosporine ...... 138 Haloperidol Lactate ...... 207 Cytarabine ...... 139 Heparin Sodium ...... 209 Dacarbazine ...... 141 Hydralazine Hydrochloride ...... 212 Dalbavancin ...... 142 Hydrocortisone Sodium Succinate ...... 213 Daptomycin ...... 143 Hydromorphone Hydrochloride ...... 214 DAUNOrubicin Hydrochloride (Daunomycin) ...... 145 Hydroxyzine Hydrochloride ...... 216 Deferoxamine Mesylate ...... 146 Ibuprofen ...... 217 Dexamethasone Sodium Phosphate ...... 149 Ibuprofen LYSINATE ...... 218 DimenHYDRINATE ...... 151 Ifosfamide ...... 219 DIphenhydrAMINE Hydrochloride ...... 152 Imipenem–Cilastatin Sodium ...... 221 DOBUTamine Hydrochloride ...... 153 Immune Globulin (Human) ...... 223 Docetaxel ...... 154 Infliximab ...... 226 Dolasetron Mesylate ...... 155 Interferon alfa-2b ...... 227 DOPamine Hydrochloride ...... 156 Irinotecan Hydrochloride ...... 228 Doripenem ...... 158 Iron Sucrose ...... 229 DOXOrubicin Hydrochloride ...... 161 Ketamine Hydrochloride ...... 230 Doxycycline Hyclate ...... 164 Ketorolac Tromethamine ...... 232 Enoxaparin Sodium ...... 166 Leucovorin Calcium ...... 234 Epirubicin Hydrochloride ...... 167 Levofloxacin ...... 236 Epoetin Alfa ...... 169 Linezolid ...... 237

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Drug Monographs, continued Lorazepam ...... 238 Piperacillin Sodium–Tazobactam Sodium ...... 293 Meperidine Hydrochloride ...... 240 Quinupristin–Dalfopristin ...... 295 Meropenem ...... 242 Ranitidine Hydrochloride ...... 296 Mesna...... 245 Rituximab ...... 298 Methadone Hydrochloride...... 247 Ropivacaine Hydrochloride...... 299 Methotrexate Sodium ...... 248 Sargramostim ...... 301 Methylprednisolone Sodium Succinate ...... 250 Sufentanil Citrate ...... 302 Metoclopramide Hydrochloride ...... 252 Tedizolid Phosphate ...... 304 Metronidazole ...... 254 Telavancin Hydrochloride ...... 305 Micafungin Sodium ...... 256 Thiotepa ...... 306 Midazolam Hydrochloride ...... 258 Tigecycline ...... 307 Milrinone Lactate ...... 260 Tobramycin Sulfate ...... 308 Mitomycin ...... 261 Tocilizumab ...... 310 Mitoxantrone Hydrochloride ...... 263 Topotecan Hydrochloride ...... 311 Morphine Sulfate ...... 264 Trastuzumab ...... 312 Nafcillin Sodium ...... 269 Treprostinil Sodium ...... 313 Octreotide Acetate ...... 272 Valproate Sodium ...... 315 Ondansetron Hydrochloride ...... 273 Vancomycin Hydrochloride ...... 316 Oprelvekin (Interleukin-11) ...... 275 VinBLAStine Sulfate ...... 318 Oritavancin Diphosphate ...... 276 VinCRIStine Sulfate ...... 320 Oxacillin Sodium ...... 277 Vinorelbine Tartrate ...... 322 Oxaliplatin ...... 279 Voriconazole ...... 323 Oxytocin ...... 280 Ziconotide Acetate ...... 324 Paclitaxel ...... 281 Zidovudine ...... 327 Pantoprazole Sodium ...... 283 Zoledronic Acid ...... 328 Pemetrexed Disodium ...... 285 Part III Penicillin G Potassium ...... 286 Appendix A: Manufacturer and Compendium Penicillin G Sodium ...... 288 Abbreviations ...... 331 Pentamidine Isethionate ...... 290 Appendix B: Glossary of Terms ...... 335 Pertuzumab ...... 292 Index ...... 337

vi Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Preface EXTENDED STABILITY FOR PARENTERAL DRUGS

The scarcity of published and/or labeled stability data beyond 24 hours at any temperature has been a historically compli- cating factor in the care of patients in alternate care sites. When home infusion practice emerged and grew in the 1980–90s, accurate information on extended parenteral stability was very limited. Independent and hospital-based home care pharmacists were challenged to find drug stability data that supported realistic and cost-effective compounding and patient delivery schedules. Some national infusion companies put considerable resources to the task of compiling drug stability information to support their operational and patient care processes and maintained full-time drug information specialists supporting clinicians at their many national locations. The highly competitive nature of the home infusion industry also led to the development of unpublished, proprietary drug stability data based on independent studies contracted by large home infusion companies and drug product manufacturers. The home infusion industry experienced tremendous change in the later part of the 1990s. Industry leaders merged or were acquired, resulting in fewer but larger national companies. A continuing trend includes acquisitions of home and specialty infusion providers by chain pharmacy corporations, pharmacy benefit managers, and pharmacy-by-mail companies. Hospital and health-system infusion programs expanded in number, scope, and size in many areas. Growth in the subacute care component of long-term care pharmacy continues to contribute to the increased use of infusion products outside the hospital setting. The number and scope of services of free-standing, hospital-based, and physician-office-based ambulatory infusion programs have also increased. Reduced reimbursement, increased case management, and changes in technology decreased the typical length of service for alternate site home infusion services from primarily long-term (months to years) parenteral nutrition therapy to include more short-term (days to weeks) drug therapies such as anti-infectives. Many newer drug therapies for chronic diseases are infused in the home and outpatient infusion settings. Inpatient pharmacy services increasingly rely on extended beyond-use dating to minimize the wastage of high cost parenteral medication via appropriate recycling of unused compounded sterile parenterals. Implementation of sterile compounding practices under USP <797> and other strict standards help to support extending beyond-use dating for many medications past the more traditional 24-hour post-admixture expiration date. Drug shortages also have forced practitioners to consider the need for extended stability data in order to limit the wasting of limited supply medications where feasible. The extended stability monographs and parenteral nutrition monographs in this edition represent a continuing drug information project focused on identifying, reviewing, and compiling relevant available information in a concise format. Monographs selected include most of the anti-infective medications and other parenteral drugs with useful extended stability dating. They cite the majority of extended stability data available at the time of the edition. Many of the monographs reference well-known sources, such as the Handbook on Injectable Drugs (a “must-have” reference for every pharmacy that compounds sterile preparations). Additional references and sources include previously unpublished data for specific types of infusion devices and containers, direct communications from drug and device manufacturers, and a focused review of previously published data from the perspective of practitioners who use this information in their home and ambulatory infusion practice settings. The third edition included a comprehensive chapter on total parenteral nutrition; this chapter was reformatted for the fourth edition with stability and compatibility data summarized in parenteral nutrition monographs for some of the most common additives to parenteral nutrition preparations, and information on calcium/phosphate solubility was added to the fifth edition. In the fifth edition, Applying Stability Data in Patient Care added a nursing perspective, with a primer on the types of vascular access devices used in medication administration and important considerations for pH, osmolality, concentration, and administration devices. The practices and integrity of pharmacists and others who compound sterile preparations have been under great scrutiny in recent years. Increased awareness by health care consumers, boards of pharmacy, and federal regulators further presses us to employ the diligence and professionalism with which we are entrusted to protect the public. We strongly emphasize the importance of using the extended stability data in this compilation responsibly and as part of the overall quality and standards-focused process of preparing sterile compounds. The monographs and chapters are compiled as an easy-to-use reference on extended stability of the parenteral drugs and biologicals most common to alternate site infusion practice, including data in container types commonly used outside the acute care setting. The user should always consult the newest literature, and manufacturer labeling, prior to establishing the beyond-use date for a compounded sterile preparation.

vii Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Preface EXTENDED STABILITY FOR PARENTERAL DRUGS

What's New in This Edition The 165 stability monographs in this sixth edition include updates to all but five of the monographs from the fifth edition, and 11 new stability monographs: ado-trastuzumab emtansine, blinatumomab, ceftolozane-tazobactam, coagulation factor X, dalbavancin, ferric carboxymaltose, ibuprofen lysinate, iron sucrose, oritavancin diphosphate, pertuzumab, and tedizolid phosphate. Monograph updates include revisions for a number of container types, as well as information for new elastomeric infusion device brands. The Parenteral Nutrition chapter cites fifteen new references; the Applying Stability Data in Patient Care chapter also cites fifteen new or revised references, and summarizes the implications of nursing, pharmacy, and compounding standards of practice revisions for extended beyond-use dating. Also noteworthy is our decision to retain stability data on some devices that were previously widely used and are now no longer marketed in the United States, but are still available internationally and in Puerto Rico; monograph footnotes clarify this status. My long time friend and col- league, Anna Nowobilski-Vasilios, has been a monograph writer/reviewer since the first edition of this book at the turn of the millennium; Anna willingly continued for her second ‘term’ as the invaluable co-editor for this edition. As with prior editions, the publisher, editors, and writers welcome your feedback and suggestions.

Caryn Dellamorte Bing, RPh, MS, FASHP May 2017, Las Vegas, NV

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Caryn Dellamorte Bing, RPh, MS, FASHP, is Principal at CB Healthcare Consulting. Caryn mostly retired in 2014 after a diverse career in home and specialty infusion. She is a contract surveyor for the Center for Pharmacy Practice Accreditation (CPPA). Caryn was Senior Manager Clinical Services and PGY1 Residency Program Director for Critical Care Systems, Inc., a national home and specialty infusion provider, with responsibilities for developing and supporting clinical standards of practice, clinician training and professional development, and leadership and management of PGY1 Pharmacy Residency programs. Caryn’s career spanning more than 30 years has included corporate leadership, general management, operations, clinical management, accreditation surveyor, consulting, training, and pharmacy practice roles in national and regional home/specialty infusion and other alternate site and acute care practice settings. Caryn holds a BS from University of Illinois College of Pharmacy and MS in Health Systems Management from Rush University. She completed her pharmacy residency at Rush Medical Center. She is a Rho Chi Scholar and Fellow of the American Society of Health-System Pharmacists. Caryn has been active in professional association leadership throughout her career, including terms as a presidential officer for the Illinois and Nevada ASHP state affiliates, and numerous times as an ASHP Delegate and Alternate Delegate. She served on and chaired the NHIA Education Committee; still serves as a reviewer for articles, practice standards, accreditation standards, and other publications; and has mentored practitioners and students in a variety of settings. She served on the ASHP Home Care Section Executive Committee and was Chairperson for the ASHP Continuity of Care Task Force. Caryn received the first Distinguished Service Award from the ASHP Home Care Section, and is the 2017 ASHP Board of Directors Distin- guished Leadership Award recipient. She served on several editorial boards for national professional journals; has published a number of articles and book chapters; and has presented at many state and national meetings. Caryn has been Editor of Extended Stability for Parenteral Drugs since its inception.

Anna Nowobilski-Vasilios, PharmD, MBA, FASHP, BCNSP, CNSC, is Principal at Anovation, Inc., a practice specializing in the consultative support of home infusion, specialty pharmacy, ambulatory care, accrediting organizations, and other industries related to outpatient clinical services. Prior to establishing her consulting practice, she served Option Care, Inc. for 14 years in roles of increasing responsibility, culminating as Senior Vice President of Care Management Services. Previously, she held various management and clinical positions at home infusion companies, home health agencies, and hospitals. Anna received a BS (Pharmacy) from the University of Illinois (1979), MBA from the Keller Graduate School of Management (1993), and PharmD from Midwestern University (2). She is a Fellow of the American Society of Heath-System Pharmacists (FASHP), and has been board certified in nutrition support pharmacy (BCNSP) for over 20 years. Anna is an active member of ASHP, NHIA, ASPEN, INS, ICHP, and the Polish American Pharmacists’ Association (PAPA). She has lectured and directed courses related to home infusion therapy and sterile preparation at Midwestern University, Chicago State University, Uni- versity of Illinois, and Roosevelt University. She served on the Practice Analysis Task Force in Sterile Compounding for the Board of Pharmacy Specialties (BPS), and she has been appointed as content matter expert for the APhA/ASHP petition to BPS for specialty recognition of sterile compounding. Anna is a contract surveyor and consultant for the Center for Pharmacy Practice Accreditation (CPPA). She has spoken and published on topics related to home infusion therapy, specialty pharmacy, new drug approvals, accreditation, sterile preparation, nutrition support, and interdisciplinary collaboration.

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Co-Editors

Caryn Dellamorte Bing, RPh, MS, FASHP Anna Nowobilski-Vasilios, PharmD, MBA, FASHP, Principal Consultant BCNSP, CNSC CB Healthcare Consulting Principal Las Vegas, Nevada Anovation, Care Management Innovation Chicago, Illinois

Writers

Gene Bernieri, PharmD, CNSC Diane Nitzki-George, PharmD, MBA Staff Pharmacist Clinical Pharmacist UCLA Medical Center Physicians Regional Hospital Los Angeles, California Naples, Florida and Stanley N. Chamallas, RPh, FASHP Clinical Assistant Professor Area Clinical Director—Northeast Working Professional Doctor of Pharmacy Program Option Care University of Florida College of Pharmacy Newmarket, New Hampshire and Donald J. Filibeck, PharmD, MBA, CSP, FASHP Freelance Medical Writer/Clinical Consultant Vice President, Pharmacy DNG Consulting, Inc. Option Care Dublin, Ohio Shamir K. Patel, PharmD Pharmacy Supervisor, Coram CVS/Specialty Infusion Crystin Gloude, PharmD Services Arlington Heights, Illinois Norwood, Massachusetts

Brenda L. Gray, PharmD, CNSC, BCNSP Kevin L. Ross, BSN, RN Owner and Senior Pharmacy and Accreditation Consultant Vice President, Nursing Operations Clinical Pharmacy Partners Soleo Health Tampa, Florida Sharon Hill, Pennsylvania

Annemarie Hocking, PharmD Lisa L. Siefert, RPh, FASHP, ASQ-CMQ/OE Clinical Pharmacist & Lead Preceptor PGY1 Residency Senior Director of Specialty Services Option Care Kloudscript Wood Dale, Illinois Oakbrook Terrace, Illinois

Barbara Limburg-Mancini, PharmD, BCNSP Paula Zelle, PharmD, FASHP Burr Ridge, Illinois Pharmacy and Accreditation Consultant Infusion Consultant Services Kevn M. McNamara, PharmD, CNSC Canton, Ohio Owner and Senior Pharmacy and Accreditation Consultant Clinical Pharmacy Partners Tampa, Florida

x Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) How to Use This Reference EXTENDED STABILITY FOR PARENTERAL DRUGS

Stability Monographs Each monograph in this reference represents a drug for which some extended parenteral chemical stability information is available from peer reviewed publications and/or drug and/or device/container manufacturers. Practitioners who are unfa- miliar with this reference and the principles of extended stability should review the “Applying Stability Data in Patient Care” chapter. Selected monographs include shorter stability data that may be useful in alternate site practice. Stability monographs are alphabetical by generic drug name. Each monograph includes a compilation of drug stability data for various container systems, solutions, concentrations, and temperature storage and administration conditions. The parenteral nutrition additive monographs are only applicable to parenteral nutrition formulations. The following temperature ranges were adapted from the USP to evaluate reported stability study conditions1:

Refrigerated 2°C to 8°C Frozen –25°C to –10°C Room Temperature* 15°C to 30°C Body Temperature 37°C *See the USP definition of Controlled Room Temperature in Appendix B, Glossary of Terms.

When studied storage conditions fall outside these ranges, a monograph note will indicate the variation. To use a stability monograph, find the desired container or material type in the first column. When a container type is not listed, then clinically useful or extended stability data were not available for the drug in that container type. Next, check the concentration, diluent, and manufacturer of the drug studied in that container type. The next column indicates the osmolality of the sample studied if it was assayed or calculated by the authors of the cited study. The pH column either includes the actual or range of pH for the specific concentration, or a note that ties to more general pH data for the drug product. Additional columns list the extended stability data that have been documented for the drug in the container and specified conditions. If frozen stability information is available, check the post-thaw stability data; this may differ from the room temperature and refrigerated stability data for the same drug in a never-frozen state. The final column indicates the reference(s) used for the particular line in the monograph. When n/a is noted in any field, no information is available for that item. Within the stability monograph, footnotes highlight important information. Each footnote corresponds to information in the Notes section of the monograph that is crucial to interpretation of the data. These include comments on variations from USP temperature ranges, detailed descriptions of storage conditions, and more. A Special Considerations section includes special information on drug storage and preparation. Flush compatibility refers to the chemical compatibility of the drug with common solutions used to flush vascular access devices. Practitioners should be aware of nursing practice guidelines (such as those of the Intravenous Nurses Society), access device specifications, and drug-solution compatibility when determining the type and volume of solution(s) used for line maintenance. When a drug is incompatible with heparinized saline (i.e., heparin lock flush), it may be necessary to flush with saline before and after administration. (Commonly referred to as SASH, this stands for Saline-Administration- Saline-Heparin.) A few drugs are not compatible with saline or heparinized saline; in these cases, flushing with an alternative compatible solution, such as D5W, may be necessary. If the line flush procedures for a specific therapy vary from the organization's standard approach, the pharmacist should provide written directions to clarify the flush method used. Hepa- rinization may not always be required to maintain line patency for some access devices (e.g., Groshong catheters) or when positive displacement catheter caps are used. Some references and notes from previous editions have been removed from this edition. The reference numbers and/or notes are not sequential on monographs where this is applicable.

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Use of Additional Resources The information contained in these monographs is a compilation of extended stability data from multiple sources. This information is not a substitute for the official product literature. Practitioners should consult the primary literature and the product manufacturer to determine the applicability of stability data to a particular patient and practice scenario. Practitioners should maintain current drug reference resources as well as the most current edition of a comprehensive reference on drug stability and compatibility. Every pharmacy that compounds or provides sterile preparations should maintain resource files, including the phone numbers and all correspondence with the medical or clinical affairs departments of pharmaceutical manufacturers. The pharmacy should also have access to a drug information center or the expertise and ability to conduct a literature search for the most up-to-date clinical and pharmaceutical information on parenteral drugs. General Abbreviations d day(s) h hour(s) iso iso-osmotic m month(s) min minute(s) n/a not available RTU ready to use from manufacturer unspec. unspecified w week(s) y year(s) Solution Abbreviations BWFI Bacteriostatic water for injection D Dextrose solution (percentage unspecified) D2.5 Dextrose 2.5% in water D2.5½S Dextrose 2.5% in sodium chloride 0.45% D5LR Dextrose 5% in lactated Ringer’s D5¼S Dextrose 5% in sodium chloride 0.225% D5½S Dextrose 5% in sodium chloride 0.45% D5S Dextrose 5% in sodium chloride 0.9% D10S Dextrose 10% in sodium chloride 0.9% D5W Dextrose 5% in water D7W Dextrose 7% in water D10W Dextrose 10% in water DXN-6 Dextran 6% LR Ringer's injection, lactated M10 Mannitol 10% NMD5W Normosol M in dextrose 5% NRD5W Normosol R in dextrose 5% NS Sodium chloride 0.9% R Ringer's solution ½S Sodium chloride 0.45% ¼S Sodium chloride 0.22% W Sterile water for injection Reference 1. United States Pharmacopeial Convention. Chapter <795> Pharmaceutical Compounding—Nonsterile Preparations. Official August 1, 2008.

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PART I

Applying Stability Data in Patient Care Introduction Factors Affecting Extended Drug Stability Preparation Sterility and Quality Assurance Professional, Regulatory, and Accreditation Expectations Commercial Products and Extemporaneous Compounding Infusate Properties Vascular Access Devices and Catheters Used in Medication Administration Labeling Instructions Assigning Beyond-Use Dates Patient and Site-Specific Considerations Considerations in Selecting Administration Methods and Infusion Devices External Factors Affecting Stability Ethanol and Antibiotic Locks Summary Parenteral Nutrition Beyond-Use Dating of Parenteral Nutrition (PN) Formulations Non-Formulation Factors Affecting PN Stability Formulation Factors Affecting PN Stability Commercial Products and Extemporaneous Compounding Professional, Regulatory, and Accreditation Expectations and Guidance Summary PARENTERAL NUTRITION MONOGRAPHS

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Applying Stability Data in Patient Care Caryn Dellamorte Bing, Kevin L. Ross

Introduction Alternate site pharmacists must use extended stability data to assign beyond-use dating to facilitate the cost-effective dispensing and delivery of compounded sterile preparations for multiple days of therapy. Pharmacists, regardless of practice setting, should always assign beyond-use dates that accurately represent the stability of the medication, combination of medications, or other component ingredients under the intended preparation, packing, shipping, storage, and administration conditions. To do this, the pharmacist must be familiar with the chemical and physical factors that affect the sterility, integrity, and stability of the final preparation. Additionally, environmental, operational, and personnel factors that contribute to the quality of a compound cannot be discounted. In light of very visible examples and tragic patient outcomes from contaminated preparations,1 pharmacists and technicians must diligently ensure that their facility produces contaminant-free preparations, which can then be assigned reasonable extended stability dates that are valid for their organization. Nurses and other professionals who administer parenteral medications must understand the application of beyond-use dating and physical/chemical characteristics of compounded sterile preparations in the patient care and patient education process. Parenteral drugs are usually compounded and/or packaged in something other than the original manufacturer's container. They are often diluted prior to administration and stored under different conditions than the bulk (source) ingredients. These factors have a direct and important impact on the stability of the final preparation.

Factors Affecting Extended Drug Stability Key terminology, definitions, a discussion of factors affecting extended drug stability, and some considerations for alternate site practice are provided below. References 3 and 40 are additional resources on the topics of drug stability, compatibility, and beyond-use dating.3,40 The shelf life stability of a drug is the length of time that the preparation retains the labeled potency of the active ingredient(s) under the labeled storage conditions. The common types of stability include chemical, physical, microbiological, therapeutic, and toxicological.40 The extended stability expiration dating in the monographs contained in this reference is the maximum time in which 90% or greater of a labeled active ingredient is measurable in the solution and container specified, under the stated storage conditions. For coagulation factor products, the stability is defined as retaining at least 80% of baseline activity. Instability refers to the chemical processes that result in drug degradation, including hydrolysis, oxidation, reduction, and photochemical decomposition reactions. Increased temperature and exposure to light can increase the likelihood of chemical instability for many drugs, particularly those that are affected by hydrolysis or oxidation reactions. Practitioners should always be aware of the basis for a preparation's instability, as the byproduct(s) of drug degradation can have therapeutic and/or toxicity implications for patient care. Incompatibility refers to a physical or chemical phenomenon that reduces the concentration of the active ingredient. In some cases, the incompatibility is easily observed, as with a precipitate, haze, color

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formation, or other obvious visual change. However, many incompatibilities are not readily observed. Factors that affect drug stability, such as the diluent, its pH, the concentration of the drug, the component makeup of the container, and the presence of other agents and buffers, are summarized in Table 1.4,40 Combination drugs. Practitioners must establish the beyond-use date based on the least stable moiety of a combination drug. For example, with ticarcillin disodium/clavulanate potassium or piperacillin sodium/tazobactam sodium, the ticarcillin and piperacillin are the least stable components of the combinations and are the basis for determining the beyond-use dating of these combination drugs. Concentration dependence or independence of chemical stability. Many drugs exhibit consistent chemical stabilities within the normally used clinical ranges; however, there are exceptions. For example, as the concentration of ampicillin sodium increases in solution, its stability decreases. Practitioners should verify that documented drug stability data is applicable to the desired concentration.

Preparation Sterility and Quality Assurance The manufacturer-approved stability information for parenteral drugs (i.e., the information permitted by the Food and Drug Administration [FDA]) is often based on concerns for preparation sterility rather than chemical stability. A detailed discussion of proper aseptic technique as well as parenteral preparation quality assurance is beyond the scope of this text. Practitioners should be familiar with

Table 1. Common Factors Affecting Drug Stability Factor Incompatibility or Instability Common Examples Contact with metal (e.g., Chemical reaction Hydralazine, metronidazole (with needles or components aluminum) of devices) Freezing temperature Inactivation, denaturation, emulsion Heparin, filgrastim, erythropoietin, cracking lipid-containing TPN, biologicals Large organic anions and Precipitation or formation of insolu- Heparin with aminoglycosides cations ble complex Light (natural and room) Accelerated chemical degradation Dobutamine, furosemide, cisplatin, reactions hydroxyzine, carboplatin Low temperature (refrigerated) Crystallization or precipitation 5-fluorouracil, furosemide, acyclovir, metronidazole Plastic containers, sets, in-line Adsorption of lipophilic agents— Sufentanil, filgrastim, calcitriol, filters especially important at low lorazepam, aldesleukin, insulin concentrations PVC or flexible plastic con- Evaporation, with resultant over- PVC or flexible plastic containers tainer permeability concentration of solution distributed in overwrap bags; small volume bags are most susceptible Plasticizer content of PVC Leaching carcinogenic plasticizer Paclitaxel, lipid emulsion, containers, sets DEHP from DEHP-containing PVC cyclosporine Saturation solubility exceeded Precipitation or crystallization Morphine sulfate, etoposide Temperature above 8°C Accelerated chemical degradation Ampicillin, biologicals reactions

Source: References 40 (USP <1191>) and 4 (Lima).

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professional standards, including those of the American Society of Health-System Pharmacists (ASHP) and the United States Pharmacopeia (USP), related to sterile preparation quality assurance. (See Profes- sional, Regulatory, and Accreditation Expectations below.) Practitioners have a responsibility to ensure that the beyond-use date assigned to a compounded parenteral preparation is consistent with the quality control practices in their parenteral preparation admixture program. Sterile preparation process validation and employee competence assessments should encompass all container systems and the longest beyond-use dating contemplated.

Professional, Regulatory, and Accreditation Expectations Pharmacists have a professional and legal responsibility for all aspects of the medication compounding and dispensing process. In addition to any issues unique to each state's pharmacy practice act, professional standards of practice set the expectations for practitioners in inpatient and alternate site care. Pharmacists should be aware of these expectations, including requirements applicable to their specific practice setting(s).

USP STANDARDS USP's Chapter <1206> Sterile Drug Products for Home Use outlined USP performance expectations in the provision of home-use sterile drug preparations, including stability and expiration dating.5 However, this document only applied to one practice setting and was not considered a compendial requirement. USP published Chapter <797> Pharmaceutical Compounding—Sterile Preparations6 in 2004 as a revi- sion to <1206>, and further updated this compendial standard, effective June 1, 2008.7 USP Chapter <797> is a general tests and assays chapter with regulatory weight and applicability for settings that compound sterile preparations. All practitioners involved with compounded sterile preparations (CSPs) should be familiar with the parameters for and limitations on extending beyond-use dating as set forth in USP Chapter <797>. USP Chapter <797> pertains to all pre-administration manipulations of CSPs (including compounding, storage, and transport), but not to the administration of CSPs to patients. USP published proposed revisions to Chapter <797> in 2015; revisions and implementation are pending. The proposed revisions include specified maximum beyond-use dating based on the method of preparation, sterilization, and, if applicable, addition of preservatives and sterility testing of CSPs.39

ASHP STANDARDS ASHP Guidelines on Home Infusion Pharmacy Services outline the requirements for the operation and management of pharmaceutical services provided by home care pharmacies.8 These guidelines affirm the pharmacist's responsibility for sterile preparation quality and integrity, including assignment of reliable beyond-use dating. ASHP Guidelines on Compounding Sterile Preparations assists pharmacists in establishing quality assurance procedures for sterile drug preparations based on the risk level associated with the process and preparation.9 These professional guidelines should be used in conjunction with other best practice resources that address the procedures and quality assurance for compounding sterile preparations.

FDA COMPOUNDING REGULATIONS The Food and Drug Administration Modernization Act of 1997 (FDAMA) included provisions that affect pharmacy compounding activities. The provisions of this act preclude pharmacies from bulk production of pharmaceuticals that are not intended for a specific or anticipated patient, and from copying commercially available preparations (although they can modify the preparation based on patient needs, as in the exclusion of a dye or preservative due to a patient allergy). Further, compounding pharmacists must ensure compliance with all USP standards. In 2002, a Federal Court of Appeals decision rendered unconstitutional the pharmacy compounding provisions of FDAMA due to the limitations they imposed on advertising.

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Following the tragic deaths and injuries from a fungal meningitis outbreak traced to a compounding pharmacy in 2012, the U.S. Government enacted the 2013 Compounding Quality Act. This legislation removed the unconstitutional provisions of FDAMA associated with 503A compounding and established another category: 503B outsourcing facilities. 503A compounders qualify for certain exemptions from the Food, Drug and Cosmetic Act (FDCA), specifically: no FDA approval prior to marketing; no requirements for good manufacturing practice (CGMP); no specific labeling directions per FDA requirements for drug products; and 503A facilities are not registered with the FDA. The FDA has authority to enforce compliance in 503A facilities if drugs are prepared in unsanitary conditions and/or are deemed adulterated, although the inspection and enforcement responsibility typically falls to the states as part of pharmacy licensure and regulatory authority. A number of states have instituted compounding pharmacy licensure and stringent in-state and out-of-state inspection requirements. A pharmacy cannot hold a 503A exemption status if it qual- ifies for and functions as a 503B outsourcing facility. 503B outsourcing facilities must register with the FDA, comply with CGMP, and meet additional FDA reporting requirements. A complete description of the requirements for and differences between 503A compounders and 503B outsourcing facilities is beyond the scope of this publication. However, all compounding pharmacy staff and management should be well aware of the applicability, associated requirements, and limitations of the 2013 Compounding Quality Act.46

STATE LAWS AND REGULATIONS Many states now have specific requirements for compounding sterile preparations. Some state boards of pharmacy have fully adopted USP Chapter <797> as the minimum standard, while others have developed state-specific provisions. These range from general guidelines to very specific facility, training, and quality assurance rules and regulations. Practitioners must be cognizant of all state requirements related to the compounding and dating of sterile preparations. However, it would be inadvisable to rely solely on the board of pharmacy or state regulations for the requirements and standards for preparing sterile compounds.

ACCREDITATION STANDARDS Accreditation standards set practice and operational expectations for organizations. The Joint Com- mission® (TJC) has standards that apply to many types of healthcare providers. The Community Health Accreditation Program (CHAP) and the Accreditation Commission for Health Care (ACHC) have standards that apply to home care and ambulatory infusion pharmacies. Accrediting bodies require adherence to accepted standards of practice, as well as law and regulation. Each accredited organization must establish and implement procedures that are appropriate and in compliance with legal and practice norms.

MEDICARE CERTIFICATION REQUIREMENTS The Centers for Medicare & Medicaid Services updated guidance documents, issued in October 2015, require inclusion of CSPs in the survey and review process of acute care facilities. State and/or deemed status accreditation surveys of acute care facilities now include this focus, including very specific elements of pharmaceutical services and preparation of CSPs outside the pharmacy.41

Commercial Products and Extemporaneous Compounding

EXTEMPORANEOUS COMPOUNDING A number of ready-to-use parenteral products are commercially available, and many of these have a shelf life beyond published or referenced stability data. However, practitioners should never extrapolate a commercial product's labeled shelf life stability to pharmacy-compounded sterile preparations.

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Commercial formulations often contain buffering systems and stabilizing agents, and use special packaging methods that allow for FDA-approved extended dating. In addition, pharmaceutical manufacturers must comply with extensive quality control standards to produce and label a sterile parenteral product.

CONSIDERATIONS FOR NONSTERILE INGREDIENTS Because certain sterile products are not commercially available, some pharmacies have adopted the practice of compounding parenteral preparations from nonsterile ingredients, then cold sterilizing them through 0.22-micron filters. USP Chapter <797> quality assurance measures for compounding from nonsterile components begin to approach the requirements applicable to parenteral manufacturers. Inadequately sterilized compounds prepared from nonsterile components have caused tragic infections and deaths of patients. Safety-conscious practitioners must consider the stringent USP compendial requirements for sterilization, testing, and quality assurance as a minimum standard for compounding these types of sterile preparations from nonsterile ingredients.

FREEZING PARENTERAL PREPARATIONS The institutional practice of freezing extemporaneously compounded parenteral preparations set the stage for the use of frozen medications in alternate site pharmacies. However, this practice is controversial. Most of the stability studies for frozen preparations are at a very controlled –10 to –20°C; some have been conducted with a flash-freeze process in which solutions are rapidly frozen and stored in commercial freezers. These conditions cannot be replicated when compounding a large quantity of small-volume parenteral preparations and freezing them overnight in the freezer compartment of a residential-style refrigerator. Similarly, frozen stability data do not apply to scenarios in which patients are instructed to place unfrozen preparations in home freezers upon receipt. Practitioners should not extrapolate frozen or post-thaw stability data from commercial frozen product labeling to extemporaneous preparations. Infusate Properties OSMOLARITY AND OSMOLALITY Whenever extemporaneous parenteral preparations are compounded, practitioners need to consider the osmolarity (mOsm/L of solution) or osmolality (mOsm/kg of solvent) of the final solution. In the absence of confirmed central placement of a patient's intravenous line, practitioners should prepare solutions that are within a reasonable osmotic range for peripheral infusions. Increased use of peripherally inserted central catheters has decreased concerns about peripheral vein irritation and phlebitis due to hyperosmotic/hypertonic infusions; however, hypo-osmotic/hypotonic solutions can cause hemoly- sis, and rapid hypertonic infusions can cause a variety of clinical complications. As a general rule, the greater the volume and rate of the infusion, the closer the solution should be to isotonicity (282–288 mOsm/kg),13 regardless of vascular access type or catheter placement. Osmolarity is an additive figure for all of the chemical ingredients of a solution, including the diluent. Theoretical osmolar concentration of a substance or drug can be determined using a variety of equations, including the following14:

[weight of substance per liter of solution (g/L)] Osmolar concentration (mOsm/L) ϭ [molecular weight (g)] ϫ number of species ϫ 1000

The number of species is the number of ions formed when the drug is dissolved in solution. Drugs that are not salts produce a species number of 1; monovalent salts and electrolytes produce a species of 2; and divalent salts and electrolytes produce a species number of 3. To obtain the osmolarity of the preparation, add the osmolarity of the diluent to this calculated answer. 7 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Applying Stability Data in Patient Care EXTENDED STABILITY FOR PARENTERAL DRUGS

Since various factors (including temperature, pH, and concentration) can affect dissociation in solution (species), the computed and actual measured osmolarity values may vary. Although the computa- tion of theoretical osmolarity of complex mixtures (such as total parenteral nutrition or multiple drugs in solution) is possible, the actual measured osmolality for these mixtures is best determined experimen- tally if clinically significant to patient care. The monographs in this book cite the measured or calculated osmolality (mOsm/kg) when available.

USING PH VALUES IN PRACTICE The pH of compounded sterile preparations will vary based on the acid-base property of the parenteral medication additives and the base solution or diluent used. The pH of the actual infusate may be important, as extremely low or high pH solutions can cause vascular irritation, phlebitis, and endothelial damage. If infiltrated, these solutions can result in further tissue damage. The normal physiologic (intravascular fluid) pH is 7.4. Some manufacturers and independent stability studies report the actual measured pH or pH range for specific CSP concentrations. However, these are often reported as a wide range and may reflect only the initial reconstituted or commercial solution pH. Practitioners should use available pH data and known pH ranges of commercial parenteral infusion solutions to determine when a preparation is suitable for infusion through peripheral vascular access devices. Table 2 includes the osmolarity and pH for some common commercial infusion solutions. Vascular Access Devices and Catheters Used in Medication Administration Factors that could impact the decision to administer a medication through a type of vascular access device (VAD) include: VAD tip placement, number of lumens, catheter material, catheter size (diameter, length), and volume from hub to tip. VAD complications can result in delays in therapy or missed doses when the VAD is not functional or must be changed. VAD complications that may be related to the drug concentration, pH, osmolality, and direct contact of irritants include:

• Infiltration (leakage of infusate into tissue surrounding a vascular access device) can occur when the VAD tip no longer resides in the blood vessel. • Extravasation (infiltration of vesicant or irritating agents into tissue surrounding a vascular access device) can result in tissue and/or nerve damage. • Chemical phlebitis is an inflammation of the inside of the blood vessel caused by direct contact with an irritant infusate. • Catheter occlusion can cause a complete or partial blockage of the VAD due to incompatibility resulting in a precipitant in the line.

Table 2. Osmolarity and pH of Commercial Infusion Solutions Solution Osmolarity (calc) mOsm/L pH Sterile Water for Injection, USP (W) 0 5.4–5.5 (5–7) Dextrose 5% in Water (D5W) 252 (calculated) 4, 4.5 (3.2–6.5) Normal Saline (NS) (Sodium Chloride 0.9%) 308 5.6 (4.5–7) Sodium chloride 0.45% (½S) 154 5.5 (4.5–7) Dextrose 10% in Water 505 (calculated) 4 (3.2–6.5) Dextrose 5% in Lactated Ringers (D5LR) 530 (calculated) 4.6 (4–6)

Source: FDA Approved Drug Products: Drugs@FDA. Available at: www.accessdata.fda.gov/. Accessed May 2016.

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The clinician should be aware of the VAD type prior to selecting or recommending the medication concentration and administration method, including frequency and duration of the infusion. Peripheral short catheters and pediatric midline catheters are stated in gauge (Ga) size, whereas adult midline and central vascular access devices are stated in French (Fr) sizes.27 Gauge refers to the diameter: the larger the gauge, the smaller the diameter. French refers to the circumference: the larger the French size, the larger the circumference.

CENTRAL VENOUS ACCESS DEVICES A central venous access device (CVAD) is a catheter whose tip terminates in the lower segment of the superior vena cava, at or near the cavoatrial junction (CAJ.)27 See Figure 1. CVADs have several distinct purposes in the clinical setting. They provide alternatives for IV administration when patients have poor peripheral venous access and also ready access for frequent blood draws. The large diameter and high flow of blood permits administration of medications with high osmolality, concentration and/or viscosity, parenteral nutrition, chemotherapy, blood products, and medications with low or high pH and other vesicant properties. CVADs may be valved or open ended. Valved catheters are designed to maintain line patency without anticoagulant flush. There are two basic types of CVADs, tunneled and non-tunneled. Tunneled CVADs are anchored by “tunneling” in tissue prior to the insertion into the large blood vessel. They are generally used for permanent or long-term venous access. Non-tunneled CVADs are placed via a percutaneous stick into the blood vessel and advanced within the blood vessel. They are not permanently placed.

Figure 1. Central placement: Tip of a CVAD catheter is located at the cavoatrial junction (CAJ)

Aorta Pulmonary artery

Superior vena cava Pulmonary Cavoatrial veins junction (CAJ) Left atrium

Right atrium

Left ventricle Right ventricle

Inferior vena cava

Oxygenated blood Deoxygenated blood

Source: Adapted with permission from Stuhan MA. Understanding Pharmacology for Pharmacy Technicians, Bethesda, MD: American Society of Health-System Pharmacists; 2013; 271.

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A peripherally inserted central catheter (PICC) is a type of non-tunneled CVAD that is inserted in the antecubital space into the basilic, brachial, or cephalic veins and advanced within the blood vessel to achieve central placement. See Figure 2. An implanted port is a type of tunneled CVAD that is implanted under skin and tissue with no portion of the catheter externally exposed. Ports must be accessed using a special non-coring needle.

Figure 2. The circulatory system

Jugular vein

Subclavian vein Superior vena cava

Cephalic vein Heart

Basilic vein Arteries

Veins

Femoral vein

Source: Adapted with permission from Stuhan MA. Understanding Pharmacology for Pharmacy Technicians, Bethesda, MD: American Society of Health-System Pharmacists; 2013; 272.

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NON-CENTRAL VASCULAR ACCESS DEVICES There are two types of non-central VADs, midline and peripheral short catheters. Non-central VADs should not be used for administration of continuous vesicants, total parenteral nutrition, or high osmolality solutions.27,28,38 Midline catheters are not CVADs. They are a type of peripherally placed VAD. A midline may be from 3 inches to 8 inches in length, with the tip terminating in the vessel between the elbow and the shoul- der (the axillary region). The catheter dwell time (length of time in place) is typically 2 to 6 weeks. Use caution with intermittent vesicant administration due to the risk of extravasation.27 The safe short-term administration of vancomycin through a novel midline catheter has been reported.27,42 Additional limitations for midlines include patients with history of thrombosis, hypercoagulability, decreased venous flow to the extremities, or end-stage renal disease requiring venous preservation.27 Peripheral short catheters are usually 1–1.5 inches in length and are available in 14–27 gauge (Ga) sizes, with the tip terminating in the peripheral vein. These devices are used for short-term and single dose IV administration. The clinician should consider the availability of peripheral access sites, the infusate properties (e.g. irritant, vesicant, pH, and/or osmolarity), as well as the anticipated duration of therapy (e.g., less than 6 days) when using a peripheral short catheter.27

Labeling Instructions Labels that specify the storage conditions and beyond-use date of compounded preparations should be placed on each parenteral dosage unit. If preparation stability varies under different temperature conditions, list the beyond-use date for each anticipated storage condition on the label; the pharmacist should make this information as clear as possible. If the preparation should be warmed to room temperature prior to administration, the label and ancillary instruction material should clearly describe this. If preparations are stable for less than 24 hours at room temperature, the label should be very specific about the end-use time. Patients and caregivers should always be trained to check preparations for current beyond-use dates prior to usage. Practitioners should establish a standardized approach to labeling that is clear, concise, conforms to applicable standards of practice, and meets all licensure and regulatory requirements, including USP Chapter <797> general labeling guidelines.15

Assigning Beyond-Use Dates As noted earlier, a number of factors can affect extended stability of parenteral preparations. When assigning a beyond-use date, practitioners should consider stability, compatibility, sterility, and the final concentration of the compounded preparation.

STABILITY Be aware of the chemical stability of the active drug ingredient. Is it light sensitive, heat sensitive, or likely to be pushed to the limits of labeled potency during the dispensing interval? When the contents of one drug container is infused over a number of days, be certain that the drug stability data reflect room or near body temperature conditions for the intended administration interval.

COMPATIBILITY Note the compatibility of the drug with the available or intended diluents, as well as the most commonly used catheter maintenance flush solutions. Although many drugs are compatible with either normal saline or dextrose 5% in water, some exhibit greater compatibility and extended stability in one of these diluents.

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STERILITY Possibly the most controversial point in assigning extended beyond-use dates, sterility is one of the most difficult variables to control. Pharmacy management must ensure that established sterile preparation quality control and quality assurance methods referred to earlier have been implemented and validated in their practice setting. Only with this type of risk management and quality assurance can pharmacists feel safe in assigning extended dating from any source.

FINAL CONCENTRATION Pharmacists should calculate the final concentration of each compounded parenteral admixture and compare this to available stability and compatibility data. Drugs exhibit different stability at different concentrations. Whenever possible, the pharmacist should compound the parenteral preparation in a concentration within the established stability range.

CONTAINER TYPE AND MATERIAL The type of infusion container or device can affect extended drug stability. Practitioners should be aware of the container material for proprietary ambulatory infusion devices and administration sets. Parenteral stability data for one type of container should not be automatically extrapolated to other brands or types of containers.

Patient and Site-Specific Considerations ROUTES OF PARENTERAL ADMINISTRATION In addition to the intravenous route, some parenteral drugs and solutions are administered continu- ously or intermittently by the following routes using specialized access and administration devices:

• Subcutaneous • Intraspinal (epidural, intrathecal) • Intraosseous

Practitioners should be familiar with the limitations and considerations unique to each parenteral route, which is beyond the scope of this publication.

SITE OF CARE CONSIDERATIONS FOR BEYOND-USE DATING Practitioners must be fully aware of the circumstances in which compounded sterile preparations will be delivered, stored, and administered. As noted earlier, these circumstances may affect the integrity and stability of the compounded sterile preparations. The following are some tips for the variety of practice settings in which extended dating may be applicable. Inpatient acute care In these circumstances, the hospital may prepare large batches of specific drug admixtures in anticipa- tion of high utilization. The internal (pharmacy) preparation and storage conditions, hospital delivery process, storage conditions on patient units, and method of handling unused medications (returns) are all factors for consideration in hospital policies regarding parenteral preparations. Home and hospice infusion Home infusion organizations often issue a weekly supply of compounded sterile preparations when documented extended stability data are available. In some cases, even longer time intervals between home deliveries may be necessary. The unpredictability of parenteral pain management for hospice and palliative care patients can pose special challenges to the preparation and delivery cycle. In addition to the pharmaceutical considerations, two key issues arise with home and hospice infusion. First,

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the delivery and storage methods and conditions will vary, which may affect drug stability. The pharmacy is responsible for ensuring appropriate delivery processes. Second, patient and caregiver education on proper storage conditions is a joint responsibility of the pharmacy and any home health and hospice practitioners who conduct patient training and/or make home visits. Home care practitioners and their patients face a number of unique and sometimes uncontrollable situations. Most home care patients do not have a nurse or other healthcare professional present for every dose, hook-up, disconnect, or parenteral route access event. Typically, the patient or caregiver is taught to administer medications that are delivered to the patient at weekly or other intervals. In addition to hooking up and infusing parenteral preparations using pumps; elastomeric devices; and intravenous push, gravity, and in-line control sets, the patients or caregivers are taught to maintain intravenous access patency with appropriate line flush and catheter care techniques. Each patient's situation is different. Practitioners must evaluate these circumstances at the start of care and reevaluate at reasonable intervals to ensure that the extended drug stability assigned is appropriate to the continuing needs of the patient.

Long-term and subacute care In many cases, these patient care facilities do not have on-site, 24-hour pharmacies to compound sterile preparations. The delivery and storage of compounded parenteral medications is similar to the circumstances for home infusion. However, a pharmacy may decide to dispense a limited number of doses due to unanticipated changes in patient status in this patient population. Any pharmacy and long-term care facility policies on the return and reuse of medications should be carefully developed to ensure that product integrity and stability are not compromised.

Ambulatory infusion A variety of clinical, reimbursement, and practice issues drive the administration of parenteral preparations in outpatient clinics, physician offices, or other ambulatory care settings. When the pharmacy provider is off-site from the location of the medication administration, delivery and storage factors are applicable. When the medication is started (connected) in the ambulatory care setting and the patient leaves with medication infusing, practitioners should establish the stability of the product at the ambient temperatures to which it is exposed.

NEONATAL, INFANT, AND PEDIATRIC PATIENTS The preparation and administration of injectable or infused medications and parenteral nutrition for neonatal, infant, and pediatric patients requires an understanding of the characteristics and unique needs of this patient population. The neonatal age group includes premature and term babies up to 1-month-old. Infants are from 1 month to 24 months. Children are 2- to 12-years-old, and adolescents are 12- to 18-years-old. The dosage ranges, dilutions, and complete factors for consideration are beyond the scope of this book. Practitioners providing parenteral therapy to these patients should also consult current references specific to pediatrics, such as Pediatric Injectable Drugs.12 The volume of infusion solutions administered over time to neonates, infants, and children presents challenges for healthcare professionals, especially for multiple infusion medication administrations throughout the day or over a course of treatment. The nurse or pharmacist should ensure that the volume of diluents plus medications administered does not exceed the daily fluid needs for that patient. The pharmacist may have to prepare more concentrated solutions to prevent fluid overload or to get the medication infused in reasonable time. Some medications are less stable at higher concentrations. In addition, higher concentrations increase the challenge of ensuring that the osmolarity and pH are appropriate for the type of catheter. Another factor to consider when administering medications to younger patients is the viscosity of the solution. Viscous solutions generally require the use of infusion devices for the accurate and timely infusion of the medication. The intravenous catheters typically used in these patients may be smaller gauge (e.g., 23 or 24 gauge) so viscous solutions will infuse more slowly.

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Avoid most of the preservatives used in parenteral medications (e.g., benzyl alcohol) in neonates. The pharmacist should ensure that the beyond-use date assigned is appropriate when utilizing products without preservatives. Here are some additional safety considerations for young patients receiving infused medications:

1. Use standardized concentrations of medications to prevent errors. 2. The overfill in a compounded syringe or container should never be equal to or greater than the dose administered. 3. Note the potential for dosage lost in administration sets. If this amount is substantial relative to the total required dose, then provide a post dose flush bag with a compatible diluent to ensure complete and accurate dosing.

Considerations in Selecting Administration Methods and Infusion Devices LENGTH OF THERAPY One of the most time-consuming and costly components of alternate site infusion is the start of care or admission visit. The training, assessment, and subsequent paperwork involved in a home healthcare start-up can take several hours for a typical case. However, with the increased emphasis on short hospital stays and improved treatments for many conditions, the length of many home infusion cases has also decreased. When patients are sent home for a 2- or 3-day completion of anti-infective therapy, practitioners must decide on an easy-to-teach administration method that maximizes patient compliance. In these circumstances, stability factors are not as much of an issue because the course of therapy is shorter. The more common home care scenario involves therapies expected to continue for extended periods of time with weekly delivery intervals.

ADMINISTRATION METHOD AND INFUSION DEVICES The following factors contribute to the selection of the infusion administration method most appropriate to the patient's circumstances:

• Patient mobility • Presence of willing and trainable caregiver(s) • Home environmental factors (e.g., safety, security) • Patient functional limitations (e.g., visual abilities, manual dexterity) • Language barriers (i.e., difficulty speaking or understanding English) • Reimbursement for devices and home care nursing visits • Patient proximity to the infusion provider site • Patient risk factors for infection (e.g., immune-compromised and/or underlying illness)

Keep in mind that the choice of administration method and device may be the main determinant of extended drug stability for a CSP. An old method of drug administration has reemerged in the alternate site care setting. Patients, caregivers, physicians, and practitioners have increasingly accepted patient- or caregiver-administered intravenous push, primarily for anti-infective therapy. Studies showing positive clinical outcomes and high satisfaction levels are expected to spur the continued growth of this practice.16 Another benefit of intravenous push is that stability data for many of the anti-infective agents in syringes are readily available and easily adopted for home care and alternate site applications.

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A number of infusion devices are marketed for the ambulatory and home care population. The list of electronic and disposable devices seems almost endless and continues to grow. With the increased incidence of latex allergies, most manufacturers have converted some or all of their infusion containers to latex-free products. Practitioners should consult the product literature to ensure that latex-free products are used whenever latex allergies are a risk factor.

SPECIFIC DRUG DELIVERY SYSTEMS The available stability data for a given container may affect the selection of the drug delivery system for a particular patient. As noted above, the myriad of infusion devices challenge the practitioner to determine whether the available stability data are applicable to the container closure system selected. In the absence of studies of a specific container, the pharmacist should consider the component materials and compare information from similar container systems that have been evaluated. Pharmacists should be aware of manufacturer guidelines for the use of specific containers, and any known changes in container material composition.

Flexible plastic containers The most common parenteral container system in use today continues to be the flexible plastic container, commonly referred to as the IV bag. This type of container can be used with or without an infusion device, depending on the requirements for rate control, IV line pressure, and compliance with organizational policies. Many infusion solutions are available in single chamber, flexible plastic containers. Empty containers are also available and used for specialized preparations.

Polyvinyl chloride (PVC) containers Most PVC containers (and other medical devices) are prepared using the plasticizer DEHP, which can be leached from the PVC material by some lipophilic medications, lipids, and blood products.24 July 2002 guidelines from the FDA caution against the use of PVC in selected specialty clinical applications.17 Practitioners should review these guidelines and establish policies that are appropriate for their patient populations and therapies provided.18 In November 2006, the Department of Health and Human Services recommended exposure to DEHP be minimized in male infants and female patients that are pregnant with a male fetus.25 Various manufacturers now offer lines of DEHP-free solution bags, infusion sets, and devices. Manufacturers of parenteral products packaged in PVC and other nonrigid plastic containers recommend maximum usage times after removal from the overwrap. This time varies with the container type, volume, and solution and/or drug. Table 3 summarizes several manufacturers' maximum

Table 3. Manufacturer Storage of Plain Commercial IV Solution Containers after Removal from Protective Overwrapc Maximum Storage Time Brand Name (Manufacturer) Volume (room temperature) LifeCareTM and ADD-Vantage® PVC 25 mL 21 d Containers (HSP)a >25 mL 30 d ViaflexTM PVC Containers (BA)b ≤50 mL 15 d ≥100 mL 30 d aManufacturer letter. Hospira, Inc., Medical Communications Department. March 2016. bManufacturer letter. Baxter Healthcare Corporation, Global Medical Affairs. March 2016. cIntact overwrap retards water loss across container wall. NOTE: Consult product labeling for all commercial premixed and frozen medications for recommended storage times and conditions after removal of protective overwrap.

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out-of-overwrap storage times for plain solution container storage at room temperature. Once additives are placed in these containers, the beyond-use date changes to the shorter of the drug stability dating or the solution manufacturer's maximum recommended time for use after removal from the overwrap and storage. Always consult product labeling for commercial premixed and frozen medications for recommended storage time and conditions.

Ethylene vinyl acetate (EVA) containers EVA containers are made of a flexible plastic that does not require phthalate plasticizers such as DEHP in the manufacturing process. EVA containers can serve as a DEHP-free alternative for preparation of medications when that choice is appropriate for the patient or therapy.

Other types of flexible containers Some of the newer types of flexible and semirigid plastic containers are made up of multilayers (lam- inates) with non-PVC fluid pathways and/or completely new types of plastic, including polyethylene, polyester, and polyolefin. Some of these container types no longer require an overwrap as a moisture barrier, which can reduce the amount of plastic waste and environmental consideration. Published and available container-compatibility and stability studies in these newest types of containers may not be available for all of the medications that have been studied in PVC. Those studies that have been conducted are designed to demonstrate drug compatibility with the newer containers when PVC adsorption and/or DEHP leaching was an issue with the PVC.29

Syringes Plastic syringes have been increasingly used as the primary drug delivery system for alternate site use. This growth is due to several factors, including an increased awareness and acceptance of administering a number of different medications by the IV push route when it is clinically appropriate. Practitioners should consult the product literature and other references to determine when it is safe to administer medications without the use of a rate controlling device. Mechanical or electronic syringe pumps are used when the rate must be safely controlled or when a medication is given over long intervals for therapeutic reasons. Special consideration should be given to the method of packing drug-filled syringes to ensure that they do not leak, that the plungers are not accidentally pushed in, and that the plungers and other clean parts of the syringe do not come in contact with potential contaminants. Further, clinical staff and patients/caregivers must be made aware that only the interior contents of a syringe (barrel, capped hub) should be considered sterile once a syringe is filled and capped during aseptic filling processes. Practitioners should be aware of manufacturer alerts and/or FDA warnings regarding drug compatibility with all components of syringes, including the stopper materials on the plunger system. Gen- eral use syringes are cleared as medical devices for fluid aspiration and injection; their suitability for closed-container drug storage has not been established by the FDA.47,48

Commercially prepared solutions Always consult the most current package labeling for stability dating of commercially available premixed solutions. Labeled frozen and post-thaw stability data for each premixed drug apply only to that specific commercial product. Practitioners must not extrapolate stability data from premixed commercial preparations of drugs in solution to extemporaneously compounded preparations.

Elastomeric reservoirs Elastomeric reservoirs are nonelectric, single-use medical devices that deliver their contents at a controlled rate. They consist of a balloon-like central container that exhibits pressure when filled, and the rate of flow is controlled by the size of a restrictor on the tubing. Each brand of elastomeric device is made of unique and proprietary materials. This precludes clinician extrapolation of drug stability from one brand of these device containers to another. 16 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Applying Stability Data in Patient Care EXTENDED STABILITY FOR PARENTERAL DRUGS

The manufacturers of most elastomeric reservoirs publish guidelines on the stability of drugs in these devices. Some device manufacturer guidelines cite data for selected agents extrapolated from other container studies or resources. In addition, not all of the references specify original stability studies in a given device. Practitioners should consult the most current guide for the specific brand of elastomeric device when determining the stability dating for a given agent. The contributors to this publication reviewed the manufacturers' guidelines and incorporated their data, but the contributors did not review the unpublished stability studies cited in guidelines and resources provided by the device manufacturers. Factors affecting the accuracy of elastomeric flow rate are reviewed in detail elsewhere. They include temperature during administration, viscosity of the solution, atmospheric pressure, back pressure (affected by position relative to infusion site), partial filling, and temperature during storage and infusion.30 Elastomeric devices have applications for many ambulatory and home infusion therapies, including intermittent dosing of anti-infective agents, continuous chemotherapy, and patient-controlled pain management. Each type of application requires a different type of elastomeric device; these are available with different specific flow rates, total volume, and bolus abilities. Practitioners should pay particular attention to the model and type of device to ensure the correct dose and rate of infusion are administered.

Other specialty devices The medication delivery device market has responded to compatibility, stability, beyond-use dating, and specialized infusion challenges with innovative devices:

• Ambulatory infusion systems. The technology of ambulatory infusion devices continues to evolve. A number of electronic and mechanical devices are available on the market today.20,21,22,31 Some providers standardize selection to one brand of device, which then allows for standardized training staff, patients, and caregivers.32 When this selection includes multifunctional devices that have several programs (e.g., PCA, intermittent, continuous, TPN ramping, and step infusion), then the programming and patient/caregiver education must ensure that the correct program parameters are used for the therapy required. • Drug-bag delivery systems. The Duplex® system is another type of dual-chambered bag. The system is stable at room temperature until the ready-to-mix drug is reconstituted with the diluent in the second chamber. This type of system is increasingly used in hospitals with automated dispensing systems (ADS), since it can be stored in the ADS cabinet until time of administration. The closed system drug activation bypasses all compounding processes. • Dual-chambered bags. Dual-chambered bags are designed for total parenteral nutrition (TPN) solutions. The provider prepares the amino acid, dextrose, and electrolyte solution in one chamber and places the fat emulsion in the second chamber. These chambers are separated by a removable divider. The bag is designed for separate storage of the lipid emulsion and amino acid/dextrose solution until just before the start of administration. A complete three-in-one total nutrient admixture (TNA) results from removing a rod that keeps the chambers separated until this point. Several brands and material types of dual-chambered bags are available. • Implanted infusion devices. These specialized devices are limited volume reservoirs that are implanted intradermally. They are filled with special needles similar to the process for accessing implanted ports, and their use is primarily for intraspinal pain management, spasticity management, regional chemotherapy and analgesia, and other neurological conditions. Intraspinal micro- infusions must be prepared without preservatives due to their potential neurological toxicity. Since these medications will be stored at body temperature for extended periods in these reservoirs, practitioners should be especially mindful of the stability, sterility, and potential for endotoxin or other adulteration of these preparations when developing procedures for their preparation, quality assurance, dispensing, and administration. • Vial-bag connectors. Specialized point-of-care activated devices and bags allow for the connection of a vial of medication to a small volume infusion container bag. Generally, the connection 17 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Applying Stability Data in Patient Care EXTENDED STABILITY FOR PARENTERAL DRUGS

Table 4. Beyond-Use Date for Point-of-Care Activated Devices Assembled in ISO Class 5 PEC** Device Company BUD Applicable Products ADD-VantageTM Hospira 30 d from date diluent 50 and 100 mL bags removed from overwrap Mini-Bag PlusTM Baxter 15 d from date diluent 50 and 100 mL bags removed from overwrap 30 d from date diluent 100 mL containers docked with the following: removed from overwrap cefazolin 1g, cefuroxime 750 mg, ceftriaxone 1 g, aztreonam 1 g, and piperacillin and tazobactam 3.375 g Add-EASETM Braun 70 d When connected to 50 or 100 mL bag 56 d When connected to Excel 250 mL bags

BUD= beyond-use date; POC= point-of-care **BUD is for assembled but not yet activated system and stored at room temperature. Always consult the most current package insert for POC- activated medication BUDs. Originally published in ASHP Guidelines on Compounding Sterile Preparations. Am J Health-Syst Pharm. 2014; 71:145–66 ©2014, American Society of Health-System Pharmacists, Inc. All rights reserved. Adapted with permission.

of the vial to the bag is made under aseptic conditions. The actual mixing of the medication with the IV fluid (activation) takes place immediately prior to administration. Patients and caregivers are trained to ensure that complete reconstitution, when applicable, and mixing takes place before administration. The most common application of these systems is with very short stability medications suitable for dilution and administration in small (≤100 mL) infusion bags. The pharmacy must consider the specific device manufacturer's guidelines when setting policy on the storage of connected, but not activated, devices. Table 4 summarizes the manufacturers' beyond-use dates for these devices after assembly in ISO Class 5 PECs and prior-to-activation.

External Factors Affecting Stability Circumstances beyond the direct control of the pharmacy that may affect the medication's potency and stability include the following6:

• Available method of delivery (e.g., common carrier, courier, pharmacy-controlled delivery process) • Availability of a functioning, clean refrigerator in the home or alternate care site • Ambient temperature in the care setting, especially non–air-conditioned residences in hot weather • The need for patients/caregivers to manipulate sterile products, sets, and other devices • Patient and caregiver adherence to labeled storage instructions of compounded preparations

DRUG DELIVERY PROCESS AND CONTROL Pharmacists can take a number of constructive steps to ensure that proper temperature and light protection conditions are met and that fragile items are carefully packaged for delivery and storage.43,44,45 The delivery process (e.g., containers, insulating and packing materials, courier, environmental conditions) should be validated to ensure that the contents of the shipment are maintained at a temperature within established stability parameters.23 The pharmacy should be aware of storage and shipping limitations and should take extra precautions for extreme temperatures (summer heat, winter freezing temperatures) to ensure that preparation stability is not affected during shipping.

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STORAGE AND ADMINISTRATION The variation and fluctuation of temperatures in noncommercial (e.g., home) refrigerators can be a major uncontrolled factor in drug stability. Many providers have established the practice of providing reliable refrigerator thermometers and teaching the patients or caregivers to monitor these temperatures at home. This is particularly important when there is only one in-home refrigerator for a number of residents. Some medications and parenteral solutions are particularly sensitive to temperature fluctuations. Pharmacists should be aware of the in-home situation, should ensure that the patient or caregiver education addresses proper drug storage and handling, and should closely monitor the status of temperature control when critical stability issues are identified. Practitioners should carefully consider specific patient circumstances and needs prior to dispensing frozen preparations. Considerations should include an assessment of freezer capabilities at the pharmacy and the patient's home or care facility. Freezer temperatures should be monitored to ensure that conditions match those reflected in the stability study or reference. When preparation stability data are based on light-protected conditions, then the drug storage and administration conditions should incorporate light protection. Some ambulatory infusion device reservoirs and elastomeric devices are made of light-protective plastics. In the absence of these devices, several methods of light protection can be employed, including UV-blocking overwrap plastic coverings or aluminum foil wraps. The pharmacist should ensure that the overwrap and the medication container are properly labeled, just in case the overwrap is accidentally removed. A double-label system (labeling both the container and the overwrap) can help ensure that the drug will be both stored and used properly.

PATIENT/CAREGIVER EDUCATION Pharmacists should always ensure that patients and caregivers know what to do with their medications, equipment, and supplies. The written instructions and labeling, coupled with oral reinforcement, should address proper drug storage, handling, administration, disposal, and any relevant precautions or issues to watch for and report to the pharmacist. This written and oral patient education provided by the pharmacist should be consistent with in-home instruction provided by home care nurses. Interdis- ciplinary (and often interorganizational) collaboration is essential to effective and accurate patient and caregiver education.

Ethanol and Antibiotic Locks Ethanol lock therapy (ELT) and antibiotic locks (ABL) are increasingly used to prevent or manage catheter-related blood stream infections.33,34 Practitioners must consider the available stability data35 as well as catheter compatibility information when determining a concentration and dwell time for these specialized forms of access device care.36,37

Summary Practitioners involved in parenteral therapy (e.g., nurses, pharmacists, physicians) must be aware of the factors affecting the application of stability data to patient care. In addition to published stability data, practitioners must consider the type of container, intravascular infusion method, medication delivery and storage conditions, and patient or caregiver abilities as well as the quality assurance, methods, and environment for sterile compounding before establishing an appropriate beyond-use date for the CSP.

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References

1. Kastango ES. The cost of quality in pharmacy. Int J Pharm Compound. 2002; 6(6):404–7. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 May. 3. Bing CD. Storage and beyond-use dating. In: Buchanan EC, Schneider PJ. Compounding Sterile Preparations. 4th edition. Bethesda, MD: American Society of Health-System Pharmacists; 2017. 4. Lima HA. Drug stability and compatibility: special considerations for home care. Infusion. 1996; 2(Aug):11–6. 5. United States Pharmacopeia (USP). Chapter <1206> Sterile Drug Products for Home Use. USP 24–NF 19. Rockville, MD: USP Convention Inc; 1999:2130–43. 6. United States Pharmacopeia (USP). U.S. Pharmacopeia 28. Chapter <797> Pharmaceutical Compounding—Sterile Prepara- tions. Rockville, MD: U.S. Pharmacopeial Convention Inc; 2004:2461–77. 7. United States Pharmacopeial Convention. General Chapter <797> Pharmaceutical compounding–Sterile Preparations. In: USP Compounding Compendium 2016 (current with USP 39–NF 34 through First Supplement). Rockville, MD: United States Pharmacopeia; 2016. 8. American Society of Health-System Pharmacists (ASHP). ASHP Guidelines on Home Infusion Pharmacy Services. Am J Health-Syst Pharm. 2014; 71:325–41. 9. American Society of Health-System Pharmacists (ASHP). ASHP Guidelines on Compounding Sterile Preparations. Am J Health-Syst Pharm. 2014; 71:145–66. 12. Phelps SJ, Hagemann TM, Lee KR, et al. Pediatric Injectable Drugs. 10th edition. Bethesda, MD: American Society of Health-System Pharmacists; 2013. 13. Buchanan EC. Sterile preparation formulation. In: Buchanan EC, Schneider PJ. Compounding Sterile Preparations. 4th edition. Bethesda, MD: American Society of Health-System Pharmacists; 2017. 14. Siegel F. Tonicity, osmoticity, osmolality, and osmolarity. In: Remington's Pharmaceutical Sciences. 18th edition. Easton, PA: Mack Publishing; 1990:1484. 15. Kuban PK. Labeling sterile preparations. In: Buchanan EC, Schneider PJ. Compounding Sterile Preparations. 4th edition. Bethesda, MD: American Society of Health-System Pharmacists; 2017. 16. Poole SM, Nowobilski-Vasilios A. To push or not to push. Infusion. 1999; 5(9):52–5. 17. U.S. Food and Drug Administration. Safety assessment of Di(2-ethylhexyl) phthalate (DEHP) released from PVC medical devices. Available at: www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ UCM080457.pdf. Accessed May 20, 2016. 18. Barrell Counce J. DEHP in medical devices: sleeping tiger or paper tiger? Infusion. 2002 (Sept–Oct); 8(5):18–25. 20. Saladow J. History in the making: healthcare delivery and pump technology continue to evolve. Infusion. 1999; 5(9):15–51. 21. Saladow J. Infusion device technologies: consolidation and change. Infusion. 2000; 6(8):9–39. 22. Saladow J. Delivery device update. Infusion. 2002; 8(5):32–5. 23. Chamallas SN, Fishwick JJ, Riesenberg M. Special delivery: keeping the product stable during shipping. Infusion. 1997(Dec); 4(3):30–2. 24. FDA Public Health Notification: PVC Devices Containing the Plasticizer DEHP. July 12, 2002. 25. Center for the Evaluation of Risks to Human Reproduction (National Toxicology Program, U.S. Department of Health and Human Services). NTP-CERHR Monograph on the Potential Human Reproductive and Developmental Effects of Di(2-Ethylhexyl) Phthalate (DEHP). NIH Publication No. 06-4476; November 2006. 27. Alexander M, ed. Infusion therapy standards of practice. J Inf Nursing. 2016; 39(1S):S1–159. 28. Boullata JI, Gilbert K, Sacks G, et al. ASPEN clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling and dispensing. J Parenter Enteral Nutr. 2014; 38(3):334–77. 29. Trissel LA, Xu QA, Baker M. Drug compatibility with new polyolefin infusion solution containers. Am J Health-Syst Pharm. 2006; 63:2379–82. 30. Skryabina EA, Dunn TA. Disposable infusion pumps. Am J Health-Syst Pharm. 2006; 63:1260–8. 31. Saladow J. Ambulatory infusion technologies: new developments and how they might affect alternate site care. Infusion. 2007; 13(4):17–22. 32. Saladow J, Prosser B. Improving the continuity of care: New infusion pump technologies. Home Infusion Continuum. 2007; 1(1):1, 8–11. 33. Bing CM, Ross KL. Antibiotic and ethanol lock therapy. Home Infusion Continuum. 2008; 1(2):1, 10–11. 34. Bestul MB, VandenBussche HL. Antibiotic lock technique: Review of the literature. Pharmacotherapy. 2005; 25(2):211–27. 35. Cober MP, Johnson CE. Stability of 70% alcohol solutions in polypropylene syringes for use in ethanol-lock therapy. Am J Health-Syst Pharm. 2007; 64:2480–2. 36. Patel D, Bing C, Goebel M, et al. Evaluating the outcomes of antibiotic lock therapy: results from a national home infusion provider. Poster presentation. Orlando, FL: National Home Infusion Association; April 2011. 37. Ustaszewski L, Bing C, Kunzendorf C, et al. Ethanol lock therapy: patient outcomes in home infusion. Poster presentation. National Home Infusion Association. Orlando, FL; April 2011. Encore poster. Boston, MA: Infectious Diseases Society of America; October 2011. 38. NHIA CVAD Guidelines for the Adult Home-Based Patient, rev 6-25-2011. Available at: http://www.nhia.org/CVADGuide- lines/NHIAAdultVADGuidelinesV6.pdf. Accessed December 10, 2011.

20 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Applying Stability Data in Patient Care EXTENDED STABILITY FOR PARENTERAL DRUGS

39. U.S. Pharmacopeial Convention. General Chapter <797> Pharmaceutical compounding-Sterile Preparations. Notice of Intent to Revise. Pharmacopeial Forum Online, 2015:41(6). Available at: http://www.usp.org/sites/default/files/usp_pdf/EN/ USPNF/usp-gc-797-proposed-revisions-sep-2015.pdf. Accessed 2016 May. 40. United States Pharmacopeial Convention. Chapter <1191> Stability Considerations in Dispensing Practice. In: USP Compounding Compendium 2016 (current with USP 39–NF 34 through First Supplement). Rockville, MD: United States Pharmacopeia; 2016. 41. Centers for Medicare and Medicaid Services. 16-01-Hospital: Revised Hospital Guidance for Pharmaceutical Services and Expanded Guidance Related to Compounding of Medications. October 30. 2015. Available at: https://www.cms.gov/ Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-01.pdf. Accessed May 2016. 42. Caparas JV, Hu JP. Safe administration of vancomycin through a novel midline catheter: a randomized, prospective clinical trial. J Vasc Access. 2014; 15(4):251–6. 43. Parenteral Drug Association. Technical Report No. 39 (Revised 2007). Guidance for Temperature-Controlled Medicinal Products: Maintaining the Quality of Temperature-Sensitive Medicinal Products through the Transportation Environment. JPDA J Pharma Sci Technol. 2007; 61(S-2):1–19. 44. United States Pharmacopeial Convention. <1079> Good Storage and Distribution Practices for Drug Products. In: USP Compounding Compendium 2016 (current with USP 39–NF 34 through First Supplement). Rockville, MD: United States Pharmacopeia; 2016. 45. Bing CD. Maintaining sterility, purity, and stability of dispensed and distributed CSPs. In: Buchanan EC, Schneider PJ. Com- pounding Sterile Preparations. 4th edition. Bethesda, MD: American Society of Health-System Pharmacists; 2017. 46. FDA, Information on Compounding: Compounding Quality Act. Available at: http://www.fda.gov/Drugs/Guidance ComplianceRegulatoryInformation/PharmacyCompounding/, Accessed July 18, 2016. 47. FDA expands warning on Becton-Dickinson (BD) syringes being used to store compounded or repackaged drugs. Available at: http://www.fda.gov/drugs/drugsafety/ucm458952.htm, Accessed July 18, 2016. 48. NHIA Educational Resource: Assessing Alternatives to the Storage of Compounded and Repackaged Medications in BD 3 mL and 5 mL General-Use Syringes. September 4, 2015. Available at: http://nhia.org/documents/20150904-NHIA-Ed- Resource-Alternatives-Affected-Syringes.pdf. Accessed July 18, 2017.

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Parenteral Nutrition

Diane Nitzki-George, Barbara Limburg-Mancini

Beyond-Use Dating of Parenteral Nutrition Formulations Parenteral nutrition (PN) is one of the most complex admixtures prepared by a pharmacy. Safety, stability, and compatibility issues should always be evaluated prior to mixing. When mixed incorrectly, calcium may form an insoluble precipitate with phosphate that can be fatal; and a cracked lipid emulsion with its free oil should never be administered to a patient. Although caregivers are instructed to inspect each PN bag for signs of precipitation or creamed/cracked lipids, the pharmacist is ultimately responsible for determining the stability of additives and assigning a beyond-use date. Often those decisions are based more on experience than on published stability. Published stability on PN admixtures applies only to the test formula and conditions reported. Pharmacists are expected to extrapolate the results and apply them to different product brands and different additive concentrations. Decision-making about PN stability is based on known causes of instability, in conjunction with the upper and lower limits of tested stability, instead of knowing that a specific formulation is stable. The pharmacist should be aware that a similar formula is stable and that there are no known factors that will cause instability. This approach is associated with a degree of risk, but has been used for years. The American Society for Parenteral and Enteral Nutrition (ASPEN) has recognized that not all products used in the preparation of PN are equivalent, and brand substitution of the amino acids, lipid emulsion, vitamins, and trace elements should not be done. Either the product formulation will affect admixture stability or the product composition will affect clinical outcome. As such, these PN additives should always additionally be labeled by brand name. Furthermore, assumptions regarding stability should be made relative to the product differences. For example, the major stability-related difference between amino acids is the pH, so stability and beyond-use dating relative to additives affected by pH (i.e., calcium phosphate solubility, lipid emulsion stability) should be brand specific. Before making a decision about the stability or beyond-use date of PN, each pharmacist should evaluate the degree of risk they are willing to assume. Below are several questions to think about when evaluating stability risk:

• Will the nutrient lose potency through degradation? • What are the possible degradation mechanisms? • Will a toxic degradation product or precipitate be formed? • Will the nutrient bind or complex with another additive or the container, and is it reversible? • Will the nutrient cause erosion or extraction of the container or tubing? • What are the professional, regulatory, and practice requirements?

The discussion and tables in this chapter are intended to assist the pharmacist with his or her evaluation of the answers to these and other questions for appropriate decision making.

Non-Formulation Factors Affecting PN Stability There are several factors, besides the PN formulation, which will affect stability. These factors are managed through product selection as well as techniques in handling and storage (Table 1). Different PN formulas have different stability concerns requiring that pharmacists have knowledge about product characteristics and handling techniques.

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NOTE: The beyond-use date used by another pharmacy is specific to their products, techniques, and policies that may not apply to all practices.

Table 1. Factors Affecting PN Stability Handling Light ·Light is a catalyst to the oxidation of several PN additives, especially vitamins.1 ·Light can affect the stability of most parenteral vitamins within 24 h, resulting in peroxide generation.2 ·Significant loss of vitamins A, C, and riboflavin (B2) occur over 48 h when PN and Total Nutrient Admixtures (TNAs) are exposed to phototherapy light.3 ·Many pharmacy refrigerators have glass doors that permit PN exposure to light during storage and can affect stability. Oxygen ·Most of the amino acids and vitamins added to PN will degrade in the presence of oxygen.4 ·During the amino acids manufacturing process, oxygen is replaced by nitrogen to ensure stability of a product through the expiration date.5 ·Not only is oxygen introduced during the compounding process, but it can also migrate through most plastic containers. ·Light, heat, and trace elements can catalyze oxygen degradation.6 · Oxygen can affect the triglycerides in a lipid emulsion, forming peroxides that have been reported to cause harm in neonates.7 ·The process of transferring lipid emulsions to a plastic syringe or making a TNA may introduce oxygen and begin the cascade of changes that lead to peroxide formation.8 Temperature ·Dextrose degrades when autoclaved.9 ·Calcium phosphate is more likely to precipitate when the temperature is high.10 ·The integrity of a lipid emulsion is maintained longer when stored at lower temperatures, but not below freezing.11 Products Container ·None of the plastic containers available for compounding PN in the United States is considered an oxygen barrier, and all are subject to oxygen migration through the plastic.12 ·Extraction of plasticizer from polyvinyl chloride (PVC) containers is a concern with lipid emulsions.13 ·Adsorption of drug to the container surface is a concern with vitamin A.14 ·Vitamin A stability appears to vary by the type of plastic container.15 pH ·Vitamin C stability is improved with lower pH (i.e., pH 5.5 compared to pH 6.5), while thiamine stability is maintained best at pH 6.5.3 ·Calcium phosphate is more soluble at lower pH when equilibrium favors the monobasic form.10 ·Lipid emulsions display less evidence of instability when the admixture pH is greater than 5.5.17 ·The pH of the amino acid product is used to estimate the overall admixture pH since amino acids are strong buffers.18 Sulfites ·Concentrations of sodium bisulfite greater than 2 mEq/L have been shown to negatively impact the stability of vitamin A and thiamine.3 ·Tryptophan, used in powder form by some pharmacies to make an amino acid solution, loses 20% potency over 4 h if mixed with sodium bisulfite. If protected from light, then only 4% is lost when stored at room temperature for 6 months.19

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Table 1. Factors Affecting PN Stability (continued) Amino Acids ·The rate of amino acid conversion to Maillard products (non-enzymatic browning) is significantly increased after admixture when stored for 30 d at 4°C; the presence of electrolytes and storage at higher temperatures facilitates the formation of these degradants.20 ·Amino acid solutions can form highly colored degradants that are not reliable indicators of the solution potency or the degree of decomposition.21 Lipids ·Lipid emulsions display less evidence of instability when the admixture pH is greater than 5.5.17 Vitamin C (ascorbic acid) ·Ascorbic acid, when oxidized, can degrade to oxalic acid, which can form a precipitate when mixed with calcium22; ascorbic acid oxidation is catalyzed by the presence of trace elements.23

HANDLING TIPS Several techniques that have been reported to minimize the impact of handling on PN stability are as follows:

• Add multivitamins immediately prior to infusion. • Store PN under refrigeration to prolong stability. • Remove air from the PN bag after mixing. • Limit the lipid emulsion hang time on a compounder to 4 hours. • Protect PN bags from light, especially if refrigerator has glass doors.104 • Vacuum-seal PN in a foil overpouch for prolonged storage.

PRODUCT TIPS Keep in mind the product features and information that may impact PN stability as follows:

• Know the pH of the amino acids product. • Use amino acid-specific calcium phosphate solubility curves that correspond to the final PN concentration. • Lipid emulsion stability in TNA should be based on the specific amino acid product used in testing and the final concentration of macro- and micronutrients. • Ensure that the types of plastic containers used for compounding are appropriate for the PN formulation. • In addition to the PN formulation, assign beyond-use dates relative to the container type, amino acids pH, light/oxygen exposure, and presence of sulfites.

Formulation Factors Affecting PN Stability The components of a PN formula, including amino acids, dextrose, and electrolytes, appear to be stable for 2 weeks or longer. Table 2 includes a summary of published studies. These studies set an upper limit for beyond-use dating that should not be exceeded without additional testing. However, the upper limit should not be assumed for all formulas. Exceptions related to product formulation factors are explained below.

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Table 2. Summary of Published Studies on PN Stability Storage Storage Formulation Conc. Time Temp.a Container Comments Amino acids Unspecified Stable 28 d Refrig PVC No significant change in the concentration of amino Dextrose acids, dextrose, sodium, Sodium/Potassium potassium, calcium, phosphate, magnesium, Magnesium and trace elements Calcium (European products) was seen (data not shown)24 Phosphate Multiple vitamins Trace elements Amino acids (FreAmine®) 4.25% Stable 12 w Refrig (4°C) Glass Samples stored at room temperature and 37°C Dextrose 25% showed more rapid Sodium chloride 10 mEq/L deterioration of amino acids21 Sodium bisulfite <0.1% Amino acids (FreAmine®) 4.25% Stable 14 d Refrig or RT Glass No additives. Tryptophan was the least stable amino Dextrose 25% acid25 a.RT—room temperature, Refrig—refrigeration.

LIPID EMULSIONS TNAs combine lipid emulsion with amino acids, dextrose, and micronutrients in a single bag. The concept of TNA, first reported in the literature in the mid-1980s, has become a standard of practice in home care and in many hospital and long-term care settings.26 Home care patients or caregivers are instructed to inject limited stability additives, such as multivitamins, immediately prior to administration. They are then able to infuse the TNA in the same manner they would other intravenous admixtures. Parenteral lipid emulsions are small droplets of oil encapsulated by a phospholipid bilayer that is suspended in the aqueous emulsion phase. Since lipid emulsions, by definition, are thermodynamically unstable, all emulsions are expected to demonstrate some degree of instability over time.27 The droplets in the lipid emulsion must be less than 0.5 microns for passage through the capillary beds in the lungs. Lipid emulsions with more than 0.4% of droplets greater than 5 microns in diameter are considered unstable.29 Serious clinical concerns arise when either free oil is liberated, as evidenced by an oil layer on the top of the emulsion, known a cracked emulsion, or when the droplets become clumped, flocculated, or enlarged as evidenced by creaming. Creaming occurs when the lipid droplets rise to the top of the aqueous phase and can be re-dispersed by gentle mixing of the container.116 Coalescence of the droplets may take as long as 3 days for free oil, indicative of an unstable emulsion, to become visually evident.28 Lipid emulsions in the United States have traditionally contained triglycerides from soybean or safflower oil. Different products, which contain olive oil, medium chain triglycerides, and structured lipids, are used globally and have begun making their way into the US market. While the triglycerides in these products have different clinical effects, the emulsifier remains an egg yolk phospholipid. The integrity of the emulsification system, which is initially a quality variable of the manufacturing process,

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can also be affected by the type of oil used. Driscoll et al. found that products that mixed soybean oil with olive oil or medium chain triglycerides had greater physicochemical stability in TNA than those made exclusively with polyunsaturated long chain triglycerides (soybean and/or safflower oils).114 The literature contains TNA studies that report stability of lipid emulsion ranging from 24 hours to 6 weeks.17,30,31,32,33,34,35,36,37,38 The key to interpreting the literature is to recognize the difference between the products tested and understand the known factors that will destabilize the emulsion as discussed below.

pH Lipid emulsions are formulated at a pH of 6–8.39,40 Evidence of emulsion instability occurs when admixture pH is less than 5.5.17 Since amino acid pH is used to estimate that for the overall PN, the amino acid product and concentration is critical to emulsion stability following admixture.18 Amino acid products with pH of 5.5 or lower should not be used to compound TNA.

Dextrose concentration Dextrose concentrations higher than 10% are needed to prevent phase separation and creaming of lipids.41 Dextrose concentrations of 15% (when tested with Aminosyn II®, Liposyn II®) resulted in greater change in the lipid emulsion droplet size compared to TNA made with 30% dextrose final concentrations.38

Divalent/Trivalent cations Concentrations of divalent cations (calcium or magnesium) higher than 20 mEq/liter can destabilize lipid emulsions.42 Sodium chloride produces very little change in the surface charge (i.e., zeta potential) of a lipid emulsion (Intralipid®).42 Trivalent cations are more disruptive to lipid emulsions than divalent cations, which are more disruptive than monovalent cations. In the late 1980s, the following formula was developed to estimate the instability of lipid emulsion based on the total cation load: (1 mono-) + (64 di-) + (729 tri-) = total load expressed as monovalent. This means that 64 mEq sodium, a monovalent cation, is as disruptive to a lipid emulsion as 2 mEq magnesium, a divalent cation.43 The ratio of monovalent, divalent, and trivalent cations is a practical approach for use by a compounding pharmacy.41 When applying this concept in practice, it would be difficult to destabilize a lipid emulsion using clinically appropriate doses of monovalent or divalent cations.112 However, trivalent cations, such as iron, can destabilize lipid emulsion even at low doses.29 Standard doses of trace elements, many of which are divalent or trivalent cations, are low enough to avoid destabilizing a lipid emulsion over a 7 day period. 113,115

Temperature Refrigerated storage maintains the integrity of lipid emulsions better than storage at room temperature.17 Autoclaving or freezing lipid emulsions will cause premature destabilization.44

Heparin Lipid emulsion in the presence of calcium (~14.4 mEq/L) and heparin appears to undergo a phase shift toward instability. Theoretically, calcium binds with both the lipid emulsion and heparin, forming a bridge (calcium-heparin bridging) that causes lipid emulsions to appear creamed.45,46

CALCIUM PHOSPHATE SOLUBILITY The addition of both calcium and phosphates to PN formulations has been associated with formation of a fatal precipitate.120 The FDA Safety alert of 1994119,124 provides steps to reduce the risk of injury

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when both electrolytes are added. Pharmacists routinely screen formulas for calcium phosphate solubility using curves and tables found in other references.47 Although the curves were generated based on limited data, they have been validated in clinical practice.108 The data are typically generated over 24 or 48 hours and do not represent extended storage. The concentrations of calcium, phosphate, and amino acid as well as the calcium salt form and amino acid pH are the primary determinants of solubility,10 although amino acids are the critical component.105 The lower total volume of PN in neonates, infants, and pediatric patients presents additional stability challenges since electrolyte concentrations are often higher. High temperatures decrease calcium phosphate solubility, while the presence of lipid emulsion does not appear to affect the solubility. Calcium chloride disassociates to a greater degree than calcium gluconate. Recent work by Migaki, et al. states that calcium chloride and sodium phosphate can be safely administered in TrophAmine® in a study based on visual inspection.117 Driscoll et al. raised concerns about these findings in which the PN may contain potentially harmful microcrystals, smaller than the eye can detect.118 The work of Newton et al.121 suggests avoiding the use of calcium chloride in phosphate-containing PN. Fansel et al. studied calcium phosphate solubility over 14 days and found a significant decrease in the calcium concentration, presumably due to precipitation, and a decrease in pH suggesting that it takes several days for equilibrium to be reached in the admixture.48 This information and the lack of long-term calcium phosphate solubility studies invalidate the typical screening done by pharmacists when beyond-use dates are assigned. The change in calcium phosphate solubility over time highlights the need for in-line filters when assigning beyond-use dates. The separate administration of lipids or use of a dual chamber bag helps the practitioner and/or caregiver to visualize calcium phosphate gross precipitation that would be masked in a TNA. How- ever, visual inspection of PN, even without lipids, is not a reliable method to detect precipitation. The human eye is able to see particles as small as 50 microns, while particles as small as 5 microns may be associated with harm.109 Outside of the United States, organic phosphates are used to minimize the risk of phosphate precipitate with calcium. PN formulations containing 1.1 mEq/100 mL of sodium glycerophosphate, an organic phosphate, do not precipitate when mixed with concentrations of calcium gluconate as high as 1000 mg/100 mL (4.64 mEq/100 mL) when stored for 7 days.110 While organic phosphate and organic calcium products are not currently available in the United States, pharmacists should be careful not to establish beyond-use dates based on the wrong form of phosphate.

VITAMINS Temperature, light, container type, and the presence of lipid emulsion all affect the stability of vitamins. Individual vitamin stability ranges from a few hours to several days depending on the conditions. There is no single set of conditions in which all thirteen vitamins are stable. Unfortunately, many parenteral vitamins can be found only in combination products, and should be added to PN/TNA immediately prior to administration. A summary of stability studies on individual vitamins that may be supplemented to PN/TNA follows. The published studies on vitamins in PN/TNA are summarized at the end of this chapter.

TRACE ELEMENTS AND OTHER MINERALS There are several contradictions in the published literature related to the stability of trace elements and other minerals, primarily due to study design and uncontrolled variables. Amino acid products with cysteine, a sulfur-containing amino acid, have been reported to form complexes with several minerals including selenium, copper, and iron. In some cases, the complexes have been reported

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to precipitate.49 These events appear to be a function of the mineral concentration, admixture pH, and amino acid concentrations. It is unclear if complexed minerals are bioavailable after administration. Lipid emulsions are easily destabilized by divalent and trivalent cations. The standard doses of trace elements are low enough to avoid instability. Iron dextran has been reported to destabilize lipid emulsion and should not be added to TNA.50 A study found particulate matter in iron sucrose- containing PN when stored beyond 4 hours, despite the fact that iron sucrose remained chemically stable.107 The published studies on trace elements and other minerals in PN/TNA are summarized at the end of this chapter. Due to significant shortage of trace elements, the FDA has allowed temporary importation of an adult and a pediatric formulation. These products are significantly different than the U.S. multiple trace elements products so careful review of the contents, doses, and compatibilities is strongly advised.122

ALBUMIN Albumin is not recommended for addition to PN admixtures for several reasons as follows106:

• Lack of test data • Reports of color change when mixed with trace elements • Risk of precipitation with amino acids • Formulated with a pH in the range of 6.6–7.4, which may increase the pH of a PN resulting in calcium phosphate instability • Potential glycosylation with dextrose • May clog a 1.2-micron filter • Large aluminum contamination

DRUGS AND OTHER ADDITIVES Limited data exists on the addition of drugs to PN. Iqbal et al.123 found w13% degradation of cefotaxime when mixed with TNA and stored at room temperature for 72 hours. In general, the addition of non-nutrients to PN, with few exceptions such as insulin, is not advised due to the complex nature of PN/TNA and potential physicochemical interactions.50 Published studies on the stability of other common additives to PN/TNA are summarized alphabetically at the end of this chapter.

Commercial Products and Extemporaneous Compounding The effect of compounding methods on lipid emulsion stability in TNA (Aminosyn®, Liposyn®, dextrose, electrolytes, trace metals, vitamins in nonphalate PVC containers) was evaluated based on sequential or simultaneous mixing (using a Nutrimix® compounder). After 3 days’ storage, no difference was noted based on compounding method.51 However, a separate study reported that TNA prepared using simultaneous pumping had a higher percentage of lipid particles larger than 5 microns compared to TNA prepared by sequential pumping.38 This suggests that the order of mixing may affect lipid emulsion stability. Manufacturer recommendations should always be followed. Ready-to-use PN products are commercially available but still require addition of multivitamins, trace elements, and possibly electrolytes. Although these products are formulated to remain stable through the product expiration date, assigning beyond-use dating should continue to follow the general PN information presented here unless instructed otherwise by the manufacturer.

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Professional, Regulatory, and Accreditation Expectations and Guidance ASPEN has developed several guidance documents related to PN. The most important for an IV admixture pharmacist are entitled Safe Practices for Parenteral Nutrition and Clinical Guidelines: Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing.50,125 These guidance documents highlight the types of medication errors and adverse events that have occurred from PN and recommend processes the pharmacy can implement to reduce the risk of error. The Safe Practices guidelines are separated into five different topics and identify specific practice recommendations for:

1. Labeling 2. Nutrient Requirements 3. Sterile Compounding 4. Stability and Compatibility 5. Administration

The Clinical Guidelines, written in a question and answer format, provide additional recommendations related to education, osmolarity, calcium intake and compatibility, commercial preparations, TNA, micronutrient contamination, and lipid emulsion repackaging. ASPEN sterile compounding recommendations include practice guidelines to ensure that the compounding process does not introduce incompatibility or instability, that in-process and end-product inspection and testing are used to confirm compounding accuracy, and that pharmacies adhere to the USP Chapter <797>, Pharmaceutical Compounding—Sterile Preparations. Additionally, practice guidelines are provided to assist pharmacists with their approach to making decisions about PN stability and compatibility. The complexity of PN preparation processes includes multiple manipulations, multiple sterile source component additives, and/or the use of automated compounding equipment. The risk for preparation error and/or contamination increases with this complexity. For most pharmacists, compounding PN is treated as a medium risk activity following USP Chapter <797> requirements, with maximum beyond-use dating not to exceed 9 days refrigerated.52 The Centers for Disease Control and Prevention (CDC), in their Guidelines for the Prevention of Intravascular Catheter-Related Infections, recommends that lipid emulsions should be infused for no longer than 12 hours when infused alone and no longer than 24 hours as a component of a TNA. Administration sets for lipids should be changed every 24 hours.54 USP Chapter <729> Globule Size Distribution in Lipid Injectable Emulsions contains methodology for manufacturers to determine the mean particle size in lipid emulsions. Since lipid globules larger than 5 microns can be trapped in the lung, USP Chapter <729> has set a limit for mean lipid globule at no greater than 5 microns. Additionally, the percent of globules larger than 5 microns, expressed as PFAT5, should not exceed 0.05%. Although most compounding pharmacies will not be equipped to perform particle sizing of the lipids in their TNAs, an understanding of how the test procedures are performed will enable the pharmacist to better interpret the published literature.52 Accrediting bodies such as The Joint Commission (TJC) and the Accreditation Commission for Health Care (ACHC) do not have specific compounding standards for PN, although compliance with USP Chapter <797>, state law, OSHA regulations, and CDC guidelines is required.

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Summary PN and TNA formulas often combine over 20 different drug and nutrient products into a single container. Calcium phosphate solubility and lipid emulsion stability are the two most important concerns when evaluating PN formulations, but certainly not the only components with potential stability and compatibility issues. Amino acid products alone are formulated to contain about 15 different nutrients, and most multiple vitamin products contain 12 or 13 vitamins plus excipients. The possible permu- tations and combinations of different PN or TNA formulas are too numerous to test for stability and compatibility. Pharmacists must rely on a “matrix approach” to evaluate the stability and compatibility literature—ensuring that the specific formulations of PN or TNA fall within tested parameters for all of the components.

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Carnitine in Parenteral Nutrition Container Stability Concentration Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Unknowna Stable 130, 200 mg/L 30 d 24 h X X X X 53 Unknownb Stable 60–420 mg/L n/a 24 h X 99

Notes a30 d refrigerated followed by 24 h at room temperature; samples exposed to light when moved to room temperature; six different formulations; neither cysteine nor ranitidine influenced carnitine stability.53 bPN includes electrolytes, multivitamins, cysteine, heparin, and trace elements; individualized dose of 10 mg/kg/d.99

Chromium in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Glassa Stable n/a 48 h X X 73

Note aFormulas include amino acids (Travasol®) alone or in TPN (no formula provided).73

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Copper in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Unspecifieda Unstable n/a 2 h X 74 Unspecifiedb Stable n/a 24 h X 75 EVAc Stable 28 d n/a X X 49 Glassd Stable n/a 48 h X X 73 PPe Unstable 30 d n/a X 76 PVCf Stable 2 d n/a X X 77 PVCg Stable 48 h n/a X X 78 EVA—ethylene vinyl acetate; PP—polypropylene; PVC—polyvinyl chloride.

Notes aFormulas include cysteine containing amino acids (Novamine®), glucose, electrolytes, and trace elements.74 bFormulas include cysteine containing amino acids (TrophAmine®), dextrose, and electrolytes.75 cFormulas include amino acids, glucose, calcium, vitamins, and trace elements (European products).49 dFormulas include amino acids (Travasol®) alone or in TPN (no formula provided).73 eFormulas include amino acids (Travasol®), dextrose, electrolytes, vitamins, and trace elements (Canadian products).76 fFormulas include amino acids, dextrose, electrolytes, and trace elements (+/Ϫ) (European products).77 gStudied as copper sulfate. Formulas: amino acids (Travasol 8.5%®), dextrose, electrolytes, trace elements, and cimetidine.78 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Famotidine in Parenteral Nutrition Container Stability Concentration Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Unspecifieda Stable 83, 166, 250 mg/L n/a 48 h X X 91 Unspecifiedb Stable 20 mg/L n/a 48 h X X X 92 EVAc Stable 20, 50 mg/L 24 h 24 h X 93 EVAd Stable 20 mg/L n/a 24 h X X 94 EVAe Stable 20, 40 mg/L 7 d 48 h X X 95 EVAf Stable 20 mg/L n/a 48 h X X X 89 EVAg Stable 20, 40 mg/L n/a 72 h X X 96 PVCh Stable 20 mg/L 35 d n/a X X 97 EVA—ethylene vinyl acetate; PVC—polyvinyl chloride.

Notes aFormulas include amino acids (FreAmine III®), glucose, electrolytes, heparin, iron, and trace elements (Canadian products).91 bTested in individual solutions of either amino acids, D5W, lipid emulsion (Intralipid®), or NS (European products).92 cStability was 48 h total (24 h refrigerated followed by 24 h at room temp). Formula includes amino acids (FreAmine III®), dextrose, lipid emulsion (Intralipid 20%®), electrolytes, and trace elements; no impact on emulsion stability.93 dFormula includes amino acids (Novamine®), dextrose, lipid emulsion, electrolytes, vitamins, and trace elements.94 eFormula includes amino acids (FreAmine III®), dextrose, electrolytes, vitamins, heparin, and trace elements.95 fFormula includes amino acids (Travasol®), dextrose, lipid emulsion (+/Ϫ) (Liposyn II®, Intralipid®), electrolytes, vitamins, and trace elements; no effect on emulsion stability.89 gFormula includes amino acids, glucose, lipid emulsions, electrolytes, vitamins, and trace elements.96 hFormula includes amino acids (Travasol®), dextrose, electrolytes, and trace elements.97 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Folic acid in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

PVCa Stable 48 h 48 h X X X 56 EVAb Stable n/a 24 h X X 57 Glassa Stable 48 h 48 h X X X 56 Glassc Stable 48 h 48 h X X X 58 Glassd Stable n/a 24 h X X X 59 PVCe Stable 2 w 2 w X X 60 PVCf Stable n/a 24 h X X 23 Unspecifiedg Stable n/a 8 h X X 55 Unspecifiedg Stable 7 w n/a X X 55 EVA—ethylene vinyl acetate; PVC—polyvinyl chloride.

Notes aFormulas include amino acids (four different brands), sulfites (+/Ϫ), dextrose, lipid emulsion (+/Ϫ), electrolytes, vitamins, and trace elements.56 bFormula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).57 cFormula includes Aminosyn® and dextrose only.58 dAdmixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 eThe pH must remain above 5 to avoid precipitation of folic acid; formula includes amino acids, dextrose, electrolyte, zinc sulfate, and vitamins (European products).60 fFormula includes amino acids, dextrose, electrolytes, trace elements, and MVI-12® (European products).23 gFormula includes amino acids, dextrose, electrolytes, vitamins (Multivitamin Concentrate®), and trace elements.55 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Heparin in Parenteral Nutrition Container Stability Concentration Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

PVCa Stable 3,000, 5,000, 21 d n/a X 98 10,000, 20,000 units/L PVC—polyvinyl chloride.

Notes aFormula includes amino acids (+/Ϫ) (Travasol®), dextrose, electrolytes, and trace elements; longer stability with amino acids included in formula.98 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

Iron in Parenteral Nutrition Container Stability Concentration Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

EVAa Unstable 2 mg/L (dextran) n/a 30 h X 29 Unspecifiedb Stable 100 mg/L (dextran) n/a 18 h X 79 EVAc Unstable 50 mg/L (dextran) n/a 24 h X X 80 Glassd Stable 2 mg/L (dextran) 48 h 48 h X 81 PPe Unstable 10 mg/L (dextran) n/a 12 h X X 82 Unspecifiedf Unstable 1–100 mg/L (sucrose) n/a 8 h X 107 EVA—ethylene vinyl acetate; PP—polypropylene.

Notes aFormulas include amino acids (Aminosyn II®), dextrose, lipid emulsion (Liposyn III®), and electrolytes; instability defined as disruption of emulsion stability.29 bFormulas include amino acids (Travasol®), dextrose, electrolytes, vitamins (+/Ϫ), and trace elements (+/Ϫ).79 cFormulas include amino acids (Travasol®), dextrose, lipid emulsion (Intralipid®), electrolytes, vitamins, trace elements, and cimetidine; loss of iron and destabilization of emulsion noted.80 dFormulas include amino acids (Travasol®), dextrose, lipid emulsions (Intralipid®, Liposyn II®), electrolytes, and heparin.81 eFormulas include <2% cysteine containing amino acids (TrophAmine®), dextrose, electrolytes, heparin, vitamins (+/Ϫ), and trace elements (+/Ϫ); samples with higher concentrations of amino acid were stable for 48 h.82 fFormulas include amino acids (TrophAmine® 10%), dextrose, electrolytes, trace elements, multivitamins (MVI Pediatric®), cysteine (+/Ϫ), ranitidine (Zantac®) (+/Ϫ), and carnitine (+/Ϫ).107 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Manganese in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Glassa Stable n/a 48 h X X 73 PPb Unstable 30 d n/a X 76 PVCc Stable 7 d n/a X X 77 PP—polypropylene; PVC—polyvinyl chloride.

Notes aFormulas include amino acids (Travasol®) alone or in TPN (no formula provided).73 bFormulas include amino acids (Travasol®), dextrose, electrolytes, vitamins, and trace elements (Canadian products).76 cFormulas include amino acids (+/Ϫ), dextrose (+/Ϫ), electrolytes (+/Ϫ), and trace elements (European products).77 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

Ranitidine in Parenteral Nutrition Container Stability Concentration Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Unspecifieda Stable 83, 166, 250 mg/L n/a 72 h X 100 EVAb Stable 50, 100 mg/L n/a 12 h X X 101 EVAc Stable 75 mg/L n/a 24 h X X X 89 EVAd Stable 50, 100 mg/L 48 h 48 h X X X X 102 PVCe Stable 50, 100 mg/L n/a 24 h X X 103 EVA—ethylene vinyl acetate; PVC—polyvinyl chloride.

Notes aFormula includes amino acids (FreAmine III®), glucose, electrolytes, vitamins, trace elements, iron, and heparin (Canadian products).100 bFormula includes amino acids, dextrose, lipid emulsion, electrolytes, vitamins, and trace elements (Euro- pean products); no destabilization of emulsion.101 cFormula includes amino acids (Travasol®), dextrose, lipid emulsion (+/Ϫ) (Liposyn II®, Intralipid®), electrolytes, vitamins, and trace elements; no effect on emulsion stability.89 dFormula includes amino acids (Travasol®), dextrose, and lipid emulsion (+/Ϫ) (Intralipid®); longer stability when lipid added; no effect on emulsion stability.102 eFormulas include amino acids (Travasol®), dextrose, electrolytes (+/Ϫ), vitamins (including K), trace elements, and heparin.103 (+/Ϫ) indicates that sample was mixed both with and without the nutrient. 37 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Parenteral Nutrition EXTENDED STABILITY FOR PARENTERAL DRUGS

Selenium in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Unspecifieda Stable a a X 84 Unspecifiedb Unstable b b X 85 Unspecifiedc Stable n/a n/a X 86 PPd Stable 30 d 30 d X 76 PVCe Stable 10 w n/a X 72 PP—polypropylene; PVC—polyvinyl chloride.

Notes a24 h. Formulas include amino acids (Travasol®), dextrose, electrolytes, vitamins, and trace elements; results only apply to solutions with pH >4.75.84 b30 min storage at an unspecified temperature. Formulas included cysteine-containing amino acids (+/Ϫ), dextrose (+/Ϫ), electrolytes (+/Ϫ), ascorbic acid (+/Ϫ), and trace elements (+/Ϫ) (European products).85 cFormulas include amino acids, dextrose, electrolytes, ascorbic acid, and trace elements (European products).86 dFormulas include amino acids (Travasol®), dextrose, electrolytes, vitamins, and trace elements (Canadian products).76 eFormulas include amino acids (Aminosyn®), dextrose, electrolytes, vitamins, trace elements, and iron (Canadian products).72 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

Trace Elements in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

PVCa Stable n/a 72 h X 83 PVC—polyvinyl chloride.

Note aFormulas include amino acids, dextrose, electrolytes, and trace elements (European products); no precipitate was identified when normal concentrations were added, but several precipitates were identified with higher concentrations including iron, manganese, and copper phosphate and insoluble selenium (due to ascorbic acid).83

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Vitamin A in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Body Exposed Protected With Without

EVAb Stable 24 h 24 h 24 h X X 62 EVAc Unstable n/a 6 h n/a X X X 63 EVAd Stable 6 d 24 h n/a X Xd X 64 EVAk Stable 24 h 24 h 24 h X X 68 EVA, Glass, PVCe Stable 20 d n/a n/a X X X 65 Glassf Stable 48 h 48 h n/a X X 56 Glassg Stable n/a 24 h n/a X X X 59 PVCh Stable 7 d 7 d n/a X X 66 PVCi Stable n/a 8 h n/a X 24 PVCi Stable 5 d 39 h n/a X 24 PVCj Unstable n/a 24 h n/a X X 67 Unspecifieda Unstable n/a 5 h n/a X 61 EVA—ethylene vinyl acetate; PVC—polyvinyl chloride.

Notes aLoss of potency attributed to tubing adsorption; samples tested as vitamins alone or plus TPN (formula not identified).61 bFormula includes amino acids, glucose, lipid emulsion, electrolytes, vitamins, and trace elements (Euro- pean products).62 cFormula includes amino acids, glucose, lipid emulsion (+/Ϫ), electrolytes, and trace elements (European products).63 dRetinyl palmitate. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); refrigerated samples were protected from light; stability defined as greater than 80% of initial concentration; room temperature storage followed 6 d refrigeration.64 eFormula includes amino acids, glucose, lipid emulsion (+/Ϫ), electrolytes, MVI-12®, and trace elements (+/Ϫ) (European products); stability defined as greater than 80% of initial concentration.65 fFormulas include amino acids (four different brands), sulfites (+/Ϫ), dextrose, lipid emulsion, electrolytes, vitamins, and trace elements; unstable if lipid not in formula or if stored in PVC plastic.56 gRetinol admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 hFormula includes amino acids (+/Ϫ), glucose (+/Ϫ), lipid emulsion (+/Ϫ), vitamins, and trace elements (+/Ϫ); no electrolytes (European products).66 iFormulas include amino acids, glucose, electrolytes, and trace elements (European products); also stable 8 h at room temperature when exposed to light.24 jFormula includes amino acid, dextrose, electrolytes, vitamins, and trace elements (Canadian products); in-line filtration did not affect stability.67 kRetinol formulas include amino acids, glucose, lipid emulsions (Liposyn 20%®, Intralipid 20%®, ClinOleic 20%®), electrolytes, vitamins, and trace elements; no change in emulsion stability over 4 d.68 (+/Ϫ) indicates that sample was mixed both with and without the nutrient. 39 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Parenteral Nutrition EXTENDED STABILITY FOR PARENTERAL DRUGS

Vitamin B1 in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

PVC, Glassf Stable 48 h n/a X X X 56 Glasse Stable n/a 24 h X X X 59 EVAa Stable 96 h n/a X X 64 EVAb Stable n/a 24 h X X 57 PVCh Stable n/a 22 h X 69 PVCd Stable 5 d 5 d X X X 24 PVC, Glassf Unstable n/a 12 h X X X 56 EVAi Unstable 72 h 72 h X X 62 PVCg Unstable n/a 5 h X 69 Unspecifiedc Unstable n/a 8 h X X 55 MLj Stable 72 h 72 h X X X 111 EVA—ethylene vinyl acetate; ML—multilayer; PVC—polyvinyl chloride.

Notes aThiamine. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration. Room temp studied followed 6 d refrigerated.64 bThiamine hydrochloride. Formula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).57 cThiamine. Formula includes amino acids, dextrose, electrolytes, vitamins (Multivitamin Concentrate®), and trace elements.55 dThiamine. Formulas include amino acids, glucose, electrolytes, and trace elements (European products).24 eThiamine. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 fThiamine. Formulas include amino acids (Novamine®, Neopham®, FreAmine III®, Travasol®), sulfites (+/Ϫ), dextrose, lipid emulsion (Intralipid®) (+/Ϫ), electrolytes, vitamins (MVI 12®), and trace elements; thiamine is less stable in FreAmine III® (pH=6.5) than other amino acids; thiamine stability decreased at high pH and high sulfite content.56 gThiamine. Mixed in amino acids with sulfites (<0.05%) and no other additives.69 hThiamine. Amino acids with sulfites, dextrose, and vitamins.69 iThiamine. Formula includes amino acids, glucose, lipid emulsion, electrolytes, vitamins, and trace elements (European products).62 jFormula includes amino acids, dextrose, electrolytes, trace elements, pediatric multivitamins, high concentration calcium, and organic phosphate (Brazilian products).111 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Vitamin B2 in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

EVAa Stable 6 d 24 h X X X 64 EVAb Unstable 24 h n/a X X 57 Unspecifiedc Unstable n/a 4 h X X 55 PVC, Glassd Stable 48 h 48 h X X X 56 Glasse Stable n/a 24 h X X X 59 MLf Stable 72 h 72 h X X X 111 EVA—ethylene vinyl acetate; ML—multilayer; PVC—polyvinyl chloride.

Notes aRiboflavin. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration. Room temp studied followed 6 d refrigerated.64 bRiboflavin 5 phosphate sodium. Formula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).57 cRiboflavin. Formula includes amino acids, dextrose, electrolytes, vitamins (Multivitamin Concentrate®), and trace elements.55 dRiboflavin. Formulas include amino acids (four different brands), dextrose, lipid emulsion (+/Ϫ), electrolytes, vitamins, and trace elements.56 eRiboflavin. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 fFormula includes amino acids, dextrose, electrolytes, trace elements, pediatric multivitamins, high- concentration calcium, and organic phosphate (Brazilian products).111 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Vitamin B3 in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

EVAa Stable 96 h n/a X X 64 EVAb Stable 24 h n/a X X 57 Unspecifiedc Stable n/a 8 h X X 55 EVA—ethylene vinyl acetate.

Notes aNicotinamide. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration.64 bNicotinamide. Formula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).57 cNiacinamide. Formula includes amino acids, dextrose, electrolytes, vitamins (Multivitamin Concen- trate®), and trace elements.55

Vitamin B5 in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

EVAa Stable 96 h n/a X X 64 EVA—ethylene vinyl acetate.

Note aPantothenate. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration.64

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Vitamin B6 in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

EVAa Stable 96 h n/a X X 64 EVAb Stable 24 h n/a X X 57 Unspecifiedc Unstable n/a 8 h X X 55 Glassd Stable n/a 24 h X X X 59 MLe Stable 72 h 72 h X X X 111 EVA—ethylene vinyl acetate; ML—multilayer.

Notes aPyridoxine. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration. Room temp studied followed 6 d refrigerated.64 bPyridoxine hydrochloride. Formula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).57 cPyridoxine. Formula includes amino acids, dextrose, electrolytes, vitamins (Multivitamin Concentrate®), and trace elements.55 dPyridoxine. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 eFormula includes amino acids, dextrose, electrolytes, trace elements, pediatric multivitamins, high- concentration calcium, and organic phosphate (Brazilian products).111

Vitamin B12 in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

EVAa Stable 96 h n/a X X 64 EVA—ethylene vinyl acetate.

Note aCyanocobalamin. Formula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration.64

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Vitamin C in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

PVC, Glassa Stable 48 h n/a X X X 56 Glassb Unstable n/a 24 h X X X 59 Glassc Unstable n/a 12 h X X 71 Glass, PVCd Unstable 3 h 3 h X X 70 EVAe Unstable n/a 24 h X X 57 EVAf Unstable 6 h 6 h X X 62 EVAg Unstable 24 h n/a X X 64 MLh Unstable 24 h 24 h X 62 PVCi Stable 39 h n/a X X 24 PVCj Unstable 24 h 24 h X X X 23 MLk Stable 72 h 24 h X X X 111 EVA—ethylene vinyl acetate; ML—multilayer (oxygen barrier); PVC—polyvinyl chloride.

Notes aFormulas include amino acids (four different brands), sulfites (+/Ϫ), dextrose, lipid emulsion (+/Ϫ), electrolytes, vitamins, and trace elements.56 bAscorbate. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 cAscorbic acid. Formula includes amino acids, glucose, electrolytes, and trace elements (+/Ϫ) (European products).71 dAscorbic acid. Tested in the presence of copper. Formula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).70 eAscorbic acid. Formula includes amino acids, glucose, electrolytes, vitamins, and trace elements (European products).57 fFormula includes amino acids, glucose, lipid emulsion, electrolytes, vitamins, and trace elements (European products).62 gFormula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); stability defined as greater than 80% of initial concentration.64 hFormula includes amino acids, glucose, lipid emulsions (MCT/LCT), and electrolytes (European products); three different ML bags evaluated; minimum of 11.8% ascorbic acid loss in 24 h.62 iFormulas include amino acids, glucose, electrolytes, and trace elements (European products).24 jAscorbic acid. Formula includes amino acids, glucose, electrolytes, MVI-12®, and trace elements (European products).23 kFormula includes amino acids, dextrose, electrolytes, trace elements, pediatric multivitamins, high- concentration calcium, and organic phosphate (Brazilian products).111 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Vitamin D in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Glassa Stable n/a 24 h X X X 59 PVCb Unstable n/a 24 h X X 67 PVC—polyvinyl chloride.

Notes aErgocalciferol. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 bFormula includes amino acid, dextrose, electrolytes, vitamins, and trace elements (Canadian products); in-line filtration did not affect stability.67

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Vitamin E in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Body Exposed Protected With Without

PVC, Glassa Stable 48 h 48 h n/a X X X 56 EVAb Stable 6 d 24 h n/a X X X 64 EVAc Stable 72 h 72 h 72 h X X 62 EVAd Stable 24 h 24 h 24 h X X 68 EVA, Glass, PVCe Stable 20 d n/a n/a X X X 65 EVAf Unstable n/a 1 h n/a X X X 63 Glassg Stable n/a 24 h n/a X X X 59 PVCh Stable n/a 24 h n/a X X 72 PVCi Unstable n/a 24 h n/a X X 67 EVA—ethylene vinyl acetate; PVC—polyvinyl chloride.

Notes aFormulas include amino acids (four different brands), sulfites (+/Ϫ), dextrose, lipid emulsion (+/Ϫ), electrolytes, vitamins, and trace elements.56 bFormula includes amino acids, glucose, lipid emulsion (Intralipid®), electrolytes, vitamins, and trace elements (European products); refrigerated samples were protected from light; stability defined as greater than 80% of initial concentration.64 cFormula includes amino acids, glucose, lipid emulsion, electrolytes, vitamins, and trace elements (Euro- pean products).62 dTocopherol. Formulas include amino acids, glucose, lipid emulsions (Liposyn 20%®, Intralipid 20%®, ClinOleic 20%®), electrolytes, vitamins, and trace elements; no change in emulsion stability over 4 d.68 eFormula includes amino acids, glucose, lipid emulsion (+/Ϫ), electrolytes, MVI-12®, and trace elements (+/Ϫ) (European products); stability defined as greater than 80% of initial concentration.65 fFormula includes amino acids, glucose, lipid emulsion (+/Ϫ), electrolytes, and trace elements (European products).63 gTocopherol. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 hFormula includes amino acids (Aminosyn®), dextrose, electrolytes, vitamins, trace elements, and iron (Canadian products).72 iFormula includes amino acid, dextrose, electrolytes, vitamins, and trace elements (Canadian products); in-line filtration did not affect stability.67 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

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Vitamin K in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Glassa Stable n/a 24 h X X X 59 EVA, Glass, PVCb Stable 20 d n/a X X X 65 EVA—ethylene vinyl acetate; PVC—polyvinyl chloride.

Notes aPhylloquinone. Admixture of only Intralipid® and multivitamins; stability defined as greater than 80% of initial concentration.59 bVitamin K1. Formula includes amino acids, glucose, lipid emulsion (+/Ϫ), electrolytes, MVI-12®, and trace elements (+/Ϫ) (European products); stability defined as greater than 80% of initial concentration.65 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

Zinc in Parenteral Nutrition Container Stability Temperature Light Lipids Reference Refrigerator Room Exposed Protected With Without

Glassa Stable n/a 48 h X X 73 PVCb Stable 7 d n/a X X 77 PPc Unstable 30 d n/a X 76 PP—polypropylene; PVC—polyvinyl chloride.

Notes aFormulas include amino acids (Travasol)® alone or in TPN (no formula provided).73 bFormulas include amino acids, dextrose, electrolytes, and trace elements (+/Ϫ) (European products).77 cFormulas include amino acids (Travasol®), dextrose, electrolytes, vitamins, and trace elements (Canadian products).76 (+/Ϫ) indicates that sample was mixed both with and without the nutrient.

References

1. Brawley V, Bhatia J, Karp WB. Hydrogen peroxide generation in a model paediatric parenteral amino acid solution. Clin Sci. 1993; 85(6):709–12. 2. Laborie S, Lavoie JC, Pineault M, et al. Contribution of multivitamins, air, and light in the generation of peroxides in adult and neonatal parenteral nutrition solutions. Ann Pharmacother. 2000; 34(Apr):440–5. 3. Smith JL, Canham JE, Wells PA. Effect of phototherapy light, sodium bisulfite, and pH on vitamin stability in total parenteral nutrition admixtures. J Parent Enteral Nutr. 1988; 12(4):394–402.

47 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Parenteral Nutrition EXTENDED STABILITY FOR PARENTERAL DRUGS

4. Li S, Schoneich C, Borchardt RT. Chemical pathways of peptide degradation. Part 8. Oxidation of methionine in small model peptides by prooxidant/transition metal ion systems: influence of selective scavengers for reactive oxygen intermedi- ates. Pharm Res. 1995; 12(Mar):348–55. 5. Guerret J, Murano RA. The unique challenges of manufacturing parenteral nutrition products. Eur J Parent Sci. 2002; 7(4):127–30. 6. Allwood MC, Hardy G, Sizer T, et al. Effects of air and oxygen on parenteral nutrition admixtures—an underrated risk? Nutrition. 1996; 12(3):222–3. 7. Weinberger B, Watorek K, Strauss R, et al. Association of lipid peroxidation with hepatocellular injury in preterm infants. Crit Care Med. 2002; 6(6):521–5. 8. Pironi L, Guidetti M, Zolezzi C, et al. Peroxidation potential of lipid emulsions after compounding in all-in-one solutions. Nutrition. 2003; 19(9):784–8. 9. Postaire E, Pradier F, Postaire M, et al. Various techniques for the routine evaluation of the degradation of glucose in parenteral solutions—a critical study. J Pharmaceut Biomed Anal. 1987; 5(4):309–18. 10. Driscoll DF, Newton DW, Bistrian BR. Precipitation of calcium phosphate from parenteral nutrient fluids. Am J Hosp Pharm. 1994; 51(Nov 15):2834–6. 11. Lee MD, Yoon JE, Kim SI, et al. Stability of total nutrient admixtures in reference to ambient temperatures. Nutrition. 2003; 19(10):886–90. 12. Cutter CN. Microbial control by packaging: a review. Crit Rev Food Sci Nutr. 2002; 42(2):151–61. 13. Mazur HI, Stennett DJ, Egging PK. Extraction of diethylhexylphthalate from total nutrient solution-containing polyvinyl chloride bags. J Parent Enteral Nutr. 1989; 13(Jan–Feb):59–62. 14. Gutcher GR, Lax AA, Farrell PM. Vitamin A losses to plastic intravenous infusion devices and an improved method of delivery. Am J Clin Nutr. 1984; 40(1):8–13. 15. Henton DH, Merritt RJ. Vitamin A sorption to polyvinyl and polyolefin intravenous tubing. J Parent Enteral Nutr. 1990; 14(Jan–Feb):79–81. 16. Bluhm DP, Summers RS, Lowes MM, et al. Influence of container on vitamin A stability in TPN admixtures. Int J Pharma- ceut. 1991; 68(Feb 1):281–3. 17. Bettner FS, Stennett DJ. Effects of pH, temperature, concentration and time on particle counts in lipid containing total parenteral nutrition admixtures. J Parent Enteral Nutr. 1986; 10(Jul–Aug):375–80. 18. Lundgren P, Landersjo L. Studies on the stability and compatibility of drugs in infusion fluids. I. pH and buffer capacity of infusion fluids. Acta Pharmaceutica Suecica. 1970; 7(4):407–22. 19. Kleinman LM, Tangrea JA, Gallelli JF, et al. Stability of solutions of essential amino acids. Am J Hosp Pharm. 1973; 30(Nov):1054–7. 20. Fry LK, Stegink LD. Formation of Maillard reaction products in parenteral alimentation solutions. J Nutr. 1982; 112(8):1631–7. 21. Laegeler WL, Tio JM, Blake MI. Stability of certain amino acids in a parenteral nutrition solution. Am J Hosp Pharm. 1984; 31(8):776–9. 22. Das Gupta V. Stability of vitamins in total parenteral nutrient solutions. Am J Hosp Pharm. 1986; 43(9):2132, 38, 43. 23. Nordfjeld K, Pedersen JL, Rasmussen M, et al. Storage of mixtures of total parenteral nutrition III. Stability of vitamins in TPN mixtures. J Clin Hosp Pharm. 1984; 9(4):293–301. 24. Shine B, Farwell JA. Stability and compatibility in parenteral nutrition solutions. Br J Parenter Ther. 1984; 5(Mar):42–6. 25. Jurgens RW Jr, Henry RS, Welco A. Amino acids stability in a mixed parenteral nutrition solution. Am J Hosp Pharm. 1981; 38(9):1358–9. 26. Daly JM, Masser E, Hanse L, et al. Peripheral vein infusion of dextrose/amino acid solutions +/ 20% fat emulsion. J Parent Enteral Nutr. 1985; 9(3):296–99. 27. Washington C. Stability of intravenous fat emulsions in total parenteral nutrition mixtures. Int J Pharmaceut. 1990; 66(Dec 1):1–21. 28. Black CD, Popovich NG. A study of intravenous emulsion compatibility: effects of dextrose, amino acids, and selected electrolytes. Drug Intel Clin Pharm. 1981; 15(3):184–93. 29. Driscoll DF, Bhargava HN, Li L, et al. Physicochemical stability of total nutrient admixtures. Am J Health-Syst Pharm. 1995; 52(Mar 15):623–34. 30. Lea PJ, Calvieri B. Electron microscopy of all-in-one admixture liposomes. Nutr Support Serv. 1987; 7(Oct):26. 31. Thomas SM. Stability of Intralipid in a parenteral nutrition solution. Aust J Hosp Pharm. 1987; 17(Jun):115–7. 32. Turner SA. Stability and clinical use of intravenous admixtures containing lipid emulsions. Pharmaceut J. 1985; 234(Jun 22):799–800. 33. Ang SD, Canham JE, Daly JM. Parenteral infusion with an admixture of amino acids, dextrose and fat emulsion solution: compatibility and clinical safety. J Parent Enteral Nutr. 1987; 11(Jan–Feb):23–7. 34. Barat AC, Harrie K, Jacob M, et al. Effect of amino acid solutions on total nutrient admixture stability. J Parent Enteral Nutr. 1987; 11(Jul–Aug):384–8. 35. Bullock L, Fitzgerald JF, Walter WV. Emulsion stability in total nutrient admixtures containing a pediatric amino acid formulation. J Parent Enteral Nutr. 1992; 16(Jan–Feb):64–8. 36. Driscoll DF, Bacon MN, Bistrian BR. Effects of in-line filtration on lipid particle size distribution in total nutrient admixtures. J Parent Enteral Nutr. 1996; 20(Jul–Aug):296–301. 37. Tripp MG, Menon SK, Mikrut BA. Stability of total nutrient admixtures in a dual chamber flexible container. Am J Hosp Pharm. 1990; 47(Nov):2496–503. 38. Li LC, Sampogna TP. Factorial design study on the physical stability of 3-in-1 admixtures. J Pharm Pharmacol. 1993; 45(Nov):985–7.

48 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Parenteral Nutrition EXTENDED STABILITY FOR PARENTERAL DRUGS

39. Intralipid package insert. Deerfield, IL: Baxter Healthcare Corporation; April 2000. 40. Liposyn III package insert. North Chicago, IL: Abbott Laboratories; May 2000. 41. Washington C, Ferguson JA, Irwin SE. Computational prediction of the stability of lipid emulsions in total nutrient admixtures. J Pharmaceut Sci. 1993; 82(Aug):808–12. 42. Washington C. Electrokinetic properties of phospholipid stabilized fat emulsions. Part 6. Zeta potentials of Intralipid 20% in TPN mixtures. Int J Pharmaceut. 1992; 87(Nov 10):167–74. 43. Davis SS, Galloway M. Studies on fat emulsion in combined nutrition solutions. J Clin Hosp Pharm. 1986; 11(1):33–45. 44. Washington C, Koosha F, Davis SS. Physicochemical properties of parenteral fat emulsions containing 20% triglyceride: Intralipid and Ivelip. J Clin Pharm Therapeut. 1993; 18(2):123–31. 45. Raupp P, Von Kries R, Schmidt E, et al. Incompatibility between fat emulsion and calcium plus heparin in parenteral nutrition of premature babies. Lancet. 1988; 1(Mar 26):700. 46. Johnson OL, Washington C, Davis SS, et al. The destabilization of parenteral feeding emulsions by heparin. Int J Pharma- ceut. 1989; 53(Aug 1):237–40. 47. Trissel LA. Calcium and Phosphate Compatibility in Parenteral Nutrition. Houston, TX: TriPharma Communications; 2001. 48. Fansel CA, Newton DW, Driscoll DF, et al. Effect of fat emulsion and supersaturation on calcium phosphate solubility in parenteral nutrient admixtures. Int J Pharmaceut Comp. 1997; 1(1):54–9. 49. Allwood MC, Martin H, Greenwood M, et al. Precipitation of trace elements in parenteral nutrition mixtures. Clin Nutr. 1998; 17(5):223–6. 50. Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition. J Parent Enteral Nutr. 2004; 28(6):S39–S70. 51. Tripp MG. Automated 3-in-1 admixture compounding: comparative study of simultaneous versus sequential pumping of core substrates on admixture stability. Hosp Pharm. 1990; 25(Dec):1090–3, 1096. 52. The United States Pharmacopeial Convention. USP 35/NF 30. Chapter <797>. Rockville, MD: The United States Pharma- copeial Convention; 2012. 53. Storm C, Wang B, Helms RA. Stability of carnitine in pediatric TPN and TNA formulations. J Parenter Enteral Nutr. 1998; 22:S18. Abstract 71. 54. O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Appendix B. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002; 51(RR-10):1–29. 55. Chen MF, Boyce HW Jr, Triplett L. Stability of the B vitamins in mixed parenteral nutrition solutions. J Parent Enteral Nutr. 1983; 7(5):462–4. 56. Smith JL, Canham JE, Kirkland WD, et al. Effect of Intralipid, amino acids, container, temperature, and duration of storage on vitamin stability in total parenteral nutrition admixtures. J Parent Enteral Nutr. 1988; 12(5):478–83. 57. Van Der Horst A, Martens HJ, De Goede PN. Analysis of water-soluble vitamins in total parenteral nutrition solution by high pressure liquid chromatography. Pharm Weekly Sci. 1989; 11(Oct 20):169–74. 58. Louie N, Stennet DJ. Stability of folic acid in 25% dextrose, 3.5 amino acids, and multivitamin solution. J Parent Enteral Nutr. 1984; 8(4):421–6. 59. Dahl GB, Svensson L, Kinnander NJ, et al. Stability of vitamins in soybean oil fat emulsion under conditions simulating intravenous feeding of neonates and children. J Parent Enteral Nutr. 1994; 18(3):234–9. 60. Barker A, Hebron BS, Beck PR, et al. Folic acid and total parenteral nutrition. J Parent Enteral Nutr. 1984; 8(Jan–Feb):3–8. 61. Riggle MA, Brandt RB. Decrease of available vitamin A in parenteral nutrition solutions. J Parent Enteral Nutr. 1986; 10(Jul–Aug):388–92. 62. Dupertuis YM, Morch A, Fathi M, et al. Physical characteristics of total parenteral nutrition bags significantly affect the stability of vitamins C and B1: a controlled prospective study. J Parent Enteral Nutr. 2002; 26(5):310–6. 63. Allwood MC, Martin HJ. The photodegradation of vitamins A and E in parenteral nutrition mixtures during infusion. Clin Nutr. 2000; 19(5):339–42. 64. Dahl GB, Jeppsson RI, Tengborn HJ. Vitamin stability in a TPN mixture stored in an EVA plastic bag. J Clin Hosp Pharm. 1986; 11(4):271–9. 65. Billion-Rey F, Guillaumont M, Frederich A, et al. Stability of fat-soluble vitamins A (retinol palmitate), E (tocopherol acetate), and K1 (phylloquinone) in total parenteral nutrition at home. J Parent Enteral Nutr. 1993; 17(Jan–Feb):56–60. 66. Bluhm DP, Summers RS, Lowes MM, et al. Lipid emulsion content and vitamin A stability in TPN admixtures. Int J Pharma- ceut. 1991; 68(Feb 1):277–80. 67. Gillis J, Jones G, Pencharz P. Delivery of vitamins A, D and E in total parenteral nutrition solutions. J Parent Enteral Nutr. 1983; 7(Jan–Feb):11–4. 68. Sforzini A, Bersani G, Stancari A, et al. Analysis of all-in-one parenteral nutrition admixtures by liquid chromatography and laser diffraction: study of stability. J Pharmaceut Biomed Anal. 2001; 24(5–6):1099–109. 69. Bowman BB, Nguyen P. Stability of thiamin in parenteral nutrition solutions. J Parent Enteral Nutr. 1983; 7(6):567–8. 70. Allwood MC. Factors influencing the stability of ascorbic acid in total parenteral nutrition infusions. J Clin Hosp Pharm. 1984; 9(2):75–85. 71. Gibbons E, Allwood MC, Neal T, et al. Degradation of dehydroascorbic acid in parenteral nutrition mixtures. J Pharm Biomed Anal. 2001; 25:605–11. 72. McGee CD, Mascarenhas MG, Ostro MJ, et al. Selenium and vitamin E stability in parenteral solutions. J Parent Enteral Nutr. 1985; 9(Sep–Oct):568–70. 73. Boddapati S, Yang K, Murty R. Intravenous solution compatibility and filter retention characteristics of trace element preparations. Am J Hosp Pharm. 1981; 38(Nov):1731–6. 74. Bates CG, Greiner G, Gegenheimer A. Precipitate in admixtures of new amino acid injection. Am J Hosp Pharm. 1984; 41(Jul):1312.

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75. Cochran EB, Boehm KA. Prefilter and postfilter cysteine/cystine and copper concentrations in pediatric parenteral nutrition solutions. J Parent Enteral Nutr. 1992; 16(Sep–Oct):460–3. 76. Pluhator-Murton MM, Fedorak RN, Audette RJ, et al. Trace element contamination of total parenteral nutrition. Part 2. Effect of storage duration and temperature. J Parent Enteral Nutr. 1999; 23(Jul–Aug):228–32. 77. Allwood MC. Compatibility of four trace elements in total parenteral nutrition infusions. Int J Pharmaceut. 1983; 16(Aug):57–63. 78. Mitrano FP, Baptista RJ. Stability of cimetidine HCl and copper sulfate in a TPN solution. DICP Ann Pharmacother. 1989; 23(May):429–30. 79. Kee Wan K, Tsallas G. Dilute iron dextran formulation for addition to parenteral nutrient solutions. Am J Hosp Pharm. 1980; 37(2):206–10. 80. Vaughan LM, Small C, Plunkett V. Incompatibility of iron dextran and a total nutrient admixture. Am J Hosp Pharm. 1990; 47(Aug):1745–6. 81. Tu YH, Knox NL, Biringer JM, et al. Compatibility of iron dextran with total nutrient admixtures. Am J Hosp Pharm. 1992; 49(Sep):2233–5. 82. Mayhew SL, Quick MW. Compatibility of iron dextran with neonatal parenteral nutrient solutions. Am J Health-Syst Pharm. 1997; 54(5):570–1. 83. Allwood MC, Greenwood M. Assessment of trace element compatibility in total parenteral nutrition infusions. Pharm Weekly Sci. 1992; 14(Oct 16):321–4. 84. Ganther HE, Kraus RJ. Chemical stability of selenious acid in total parenteral nutrition solutions containing ascorbic acid. J Parent Enteral Nutr. 1989; 13(2):185–8. 85. Postaire E, Le Hoang MD, Anglade P, et al. Stability and behavior of selenium in total parenteral nutrition solutions. Int J Pharmaceut. 1989; 55(Oct 15):99–103. 86. Postaire E, Anglade P. Selenium stability in total parenteral nutrition solutions. J Parent Enteral Nutr. 1990; 14(2):223–4. 87. Allwood MC, Martin HJ. Long-term stability of cimetidine in total parenteral nutrition. J Clin Pharm Ther. 1996; 21(1):19–21. 88. Baptista RJ, Palombo JD, Tahan SR, et al. Stability of cimetidine hydrochloride in a total nutrient admixture. Am J Hosp Pharm. 1985; 42(Oct):2208–10. 89. Hatton J, Luer M, Hirsch J, et al. Histamine receptor antagonists and lipid stability in total nutrient admixtures. J Parent Enteral Nutr. 1994; 18(4):308–12. 90. Tsallas G, Allen LC. Stability of cimetidine hydrochloride in parenteral nutrition solutions. Am J Hosp Pharm. 1982; 39(Mar):484–5. 91. Walker SE, Iazzetta J, Lau DW, et al. Famotidine stability in total parenteral nutrient solutions. Can J Hosp Pharm. 1989; 42(3):97–103. 92. Underberg WJ, Koomen JM, Beijnen JH. Stability of famotidine in commonly used nutritional infusion fluids. J Parent Sci Tech. 1998; 42(3):94–7. 93. Bullock L, Fitzgerald JF, Glick MR. Stability of famotidine 20 and 50 mg/L in total nutrient admixtures. Am J Hosp Pharm. 1989; 46(Nov):2326–9. 94. Shea BF, Souney PF. Stability of famotidine in a 3-in-1 total nutrient admixture. DICP Ann Pharmacother. 1990; 24(Mar):232–5. 95. Bullock L, Fitzgerald JF, Glick MR, et al. Stability of famotidine 20 and 40 mg/L and amino acids in total parenteral nutrient solutions. Am J Hosp Pharm. 1989; 46(Nov):2321–5. 96. Montoro JB, Pou L, Salvador P, et al. Stability of famotidine 20 and 40 mg/L in total nutrient admixtures. Am J Hosp Pharm. 1989; 46(Nov):2329–32. 97. DiStefano JE, Mitrano FP, Baptista RJ, et al. Long-term stability of famotidine 20 mg/L in a total parenteral nutrient solution. Am J Hosp Pharm. 1989; 46(Nov):2333–5. 98. Hensrud DD, Burritt MF, Hall LG. Stability of heparin anticoagulant activity over time in parenteral nutrition solutions. J Parent Enteral Nutr. 1996; 20(May–Jun):219–21. 99. Borum PR. Is L-carnitine stable in parenteral nutrition solutions prepared for preterm neonates? Neonatal Intensive Care. 1993; Sept/Oct:30–2. 100. Walker SE, Bayliff CD. Stability of ranitidine hydrochloride in total parenteral nutrient solution. Am J Hosp Pharm. 1985; 42(Mar):590–2. 101. Cano SM, Montoro JB, Pastor C, et al. Stability of ranitidine hydrochloride in total nutrient admixtures. Am J Hosp Pharm. 1988; 45(May):1100–2. 102. Williams MF, Hak LJ, Dukes G. In vitro evaluation of the stability of ranitidine hydrochloride in total parenteral nutrient mixtures. Am J Hosp Pharm. 1990; 47(Jul):1574–9. 103. Bullock L, Parks RB, Lampasona V, et al. Stability of ranitidine hydrochloride and amino acids in parenteral nutrient solutions. Am J Hosp Pharm. 1985; 42(12):2683–7. 104. Allwood MC. Light protection during parenteral nutrition infusion: is it really necessary? Nutrition. 2000; 16:234–5. 105. Klang MG, Lewars K, Nguyen H. Calcium-phosphate precipitation in amino acid-dextrose solutions as measured by nephe- lometric analysis [poster 50–524]. Clinical Nutrition Week. 2008. 106. Lester LR, Crill CM, Hak EB. Should adding albumin to parenteral nutrient solutions be considered an unsafe practice? Am J Health-Syst Pharm. 2006; 63:1656–61. 107. MacKay M, Rusho W, Jackson D, et al. Physical and chemical stability of iron sucrose in parenteral nutrition. Nutr Clin Pract. 2009; Dec 24(6):733–7. 108. MacKay M, Jackson D, Eggert L, et al. Practice-based validation of calcium and phosphorous solubility limits for pediatric parenteral nutrition solutions. Nutr Clin Pract. 2011; Dec 26(6):708–13.

50 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Parenteral Nutrition EXTENDED STABILITY FOR PARENTERAL DRUGS

109. Matsusue S. White milky color veils dirt. J Parenter Enteral Nutr. 1996; Nov–Dec 20(6):435. 110. Ribeiro DO, Lobo BW, Volpato NM, et al. Influence of the calcium concentration in the presence of organic phosphorous on the physicochemical compatibility and stability of all-in-one admixtures for neonatal use. Nutr J. 2009; Oct 26(8):51. 111. Ribeiro DO, Pinto DC, Lima LM, et al. Chemical stability study of vitamins thiamine, riboflavin, pyridoxine and ascorbic acid in parenteral nutrition for neonatal use. Nutr J. 2011; May 14(10):47. 112. Mirkovic´ D, Ibric´ S, Antunovic´ M. Quality assessment of total parenteral nutrition admixtures by the use of fractional factorial design. Vojnosanit Pregl. 2013; Apr 70(4):374–9. 113. Lobo BW, da Veiga VF, Cabral LM, et al. Influence of the relative composition of trace elements and vitamins in physicochemical stability of total parenteral nutrition formulations for neonatal use. Nutr J. 2012; Apr 17(11):26. 114. Driscoll DF, Giampietro K, Wichelhaus DP, et al. Physicochemical stability assessments of lipid emulsions of varying oil composition. Clin Nutr. 2001; Apr 20(2):151–7. 115. Télessy IG, Balogh J, Szabó B, et al. Kinetic stability of all-in-one parenteral nutrition admixtures in the presence of high dose Ca2+ additive under clinical application circumstances. Nutr J. 2012 May 16;11:32. 116. Allen LV ed. Remington: The Science and Practice of Pharmacy. 22nd ed. Philadelphia, PA: Pharmaceutical Press; 2013. Chapter 36:752–3. 117. Migaki EA, Melhart BJ, Dewar CJ, et al. Calcium chloride and sodium phosphate in neonatal parenteral nutrition containing TrophAmine®: precipitation studies and aluminum content. J Parent Entr Nutr. 2012; 36(4):470–5. 118. Driscoll DF, Newton DW, Bistrian BR. Potential hazards of precipitation associated with calcium chloride in parenteral admixtures: response to Migaki, et al. J Parent Entr Nutr. 2012; 36(5):497–8. 119. Hazards of precipitation associated with parenteral nutrition. U.S. Food and Drug Administration website. April 18, 1994. As found at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm238205.htm. Accessed on January 26, 2016. 120. Knowles, JB, Cusson G, Smith M, et al. Pulmonary deposition of calcium phosphate crystals as a complication of home total parenteral nutrition. J Parent Entr Nutr. 1989; 13(2):209–13. 121. Newton DW, Driscoll DF. Calcium and phosphate revisited again. Am J Health-Syst Pharm. 2008; 65:73–80. 122. Medical Information Department [personal communication]. Adult multi-trace element availability. Lake Zurich, IL: Frese- nius Kabi USA; May 29, 2013. 123. Iqbal MS, Bahari MB, Darwis Y, et al. An RP-HPLC-UV method with SPE for cefotaxime in all-in-one total parenteral nutritional admixtures: application to stability studies. J AOAC Int. 2013 Mar-Apr; 96(2):290–4. 124. McKinnon BT. FDA Safety alert: hazards of precipitation associated with parenteral nutrition. Nutr Clin Pract. 1996 Apr; 11(2):59–65. 125. Boullata JI, Gilbert K, Sacks G, et al. A.S.P.E.N. Clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. J Parent Enteral Nutr. 2014; 38:334–77.

51 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Acetaminophen 3 5 1 1 5 1 Body Temp Refer. 7 2012; 69:1999–2001. 2006; 12:81–4. Storage Conditions TemperatureTemp Post-thaw Am J Health-Syst Pharm. 84 h n/a n/a n/a n/a n/a 6 h6 h n/a84 h n/a n/a n/a n/a n/a6 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Eur J Hosp Pharm. Room Refrig Frozen Room Refrig Acetaminophen is known internationally as paracetamol. 6 Osmolality (mOsm/kg) pH n/a 3.7–6.6 48 h n/a n/a n/a n/a n/a ccc b b b d,e d c b d c b

1 undiluted , 22nd ed. London, UK and Philadelphia, PA: Philadelphia College of Pharmacy; 2013:1193. 6 e 1 Drug Manufacturer Concentration Diluents CAD 10 mg/mL undiluted CADCADCAD 10 mg/mL 10 mg/mLCAD undiluted 10 mg/mLBMS undiluted undiluted 10 mg/mL 10 mg/mL undiluted Store at room temperature; do not refrigerate or freeze. Heparin sodium and normal saline. Remington: The Science and Practice of Pharmacy [package insert]. Hazelwood, MO: Mallinckrodt Pharmaceuticals, Inc.; December 2014. TM Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER OTHER INFUSION CONTAINERS Undiluted, after opening and within original glass vial. pH of undiluted solution is approximately 5.5. With ketoprofen (Profenid, SAV) 100 mg added to paracetamol (Perfalgan, BMS) 10 mg/mL in original glass vial. With ketoprofen (Profenid, SAV) 100 mg added to paracetamol Osmolality of undiluted solution is approximately 290 mOsm/kg. Bags, Plastic Syringes, Plastic (BD) Syringes, Polypropylene Glass Flush Compatibility: Acetaminophen Special Considerations: Notes b c 3. injection admixed with ketoprofen. Kambia NK, Lyuckx M, Dine T, et al. Stability and compatibility of paracetamol d e References 1. Ofirmev 5. acetaminophen in syringes and opened vials. Kwiatkowski JL, Johnson CE, Wagner DS. Extended stability of intravenous Note: 6. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 July. 7. Allen LV, ed. 55 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Acyclovir Sodium 1 1 1 1 1 1 1 7 8 4 3 2 2 8 6 Body Temp Refer. continued on next page n/an/a n/an/a n/an/a n/a n/an/a n/a n/an/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 9 n/a n/a n/a n/a Storage Conditions b,e b,e b b b,e b,e b n/a35 d n/a35 d n/a n/a35 d 35 d n/a i n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw g d d d f d f 28 d 35 d 7 d 37 d37 d 37 d 28 d 37 d 21 d 30 d 5 d 5 10 d 30 d 4 d29 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig h h h h 10.4–10.7 cc h c h c h h c h cc h h Osmolality (mOsm/kg) pH Drug WELBWBW 2.5, 5 mg/mLBWBW 1 mg/mLBW 1, 7, 10 mg/mL NSBW 5 mg/mL 5 mg/mLAPP NS D5W 7 mg/mL n/a 10 mg/mL NS 10 mg/mL D5W D5W D5W 316 289 NS n/a unspec 10 mg/mL NS n/a n/a WEL 1–10 mg/mL D5W n/a n/a 4 d unspec. 10 mg/mL NS n/a n/a 5 d n/a n/a n/a n/a n/a unspec. 10 mg/mL NS WEL 10 mg/mL NS, D5W WEL 1–10 mg/mL D5W, NS WEL 10 mg/mL NS n/a n/a 29 d unspec 10 mg/mL NS n/a n/a 5 d n/a n/a n/a n/a n/a Manufacturer Concentration Diluents / j ® Braun) C-Series C-Series

® (Leventon) ST/LT (B. Braun) (Epic Medical) ® ® ® (B. TM CONTAINER OTHER INFUSION CONTAINERS Homepump Ethyvinyl Acetate (EVA) Polyvinyl Chloride (PVC) Syringes, Polypropylene AccuFlo Homepump Eclipse INTERMATE (Baxter) Easypump Dosi-Fuser (Halyard) SMARTeZ Acyclovir Sodium 56 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Acyclovir Sodium (cont’d) 1 Int J Pharm Special attention must be paid to the 1 Bethlehem, PA: B. Braun USA; April 2015. 1 . Bethlehem, PA: B. Braun USA; April 2015. . Lake Forest, CA: Halyard Health; March 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. 1 ST/LT Elastomeric Infusion System. ® 1 Elastomeric Infusion System TM 1 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Do not use bacteriostatic water for injection containing parabens or benzyl alcohol reconstitution. Heparin lock flush and normal saline. 2001; 5(1):75–77. 1 Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Compounding Drug Stability Table-Dosi-Fuser SMARTeZ Stability Data for Drugs Using B. Braun’s AccuFlo Intermate/Infusor Drug Stability Information. Systems Data for Drugs Using Homepump Disposable Ambulatory Infusion respectively. instability is the principal limitation to long-term storage due to persistent subvisual microprecipitates and frank persistent precipitates after as few 7 d. instability is the principal limitation to long-term storage due persistent subvisual microprecipitates and frank precipitates Solutions were maintained at room temperature only, protected from light. Solutions were maintained at room temperature only, protected Refrigeration may cause precipitation; product will resolubilize at room temperature but should be used immediately due to reformation of microprecipitates. Physical Refrigeration may cause precipitation; product will resolubilize at room temperature but should be used immediately due to reformation pH of reconstituted solution is approximately 11. Authors recommend using refrigerated admixtures immediately after warming to room temperature. Authors recommend using refrigerated admixtures immediately Acyclovir 10 mg/mL has an osmolality of 342 and 316 mOsm/kg in NS and D5W respectively; at 5 mg/mL osmolality is 316 and 289 mOsm/kg in NS D5W Acyclovir 10 mg/mL has an osmolality of 342 and 316 mOsm/kg in NS D5W respectively; at 5 is No significant increases in subvisual particulates in EVA container after 28 d. No significant increases in subvisual particulates EVA container Manufacturer(s) extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Precipitate formed within 5 d stored at 5°C. 7. 9. sodium chloride injection and storage in polypropylene syringes for pediatric use. Ling J, Das Gupta V. Stability of acyclovir sodium after reconstitution in 0.9% Acyclovir Sodium (cont’d) Note: 8. Flush Compatibility: 6. 4. j References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 February. 2. 3. Special Considerations: i drug's potential for precipitation. Precipitation depends on preparation, storage conditions, concentration, pH, and diluent. Notes b c d e f g h 57 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) ADO-Trastuzumab Emtansine 1 edications. edications. Body Temp Refer. n/an/a n/an/a n/a n/a n/a n/a 1, 2 n/a 1, 2 b b b 1 filter. Do not confuse ADO-trastuzumab ADO-trastuzumab confuse not Do filter. Storage Conditions TemperatureTemp Post-thaw n/a 24 h Room Refrig Frozen Room Refrig 5 1 Osmolality (mOsm/kg) pH n/a NSNSW n/a n/a n/a n/a n/a n/a 24 h 24 h a a ); these have different physicochemical properties and clinical indications. ®

1 Drug 1 Manufacturer Concentration Diluents GEN 20 mg/mL GENGEN unspec. unspec. 2 Do not mix or dilute with dextrose 5% solution. administer as an IV push bolus. co-infuse other m Saline. ) with trastuzumab (Herceptin ® [package insert]. South San Francisco, CA: Genentech, Inc.; May 2015. ® c CONTAINER Do not freeze reconstituted or diluted solutions. Concentrations will vary; calculated dosage should be added to 250 mL NS IV bag. Latex-free, PVC-free bag. Vial Polyolefin Polyvinyl Chloride (PVC) 2. Medical Communications Department [personal communication]. South San Francisco, CA: Genentech Inc.; July 2015. References 1. Kadcyla c Flush Compatibility: b ADO-Trastuzumab Emtansine ADO-Trastuzumab Special Considerations: Do not shake reconstituted vial or infusion solution. Administer IV only with 0.2 0.22 micron in-line polyethersulfone (PES) emtansine (Kadcyla Notes a 58 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Aldesleukin 2 2 2 2 2 3 2 2 Body Temp Refer. Storage Conditions n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw c c c c 6 d 6 d n/an/a 14 d48 h 5 d n/a 48 h n/a n/a n/a6 d n/a n/a6 d n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e e e e e e e n/a n/a Osmolality (mOsm/kg) pH D5W n/a W W D5W n/a d d 2 2 Do not mix with normal saline. Do not use in-line filters. Reconstitution or dilution with NS or BWFI may cause aggregation (deactivation). Do not mix with normal saline. use in-line filters. Reconstitution or dilution NS BWFI Drug Heparin lock flush. CETCETCET 0.005, 0.04 mg/mL CET 0.1–0.5 mg/mLPRO 0.22 mg/mL 18 million I.U./mL CET 18 million I.U./mL (1.1 mg/mL) CET D5W 0.005, 0.04 mg/mL D5W n/a 0.1–0.5 mg/mL n/a D5W n/a Manufacturer Concentration Diluents [package insert]. San Diego, CA: Prometheus Laboratories, Inc.; July 2012. ® Cassette Cassette ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. container, as well microaggregation. CONTAINER OTHER INFUSION CONTAINERS Solutions also contained human serum albumin (HSA) for a final albumin concentration of 0.1%. Addition HSA to aldesleukin 5–70 mcg/mL prevents sorption the Solutions also contained human serum albumin (HSA) for a final pH of reconstituted product is 7.2–7.8. Solutions stored at 32°C. Polyvinyl Chloride Chloride Polyvinyl (PVC) Syringes, Plastic Unspecified CADD (SIMS Deltec) Note: References 2. ASHP's Interactive Handbook on Injectable Drugs. 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 3. Proleukin Special Considerations: Aldesleukin Flush Compatibility: of activity. Consult current Various measurement units have been used and reported for this agent. The International Unit (I.U.) is now the standard measure manufacturer's literature for conversion factors. Notes c d e 59 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Amikacin Sulfate 7 3 3 8 6 2 1 1 1 1 4 4 9 Body Temp Refer. n/an/a n/a n/a continued on next page f h n/a n/a n/a n/a Storage Conditions c 7 d 28 dn/a n/a 30 d 48 h 24 h TemperatureTemp Post-thaw f h c 1 d 48 h 24 h 48 h 28 d 31 d n/a n/a n/a 1 d 7 d n/a n/a n/a n/a n/an/a n/a48 h n/a 6 m n/a24 h n/a 30 d24 h 60 d n/a 24 h n/a 60 d 30 d n/a n/a n/a 30 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 h 10 d 30 d n/a n/a n/a 24 h 28 d n/a n/a n/a n/a 1 d 7 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig e 1 e e e e e 6.36–6.55 e e e e e Osmolality (mOsm/kg) pH 1 ab e e 1 Drug Manufacturer Concentration Diluents unspec. 10 mg/mL NS n/a BMS 0.25–20 mg/mL D5W, NS n/a BMS 20 mg/mL D5W, NS n/a unspec. 10 mg/mL NS, D5W n/a unspec. 10 mg/mL NS n/a BMSBRBR 50 mg/mLBRBR 20 mg/mL NS 187.5 mg/mL D5W 0.25, 5 mg/mL NS 0.25, 5 mg/mL 358–367 NS n/a D5W n/a unspec. 10 mg/mL NS n/a unspec. 10–20 mg/mL NS n/a unspec. 10 mg/mL NS n/a n/a Normal saline. Incompatible with heparin; immediate precipitation occurs. / g ® C-Series C-Series ® ST/LT ST/LT (Leventon) (Leventon) (Epic Medical) ® ® ® (B. Braun) TM Braun)

CONTAINER OTHER INFUSION CONTAINERS Amikacin sulfate 5 mg/mL in D5W has a calculated osmolality of 319 mOsm/kg. Amikacin sulfate 5 mg/mL in NS has a calculated osmolality of 349 mOsm/kg. Manufacturer(s) extrapolated data from other sources. SMARTeZ Easy Pump Dosi-Fuser Homepump Glass Polyvinyl Chloride (PVC) Syringes, Polypropylene Unspecified AccuFlo Homepump Eclipse INTERMATE (Baxter) (B. (Halyard) c b Flush Compatibility: Special Considerations: Notes a Amikacin Sulfate 60 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Amikacin Sulfate (cont’d) 2010; 29:807–11. Cornea Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. 1 Elastomeric Pump (ES.H.00.730-10). ® 3 3 Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Elastomeric Stability Data for Drugs Using B. Braun’s AccuFlo After 30 d at –20°C. pH of undiluted solution is 3.5–5.5. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices After 28 d at 2–8°C. 9. 8. Amikacin Sulfate (cont’d) Note: e f g h References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. ophthalmic antibiotics stored at –20 deg C for 6 months. Chedru-Legros V, Fines-Guyon M, Cherel A, et al. In vitro stability of fortified 7. 3. 4. 6. 61 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Amiodarone Hydrochloride 3 3 Body Temp Refer. n/a n/a n/a n/a Storage Conditions International Journal of Pharmaceutical c n/a n/a n/a n/a n/a 5, 6 32 d 5 TemperatureTemp Post-thaw c

g 24 h n/a n/a n/a n/a n/a 3, 4 Room Refrig Frozen Room Refrig e e 6 Osmolality (mOsm/kg) pH n/a n/a 5 d f D Use an in-line filter during administration. 3 3 Drug 6 Manufacturer Concentration Diluents BEDLZ 1 mg/mLWYBA D5W 0.6 mg/mL 2 mg/mL n/a D5W D5W 1.5, 1.8 mg/mL n/a n/a n/a n/a 5 d 32 d n/a n/a n/a n/a n/a 3 Use only glass or polyolefin bags to administer infusions exceeding 2 h due to adsorption to PVC as well as leaching of plasticizers. The Use only glass or polyolefin bags to administer infusions exceeding 2 h due adsorption PVC as D5W. 2009; 13(2):162–5. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Compounding Aloumanis V, Ben M, Kupiec TC, et al. Drug compatibility with a new generation of VISIV polyolefin infusion solution containers.

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) pH of undiluted solution is 4.08. In amber glass container. When removed from individualized cardboard carton and exposed to ambient conditions, including fluorescent light. When removed from individualized cardboard carton and exposed Iso-osmotic solution in dextrose. Polyolefin VISIV (Hospira) Glass Container Plastic GALAXY (Baxter) g use of evacuated glass containers is not recommended since the buffer in these containers may cause precipitation of amiodarone. Dilute only with D5W due to use of evacuated glass containers is not recommended since the buffer in these may cause precipitation amiodarone. conflicting stability data in other solutions. Special Considerations: References 3. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 4. Flush Compatibility: Notes c e f Amiodarone Hydrochloride 5. Medical Affairs Department [personal communication]. Deerfield, IL: Baxter Healthcare Corporation; September 2015. 6. [package insert]. Deerfield, IL: Baxter Healthcare Corporation; March 2014. Nexterone (amiodarone HCl) Premixed Injection for intravenous use Note: 62 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Amphotericin B 2 1 1 1 4 6 Body Temp Refer. 1991;48:2635–7. Am J Health-Syst Pharm. n/a n/a n/a n/a 1, 3 n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions b f d n/a n/a n/a n/a n/a 10 d 10 d TemperatureTemp Post-thaw h d n/a 10 d n/a n/a n/a n/a n/a 35 d 5 d 5 d n/a n/a n/a n/a 24 h 24 h n/a n/a n/a n/a24 h n/a n/a n/a Room Refrig Frozen Room Refrig c 1 c c c c c c , n/a 5.7 a Osmolality (mOsm/kg) pH Flush all sodium chloride-containing solutions from lines with D5W before and after 1 . Irvine, CA: Halyard Health; March 2015. D5W n/a D5W n/a f Barcelona, Spain: Leventon SAU; October 2015. 0.2, 0.5, 1 mg/mL 1 Ontario, Canada: Baxter Corporation; October 2008. Drug Manufacturer Concentration Diluents SQ 0.2–0.5 mg/mL D5W n/a SQ BMSSQSQ 0.05, 0.5 mg/mL 0.1 mg/mL D5W 0.1, 0.25 mg/mLunspec. n/a D5W D5W 256 n/a 0.2 mg/mL D5W n/a unspec. 0.25–0.5 mg/mL 1

Elastomeric Pump (ES.H.00.730-10). ® ® In situations where filtration is necessary, the filter pore size must be 1 micron or larger. Use only SWFI (without preservatives) for In situations where filtration is necessary, the filter pore size must be 1 micron or larger. Use only SWFI Incompatible with normal saline and heparin lock flush. /Homepump g ® Protect from light. Do not interchange amphotericin B with other product salts or formulations. 1 (Leventon) (Leventon) ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Drug Stability Table-Dosi-Fuser Mitrano FP, Outman WR, Baptista RJ, et al. Chemical and visual stability of amphotericin B in 5% dextrose injection stored at 4°C for 35 days.

CONTAINER OTHER INFUSION CONTAINERS Special attention must be paid to the drug’s potential for precipitation, which may occur depending on preparation, storage conditions, concentration, pH, and diluents. 4% amphotericin loss. Stored protected from light. Stored protected from light and exposed to fluorescent light. A 0.1-mg/mL solution in D5W is 256 mOsm/kg. pH of 0.1 mg/mL in D5W is 5.7. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Manufacturer(s) extrapolated data from other sources. Polyvinyl Chloride (PVC) Dosi-Fuser Homepump Eclipse C-Series (Halyard) INTERMATE (Baxter) Flush Compatibility: amphotericin B administration. Special Considerations: reconstitution. Notes a Amphotericin B f g h References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. 3. Note: 4. 6. d b c 63 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Amphotericin B Lipid Complex 3 1 4 Body Temp Refer. Europ J Hosp Pharm n/a n/a n/a n/a Storage Conditions c,d 7 d 48 h n/a n/a n/a n/a ) after dilution in dextrose 5%. 4 ® TemperatureTemp Post-thaw c e n/a 10 d n/a n/a n/a n/a 6 h Room Refrig Frozen Room Refrig Do not interchange Amphotericin B Lipid Complex 1 b b b Be certain to resuspend these emulsions by gently shaking the 2 Osmolality (mOsm/kg) pH D5W n/a 5–5.5 7 d 0.4, 0.8, 2 mg/mL 2 Prepare using the 5-micron filter needed provided with product. Drug Flush line with D5W before and after administration; incompatible saline heparin. SIT 1 mg/mL D5W n/a SITZNS 1 mg/mL D5W n/a Manufacturer Concentration Diluents (Amphotericin B Lipid Complex Injection) [package insert]. Gaithersburg, MD: Sigma-Tau Pharmaceuticals, Inc.; May 2010. stability letter [personal communication]. Gaithersburg, MD: Sigma-Tau Pharmaceuticals, Inc.; January 10, 2012. ® ® 2007; 13:10–3. ) with other amphotericin product salts or formulations. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Science CONTAINER Stored at 4°C. pH of undiluted product is 5–7. Stable for 48 h refrigerated followed by 6 h at room temperature. Stable for 48 h refrigerated followed by 6 at room temperature. Protect from light. Note: 4. Abelcet 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 3. Vanneaux V, Proust B, Cheron M, et al. A physical and chemical stability study of amphotericin B lipid complexes (Abelcet c d e References 1. Abelcet Notes b (Abelcet Unspecified Flush Compatibility: admixtures before infusion and every 2 h during longer infusions. Do not administer with an in-line filter. Amphotericin B Lipid Complex (Unspec.) Bag IV Polyolefin Bag Special Considerations: 64 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Amphotericin B Liposome 2 2 2 2 2 2 2 2 2 2 1 Body Temp Refer. n/an/a n/a n/a n/a n/a n/a n/a n/an/a n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a yringe and add the contents into the the into contents the add and yringe Storage Conditions d d d d d d d d d d 11 d 14 d the vial vigorously to form a completely dispersed dispersed completely a form to vigorously vial the TemperatureTemp Post-thaw c c n/an/a 7 d 14 d 24 h n/a24 h 48 h n/a 48 h n/an/a 14 d n/a 14 d 14 d n/a 14 d Room Refrig Frozen Room Refrig b ) with other amphotericin product salts or formulations. ® b b b b b b b b b b isome B n/a n/a n/a Osmolality (mOsm/kg) pH 1 D10W, D10W, D20W, D25W W W After dilution (suspension) of product in W, shake W, in product of (suspension) dilution After 2 Do not interchange Amphotericin B Liposome for injection (Am Drug Flush administration line with D5W before and after administration or use a separate administration line. Incompatible with saline containing Flush administration line with D5W before and after or use a separate line. ASL 0.2 mg/mL D5W n/a ASL 2 mg/mL D5W n/a ASLASLASLASL 0.2 mg/mL 0.2 mg/mL 2 mg/mLASL 2 mg/mL ASLASL 0.5 mg/mL D5W 2 mg/mL D10WASL D5W 4 mg/mL n/a n/a n/a 4 mg/mL D5W D5W n/a n/a Manufacturer Concentration Diluents [package insert]. Deerfield, IL: Astellas Pharma US Inc.; March 2012. ® 1 (Halyard) isome ® B Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER OTHER INFUSION CONTAINERS Protected from light. pH of suspension following reconstitution with W to 4 mg/mL is 5–6. Exposed to fluorescent light. Flush Compatibility: solutions. Special Considerations: Amphotericin B Liposome Polyolefin Chloride Polyvinyl (PVC) Syringes, Plastic Glass Vial Homepump Eclipse Increased concentrations of dextrose (>D5W) reduce the stability. Notes b suspension. Withdraw the suspension required into a sterile syringe; attach manufacturer-provided, 5-micron filter to s diluent/container. Use only one filter per vial of product. May administer through an in-line membrane with a mean pore diameter not less than 1-micron. 2. Medical Information Department [personal communication]. Deerfield, IL: Astellas Pharma US Inc.; January 10, 2012. Note: c d References 1. Am 65 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ampicillin Sodium 6 8 7 3 3 2 4 1 1 1 1 5 5 9 9 9 9 9 9 9 9 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a Storage Conditions f f b b 3 d 3 d 72 h 48 h n/a n/a n/a n/a n/a TemperatureTemp Post-thaw b b f f d 1 d 3 d n/a n/a n/a n/a 1 d 8 h 8 h 8 h 1 d 3 d n/a n/a n/a n/a 8 h 3 d n/a n/a n/a n/a n/a2 h 48 h24 h n/an/a 24 h8 h n/a n/a 4 d2 h 48 h n/a n/a n/a 4 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1 h2 h 1 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a8 h 48 hn/a n/a n/a 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a8 h 72 hn/a n/a n/a 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig a 1 1 1 1 1 1 8.7 8.7 8.7 8.7 a 8.7 8.7 a a a a a a a a a a a a a a 1 1 1 1 1 1 n/a n/a n/a Osmolality (mOsm/kg) pH W W W Up to 20 mg/mL D5W n/a Up to 2 mg/mL D5W n/a Up to 20 mg/mL NS n/a Up to 30 mg/mL30 mg/mL NS NS n/a n/a Up to 20 mg/mL Up to 30 mg/mL 30 mg/mL Drug c c c unspec. 20 mg/mL NS 372 unspec. 20 mg/mL NS 372 BE 20–30 mg/mL NS n/a unspec. 20 mg/mL NS 372 BE 20 mg/mL NS 372 unspec. 20 mg/mL NS 372 BEBRAYWY 10 mg/mL 20 mg/mLWY 20 mg/mLWY 20 mg/mL NSPF D5W 2.1–33.33 mg/mL NS 2.1–33.33 mg/mL NS NS D5W n/a n/a n/a 288–439 264–416 n/a PF unspec. 20 mg/mL NS 372 PF Manufacturer Concentration Diluents / e ® C-Series C-Series ® (Leventon) (Leventon) (Epic Medical) ST/LT (B. Braun) ® ® ® (B. Braun) TM CONTAINER OTHER INFUSION CONTAINERS Easypump SMARTeZ Dosi-Fuser Homepump Polyvinyl Chloride (PVC) Syringes, Plastic Unspecified AccuFlo Homepump Eclipse INTERMATE (Baxter) (Halyard) Ampicillin Sodium 66 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ampicillin Sodium (cont’d) 1 . Bethlehem, PA: B. Braun USA; April 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; September 2015. Barcelona, Spain: Leventon SAU; October 2015. 1 HealthTek ST/LT Elastomeric Infusion System ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes. 1 Ampicillin stability decreases as concentration increases. Stability is greatly decreased in D5W. Storage temperature and pH of the solution Ampicillin stability decreases as concentration increases. Stability is greatly decreased in D5W. Storage Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® SMARTeZ Chemical Stability Data for Drugs Using B. Braun's Easypump Drug Stability Table Dosi-Fuser Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory manufacturer-specific package inserts. Stability Data for Drugs Using B. Braun's AccuFlo Followed by 1 h simulated infusion. Manufacturer extrapolated data from other source(s). INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH range of 10 mg/mL in recommended diluents and concentrations is 8–10. pH range of 20–100 mg/mL in W, NS, or D5W is 8.7–9.3. pH range of 10 mg/mL in recommended diluents and concentrations is 8–10. 20–100 W, NS, or D5W This data is applicable to other brands of ampicillin sodium injection, as this is part of the Abbreviated New Drug Application (ANDA) FDA-approved labeling. Refer to This data is applicable to other brands of ampicillin sodium injection, as this part the Abbreviated New Drug Application Data presented as refrigerated stability OR 8 h at 25°C. Ampicillin Sodium (cont’d) 9. Inc.; September 2010. Ampicillin for injection, USP [package insert]. New York, NY: Pfizer 8. 6. 7. Flush Compatibility: 3. 4. 5. Rapp RP, Hatton J, Record K. b c d e f References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 January. 2. Special Considerations: affect stability. Do not freeze. Notes a 67 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ampicillin Sodium–Sulbactam Sodium 4 3 1 4 5 1 2 8 3 6 3 3 3 7 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions

g g 4 d n/a n/a n/a n/a n/a 3 d TemperatureTemp Post-thaw g f g 2 hn/a 4 h8 h 72 h n/a 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 8 h 48 h n/a n/a n/a n/a 6 h 4 d n/a n/a n/a n/a 32 h 68 h n/a n/a n/a n/a n/a 3 d n/a n/a n/a n/a 6 h 8 h 2 h 6 h 4 dn/a n/a2 h 72 h8 h 4 h n/a n/a 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e e e e e e e e e e e e e e Osmolality (mOsm/kg) pH 322, 390, n/a 345, 413, n/a D5W NS, WNS n/a n/a NS NS n/a NS n/a NS n/a NS n/a NS n/a NS n/a NSNSD5W n/a NS n/a n/a n/a b b 1 b b b c a b c b c a,d a,d c,d Drug PFPF 20 mg/mL 30 mg/mL RR 8.3, 16.7, 33.33 mg/mL unspec. 30 mg/mL PFRR 20 mg/mL 8.3, 16.7, 33.33 mg/mL unspec. 30 mg/mL unspec. 30 mg/mL unspec. 20–45 mg/mL PF 20 mg/mL unspec. 30 mg/mL PFPFPF 20 mg/mL 20 mg/mL 30 mg/mL Manufacturer Concentration Diluents n/a Heparin lock flush and normal saline. / ® (Abbott) ® C-Series C-Series ® (Leventon) (Leventon) ST/LT ST/LT (Epic (Epic ® ® ® (B. Braun) TM Braun)

CONTAINER OTHER INFUSION CONTAINERS Unspecified Homepump Polyvinyl Chloride (PVC) Syringes, Plastic AccuFlo ADD-Vantage Homepump Eclipse (Halyard) SMARTeZ Medical) Dosi-Fuser (B. Glass Easypump Special Considerations: Ampicillin Sodium–Sulbactam Sodium Flush Compatibility: 68 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ampicillin Sodium–Sulbactam Sodium (cont’d) . Bethlehem, PA: B. Braun USA; April 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM . Irvine, CA: Halyard Health; March 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System . HealthTek ® Elastomeric Infusion System TM Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes 1 Stability Data for Drugs Using Elastomeric Infusion Pumps. ® [package insert]. New York, NY: Pfizer; January 2017. ® SMARTeZ Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using B. Braun's AccuFlo Drug Stability Table Dosi-Fuser Stability Data for Drugs Using Homepump Ambulatory Infusion Systems Concentration of final dilutions is unspecified. Stability is reported for maximum concentrations. See manufacturer's instructions preparation. Concentration of final dilutions is unspecified. Stability reported Ampicillin concentration. pH of solutions is 8–10. Concentration studied was 20 mg/mL ampicillin plus 10 sulbactam. Concentration studied was 30 mg/mL ampicillin plus 15 sulbactam. Manufacturer extrapolated from other source(s). After activation. Ampicillin Sodium–Sulbactam Sodium (cont’d) 8. 6. 5. 7. Notes a b c d e 4. Rapp RP, Hatton J, Record K. 3. Unasyn f g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2017 February. 2. 69 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Azithromycin 3 5 4 2 1 Body Temp Refer. n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions b b 7 d 7 d TemperatureTemp Post-thaw b b Room Refrig Frozen Room Refrig Bethlehem, PA: B. Braun USA; April 2015. n/a 6.4–6.6 24 h 7 d n/a n/a n/a n/a Osmolality (mOsm/kg) pH . Irvine, CA: Halyard Health; March 2015. a . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; September 2015. ST/LT Elastomeric Infusion System. ® S, D5½S with KCl 20 mEq, NMD5W, NRD5W. 3 Ł Elastomeric Infusion System 1 TM Drug unspec. 1–2 mg/mL NS n/a n/a 24 h unspec. 1–2 mg/mL NS n/a n/a 24 h 7 d n/a n/a n/a n/a unspec. 1–2 mg/mL NS n/a n/a 24 h 7 d n/a n/a n/a n/a PF 1–2 mg/mL D5W, NS unspec. 1–2 mg/mL NS, D5W n/a n/a 24 h Manufacturer Concentration Diluents 1 n/a Saline. / ® Stability Data for Drugs Using Elastomeric Infusion Pumps. C-Series C-Series ® ® ST/LT (B. Braun) (Epic Medical) ® ® (B. Braun) TM Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory SMARTeZ Stability Data for Drugs Using B. Braun’s AccuFlo CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. Equivalent stability in ½S, LR, D5½S, D5LR, D5 SMARTeZ Easypump Homepump Unspecified AccuFlo Homepump Eclipse (Halyard) 4. 5. Flush Compatibility: 3. Special Considerations: Notes a b References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. Azithromycin 70 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Aztreonam 7 3 3 3 3 9 6 8 1 1 5 1 2 4 4 4 4 n/a Body Temp Refer. b 14 d continued on next page b n/a n/a n/a 48 h c n/a n/a n/a n/a 30 d b Storage Conditions c c 7 d 28 d n/a28 d n/a n/a n/a n/a n/a n/a n/a 14 d TemperatureTemp Post-thaw d d c c 1 d 48 h n/a24 h 14 dn/a 30 d 10 d 24 h n/a n/a n/a n/a n/a n/a 24 h 1 d 7 d n/a n/a n/a n/a 1 d 7 d n/a n/a n/a n/a 96 h48 h 96 h 7 d48 h n/a 7 d n/a n/a48 h 90 d n/a37 d n/a 7 d n/a48 h 120 d n/a n/a n/a 120 d 7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 2 n/a 1, 2 n/a 28 d n/a n/a n/a n/a n/a7 d 14 d24 h 7 d n/a 28 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a a a a a a a a a a a a a a a a a a n/a 312, 347, 347, 312, 415 iso 4.5–7.5 n/a n/a Osmolality (mOsm/kg) pH W NS D mL Drug unspec. 10–30 mg/mL NS n/a BMS, SQ 5 mg/mL D5W, NS n/a BMS, SQBMS, SQ 5–20 mg/mLBMS, SQ 5–60 mg/mL 10 mg/mL D5W, NS D5W, NS n/a n/a BMS 5–20 mg/mL D5W, NS n/a unspec. 10–30 mg/mL NS n/a unspec. 10–30 mg/mL NS n/a SQSQSQ 10 mg/mL 10, 20 mg/mLBMSSQ 0.83, 16.7, 33.3 mg/ BMS NS D5W, NS Up to 20 mg/mL 20 mg/mL n/a >20 mg/mL D5W, NS n/a n/a NS NS, W n/a n/a BMS 20, 40 mg/mL unspec. 5–20 mg/mL NS n/a unspec.unspec.unspec. 20–30 mg/mL 26.7 mg/mL 60 mg/mL NS NS NS n/a n/a n/a Manufacturer Concentration Diluents / e ® C-Series C-Series ® (Leventon) (Leventon) ST/LT ST/LT (Epic Medical) ® ® ® (B. Braun) TM Braun)

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) SMARTeZ (B. Easypump Dosi-Fuser Homepump Aztreonam Polyvinyl Chloride (PVC) Syringes, Plastic Unspecified AccuFlo Homepump Eclipse INTERMATE (Baxter) Container Plastic GALAXY (Baxter) (Halyard) 71 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Aztreonam (cont’d) Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. (aztreonam for injection) [prescribing information]. Princeton, NJ: Bristol-Myers Squibb Company; and University of KY Lexington; Repro-Med Systems Inc.; 1998. ® TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. 1 HealthTek ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. 1 Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes. n/a Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. (aztreonam injection) in GALAXY Plastic Container and Azactam ® ® Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser SMARTeZ Stability Data for Drugs Using B. Braun’s AccuFlo June 2013. Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Following 28 d refrigerated. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of aqueous solutions is 4.5–7.5. Manufacturer extrapolated data from other source(s). 8. Aztreonam (cont’d) 9. 7. 6. Flush Compatibility: 3. 4. 5. Rapp RP, Hatton J, Record K. b c d e References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Azactam Special Considerations: Notes a 72 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Baclofen 1 1 3 7 5 6 6 1 1 4 5 n m m Body Temp Refer. continued on next page 1 Storage Conditions Protect from freezing. 1 TemperatureTemp Post-thaw n/a n/a n/a n/a n/a 30 d n/a n/an/a n/a n/a n/a n/a n/a n/a 56 d n/a 30 d n/a n/a n/a n/a n/a 180 d 2, 7 n/a n/a n/a n/a n/a 14 w n/a n/a n/a n/a n/a 90 d n/a n/a n/a n/a n/a 30 d 1, 3 n/a n/a n/a n/a n/a 29 d n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 30 d n/a 30 d 70 d 1, 3 n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 30 d 14 w 1, 3 Room Refrig Frozen Room Refrig g g g g g g g g g g g g l g l g n/a 6.0 n/a n/a n/a n/a n/a 20 d n/a 5.8 n/a n/a n/a n/a n/a 12 d Osmolality (mOsm/kg) pH h NS n/a NS 154–242 NS n/a NS 154–242 k undiluted NS n/a NSNSNS n/a 154–242 n/a NSNS 154–242 n/a f a j h b c i d o k d e 1 0.2 mg/mL Lioresal Intrathecal is intended only for implantable pumps specifically labeled its use. 8 Gablofen (MA) is intended only for the Medtronic Synchromed II implanted pump or other pumps specifically labeled for intrathecal Gablofen (MA) is intended only for the Medtronic Synchromed II implanted pump or other pumps Drug Normal saline. CI CI 0.2 mg/mL unspec. 0.5 mg/mLCI 1 mg/mL undiluted NVS 1.5 mg/mL NVS 0.5, 2 mg/mL undiluted n/a NVS 1 mg/mL NVS 0.5, 2 mg/mL undiluted CI 0.8 mg/mL BB 2 mg/mL CI 0.8 mg/mL CISHCI 1 mg/mL 1 mg/mL 1.5 mg/mL NVS 0.25, 0.5 mg/mL Manufacturer Concentration Diluents ) ® ) ® OTHER INFUSION CONTAINERS With morphine sulfate (DB) 1 mg/mL. With morphine sulfate (DB) 1 mg/mL and 1.5 mg/mL. With morphine sulfate (DB) 1.5 mg/mL. Notes a b c Baclofen Glass Pump Implantable Model (Fresenius VIP 30) Pump Implantable (Infusaid) Implantable (Medtronic Pump Synchromed Implantable (Medtronic Pump Synchromed II Special Considerations: administration of Gablofen. Flush Compatibility: 73 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Baclofen (cont’d) . 1997; 2007; 10:12–7. J Pain Symptom Int J Pharm (AMST) Neuromodulation . 2001; 36:950–4. Minneapolis, MN: Medtronic Inc. Minneapolis, MN: Medtronic Inc. Hosp Pharm Minneapolis, MN: Medtronic Inc. http://manuals.medtronic.com/wcm/ SynchroMed Programmable Infusion Systems Clinical Reference Guide. in 1 1 . 2004; 28:268–72. Intrathecal Baclofen Therapy for Severe Spasticity Management, Indications, Drug Stability, and Emergency Procedures: SynchroMed and IsoMed Implantable Infusion Systems. Indications, Drug Stability, and Emergency Procedures: SynchroMed groups/mdtcom_sg/@emanuals/@era/@neuro/documents/documents/contrib_163048.pdf. Accessed 2015 August. https://professional.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@neuro/documents/documents/synchii-ref-guide.pdf. Accessed 2015 August. https://professional.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@neuro/documents/documents/synchii-ref-guide.pdf. 153:13–24. Manage Shields D, Montenegro R, Aclan A. Chemical stability of admixtures combining ziconotide with baclofen during simulated intrathecal administration.

Ziconotide concentration decreased below 90% after this time. With morphine sulfate (DB) 15 mg/mL. Combined with 1 mg/mL clonidine. With ziconotide (ELN) 25 mcg/mL. Protected from light. Also stable when mixed with clonidine hydrochloride 0.2 mg/mL (both from powder). Also stable when mixed with clonidine hydrochloride 0.2 mg/mL Baclofen powder dissolved in ziconotide (ELN) 25 mcg/mL. Gablofen pH 5.5–7.5. Lioresal Intrathecal 5–7. Combined with clonidine 0.25 and 0.5 mg/mL, respectively. With morphine sulfate (DB) 21 mg/mL. Undiluted baclofen injection is an isotonic solution. With morphine sulfate (DB) 7.5 mg/mL. d e f g h i j k l m n o References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Baclofen (cont’d) 7. 8. Gablofen (baclofen injection) [package insert]. Hazelwood MO: Mallinckrodt Brand Pharmaceuticals, Inc.; February 2015. 3. of intrathecal admixtures containing baclofen and high concentrations morphine. Sitaram BR, Tsui M, Rawicki HB, et al. Stability and compatibility 4. hydrochloride admixture for intrathecal administration. Godwin DA, Kim NH, Zuniga R. Stability of a baclofen and clonidine 5. testing to support clinical feasibility investigations for intrathecal baclofen-clonidine admixture. Alvarez JC, Mazancourt P, Chartier-Kastlier E, et al. Drug stability 6. 74 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bevacizumab 2 4 2 1 1

1 Body Temp Refer. 2015; 19:70–2. n/a n/a n/a n/a Storage Conditions e Int J Pharm Compd. TemperatureTemp Post-thaw 2015; 29:820–7. Eye. n/a 6 m n/a n/a n/a n/a n/an/a 8 h 8 h n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a a a 1 n/a 6.2 n/a 3 m n/a n/a n/a n/a Osmolality (mOsm/kg) pH 1 d undilutedundiluted n/a n/a undiluted 6.2 n/a 3 m NSNS n/a n/a 3 c c c b b 4 1 1 Do not freeze. Do not administer or mix with dextrose solutions. Do not shake. Dilute desired dose in a total volume of 100 mL NS. Do not freeze. administer or mix with dextrose solutions. shake. Dilute desired dose Drug 1 Normal saline. GENGEN unspec. GEN unspec. GEN 25 mg/mL GEN 25 mg/mL 25 mg/mL Manufacturer Concentration Diluents 2006; 26:519–22. f Retina [package insert]. South San Francisco, CA: Genentech Inc.; December 2016. ® freezing. CONTAINER Pierced manufacturer’s original vial. Concentrations may vary; calculated dosage should be diluted in a total volume of 100 mL NS. Intravitreal administration maximum shelf-life is 3 d. pH of undiluted solution is 6.2. Do not administer as IV push or bolus. Must be diluted prior to administration. Also tested in polycarbonate syringes. 2. (Avastin) binding to vascular endothelial growth factor after withdrawal into a syringe and refrigeration or Bakri SJ, Snyder MR, Pulido JS, et al. Six-month stability of bevacizumab 3. Pereboom M, Becker Amenchar et al. Stability assessment of repackaged bevacizumab for intravitreal administration. References 1. Avastin b Protect vials from light. Notes a 4. in polycarbonate and polypropylene syringes. Khalili H, Sharma G, Froome A, et al. Storage stability of bevacizumab d e c f Special Considerations: Syringes, Syringes, Bevacizumab Polyolefin Bag Chloride Polyvinyl (PVC) Syringes, Plastic Polypropylene Vial Flush Compatibility: 75 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bleomycin Sulfate 1 1 1 2 Body Temp Refer. n/an/a n/a n/a n/a n/a 10 d n/a Storage Conditions d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw a a 2–4 w 2–4 4 w Room Refrig Frozen Room Refrig n/a n/a n/a 7 d Osmolality (mOsm/kg) pH d NS 1 1 d . Ontario, Canada: Baxter Corporation; October 2008. Do not reconstitute or dilute with D5W. Drug Heparin lock flush and normal saline. unspec.BR unspec. 0.02, 0.03 units/mL NS n/a n/a unspec. unspec.LUN NS 0.109 units/mL n/a NS n/a n/a 28 d n/a 2 d Manufacturer Concentration Diluents c Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. HCl 0.1 mg/mL (PD); or with fluorouracil 1 mg/mL (RC); or with gentamicin sulfate 0.05, 0.1, 0.3, 0.6 mg/mL (SC); or with heparin 10–200 units/mL (RI); or with HCl 0.1 mg/mL (PD); or with fluorouracil 1 (RC); gentamicin sulfate 0.05, 0.1, 0.3, 0.6 (SC); heparin the additives were not tested. tobramycin sulfate 0.5 mg/mL (LI); or with vinBLASTINE 0.01 and 0.1 vinCRISTINE 0.05 Intermate/Infusor Drug Stability Information CONTAINER OTHER INFUSION CONTAINERS Bleomycin activity was retained with amikacin sulfate 1.25 mg/mL (BR); or with dexamethasone sodium phosphate 0.05 mg/mL (MSD); diphenhydrAMINE Bleomycin activity was retained with amikacin sulfate 1.25 mg/mL Protected from light. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Unspecified Polyvinyl Chloride Chloride Polyvinyl (PVC) INTERMATE (Baxter) Bleomycin Sulfate Flush Compatibility: Special Considerations: Notes a c d References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2017 February. 2. Note: 76 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Blinatumomab 1 1 Body Temp Refer. 1,2 1,2 1,2 Approximate “~” 1 1,2 Storage Conditions 2016; 73:19–20. 8 d n/a n/a n/a n/a 1, 2 8 d n/a n/a n/a n/a 1, 2 8 d n/a n/a n/a n/a 1, 2 TemperatureTemp Post-thaw c c c 4 h 24 h n/a n/a n/a n/a 48 h 48 h 48 h Room Refrig Frozen Room Refrig Am J Health-Syst Pharm. 7 a a a 1 n/a n/a n/a n/a Osmolality (mOsm/kg) pH b b b W NS NS NS , , , f f f 0.12 0.12 0.12 ~ ~ ~ , , , e e e 1 0.079 0.079 0.079 ~ ~ ~ , , , d d d mcg/mL mcg/mL mcg/mL g g g 0.038 0.038 0.24 0.038 0.24 0.24

~ ~ ~ ~ ~ ~ 1 1 Reconstitute blinatumomab with preservative-free W only. The provided IV Solution Stabilizer is used to coat the prefilled IV bag prior Reconstitute blinatumomab with preservative-free W only. The provided IV Solution Stabilizer is used Drug Do not flush infusion line during bag changing or at the completion of infusion, as this may result in excess dosing and related complications. Do not flush infusion line during bag changing or at the completion of infusion, as this may result in excess AMG AMG AMG 12.5 mcg/mL AMG Manufacturer Concentration Diluents (blinatumomab) [package insert]. Thousand Oaks, CA: Amgen Inc.; December 2014. ® h (PVC)

CONTAINER OTHER CONTAINERS Preparation for administering 9 mcg over 24 h; 10.375 mcg blinatumomab added to approximately 270 mL NS with provided IV Solution Stabilizer. Preparation for administering 9 mcg over 24 h; 10.375 blinatumomab Containing provided IV Solution Stabilizer, added prior to reconstituted blinatumomab. Stored in original container, protected from light. Preparation for administering 18 mcg over 48 h; 21.25 mcg blinatumomab added to approximately 270 mL NS with provided IV Solution Stabilizer. Preparation for administering 18 mcg over 48 h; 21.25 blinatumomab pH after reconstitution with W is 7. Includes storage and infusion time. Preparation for administering 56 mcg over 48 h; 65 mcg blinatumomab added to approximately 270 mL NS with provided IV Solution Stabilizer. Preparation for administering 56 mcg over 48 h; 65 blinatumomab Preparation for administering 28 mcg over 24 h; 32.5 mcg blinatumomab added to approximately 270 mL NS with provided IV Solution Stabilizer. Preparation for administering 28 mcg over 24 h; 32.5 blinatumomab Special Considerations: IV bag and prime line with to adding reconstituted blinatumomab. Strictly follow manufacturer instructions for preparation. Do not shake. Remove air from filter. Do not freeze. prepared solution for infusion. Infuse through dedicated lumen. Administer low protein-binding 0.2 micron in-line b 2. preparation of blinatumomab infusions. Marini BL, Wechter AR, Burke PW, et al. Minimizing waste during References 1. Blincyto concentration estimates in this monograph are based on the theoretical average bag volume of 270 mL, inclusive of diluent and stabilizer. concentration estimates in this monograph are based on the theoretical average bag volume of 270 mL, inclusive diluent and Notes a g Blinatumomab Vinyl Ethylene Acetate (EVA) Non-DEHP Polyvinyl Chloride Glass Vial Flush Compatibility: c d h Polyolefin e f 77 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bortezomib 2 Body Temp Refer. . 2005; 26:206–10. . 2014; 67:102–7. . 2008; 61:14–20. Can J Hosp Pharm n/a n/a n/a n/a n/a n/a n/a n/a 4, 6 n/a n/a n/a n/a 1, 4 n/a n/a n/a n/a 4, 6 n/a n/a n/a n/a 4, 5 n/a n/a n/a n/a 1, 4 Krankenhauspharmazie Can J Hosp Pharm Storage Conditions . 2005; 39:1462–6. g e h g a b 21 d 7 d 21 d 42 d TemperatureTemp Post-thaw h h h d Room Refrig Frozen Room Refrig Ann Pharmacother 3 Osmolality (mOsm/kg) pH NS n/a n/a 42 d NS n/a n/a 21 d f f 6 Handle according to guidelines for cytotoxic drugs. Storage time of reconstituted solution must not exceed 8 h if exposed to normal indoor Handle according to guidelines for cytotoxic drugs. Storage time of reconstituted solution must not Drug Normal saline. JN 2.5 mg/mL NS n/a n/a 21 d OB 1 mg/mL NS n/a 4–7 8 h 28 d JC 1 mg/mLJCJN 1 mg/mL 2.5 mg/mL NS n/a NS n/a n/a 4 d n/a n/a 5 d OB 1 mg/mL Manufacturer Concentration Diluents for injection [package insert]. Cambridge, MA: Millennium Pharmaceuticals Inc.; September 2015. ® 3 Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER OTHER INFUSION CONTAINERS Not protected from neon light, with air bubbles removed. In original container at 5°C and protected from light. Unprotected from fluorescent light. Protected from light. Protected from light, with air bubbles removed. Without exposure to light. Stored in the original container. h References 1. mg/mL solution in plastic syringe and glass vial. Andre P, Cisternino S, Chiadmi F, et al. Stability of bortezomib 1 2. solutions containing bortezomib [in German; English Abstract]. Friess D, Nguyen HC, Lipp HP. HPLC stability data with reconstituted Caution bortezomib final concentration differs depending on route of administration. Flush Compatibility: Special Considerations: lighting. Notes a b d e f g Unspecified Note: 3. Velcade Bortezomib Syringes, Polypropylene Glass 4. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 January. 5. with 0.9% sodium chloride at 4°C and room temperature (23°C). Walker SE, Milliken D, Law S. Stability of bortezomib reconstituted 6. in vials and syringes stored at 4°C room temperature (23°C). Walker SE, Charbonneau LF, Law S. Stability of bortezomib 2.5 mg/mL 78 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bumetanide 2 Body Temp Refer. Storage Conditions TemperatureTemp Post-thaw 72 h n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig 1997; 54:422–3. a a Am J Health-Syst Pharm. Osmolality (mOsm/kg) pH 1 1 7. ~ n/a Drug Normal saline. RCRCRC 0.02 mg/mL 0.2 mg/mL 0.25 mg/mL D5W D5W undiluted n/a n/a n/a n/a n/a 72 h n/a 72 h n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 2 1, 2 Manufacturer Concentration Diluents CONTAINER pH of undiluted solution is References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2017 February. 2. dextrose injection. Cornish LA, Montgomery PA, Johson CE. Stability of bumetanide in 5% Special Considerations: Note a Bumetanide Chloride Polyvinyl (PVC) Flush Compatibility: 79 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bupivacaine Hydrochloride 7 7 6 5 1 1 1 1 1, 5 7 7 7 7 4 1 1 1 1 3 3 3 3 y 1 z y g, o aa 10 d Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 30 d n/a n/a n/ad 30 n/an/a n/a n/a n/a n/a n/a 30 d n/a n/a n/a 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 10 n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions y y y y y y q ee v y t w,x, m,x, h aa z x l,x, y g, o m,x, w,x, l,x, u, p d s, 91 d 10 d n/a n/a n/a n/a n/a 30 d 30 d 30 d n/a180 d n/a n/a n/a n/a 10 n/a n/a n/a n/a n/a 30 d 30 d 93 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw f y t s h y o e, p d r, s, g, aa ee ee dd 32 d 32 d 10 d 90 d 30 d 30 d 14 d 72 h28 d n/a 28 d n/a n/a n/a n/a n/a n/a n/a n/a 30 d 180 d Room Refrig Frozen Room Refrig c c c c c c n/a n/a 91 d n/a n/a 30 d Osmolality (mOsm/kg) pH h NS n/a 4.6–5 n/a 28 d NS n/a 3.4–5.3 n/a 28 d NS NS n/a n/a NS n/a n/a n/a 30 d NS n/a n/ad 30 NS n/a 3.3–6 n/a 28 d NS n/a 3.4–4.9 n/a 28 d NS n/a 4–4.9 n/a 28 d NS n/a 3.3–5.9 n/a 28 d NS n/a 4.1–4.3 28 d NS, D5W n/a n/a n/a 30 d NSNS n/a n/a n/a 30 d n/a 30 d NS n/a n/a 28 d NS n/a n/a 14 d u w l w l n n d s s h p m m aa z g e Drug HSP 37.5 mg/mL HSP 20 mg/mL ASTAST 1.25 mg/mL 2.5 mg/mL NS n/a unspec.AST 3 mg/mL 7.5 mg/mL undiluted n/a n/a AST 2 mg/mL AST 1 mg/mL AST 1 mg/mL NS n/a HSP 37.5 mg/mL HSP 0.01 mg/mL unspec. 0.6 mg/mL HSP 0.01 mg/mL WI 0.44 mg/mL unspec.unspec. 0.6 mg/mLAST 7.5 mg/mL 0.5–7.5 mg/mL D5W, NS D5W, NS n/a n/a n/a n/a HSP 20 mg/mL ABunspec.unspec.AST 0.85 mg/mL 0.625, 1.25 mg/mL 1.25 mg/mL 4 mg/mL NS NS n/a n/a ASTAST 0.6–7.5 mg/mL 6.75 mg/mL NS, D5W, W n/a AST 6.75 mg/mL Manufacturer Concentration Diluents

® bb Cassette Cassette ® OTHER INFUSION CONTAINERS CONTAINER Dosi-Fuser CADD (SIMS Deltec) (Leventon) Non-DEHP Bags Bags Non-DEHP (INTRAVIA, Baxter) Chloride Polyvinyl (PVC) Polypropylene INFUSOR (Baxter) Syringes, Syringes, Bupivacaine Hydrochloride 80 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bupivacaine Hydrochloride (cont’d) 1 1 9 k k Body Temp Refer. continued on next page Storage Conditions TemperatureTemp Post-thaw n/a n/a n/a n/a n/a 12 w Room Refrig Frozen Room Refrig l c 4 c n/a n/a n/a n/a n/a n/a n/a 90 d n/a Osmolality (mOsm/kg) pH i W j j i 1 spinal). TM Do not use products or diluents containing preservatives for intraspinal or epidural administration. Do not use products or diluents containing preservatives for intraspinal epidural administration. Drug n/a: Not used intravenously. unspec. 25 mg/mL unspec. 7.5 mg/mL unspec. 5 mg/mL NS n/a n/a 1 d 14 d n/a n/a n/a n/a Manufacturer Concentration Diluents

® Medical)

With hydromorphone (SZ) 0.01 mg/mL or 25 mg/mL; or morphine (SZ) 0.01 mg/mL or 25 mg/mL; or fentanyl (SZ) 0.15 mcg/mL or 25 mcg/mL. With hydromorphone (SZ) 0.01 mg/mL or 25 mg/mL; morphine fentanyl 0.15 mcg/mL With hydromorphone (SZ) 0.01 mg/mL; or morphine fentanyl 0.15 mcg/mL. With fentanyl 2 mcg/mL. Admixed with fentanyl citrate 2 mcg/mL and 20 mcg/mL. Followed by 14 d at room temperature. 30 d at 3°C and 23°C, followed by a 48 h infusion near body temperature (30°C). With fentanyl citrate (JN) 1.25 mcg/mL and epinephrine hydrochloride (AB) 0.69 mcg/mL. With fentanyl citrate (JN) 1.25 mcg/mL and epinephrine hydrochloride With fentanyl citrate (JN) 1–5 mcg/mL. Stored at 22°C, exposed to light, at 6°C protected from light; also contained hydromorphone (SAB) 0.02 mg/mL or 0.04 mg/mL. Stored at 22°C, exposed to light, 6°C protected from light; Combined with morphine tartrate (DB) 1 mg/mL and midazolam hydrochloride (RC) 0.5 mg/mL. Combined with morphine tartrate (DB) 1 mg/mL and midazolam Stored at 37°C. pH range of undiluted product is 4–6.5. Combined with fentanyl citrate (JN) 35 mcg/mL and clonidine hydrochloride (BI) 9 mcg/mL at 4°C, 21°C, 35°C. Combined with fentanyl citrate (JN) 35 mcg/mL and clonidine Followed by 3 d at room temperature, followed 5 33°C. Although pH remained within stability range for the drug, this does not definitively demonstrate stability. Protected from light. With sufentanil citrate (JN) 5 mcg/mL. Followed by 2 d at 33°C. Followed by 7 d at 33°C. Protected from light at 22°C± 2°C. With hydromorphone (SZ) 0.01 mg/mL or 43 mg/mL; or morphine (SZ) 0.01 mg/mL or 43 mg/mL; or fentanyl (SZ) 0.15 mcg/mL or 43 mcg/mL. With hydromorphone (SZ) 0.01 mg/mL or 43 mg/mL; morphine fentanyl 0.15 mcg/mL In Dextrose 8.25% (Marcaine With clonidine HCl 2 mg/mL and morphine sulfate 50 mg/mL. Synchromed Pump Implanted (Medtronic) (Epic SMARTeZ k l m n o p q r s t u v w x y f g h i j d e Flush Compatibility: Special Considerations: Notes c Bupivacaine Hydrochloride (cont’d) 81 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Bupivacaine Hydrochloride (cont’d) . 2010; 63:154–5. J Pharm Practice Res 2004; 57:230–5. Can J Hosp Pharm. Can J Hosp Pharm. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. 2002; 6:471–4. . Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Int J Pharm Compound. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser SMARTeZ 2002; 32:65–8. polypropylene syringes. Intermate/Infusor Drug Stability Information from evaporative loss. Protected from light in 50-mL ambulatory pump cassette reservoirs (Pharmacia Deltec). Drug concentration increased 12% during the observation period, possibly Protected from light in 50-mL ambulatory pump cassette reservoirs (Pharmacia Deltec). Drug concentration increased 12% INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Manufacturer extrapolated data from other sources. With sufentanil (JN) 20 mcg/mL. With sufentanil (JN) 5 mcg/mL at 4°C and 32°C. Bupivacaine Hydrochloride (cont’d) Note: 10. 10. 9. 5. bupivacaine, or clonidine solution a ternary mixture in 0.9% sodium chloride two types of Jäppinen A, Kokki H, Naaranlahti T. pH stability of injectable fentanyl, 6. and hydromorphone in polypropylene syringes. Donnelly RF. Physical compatibility and chemical stability of bupivacaine 7. bupivacaine with hydromorphone, morphine, and fentanyl. Donnelly RF, Wong K, Spencer J. Physical compatibility of high-concentration z aa bb dd ee References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 3. 4. of morphine, midazolam, and bupivacaine combinations for intravenous infusion. La Forgia SP, Sharley NA, Burgess NG, et al. Stability and compatibility 82 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Calcitriol 2 Body Temp Refer. 1992; 49:1463–6. Storage Conditions n/a n/a n/a n/a n/a 1, 3 TemperatureTemp Post-thaw c 20 d n/a 7 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig Am J Hosp Pharm. e e d, d,

1 Osmolality (mOsm/kg) pH undiluted n/a

1 f

1 2 mcg/mL undiluted iso Adsorbs rapidly to polyvinyl chloride (PVC) containers (50% in 2 h). Drug Normal saline. unspec. 0.8, 1, 2 mcg/mL Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 1994; 29:P–243. CONTAINER The pH of undiluted Calcijex (AB) is 5.9 to 7.0. The pH of undiluted calcitriol injection (AMR) is 6.7 to 7.7. 4% loss within 20 d due to sorption. Protected from light. Flush Compatibility: Calcitriol Syringes, Polypropylene Special Considerations: Notes c d f References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. calcitriol in a tuberculin syringe [Abstract]. Paper presented at: ASHP Midyear Clinical Meeting; Miami, FL. Vargas-Ruiz M, Bushman LR, Hillegas MS, et al. Stability of parenteral 3. in plastic tuberculin syringes [Abstract]. Pecosky DA, Parasrampuria J, Li LC, et al. Stability and sorption of calcitriol Note: e 83 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Carboplatin 1, 6 1, 6 6 6 5 1, 6 6 2 8 2 6 1, 6 e e e b, b, b, b i e c h, b, Body Temp Refer. continued on next page n/a n/a n/a 7d n/an/a n/a n/a n/a n/a n/a 28 d n/a n/a n/a 28 d n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a 6, 7 n/a n/a n/a n/a 6, 7 n/a n/a n/a 7 d n/a n/a n/a 28 d n/a n/a n/a 24 h 3, 6 Storage Conditions d d i b b b b b, c b, b h, b b n/a n/a n/a n/a n/a 28 d 7 d 28 d 28 d 21 d 28 d TemperatureTemp Post-thaw b b b b b b b n/a9 d 14 d n/a n/a n/a 14 d 28 d 14 d n/a n/a n/a n/a n/a 28 d 28 d 24 h 84 d n/a 91 d 24 h 84 d 28 d n/a8 d 5 d n/an/a n/a n/a n/an/a n/a n/a 91 d n/a n/a n/a 4, 6 14 d Room Refrig Frozen Room Refrig f f f f f f a f a f f f f f n/a n/a Osmolality (mOsm/kg) pH W W Drug BRBR 1 mg/mL 2.4 mg/mL D5W n/a BR 1 mg/mL D5W n/a unspec. 10 mg/mL undiluted n/a BR 1 mg/mL D5W n/a BR 1 mg/mL D5W n/a BR 0.5–10 mg/mL D5W n/a TE 0.7, 2.15 mg/mL D5W n/a TEBMS 0.7, 2.15 mg/mL 0.75, 2 mg/mL D5W n/a D5W n/a 4.6–4.7 7 d BR 1 mg/mLBMS 0.5, 4 mg/mL D5WBRBMS D5W n/a 10 mg/mL BR 10 mg/mL n/aunspec. 6 mg/mL 4.6–4.7 0.5–10 mg/mL 21 d undiluted n/a D5W D5W n/a n/a Manufacturer Concentration Diluents g

® Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS Syringes, Syringes, Glass Dosi-Fuser Polyolefin Polyolefin Carboplatin Vinyl Ethylene Acetate (EVA) Chloride Polyvinyl (PVC) Polypropylene CADD Deltec) (Pharmacia (Leventon) INFUSOR (Baxter) 84 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Carboplatin (cont’d) 2007; . 1996; 138:125–8. J Oncol Pharm Practice Int J Pharm . 1994; 101:257–62.

Int J Pharm 7 . 1987; 12:427–32. 1998; 55:602, 604. J Clin Pharm Ther Am J Health-Syst Pharm. Barcelona, Spain: Leventon SAU; October 2015. Ontario, Canada: Baxter Corporation; October 2008.

6 Elastomeric Pump (ES.H.00.730-10). ®

6 1 Equipment used to prepare or administer carboplatin should not contain aluminum because the two interact, resulting in a precipitate and Equipment used to prepare or administer carboplatin should not contain aluminum because the two Normal saline. Intermate/Infusor Drug Stability Information. 13:119–26. Drug Stability Table-Dosi-Fuser Infusions were stored refrigerated for 84 d, then stored at 25°C for 24 h, then again refrigerated another 7 d. Infusions were stored refrigerated for 84 d, then at 25°C Protected from light. Stored 91 d refrigerated followed by 7 at 37°C. Stored at 35°C. pH range for the concentrations and diluent in this study was 4.15–4.75 at various time points storage conditions. Stored 91 d refrigerated followed by 7 at 33°C. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are pH of a 1% solution is 5–7. Manufacturer extrapolated data from other sources. Flush Compatibility: Special Considerations: loss of carboplatin potency. Carboplatin (cont’d) g h i References 1. of carboplatin with three portable infusion pump reservoirs. Rochard E, Barthes D, Courtois P. Stability and compatibility study 2. in polyvinyl chloride bags. Amador FD, Azzati ES, Lopez-Coterilla A. Stability of carboplatin 4. of a carboplatin solution in syringes for continuous ambulatory infusion. Valiere C, Arnaud P, Caroff E, et al. Stability and compatibility study 5. 6. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 7. investigation of carboplatin infusion stability to facilitate “dose banding.” Kaestner S, Sewell G. A sequential temperature cycling study for the 8. Notes a b c d e f 3. continuous infusion regimens. Sewell GJ, Riley CM, Rowland CG. The stability of carboplatin in ambulatory 85 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Caspofungin Acetate 2 6 4 7 3 5 Body Temp Refer. continued on next page Storage Conditions TemperatureTemp Post-thaw 24 h 48 h n/a n/a n/a n/a 60 h 14 d n/a n/a n/a n/a 60 h 14 d n/a n/a n/a n/a 60 h 14 d n/a n/a n/a n/a 60 h 14 d n/a n/a n/a n/a 60 h 14 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig a c a c a c a c a c a c a Osmolality (mOsm/kg) pH

2 Do not mix with dextrose-containing solutions. Final concentration should not exceed 0.5 mg/mL. The reconstituted solution (vial) may be Do not mix with dextrose-containing solutions. Final concentration should exceed 0.5 mg/mL. Drug Normal saline. Incompatible with heparin. unspec. 0.2–0.5 mg/mL NS unspec. 0.2–0.5 mg/mL NS unspec. 0.2–0.5 mg/mL NS ME 0.2, 0.28, 0.5 mg/mL NS ME 0.2–0.5 mg/mL NS, LR, ½S, ¼S 266–303 ME 0.2, 0.28, 0.5 mg/mL NS Manufacturer Concentration Diluents

2 b / [package insert]. Whitehouse Station, NJ: Merck & Co Inc.; September 2014. ® ® ST/LT ST/LT

® ®

(Halyard) TM d ® Medical)

Braun) Braun)

CONTAINER OTHER INFUSION CONTAINERS INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices IV bag or bottle. pH of saturated aqueous solution is approximately 6.6. At these concentrations in NS or LR, osmolality was 266–303 mOsm/kg. Special Considerations: stored for up to 1 h at controlled room temperature. b c Homepump (B. Easypump (B. (Epic Flush Compatibility: Caspofungin Acetate Bottle IV Bag, IV (Unspecified) AccuFlo Homepump Eclipse INTERMATE (Baxter) SMARTeZ d References 1. Merck Global Medical Information [personal communication]. North Wales, PA: & Co., Inc.; January 2012. 2. Cancidas Notes a 86 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Caspofungin Acetate (cont’d) Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ 5. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 6. Caspofungin Acetate (cont’d) 3. 4. 7. 87 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefazolin Sodium 1 1 1 1 1 1 1 4 1 8 8 1 1 1 1 1 1 1 1 Body Temp Refer. continued on next page n/a n/a n/a 16 j n/a n/a n/a n/a 11 n/a n/a n/an/a n/a n/an/a n/a n/an/an/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 3 m n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 30 d n/a30 d n/a 24 h n/a n/a n/a n/a 16 16 Storage Conditions q q j a a a a a a a a a j a, a, a, a 14 d 14 d 15 d 24 d 15 d 28 d 22 d n/a n/a n/a n/a n/a 30 d 30 d 10 d 14 d 14 d TemperatureTemp Post-thaw m q q a a a, a, a, j j a a a a a a, a 2 d n/a48 h 30 d 4 d 24 hn/a n/an/a 30 d 7 d 30 d n/a5 d 24 h5 d 48 h24 h n/a72 h 4 h 24 h n/a n/a 30 d n/a n/a 13 d n/a12 d n/a 72 h 24 h 24 hn/a 24 h n/a n/a n/a 30 d n/a n/a 4 d n/a 24 h n/a n/a 30 d n/a 4 d 24 h 4 d 4 d Room Refrig Frozen Room Refrig e pH e e e e e e e e e e e p Osmolality (mOsm/kg) pp e e ppppp e e p e p e e e e n/a n/a pn/a e n/a W W W W Drug unspec. 16.7 mg/mL NS n/a BRSKF 10 mg/mL 10 mg/mLLILIBRLI, SKF 5 mg/mLLI D5W 10 mg/mL D5W, NS LI 10 mg/mL 10 mg/mLLISKF 20 mg/mLAPO 20 mg/mL D5W 20 mg/mL D5W 20 mg/mLLI, SKF D5W D5W, NS 20, 40 mg/mLLI, SKF n/a SKF NS 8.33, 16.7, 33.3 mg/mL D5W 8.33, 16.7, 33.3 mg/mLAPO NS D5W, NSAPO D5W, NS D5W, NS D5W 100, 200 mg/mL n/a 50 mg/mL 100, 200 mg/mL 309, 341, 404 285, 317, 380 n/a n/aunspec. 24 h 24 h NS 5–40 mg/mL 96 h 96 h 26 w 26 w n/a n/a n/a D5W, NS n/a n/a n/a n/a n/a SKFSKF 20 mg/mL 73.2 mg/mL D5W, NS SKF 73.2 mg/mL unspec. 10–40 mg/mL D5W n/a unspec. 50 mg/mL NS n/a Manufacturer Concentration Diluents

TM Braun)

CONTAINER OTHER INFUSION CONTAINERS (B. Dosi-Fuser Cefazolin Sodium Glass Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene AccuFlo (Leventon) 88 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefazolin Sodium (cont’d) 1 1 1 1 1 1 5 3 7 3 3 n/a Body Temp Refer. l 30 d continued on next page l n/a24 h n/a 10 d n/a n/a 48 h c l n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 10 n/a n/a n/a n/a n/a n/a n/a n/a b,h n/a n/a n/a n/a 13 n/a n/a n/a n/a 12 Storage Conditions i j a, a a a a, a g 14 d 7 d n/a14 d n/a n/a n/a 7 d 17 d 14 d 7 d n/a n/a n/a n/a 1, 15 14 d 14 d TemperatureTemp Post-thaw g i j a a a a, a a a, a 4 d n/an/a n/a4 d n/a24 h 26 w 10 d 12 w n/a n/a n/a n/a 14 4 d 24 h 7 d n/a n/a n/a n/a 2 d 24 hn/a 10 d 10 d 30 d 24 h n/a n/a n/a n/a n/a n/a 2 d Room Refrig Frozen Room Refrig e pH e e e e e e e e e e p Osmolality (mOsm/kg) on/a n/a e iso n/a 24 h iso n/a n/a n/a n/a W n f D W n Drug LIunspec.unspec.unspec. 5, 222.2, 400 mg/mL 5 mg/mLunspec. 125, 225, 330 mg/mL 250 mg/mL W, D5W, NS W, NS, BWFI n/a NS n/a SKF 10–40 mg/mL D5W n/a LI 5 mg/mL D5W n/a n/a 4 d unspec. 20 mg/mL NS n/a BRN 20, 40 mg/mL unspec. 20 mg/mL LI 5 mg/mL LR n/a n/a 7 d unspec. 16.7 mg/mL NS n/a LILI 5–40 mg/mL 20 mg/mL D5W, NS n/a LI 3.33 mg/mL NS n/a n/a 3 d unspec. 16.7 mg/mL NS n/a Manufacturer Concentration Diluents /

k ® ST/LT ST/LT

(Baxter) ® ® k Flexible

b ® ® Medical)

Braun) Braun)

COMMERCIAL PREPARATIONS (Halyard) INFUSOR Cefazolin Sodium (cont’d) Homepump Eclipse INTERMATE Duplex Dual-Chambered Container (B. Bag Galaxy (Baxter) (Epic SMARTeZ (Baxter) Unspecified Homepump (B. Easypump 89 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefazolin Sodium (cont’d) 1987; 44(10):2287–90. The calculated osmolality of cefazolin 20 mg/mL The calculated osmolality of cefazolin 20 mg/mL 1 Am J Hosp Pharm.

Bethlehem, PA: B. Braun USA; September 2015. 1

10 . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM The calculated osmolality of cefazolin 40 mg/mL (2 Gm/50 mL) is 379 mOsm/kg in D5W and 1 Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. Drug Delivery System [package insert]. Irvine, CA: B. Braun Medical Inc.; April 2012. ®

1 ST/LT Elastomeric Infusion System. . HealthTek ® Elastomeric Infusion System TM Ontario, Canada: Baxter Healthcare Corporation; October 2008. Container (PL 2040 Plastic). Rosemont, IL: Celerity Pharmaceuticals, LLC; August 2015. ® Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes 1980; 69(11):1264–7. n/a

1 dual-chamber system is iso-osmotic hydrous dextrose USP. ® Heparin lock flush and normal saline. J Pharm Sci.

1,14 Stability Data for Drugs Using Elastomeric Infusion Pumps. ®

1 Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. chromatography. 406 mOsm/kg in NS. (1 Gm/50 mL) is 321 mOsm/kg in D5W and 344 NS. Protect from light after removal of foil strip. Once light-protecting foil strip is removed, product must be activated and used within 7 d. Protect from light after removal of foil strip. Once light-protecting strip is removed, product must be activated and used within change. Under fluorescent light. The calculated osmolality of cefazolin 10 mg/mL (1 Gm/100 mL) is 291 mOsm/kg in D5W and 317 NS. 30 d at 5°C with light protection, followed by 72 h 21–25°C exposure. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded The osmolality by freezing point depression of cefazolin 225 mg/mL in W is 636 mOsm/kg. The osmolality by freezing point depression of cefazolin 225 mg/mL Thaw at room temperature or under refrigeration. Do not force thaw. Do not re-freeze. Thaw at room temperature or under refrigeration. Do not force When diluted according to manufacturer's instructions. pH is 4.5 to 6.0. Manufacturer recommends discarding solutions after 24 h at room temperature and 10 d refrigeration to reduce potential for microbial growth, color change, and pH Manufacturer recommends discarding solutions after 24 h at room temperature and 10 d refrigeration to reduce potential for INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices When frozen within 1 h of reconstitution. Prior to activation, expiration date is per manufacturer’s label. To avoid inadvertent activation, DUPLEX container should remain folded until intended activation time. Prior to activation, expiration date is per manufacturer’s label. Diluent in the Duplex Manufacturer extrapolated data from other sources. In original container. Thawed solution should not be re-frozen. 17 d refrigerated may be followed by 4 at room temperature. Note: 14. 14. Corp; November 2011. Cefazolin for Injection USP [package insert]. Weston, FL: Apotex 15. tear solutions and aqueous vehicles [Abstract]. Ahmed I, Day P. Stability of cefazolin sodium in various artificial 16. 16. 12. 12. 11. 11. 13. 13. 10. 10. Cefazolin for Injection USP and Dextrose in Duplex 8. Rapp RP, Hatton J, Record K. 7. Cefazolin Injection USP in Galaxy 5. q References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 3. 4. cefazolin sodium, cephalothin nafcillin and ticarcillin disodium by high pressure liquid Das Gupta V, Stewart KR. Quantitation of carbenicillin disodium, g h i j k l m n o p f Special Considerations: Notes a b c e Cefazolin Sodium (cont’d) Flush Compatibility: 90 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefepime Hydrochloride 1 1 2 2 3 7 2 2 1 1 1 8 n/a n/a 13 Body Temp Refer. c e 7 d n/a n/a 11 continued on next page q e 1 d 24 hr n/an/a n/a n/a n/a n/a 11 11 e q l l n/a n/a n/a n/a 1, 5 90 d n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 60 d 63 d Storage Conditions a q l r k h b 7 d 7 d 7 d 7 14 d 14 d n/a 63 d TemperatureTemp Post-thaw r h l q l 2 dn/a 23 d n/a n/a 30 d n/a n/a n/a 11 d n/a n/a 24 h n/a 63 d 1 d n/a n/a 24 h 14 d n/a n/a n/a n/a 2 d2 d 14 d n/a 7 d n/a 63 d 2 d 7 d 1 d 14 d n/a n/a n/a n/a 14 24 h 24 h 7 d n/a n/a n/a n/a 2 d 2 d 24 h 1 d 14 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig f f f f f f f f f f f f f f f n/a Osmolality (mOsm/kg) pH D5W, NS n/a n/a 48 h NS, D5W, D5S, D5S, D5W, NS, D5LR, D10W NS, D5W n/a n/a 24 h r h 5–60 mg/mL NS n /a q Drug BMSBMS 20 mg/mL 20 mg/mL NS, D5W D5W n/a n/a BMS 5–60 mg/mL NS, D5W n/a unspec. 20 mg/mL NS n/a BMS 1–5 mg/mL NS, D5W n/a BMSBMS 1–5 mg/mL 1–5 mg/mL NS, D5W NS, D5W n/a n/a unspec. 20 mg/mL NS n/a BRBRBMS 1, 40 mg/mL 1, 40 mg/mL 2.5, 5, 10, 20 mg/mL BMS NS, D5WBMS n/a 20 mg/mL 100, 200 mg/mLHSP W, NS, D5W NSunspec. n/a 10, 20, 40 mg/mL HSPHSP n/a n/a 1–5 mg/mL >5–60 mg/mL 1 d n/a 7 d NS, D5W NS, D5W 2 d n/a n/a 21 d n/a n/a n/a n/a unspec. 20 mg/mL NS n/a Manufacturer Concentration Diluents

p ®

/ ® ® ST/LT ST/LT ® (B. Braun) TM Braun)

CONTAINER OTHER INFUSION CONTAINERS Syringes, Syringes, Cefepime Hydrochloride (Halyard) Homepump (B. Glass Chloride Polyvinyl (PVC) Polypropylene AccuFlo ADD-Vantage Container (Hospira) Dosi-Fuser (Leventon) Easypump Homepump Eclipse INTERMATE (Baxter) 91 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefepime Hydrochloride (cont’d) 9 7 Body Temp Refer. 12 continued on next page 7 d 24 h n/a 12 n m, n/a n/a n/a n/a n/a n/a n/a n/a 10 Storage Conditions l j 5 d 14 d TemperatureTemp Post-thaw j l

1 d 13 Room Refrig Frozen Room Refrig f n/a 12 h f 12

iso 4–6 n/a n/a n/a n/a 24 h 7 d n/a n/a n/a n/a Osmolality (mOsm/kg) pH 13

9 o D i i NS, D5W, D5S, D5S, D5W, NS, D5LR, D10W 12

1 1,5

1–40 mg/mL 1 container, reconstitution and dilution of medication per labeled instructions. ® Drug n/a BA 20 mg/mL BRN 20, 40 mg/mL unspec. HSP 20 mg/mL NS n/a Manufacturer Concentration Diluents dual chamber system is iso-osmotic hydrous dextrose USP. After reconstitution, the drug product in solution hyper-osmotic and intended for ® Heparin lock flush and normal saline. n

9 Flexible Dual Dual Flexible ® Braun) single IV use. activated within 7 d but not beyond the labeled expiration date.

COMMERCIAL PREPARATIONS (RTU) Thaw at room temperature or under refrigeration. Do not force thaw. re-freeze. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Cepimex formulation, contains cefepime dihydrochloride monohydrate. Stored 7 d refrigerated followed by 2 at room temperature. Diluent is iso-osmotic dextrose hydrous USP 2.06 gm/100 mL. Following activation of ADD-Vantage Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer's label. Do not extrapolate Stored up to 90 d at –20°C followed by 7 4°C 1 22°C 24°C in most solutions. Stored 14 d refrigerated followed by 1 at room temperature. Stored up to 7 d at 4°C followed by 1 22°C 24°C in most solutions. Stored 63 days frozen followed by 7 d refrigerated, then 2 at room temperature. With metronidazole 5 mg/mL (AB, ES, SE). pH of reconstituted preparation is 4–6. Manufacturer extrapolated data from other sources. Prior to activation, expiration date is per manufacturer's label. Protect from light after removal of foil strip. If light-protecting foil strip is removed, product must be Prior to activation, expiration date is per manufacturer's label. Protect from light after removal of foil strip. If light-protecting Diluent in the Duplex f Cefepime Hydrochloride (cont’d) l m h Special Considerations: Notes a b c e i p q r j o k Flush Compatibility: n SMARTeZ (Epic) Unspecified Duplex Container Chambered (B. Galaxy Bag (Baxter) 92 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefepime Hydrochloride (cont’d) 1999; 56:457–9. 56:457–9. 1999; . 2000; 35:1061–4. 35:1061–4. 2000; . Hosp Pharm Am J Health-Syst Pharm. Bethlehem, PA: B. Braun USA; September 2015. Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. Container [package insert]. Irvine, CA: B. Braun Medical Inc.; November 2015. ® ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® (PL 2040) Container. Deerfield, IL: Baxter Healthcare Corporation; May 2016. ® (Cefepime Hydrochloride, USP) [package insert]. Lake Forest, IL: Hospira Inc; April 2015. Stability Data for Drugs Using Elastomeric Infusion Pumps. TM ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory Stewart JT, Maddox FC, Warren FW. Stability of cefepime hydrochloride injection and metronidazole in polyvinyl chloride bags at 4° 22°–24°C. Stewart, JT, Warren, FW, Madox FC. Stability of cefepime hydrochloride injection in polypropylene syringes at –20°C, 4°C, and 22–24°C. Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ

5. 13. 12. 12. Cefepime Injection in Galaxy 14. 14. 11. 11. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. Cefepime Hydrochloride (cont’d) Note:

9. Cefepime for Injection USP and Dextrose in Duplex 8. 7. Maxipime 10. 10. 93 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefotaxime Sodium 2 5 2 2 8 6 1 1 1 1 1 9 9 2 2 1 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a 11 n/an/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a a i 30 d i i i i Storage Conditions a 10 d TemperatureTemp Post-thaw a 12 h 7 d 24 h 7 d 24 h12 h 5 d 5 d Room Refrig Frozen Room Refrig g n/a 24 h 3 d n/a n/a n/a n/a n/a 24 h n/a n/a n/a n/a n/a n/a 24 h 3 d n/a n/a n/a n/a 9 9 9 h g h g hh g g Osmolality (mOsm/kg) pH W D5W, NS n/a n/a 24 h 10 d D5W, NSD5W, NS n/a n/a n/aD5W, NS n/a n/a 24 hW n/a 5 dW n/a n/a 13 w n/a 13 w 24 h n/a n/a 5 d n/a n/a n/a 13 w 1, 2 24 h 5 d n/a k W k k c c c Drug SAV 10–40 mg/mL unspec. 16.66 mg/mL NS 340 SAVSAV 50, 95 mg/mL 180, 230, 300, 330 mg/mL SAV unspec. HOHOHO 10 mg/mLunspec. 20 mg/mLHO 20 mg/mLHOSAVSAV 16.7, 33.3 mg/mL 16.7, 33.3 mg/mLAVE D5W, NS 50, 95 mg/mL D5W 180, 230, 300, 330 mg/mL 319, 344 NS NS 50 mg/mL n/a D5W 327 351 340, 403unspec. 24 h 317, 380 n/a 22 d n/a n/a 40 mg/mL n/a 63 d NS 24 h n/a 24 h 24 h n/a 24 h n/a 5 d 5 d n/a n/a n/a 13 w n/a 13 wunspec. NS n/a n/a n/a n/a n/a n/a n/a n/a 16.66 mg/mL n/a n/a n/a n/a n/a n/a 2 d n/a 18 d n/a n/a NS n/a 24 h n/a 340 n/a unspec. 16.66 mg/mL NS 340 Manufacturer Concentration Diluents / ®

® ST/LT ST/LT ® ®

TM Braun)

CONTAINER OTHER INFUSION CONTAINERS Glass Homepump (B. Easypump Dosi-Fuser Cefotaxime Sodium Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene AccuFlo (Leventon) Homepump Eclipse C-Series (Halyard) (B. Braun) 94 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefotaxime Sodium (cont’d) 2 7 7 2 n/a Body Temp Refer. b 10 d continued on next page b n/a n/a n/a 24 h e j n/a n/a n/a n/a 10 b, Storage Conditions a n/a 3 d TemperatureTemp Post-thaw f a Room Refrig Frozen Room Refrig

2 g n/a 24 h Bethlehem, PA: B. Braun USA; September 2015. 9 iso n/a n/a n/a Osmolality (mOsm/kg) pH NS, D5W n/aD n/a 24 h

1 ST/LT Elastomeric Infusion System. ® c

1,2 container (reconstituted and diluted medication) per labeled instructions. ® Drug n/a unspec. 16.66 mg/mL NS 340 HOHO 5–40 mg/mL 40 mg/mLSAV D5W, NSHO unspec. NS n/a 20, 40 mg/mL n/a n/a 24 h n/a n/a 30 d 24 h 24 h 10 d n/a n/a n/a n/a n/a n/a Heparin lock flush and normal saline. Manufacturer Concentration Diluents

[prescribing information]. Bridgewater, NJ: Sanofi-Aventis US LLC; March 2015. [prescribing information]. Bridgewater, NJ: Sanofi-Aventis ® ® (Epic (Epic ® l Chemical Stability Data for Drugs Using B. Braun’s Easypump COMMERCIAL PREPARATIONS (RTU) Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded A solution of 71 mg/mL in W is isotonic. Thaw at room temperature or under refrigeration. Do not force thaw. Do not re-freeze. Thaw at room temperature or under refrigeration. Do not force Manufacturer extrapolated data from other sources. In original container. Concentrations of dilutions based on reconstitution and/or dilution per manufacturer's labeling. Refer to current package insert for instructions. Concentrations of dilutions based on reconstitution and/or dilution per manufacturer's labeling. Refer to current package insert pH of injectable solutions is 5–7.5. After activation of ADD-Vantage INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Do not freeze. Reconstituted solutions stored in original containers and plastic syringes remain stable for 13 w frozen. Reconstituted solutions stored in original containers and plastic 5. k l References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. Claforan j g Cefotaxime Sodium (cont’d) h i Special Considerations: Notes a b c e f Medical) INTERMATE INTERMATE (Baxter) SMARTeZ ADD-Vantage Container Flexible (Abbott) Galaxy Bag (Baxter) Flush Compatibility: 95 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefotaxime Sodium (cont’d) . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. HealthTek Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo Cefotaxime Sodium (cont’d) Note: 11. 11. 10. 10. 7. 8. 9. Rapp RP, Hatton J, Record K. 6. 96 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefotetan Disodium 1 1 1 1 2 2 7 5 5 4 4 4 4 Body Temp Refer. continued on next page n/a n/an/an/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 a a a 30 d 7 d Storage Conditions a a d e 10 d 4 d 5 d TemperatureTemp Post-thaw a a d 14 d2 d 14 d3.5 d 14 d 41 d3.5 d 14 d n/a 60 d 13 d n/a24 h n/a n/a24 h n/a 96 h n/a 96 h n/a n/a 1 w n/a n/a n/a24 h n/a n/a n/a n/a n/a n/a n/a 24 h n/an/a n/a n/a n/a24 h 60 d n/a 10 dn/a n/a 10 d24 h 10 d n/a n/a 10 d n/a 30 d n/a n/a n/a 24 h n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig b b b b b b b b b b b b b b 4–6.5 12 h

g c n/a 290 (mOsm/kg) pH Osmolality c D W

1 n/a Drug Normal saline, heparin flush. BRN 20, 40 mg/mL STUSTUAYAY 2 mg/mL 20 mg/mLSTU 20, 40 mg/mLSTU 20, 40 mg/mL 16.7, 33.3 mg/mLSTU 16.7, 33.3 mg/mL D5W NS, D5Wunspec. NS 60 mg/mLunspec. D5W NS n/a n/a D5W 10–40 mg/mL 20 mg/mL n/a n/a STU 346, 415 STU 323, 391 STUSTU 5–60 mg/mL NS, D5W NS, D5W 5–60 mg/mL n/a 30 mg/mL n/a NS, D5W 60 mg/mL n/a D5W NS n/a NS, D5W n/a n/a Manufacturer Concentration Diluents

® Flexible / f ® ® Braun)

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Homepump Cefotetan Disodium Chloride Polyvinyl (PVC) Syringes, Plastic Dosi-Fuser (Leventon) Homepump Eclipse C-Series (Halyard) INTERMATE (Baxter) Duplex Dual-Chambered Container (B. Flush Compatibility: Special Considerations: 97 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefotetan Disodium (cont’d)

6 container should remain folded until intended activation time. ® Irvine, CA: Halyard Health; March 2015.

1 and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Barcelona, Spain: Leventon SAU; October 2015. . HealthTek Drug Delivery System [package insert]. Irvine, CA: B. Braun Medical Inc.; August 2012. ® Ontario, Canada: Baxter Corporation; October 2008.

6 Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes dual chamber system is Hydrous Dextrose in Water for Injection at a concentration that renders the reconstituted solution iso-osmotic. dual chamber system is Hydrous Dextrose in Water for Injection at a concentration that renders the reconstituted container. ® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory Drug Stability Table-Dosi-Fuser Protect from light after removal of foil strip. If light-protecting foil strip is removed, product must be activated within 7 d but not beyond the labeled expiration date. Protect from light after removal of foil strip. If light-protecting strip is removed, product must be activated within 7 d but not Prior to activation, expiration date is per manufacturer’s label. To avoid inadvertent activation, Duplex Prior to activation, expiration date is per manufacturer’s label. pH of reconstituted solutions is 4.5–6.5. Do not freeze Duplex Manufacturer extrapolated data from other sources. Diluent in the Duplex Cefotetan disodium solution 100–200 mg/mL in W is 400–800 mOsm/L. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices 4. 5. 6. Cefotetan for Injection and Dextrose in Duplex Cefotetan Disodium (cont’d) Note: 7. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Rapp RP, Hatton J, Record K. d e c Notes a b f g 98 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefoxitin Sodium 4 4 4 4 8 8 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 5 a a 24 h 24 h Body Temp Refer. a a n/a n/a 1, 9 continued on next page f n/a n/a n/a n/a 4 d 6 h n/a 4 d b a a f 30 d n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions b b b 7 d 13 d TemperatureTemp Post-thaw b b n/an/a n/an/a 10 dn/a 30 d 10 d 30 d 10 d 24 h n/a 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a54 h 10 d 24 h24 h n/a24 h 7 d48 h n/a 48 h24 h n/a n/a n/a n/an/a 7 d n/a n/a n/a n/a48 h n/a 13 w n/a24 h n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a24 h n/a n/a n/a n/a24 h n/a 13 d n/a n/an/a n/a 13 d 72 h n/a n/a n/a 30 d n/a n/a n/a n/a n/a 30 d 2 d n/a n/a 2 d n/a 23 d n/a 23 d n/a 3 m 3 m n/a n/a n/a n/a n/a n/a 24 h Room Refrig Frozen Room Refrig c c c c c c c c c c c c

i in/a i c c ii c c iiin/a c c c in/a c in/a c i c (mOsm/kg) pH Osmolality W W W W W Drug MSD 5 mg/mL NS n/a MSDMSDMSD 5–60 mg/mL 30 mg/mL 60 mg/mL D5W NS MSD 5–60 mg/mL NS, D5W MSD 10 mg/mL NS, D5W MSDMSDMSDMSD 1 mg/mLMSD 1, 2, 10 mg/mLMSD 10, 20 mg/mL 20 mg/mLMSD 20 mg/mLMSD D5W 40 mg/mL NSunspec. NS MSD 1 mg/mLMSD 1 mg/mL n/a 10, 20 mg/mL D5W, NS MSD n/a D5W 20 mg/mLMSD 20 mg/mLMSD 40 mg/mL D5W, NS NSMSD D5WMSD 16.7, 33.3 mg/mL 16.7, 33.3 mg/mL NS 100 mg/mL n/a D5W n/a 200 mg/mL NS D5W 352 326 344, 411 321, 388 n/a n/a 24 h 24 h 7 d 7 d 30 w 30 w n/a n/a n/a n/a n/a n/a unspec. 20 mg/mL NS, D5W Manufacturer Concentration Diluents / h ® C-Series C-Series ® (Leventon) (Leventon) ® CONTAINER OTHER INFUSION CONTAINERS Homepump Cefoxitin Sodium Glass Chloride Polyvinyl (PVC) Syringes, Plastic Dosi-Fuser Homepump Eclipse INTERMATE (Baxter) (Halyard) 99 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefoxitin Sodium (cont’d)

6 6 1 1 1 Body Temp Refer. n/a n/a n/a Storage Conditions e g 7 d 1 m n/a n/a n/a n/a 1979; 36:33–8. TemperatureTemp Post-thaw e Room Refrig Frozen Room Refrig

6 container should remain folded until intended activation time. ® c Am J Hosp Pharm. 6.5 12 h ~ n/a 48 h 7 d 30 w 24 h 7 d n/a

i 290 ~ i n/an/a n/a n/a 48 h 48 h 7 d 13 w n/a n/a n/a (mOsm/kg) pH Osmolality Irvine, CA: Halyard Health; March 2015.

1 and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM d D W W W Barcelona, Spain: Leventon SAU; October 2015.

1 . HealthTek Ontario, Canada: Baxter Corporation; 2008.

6 container has 50 mL Dextrose Injection (4% for 1 gm dose and 2.2% 2 dose) such that the reconstituted solutions are iso-osmotic. Elastomeric Pump (ES.H.00.730-10). ® ® Drug Stability in Plastic Syringes Drug

BRN 20, 40 mg/mL unspec.unspec.unspec. 100 mg/mL 250 mg/mL 500 mg/mL n/a 9 containers. Manufacturer Concentration Diluents ® Heparin lock flush and normal saline. Flexible Dual- ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Braun) Intermate/Infusor Drug Stability Information. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory Drug Stability Table-Dosi-Fuser 415, and 508 mOsm/kg. At 112 mg/mL in W, osmolality is 437 Protect from light after removal of foil strip. If light-protecting, foil strip is removed; product must be activated within 7 d but not beyond the labeled expiration date. Protect from light after removal of foil strip. If light-protecting, strip is removed; product must be activated within 7 d but not Allow refrigerated reconstituted DUPLEX bag to equilibrate room temperature before administration.

COMMERCIAL PREPARATIONS (RTU) Manufacturer(s) extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Diluent chamber of the DUPLEX Prior to activation, expiration date is per manufacturer's label. To avoid inadvertent activation, DUPLEX Prior to activation, expiration date is per manufacturer's label. Stable for 24 h at 37°C after 30 d frozen, then 4 refrigerated temperature. pH of reconstituted solution is 4.2–7. Do not freeze DUPLEX Thawed in a microwave. Osmolality of 10, 20, 40, and 62 mg/mL in Dextrose 5% is 293, 326–329, 388, and 531 mOsm/kg; solutions of 10, 20, 40, 56 mg/mL in NS is 319, 352–355, Osmolality of 10, 20, 40, and 62 mg/mL in Dextrose 5% is 293, 9. infusions and additives [Abstract]. O’Brien MJ, Portnoff JB. Cefoxitin sodium compatibility with intravenous 4. 5. 6. insert]. Irvine, CA: B. Braun Medical Inc.; April 2013. Cefoxitin and Dextrose (cefoxitin sodium injection, solution) [package 8. Note: f g h i References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Rapp RP, Hatton J, Record K. Special Considerations: Notes a b c d Flush Compatibility: Cefoxitin Sodium (cont’d) Duplex Container Chambered (B. e Unspecified 100 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftaroline Fosamil 1 1 Body Temp Refer. n/a n/a n/a n/a Storage Conditions b 24 h TemperatureTemp Post-thaw b 6 h 6 h 24 h n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a

1 n/a Osmolality (mOsm/kg) pH NS n/a NS, D5W, D2.5W, ½S, LR

1 c c Store unreconstituted vials at 25°C; excursions are permitted to 15–30°C. Do not mix with or physically add to solutions containing other Store unreconstituted vials at 25°C; excursions are permitted to 15–30°C. Do not mix with or physically Drug Normal saline, heparin lock flush. FOR 8–12 mg/mL FOR 4–12 mg/ml Manufacturer Concentration Diluents

TM (ceftaroline fosamil) [package insert]. Parsippany, NJ: Forest Pharmaceuticals; Inc.; May 2016. ® CONTAINER OTHER INFUSION CONTAINERS After activation/reconstitution in 50 or 100 mL containers. pH of constituted solution (20–30 mg/mL) is 4.8–6.5. Reconstituted and diluted according to package insert. Ceftaroline Fosamil Unspecified Bag Mini-Bag Plus (Baxter) Flush Compatibility: c Special Considerations: the same solution as original drugs. Reconstitute vial with 20 mL W, NS, D5W, or LR. Dilute total dose in 50–250 of solution prior to infusion. exceed 12 mg/mL; for dilution in diluent, except use NS, D5W, D2.5W, ½S, or LR if W was used for reconstitution. Infusion solution concentration should not 50-mL bags, withdraw 20 mL of solution from bag prior to addition the reconstituted drug. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. References 1. Teflaro Notes a b 101 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftazidime 1 7 7 1 1 1 1 1 1 1 1 1 4 1 Body Temp Refer. continued on next page n/a n/a n/a 15 e n/a n/a n/a n/a 15 Storage Conditions e 7 d Temperature Post-thaw Temp e 24 h 14 d n/a n/a n/a n/a 12 n/a2 d n/a2 d 21 d 30 d 28 d 90 d n/a 90 d n/a n/a 4 d n/an/a n/a 24 h 24 h n/a n/a24 h n/a 14 d 10 d 30 d n/a n/a n/a n/a n/a 4 d n/a 24 h n/a n/a n/a 24 h n/a7 d n/a 28 d 8 w 84 d n/a n/a n/a 15 24 h 14 d n/a n/a n/a n/a 8 h 96 h 91 d 8 h 4 d n/a 8 h 96 h 91 d 8 h 4 d n/a 1 Room Refrig Frozen Room Refrig c c c c c c c c c c c c c c Osmolality (mOsm/kg) pH n/a n/a 3 d 17 d 60 d n/a n/a n/a 304, 330, 383 n/a281, 306, 360 n/a 24 h 24 h 7 d 7 d 12 w 12 w n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a k k k k k NS D5W W W W W 8.33, 16.7, 33.3 mg/mL 8.33, 16.7, 33.3 mg/mL Drug unspec. unspec. unspec. 40 mg/mL NS n/a GLunspec.unspec.GL 40 mg/mL 36.6 mg/mL 40 mg/mLGLunspec. 100, 200 mg/mL GW D5WGL 4 mg/mL 2, 6 mg/mL NSGLGL 10 mg/mL 36.6 mg/mL HSP D5W, NS 40 mg/mL n/a D5W, NS 40 mg/mL n/a D5W, NS 1 mg/mLGL n/a n/a NS D5W n/a 100, 200 mg/mL NS n/a n/aGSK 24 h n/a n/a 24 hGSK n/a n/aGSK 24 h 24 h 5–40 mg/mL n/a n/a 24 h 5–60 mg/mL 60 mg/mL n/a n/a n/a NS, D5W n/a n/a n/a NS n/a n/a n/a NS, D5W n/a n/a n/a n/a unspec. 40 mg/mL NS n/a Manufacturer Concentration Diluents

ST/LT ST/LT ® ®

TM Braun)

CONTAINER OTHER INFUSION CONTAINERS Syringes, Syringes, (B. Ceftazidime Glass Chloride Polyvinyl (PVC) Syringes, Plastic Polypropylene AccuFlo (Leventon) Easypump Dosi-Fuser (B. Braun) 102 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftazidime (cont’d) 1 1 5 5 5 5 5 5 6 6 6 6 8 1 1 1 1 1 Body Temp Refer. continued on next page n/a n/a n/a n/a 13 Storage Conditions e 14 d Temperature Post-thaw Temp e 24 hn/a 7 d n/a n/a 3 m n/a 8 h n/a 4 d n/a n/a 24 h24 h 7 dn/a 10 d n/an/a 30 d 5 dn/a n/a n/a 24 h n/a 10 d n/a n/a 8 w n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a 18 h 4 d n/a n/a n/a n/a n/a24 h 28 d18 h 14 d n/an/a 7 d n/a n/a 14 d 84 d n/a 14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 h 12 h 3 d24 h n/a 7 d n/an/a n/a24 h n/a n/a24 h n/a 48 h n/an/a 7 d 97 d n/a n/an/a 2, 14 24 h n/a n/a n/a n/a n/a 4 d 6 m n/a n/a 3 m n/a 24 h n/a n/a 8 h 7 d n/a 4 d n/a n/a Room Refrig Frozen Room Refrig c c c c c c c c c c c c c c c c c c c c c Osmolality (mOsm/kg) pH n/a n/a n/a n/a n/a n/a a W W D5W, NS, D5S, D5S, NS, D5W, D5½S, D5¼S, D10W, LR D5S, NS, D5W, D5½S, D5¼S, D10W, LR W Drug GSK, HSP 280 mg/mL GL 5–40 mg/mL NS, D5W n/a GLGLGLGL 5–40 mg/mL 5–40 mg/mL 5–60 mg/mL 20 mg/mL NS, D5W D5W NS n/a n/a n/a GL 10–40 mg/mL D5W n/a unspec.unspec.unspec. 5–30 mg/mLunspec. 5–40 mg/mL 20 mg/mL 60 mg/mL NS NS NS NS n/a unspec. n/a n/a 40 mg/mLCOV, SAG n/a 1–40 mg/mL HSP NSGL 1–40 mg/mL GLunspec.GSK 20 mg/mLHSP 95–280 mg/mL n/a 20 mg/mLunspec. 100–180 mg/mL 100–180 mg/mL 280 mg/mL NS D5W, D5S, NS NS, W NS, D5W n/a BWFI n/a n/a n/a Manufacturer Concentration Diluents l l

® (Epic (Epic ® / ® Ceftazidime (cont’d) SMARTeZ Homepump Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) (Baxter) INTERMATE Medical, Inc.) Unspecified 103 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftazidime (cont’d) 2 Body Temp Refer. 8 h 3 d n/a h n/a n/a n/a n/a 10 f, Storage Conditions j 3 d Temperature Post-thaw Temp j Room Refrig Frozen Room Refrig c Bethlehem, PA: B. Braun USA; September 2015. Osmolality (mOsm/kg) pH 300 5–7.5 n/a n/a Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Drug Delivery System [package insert]. Bethlehem, PA; B. Braun Medical Inc.; May 2015. ® Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

1 i D

1 ST/LT Elastomeric Infusion System. . HealthTek ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; 2008. 20, 40 mg/mL

1 Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes after reconstitution; allow the gas to disperse before placing in syringes. 2 n/a Drug BRN COV 20, 40 mg/mL D5W 340, 400 5–7.5 12 h Heparin lock flush and normal saline. Manufacturer Concentration Diluents Stability Data for Drugs Using Elastomeric Infusion Pumps. Braun) ®

Injection [package insert]. Lake Forest, IL: Hospira Worldwide, Inc.; October 2014. Injection [package insert]. Cary, NC: Covis Pharmaceuticals; August 2014. ® ® Flexible ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun's Easypump SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo activation time. Protect from light after removal of foil strip. If light-protecting foil strip is removed, product must be activated within 7 d but not beyond the labeled activation time. Protect from light after removal of foil strip. If light-protecting strip is removed, product must be activated expiration date. COMMERCIAL PREPARTIONS (RTU) Thaw at room temperature or under refrigeration. Do not force thaw. Do not re-freeze. Thaw at room temperature or under refrigeration. Do not force Manufacturer extrapolated data from other sources. Also tested in lidocaine HCl 0.5% and 1% for IM injection only. Ceftazidime produces CO pH of reconstituted solutions is 5–8. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer's label. Do not extrapolate After activation. Prior to activation, expiration date is per manufacturer's label. To avoid inadvertent activation, DUPLEX container should remain folded until intended After activation. Prior to activation, expiration date is per manufacturer's label. To avoid inadvertent DUPLEX container INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Dextrose added to adjust osmolality. Ceftazidime (cont’d) Note: 14. 14. Sagent Pharmaceuticals; January 2015. Ceftazidime for Injection, USP [package insert]. Schaumburg, IL: 15. Notes a Special Considerations: 12. 12. 10. 10. Ceftazidime for Injection USP and Dextrose in Duplex 8. Tazicef c Duplex Dual-Chambered Container (B. Galaxy Bag (Baxter) Flush Compatibility: 13. 13. 5. 6. 7. Rapp RP, Hatton J, Record K. e f h i j k 4. l References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. Fortaz 104 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftolozane–Tazobactam

5 3 3 4 5 Body Temp Refer.

n/a n/a n/a n/a 1 n/a n/a n/a n/a Due to the appearance of of appearance the to Due n/a n/a n/a n/a Storage Conditions d 7 d TemperatureTemp Post-thaw d 24 h 7 d n/a 24 h 7 d n/a 24 h 7 d n/a n/a n/a n/a 24 h24 h 7 d n/a n/a n/a n/a 1, 5 Room Refrig Frozen Room Refrig

2 [personal communication]. Lexington, MA: Cubist Pharmaceuticals, US; March 2015. b a b a b a bb a a Osmolality (mOsm/kg) pH [personal communication]. North Wales, PA: Merck and Co, Inc.; November 2015. D5W, NS D5W, NS [personal communication]. North Wales, PA: Merck and Co, Inc.; September 2015. c e 9.86/4.93 mg/mL D5W, NS 1.21/0.6 mg/mL D5W, NS 87.7/43.9 mg/mL NS, W n/a n/a 1 h n/a n/a n/a n/a n/a 1, 4 ~ ~ ~

Stability in Eclipse Elastomeric Infusion Pump pH and Osmolality 1 ® ® Stability following Reconstitution in Polyvinylchloride bags ® Zerbaxa Zerbaxa Drug Reconstituted solution is not suitable for direct injection. Refrigerate intact vials protected from light. Slight color variations (colorless to Reconstituted solution is not suitable for direct injection. Refrigerate intact vials protected from light. MSD MSD unspec. MSD CUB 1–10 mg/mL MSD CUB 2.4/1.2, 23.1/11.5 mg/mL D5W, NS Manufacturer Concentration Diluents Zerbaxa Normal saline.

® (ceftolozane/tazobactam) for Injection intravenous use [package insert]. Whitehouse Station, NJ: Merck Sharp and Dohme Corp.; July 2015. ® degradation compounds, the manufacturer recommends that IV bags stored under refrigeration be used within 7 d, and 24 h if at ambient temperatures. CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Tested over 14 d at refrigerated and 2 days room temperature. Drug concentrations remained above 90% during the test period. Osmolality of 1000/500 mg ceftolozane/tazobactam reconstituted with 10 mL NS and diluted in D5W or NS 100 mL is approximately 500 mOsm/kg. Osmolality of 1000/500 mg ceftolozane/tazobactam reconstituted with 10 mL NS and diluted in D5W or 100 is approximately When reconstituted with W or NS and diluted in 100 mL NS or D5W per manufacturer labeling. When reconstituted with W or NS and diluted in 100 mL pH when reconstituted with NS or W and diluted in D5W 100 mL is 5.9–6.0. Single concentrations are reported as the ceftolozane sulfate component, which is in a 2:1 fixed ratio with the tazobactam sodium component. Single concentrations are reported as the ceftolozane sulfate component, which is in a 2:1 fixed ratio with tazobactam sodium Notes a c b d e Flush Compatibility: Special Considerations: slightly yellow) do not affect potency. Do freeze reconstituted or diluted solutions. Unspecified (I-Flow) Ceftolozane–Tazobactam Chloride Polyvinyl (PVC) Glass Vial Homepump Eclipse 3. Global Medical Information, 5. Medical Information, 4. Zerbaxa References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 September. 2. Global Medical Information, 105 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftriaxone Sodium 1 4 4 1 1 1 1 7 1 1 1 6 Body Temp Refer. n/a n/a continued on next page j n/a n/a n/a 14 a n/an/a n/a n/a n/a n/a n/a n/a 13 13 30 d Storage Conditions a i i 14 d TemperatureTemp Post-thaw a 1 d1 d 6 d 6 d n/a n/a n/a n/a n/a n/a n/a n/a 1 d 6 d 1 d 6 d n/an/a n/a10 d n/a 26 w14 d n/a 14 w n/an/a 14 d n/a 44 d 2 d n/a n/a n/a2 d n/a n/an/a n/a n/a 26 w 10 d3 d n/a n/a n/a 14 d n/a n/a 1, 11 72 h 30 d n/a n/a n/a n/a n/a n/a 10 d n/a48 h n/a n/a n/a72 h 26 w n/a 48 h n/a3 d n/a n/a n/a 40 d 1, 11 10 d n/a n/a 180 d 35 d n/a 11 n/a n/a 11 n/a n/a 168 d n/a n/a n/a n/a n/a 2 d n/a n/a n/a 72 h n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig f f f f f f f f f f f f f f f f f f f f Osmolality (mOsm/kg) pH n/a n/a n/a D5W, NS NS D5W, W m Drug unspec. 50 mg/mL NS n/a unspec. 10 mg/mL D5W, NS n/a unspec. 50 mg/mL NS n/a unspec. 10 mg/mL D5W, NS n/a RCRCunspec. 10–40 mg/mLRC 20 mg/mLRC 1 mg/mLRCRC 2 mg/mLRC 10–40 mg/mL RC D5W, NS 10, 20, 40 mg/mL 10, 20, 40 mg/mLRC D5W n/a 40 mg/mL NSRC 40 mg/mLRC D5½S, D5S 8.33, 16.67, 33.33 mg/mL D5WRC n/a D5W, NS, W n/a n/a 10, 40 mg/mL n/a NS 100 mg/mL n/a 250, 450 mg/mL D5W NSRC 303, 335, 392 n/a NS, D5W n/a n/a 5–40 mg/mLunspec. 20 mg/mL D5W, NS n/a NS n/a Manufacturer Concentration Diluents

ST/LT ST/LT ® ®

/ TM ® Braun) Braun)

CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser (B. (B. Homepump Ceftriaxone Sodium Polyolefin Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene AccuFlo (Leventon) Easypump Homepump Eclipse C-Series (Halyard) 106 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftriaxone Sodium (cont’d) 1 1 1 1 1 1 1 1 5 5 5 5 2 n/a Body Temp Refer. e n/a n/a 21 d continued on next page e n/a n/a 48 h n/a n/a n/a n/a n/a n/a n/ae n/a n/a 1, 10 Storage Conditions i i h 7 d TemperatureTemp Post-thaw h 24 h24 h 10 d 3 d n/a n/a n/a n/a n/a n/a n/a n/a 1, 11 1, 11 1 d 14 dn/a n/a7 d 20 d48 h n/a n/a48 h n/a 72 h72 h n/a 96 h n/a n/a n/a7 d 96 h n/a7 d n/a n/a n/a n/a 12 w n/a24 h n/a 5 w 12 n/a 12 w2 d n/a n/a 12 w n/a n/a n/a n/a 12 w n/a 10 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 11 24 h24 h 28 d n/a 21 d n/a n/a 10 d 30 d n/a 24 h n/a n/a n/a n/a n/a 24 h Room Refrig Frozen Room Refrig f f f f f f f f f f f f f f f f f f Osmolality (mOsm/kg) pH n/a n/a n/a 290 iso 6–8 n/a n/a c,d c,d D5W, NS, W, W, NS, D5W, BWFI W D

1 28 d old) if they require or are expected to require treatment with calcium-containing IV solutions, 28 d old) if they require or are expected to treatment with ≤ l g Do not administer to neonates ( Drug RC 250, 350 mg/mL unspec. 40 mg/mL NS n/a unspec.RCRC 5, 40 mg/mLRCRC 10 mg/mLRC 10 mg/mLRC 10 mg/mLRC 10 mg/mLRC D5W, NS 10 mg/mLRC 50 mg/mL n/a 50 mg/mL NS 100 mg/mL NS 100 mg/mL D5½S D5W n/a D5W n/a n/a NS D5W n/a D5W, NS, W n/a BWFI n/a 364 351 RCRCRCRC 5 mg/mL 5–40 mg/mL 5–40 mg/mL 30 mg/mL D5W, NS D5W, NS D5W, NS n/a n/a n/a BRNBA 20, 40 mg/mL 20, 40 mg/mL Heparin lock flush and normal saline. Manufacturer Concentration Diluents Braun)

(Epic (Epic ® Flexible k ® COMMERCIAL PREPARATIONS (RTU) Special Considerations: including parenteral nutrition, because of the risk of rapid precipitation of ceftriaxone-calcium. Fatalities in neonates have been reported. For all other patients, including parenteral nutrition, because of the risk rapid precipitation ceftriaxone-calcium. Fatalities in neonates have been via Y-site); flush infusion do not administer simultaneously with calcium-containing IV solutions (including continuous parenteral nutrition Medical) Unspecified Ceftriaxone Sodium (cont’d) INTERMATE (Baxter) SMARTeZ Duplex Dual-Chambered (B. Container Plastic Galaxy Container (Baxter) Flush Compatibility: 107 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ceftriaxone Sodium (cont’d)

10 Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015.

2 . Bethlehem, PA: B. Braun USA; April 2015.

and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. 1,11 TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

ST/LT Elastomeric Infusion System. . HealthTek 1,2,9,11 Drug Delivery System [package insert]. Bethlehem, PA: B. Braun Medical Inc.; July 2015. ® ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008.

11 Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes dual-chamber system is Hydrous Dextrose Injection at a concentration that renders the reconstituted solution iso-osmotic. ® Important Clarification of Prescribing Information, Dear Healthcare Professional Letter. Nutley, NJ: Roche Laboratories, Inc.; May 2009. [prescribing information]. South San Francisco, CA: Genentech; June 2015. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® ® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo Protect from light after removal of foil strip. If light-protecting foil strip is removed, product must be activated within 7 d. Do not freeze. Protect from light after removal of foil strip. If light-protecting strip is removed, product must be activated within 7 d. Do temperature or under refrigeration. Do not force thaw. re-freeze. In lidocaine 1% (DW). Lidocaine not tested. Lidocaine HCl 1% (without epinephrine) was also studied as a diluent. Lidocaine HCl 1% (without epinephrine) was also studied as a Prior to activation, expiration date is per manufacturer's label. To avoid inadvertent activation, DUPLEX container should remain folded until intended activation time. Prior to activation, expiration date is per manufacturer's label. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Thaw at room Frozen expiration date per manufacturer's label. Do not extrapolate Manufacturer extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Bacteriostatic water for injection contained benzyl alcohol 0.9% as a preservative. Diluent in the Duplex pH of 1% reconstituted solution is 6.7. Study showed 10% drug loss in 44–56 d depending on the power level used for thawing. After activation. May be followed by 24 h at room temperature. 13. 13. Ceftriaxone Sodium (cont’d) Note: 14. 14. 10. 10. Ceftriaxone for Injection and Dextrose in DUPLEX 9. Rocephin 12. 12. 11. 11. Rocephin 5. 6. 7. Rapp RP, Hatton J, Record K. i j k l m References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. Ceftriaxone Injection, USP in Dextrose Galaxy Container [package insert]. Deerfield, IL: Baxter Healthcare Corporation; June 2014. 4. h g f e Notes a c d line between infusions of ceftriaxone and any calcium-containing infusion. Do not use diluents containing calcium (such as Ringer's or Hartmann's solution) to line between infusions of ceftriaxone and any calcium-containing infusion. Do not use diluents containing calcium (such as Ringer's reconstitute or further dilute ceftriaxone for administration. 108 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefuroxime Sodium 1 1 5 5 1 1 1 8 8 7 1 6 6 c Body Temp Refer. continued on next page n/a n/a n/a 10 n/a n/a n/a b b n/a n/a n/a n/a 30 d n/a n/a n/a n/an/a 10 n/a n/a n/a Storage Conditions b a b b 7 d 7 d TemperatureTemp Post-thaw b b n/a n/a 30 d n/a 4 d n/a 15 hn/a 7 d 14 d n/a n/a n/a n/a n/a 31 d24 h 98 dn/a 24 h n/a24 h n/a n/a 18–21 d24 h n/a 7 d n/a 6 m 7 d 6 m 24 h n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a 7 dn/a n/a n/a15 h 10 d 24 h n/a 14 d n/an/a n/a 8 h 24 h 11 d n/an/a n/a n/a n/a n/a n/a 30 d n/a 10 n/a Room Refrig Frozen Room Refrig e 4.5–7.3 24 h 30 de 30 de n/a n/a n/a 1, 11 4.5–7.3 24 h 30 d 30 d n/a n/a n/a 1, 11

j (mOsm/kg) pH Osmolality j e jj e e jj jj e e e jjjj e j j e e j e j e e e W W Drug GL 15–30 mg/mL D5W GL 30, 60 mg/mL GL 15–30 mg/mL D5W unspec.GL 15 mg/mLunspec.COV 6 mg/mL 5, 10 mg/mLGLGL 7.5, 15, 30 mg/mL D5W GL 12.5, 25, 50 mg/mL NS, D5W NS, D5W 12.5, 25, 50 mg/mL D5W, NS NS 50 mg/mLGL D5WGL 22.5, 45 mg/mL GL 320, 379, n/a 305, 355, n/a NSunspec. 5–30 mg/mLGL 60 mg/mL 15–30 mg/mLGLunspec. 335 5, 10 mg/mLunspec. NS, D5W 15 mg/mL D5W 1–30 mg/mL NS 5, 10 mg/mL 6.9–7.3 D5W, NS 2 d NS, D5W D5W 21 d D5W, NS n/a n/a n/a n/a Manufacturer Concentration Diluents h

® / Cassette Cassette ® ® CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser Homepump Cefuroxime Sodium Polyolefin Bags Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene CADD (Pharmacia) (Leventon) Glass Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) 109 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefuroxime Sodium (cont’d) 2 2 2 5 2 n/a Body Temp Refer. d 28 d continued on next page d 24 h n/a n/a n/a n/a n/a n/a n/a n/a 1, 9 d Storage Conditions k g 7 d 7 d TemperatureTemp Post-thaw k g 24 h 7 d24 h n/a 7 d n/a n/a n/a n/a n/a n/a n/a n/a 10 d 30 d 24 h n/a n/a Room Refrig Frozen Room Refrig e

j (mOsm/kg) pH Osmolality jj e e j e 300 5–7.5 n/a n/a 290 n/a 24 h f NS, D5W, D5S, D5S, D5W, NS, D5½S, D5¼S D i

1,2 n/a Drug dual-chamber system is Hydrous Dextrose Injection at a concentration that renders the reconstituted solution iso-osmotic. ® Heparin lock flush and normal saline. COVCOV 1–30 mg/mL 7.5, 15 mg/mL NS, D5W BRN 15, 30 mg/mL LICOV 5–30 mg/mL 7.5, 15, 30 mg/mL D5W, NS D5W, NS, ½S n/a n/aGSK 24 h 30 mg/mL Manufacturer Concentration Diluents

TM Flexible h ® Braun) Protect from light after removal of foil strip. If light-protecting foil strip is removed, product must be activated within 7 d, but not beyond the labeled expiration date. Protect from light after removal of foil strip. If light-protecting strip is removed, product must be activated within 7 d, but solutions.

COMMERCIAL PREPARATIONS (RTU) Frozen expiration date per manufacturer's label stored at or below –20°C. Do not extrapolate commercial premix stability data to extemporaneously compounded Frozen expiration date per manufacturer's label stored at or below Manufacturer(s) extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of reconstituted solution is 6–8.5. May be followed by 15 h at room temperature. Eleven to twelve percent loss by HPLC in 16 h at 30°C; 4–6% 8 30°C. Prior to activation, expiration date is per manufacturer's label. To avoid inadvertent activation, DUPLEX container should remain folded until intended activation time. Prior to activation, expiration date is per manufacturer's label. Diluent in the Duplex Cefuroxime Sodium (cont’d) g h f Special Considerations: Notes a b c d e Unspecified INTERMATE INTERMATE (Baxter) TwistVial Compatible Container Duplex Dual-Chambered Container (B. Plastic Galaxy Container (Baxter) Flush Compatibility: 110 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cefuroxime Sodium (cont’d) Int J Pharm 1986; 11:47–54. 2 J Clin Hosp Pharm.

. Irvine, CA: Halyard Health; March 2015. 2 and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Drug Delivery System [package insert]. Bethlehem, PA: B. Braun Medical Inc.; May 2015. ® . Barcelona, Spain: Leventon SAU; October 2015. . HealthTek

1 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10) ® Drug Stability in Plastic Syringes compatible vial-bag connector diluent container. TM 2003:7(4); 310–2. (cefuroxime for injection, cefuroxime injection) [package insert]. Cary NC: Covis Pharmaceuticals, Inc.; September 2014. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Compound. Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory mg/mL in W, osmolality is 489 mOsm/kg. After activation of TwistVial Osmolality of 30, 50, and 76 mg/mL in Dextrose 5% is 315, 329, and 568 mOsm/kg; solutions of 30, 50, and 68 mg/mL in NS is 314, 335, and 541 mOsm/kg. At 137 Osmolality of 30, 50, and 76 mg/mL in Dextrose 5% is 315, 329, 568 mOsm/kg; solutions 68 NS Commercial frozen product is an iso-osmotic solution containing 9.7 mEq of sodium in the 1.5 Gm/50 mL dosage unit. Commercial frozen product is an iso-osmotic solution containing 9. Cefuroxime for Injection USP and Dextrose in Duplex 11. 11. buffered solutions and intravenous admixtures. Gupta VD, Stewart KR. Stability of cefuroxime sodium in some aqueous 10. 10. 8. Rapp RP, Hatton J, Record K. 6. 5. 7. in 0.9% sodium chloride injection and storage polypropylene syringes for pediatric use. Gupta, VD. Chemical stability of cefuroxime sodium after reconstitution References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Zinacef Cefuroxime Sodium (cont’d) Note: j i k 111 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Chlorpromazine Hydrochloride 1 1 Body Temp Refer. n/a n/a n/a n/a n/a n/a 1, 3 n/a n/a n/a e e

1 Storage Conditions c e n/a n/a 12 m TemperatureTemp Post-thaw c c a 7 d 30 d 12 m Room Refrig Frozen Room Refrig d d d d . 1984; 37:9. Osmolality (mOsm/kg) pH Can J Hosp Pharm n/a n/a b

1,2 n/a Drug Normal saline, D5W. MBES 0.009 mg/mLSKF 6.25 mg/mL 1 mg/mL NS n/a NS n/a Manufacturer Concentration Diluents During a 7 h simulated infusion through an infusion set (cellulose propionate burette chamber and PVC tubing by Travenol), 41% of the drug was lost to sorption. No During a 7 h simulated infusion through an set (cellulose propionate burette chamber and PVC tubing by Travenol), 41% appreciable loss occurred when infused through a polyethylene administration set (Tridilset) over 8 h at room temperature. CONTAINER OTHER INFUSION CONTAINERS pH of undiluted solution is 3.4–5.4. With hydroxyzine HCl 12.5 mg/mL (Pfizer) and meperidine 25 (Winthrop). Do not freeze. About 5% sorption during 1 w of storage in Travenol NS PVC bags. However, when buffered from pH 5 to pH 7.4, 86% of the drug was lost in 1 w due to sorption. About 5% sorption during 1 w of storage in Travenol NS PVC bags. However, when buffered from pH 5 to 7.4, 86% the Protected from light. Authors attributed variable assay results to variability of assay method and concluded the solution did not undergo significant loss of potency. Protected from light. Authors attributed variable assay results to variability of method and concluded the solution did not b c d Chlorpromazine Hydrochloride Chloride Polyvinyl (PVC) Syringes, Plastic Vials, Sterile Unspecified Flush Compatibility: e References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. NJ: West-Ward Pharmaceuticals; January 2012. Chlorpromazine Hydrochloride Injection, USP [package insert]. Eatontown, 3. vials. DeVane CL, Wailand LA. Stability of chlorpromazine in five milliliter Special Considerations: Notes a 112 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cidofovir 1 1 1 1 1 1 1 1 1 Body Temp Refer. n/a n/a n/a n/a n/a n/a a a 5 d 5 d n/a n/a n/a n/a Storage Conditions a a a 24 h n/a n/a n/a n/a 24 h n/a n/a24 h n/a n/a n/a n/a n/a n/a 24 h24 h n/a n/a n/a n/a24 h n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw c c c c c c 24 h Room Refrig Frozen Room Refrig b 7.1–7.5 7.1–7.5

2 Osmolality (mOsm/kg) pH

2 Product labeling recommends dilution in 100 mL NS prior to administration. Compatibility with R, LR, or bacteriostatic fluids has not been Product labeling recommends dilution in 100 mL NS prior to administration. Compatibility with R, Drug n/a GIL 0.21, 8.12 mg/mL D5W 241, 286 7.2–7.6 24 h GIL 0.21, 8.12 mg/mLGIL 0.21, 8.12 mg/mL D5W 241, 286 NS 7.2–7.6 24 h 275, 315 7.1–7.5 24 h GILGIL 0.21, 8.12 mg/mL 0.2, 8.1 mg/mLGIL NS 0.2, 8.1 mg/mL NS 275, 315 275, 315 NS 7.1–7.5 n/a 275, 315 5 d 7.1–7.5 n/a 5 d GIL 0.085, 3.51 mg/mLGIL D5½S 0.085, 3.51 mg/mLGIL 382, 392 6.7–7.0 D5½S 6.25 mg/mL 24 h 382, 392 6.7–7.0 24 h NS n/a 7.1–7.5 150 d 150 d Manufacturer Concentration Diluents

2 CONTAINER pH of undiluted solution is 7.4. Manufacturer does not recommend extending stability by refrigeration or freezing. At 30°C. Syringes, Syringes, c References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 January. 2. LLC; November 2012. Cidofovir Injection [package insert]. Rockford, IL: Mylan Institutional Flush Compatibility: Special Considerations: evaluated. Notes a b Cidofovir Polyolefin Chloride Polyvinyl (PVC) Polypropylene 113 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ciprofloxacin 7 4 4 3 6 1 2 8 5 Body Temp Refer. continued on next page n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions b c c b 30 d 90 d 90 d n/a n/a n/a n/a n/a 2, 9 90 d TemperatureTemp Post-thaw b c c b 10 d 30 d 30 d d 10 d 30 d n/a n/a n/a n/a 10 d 30 d n/a n/a n/a n/a 90 d 90 d14 d n/a 14 d n/a n/a n/a n/a30 d n/a n/a n/a 24 h 27 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e e e e e e e e e

1 n/a 3.5–4.6 n/a Osmolality (mOsm/kg) pH

D5W, D5½S, D5¼S, D5¼S, D5½S, D5W, D10W, LR, NS, W 1,2,9 0.5–2 mg/mL Drug Protect from light. Do not freeze. unspec. 2 mg/mL D5W n/a BAY 0.5–2 mg/mL D5W, NS n/a MI 0.5–6 mg/mL D5W, NS, W n/a unspec. 2 mg/mL D5W n/a unspec. 2 mg/mL D5W n/a MI BAY 2.86 mg/mL NS, D5Wunspec. 0.5–6 mg/mL n/a D5W, NS n/a HSP, BAY 2 mg/mL RTU unspec. 2 mg/mL n/a n/a Manufacturer Concentration Diluents Normal saline. White precipitate forms immediately with heparin. / f ®

a Braun) C-Series C-Series

ST/LT ST/LT (Epic (Epic ® ® ® (B. TM Braun)

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Special Considerations: Medical) SMARTeZ Flush Compatibility: Dosi-Fuser Homepump (B. Ciprofloxacin Chloride Polyvinyl (PVC) Unspecified AccuFlo (Leventon) Easypump Homepump Eclipse INTERMATE (Baxter) Flexible Container (Baxter) (Halyard) 114 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ciprofloxacin (cont’d) Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ®

Elastomeric Infusion System

9 2 TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Latex-free PVC bag (HSP). 2 Stability Data for Drugs Using Elastomeric Infusion Pumps. ® IV [package insert]. Wayne, NJ: Bayer Healthcare Pharmaceuticals, Inc.; July 2013. ® Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Expiration date per manufacturer's label. Do not extrapolate commercial Manufacturer extrapolated data from other sources. pH of undiluted 1% aqueous solution is 3–3.9. Latex-free bag (BAY). Stable for 14 d room temperature following 90 refrigerated. Premixed solution of 0.2% ciprofloxacin in D5W. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Ciprofloxacin (cont’d) 9. Inc.; August 2016. Ciprofloxacin Injection [package insert]. Lake Forest, IL: Hospira, 8. Notes a b c d e 4. 5. 6. f g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. CIPRO 3. 7. 115 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) CISplatin 9 12 4 4 1, 4 8 2 4 3 5 e j f b, b i, d c, Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d Storage Conditions a,c,d a a n/a n/a n/a n/a 24 h n/a n/an/a n/a n/an/a n/a n/a n/an/a 28 d n/a n/a n/a n/a n/a n/a 4, 7 n/a n/a 4, 7 n/an/a 4, 7 n/a n/a n/an/a 14 d n/a n/a n/a n/a 4, 7 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 h TemperatureTemp Post-thaw b b b b b b i j i, b 1 d 7 d 14 d4 d n/a n/a n/a n/a n/a 12 1 d 7 d 28 d 14 d 14 d 14 d 14 d 14 d n/a n/a n/a n/a n/a 10 m 9 d 14 d n/a n/a n/a n/a n/a 28 d n/a Room Refrig Frozen Room Refrig g g g g g g g g g g g g g g h g h g Osmolality (mOsm/kg) pH W undiluted NS n/a c f Drug unspec. 0.2 mg/mL NS n/a unspec. 1 mg/mL NS n/a unspec. 1.25 mg/mL NS n/a unspec. 0.2 mg/mL NS n/a BELWAS 0.5, 0.9 mg/mLWAS 0.167 mg/mL NSWAS 0.167 mg/mLBMS NS n/a 0.167 mg/mL NS 0.455 mg/mL n/a NS n/a DB n/a 1 mg/mL WASunspec. 0.167 mg/mL 1 mg/mL NS n/a BELunspec. 0.6 mg/mL 1 mg/mL NS NS n/a n/a unspec. 0.5 mg/mL NS n/a Manufacturer Concentration Diluents

® / ® Braun) C-Series

® (Leventon) (Leventon) ST/LT ST/LT ® ® (B. TM Braun)

CONTAINER OTHER INFUSION CONTAINERS (B. Easypump Dosi-Fuser Homepump CISplatin Acetate Vinyl Ethylene (EVA) (Palex Bag Polyethylene Labs) (Ern Bag Polypropylene Labs) Chloride Polyvinyl (PVC) AccuFlo Reservoir Cassette (Pharmacia Deltec) Glass Bottles Homepump Eclipse (Halyard) 116 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) CISplatin (cont’d) 6 j b, Body Temp Refer. 1993; 15:34–6.

11 1995; 52:2570–3. Pharm World Sci. n/a n/a n/a n/a 10 Am J Health-Syst Pharm. 1992; 17:315–8. Storage Conditions 1987; 22:685–7. i a, 7 d n/a n/a n/a n/a 24 h TemperatureTemp Post-thaw j Hosp Pharm. i b, J Clin Pharm Ther. 1 d 4 d Room Refrig Frozen Room Refrig g g g Bethlehem, PA: B. Braun USA; September 2015. Manufacturer states that cisplatin remaining in amber vial following initial entry is 4 Irvine, CA: Halyard Health; March 2015. Osmolality (mOsm/kg) pH Bethlehem, PA: B. Braun USA; April 2015. Store at room temperature and protect unopened container from light. 4,11 Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

4 ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System. TM Ontario, Canada: Baxter Corporation; October 2008.

4 Elastomeric Pump (ES.H.00.730-10). ® Drug unspec. 0.2 mg/mL NS n/a BEL 1.25 mg/mL NS n/a Protect from light if solution will not be used within 6 h. Manufacturer Concentration Diluents

Heparin lock flush and normal saline. 4 k Stability Data for Drugs Using Elastomeric Infusion Pumps. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® (Epic (Epic ® Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using B. Braun’s AccuFlo Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Drug Stability Table-Dosi-Fuser Solution was initially refrigerated for 24 h prior to storage at 30°C for 7 d. Solutions were protected from light. Solution was initially refrigerated for 24 h prior to storage at 30°C Solution protected from light. Undiluted product is 285 mOsm/kg. Stored at 35°C. Manufacturer recommends not refrigerating because of danger precipitation. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices With ondansetron (GL) 1.091 mg/mL. pH range is 3.5–4.5. With sodium chloride 9 mg/mL and mannitol 10 mg/mL, stored at 40°C in vials. With sodium chloride 9 mg/mL and mannitol 10 mg/mL, stored Stored 4 d at 25°C, followed by 24 h 33°C. Manufacturer extrapolated data from other sources. Special Considerations: Medical) SMARTeZ Flush Compatibility: i j k References 1. vinylacetate portable infusion pump reservoirs. Rochard E, Barthes D, Courtois P. Stability of cisplatin in ethylene stable for 28 d protected from light or 7 under fluorescent room light. h Notes a b c d e f g 3. for a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines 2. ondansetron hydrochloride in admixtures for continuous infusion. Henry DW, Marshall JL, Nazzaro D, et al. Stability of cisplatin and INFUSOR (Baxter) 4. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 5. 6. 7. chloride 0.9% intravenous solution related to the container's material. Cubells MP, Aixela JP, Brumos VG, et al. Stability of cisplatin in sodium 8. 9. CISplatin (cont’d) 10. 10. 11. 11. LLC; February 2015. CISplatin Injection [package insert]. Paramus, NJ; WG Critical Care 12. 117 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cladribine 1 Body Temp Refer. 1997; 3:154–6. n/a n/an/a n/a n/a n/a n/a 1, 2 n/a 1, 2

1,3 Storage Conditions a a 30 d 30 d n/a n/a n/a n/a n/a 1, 3 Eur Hosp Pharm. TemperatureTemp Post-thaw a a 30 d 30 d n/a 14 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig b D5W is not recommended as a diluent because of increased 1 cc b b c b Osmolality (mOsm/kg) pH e c b f NS

2 d

Store intact cladribine vials under refrigeration and protected from light. Drug 1,3 Heparin lock flush and normal saline. JCJC 0.016 mg/mL 0.016 mg/mLOB NS unspec. NS unspec. 0.024 mg/mL NS Manufacturer Concentration Diluents (cladribine) Injection [package insert]. Raritan, NJ: Ortho Biotech; August 2007. ® through 0.22-micron filters, then aspirate all air bubbles from the reservoir through a dry sterile filter or sterile vent filter assembly. Solutions prepared for patients through 0.22-micron filters, then aspirate all air bubbles from the reservoir a dry sterile filter or vent assembly. weighing more than 85 kg may have reduced preservative effectiveness due to dilution of the benzyl alcohol preservative. CONTAINER OTHER INFUSION CONTAINERS Concentrations vary; calculated dose is diluted to a total volume of 100 mL. Concentrations vary; calculated dose is diluted to a total volume pH of undiluted solution is 5.5–8. Use only bacteriostatic NS (containing 0.9% benzyl alcohol preservative) when preparing a 7 d continuous infusion. Add both drug and diluent to the infusion reservoir Use only bacteriostatic NS (containing 0.9% benzyl alcohol preservative) Solutions stored exposed to light and protected from light. Undiluted solution is isotonic. Chemical and physical stability for 7 d infusions were demonstrated in this device. Chemical and physical stability for 7 d infusions were demonstrated Special Considerations: Cladribine Polyethylene-Lined Infusion Bag Chloride Polyvinyl (PVC) Reservoir Cassette (SIMS Deltec) cladribine degradation. Notes a Glass Flush Compatibility: 3. LEUSTATIN b d e f References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 November. 2. either polyethylene containers or polyvinyl chloride bags. Daouphars M, Vigneron J, Perrin A, et al. Stability of cladribine in c 118 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Clindamycin Phosphate 1 1 1 1 1 1 1 1 7 3 1 1 1 1 5 6 1 5 5 Body Temp Refer. continued on next page n/an/a n/a n/a n/a n/a 10 10 n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a a a a b b b b 30 d 30 d 8 w 60 d 8 w Storage Conditions a b b b b n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 10 d 10 d n/a 60 d 32 d 30 d n/a 60 d 32 d TemperatureTemp Post-thaw e a a b b a, a a b b n/a n/a 79 d n/a n/a n/a 48 h 48 h 24 h24 h 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a16 d n/a 32 d 30 d 8 w 24 h n/a n/a n/a n/a n/a 1, 9 22 dn/a 54 d 68 d n/a n/a 28 d n/a n/a n/a n/a n/a 3 d 10 d n/a n/a n/a n/a 24 h 24 h 3 d 10 d n/a n/a n/a n/a 16 d91 d 32 d30 d 91 d 8 wn/a n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a 14 d n/a 16 d 30 d 48 h 16 d 24 h 10 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig d d d d d d d g d g d

g g d g d (mOsm/kg) pH Osmolality g d g d gg d d g d g d g d g d gn/a n/a g d d n/a g d g d W W W Drug UP 150 mg/mL undiluted n/a unspec.UP 150 mg/mLunspec.unspec. 0.6 mg/mL 0.25 mg/mL 6 mg/mL undiluted n/a D5W, NS, LR D5S, NS D5W n/a 268 unspec. 6, 9, 12 mg/mL D5W 268, n/a, 293 UP 6, 9, 12 mg/mL D5W, LR, NS QUUP 6, 12 mg/mL 18 mg/mL D5W, NS D5W, NS unspec. 6–12 mg/mL NS UP 12 mg/mL D5W UP 2–12 mg/mL NS unspec. 6–12 mg/mL NS UPABunspec. 6 ,9, 12 mg/mLUP 20, 40, 60, 120 mg/mL 15 mg/mL UP D5W, LR, NS 7.6 mg/mL 6 mg/mL D5W D5W 268 unspec. 6, 9, 12 mg/mL NS 294, n/a, 309 UP 20, 40, 60, 120 mg/mL UP 5, 10 mg/mL D5W, NS unspec. 10 mg/mL NS Manufacturer Concentration Diluents a / Braun) ®

a Braun) C-Series C-Series

® (Leventon) ® ST/LT (B. (B. ® TM a CONTAINER OTHER INFUSION CONTAINERS Unspecified Homepump (Halyard) Easypump Dosi-Fuser Clindamycin Phosphate Glass Container Polyolefin (McGaw) Polyvinyl Chloride (PVC) Syringes, Plastic Syringes, Polypropylene AccuFlo Homepump Eclipse 119 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Clindamycin Phosphate (cont’d) 8 4 4 4 4 Body Temp Refer. 1982 Jan; 39(1):104–8. 39(1):104–8. Jan; 1982 When refrigerated or frozen, 1 5 mg/mL is 302 mOsm/kg in NS and 1 Am J Hosp Pharm. n/a n/a n/a n/a Storage Conditions b n/a n/a n/a n/a n/a 1, 2 10 d TemperatureTemp Post-thaw b 3 d 24 h n/a n/a n/a n/a n/a n/a24 h 10 dn/a 10 d 30 d 30 d 10 d 24 h 24 h n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig d d c d

1 Bethlehem, PA: B. Braun USA; September 2015. g d (mOsm/kg) pH Osmolality g d ggn/a d d Irvine, CA: Halyard Health; March 2015. Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998.

TM 6 W Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

HealthTek 1 ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System. TM Ontario, Canada: Baxter Corporation; 2008.

1 Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes. Drug PF 6, 12, 18 mg/mL D5W 296, 322, 339 unspec. 6–12 mg/mL NS UP 2–12 mg/mL D5W UPUPUP 2–12 mg/mL 6 mg/mL 12 mg/mL NS D5W 279

Manufacturer Concentration Diluents 6 Clindamycin phosphate infusions should not exceed 18 mg/mL; do administer undiluted as IV bolus. Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® (clindamycin phosphate injection, solutions) [package insert]. New York, NY: Pfizer Inc.; February 2017. (Baxter) f ® (Epic Medical) ® Stability Data for Drugs Using B. Braun's AccuFlo Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory Holmes CJ, Ausman RK, Kundsin RB, et al. Effect of freezing and microwave thawing on the stability six antibiotic admixtures in plastic bags. Drug Stability Table-Dosi-Fuser

279 mOsm/kg in D5W. vials or disposable syringes, storage at room temperature should be limited to a few days. COMMERCIAL PREPARATIONS (RTU) 9. pH range is 5.5–7, typically 6–6.3. Manufacturer(s) extrapolated data from other sources. Under fluorescent light Clindamycin phosphate is incompatible with natural rubber closures because of the risk of crystalline particulate extraction. If clindamycin phosphate is repackaged in Clindamycin phosphate is incompatible with natural rubber closures because of the risk crystalline particulate extraction. If Expiration date per manufacturer label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Expiration date per manufacturer label. Do not extrapolate commercial premix stability data to extemporaneously compounded Osmolality of 12 mg/mL is 293 mOsm/kg in D5W and 309 NS; undiluted 150 product 825–880 mOsm/kg. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices

References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Cleocin 3. 7. b c d 8. e f g 4. 5. 6. Rapp RP, Hatton J, Record K. Notes a Special Considerations: Clindamycin Phosphate (cont’d) INTERMATE Galaxy Bag (Baxter) Flush Compatibility: solutions form crystals that must be redissolved before administration. 10. 10. SMARTeZ 120 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Clonidine Hydrochloride 2 1 1, 4 1 1, 4 1, 3 1 1 1 1 1 1 1 1 6 8 8 q q v r t q q t l, c,d, h, q, s, n, m, q, w q q Body Temp Refer. 10 w continued on next page n/a n/a n/a 3 m n/a n/a n/a 30 d n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions g w h c, r 24 m 30 d n/a n/a n/a n/a n/a 28 d n/a n/a n/a n/a n/a 1, 5 n/a n/a n/a n/a n/a 1, 5 TemperatureTemp Post-thaw k g k w h b c, i,j, i, Room Refrig Frozen Room Refrig 30 d 7 d n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d 21 d 24 d 7 d n/a30 d n/a 30 d n/a n/a n/a n/a n/a n/a 30 d 7 d n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a 35 d n/a n/a n/a n/a n/a 90 d n/a n/a n/a n/a n/a 14 w n/a n/a n/a n/a n/a 40 d n/a n/a n/a n/a n/a 7 d n/a 40 d 30 d r r p p p p p p p p p p p p p p 3.46 p 3.46 p r r n/a n/a n/a n/a n/a n/a n/a 28 d n/a Osmolality (mOsm/kg) pH NS n/a NS 285 6.5 24 m NS n/a NSNS n/a n/a NS n/a unspec. n/a W NS n/a NS 1030 NS 1030 NS n/a w l n r r i d j h i, b g v u m 0.15, 0.5, and 1.5 mg/mL Drug SH 0.2 mg/mL BI 9 mcg/mL ROXASH 100 mcg/mL undiluted n/a BI 15 mcg/mL unspec. 100 mcg/mL undiluted n/a BIBIBI 5 mcg/mL ROXBI 3 mcg/mL 9 mcg/mL BI 100 mcg/mL 15 mcg/mL 9 mcg/mL undiluted n/a NS n/a ROXBI 100 mcg/mL 0.15 mg/mL undiluted n/a BI 50 mcg/mL BB 2 mg/mL unspec. 2 mg/mL NVS 0.25, 0.5, 1 mg/mL unspec. 100 mcg/mL undiluted n/a Manufacturer Concentration Diluents

(SIMS (SIMS ® ®

® (Abbott) ® CONTAINER OTHER INFUSION CONTAINERS Glass Glass Vials Clonidine Hydrochloride II (Mark Polypropylene Polybag) Polyvinyl Chloride (PVC) Syringes, Plastic (BD) Syringes, Polypropylene Epi-Cath PORT-A-CATH Pump Reservoir (Bard) Synchromed Pump Implantable (Medtronic) Synchromed II Implantable Pump (Medtronic) Deltec) 121 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Clonidine Hydrochloride (cont’d) 1 1 x y q, q, Body Temp Refer. 1997; 1:274–7. continued on next page Int J Pharm Compound. Storage Conditions TemperatureTemp Post-thaw Room Refrig Frozen Room Refrig p Osmolality (mOsm/kg) pH unspec.unspec. n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 3 m 3 m

1 y x

1,7 Drug BI 50 mcg/mL BF 1.84 mg/mL Manufacturer Concentration Diluents Do not use products or diluents containing preservatives for intraspinal administration. Heparin lock flush and normal saline.

® after 35 d, with no loss of morphine, ropivacaine, or clonidine. Combined with bupivacaine 25 mg/mL and morphine sulfate 50 mg/mL. Terminally sterilized compound. pH of the undiluted solution is 5–7. Solutions contained clonidine alone, or combined with baclofen 1 mg/mL. Both solutions exhibited same stability. Solutions contained clonidine alone, or combined with baclofen Tested at 37°C. With meperidine hydrochloride 8 mg/mL. Combined with fentanyl citrate 35 mcg/mL and bupivacaine hydrochloride 1 mg/mL. Combined with fentanyl citrate 35 mcg/mL and bupivacaine hydrochloride Combined with hydromorphone 25 mcg/mL. Clonidine powder dissolved in ziconotide acetate for injection. Clonidine powder dissolved in ziconotide acetate for injection. Tested at 30°C. Protected from light. Solution also contained bupivacaine 1 mg/mL and fentanyl 35 mcg/mL. Solution also contained bupivacaine 1 mg/mL and fentanyl 35 With ziconotide 25 mcg/mL. With morphine sulfate 2 mg/mL. With morphine sulfate 20 mg/mL (Infumorph). In Terumo syringes. Solutions in Omnifix syringes demonstrated a pH shift outside the acceptable range. In Terumo syringes. Solutions in Omnifix syringes demonstrated Combined with ziconotide 0.1, 0.25, 0.5, or 0.75 mcg/mL, morphine 7.5 mg/mL, and ropivicaine 7.5 mg/mL. There was a 53.4% residual concentration of ziconotide Combined with ziconotide 0.1, 0.25, 0.5, or 0.75 mcg/mL, morphine 7.5 mg/mL, and ropivicaine mg/mL. There was a 53.4% Stored at 35°C. Also contains ropivacaine 2 mg/mL undiluted. Combined with baclofen 0.25, 0.5, and 1 mg/mL, respectively. Also contains ropivacaine 1 mg/mL prepared with NS. Synchromed EL Pump Implantable (Medtronic) Special Considerations: Notes b c d g h i j k l m n p Clonidine Hydrochloride (cont’d) Flush Compatibility: q r s t u v w x y References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Trissel LA, Xu QA, Hassenbusch SJ. Development of clonidine hydrochloride injections for epidural and intrathecal administration. 122 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Clonidine Hydrochloride (cont’d) . 2014; J Pain Symptom Neuromodulation 2002; 27:39–45. 2001; 36:950–4. Hosp Pharm. J Clin Pharm Ther. 2002; 6:471–4. Int J Pharm Compound. (clonidine hydrochloride) Injection [package insert]. Lake Forest, IL: Bioniche Pharma USA; May 2010. ® . 2004; 28:268–72. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Manage polypropylene syringes. 17:472–82. Dupoiron D, Richard H, Chabert-Desnot V, et al. In vitro stability of low-concentration ziconotide alone or in admixtures intrathecal pumps.

8. 6. testing to support clinical feasibility investigations for intrathecal baclofen-clonidine admixture. Alvarez JC, Mazancourt P, Chartier-Kastlier E, et al. Drug stability 7. Duraclon 3. hydrochloride admixture for intrathecal administration. Godwin DA, Kim NH, Zuniga R. Stability of a baclofen and clonidine 4. bupivacaine, or clonidine solution a ternary mixture in 0.9% sodium chloride two types of Jappinen A, Kokki H, Naaranlahti T. pH stability of injectable fentanyl, 5. with morphine, sufentanil, fentanyl or clonidine. Svedberg KO, McKenzie EJ, Larrivee-Elkins C. Compatibility of ropivacaine Clonidine Hydrochloride (cont’d) Note: 123 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor VIIa Recombinant 3 4 Clin Body Temp Refer. 1998; 9(suppl 1):S103–5. 1996; 75:432–6. Storage Conditions n/a n/a n/a n/a n/a 1, 5 n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 5 n/a 1, 5 n/a n/a n/a 24 h 2, 5 Blood Coagul Fibrinolysis

3 Thromb Haemost. TemperatureTemp Post-thaw h h h h

1 3 h 3 h n/a n/a n/a n/a 3 d 3 d 3 d 3 d 6 h 24 h n/a n/a n/a n/a Room Refrig Frozen Room Refrig d

3 d d d d d d 2002; 36:882–91. 3 n/a n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH Ann Pharmacotherapy g W W W W g e e e f a, a, a, a, 1 mg/mL RT package is 10 mmol solution of L-histidine in W. c c c c c c a ® Drug NNO NNO NNO NNO NNO NNO Manufacturer Concentration Diluents Prior to reconstitution, store product and included histidine diluent between 2–25°C. Do not freeze. If refrigerated, bring product and Prior to reconstitution, store product and included histidine diluent between 2–25°C. Do not freeze. 2 n/a RT (Coagulation Factor VIIa Recombinant) [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc.; October 2015. 2008; 30(7):1309–15. ® Coagulation Factor VIIa recombinant. ® Plus Cassette ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 5–10 units/mL caused a 50% decrease in FVII activity 4 h, whereas the LMWH did not affect activity. 30 min, respectively. Therapeutics CONTAINER OTHER INFUSION CONTAINERS When reconstituted as recommended, the resulting solution is clear and colorless, with a pH of approximately 6.0. When reconstituted as recommended, the resulting solution is Protected from light. Evaluated alone, with a low molecular weight heparin (LMWH), concentrations unspecified, and with heparin 5–10 units/mL in W. Note that addition of heparin concentrations unspecified, and with heparin 5–10 units/mL in W. Note that addition of Evaluated alone, with a low molecular weight heparin (LMWH), Concentration is at manufacturer’s recommended dilution upon reconstitution. NovoSeven Diluent supplied in NovoSeven Evaluated alone and with enoxaparin (LMWH), heparin, or NS. Addition of heparin at pH 7, LMWH, and NS did not affect rFVIIa activity for periods 2 hr, 72 Evaluated alone and with enoxaparin (LMWH), heparin, or NS. Coagulation Factor VIIa Recombinant Polyvinyl Chloride (PVC) Syringes, Plastic CADD WalkMed Reservoir Bag Glass Vial Flush Compatibility: Special Considerations: diluent to room temperature before preparation. Do not store reconstituted product in syringes. d Notes a c e Note: h References 1. Schulman S, Bech Jensen M, Varon D, et al. Feasibility of using recombinant factor VIIa in continuous infusion [Abstract]. 2. Bonde C, Jensen MB. Continuous infusion of recombinant activated factor VII: stability in pump systems [Abstract]. f g 5. Stanchnik JM, Gabay MP. Continuous infusion of coagulation factor products. 4. and reconstituted recombinant activated factor VII formulated for storage at room temperature. Negergaard H, Vestergaard S, Jensen PT, et al. In vitro stability of lyophilized 3. Novo Seven 124 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor VIII 2 2 2 1 2 1 7 8 7 3 9 8 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions w w o, w o, w 7d 7d n/a n/a n/a n/a n/a 5, 6 n/a n/a n/a n/a n/a 5, 6 7 d n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 7, 8 n/a n/a n/a n/a n/a 7, 8 TemperatureTemp Post-thaw u u u x x u u u w w n, n, n, o, w m, x m, o, w x 24 h 48 h 48 h Room Refrig Frozen Room Refrig n/a n/a 7 d n/a n/a 7 d n/a n/a 4 d n/a n/a 4 d n/a n/a 4 d n/a n/a 7 d n/a n/a n/a n/a 15 d n/a n/a n/a n/a n/a n/an/a n/a n/a 7 d 4 d n/a n/a 24 h n/a n/a n/a n/a 48 h n/a n/a n/a n/a 48 h Osmolality (mOsm/kg) pH o m o n n m n Diluents W W W W W W W W W W W W W W W a ~100 units/mL ~100 units/mL various various ~100 units/mL various various various ~100 units/mL various 50, 80, 120 units/mLvarious various W, NS, LR n/a n/a 72 h n/a n/a n/a n/a n/a various various various d d d d d e Drug g g c h c h h h h h BAY BAY BA BA BAY BA BA CSL BAY BA BAY BA BA BA BA BA Manufacturer Concentration

Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS Syringes, Syringes, Unspecified Coagulation Factor VIII Polyethylene Chloride Polyvinyl (PVC) (Deltec) Syringes, Plastic Polypropylene CADD 125 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor VIII (cont’d) 1, 5 20, 21 20, 21 4 5 1 r r r <24 h <24 h Body Temp Refer. continued on next page n/a n/a n/a 2 w n/a n/a n/a n/a n/a n/a Storage Conditions r r r 4 w n/a n/a n/a n/a n/a 22 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 15 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 10 n/a n/a n/a n/a n/a 18 n/a n/a n/a n/a n/a 16 n/a n/a n/a n/a n/a 11 4 w 4 w r TemperatureTemp Post-thaw b b b b b b b b r r >24 h Room Refrig Frozen Room Refrig n/a n/a 3 h n/a n/a n/a n/a n/a 22 n/a n/a 3 h n/a n/a n/a n/a n/a 15 n/a n/a 4 w n/an/an/a n/a n/a n/a 3 h 3 h n/a 3 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 10 n/a 14 12 n/a n/a 3 h n/a n/a n/a n/a n/a 18 n/a n/a 3 h n/a n/a n/a n/a n/a 16 n/an/a n/a n/a 3 h 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 11 17 n/a n/a 3 h n/a n/a n/a n/a n/a 13 n/an/a n/a n/a 3 h n/a n/a n/a n/a n/a 19 n/a n/a 4 w Osmolality (mOsm/kg) pH r r r Diluents W W W W W W W W W W W W W W a unspec. n/a n/a n/a n/a 6 m unspec. NS n/a n/a 3 h n/a n/a n/a n/a n/a unspec. unspec. n/a n/a n/a n/a 3 m n/a n/a n/a n/a 6 m unspec. unspec. unspec. n/a n/a n/a n/a 6 m unspec. n/a n/a n/a n/a 12 m unspec. n/a n/a n/a n/a 6 m n/a n/a n/a n/a 12 m unspec. unspec. n/a n/a n/a n/a 6 m unspec. unspec. unspec. unspec. t t f s s j j d d g p q e p e i k, k, Drug c, h h h c c g g BGD WY BGD BA KED WY KED CSL CSL GRI OCT CSL CSL BAY CSL BAY BA BA BA BA BA BA BA Manufacturer Concentration Coagulation Factor VIII (cont’d) Polypropylene Glass Vial 126 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor VIII (cont’d) . 1998; J Thromb Haemost Haemophilia continued on next page

6 2000; 6:513–22. Haemophilia ). TM ) stability for continuous infusion using a minipump device. ® Do not freeze. Bring refrigerated products and diluents to room temperature before preparation. Refer to product labels/package inserts for Do not freeze. Bring refrigerated products and diluents to room temperature before preparation. Refer NS, D5W. brand. TM brand. brand. ® ® brand. brand. brand. brand. ® FS brand. (von Willebrand Factor/Coagulation Factor VIII Complex, Human) [package insert]. Hoboken, NJ: Octapharma USA, Inc.; August 2015. ® ® ® FS brand. ® ® brand. ® brand. brand. Solofuse ® brand. ® ® ® ® 4:785–9. 1994; 72:403–7. Combined with heparin 1 unit/mL. Tested at 5°C, 25°C, and 30°C. Helixate Kogenate Humate-P Unopened product stored at room temperature in manufacturer’s original vial. Do not place product back into refrigerator after room temperature storage. Unopened product stored at room temperature in manufacturer’s original vial. Do not place back into refrigerator after Combined with heparin 4 units/mL. Advate Combined with heparin 2 units/mL. Tested at 30°C. Monoclate-P Concentration is at manufacturer’s recommended dilution unless noted. Xyntha Hemofil M Recombinate Tested at 20–25°C and 30 ± 2°C. Xyntha Samples stored in the dark. Eloctate Wilate Koate DVI Alphanate 3. Schulman S, Varon D, Keller N, et al. Monoclonal purified F VIII for continuous infusion: stability, microbiological safety, and clinical experience [Abstract]. 5. Global Medical Affairs [written correspondence]. Westlake Village, CA: Baxter Bioscience; February 21, 2005. 6. factor VIII (Recombinate Parti R, Ardosa J, Yang L, et al. In vitro stability of recombinant human Coagulation Factor VIII (cont’d) Flush Compatibility: Special Considerations: complete storage, light protection, preparation, and administration requirements. studies noted variation in the loss Stability is defined as retaining >80% of baseline value indicated by one-state clotting assay. Several continuous factor VIII infusion resolved relatively quickly, and was of factor VIII activity in PVC or polyethylene tubing upon initial dilution infusion. This was primarily due to adsorption, negligible. less pronounced with higher flow rates; the overall impact on a long duration continuous factor infusion was therapeutically 4. Wilate g d e Notes a b c f h i j m n o p k q u w x References 1. Global Medical Affairs, Baxter Bioscience [written correspondence]. Westlake Village, CA: Bioscience; August 9, 2004. 2. VIII (Kogenate Hurst D, Zabor S, Malianni et al. Evaluation of recombinant factor t r s 127 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor VIII (cont’d) Blood Coagul 2003; 1(suppl 1):P1625. J Thromb Haemostatis. (Antihemophilic Factor, Recombinant) [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals, Inc.; October 2014. TM (Antihemophilic Factor, Recombinant) [package insert]. Westlake Village, CA: Baxter Healthcare Corporation; December 2010. (Antihemophilic Factor, Human) [package insert]. Kankakee, IL: CSL Behring; February 2014. ® ® (Antihemophilic Factor/von Willebrand Factor Complex, Human) [package insert]. Kankakee, IL: CSL Behring LLC; June 2014. (Antihemophilic Factor/Von Willebrand Factor Complex, Human) [package insert]. Los Angeles, CA: Grifols Biologicals, Inc.; March 2015. 2006; 17:165–71. FS (Antihemophilic Factor, Recombinant) [package insert]. Whippany, NJ: Bayer Healthcare LLC; August 2015. ® ® FS (Antihemophilic Factor, Recombinant) [package insert]. Kankakee, IL: CSL Behring LLC; August 2015. ® M (Antihemophilic Factor, Human) [package insert]. Westlake Village, CA: Baxter Healthcare Corporation; April 2012. (Antihemophilic Factor [Recombinant] Fc Fusion Protein) [package insert]. Cambridge, MA: Biogen Idec, Inc.; June 2014. ® ® (Antihemophilic Factor, Recombinant) [package insert]. Westlake Village, CA: Baxter Healthcare Corporation; May 2015. Solofuse (Antihemophilic Factor, Recombinant) [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals, Inc.; October 2014. ® ® ® ® -DVI (Antihemophilic Factor, Human) [package insert]. Fort Lee, NJ: Kedrion BioPharma, Inc.; August 2012. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Fibrinolysis 20. 20. Xyntha Note: 10. 10. Helixate 14. Humate-P 19. 19. Recombinate 22. 22. Eloctate 13. 13. Hemofil 17. 17. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 18. Monoclate-P 21. 21. Xyntha 12. 12. Alphanate 16. 16. Kogenate 11. 11. Advate 15. 15. Koate Coagulation Factor VIII (cont’d) 7. Global Medical Affairs [written correspondence]. Westlake Village, CA: Baxter Bioscience; February 9, 2005. 8. factor (recombinant) plasma/albumin-free method, during simulated continuous infusion. Fernandez M, Yu T, Bjornson E, et al. Stability of ADVATE, antihemophilic 9. factor VIII Kogenate FS stored in syringes [Abstract]. Rand M, Schmugge Clark D, et al. Stability of dilutions the recombinant 128 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor IX 9 8 6 5 5 4 3 2 3 1 1 r Body Temp Refer. continued on next page n/a n/a n/a 7 d Storage Conditions r n/a n/a n/a n/a n/a 12 n/a n/a n/a n/a n/a 11 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 28 d TemperatureTemp Post-thaw q k f f r q 3 h n/a n/a n/a n/a n/a 28 d Room Refrig Frozen Room Refrig n/a n/a 3 h n/a n/a n/a n/a n/a 12 n/a n/a 3 h n/a n/a n/a n/a n/a 11 n/a n/a 3 h n/a n/a n/a n/a n/a 10 n/a n/a 3 h n/a n/a n/a n/a n/a n/a n/a 3 h n/a n/a n/a n/a n/a n/a n/a 3 h n/a n/a n/a n/a n/a n/a n/a 3 h n/a n/a n/a n/a n/a n/a n/a 4 d 14 d n/a n/a n/a n/a n/a n/a 7 d 14 d n/a n/a n/a n/a Osmolality (mOsm/kg) pH l l l l l l m m l l l m m l W l W W W W ¼S W W W W c e e e e e e e e n/a n/a n/a n/a 12 m various n/a n/a n/a n/a 6 m various various n/a n/a n/a n/a 12 m various various n/a n/a n/a n/a 30 d various various n/a n/a n/a n/a 30 d 100 units/mL 100 units/mL various 100 units/mL o o n Stability is defined as retaining >80% of baseline value indicated by one-state clotting assay. Do not freeze. Some factor products require Stability is defined as retaining >80% of baseline value indicated by one-state clotting assay. Do not d d g b b a a a Drug p p j j d n/a BA BA BGD BGD CAN BA BA GRI CSL CSL WY GRI WY AR GRI WY Manufacturer Concentration Diluents brand. ® brand. ® brand. ® CONTAINER OTHER INFUSION CONTAINERS Mononine AlphaNine SD BeneFIX Combined with unfractionated heparin 4 units/mL. Flush Compatibility: Special Considerations: refrigeration until use; refer to product labels/package inserts for complete storage, preparation, and administration requirements. refrigeration until use; refer to product labels/package inserts for complete storage, preparation, and administration requirements. Notes a b c d Coagulation Factor IX Syringes, Plastic Plastic Syringes, (Polypropylene) Glass Vial 129 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor IX (cont’d) 2001; Haemophilia 1995; 1:103–10. Haemophilia ) by adjusted continuous infusion; a study of stability, sterility and clinical experience. ® (Coagulation Factor IX Human) [package insert]. Los Angeles, CA: Grifols Biologicals, Inc.; January 2013. ® (Coagulation Factor IX Human) [package insert]. Kankakee, IL: CSL Behring LLC; February 2013. (Factor IX Complex) [package insert]. Los Angeles, CA: Grifols Biologicals, Inc.; May 2014. ® (Coagulation Factor IX [Recombinant] Fc Fusion Protein) [package insert]. Cambridge, MA: Biogen Idec, Inc.; March 2014. ® (Coagulation Factor IX Recombinant) [package insert]. Philadelphia, PA: Wyeth; August 2015. (Factor IX Complex) [package insert]. Westlake Village, CA. Baxter Healthcare Corporation; July 2012. (Coagulation Factor IX [Recombinant]) [package insert]. Westlake Village, CA: Baxter Healthcare Corporation; September 2014. ® brand. TM ® (Coagulation Factor IX [Recombinant]) [package insert]. Baltimore, MD: Cangene bioPharma, Inc.; April 2015. ® ® ® brand. brand. brand. ® ® brand. ® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 7:140–5. temperature exposures. When reconstituted as recommended, the resulting solution is a clear, colorless, isotonic preparation of neutral pH. Rixubis Do not place product back into refrigerator after room temperature storage. Alprolix Ixinity Dilution per manufacturer's instruction. Stored at 30°C, protected from light, to simulated unrefrigerated temperature excursion during warehousing or shipping. Manufacturer recommends minimizing such Stored at 30°C, protected from light, to simulated unrefrigerated Profilnine Stored in the dark. Unopened product stored at room temperature. Bebulin Manufacturer-supplied diluent. 6. Profilnine Note: Coagulation Factor IX (cont’d) 5. Mononine 11. 11. Alprolix 12. 12. Rixibus 9. Global Medical Affairs, Baxter Bioscience [written correspondence]. Westlake Village, CA: Bioscience; April 14, 2008. 10. Ixinity 4. BeneFIX 8. Bebulin 3. Alphanine SD 2. containing factor IX for continuous infusion. Schulman S, Gitel Zivelin A, et al. The feasibility of using concentrates j e f g k l m n q r References 1. Chowdary P, Dasani H, Jones JAH, et al. Recombinant factor IX (Benefix o p 130 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor X 1 Body Temp Refer. Storage Conditions TemperatureTemp Post-thaw Room Refrig Frozen Room Refrig n/a n/a 1 h n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH b W 100 IU/mL Store at 2–8°C or less than 30°C. Protect from light. Do not freeze. Bring product and diluent to room temperature before preparation using Store at 2–8°C or less than 30°C. Protect from light. Do not freeze. Bring product and diluent to room a Drug No information available. BPL Manufacturer Concentration Diluents

1 (Coagulation Factor X [Human]) [package insert]. Durham, NC: Bio Products Laboratory USA, Inc.; October 2015. ® brand. ® OTHER INFUSION CONTAINERS Diluent provided with product. Coagudex Glass Vial Flush Compatibility: Special Considerations: diluent provided. Notes a Coagulation Factor X b Reference 1. Coagudex 131 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Coagulation Factor XIII 2 1 1 Body Temp Refer. n/a n/a n/a n/a Storage Conditions TemperatureTemp Post-thaw c c Room Refrig Frozen Room Refrig in syringes. Bring product and diluent to room temperature before

® n/a n/a 3 h 3 h n/a n/a n/a n/a n/a n/a 4 h n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH e b, b W W n/a unspec. n/a n/a n/a n/a 6 m d Store at 2–8°C. Protect from light. Do not freeze. store Tretten a a Drug No information available. NNO CSL CSL Manufacturer Concentration Diluents (Factor XIII Concentrate [Human]) [package insert]. Kankakee, IL: CSL Behring LLC; January 2013. (Coagulation Factor XIII, A-Subunit [Recombinant]) [package insert]. Plainsboro, NJ: Novo Nordisk Inc.; April 2014. ® brand, Coagulation Factor XIII Concentrate (Human). ® brand, Coagulation Factor XIII, A-Subunit (Recombinant). brand, Coagulation Factor XIII, A-Subunit (Recombinant). ® ® return to refrigerator once stored at room temperature. OTHER INFUSION CONTAINERS Tretten Diluent provided with product. Once reconstituted with diluent provided, product may be diluted with NS to facilitate measurement of small volumes. Once reconstituted with diluent provided, product may be diluted Corifact Unreconstituted product may be stored at room temperature up to 25°C for up to 6 months in original vial if within labeled manufacturer expiration date; do not Unreconstituted product may be stored at room temperature up to 25°C for 6 months in original vial if within labeled manufacturer preparation. Notes a b c d e References 1. Corifact 2. Tretten Flush Compatibility: Special Considerations: Coagulation Factor XIII Vial 132 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Colistimethate Sodium 3 5 4 2 6 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions d d 1 d 30 d n/a n/a n/a n/a 30 d TemperatureTemp Post-thaw d b, b d 2 h 1 d n/a n/a n/a n/a 2 h 24 h n/a n/a n/a n/a2 d n/a2 h 1, 7 1 d2 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a a a a a a n/an/a 7–8 7 d 7 d n/a n/a n/a n/a 1, 7 Osmolality (mOsm/kg) pH W D5W NS, LR, D5¼S, D5S, D5½S

1,7

1 Dosage and concentration stated as colistin base activity. Reconstitute 150 mg vial with 2 mL W for final concentration of 75 mg/mL colistin Dosage and concentration stated as colistin base activity. Reconstitute 150 mg vial with 2 mL W for Drug Normal saline and heparin. unspec. 3 mg/mL NS n/a unspec. 3 mg/mL NS n/a unspec.unspec. 75 mg/mL unspec. unspec. 1–3 mg/mLunspec. 3 mg/mLPX 1–3 mg/mL NS, D5W n/a NS NS, D5W n/a n/a Manufacturer Concentration Diluents ST/LT ST/LT

® ® ®

TM c Medical)

Braun)

CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. After 30 d refrigerated storage. pH of reconstituted product is 7–8. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Special Considerations: base activity. Gently swirl to prevent frothing. Dosi-Fuser (B. (Epic Flush Compatibility: Glass Vial Unspecified AccuFlo (Leventon) Braun) (B. INTERMATE (Baxter) SMARTeZ Easy Pump Notes a Colistimethate Sodium b c d 133 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Colistimethate Sodium (cont’d) Bethlehem, PA: B. Braun USA; September 2015. . Fenton, MO: Progressive Medical, Inc.; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM . Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information Stability Data for Drugs Using B. Braun’s AccuFlo Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Colistimethate Sodium (cont’d) 7. Pharmaceuticals; December 2013. Colistimethate for Injection, USP [package insert]. Schaumburg, IL: Sagent 6. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. 4. 5. 134 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Co-Trimoxazole (Trimethoprim–Sulfamethoxazole) 1 1 1 1 Body

Temp Refer. 2

1 Storage Conditions TemperatureTemp Post-thaw 48 h24 h n/a n/a24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e gn/a e n/a 9.5–10.5 60 h n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH

2 d g e f d D5½S, ½S ½S D5½S, LR, D5W, NS

1 Concentrations are stated as the trimethoprim component of 1:5 fixed ratio with sulfamethoxazole. Drug Heparin lock flush and normal saline. ES 16 mg/mLRC, BWRC, BW 0.64 mg/mLRC 0.8 mg/mL 0.64, 0.8 mg/mL undiluted D5W, NS D5W Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 1.6 mg/mL (trimethoprim component) in NS is 833 mOsm/kg. CONTAINER OTHER INFUSION CONTAINERS Manufacturer recommends only D5W for dilution and infusion. pH of undiluted solution is 9.5–10.5. The osmolalities of co-trimoxazole (BW) 0.8, 1.1, and 1.6 mg/mL (trimethoprim component) in D5W are 541, 669, and 798 mOsm/kg, respectively. The osmolality of The osmolalities of co-trimoxazole (BW) 0.8, 1.1, and 1.6 mg/mL Not for direct injection; must be diluted per product labeling prior to infusion. Not for direct injection; must be diluted per product labeling prior g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Sulfamethozazole and Trimethoprim Injection, USP [package insert]. Sellerville, PA: Teva Pharmaceuticals, Inc.; April 2013. Note: f Special Considerations: Co-Trimoxazole (Trimethoprim–Sulfamethoxazole) (Trimethoprim–Sulfamethoxazole) Co-Trimoxazole Syringes, Polypropylene Glass Unspecified Flush Compatibility: Product labeling states that unit-dose glass, polyvinyl chloride, and polyolefin containers may be used for final dilution. Do not refrigerate admixtures. Product labeling states that unit-dose glass, polyvinyl chloride, and polyolefin containers may be used for final dilution. Do not e Notes d 135 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cyclophosphamide 4 5 5 6 Body Temp Refer. Do not use benzyl 10 continued on next page n/a n/a n/a 10 n/a n/a n/a 2, 5 c c n/a n/a n/a n/a 3, 7 n/a n/a n/a n/a 13 n/a n/a n/a n/a 12 n/a n/a n/a n/a 1, 5 n/a n/a n/a n/a n/a n/a n/a n/a 5, 6 Storage Conditions h k f e k b 48 d 7 d 8 d 48 h 48 h TemperatureTemp Post-thaw e k k b f 2 d 48 d 24 h 4 w 19 w 2 d 7 d 7 d n/a n/a7 d n/a n/a n/a 4 w8 h n/a 6 d n/a n/a n/a n/a 8 h 6 d n/a n/a n/a n/a n/a6 d 19 w n/a 19 w n/a n/a n/a n/a n/a n/a 2, 5 n/a 11 4 d 6 h 24 h Room Refrig Frozen Room Refrig If frozen, avoid microwave thawing. 5 g g g g g g g g g g g g i g i g hypotonic hypotonic Osmolality (mOsm/kg) pH

5,14 i i W NS n/a W D5W, NS n/a D5W n/a D5W n/a

5 b e f 4.5 mg/mL mg/mL 4.5 Reconstitute cyclophosphamide with NS only. 10 Cyclophosphamide solutions should not be stored at temperatures above 25°C. Drug Heparin lock flush and normal saline. MJ 2–20 mg/mL NS n/a AMMJ 1.8 mg/mL ES, BR, AD 0.3, 2 mg/mL unspec.CE 20 mg/mL unspec. D5W, NS 2–20 mg/mLunspec. n/a 4.5 mg/mLunspec. NS NS n/a n/a MJunspec. 21 mg/mL 0.1, 3.1 mg/mL D5S, D5W n/a CEunspec. 8 mg/mL 4 mg/mL NS NS n/a n/a AM 10.8 mg/mL Manufacturer Concentration Diluents j -

® / ® CONTAINER OTHER INFUSION CONTAINERS Special Considerations: Homepump Polyethylene Bag Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypro pylene (BD) Dosi-Fuser (Leventon) Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) (Epic SMARTeZ Medical) Flush Compatibility: Unspecified alcohol-preserved diluents. Cyclophosphamide 136 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cyclophosphamide (cont’d) 1984; 5:90, 2, 5,14 2003; 37:1789–92. 1995; 52:514–6. 1987; (Mar–Apr):65–8. Br J Parenter Ther. J Pharm Technol.

Ann Pharmacotherapy 2,5 1987; 22:685–7. Am J Health-Syst Pharm. Hosp Pharm. . Irvine, CA: Halyard Health; March 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. . HealthTek

7 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. 4, 6–7. Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory SMARTeZ exhibited a marked contraction of the plungers during cooling that allowed seepage solution onto syringe barrel. Combined with ondansetron (GL) 0.05 mg/mL and 0.4 mg/mL, respectively. 48 d refrigerated followed by 12 h at room temp. Solution also contained mesna (AM) 3.2 mg/mL. Manufacturer extrapolated data from other sources. Solution in syringes precipitated after a microwave thaw and required vigorous shaking. Solutions may not precipitate if concentrations are 8 mg/mL. Frozen syringes Solution in syringes precipitated after a microwave thaw and required vigorous shaking. Solutions may not precipitate if concentrations pH of reconstituted solution is 3–9; 22 mg/mL 6.87. Solution also contained mesna (AM) 0.54 mg/mL. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Reconstitution with W results in a hypotonic solution, which must be further diluted with an appropriate infusion solution prior to administration. Reconstitution with W results in a hypotonic solution, which must Cyclophosphamide (cont’d) 14. 14. Corporation; May 2013. Cyclophosphamide [package insert]. Deerfield, IL: Baxter Healthcare Note: 2. injection: effect of low temperature storage and microwave thawing. Kirk B, Melia CD, Wilson JV, et al. Chemical stability of cyclophosphamide 13. 13. Notes b c e f g 11. 11. for a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines 7. 10. Rapp RP, Hatton J, Record K. j k References 1. and cyclophosphamide in injectable solutions. Fleming RA, Olsen DJ, Savage PD, et al. Stability of ondansetron hydrochloride i 3. Travenol Infusor in administering chemotherapy the home. Akahoshi MP, Enriquez NC, Maki JK, et al. Safety and reliability of the 4. 5. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 November. 6. and mesna admixtures in polyethylene infusion bags. Menard C, Bourguignon Schlatter J, et al. Stability of cyclophosphamide h 12. 12. 137 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cyclosporine 1 1 1 1 1 3 Am J Body Temp Refer. 2011; 68:1646–50. 68:1646–50. 2011; n/a n/a n/a n/a Am J Health-Syst Pharm. Storage Conditions d n/a n/a n/a n/a48 h n/a TemperatureTemp Post-thaw b d Room Refrig Frozen Room Refrig

4 Do not use DEHP-containing containers or tubing to administer 1,2 Osmolality (mOsm/kg) pH EL can cause phthalate stripping from PVC. ®

1 Due to leaching of syringe plunger components, polypropylene syringes cannot be recommended for storage of cyclosporine solutions. Due to leaching of syringe plunger components, polypropylene syringes cannot be recommended Drug Normal saline. SZSZunspec. 2 mg/mL 2 mg/mL 1 mg/mL NS NS D5W n/a n/a n/a n/a n/a n/a 24 h 72 h 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a NVS 0.2, 2.5 mg/mL D5W, NS n/a n/a 14 d n/a n/a n/a n/a n/a 1, 2 NVSSZ 0.2 mg/mL 2 mg/mLSZ D5W, NS n/a 2 mg/mL D5W, NS n/a n/a 7 d n/a D5W n/a 24 h n/a n/a n/a n/a n/a n/a 48 h 2013; 70:1971–2. Manufacturer Concentration Diluents c (cyclosporine injection, USP) [package insert]. East Hanover, NJ; Novartis Pharmaceuticals Corporation; March 2015. ® b Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Health-Syst Pharm. Li M, Forest JM, Coursol C, et al. Stability of cyclosporine solutions stored in polypropylene–polyolefin bags and polypropylene syringes.

CONTAINER OTHER INFUSION CONTAINERS Exposed to fluorescent light. The manufacturer labeling states that Cremophor Polypropylene–polyolefin bag. Unspecified Flush Compatibility: Special Considerations: Short term (less than 10 min) syringe use for preparation and transfer is considered safe. cyclosporine. Use non-PVC administration sets and containers for administration. Notes b c d References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed May 2016. 2. Ethyvinyl Acetate Acetate Ethyvinyl (EVA) Chloride Polyvinyl (PVC) (Baxter) Bag AVIVA Glass Bottles 3. 0.9% sodium chloride injection or 5% dextrose and stored in ethylene-vinyl acetate containers. Li M, Coursol C, LeClaire G. Stability of cyclosporine diluted with 4. Sandimmune Cyclosporine Note: 138 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cytarabine 5 6 6 6 3 6 6 6 6 1, 6 6 2 f c a, a, 24 h Body Temp Refer. continued on next page n/a n/a n/a 7 d n/a n/a n/a n/a Storage Conditions a a n/a n/a n/a n/a 28 d 29 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw a a f a, g 7 d 28 d 8 d n/a7 d n/a 7 d n/a7 d 7 d n/a 7 d n/a29 d n/a n/a n/a 6, 7 7 d n/a n/a 14 d n/a n/a n/a n/a n/a n/a7 d n/a n/a 7 d8 d n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 6, 7 n/a n/a n/a n/a n/a 15 d 4, 6 5 d 8 d n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e e e e e e e e e e e e e n/a n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH d b i D5W, D5¼S, D5¼S, D5W, NS D5¼S, D5W, NS D5W, NS, W BWFI n/a g

6 Some preparations contain preservatives and should not be used for intrathecal administration. Preservative-free bulk vials should only be Some preparations contain preservatives and should not be used for intrathecal administration. Preservative-free Drug Normal saline. UP 5 mg/mL D5W n/a UPHSP 1.25, 25 mg/mLUP unspec.unspec.UP D5W, NS 8, 24, 32 mg/mL 20 mg/mLunspec. n/a DB 40, 80 mg/mL 20 mg/mL D5W, NS, Wunspec. n/a unspec. 20, 50 mg/mLunspec. BWFI, NS 0.5 mg/mL 0.5–5 mg/mL BWFI 20, 250 mg/mL unspec.UP unspec. n/aHSP n/a UP D5W, NS 8, 24, 32 mg/mL D5W, LR, NSUP n/a unspec. n/a n/a 20 mg/mL 1 mg/mL 15 d 15 d n/a n/a unspec. n/a Elliott’s B n/a 7 d n/a 7 d 7 d n/a n/a n/a n/a Manufacturer Concentration Diluents h (BD) CONTAINER OTHER INFUSION CONTAINERS Cytarabine Flush Compatibility: Special Considerations: used for preparation of intravenous infusions. Ethylene Vinyl Vinyl Ethylene Acetate (EVA) Infusion Plastic Bags, Unspecified Chloride Polyvinyl (PVC) Plastic Syringes, (BD) Syringes, Polypropylene Unspecified Glass Pump Implantable (Infusaid) INFUSOR (Baxter) 139 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Cytarabine (cont’d) Am J Hosp

6 1982; 39:1321–3.

6 1987; 22:685–7. Hosp Pharm. Am J Hosp Pharm. 1990; 12:53–4, 60. Br J Pharm Pract. Ontario, Canada: Baxter Corporation; October 2008.

8 Solution [package insert]. Scotch Plain, NJ: Lukare Medical, LLC; October 2015. ® Solution is comparable to cerebrospinal fluid in pH, osmolarity, electrolyte, and glucose content. It is used as a diluent for the intrathecal administration of Solution is comparable to cerebrospinal fluid in pH, osmolarity, electrolyte, and glucose content. It used as a diluent 1992; 49:619–23. ® cytarabine. Pharm. Intermate/Infusor Drug Stability Information. NS with and without bacteriostat. Elliotts B INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of preservative-free commercial injection 20 mg/mL is 7.4 and 100 mg/mL is 7.7. pH of 20 multi-dose vial containing benzyl alcohol 7.6. pH of preservative-free commercial injection 20 mg/mL is 7.4 Solutions stored in the dark. Storage at 35°C. Cytarabine has an aqueous solubility of 100 mg/mL. Precipitation from more concentrated solutions has been observed. Cytarabine has an aqueous solubility of 100 mg/mL. Precipitation Stored at 25°C for 7 d, followed by 24 h 33°C. Accompanying bacteriostatic diluent. f g c d e Cytarabine (cont’d) Notes a b 4. in a totally implanted drug delivery system. Keller JH, Ensminger WD. Stability of cancer chemotherapeutic agents h i References 1. or doxorubicin hydrochloride in ethylene vinylacetete portable infusion-pump containers. Rochard EB, Barthes DMC, Courtois PY. Stability of fluorouracil, cytarabine, 2. a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines for 5. 6. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 7. January 2015. Cytarabine Injection [package insert]. Lake Forest, IL: Hospira, Inc.; 8. Elliotts B 3. injections. Weir PJ, Ireland DS. Chemical stability of cytarabine and vinblastine 140 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Dacarbazine 2 3

1 Body Temp Refer. n/a n/a n/an/a n/a n/a 1, 2 n/a n/a 2002; 59:1351–6. Storage Conditions c c

1 7 d 96 h TemperatureTemp Post-thaw c e 48 h 24 h 8 h 72 h n/a n/a n/a n/a Room Refrig Frozen Room Refrig Am J Health-Syst Pharm. b b b b n/a n/a Osmolality (mOsm/kg) pH

3 W W

Manufacturer recommends protection from light. Drug Normal saline. Dacarbazine 10 mg/mL in NS showed no observable precipitation when combined with heparin sodium 100 units/mL. Normal saline. Dacarbazine 10 mg/mL in NS showed no observable precipitation when combined with AVE 1.4 mg/mLAVETE 11 mg/mL 10 mg/mL D5W n/a Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. d CONTAINER OTHER INFUSION CONTAINERS Manufacturer original vial. pH of reconstituted preparation 10 mg/mL in W is 3–4. Exposed to fluorescent light. Protected from light. 3. Dacarbazine [package insert]. North Wales, PA: Teva Pharmaceuticals USA, Inc.; November 2014. Note: c d e References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. glass vials and polyvinyl chloride bags. El Aatmani M, Poujol S, Astre C, et al. Stability of dacarbazine in amber Special Considerations: Notes b Dacarbazine Chloride Polyvinyl (PVC) Glass (Amber Vial) Vial Flush Compatibility: Dacarbazine 25 mg/mL in NS formed an immediate precipitation when combined with heparin sodium 100 units/mL. 141 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Dalbavancin 1 Body Temp Refer.

2 Storage Conditions TemperatureTemp Post-thaw Room Refrig Frozen Room Refrig Flush infusion line with D5W before and after to avoid 1 Osmolality (mOsm/kg) pH Do not shake. Avoid mixture or co-infusion with saline-based infusion solutions due to precipitation. Drug Incompatible with heparin flush and saline. Flush dextrose only. DRT 1–5 mg/mL D5W n/a n/a 48 h 48 h n/a n/a n/a n/a Manufacturer Concentration Diluents

2 (dalbavancin) Injection [package insert]. Chicago, IL: Durata Therapeutics U.S. Limited; January 2016. ® CONTAINER precipitations. Special Considerations: Dalbavancin Unspecified Flush Compatibility: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. Dalvance 142 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Daptomycin 7 8 4 1 2 2 6 5 9 1 2 Body Temp Refer. continued on next page n/a n/a n/a n/a Storage Conditions d 10 d TemperatureTemp Post-thaw d Room Refrig Frozen Room Refrig b pH b n/a n/a n/a 14 d 14 d n/a n/a n/a Osmolality (mOsm/kg) e NS n/aLR n/a 12 h 48 h n/a n/a n/a n/a e a Drug unspec. 20 mg/mL NS 323 4.5 1 d 10 d n/a n/a n/a n/a unspec. 20 mg/mL NS 323 4.5 1 d 10 d n/a n/a n/a n/a unspec. 20 mg/mL NS 323 4.5 1 d MECUB unspec. CUB 2.5, 10, 20 mg/mLCUB 20 mg/mL NS 5 mg/mL n/a, 323 n/a, 4.5 NS n/a 10 d 323unspec. n/a n/a 20 mg/mL 4.5 n/aCUB n/a n/a 20 mg/mL NS 10 d n/a n/a 323 NS n/a 4.5 n/a 323 n/a 4.5 10 d n/a n/a n/a 10 d n/a n/a n/a n/a n/a n/a MECUB 50 mg/mL 50 mg/mL NS W, LR 38–47, 307 n/a 4.8–5, 4.59 12 h n/a 48 h n/a n/a 12 h 48 h n/a n/a n/a n/a n/a n/a Manufacturer Concentration Diluents

® ST/LT ST/LT (Epic (Epic ® ®

/ TM c ® f f Braun)

CONTAINER OTHER INFUSION CONTAINERS Daptomycin (B. Braun) Easypump (B. Homepump Medical) IV Bag Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene AccuFlo Homepump Eclipse C-Series (Halyard) INTERMATE (Baxter) SMARTeZ Vial 143 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Daptomycin (cont’d) brand ®

1 Bethlehem, PA: B. Braun USA; September 2015. [personal communication]. Lexington, MA: Drug Information Department, Cubist Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. . 2014; 71:956–9.

10 ST/LT Elastomeric Infusion System. ®

2 Elastomeric Infusion System TM Compatibility and Stability in Elastomeric Pumps Am J Health Syst Pharm ® Cubicin

1 Incompatible with dextrose-containing solutions. Package insert recommends a 21-gauge or smaller beveled needle or needle-less device Incompatible with dextrose-containing solutions. Package insert recommends a 21-gauge or smaller Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® [package insert]. Whitehouse Station, NJ: Merck and Co, Inc.; July 2016. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump polypropylene syringes at 4 and –20°C. Stability Data for Drugs Using B. Braun’s AccuFlo Pharmaceuticals Inc.; August 5, 2008. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory SMARTeZ Manufacturer extrapolated data from other sources. pH and osmolality data provided by manufacturer. Combined with heparin sodium to a final concentration of 99.1 ± 0.8 units/mL and daptomycin 5 0.6 mg/mL in LR. Combined with heparin sodium to a final concentration of 99.1 Appropriate volume of reconstituted (50 mg/mL) daptomycin is further diluted into 50 mL NS. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Original product vial. Flush Compatibility: for vial access. During reconstitution, avoid vigorous agitation or shaking of the vial to minimize foaming; slowly transfer 10 mL NS to vial and gently rotate for vial access. During reconstitution, avoid vigorous agitation or shaking of the to minimize foaming; slowly transfer 10 mL NS Do not use with ReadyMED wet product. Allow to stand undisturbed for 10 minutes. Then gently rotate or swirl vial contents completely reconstitute. Special Considerations: 8. Daptomycin (cont’d) 10. 10. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. Note: elastomeric infusion pumps. 9. 5 mg/mL and heparin sodium 100 units/mL combined in lactated Ringer's injection stored Ortega R, Salmerón-García A, Cabeza J, et al. Stability of daptomycin 2. Drug Information Department [personal communication]. Lexington, MA: Cubist Pharmaceuticals Inc.; January 2008. 4. c d e f References 1. Cubicin 5. Drug Information Department. Notes a b 6. 7. 144 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DAUNOrubicin Hydrochloride (Daunomycin) Body Temp Refer. n/a n/a n/a 1, 2 b a, 43 d n/a n/a n/a n/a 1, 2 1990; 15:279–89. Storage Conditions a a 1985; 39(Nov–Dec):220–2. 43 d n/a n/a n/a n/a n/a 1, 3 TemperatureTemp Post-thaw a a J Clin Pharm Ther. 43 d n/a 43 d 28 d Room Refrig Frozen Room Refrig c c c c Bull Parenter Drug Assoc. n/a n/a Osmolality (mOsm/kg) pH

1 W LR, D5W, NS ; maximum stability is at pH 4.5–5.5. 4

1 n/a Drug Normal saline. RPRP 0.1 mg/mLRP 2 mg/mL 0.1 mg/mL NS, D5W n/a Manufacturer Concentration Diluents CONTAINER Frozen samples were subjected to 11 freeze/thaw cycles with no apparent loss in potency between cycles. Protected from light. pH of a 5 mg/mL aqueous solution is 4–5 DAUNOrubicin Hydrochloride (Daunomycin) DAUNOrubicin 4. Bedford Laboratories; June 2013. Daunorubicin Hydrochloride Injection [package insert]. Bedford, OH: Polyvinyl Chloride Chloride Polyvinyl (PVC) Polypropylene Tubes, Test Polypropylene Flush Compatibility: 3. agents in infusion fluids. Beijnen JH, Rosing H, DeVries PA, et al. Stability of anthracycline antitumour References 1. ASHP's Interactive Handbook on Injectable Drugs. 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. and epirubicin in plastic syringes minibags. Wood MJ, Irwin WJ, Scott DK. Stability of doxorubicin, daunorubicin Special Considerations: Notes a b c Syringes, Syringes, 145 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Deferoxamine Mesylate 3 6 7 2 2 2 4 4 1 4 4 4 4 4 4 4 4 i i i i i i i i i i Body Temp Refer. continued on next page n/a n/a n/a 7 d n/a n/a n/a 6 d n/a n/a n/a 3 d n/a n/a n/a 3 d n/a n/a n/a 7 d Storage Conditions j p e q j n/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a 5 d n/a n/a n/a n/a 7 d n/a n/a n/a n/a 5 d n/a n/a n/a n/a 2 d TemperatureTemp Post-thaw a g h k g h Room Refrig Frozen Room Refrig n/a 2 d 14 d n/a n/a n/a n/a n/a 2 d 14 d n/a n/a n/a n/a n/a 21 d n/an/an/a n/an/a 12 d n/a n/a n/a n/a 7 d 28 d n/a n/a 28 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 14 d n/a 3 d n/a 6 d n/a 14 d n/a 3 d 15 d n/a 3 d 35 d n/a 3 d 35 d n/a 17 d n/a 4 d 31 d n/a 21 d n/a 3 d 15 d

f f f f f f f f f f f f f f f f f f (mOsm/kg) pH Osmolality W W W NS NS NS NS NS W NS W NS NS o o o o o o o o o d o Drug CG 0–83 mg/mL unspec. 5, 22, 100 mg/mL NS unspec. 5, 22, 100 mg/mL NS CG 250 mg/mL CG 10, 100 mg/mL unspec.unspec.unspec. 5 mg/mL 5–160 mg/mL 73 mg/mL NS NS CG 0–83 mg/mL CG 0–83 mg/mL CG 0–83 mg/mL CG 0–83 mg/mL CG 0–83 mg/mL CG 0–83 mg/mL CG 83.3 mg/mL CGCG 25 mg/mL 83.3 mg/mL Manufacturer Concentration Diluents r

ST/LT ST/LT ® ®

/ TM ® Braun)

CONTAINER OTHER INFUSION CONTAINERS (B. Dosi-Fuser (B. Braun) Homepump Syringes, Syringes, Polypropylene AccuFlo (Leventon) Easypump Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) Deferoxamine Mesylate 146 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Deferoxamine Mesylate (cont’d) 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 i i i i i i i i i i i i Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a 4 d n/a n/a n/a 4 d n/a n/a n/a 5 d n/a n/a n/a 7 d n/a n/a n/a 7 d n/a n/a n/a 6 d Storage Conditions t c c j m j p 14 d n/a n/a n/a n/a 4 d n/a n/a n/a n/a 4 d n/a n/a n/a n/a 5 d n/a n/a n/a n/a 2 d n/a n/a n/a n/a 1 d n/a n/a n/a n/a 7 d TemperatureTemp Post-thaw k l t n n h g Room Refrig Frozen Room Refrig n/a 3 d n/a 3 d 15 d n/a 3 d 15 d n/a 10 d n/a n/a n/a n/a n/a n/a 3 d 15 d n/a 3 d 35 d n/a 3 d n/a 3 d 15 d n/a 6 d n/a 12 d n/a 14 d n/a 3 d n/a 15 d n/a n/a n/a n/a n/a n/a 20 d n/a n/a n/a n/a n/a n/a 3 d 35 d

f f f f f f f f f f f f f f f f (mOsm/kg) pH Osmolality W W W W W W W W W W W W W W W s s s s s s

s s s s s s 1 o, o, o, o, o, o, o o o

1 Reconstitute only with W and do not refrigerate. Do not use turbid solutions. Precipitate may form at higher concentrations and over longer Reconstitute only with W and do not refrigerate. Do use turbid solutions. Precipitate may form Drug Normal saline. unspec. 5, 22, 100 mg/mL NS n/a n/a 2 d FAU 200–210 mg/mL FAU 200–210 mg/mL FAU 175–212 mg/mL CG 100–200 mg/mL FAU 160–200 mg/mL CG 90 mg/mL FAU 160–200 mg/mL CG 83–160 mg/mL CG 83–160 mg/mL CG 83–160 mg/mL CG 83–160 mg/mL CG 83–160 mg/mL CG 83.3 mg/mL CG 83.3 mg/mL CG 83–160 mg/mL Manufacturer Concentration Diluents

1 (Epic (Epic ® Packaged as 3 mL in 10 mL infusion pump syringes (Pharmacia Deltec). Packaged as 3 mL in 10 infusion pump syringes (Pharmacia Followed by 5 d at 33°C. Followed by 3 d at 25°C, followed 33°C. Stored at 30°C. Followed by 3 d at 25°C, followed 4 33°C. Followed by 7 d at 33°C. Reconstituted deferoxamine 95 mg/mL is isotonic. Flush Compatibility: Special Considerations: time periods. Notes a c d e f Medical) SMARTeZ g h Deferoxamine Mesylate (cont’d) 147 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Deferoxamine Mesylate (cont’d) Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo Intermate/Infusor Drug Stability Information. SMARTeZ Followed by 3 d at 25°C, followed 5 33°C. Followed by 3 d at 25°C, followed 6 33°C. Followed by 4 d at 25°C, followed 3 33°C. Concentrations up to 100 mg/mL were reconstituted with W and diluted with NS. Concentrations up to 100 mg/mL were reconstituted with W and Followed by 4 d at 33°C. Followed by 2 d at 33°C. Concentrations above 100 mg/mL were reconstituted and diluted with W. Concentrations above 100 mg/mL were reconstituted and diluted INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Manufacturer extrapolated data from other sources. Followed by 3 d at 25°C, followed 7 33°C. Followed by 1 d at 33°C. Near body temperature, 33°C. 6. Deferoxamine Mesylate (cont’d) Note: 7. i j k l m n o p q r s t References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. 3. 4. 5. 148 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Dexamethasone Sodium Phosphate 1 2 1 1 1 1 3 1 1 1 9 9 1 1 3 1 1, 4 m l, n/a Body Temp Refer. v continued on next page n/a 30 d v n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 8 d n/a n/a n/a n/a 1, 6 Storage Conditions s d h u a c, b, m l, b,p 14 d n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a 14 d 28 d n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 28 d n/a n/a n/a n/a n/a 1, 5 8 d 5 d t d TemperatureTemp Post-thaw h, b u b e f a o b, m i b, b,p l, 7 d 48 h 14 d n/a n/a n/a n/a n/a 14 d 14 d 28 d 14 d 14 d 35 d 55 d 91 d 91 d28 d n/a 28 d n/a n/a n/a n/a n/a n/a n/a 28 d n/a n/a 3 m 8 d 22 d n/a n/a n/a n/a n/a 1, 8 Room Refrig Frozen Room Refrig

l m g pH n/a 5 d 5.29–5.40 4.26–4.37 n/a 5 d y y g y g y g y g y g y g yy g g yy g g y g y g y y g y x y Osmolality (mOsm/kg) r y g n y unspec. D5W, NS NS NS NS D5W, NS NS, D5W NS NS D5W NS o d p w s m i a l, h u v Drug AMR 0.4 mg/mL MSD 0.4 mg/mL AMR 0.2, 0.4 mg/mL AMRES 0.094, 0.658 mg/mL 0.2, 0.4 mg/mL D5W MSD 0.43 mg/mL ORAMRAMR 0.1 mg/mL 0.092, 0.66 mg/mL 0.092, 0.66 mg/mL NS OTOTOR 10 mg/mL 10 mg/mL 0.07 mg/mL unspec. undiluted unspec. undiluted 0.8 mg/mLOT 0.8 mg/mLLY 10 mg/mLunspec. NS 1 mg/mL 0.02 mg/mL D5W n/a n/a undiluted n/a NS n/a 24 h 24 h 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a ME 0.33–3.33 mg/mL APPME 0.1, 1 mg/mL 0.33, 1.33, 1.67, 3.33 mg/mL NS Manufacturer Concentration Diluents

® CONTAINER OTHER INFUSION CONTAINERS Dexamethasone Sodium Phosphate Polyolefin Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Dosi-Fuser (Leventon) Syringes Glaspak (Becton Dickinson) Glass Vials Cassette PVC Deltec) (Pharmacia 149 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Dexamethasone Sodium Phosphate (cont’d) Int J 2007; 2006; 56(10):714–20. 1989; 7(12):1903–8. J Clin Pharm Ther. J Clin Oncol.

1 Arzeneimittelforschung

1 Barcelona, Spain: Leventon SAU; October 2015.

1 2005; 30(1):80–6. Elastomeric Pump (ES.H.00.730-10). ® , PF) 42.9 mg/mL, exposed to normal fluorescent light. n/a 1997; 54(May 1):1065–8. . 2002; 6:395–7. , PF) 3.6 mg/mL, exposed to normal fluorescent light. ® ® Heparin lock flush and normal saline. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. diphenhydramine, and metoclopramide only. Journal of Pain and Symptom Management Am J Health Syst Pharm. 32(5):441–4. Drug Stability Table-Dosi-Fuser Pharmaceut Compound With ketamine (Ketalar With palonosetron 0.005 mg/mL (MGI). With furosemide (HO) 3.33–10 mg/mL. With granisetron (SKB) 0.01 and 0.04 mg/mL. Stored protected from light. With tramadol 8.3, 16.66, 33.33 mg/mL (GRU, Spain). With 200 mg diphenhydramine (ES), 4 mg lorazepam (WY), and 400 mg metoclopramide (DU) in 100 mL NS. Above stability pertains to dexamethasone, With 200 mg diphenhydramine (ES), 4 lorazepam (WY), and Parkfield Pharmaceuticals. With ondansetron 0.14 mg/mL (GL). In 1-mL Monoject syringe (Sherwood). With ondansetron (GL) 0.15 mg/mL. 30 d refrigerated followed by 2 at room temperature. pH of undiluted solutions is 7–8.5. Dilutions of 0.5, 1, and 2 mg/mL in NS are 7.3, and 7.5. pH of undiluted solutions is 7–8.5. Dilutions 0.5, 1, and 2 mg/mL With ondansetron 0.08 mg/mL (GSK). Osmolality of 4 mg/mL (ES) is 356 mOsm/kg. Dilutions 0.5, 1, and 2 (DB) in NS were 269, 260, 238 The pH of 1 mg/mL decreased from 7.3 to 7.2 in 22 days, while the 0.1 6.5 6.3. With ondansetron 0.1, 0.2, 0.4, and 0.64 mg/mL (CER). Bacteriostatic sodium chloride 0.9%. At 23°C and 30°C. In 3-mL Monoject syringe (Sherwood). With ketamine (Ketalar With morphine sulfate 15 mg/mL. h i l m Special Considerations: Notes a b c d e f g n o p r s t u v w x y Flush Compatibility: 5. tramadol and dexamethasone in solution its use terminally ill patients. Negro S, Salama A, Sanchez Y, et al. Compatibility and stability of 4. sodium phosphate and ketamine hydrochloride subcutaneous infusions in polypropylene syringes. Watson DG, Lin M, Morton A, et al. Compatibility and stability of dexamethasone 3. and dexamethasone sodium phosphate in 0.9% chloride injection 5% dextrose injection. Evrard B, Ceccato A, Gaspard O, et al. Stability of ondansetron hydrochloride 6. and dexamethasone combined in infusion solutions. Negro S, Randon AL, Azuara ML, et al. Compatibility and stability of furosemide Dexamethasone Sodium Phosphate (cont’d) Note: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. chronic cancer pain in the ambulatory setting: a report of 117 patients. Swanson G, Smith J, Bulich R, et al. Patient-controlled analgesia for 9. 8. Gupta VD. Chemical stability of dexamethasone sodium phosphate after reconstitution in 0.9% chloride injection and storage polypropylene syringes [Abstract]. 150 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DimenHYDRINATE 2 1 2 Body Temp Refer. n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions d c c, 60 d 91 d . 2002; 55(5):307–12. TemperatureTemp Post-thaw b d b, 7 d 60 d 10 d n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig Can J Hosp Pharm a a a Osmolality (mOsm/kg) pH

1 1 Avoid freezing. Drug Heparin lock flush and normal saline. SABSAB 0.5, 1, 2 mg/mL 2.5, 5, 10 mg/mLunspec. D5W, NS unspec. n/a NS n/a D5W, NS n/a Manufacturer Concentration Diluents e

2 of bags. CONTAINER OTHER INFUSION CONTAINERS Follow institutional policies on storage of minibags without overwrap, as concentrations increase over time due to evaporation from container and physical breakdown Follow institutional policies on storage of minibags without overwrap, Exposed to light. Sealed with friction caps. The pH of undiluted solution is 6.4–7.2. Protected from light. Special Considerations: Polyvinyl Chloride Chloride Polyvinyl (PVC) Polypropylene Unspecified Flush Compatibility: Syringes, Syringes, Notes a b c d e References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. Donnelly RF. Chemical stability of dimenhydrinate hydrochloride in minibags and polypropylene syringes. DimenHYDRINATE DimenHYDRINATE 151 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DiphenhydrAMINE Hydrochloride 2 2 1 Body Temp Refer. n/a n/an/a n/a n/a n/a n/a n/a Storage Conditions b b 1999; 52:150–5. 91 d 28 d 14 d n/a n/a n/a n/a TemperatureTemp Post-thaw b b d Room Refrig Frozen Room Refrig Can J Hosp Pharm. c Osmolality (mOsm/kg) pH NS n/a n/a 14 d

1 1 a 1 Protect from light; avoid freezing. Drug Heparin lock flush and normal saline. PDPD 0.25, 0.5, 1 mg/mL 1.25, 2.5, 5 mg/mLES D5W, NS n/a 2 mg/mL NS n/a n/a 91 d n/a 28 d Manufacturer Concentration Diluents e diphenhydramine, and metoclopramide only. CONTAINER OTHER INFUSION CONTAINERS At 23°C and 30°C. Protected from light. Sealed with friction caps. With 40 mg dexamethasone (AMR), 4 mg lorazepam (WY), and 400 mg metoclopramide (DU) in 100 mL NS. Above stability pertains to dexamethasone, With 40 mg dexamethasone (AMR), 4 lorazepam (WY), and 400 metoclopramide (DU) in 100 mL NS. Above stability pH of undiluted solution is 4–6.5. Special Considerations: Syringes, Syringes, Flush Compatibility: Polyvinyl Chloride Chloride Polyvinyl (PVC) Polypropylene Cassette PVC Deltec) (Pharmacia d e References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. Donnelly RF. Chemical stability of diphenhydramine hydrochloride in minibags and polypropylene syringes. Notes a b c DiphenhydrAMINE Hydrochloride 152 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DOBUTamine Hydrochloride 1 1 1 1 1 1 Body Temp Refer.

1 n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a Storage Conditions f a a 100 d 234 d 30 d n/a n/a n/a n/a n/a 5, 6 TemperatureTemp Post-thaw a d b, n/a 48 h 48 h n/a n/a n/a n/a 48 h48 h 7 d48 h n/a30 d n/a n/a n/a n/a n/a n/a n/a7 d n/a Room Refrig Frozen Room Refrig c c c c c c gg c c h

5 259, 266, 266, 259, 280 Osmolality (mOsm/kg) pH

n/a 6 Drug Normal saline. Heparin lock flush. (Several studies show heparin and dobutamine combinations to be incompatible in D5W.) Normal saline. Heparin lock flush. (Several studies show heparin and dobutamine combinations to be incompatible LILILIAB 0.25 mg/mLLI 1 mg/mLLI 1 mg/mL 4 mg/mL 5 mg/mLBA 5 mg/mL NS, D5W n/a D5W NS 1, 2, 4 mg/mL D5W n/a D5W D5W n/a n/a 361 D5W 361 Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER COMMERCIAL PREPARATIONS (RTU) Do not use beyond this date after removal of manufacturer's protective overwrap. Do not use beyond this date after removal of manufacturer's protective Expiration date per manufacturer's label when stored in the protective overwrap under labeled storage conditions. Calculated (mOsmol/L). Stored protected from light. pH of premixed solution and undiluted solutions is 2.5–5.5. Osmolality at 5 mg/mL, unspecified manufacturer and diluent. Stability reported as 234.7 d, protected from light. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 5. Medical Affairs Department [personal communication]. Deerfield, IL: Baxter Healthcare Corporation; September 2015. 6. DOBUTamine Hydrochloride in 5% Dextrose Injection Plastic Container VIAFLEX Plus [package insert]. Deerfield, IL: Baxter Healthcare Corporation; April 2014. Note: DOBUTamine Hydrochloride DOBUTamine h d Syringes, Syringes, f g Polyvinyl Chloride Chloride Polyvinyl (PVC) Polypropylene Viaflex (Baxter) Flush Compatibility: Special Considerations: Notes a b c 153 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Docetaxel 2 Can J Hosp Body Temp Refer. . 1999; 21:137–41. 21:137–41. 1999; . Pharm World Sci A one-vial (liquid) formulation, 1 n/a n/a n/a n/a 1, 3 Storage Conditions

4 a 28 d n/a n/a n/a n/a n/a 1, 3 n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 3 1, 3 TemperatureTemp Post-thaw a a a a 35 d n/a n/a n/a n/a n/a 1, 2 Room Refrig Frozen Room Refrig d n/an/a n/a n/a 21 d 28 d 21 d n/a n/a n/a n/a Osmolality (mOsm/kg) pH c c

1 Do not admix in PVC containers. Manufacturer recommends use of glass or polyolefin (polyethylene or polypropylene) containers and Do not admix in PVC containers. Manufacturer recommends use of glass or polyolefin (polyethylene Drug Heparin lock flush and normal saline. AVERPR 10 mg/mL 10 mg/mL RPRRPR 0.3, 0.9 mg/mL 0.3, 0.9 mg/mL NSRPR D5W 0.3, 0.9 mg/mL n/a n/a n/a n/a D5W, NS 28 d n/a 28 d n/a 28 d AVE 0.4, 0.8 mg/mL NS n/a Manufacturer Concentration Diluents

2 (docetaxel injection) [package insert]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; November 2014. (docetaxel injection) [package insert]. Bridgewater, NJ: Sanofi-Aventis ® . 2007; 60:231–7. solutions. Pharm Thiesen J, Kramer I. Physico-chemical stability of docetaxel premix solution and infusion solutions in PVC bags polyolefin containers.

CONTAINER OTHER INFUSION CONTAINERS Initial pH values for 0.4 mg/mL solution were 5.13 to 5.16 and 4.80 for 0.8 mg/mL. Within 35-day test period, pH changed by less than 0.06 unit all tested Initial pH values for 0.4 mg/mL solution were 5.13 to 5.16 and Partial Additive Bag (PAB). Protected from light. Two-vial formulation contained the drug vial with solubilizer polysorbate 80, plus a diluent containing 13% ethanol in water. Special Considerations: polyethylene-lined administration sets to minimize patient exposure plasticizer (DEHP) from PVC. Inline filtration is not required. available as 20 mg/mL in a 50/50 (v/v) ratio polysorbate 80/dehydrated alcohol, is ready for addition to infusion solutions. Flush Compatibility: Notes a b c d 3. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Walker SE, Charbonneau F, Law S. Stability of docetaxel solution after dilution in ethanol and storage vials normal saline bags. Glass (Vial) 4. Taxotere Docetaxel Polyethylene Polypropylene Polypropylene- Polyethylene Copolymer Bag Glass Bottle (B. Braun) 154 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Dolasetron Mesylate 2 2 2 Body Temp Refer. Precipitation occurs when dolasetron 3 Storage Conditions TemperatureTemp Post-thaw 31 d31 d 31 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 h 48 h n/a n/a n/a n/a 1, 2 Room Refrig Frozen Room Refrig a a a a Not compatible with heparin. 3 1,2 n/a Osmolality (mOsm/kg) pH D5W, NS, LR, D5½S, M10, D5LR 1,2 b Flush the infusion line before and after administration. 1 1 Maximum rate for administration of undiluted intravenous administration is 100 mg in 30 seconds. When diluted in 50 mL a compatible Maximum rate for administration of undiluted intravenous is 100 mg in 30 seconds. Drug Normal saline. HMRunspec.SAV 10 mg/mL 12.5 mg/mLSAV 20 mg/mL unspec. NS D5W, NS n/a undiluted n/a n/a 3.2–3.8 240 d n/a n/a n/a n/a n/a Manufacturer Concentration Diluents Injection [package insert]. Bridgewater, NJ: Sanofi-Aventis; October 2014. Injection [package insert]. Bridgewater, NJ: Sanofi-Aventis; ® CONTAINER Unspecified concentration diluted for infusion. pH of undiluted solution is 3.2–3.8. b References 1. Anzemet 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 November. 3. NJ: Sanofi-Aventis; January 2008. Medical Information Center [personal communication]. Bridgewater, mesylate diluted in NS is administered by y-site with heparin sodium 50 units/mL (ES) NS. Special Considerations: solution, infuse over up to 15 min. Do not mix with other drugs. Notes a Dolasetron Mesylate Syringes, Polypropylene Syringes, Unspec. Unspecified Flush Compatibility: 155 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DOPamine Hydrochloride

1 3 1 1 1 1 1 1 Body Temp Refer. continued on next page n/a n/a n/a d c, 6 m n/a n/a n/a n/a Storage Conditions a

c 6 3 m n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2, 6 TemperatureTemp Post-thaw h f c b, 7 d 48 h 48 h n/a n/a n/a n/a 48 h48 h 7 d n/a96 h n/a48 h n/an/a n/a n/a24 h n/a 14 d n/a n/a n/a24 h n/a n/a n/a n/a n/a n/a 1, 7 n/a n/a n/a 1, 7 n/a n/a n/a7 d n/a n/a n/a Room Refrig Frozen Room Refrig e e e e e e e e e e g e Osmolality (mOsm/kg) pH

1 Dopamine decomposes in alkaline solutions forming a pink to violet or yellow to brown color. Discolored solutions should not be used. Dopamine decomposes in alkaline solutions forming a pink to violet or yellow brown color. Discolored Drug Heparin lock flush. NY 0.5 mg/mL D5W n/a TLP 4 mg/mL D5W n/a ASASunspec.ES 0.8 mg/mLDB 0.8 mg/mL 0.3 mg/mLSOAB 0.4, 3.2 mg/mL 3.2 mg/mL 6.1 mg/mL D5W 4 mg/mL NS D10W D5W, NS n/a BA n/a n/a n/a D5W D5W 0.8, 1.6, 3.2 mg/mL n/a D5W n/a n/a D5W Manufacturer Concentration Diluents

CONTAINER COMMERCIAL PREPARATIONS (RTU) Frozen stability data was consistent only in Codan syringes. Do not use Braun syringes if preparation will be frozen. Frozen stability data was consistent only in Codan syringes. Do Expiration date per manufacturer’s label when stored in the protective overwrap or overpouch under labeled storage conditions. Expiration date per manufacturer’s label when stored in the protective overwrap or overpouch under labeled storage conditions. Exposed to fluorescent light. pH of premixed solution range is 2.5–4.5, and undiluted solution is 2.5–5. pH of premixed solution range is 2.5–4.5, and undiluted 5% loss in 14.75 d, protected from light. Protected from light. Osmolarlity is 261, 269, and 286 mOsmol/liter (calc.) for 0.8, 1.6, and 3.2 mg/mL concentrations, respectively, in D5W. Osmolarlity is 261, 269, and 286 mOsmol/liter (calc.) for 0.8, Do not use beyond this date after removal of manufacturer’s protective overwrap. Do not use beyond this date after removal of manufacturer’s protective Special Considerations: DOPamine Hydrochloride Glass Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Bag Plus Viaflex (Baxter) Flush Compatibility: Notes a b c d e h f g 156 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DOPamine Hydrochloride (cont’d) Am J . 2003; 28:471–4. J Clin Pharm Ther . 1975; 32:575–8. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Hosp Pharm 6. DOPamine Hydrochloride and 5% Dextrose Injection, USP in Plastic Container VIAFLEX Plus [package insert]. Deerfield, IL: Baxter Healthcare Corporation; April 2014. 7. intravenous admixture compatibility. Part 1: stability with common fluids [Abstract]. Gardella LA, Zaroslinski JF, Possley LH. Intropin (dopamine hydrochloride) DOPamine Hydrochloride (cont’d) Note: References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Medical Information Department [personal communication]. Deerfield, IL: Baxter Healthcare Corporation; September 2015. 3. Braenden JU, Stendal TL, Fagernaes CB. Stability of dopamine hydrochloride 0.5 mg/mL in polypropylene syringes. 157 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Doripenem 6 4 3 2 2 2 2 1 1 6 6 Refer. h f Body Temp 8–12 h continued on next page n/a n/a 5, 6 n/a n/a 5, 6 n/a n/a 5, 6 d e d 16 h 16 h 16 h Room Refrig b b b n/a n/a n/a n/a n/a n/a n/a n/a Frozen Storage Conditions l l n/a n/a n/a n/a n/a n/a n/a n/a n/a 72 h 24 h Temperature Post-thaw Temp j g k k 12 h4 h 72 h n/a 48 h n/a n/a n/a4 h n/a12 h 48 h n/a n/a 72 h n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig i i i i 4.83–5.12 4.74–4.83 4.84–4.99 4.85–5.24 n/a n/a 24 h n/a n/a n/a n/a 12 h Osmolality (mOsm/kg) pH W NSD5W n/a n/a n/a n/a 12 h 4 h c c Drug OMNOMN 10 mg/mL 10 mg/mL D5W NS n/a n/a n/a n/a 16 h 7 d 24 h n/a 7 d n/a 14 d n/a n/a 5, 6 OMN 5, 10 mg/mL NS n/a n/a n/a n/a 28 d OMN 5, 10 mg/mL D5W n/a n/a 18 h OMNOMNOMN 1, 10 mg/mLOMN 1, 10 mg/mLOMN 5 mg/mLOMN 5 mg/mLOMN 1, 10 mg/mLOMN 1, 10 mg/mL NSOMN 5 mg/mL D5WOMN 5 mg/mL 5 mg/mL NS n/a n/a 5 mg/mL D5W NS D5W n/a n/a n/a SHI n/a D5WSHI n/a n/a D5W 12 h NS 8 h 2.3–4.5 mg/mL n/a NS 72 h 2.3–4.5 mg/mL n/a n/a 48 h n/a n/a n/a n/a n/a n/aJN n/a 12 h n/a 8 h 72 h n/a 48 h n/a 16 h n/a n/a n/a n/a 10 mg/mL 10 d n/a n/a n/a n/a 6, 7 6, 7 n/a 24 h n/a n/a 10 d n/a n/a n/a 14 d 6, 7 n/a 6, 7 5, 6 OMNOMNOMN 5 mg/mL 5 mg/mL 5 mg/mL D5W NS NS n/a n/a n/a n/a n/a n/a 4 h 48 h 12 h 16 h n/a 72 h n/a n/a n/a n/a n/a n/a n/a Manufacturer Concentration Diluents CONTAINER OTHER INFUSION CONTAINERS Doripenem Bag, Polyethylene Chloride Polyvinyl (PVC) Unspecified Infusion Bag Glass 158 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Doripenem (cont’d) 5 5 5 1 2 2 1 Refer. Body Temp continued on next page n/a n/a n/a n/a n/a n/a d e d 16 h 16 h 16 h Room Refrig b b b n/a n/a n/a n/a n/a n/a n/a n/a Frozen Storage Conditions l l 72 h 24 h Temperature Post-thaw Temp k k 12 h4 h 72 h n/a 48 h n/a n/a n/a n/a n/a n/a n/a Room Refrig i i 4.81–5.12 4.81–4.96 Osmolality (mOsm/kg) pH

6 After constitution with SW or NS, suspension in vial may be held for up to 1 h prior to further dilution. Package insert states not to freeze After constitution with SW or NS, suspension in vial may be held for up to 1 h prior further dilution. Drug Normal saline, heparin flush. OMN 10 mg/mL D5W n/a n/a 16 h 7 d n/a n/a n/a n/a 5, 6 OMN 10 mg/mL NS n/a n/a 24 h 7 d 14 d OMN 5, 10 mg/mL NS n/a n/a n/a n/a 28 d OMNOMN 5 mg/mL 5 mg/mL NS D5W n/a n/a OMNOMN 5 mg/mL 5 mg/mL D5W NS n/a n/a n/a n/a 16 h 10 d 24 h n/a 10 d n/a 14 d n/a n/a 5, 6 SHI unspec. NS n/a n/a 12 h SHI unspec. D5W n/a n/a 4 h Manufacturer Concentration Diluents / TM ® (Halyard) ® previously frozen solution until all the precipitate has been fully redissolved. Thawed at 25°C. After thawing, a white precipitate was observed which returned to the solution after vigorous shaking for 3–12 min; to avoid potential for patient injury, do not infuse a After thawing, a white precipitate was observed which returned to the solution after vigorous shaking for 3–12 min; avoid 12 h stability at 35°C; 8 40°C. Thawed at 4°C for 24 h and then 25°C 2 h. Includes room temperature storage and infusion time. Final concentration when prepared per prescribing information. Stored at 30°C. Approximately 12 h. Protected from light. Includes refrigerator storage and infusion time. Acceptable pH range was 4.5–6; all samples met this criteria. Special Considerations: constituted suspension or diluted infusion solutions. Flush Compatibility: Doripenem (cont’d) Homepump Eclipse Minibag Plus Notes b c d e f g h i j k l Homepump 159 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Doripenem (cont’d) 2010; 2011; 37:174–85. J Antimicrob Chemother. 2010; 67:1539–44. 2008; 30:2075–87. Clin Ther. Int J Antimicrob Agents Am J Health-Syst Pharm. (doripenem for injection) [prescribing information]. Florham Park, NJ: Shionogi, Inc.; August 2015. (doripenem for injection) [prescribing information]. Florham ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. presentation at ASHP Summer Meeting and Exhibition. Seattle, WA: June 8–11, 2008. presentation at ASHP Summer Meeting and Exhibition. Seattle, WA: 65(5):1073–5. Doripenem (cont’d) 6. ASHP’s Interactive Handbook on Injectable Drugs. 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 September. 7. concentrations of doripenem (500 mg) for injection in representative infusion fluids and containers. Poster Psathas P, Gilmor T, Schaufelberger D, et al. Stability of high and low Note: 4. and doripenem solutions for administration by continuous infusion. Berthoin K, LeDuff C, Marchand-Brynaert J, et al. Stability of meropenem 5. chloride bags and elastomeric pumps. Crandon J, Sutherland C, Nicolau D. Stability of doripenem in polyvinyl 3. and meropenem at elevated room temperatures. Keel R, Sutherland C, Crandon J, et al. Stability of doripenem, imipenem References 1. Doribax 2. in representative infusion solutions and bags. Psathas P, Kuzmission A, Ikeda K, et al. Stability of doripenem in vitro 160 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DOXOrubicin Hydrochloride 1, 2 2, 8 2, 8 2, 4 2, 8 1, 2 2, 3 2 9 1, 2 2 2 t t t l, m, n, v s h, g, s s g, g, s Body Temp Refer. continued on next page n/a n/a n/a 13 n/a n/a n/a 2, 14 b a, f n/a n/a n/a 124 h n/a n/a n/a 124 h n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a 124 h n/a n/a n/a 7 d n/a n/a n/a 14 d n/a43 d n/a n/a n/a n/a30 d n/a n/a n/a 13 n/a n/a n/a 4 d Storage Conditions c l m n g g g a f f g g,q 28 d 124 d 14 d 28 d 43 d 34 d 30 d Temperature Post-thaw Temp c g g g a f f n/a 124 h n/a 124 h 28 d 14 d 14 d n/a n/a n/a 28 d 124 d n/a 124 h 1 d 14 d n/a n/a n/a n/a 14 d 1 d 14 d n/a n/a n/a n/a 12 14 d n/a43 d 7 d 14 d9 d 60 d30 d n/a n/a n/a n/a 13 14 dn/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a n/a 10 n/a 7 d Room Refrig Frozen Room Refrig j j j j j j j j j j j j j j j j j j j n/a Osmolality (mOsm/kg) pH d NS n/a NS n/a NS n/a NS l m d n Concentration Diluents Drug Drug PHU 0.12 mg/mL PHU 0.24 mg/mL PHU 0.4 mg/mL BEL 1.25 mg/mL NS, D5W n/a CET 2 mg/mL NS n/a AD 1, 2 mg/mL NS n/a unspec. 2 mg/mL NS n/a BEL 0.5 mg/mL NS n/a unspec. 2 mg/mL NS n/a BEL 0.5 mg/mLunspec.FA D5W 0.04 mg/mL 0.1 mg/mL n/a FA NS, D5W n/a 2 mg/mL NS, D5W n/a NYunspec.unspec. 1.67 mg/mL undilutedunspec. 0.2–5 mg/mL 0.2–5 mg/mL n/a 3 mg/mL 3.0 NS n/a NS 43 d D5W n/a n/a n/a n/a n/a n/a n/a 2, 14 unspec.FA 1 mg/mL 1.4 mg/mL NS NS n/a n/a Manufacturer ®

ST/LT ST/LT ® ®

TM Cassette Cassette ® Braun)

CONTAINER OTHER INFUSION CONTAINERS Polyolefin Dosi-Fuser Syringes, Syringes, CADD (B. (B. Braun) DOXOrubicin Hydrochloride DOXOrubicin Vinyl Ethylene Acetate (EVA) Chloride Polyvinyl (PVC) Plastic, Syringes, Terumo Monoject, Polypropylene AccuFlo (Pharmacia Deltec) (Leventon) Easypump 161 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DOXOrubicin Hydrochloride (cont’d) 2, 3 2, 7 5 5 5 5 5 6 2 2 o s g Body Temp Refer. continued on next page

2 n/an/a n/a n/a n/a n/a n/a n/a n/an /a n/a n /a n/a n /a 4 d n /a 11 4 w n/a n/a 7 d Storage Conditions p e f g g,q 14 d n/a n/a n/a n/a 14 d Temperature Post-thaw Temp o f

14 n/a9 d 47 d5 d n/a9 d n/a 42 d 9 d n/a 34 d n/a 96 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 48 h n/an/a n/a n/a n/a n/a n/a n/a n/an/a1 d 1 w 7 d n/a 14 d 14 d Room Refrig Frozen Room Refrig j j j j j j j j j j j j n/a n/a n/a Osmolality (mOsm/kg) pH o d i W NS D5½S, NS d o i Concentration Diluents

2 Heparin at 1,000 units/mL caused immediate precipitation when injected into Y-site with no flush. Drug Drug Normal saline. AD 0.2 mg/mL NS n/a ADADADAD 0.2–1 mg/mLNY 0.2–2 mg/mL 0.2–5 mg/mL 1 mg/mL 1.67 mg/mL NS NS NS n/a NS n/a n/a n/a PHU 2 mg/mL unspec. 2 mg/mLunspec. 3, 5 mg/mL NS NS n/a unspec. 2 mg/mLFA n/a 1.4 mg/mL NS n /a Manufacturer r

® 9000 9000 TM / ® Solutions also contained vincristine sulfate 0.036 mg/mL (LI). Frozen samples were subjected to 11 freeze/thaw cycles with no apparent loss in potency between cycles. Followed by 9 d at 25°C. Solutions stored in dark. Solutions not protected from light. Manufacturer extrapolated data from other sources. c d e f Homepump DOXOrubicin Hydrochloride (cont’d) DOXOrubicin Cassette PVC (Graseby Medical) Homepump Eclipse C-Series (Halyard) Pump Implantable (Medtronic DAD) INFUSOR (Baxter) (Epic SMARTeZ Medical) Unspecified Flush Compatibility: Special Considerations: Notes a b Graseby 162 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) DOXOrubicin Hydrochloride (cont’d) 1996; Am J Hosp Am J Health-Syst Pharm. 1998; 4(3):143–9. 1990; 15:279–89. 1987; 22:685–7. J Clin Pharm Ther. Hospital Pharmacy J Oncol Pharm Practice. 1991; 48:1976–7.

2 Bethlehem, PA: B. Braun USA; September 2015. Am J Hosp Pharm. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. . Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10) ® 2001; 58:594–8. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® 1992; 49:619–23. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser 53:1171–3. Stability Data for Drugs Using B. Braun’s AccuFlo Pharm. Am J Health-Syst Pharm. SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Also contains etoposide phosphate (BMS) 1.2 mg/mL and vincristine sulfate (LI) 10 mcg/mL. Followed by 5 d at 25°C. Followed by 4 d at 35°C. Also contains vincristine sulfate (LI) 33 mcg/mL; stored at 25°C, 30°C, and 37°C. Also contains vincristine sulfate (LI) 33 mcg/mL; stored at 25°C, Measured at 30°C. Also contains etoposide phosphate (BMS) 2 mg/mL and vincristine sulfate (LI) 16 mcg/mL. Also contains etoposide phosphate (BMS) 2 mg/mL and vincristine Measured at 40°C. Protected from light. After 14 d at 3°C or 23°C. Measured at 35°C. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Measured at 35–40°C. pH of lyophilized product reconstituted in NS is 3.8–6.5. undiluted solution 3.0. Also contains etoposide phosphate (BMS) 0.6 mg/mL and vincristine sulfate (LI) 5 mcg/mL. Solution also contained vincristine sulfate (FAU) 0.2 mg/mL. 12. 12. 14. 14. and epirubicin in plastic syringes minibags. Wood MJ, Irwin WJ, Scott DK. Stability of doxorubicin, daunorubicin 13. 13. g h i j 4. pump reservoirs. Stiles ML, Allen LV. Stability of doxorubicin hydrochloride in portable 9. DOXOrubicin Hydrochloride (cont’d) DOXOrubicin Note: 10. 10. for a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines 2. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 3. hydrochloride and vincristine sulfate in two portable infusion-pump reservoirs. Nyhammar EK, Johansson SG, Seiving BE. Stability of doxorubicin 8. of vincristine sulfate, doxorubicin hydrochloride, and etoposide phosphate in 0.9% sodium chloride injection. Yuan P, Grimes GJ, Shankman SE, et al. Compatibility and stability 11. l m n o p q r s t u v References 1. or doxorubicin hydrochloride in ethylene vinylacetete portable infusion-pump reservoirs. Rochard EB, Barthes DMC, Courtois PY. Stability of fluorouracil, cytarabine, 5. 6. 7. Graseby 9000 ambulatory infusion pump. Priston MJ, Sewell GJ. Stability of three cytotoxic drug infusions in the 163 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Doxycycline Hyclate 6 1 4 1 1 7 7 7 5 3 3 d Body Temp Refer. continued on next page n/a n/an/a n/a n/a n/a n/a n/a n/a c c c n/a n/a n/a n/a n/a n/a n/a n/a 1, 2 8 w n/a8 w n/a n/a n/a n/a n/a n/an/a n/a n/a n/a 24 h Storage Conditions b d c c c c c 3 d 72 h 3 d 3 d 3 d 3 d TemperatureTemp Post-thaw c a c c c c 12 h 12 h 3 d n/a n/a n/a n/a 48 h 96 h 7 dn/a n/a n/a n/a 8 w n/a n/a12 h 12 h n/a n/a 2 d n/a 12 h 3 dn/a n/a48 h n/a n/an/a 8 w n/a n/a n/an/a n/a 8 w n/a 24 h n/a 1, 2 Room Refrig Frozen Room Refrig e e e e

f f e f e ff e e ffff e e e 507 f e f e e (mOsm/kg) pH Osmolality D5W, NS NS D5W, D5W, NS NS D5W, W

1 Drug Normal saline. Incompatible with heparin. unspec. 1–1.5 mg/mL D5W, NS unspec. 1–1.5 mg/mL PFPFPF 0.1–1 mg/mL 0.8, 1 mg/mL 1 mg/mLPFPFPF D5W, NS unspec. 1 mg/mL 1 mg/mL D5W 1.5 mg/mL 1–1.5 mg/mLPFunspec. 292 unspec. 10 mg/mL 0.1–1 mg/mL D5W 1 mg/mL NS ES D5W, NS D5W, NS 2 mg/mL D5W, NS D5W 292 NS Manufacturer Concentration Diluents

ST/LT ST/LT

(Epic (Epic ® ® ®

/ TM ® Braun)

CONTAINER OTHER INFUSION CONTAINERS Medical) Flush Compatibility: SMARTeZ Dosi-Fuser (B. Homepump (B. Braun) Doxycycline Hyclate Chloride Polyvinyl (PVC) Unspecified AccuFlo (Leventon) Easypump Glass Vials Homepump Eclipse C-Series (Halyard) Pump Portable Reservoir Deltec) (Pharmacia 164 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Doxycycline Hyclate (cont’d)

1, 2

1 Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM 1, 2 Elastomeric Pump (ES.H.00.730-10). ® Administer by slow intravenous infusion over 1–4 h. Avoid extravasation. Protect from direct sunlight. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Simulated administration at 30°C. 5% loss in freshly prepared solution after 24 h; >5% loss in 6 h storage at 5°C for h. Simulated administration at 30°C. 5% loss in freshly prepared When protected from artificial light and sunlight, and stored under refrigeration for 72 h prior to start of infusion, infusion must then be completed within 12 h. When protected from artificial light and sunlight, stored under refrigeration for 72 h prior to start of infusion, infusion must pH of reconstituted solution is 1.8–3.3. Protect from direct sunlight. Manufacturer extrapolated data from other sources. Osmolality of 1 mg/mL (ES) is 292 mOsm/kg in dextrose 5% and 310 mOsm/kg in sodium chloride 0.9%. Osmolality of 1 mg/mL (ES) is 292 mOsm/kg in dextrose 5% and Special Considerations: Notes a b c d Doxycycline Hyclate (cont’d) 7. e f References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 September. 2. January 2008. Doxycycline for injection USP [package insert]. Schaumburg, IL: APP Pharmaceuticals; 3. 4. 5. 6. 165 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Enoxaparin Sodium 1 1 1 1 2 Body Temp Refer. . 2011; 47(5):299–301. n/a n/a n/a n/a Storage Conditions J Paediatr Child Health c 42 d TemperatureTemp Post-thaw b 42 d Room Refrig Frozen Room Refrig n/a n/a 14 d 14 d n/a n/a n/a n/a Osmolality (mOsm/kg) pH W

1 20 mg/mL NS n/a n/a n/a a Drug Normal saline. RPRRPR 1.2 mg/mLRPRunspec. 100 mg/mLSAV 100 mg/mL 20 mg/mL NS undiluted undiluted n/a n/a n/a n/a 5.5–7.5 5.5–7.5 n/a 48 h 5 d 10 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Manufacturer Concentration Diluents ; SAV, Macquarie Park NSW, Australia. ® CONTAINER Under natural light and in the dark. Clexane In the dark. Enoxaparin Sodium Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Flush Compatibility: Special Considerations: Notes a b c References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. of diluted enoxaparin under three different storage conditions. Summerhayes R, Chan M, Ignajatovic V, et al. Stability and sterility 166 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 166 22/05/17 1:55 PM Epirubicin Hydrochloride 1 1 1 1 1 1 1 1 1 4

5 g d, Body Temp Refer. continued on next page n/a n/a n/a 1, 6 a n/a n/a n/a 7 d n/an/a n/an/a n/a n/an/a n/a n/an/a n/a n/a43 d n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/an/a n/a n/a n/a n/a n/an/a n/a n/an/a 1, 3 n/a n/a 1, 2 n/a n/a 1, 6 n/a n/a n/a Storage Conditions a f d, a a a a a b a a a a 43 d TemperatureTemp Post-thaw a n/a 91 d n/an/a 30 d n/a 25 d n/a 7 d n/a 30 d 43 d 25 d n/a28 d n/a 28 dn/a 4 w14 d n/a 84 d n/an/a 180 d n/a n/a 43 d n/an/a n/a n/a n/a 30 d 25 d Room Refrig Frozen Room Refrig c c c c c c c c c c c c c c c n/a Osmolality (mOsm/kg) pH W

1,5 Store at 2°C to 8°C. Do not freeze. Protect from light. Refrigerated storage of 2 mg/mL commercial solution can result in formation of gelled Store at 2°C to 8°C. Do not freeze. Protect from light. Refrigerated storage of 2 mg/mL commercial solution Drug Normal saline. Incompatible with heparin. unspec. 0.2–1 mg/mL NS n/a FAFAFAFA 0.05 mg/mLFA 0.05 mg/mLRP 0.04 mg/mLunspec. 0.05 mg/mLunspec. 0.05 mg/mL 1 mg/mL 0.1 mg/mL D5WPH NS 0.5 mg/mLFARP D5W, NS n/a D5W 1 mg/mL n/a n/a NS 2 mg/mLFA D5W, NS 2 mg/mL NS n/a FA NS n/a n/a 0.05 mg/mL n/a 0.05 mg/mL NS n/a NS n/a n/a D5W NS n/a n/a Manufacturer Concentration Diluents e CONTAINER OTHER INFUSION CONTAINERS Special Considerations: removal from refrigeration. product, which will return to slightly viscous mobile solution after 2–4 h at controlled room temperature. Use within 24 Epirubicin Hydrochloride Polyethylene Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Glass INFUSOR (Baxter) Flush Compatibility: 167 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 167 22/05/17 1:55 PM Epirubicin Hydrochloride (cont’d) 1990; 15:279–89. 2003; 28:349–53. J Clin Pharm Ther. J Clin Pharm Ther. 1997; 31:992–5.

4 Ann Pharmacother. Ontario, Canada: Baxter Corporation; October 2008.

1 Intermate/Infusor Drug Stability Information. Solutions <0.5 mg/mL should be protected from light. Data are valid for unbuffered solutions. Solutions <0.5 mg/mL should be protected from light. Data are Storage at 8°C followed by 2 h 25°C, then 1 37°C to simulate storage, transport, and clinical use. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Protected from light. pH of undiluted preparation is 3.0. At 33°C. Followed by 7 d at 33°C. e f g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. 0.9% injection. Pujol M, Munoz Prat J, et al. Stability study of epirubicin in NaCl 4. 5. KY: Areva Pharmaceuticals, Inc.; January 2012. Epirubicin Hydrochloride Injection [product information]. Elizabethtown, 6. and epirubicin in plastic syringes minibags. Wood MJ, Irwin WJ, Scott DK. Stability of doxorubicin, daunorubicin Notes a b c d 3. infusion: a sequential temperature study. Sewell GJ, Rigby-Jones AE, Priston MJ. Stability of intravesical epirubicin Epirubicin Hydrochloride (cont’d) 168 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 168 22/05/17 1:55 PM Epoetin Alfa 1 1 1 1 Body Temp Refer. n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions d c 12 w 14 d TemperatureTemp Post-thaw d c 14 d n/a 6 w n/a n/a n/a n/a Room Refrig Frozen Room Refrig f f e, e, Product is available in multidose preserved and single-dose un- 2 n/a n/a 12 w Osmolality (mOsm/kg) pH b D10W n/a n/a 24 h n/a n/a n/a n/a n/a 1, 3

1 1 a Store under refrigeration, do not freeze, protect from light until use. Drug n/a ORT 0.1 units/mL ORT 4,000 units/mL NS unspec. 2,000, 10,000 units/mL undiluted iso AMG 20,000 units/mL undiluted iso Manufacturer Concentration Diluents (epoetin alfa) injection [package insert]. Thousand Oaks, CA: Amgen, Inc.; April 2014. ® dose vial; dilutions to higher concentrations of epoetin alfa (e.g., 5,000 units/mL) have lower benzyl alcohol preservative concentrations and failed the preservative dose vial; dilutions to higher concentrations of epoetin alfa (e.g., 5,000 units/mL) have lower benzyl alcohol preservative effectiveness test. CONTAINER OTHER INFUSION CONTAINERS This dilution with benzyl alcohol-preserved NS is stable and bacteriostatic for up to 12 w. Literature recommends limiting the use of this dilution 28 d as a multiple This dilution with benzyl alcohol-preserved NS is stable and bacteriostatic NS preserved with 0.9% benzyl alcohol was added to epoetin vials at a dilution of 1.5:1. The pH of undiluted epoetin alfa from single use vials is 6.6–7.2. Samples also contained a final concentration of albumin 0.05% or 0.1%. Due to lack of preservative in single use vials, manufacturer recommends shortly after drawing up syringes. The pH of undiluted epoetin alfa from multidose vials is 5.8–6.4. Flush Compatibility: Special Considerations: Epoetin Alfa Syringes, Plastic Glass Vials f 3. in commonly used neonatal intravenous solutions. Ann Pharmacother. 1996; 30:466–8. Ohls RK, Christensen RD. Stability of human recombinant epoetin alfa References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 April. 2. Epogen preserved formulations. The commercial multidose vials may be stored under refrigeration after initial dose removal and discarded 21 days after initial vial entry. preserved formulations. The commercial multidose vials may be stored under refrigeration after initial dose removal and discarded 7 days at room temperature. Unopened single-dose vials may be stored for 14 days at room temperature, and unopened multidose Notes a b c d e 169 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 169 22/05/17 1:55 PM Epoprostenol Sodium

2,4,5 5 2 (ng)/mL. Body Temp Refer. continued on next page nanograms 15,000 ng/mL. See package insert ≥ n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 4 n/a n/a n/a n/a 1, 4 n/a n/a n/a n/a 1, 2 n/a n/a n/a n/a 1, 4 Storage Conditions c c p p o p 40 h 8 d 8 d 8 d 40 h 8 d TemperatureTemp Post-thaw o h h h b b 72 h 8 h Room Refrig Frozen Room Refrig

2 e 11.7–12.3 10.2–10.8 3,000 and <15,000 ng/mL 48 h for ≥ n/a n/a n/a 11–11.8 8 h Osmolality (mOsm/kg) pH j j a, a, n j,

Product labeling states preparation and administration concentrations in 2 2,5

pH 12 sterile sterile 12 pH diluent W, NS n/a 11–13 72 h 2,4,5

2,4,5 DO NOT FREEZE. 2,4,5 60,000 ng/mL 3,000–15,000 ng/mL sterile diluent up to 15,000 ng/mL ≥ 3,000–15,000 ng/mL sterile diluent 15,000 to <60,000 ng/mL W, NS n/a 11–13 48 h 3,000 to <15,000 ng/mL W, NS n/a 11–13 48 h Protect from light. f f f k k Drug i n/a. Infusion should not be interrupted. GSK GSK ACT TE ACT ACT Manufacturer Concentration Diluents [ACT]. [GSK]. ® ® to use provided that total time of refrigerated storage plus administration using a cold pouch does not exceed 48 h. solutions. administration: 72 h at up to 25°C, 48 30°C, 24 35°C, and 12 40°C. for concentration- and temperature-dependent stability data when administered above controlled room temperature. OTHER INFUSION CONTAINERS If stored for up to 8 days at 2–8ºC, administration time 25°C is 24 h concentrations When used with a cold pouch and frozen gel packs, reconstituted solutions may be used for up to 24 h. Change gel packs every 12 h. May be stored refrigerated prior When used with a cold pouch and frozen gel packs, reconstituted solutions may be for up to 24 h. Change packs every Solutions prepared with pH-12 Sterile Diluent may be stored for up to 8 days at 2–8ºC prior administration. Ambient temperature affects the stability Solutions prepared with pH-12 Sterile Diluent may be stored Prepared with pH-12 Sterile Diluent provided by the manufacturer. Used after reconstitution and immediate dilution to final concentration and immediate administration. Used after reconstitution and immediate dilution to final concentration Preparation is increasingly unstable at lower pH. Sterile diluent 50 mL vial provided by manufacturer contains 94 mg glycine, 73.3 mg sodium chloride, and sodium hydroxide (to adjust pH) W. Sterile diluent 50 mL vial provided by manufacturer contains 94 mg glycine, 73.3 sodium chloride, and hydroxide Flolan Following reconstitution or removal from refrigerated storage. Protect reconstituted product from temperatures <0°C and >25°C. Do not freeze reconstituted Following reconstitution or removal from refrigerated storage. Protect reconstituted product temperatures <0°C and >25°C. Veletri Do not reconstitute or mix with other solutions medications. Epoprostenol Sodium for Injection [TE]. Special Considerations: Stability is formulation dependent. Do not extrapolate stability data across brands. Notes a b c e Flush Compatibility: o p n f h i j k Epoprostenol Sodium Ambulatory Pump Infusion Reservoir (Polyvinyl Chloride, or Polypropylene, Glass) 170 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 170 22/05/17 1:55 PM Epoprostenol Sodium (cont’d) (epoprostenol) for Injection [prescribing information]. South San Francisco, CA: Actelion Pharmaceuticals; June 2012. (epoprostenol) for Injection [prescribing information]. South (epoprostenol sodium) for injection for IV use [prescribing information]. Research Triangle Park, NC: Glaxo Smith Kline; April 2015. (epoprostenol sodium) for injection IV use [prescribing information]. ® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 February. 2. Flolan Epoprostenol Sodium (cont’d) 5. CA: Teva; October 2011. Epoprostenol Sodium for Injection [prescribing information]. Irvine, Note: 4. Veletri 171 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 171 22/05/17 1:55 PM Ertapenem Sodium 6 6 3 3 5 5 1 1 2 2 4 4 3 Body Temp Refer. continued on next page n/an/a n/a n/a n/a n/a n/a n/a n/an/a n/a28 d n/a n/a 1 h n/a n/a n/a n/a n/a Storage Conditions e e f d d 7 d 5 d 110 h 110 h 24 h TemperatureTemp Post-thaw e e d d

1 d 1 d 30 h24 h 8 d 7 d n/a n/a n/a n/a n/a n/a n/a n/a 1 d 5 d n/a n/a n/a n/a 1 d 7 d n/a n/a n/a n/a 24 h24 h 7 d 5 d n/a n/a n/a n/a n/a n/a n/a n/a 24 h18 h 7 d 5 d n/a n/a n/a n/a n/a n/a n/a n/a 17 h 19 h 30 min 3 Room Refrig Frozen Room Refrig a a a a a a a a a a a a a a Do not freeze. 3,7 4 n/a Osmolality (mOsm/kg) pH W 3

3 Concentration Diluents 3 Drug Do not reconstitute or dilute with dextrose-containing solutions. unspec. 20 mg/mL NS n/a unspec. 10 mg/mL NS n/a ME 10 mg/mL NS n/a ME 20 mg/mL NS n/a unspec. 20 mg/mL NS n/a unspec. 10 mg/mL NS n/a unspec.unspec. 10 mg/mL 20 mg/mL NS NS n/a n/a ME 20 mg/mL NS n/a ME 10 mg/mL NS n/a MEMEME 20 mg/mL 20 mg/mL 100 mg/mL NS NS n/a n/a Manufacturer Heparin lock flush and normal saline. / c ® Braun)

ST/LT ST/LT

® (Halyard) ® (B.

® TM Medical)

Braun)

CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. Storage in 60 mL luer-tip plastic syringes (BD) with tubing (RMS) attached and capped. Storage in 60 mL luer-tip plastic syringes (BD) with tubing (RMS) pH of reconstituted solution is 7.5. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Stable for 4 h at room temperature after 24 under refrigeration. Special Considerations: Flush Compatibility: (Epic SMARTeZ (B. Easypump Ertapenem Sodium Syringes, Plastic (BD) Syringes, Polypropylene AccuFlo Homepump Eclipse Homepump C-Series INTERMATE (Baxter) c d e Notes a f 172 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 172 22/05/17 1:55 PM Ertapenem Sodium (cont’d) Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. (data on file). Chester, NY: RMS Medical Products; July 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Antibiotic Stability in Freedom 60 Syringe and Tubing System Stability Data for Drugs Using Elastomeric Infusion Pumps. (ertapenem for injection) [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; September 2014. ® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory 7. INVANZ Ertapenem Sodium (cont’d) Note: 5. References 1. 6. 2. 3. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 4. Fugit D, Anderson B. 173 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 173 22/05/17 1:55 PM Erythromycin Lactobionate 1 1 1 1 1 1 1 3 3 3 b Body Temp Refer.

1 n/a n/an/an/a n/a n/an/a n/a 24 h n/a n/a n/a n/a n/a n/a n/a Storage Conditions e e e b 10 d 10 d TemperatureTemp Post-thaw e e n/an/a 24 h24 h n/a 24 hn/a n/a n/an/a n/a n/a n/an/a n/a 60 d n/a 12 m n/a n/a 20 d n/a n/a n/a n/an/a n/a n/a n/a n/a n/a 24 h n/a n/a24 h n/a n/a n/a n/a 24 h 10 d n/a Room Refrig Frozen Room Refrig d d d d d d d d d d d n/a Osmolality (mOsm/kg) pH

1 NS, D5W, D5S

1 Ontario, Canada: Baxter Healthcare Corporation; October 2008. Do not use normal saline or other solutions containing inorganic ions to reconstitute regular vials; precipitate will result. Do not use normal saline or other solutions containing inorganic ions to reconstitute regular vials; precipitate Drug Incompatible with heparin; forms precipitate. ABABAB 1 mg/mL ABAB 1 mg/mL 4 mg/mLAB 4.55 mg/mL 8.3 mg/mLES 2 mg/mL NS, D5W, D5SAB n/a NS NSAB 20 mg/mLAB NS 2.5–10 mg/mL NS 2.5–10 mg/mL n/a n/a 10 mg/mL n/a NS NS n/a D5W n/a D5W n/a n/a n/a Manufacturer Concentration Diluents f Cassette Cassette ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. CONTAINER OTHER INFUSION CONTAINERS pH of reconstituted product is 6.5–7.5 in W. Stable for 24 h at 30°C after refrigerated. Diluents were used as is. D5W was not neutralized as instructed by drug insert; therefore, allocated shelf life is worst case. Diluents were used as is. D5W was not neutralized instructed INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Notes b d Special Considerations: e f References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 September. 3. Note: Erythromycin Lactobionate Glass Chloride Polyvinyl (PVC) Unspecified CADD Deltec) (Pharmacia INTERMATE (Baxter) Flush Compatibility: 174 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 174 22/05/17 1:55 PM Ethanol (Catheter Lock)

5 2 4 2 J Parent Body Temp Refer. 2007; 13:33–7. 2007; 64:2480–2. Ethanol may cause deterioration of 3 Storage Conditions J Oncol Pharm Practice. TemperatureTemp Post-thaw Am J Health-Syst Pharm. Room Refrig Frozen Room Refrig n/a n/a 14 d n/a n/a n/a n/a n/a n/a n/a 28 d n/a n/a n/a n/a n/a n/a n/a 14 d n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH 2008; 1(2):1, 10–1. a

W W 2,5 Home Infusion Continuum c Incompatible with heparin. 3,5 50% Ethanol concentrations above 40% are required to inhibit bacterial growth in established biofilms. Drug Normal saline. b AMRAMR 70% 70% BWFI Manufacturer Concentration Diluents 2011; 35:67–73. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Enteral Nutr. CONTAINER AAPER Alcohol and Chemical, Shelbyville, KY. BWFI containing benzyl alcohol as a preservative. Diluted solution was filtered through two 0.2-micron filters. 5. Bing CM, Ross KL. Antibiotic and ethanol lock therapy. Special Considerations: 3. Cober MP, Kovacevich DS, Teitelbaum DH. Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. Note: 4. Pomplun M, Johnson JJ, Johnston S, et al. Stability of a heparin-free 50% ethanol lock solution for central venous catheters. Flush Compatibility: certain plastic materials; check with the device manufacturer to verify compatibility or potential for degradation due to extended exposure to ethanol catheter lock. certain plastic materials; check with the device manufacturer to verify compatibility or potential for degradation due extended Ethanol (Catheter Lock) Syringes, Polypropylene Notes a b c References 2. Cober MP, Johnson CE. Stability of 70% alcohol solutions in polypropylene syringes for use ethanol-lock therapy. 175 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 175 22/05/17 1:55 PM Etoposide 2 6 8 3 4 6 4 5 Body Temp Refer. continued on next page n/a n/a n/a n/a Storage Conditions a 28 d n/a n/a n/a n/a7 d n/a n/a n/a n/a n/a 5, 6 22 d22 d n/a14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 5, 6 5, 6 TemperatureTemp Post-thaw a h b,c h h h 28 d 22 d 22 d n/a n/a n/a n/a 9 d n/a n/a n/a n/a n/a 9 d n/a n/a n/a n/a n/a 4 d n/a n/a n/a n/a n/a 48 h4 d 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 72 h 4 d22 d n/a2 d 14 d4 d n/a n/a 7 d48 h n/a5 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 n/a 5, 6 n/a n/a 5, 6 n/a 1, 6 1, 6 14 d 7 d 7 d Room Refrig Frozen Room Refrig i i i i i i i i i i i i i i i i i i n/a n/a n/a Osmolality (mOsm/kg) pH e d NS n/a NS D5W n/a NS NS LR, D5W, NS n/a NSNSNS n/a n/a n/a e j h d h h h a Drug unspec. 1 mg/mL unspec. 0.2 mg/mL NS n/a SZ 0.157 mg/mL TE 0.24 mg/mL NS n/a unspec. 0.1–0.4 mg/mL NS n/a BMS 0.2 mg/mL BMS 0.125, 0.175 mg/mL BR 0.4 mg/mL NS n/a BRNOVNOVBR 0.05–0.4 mg/mL 0.2 mg/mLBR 0.3 mg/mLNOVNOV 0.4 mg/mL 0.5 mg/mL 10 mg/mL NS 10.5 mg/mL NS NS n/a n/a NS n/a n/a NOVNOV 11 mg/mL 12 mg/mL Manufacturer Concentration Diluents g

® / ® Container k ® CONTAINER OTHER INFUSION CONTAINERS Unspecified Homepump Etoposide Chloride Polyvinyl (PVC) Polypropylene Dosi-Fuser (Leventon) Excel (McGaw Canada) Homepump Eclipse C-Series (Halyard) Syringes, Syringes, Glass 176 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 176 22/05/17 1:55 PM Etoposide (cont’d) 10 10 9 10 10 m m m m Body Temp Refer. continued on next page Storage Conditions n/a n/a n/a n/a n/a TemperatureTemp Post-thaw n 9 d Room Refrig Frozen Room Refrig i i 10 mg/mL not exceed 5 d. ≥ Osmolality (mOsm/kg) pH NS n/a n

6 6 Precipitation of etoposide may be exacerbated by the use of peristaltic pumps, especially at concentrations of 0.4 mg/mL or above. Precipitation of etoposide may be exacerbated by the use peristaltic pumps, especially at concentrations Drug Normal saline. unspec. 0.1–0.4 mg/mL TE 0.6 mg/mL NS, D5W n/a n/a 8 h n/a n/a n/a n/a 6 h TE 0.4 mg/mL NS, D5W n/a n/a 24 h n/a n/a n/a n/a 24 h TE 0.1 mg/mL NS n/a n/a 24 h n/a n/a n/a n/a 24 h TE 0.1 mg/mL D5W n/a n/a 12 h n/a n/a n/a n/a 12 h Manufacturer Concentration Diluents (Epic (Epic ® l containers are polyolefin-lined. ® patient exposure to DEHP. precipitate of drug. At least one syringe seized during administration because of crystallization at a concentration of 1 mg/mL. The author noted that etoposide precipitate of drug. At least one syringe seized during administration because crystallization at a concentration 1 mg/mL. refrigerator. syringes prepared at a concentration of 0.5 and 1 mg/mL have remained stable free precipitate for over y stored in laboratory mL and doxorubicin 35 mcg/mL. Stored at 33°C. Sample also contained vincristine 1.6 mcg/mL and doxorubicin 40 mcg/mL. Sample also contained vincristine 1.6 mcg/mL and doxorubicin Protected from light. Manufacturer extrapolated data from other sources. Authors recommended that room temperature storage of etoposide solutions in NS Authors recommended that room temperature storage of etoposide 0.125 mg/mL etoposide solution also contained vincristine 1 mcg/mL and doxorubicin 25 mcg/mL. 0.175 mg/mL etoposide solution also contained vincristine 1.4 mcg/ 0.125 mg/mL etoposide solution also contained vincristine 1 mcg/mL Manufacturer recommends against using solutions more concentrated than 0.4 mg/mL. Etoposide crystallization is unpredictable. Some syringes in the study showed Manufacturer recommends against using solutions more concentrated than 0.4 mg/mL. Etoposide crystallization is unpredictable. The polysorbate-80 surfactant in the etoposide formulation leaches DEHP plasticizer from PVC containers and tubing. Use non-PVC tubing to reduce The polysorbate-80 surfactant in the etoposide formulation leaches Sample storage temperature 31–33°C. Excel Also contains cytarabine (UP) 0.157 mg/mL and daunorubicin HCl (BEL) 15.7 mcg/mL. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. pH of undiluted solution is 3–4. j k l m n Medical) SMARTeZ i Flush Compatibility: Special Considerations: Volumetric pumps may reduce this problem. h Notes a b c d e g Etoposide (cont’d) INTERMATE (Baxter) 177 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 177 22/05/17 1:55 PM Etoposide (cont’d)

Am J Health-Syst J Parenter Sci Technol. . 2014; 14:13–23. Drugs R D 1987; 238:476–8. Pharm J. 2000; 53:338–45. Can J Hosp Pharm. . Irvine, CA: Halyard Health; March 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® 1999; 56:985–9. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 1991; 45:108–12. Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Pharm. SMARTeZ Drug Stability Table-Dosi-Fuser 10. 10. in disposable infusion devices for day hospital cancer practices. Klasen A, Kessari R, Mercier L, et al. Stability of etoposide solutions Etoposide (cont’d) Note: References 1. Beijnen JH, Beijnen-Bandhoe AU, Dubbelman AC, et al. Chemical and physical stability of etoposide teniposide in commonly used infusion fluids. 2. of home infusion therapy for cancer patients. Adams PS, Haines-Nutt RF, Bradford E, et al. Pharmaceutical aspects 3. 4. sulfate, doxorubicin hydrochloride, and etoposide in 0.9% sodium chloride injection. Wolfe JL, Thoma LA, Du C, et al. Compatibility and stability of vincristine 5. in normal saline. Lepage R, Walker SE, Godin J. Stability and compatibility of etoposide 9. 6. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 8. 178 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 178 22/05/17 1:55 PM Etoposide Phosphate 1 1 3 3 1, 2 1, 2 1, 2 j j i h, h, h, a a Body 124 h Temp Refer. continued on next page n/a n/a n/ah 124 n/a n/a n/ah 124 n/a n/a n/a Storage Conditions j j j TemperatureTemp Post-thaw Room Refrig Frozen Room Refrig n/a n/a 31 d 31 d n/a n/a n/a 7 d n/a n/a 24 h 7 d n/a n/a n/a n/a n/a n/a 48 h 7 d n/a n/a n/a n/a Osmolality (mOsm/kg) pH

3 b NS b

3 b W W, D5W, NS NS n/a n/a n/a 124 h BWFI, NS n/a n/a n/a 124 h NS n/a n/a n/a 124 h

2 k k e f g

1 Unlike etoposide, the phosphate ester etoposide phosphate is very water soluble and is suitable for administration via multiple-day Unlike etoposide, the phosphate ester etoposide is very water soluble and suitable for Drug Heparin lock flush and normal saline. BMSBMS 10, 20 mg/mL 0.6 mg/mL BRBR 0.1, 10 mg/mL 10, 20 mg/mL D5W, NS n/a n/a 31 d 31 d n/a n/a n/a 7 d BMS 10, 20 mg/mL BMS 1.2 mg/mL BMS 2 mg/mL Manufacturer Concentration Diluents

2 CONTAINER Bacteriostatic, preserved with benzyl alcohol. Tested at 35–40°C. Also contains vincristine sulfate (LI) 5 mcg/mL and doxorubicin HCl (PHU) 120 mcg/mL. Also contains vincristine sulfate (LI) 5 mcg/mL and doxorubicin Storage at 32°C. Etoposide phosphate concentration expressed as etoposide equivalent. Also contains vincristine sulfate (LI) 16 mcg/mL and doxorubicin HCl (PHU) 400 mcg/mL. Also contains vincristine sulfate (LI) 16 mcg/mL and doxorubicin Also contains vincristine sulfate (LI) 10 mcg/mL and doxorubicin HCl (PHU) 240 mcg/mL. Also contains vincristine sulfate (LI) 10 mcg/mL and doxorubicin Tested in the dark. Tested in the dark and under regular fluorescent light. j Special Considerations: ambulatory infusion devices. k Syringes, Syringes, Flush Compatibility: Refrigerate unopened vials and retain original package to protect from light. Etoposide Phosphate Glass Vial Polyolefin-Lined Bag (McGaw) Chloride Polyvinyl (PVC) Polypropylene Notes a b e f g h i 179 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 179 22/05/17 1:55 PM Etoposide Phosphate (cont’d) Am 2001; 58:594–8. (etoposide phosphate) for Injection [package insert]. Princeton, NJ: Bristol-Myers Squibb; July 2015. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. J Health-Syst Pharm. Note: Etoposide Phosphate (cont’d) 3. Etopophos References 1. ASHP's Interactive Handbook on Injectable Drugs. 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. of vincristine sulfate, doxorubicin hydrochloride, and etoposide phosphate in 0.9% sodium chloride injection. Yuan P, Grimes GJ, Shankman SE, et al. Compatibility and stability 180 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_E.indd 180 22/05/17 1:55 PM Famotidine C o 1 1 5 1 1 1 3 4 Body Temp Refer. Storage Conditions n/a n/a n/a n/a n/a TemperatureTemp Post-thaw n/a15 d n/a 63 d48 h 28 dn/a n/a 28 d n/a15 d 28 d 14 d n/an/a 14 d n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a 8 w n/a n/a n/a n/a n/aa n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig b b ccc b b cc b c b b b Osmolality (mOsm/kg) pH

1 and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM D5W, NS, W, W, NS, D5W, D10W, LR

1 HealthTek

1 Drug Stability in Plastic Syringes. Store vials under refrigeration and protect from freezing; room temperature excursion statements support vial storage for 3 months to 26 Store vials under refrigeration and protect from freezing; room temperature excursion statements Drug Heparin lock flush and normal saline. MSDunspec.unspec. 0.2 mg/mL 0.2 mg/mLMSD 0.33 mg/mLMEMSD 2 mg/mLAPP 0.2 mg/mL D5W, NS 2 mg/mL D5W, NS D5W, NS 0.2 mg/mL BA 256, 279 D5W, NS, W D5W, NS 0.4 mg/mL D5W, NS, W NS iso 5.7–6.4 Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. does not adversely affect the commercial premix product. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. does not adversely affect the commercial premix product. Do extrapolate stability data to extemporaneously CONTAINER COMMERCIAL PREPARATIONS (RTU) pH of undiluted solution is 5–5.6. Expiration date per manufacturer's label when stored under the recommended conditions at controlled room temperature. Brief exposure to temperatures up 35 Expiration date per manufacturer's label when stored under the recommended conditions at controlled room temperature. Brief Osmolarity of the single and multiple dose products are 217 290 mOsm/L. Special Considerations: weeks at controlled room temperature. Famotidine Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Unspecified Bag Galaxy (Baxter) Flush Compatibility: b Note: Notes a c References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 3. LLC; July 2011. Famotidine injection [package insert]. Schaumburg, IL: APP Pharmaceuticals 4. insert]. Deerfield, IL: Baxter Healthcare Corporation; April 2015. Famotidine Injection in Galaxy Plastic Container (PL2501) [package 5. Rapp RP, Hatton J, Record K. 181 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 181 22/05/17 1:55 PM Fentanyl Citrate 1, 4 1, 4 1 1 8 8 8 8 1 1 1 1 1 1 8 8 1 1 1 1 t k, t Body Temp Refer. continued on next page n/a n/a n/a n/a 1, 6 n/a n/a n/a 30 d n/an/a n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions r r q p k z t p q h k, t o h, j i a h, h, h, h s a h, h, h, h, o 30 d n/a n/a n/a n/a n/a 1, 7 30 d 24 h 28 d 28 d 51 d 30 d 30 d 30 d 7 d n/a n/a n/a n/a n/a 1, 5 n/a n/a n/a n/a n/a 1, 5 30 d 30 d 28 d TemperatureTemp Post-thaw m l k z t

k, h t o f,h, j i a f,h, s a h, h, o Room Refrig Frozen Room Refrig 28 d 28 d 30 d 7 d 7 d n/a n/a n/a 7 d 30 d 24 h 51 d 30 d 30 d 30 d 30 d 7 d 48 h n/a n/a n/a n/a n/a 30 d 28 d 28 d 30 d 30 d 30 d n/a n/a n/a n/a 30 d 24 d n y y n n n n n n n n n n n n n n n n Osmolality (mOsm/kg) pH NS n/a NS n/a NS n/a 4.4–5.8 n/a NS n/a 4.5–5.3 n/a NS n/a NSNS n/a NSNSNS n/a n/a n/a n/a NS n/a NS n/a 4.1–4.7 n/a 28 d NS n/a 4.6–5 n/a 28 d NS n/a 4–4.9 n/a 28 d NS n/a 4.1–5.6 n/a 28 d NS n/a NS n/a NS n/a p q q p l z r r k s a k o m j i a o Drug AB 50 mcg/mL undiluted n/a 5.43 JN 35 mcg/mL DBES 12.5, 33 mcg/mL 16.7 mcg/mL NS n/a JN 35 mcg/mL NS n/a HSP 5 mcg/mL NS n/a 4.1–4.5 90 d SZ 0.15, 43 mcg/mL SZ 0.15, 25 mcg/mL SZ 0.15, 25 mcg/mL CURSZ 3 mcg/mL JN 0.15 mcg/mL JNunspec. 1 mcg/mL unspec.CUR 2 mcg/mL 2 mcg/mL JN 2 mcg/mL DB 3 mcg/mL 5 mcg/mL 10 mcg/mL SZ NS, D5W 0.15 mcg/mL n/a JN 1, 10 mcg/mL SZ 0.15, 43 mcg/mL JNJN 20 mcg/mL 20 mcg/mL NS n/a JN 35 mcg/mL AB 50 mcg/mL undiluted n/a 5.43 Manufacturer Concentration Diluents CONTAINER Fentanyl Citrate Vinyl Ethylene Acetate (EVA) Bags Non-DEHP (INTRAVIA, Baxter) Polypropylene (Mark II Polybag) Chloride Polyvinyl (PVC) Polypropylene Syringes, Syringes, 182 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 182 22/05/17 1:55 PM Fentanyl Citrate (cont’d) 3 3 3 3 1 2 1 9 1 1 1 v x e, d w, c b 48 h Body Temp Refer. continued on next page n/a n/a n/a 7 d n/a n/a n/a 5 d n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a x Storage Conditions w, d c e o 30 d 90 d n/a n/a n/a n/a 7 d 30 d 51 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw x c b e o s w, Room Refrig Frozen Room Refrig 3 d n/a 90 d 14 d 30 d 30 d14 d 30 d 14 d n/a n/a n/a n/a n/a n/a n/a n/a 30 d 30 d 60 d51 d 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a 30 d n n n n n n n n n n n n n/a Osmolality (mOsm/kg) pH NS, D5W n/a NS n/a NS n/a

1 x e e w, s o Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating the need for extended medication storage in BD Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating need for extended Drug Heparin lock flush and normal saline. JN 1–5 mcg/mL JN 1–5 mcg/mL NS, D5W n/a JN 1–5 mcg/mL NS, D5W n/a JN 1–5 mcg/mL NS, D5W n/a JNME 20 mcg/mL 30, 50 mcg/mL NS NS n/a n/a JNJN 1.25 mcg/mL CURJN 1–5 mcg/mLDB 3 mcg/mL 5 mcg/mL 10 mcg/mL NS n/a NS, D5W n/a Manufacturer Concentration Diluents u

10 Cassette Cassette ® OTHER INFUSION CONTAINERS Storage for 90 d refrigerated, followed by 7 at 33°C. Storage for 30 d at room temperature followed by 7 33°C. Protected from light. Also contained bupivacaine 0.44 mg/mL and epinephrine 0.69 mcg/mL. Also contained bupivacaine 0.44 mg/mL and epinephrine 0.69 Combined with bupivacaine 1.25 mg/mL. Combined with bupivacaine hydrochloride 1 mg/mL and clonidine hydrochloride 9 mcg/mL. Combined with bupivacaine hydrochloride 1 mg/mL and clonidine Storage for 90 d refrigerated, followed by 14 room temperature, 7 at 33°C. Tested at 30°C (near body temperature). Combined with lidocaine 2.5 mg/mL (AST). Combined with bupivacaine 600 mcg/mL. Notes a b c d e f h i j k Special Considerations: syringes. Flush Compatibility: Dosi-Fuser Fentanyl Citrate (cont’d) CADD (SIMS Deltec) (Leventon) Glass INFUSOR (Baxter) 183 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 183 22/05/17 1:55 PM Fentanyl Citrate (cont’d) . . 2010; 63:154–5. Am J Health-Syst Pharm 2002; 27:39–45. 1990; 47:1572–4. Can J Hosp Pharm J Clin Pharm Ther. . 2005; 9(6):482–3. Am J Health-Syst Pharm.

1 Int J Pharm Compound Barcelona, Spain: Leventon SAU; October 2015. 2002; 6:471–4. Ontario, Canada: Baxter Corporation; October 2008.

1 Elastomeric Pump (ES.H.00.730-10). ® Int J Pharm Compound. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. Accessed There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. June 5, 2016. Drug Stability Table-Dosi-Fuser 2009; 6:860–3. Intermate/Infusor Drug Stability Information. polypropylene syringes. Combined with ropivacaine 1 mg/mL. With 0.5–7.5 mg/mL bupivacaine hydrochloride (AST). With 0.01 mg/mL bupivacaine hydrochloride (HSP). With 20 mg/mL bupivacaine hydrochloride (HSP). Combined with ropivacaine 1.5 mg/mL. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH range of undiluted solutions is 4–7.5. Storage for 30 d at 3°C or 23°C, then 48 h 30°C. pH did not exceed 5.43. Combined with ondansetron 1.33 mg/mL (GW). Storage for 30 d refrigerated, followed by 3 room temperature, 5 at 33°C. With 50 mcg/mL droperidol (JN) and 1 mg/mL ketamine hydrochloride (JN). With 50 mcg/mL droperidol (JN) and 1 mg/mL ketamine hydrochloride With 37.5 mg/mL bupivacaine hydrochloride (HSP). Although pH remained within stability range for the drug, this does not definitively demonstrate stability. Although pH remained within stability range for the drug, this Combined with ropivacaine 2 mg/mL. Fentanyl Citrate (cont’d) 10. 10. FDA Safety Alert for Human Medical Products: Compounded or Repackaged Drugs Stored in Becton-Dickinson (BD) 3 mL and 5 Syringes: Alert—Do Not Use Unless Note: 9. 8. bupivacaine with hydromorphone, morphine, and fentanyl. Donnelly RF, Wong K, Spencer J. Physical compatibility of high-concentration 7. diluted with 0.9% sodium chloride injection and stored in polypropylene syringes. McCluskey SV, Graner KK, Kemp J, et al. Stability of fentanyl 5 mcg/mL u v w x y z References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. chloride solution in portable infusion pumps. Allen LV, Stiles ML, Tu YH. Stability of fentanyl citrate in 0.9% sodium 6. and polyvinyl chloride bags. Donnelly RF. Chemical stability of fentanyl in polypropylene syringes o p q r s t l m n 3. 4. bupivacaine, or clonidine solution a ternary mixture in 0.9% sodium chloride two types of Jappinen A, Kokki H, Naaranlahti T. pH stability of injectable fentanyl, 5. with morphine, sufentanil, fentanyl or clonidine. Svedberg KO, McKenzie EJ, Larrivee-Elkins C. Compatibility of ropivacaine 184 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 184 22/05/17 1:55 PM Ferric Carboxymaltose 1 Body Temp Refer. Storage Conditions TemperatureTemp Post-thaw 72 h n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig

1 b Osmolality (mOsm/kg) pH NS iso.

1 a

1 1 ed in mg of elemental iron; product Store vials at 20˚C to 25˚C; excursions permitted 15˚C 30˚C. Do not freeze. Dosage is express Drug Normal saline. AMR 2 mg/mL Manufacturer Concentration Diluents (ferric carboxymaltose injection) [package insert]. Shirley, NY: American Regent, Inc.; July 2013. ® CONTAINER pH of undiluted product is 5.0–7.0. Dilute up to 750 mg iron in no more than 250 mL NS; final concentration must be at least 2 mg/mL. Notes a Reference 1. INJECTAFER b Ferric Carboxymaltose Unspecified Bag Flush Compatibility: Special Considerations: Avoid extravasation. Discard any contains 50 mg/mL elemental iron. May be administered undiluted as a slow IV push. Must diluted for intravenous infusion. unused drug; vials are single use and preservative free. 185 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 185 22/05/17 1:55 PM Filgrastim 1 1 1 1 1 Body Temp Refer.

2 Storage Conditions TemperatureTemp Post-thaw 24 h 7 d n/a n/a n/a n/a 24 h 7 d n/a n/a n/a n/a 24 h 7 d n/a n/a n/a n/a 24 h24 h 7 d 7 d n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig c c c c c c

1 Osmolality (mOsm/kg) pH D5W n/a D5W n/a

1 b b a, a, Store under refrigeration, protect from light, avoid freezing or shaking, discard if frozen more than once. Store under refrigeration, protect from light, avoid freezing or shaking, discard if frozen more than Drug D5W. Incompatible with sodium chloride, incompatible heparin. AMGAMG 5–15 mcg/mL 5–15 mcg/mL AMG >15 mcg/mL D5W n/a AMGAMG >15 mcg/mL 300 mcg/mL D5W undiluted n/a n/a Manufacturer Concentration Diluents (filgrastim) injection [package insert]. Thousand Oaks, CA: Amgen, Inc.; July 2015. ® CONTAINER The manufacturer does not recommend dilutions less than 5 mcg/mL. At filgrastim concentrations between 5 and 15 mcg/mL, add human albumin 2 mg/mL to minimize adsorption to containers. At filgrastim concentrations between 5 and 15 mcg/mL, add human albumin 2 mg/mL to minimize adsorption containers. Stable at pH 3.8 to 4.2; stability is limited neutral pH. When diluted in D5W or D5 plus human albumin, filgrastim is compatible with glass, PVC, polyolefin, and polypropylene containers. Filgrastim Chloride Polyvinyl (PVC) Syringes, Plastic Notes a b c References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. Neupogen Special Considerations: Flush Compatibility: 186 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 186 22/05/17 1:55 PM Floxuridine

5 1, 2 1 4 1 1, 3 1, Refer. d a Body 4–12 d Temp Storage Conditions 1982; 39:1321–3. TemperatureTemp Post-thaw n/a n/a n/an/a n/a n/a n/a n/a 21 d n/a n/a 6 w 1 d 14 d14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig Am J Hosp Pharm. c Caution: Used only for continuous regional intra-arterial infusion. c c c c c 1 Osmolality (mOsm/kg) pH NS n/a Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. 1996; 53:1583–8. b Am J Health-Syst Pharm.

1 1 Store reconstituted solution under refrigeration and use within 2 weeks. Drug Normal saline. RC 1, 50 mg/mLunspec. 10 mg/mLRC NS 2.58–12.2 mg/mL unspec. n/a n/a unspec. 10 mg/mL NS n/a unspec. 5–10 mg/mL D5W, NS n/a Manufacturer Concentration Diluents Stability Data for Drugs Using Elastomeric Infusion Pumps. ® (Epic (Epic

® 3 days). polypropylene infusion-pump syringes. SMARTeZ CONTAINER OTHER INFUSION CONTAINERS At least 95% of initial concentration remained upon in vivo assessment of drug removed from devices after 8 different infusions for 5 patients (after 4, 7, 10, 11, and 12 At least 95% of initial concentration remained upon in vivo assessment Solution also contained 200 units/mL heparin sodium in bacteriostatic saline. Stored at 30°C. pH of 2% aqueous solution is 4–5.5. 5. January 2008. Floxuridine for Injection, USP [package insert]. Schaumburg, IL: APP Pharmaceuticals; 3. in a totally implanted drug delivery system. Keller JH, Ensminger WD. Stability of cancer chemotherapeutic agents Floxuridine Syringes, Polypropylene Pump Implantable (Fresenius) Pump Implantable (Infusaid) Special Considerations: Notes a b c d References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. fluorouracil, hydromorphone hydrochloride, lorazepam, and midazolam hydrochloride in Stiles ML, Allen LV, Prince SJ. Stability of deferoxamine mesylate, floxuridine, Medical) Unspecified Flush Compatibility: SMARTeZ 4. 187 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 187 22/05/17 1:55 PM Fluconazole 2 5 8 9 1 4 3 7 6 6 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a 10 Storage Conditions b b n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw b c 2 d 7 d n/a n/a n/a n/a 2 d 7 d n/a n/a n/a n/a 2 d n/a 15 d 24 h 14 d n/an/a n/a 15 d n/a n/a n/a n/a n/a n/a c c c Room Refrig Frozen Room Refrig e 4–8, 4–8, 3.5–6.5 e e e e e e iso iso 3.5–6.5 Osmolality (mOsm/kg) pH d d D Drug unspec. 2 mg/mL RTU n/a unspec. 2 mg/mL RTU n/a unspec. 2 mg/mL RTUPF n/a 2 mg/mL NS, D BA 1 mg/mLPF 2 mg/mL D5W, LRunspec. n/a 2 mg/mLPF n/a NS 24 h 2 mg/mL n/a RTU n/a HSP n/a iso n/aBA 2 mg/mL n/a NS n/a 2 mg/mL iso NS iso 4–6.5 HSP 2 mg/mL NS iso 4–8 Manufacturer Concentration Diluents

ST/LT ST/LT (Epic (Epic ® ® ®

Plastic / TM g Plus Bag ® ® ® Braun)

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Dosi-Fuser (B. (B. Braun) Homepump Medical) (Baxter) Fluconazole Chloride Polyvinyl (PVC) AccuFlo (Leventon) Easypump Homepump Eclipse C-Series (Halyard) INTERMATE (Baxter) SMARTeZ Plastic Flexible Container (Hospira) Container (Baxter) Viaflex Intravia 188 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 188 22/05/17 1:55 PM Fluconazole (cont’d) Bethlehem, PA: B. Braun USA; April 2015.

2 . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015.

1 Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

1 ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Deerfield, IL: Baxter Healthcare Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Do not freeze solutions containing fluconazole. Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. Injection [package insert]. New York, NY: Pfizer Inc.; March 2014. ® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ extemporaneously prepared solutions. Each mL of RTU solution also contains 56 mg of dextrose, hydrous. Each mL of RTU solution also contains 56 mg dextrose, hydrous. Manufacturer(s) extrapolated data from other sources. pH of RTU solution is 3.5–6.5 in dextrose diluent; 4–8 in sodium chloride diluent. pH of RTU solution is 3.5–6.5 in dextrose diluent; 4–8 sodium Expiration date per manufacturer's label. Do not remove from overwrap moisture barrier until ready to use. Do not extrapolate commercial premix stability data to Expiration date per manufacturer's label. Do not remove from overwrap moisture barrier until ready to use. extrapolate INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Fluconazole (cont’d) Note: 10. 10. Special Considerations: Flush Compatibility: 6. July 2014. Fluconazole Injection [package insert]. Lake Forest, IL: Hospira Inc.; 7. Deerfield, IL: Baxter Healthcare, Inc.; June 2014. Fluconazole Injection in Intravia Plastic Container [package insert]. 8. Notes b c d e 4. 3. 5. g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 September. 2. Diflucan 9. 189 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F1.indd 189 22/05/17 1:55 PM Fludarabine Phosphate 3 4 1 1 1 4 3 2 Body Temp Refer. . 2011; 15(3):142–6. n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions Wspólcz Onkol c c 15 d n/a n/a15 d n/a n/a n/a TemperatureTemp Post-thaw c a c 48 h 48 h n/a48 h n/a16 d 48 h n/a n/a15 d n/a n/a35 d n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig . 2012; 6(1):14–5. b b b b b b Eur J Onc Pharm

6 Osmolality (mOsm/kg) pH

1 pH of liquid product is 6.0–7.1. 1,5 Ontario, Canada: Baxter Corporation; October 2008.

1 n/a Drug Heparin lock flush and normal saline. TETEunspec. 0.05 mg/mL 0.04, 0.2, 1 mg/mL 0.04 mg/mLunspec.unspec.TE 0.04 mg/mL NS NSTE 1 mg/mL D5W, NSSC 25 mg/mL n/a n/a n/a 25 mg/mL D5W, NS 0.1–1.5 mg/mL 4.8–6.9 n/a n/a D5W, NS 21 d n/a 21 d undiluted 15 d undiluted D5W, NS n/a n/a n/a n/a n/a n/a 4.8–6.9 n/a 21 d 21 d n/a n/a n/a n/a Manufacturer Concentration Diluents d Intermate/Infusor Drug Stability Information. CONTAINER OTHER INFUSION CONTAINERS INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of reconstituted powder product is 7.2–8.2. Solution exposed to normal room light. Protected from light. c d References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 September. 2. 3. phosphate in concentrate and diluted with sodium chloride 0.9%. Szalek E, Kaminska A, Urjasz H, et al. The stability of fludarabine 4. Pharmacopoeia 7.0. Trittler R. New stability studies for fludarabine according to the European 5. Parsippany, NJ: Actavis Pharma, Inc.; June 2014. Fludarabine Phosphate for Injection USP (Lyophilized) [package insert]. 6. Fludarabine Phosphate Injection USP [package insert]. North Wales, PA: Teva Pharmaceuticals USA, Inc.; August 2015. b Special Considerations: Notes a Fludarabine Phosphate Polyethylene Bags Polyolefin Bags Chloride Polyvinyl (PVC) Glass Vials INTERMATE (Baxter) Flush Compatibility: 190 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 190 22/05/17 1:55 PM Fluorouracil 9 5 8, 9 8, 9 9 9 9 9 9 7 7 7 7 9 9 9 2 a,g a,g j a 28 d 28 d Body Temp Refer. continued on next page n/a n/a n/a d n/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a Storage Conditions h a a a a, n/a n/a n/a n/a n/a 3, 9 n/a n/a n/a n/a 7 d 28 d 28 d n/a n/a n/a91 d n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw i a a a a a j 28 d 28 d n/a n/a n/a n/a 6, 9 n/an/a 45 d 45 d n/a n/a n/a n/a n/a n/a n/a n/a 12 12 28 d 72 h 14 d8 w 14 d7 d n/a n/a n/a n/a n/a n/a n/an/a n/a 72 h n/a n/an/a 8 w 14 d 90 d30 d n/a90 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a7 d n/an/a 16 w 79 d 14 d n/a n/a n/a n/a 28 d n/a n/a n/a n/a n/a 9, 11 14 d Room Refrig Frozen Room Refrig e e e e e e e e e e e e e e e e e e n/a Osmolality (mOsm/kg) pH b NS n/a l Drug unspec.RC 25 mg/mL 50 mg/mL undiluted n/a undiluted n/a 8.6–9.4 21 d LY, RC, SO 50 mg/mL undiluted n/a 8.6–9.4 7 d unspec.unspec. 5 mg/mL 5–50 mg/mL D5W, NS NS n/a n/a RCRCRC 10 mg/mLRC 15, 45 mg/mLRC 50 mg/mLFA, RC 1, 10 mg/mL 1.5 mg/mL 5, 50 mg/mL D5W, NS NSAbic n/a undilutedRC D5W, NS n/a DB NS, undiluted n/a D5W, NS 10 mg/mL n/a n/a 12, 40 mg/mL n/a 24.04 mg/mL 8.6–9.4 28 d NS D5W, NSunspec. n/a unspec. n/a unspec. 1, 10 mg/mLunspec. 5, 15, 30 mg/mL 10 mg/mL 50 mg/mL NS NS D5W n/a undiluted n/a n/a n/a 8.6–9.4 30 d n/a n/a n/a n/a n/a TERCDBunspec. 8 mg/mL 10 mg/mL 50 mg/mL 25 mg/mL D5W undiluted unspec. n/a n/a n/a 8.6–9.4 14 d n/a n/a n/a n/a n/a Manufacturer Concentration Diluents

® TM TM Cassette ® Braun)

CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser CADD Fluorouracil Vinyl Ethylene Acetate (EVA) Chloride Polyvinyl (PVC) Polypropylene AccuFlo (Leventon) (B. Syringes, Syringes, 191 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 191 22/05/17 1:55 PM Fluorouracil (cont’d) 9 9 4 4 9 9 1 1 1 10 9, 10 c c j j Body Temp Refer. continued on next page n/a n/a n/a n/a 14 n/a n/a n/a 7 d n/a n/a n/a n/a Storage Conditions f n m n/a n/a n/a n/a 7 d 123 d n/a n/a n/a n/a 7 d 45 d n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a 7 d TemperatureTemp Post-thaw f m m m j j n/a 45 d n/a 38 d n/a 16 w n/a n/a n/a n/a 45 d n/an/a 45 d21 d 45 d n/a 14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 13 21 d 13 Room Refrig Frozen Room Refrig e e e e e e e e e Osmolality (mOsm/kg) pH

9 n/a Drug Heparin lock flush and normal saline. unspec. 5–50 mg/mL NS n/a various 0.1–25 mg/mL D5W, NS n/a variousRC 0.1–50 mg/mL 10 mg/mL D5W, NS n/a D5W n/a unspec. 50 mg/mLunspec.unspec. 1–25 mg/mL 50 mg/mL undilutedLY, RC, SO NS n/a 50 mg/mL undilutedLY, RC, SO 50 mg/mL n/a 8.6–9.4 n/a n/a n/a 8.6–9.4 undiluted 8 w n/a n/a undiluted n/a n/a n/a 8.6–9.4 8 w 7 d 8.6–9.4 7 d unspec. 50 mg/mL undiluted n/a 8.6–9.4 45 d ICN 50 mg/mL undiluted n/a 8.6–9.4 21 d n/a n/a n/a n/a 21 d unspec.unspec.ICN 5 mg/mL 5–50 mg/mL 25 mg/mL D5W, NS NS n/a D5W, NS n/a n/a Manufacturer Concentration Diluents k

® ST/LT ST/LT

(Epic (Epic ® ® / ® Stability was not affected by re-freezing and further storage at –20°C for 2 additional weeks (total of 10 w). Stability was not affected by re-freezing and further storage at Diluted to a concentration of 961.54 units/mL heparin. Solutions protected from light. Stored at 31°C. Special Considerations: Notes a b c d Medical) Flush Compatibility: SMARTeZ Medfusion Medfusion Homepump Fluorouracil (cont’d) 30 VIP Fresenius Implantable Pump Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) 200 Infumed Provider Pancretec 2000 (B. Braun) Easypump 192 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 192 22/05/17 1:55 PM Fluorouracil (cont’d) 2009; Am J Hosp Can J Hosp Pharm. 1987; 22:685–7. 1987; 238:476–8. 2003; 9:109–12. Hosp Pharm. Pharm J. J Oncol Pharm Practice. Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. . Barcelona, Spain: Leventon SAU; October 2015. 1996; 53:1583–8. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008.

9 Am J Health-Syst Pharm. 1994; 19:127–33. Elastomeric Pump (ES.H.00.730-10) ® J Clin Pharm Ther. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® 1992; 49:619–23. Chemical Stability Data for Drugs Using B. Braun’s Easypump 62:34–8. Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. infusion regimens. polypropylene infusion-pump syringes. Pharm. Drug Stability Table-Dosi-Fuser Potential for drug precipitation depending on preparation, storage conditions, concentration, pH, and diluent. Followed by 7 d at 25°C in the dark. Manufacturer extrapolated data from other sources. pH of the undiluted solution is 8.6–9.4. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Stored at 35°C; concentrations increased due to water evaporation. Stored at 35°C; concentrations increased due to water evaporation. Followed by 7 d at 33°C. Fine precipitation was observed with the Roche product in tubing and bags. Due to commercial bag overfill, actual concentration was approximately 6.8 mg/mL. Stored at 30°C. Fluorouracil (cont’d) 13. 13. 12. 12. 14. 14. f g h i j k l m n References 1. 2. for a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines 11. 11. in 0.9% sodium chloride after freezing, microwave thawing and refrigeration. Galanti L, Lebitasy MP, Hecq JD, et al. Long term stability of 5-fluorouracil 4. 5. of 5-fluorouracil with carboplatin and heparin for administration in continuous Sewell GJ, Allsopp M, Collinson MP, et al. Stability studies on admixtures 3. floxuridine, fluorouracil, hydromorphone hydrochloride, lorazepam, and midazolam hydrochloride in Stiles ML, Allen LV, Prince SJ. Stability of deferoxamine mesylate, e 6. of home infusion therapy for cancer patients. Adams PS, Haines-Nutt RF, Bradford E, et al. Pharmaceutical aspects 9. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 10. infusions in the Braun Easypump. Roberts S, Sewell GJ. Stability and compatibility of 5-fluorouracil 8. or doxorubicin hydrochloride in ethylene vinylacetate portable infusion-pump reservoirs. Rochard EB, Barthes DMC, Courtois PY. Stability of fluorouracil, cytarabine, 7. 193 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 193 22/05/17 1:55 PM Foscarnet Sodium 6 6 3 3 3 3 3 1 1 7 7 7 7 7 5 4 4

3 Body Temp Refer. continued on next page

5 n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/an/a n/an/a n/an/a n/a n/an/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions e e b h e e e e e 14 d 14 d 16 d n/a n/a n/a n/a n/a 14 d 14 d 14 d 72 d 28 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw f e e e e e e e 7 d 7 d 4 d7 d 14 d 10 d n/a16 d16 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 35 d30 d 35 d 30 d n/a4 d n/a7 d n/a2 d 72 d n/a 28 d c 7 d 14 d n/a n/a n/a n/a 7 d 14 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig d d d d d d d d d d d d d d d d d Osmolality (mOsm/kg) pH 60 mg/kg/h. For peripheral administration, dilute to 12 mg/mL with D5W or NS. ≤

1 Incompatible with calcium-containing solutions such as Ringer's lactate or TPN. 5 Precipitation may occur during storage of 24 mg/mL solution at 2–8°C; visually inspect all solutions before administration. 1 Drug Do not give by rapid injection. Administer IV at≤ unspec. 24 mg/mL undiluted iso unspec. 12 mg/mL NS n/a AST 2–20 mg/mL D5W, NS n/a ASTASTASTAST 2–20 mg/mL 12 mg/mL 12 mg/mL 24 mg/mL NS, D5W NS, D5W n/a NS, D5W n/a undiluted n/a iso ASTAST 12 mg/mLAST 12 mg/mLASTASTAST 2–10 mg/mLAST 12 mg/mL D5W, NS 24 mg/mL NS 24 mg/mL n/a 24 mg/mL NS, D5W n/a NS n/a undiluted undiluted iso undiluted n/a iso iso HSP 24 mg/mL undiluted iso 7.4 AST 12 mg/mL NS, D5W n/a AST 24 mg/mL undiluted iso Manufacturer Concentration Diluents Heparin lock flush and normal saline. / g ® C-Series C-Series ®

® ® Medical)

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Foscarnet is available as an isotonic 24 mg/mL solution. Administer with an infusion pump. (Epic SMARTeZ Special Considerations: Homepump Foscarnet Sodium Chloride Polyvinyl (PVC) Dosi-Fuser (Leventon) Homepump Eclipse INTERMATE (Baxter) Bottle Glass (Hospira) Flush Compatibility: (Halyard) 194 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 194 22/05/17 1:55 PM Foscarnet Sodium (cont’d)

5 Irvine, CA: Halyard Health; March 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcleona, Spain: Leventon SAU; October 2015. Ontario, Canada: Baxter Corporation; October 2008.

1,5 Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® (foscarnet sodium injection) [package insert]. Lake Forest, IL: Hospira Inc; November 2014. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser SMARTeZ Intermate/Infusor Drug Stability Information. Infusion Systems. Stability Data for Drugs Using Homepump Disposable Ambulatory pH of undiluted solution is 7.4. Room temperature stability 4 d following 14 refrigerated. Protected from light. Manufacturer extrapolated data from other source(s). Expiration date per manufacturer's label, and must be used within 24 h of initial entry into the bottle. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices 10 d room temperature after 16 refrigerated. Foscarnet Sodium (cont’d) Note: 7. d 6. e f g h References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed November 3. 4. 5. Foscavir Notes b c 195 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 195 22/05/17 1:55 PM Fosphenytoin Sodium 2 1 2 1 2 1 1 Ann Body Temp Refer. Storage Conditions TemperatureTemp Post-thaw Room Refrig Frozen Room Refrig n/a n/an/a 7 d n/an/a n/a n/a 7 d n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH D5LR, LR, LR, D5LR, D5½S, D10W LR, D5LR, D5½S, D10W LR, D5LR, D5½S, D10W

1 Concentrations expressed as phenytoin equivalent (PE). Drug Normal saline. PDPD 1 mg PE/mLPD 1 mg PE/mL PD 8 mg PE/mLPD 8 mg PE/mL PD D5W, NS 20 mg PE/mL n/aPD 20 mg PE/mL D5W, NS n/a n/a 50 mg PE/mL D5W, NS 30 d n/a n/a 30 d 30 d undiluted 30 d 7 d n/a n/a 30 d 7 d 30 d 30 d n/a 7 d 30 d 8.6–9 7 d 30 d 30 d 7 d n/a 30 d 7 d 30 d n/a 7 d 7 d n/a Manufacturer Concentration Diluents 1997; 31:553–9. Pharmacother. CONTAINER Fosphenytoin Sodium Chloride Polyvinyl (PVC) Syringes, Polypropylene (BD) Flush Compatibility: Special Considerations: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. with intravenous solutions in glass bottles, polyvinyl chloride bags, and polypropylene syringes. Fischer JH, Cwik MJ, Luer MS, et al. Stability of fosphenytoin sodium 196 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 196 22/05/17 1:55 PM Furosemide 6 4 1 1 1 1 5 2 Body Temp Refer. continued on next page n/an/a n/an/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 3 n/a n/a n/a n/a Storage Conditions b c c g d 84 d 84 d 5 d 7 d TemperatureTemp Post-thaw c c g d 4 d 7 d n/a n/a n/a n/a 4 d 7 d n/a n/a n/a n/a 24 h84 d 26 d 84 d 5 d 4 d 4 d 7 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig 1 e pH f f e f e fff e e e f e f e Osmolality (mOsm/kg) a f e

1 Drug Refrigeration may result in precipitation or crystallization; resolubilization at room temperature will not affect drug stability. Protection from Refrigeration may result in precipitation or crystallization; resolubilization at room temperature will not unspec. 10 mg/mL NS unspec. 10 mg/mL NS HOABAB 1 mg/mLHO 1.2, 2.4, 3.2 mg/mLHO 1, 2, 4, 8 mg/mL 3.33–10 mg/mL NS 10 mg/mL NS NS NS undiluted 287 8–9.3 24 h n/a n/a n/a n/a n/a unspec. 10 mg/mL NS unspec. 0.5–10 mg/mL NS Manufacturer Concentration Diluents Heparin lock flush and normal saline. / ® Braun) C-Series C-Series

® ST/LT ST/LT

® ® (B. TM Medical)

Braun)

CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. 10% furosemide loss at 6°C. pH of undiluted solution is 8–9.3. With dexamethasone sodium phosphate (ME) 0.33–3.33 mg/mL. Stored protected from light followed by 7 d at room temperature in fluorescent light. Protected from light. Osmolality of 10 mg/mL (HO) is 287 mOsm/kg. Other unspecified brands ranged from 289–291 mOsm/kg. Osmolality of 10 mg/mL (HO) is 287 mOsm/kg. Other unspecified Notes a b c d e f Special Considerations: light is recommended. Do not use if solution has a yellow color. (B. Easypump Homepump Furosemide Chloride Polyvinyl (PVC) Syringes, Polypropylene AccuFlo Homepump Eclipse Flush Compatibility: (Epic (Halyard) SMARTeZ g 197 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 197 22/05/17 1:55 PM Furosemide (cont’d) 2006; (56)10:714–20. Arzeneimittelforschung. Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo Furosemide (cont’d) 6. 5. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. and dexamethasone combined in infusion solutions. Negro S, Rendon AL, Azuara ML, et al. Compatibility and stability of furosemide 4. 198 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_F2.indd 198 22/05/17 1:55 PM Ganciclovir Sodium 6 3 8 1 1 1 1 1 4 4 1 1 1 9 5 5 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions i c b h 14 d 15 d n/a15 d n/a n/a n/a n/a TemperatureTemp Post-thaw i b h h 24 h 2 d 14 d n/a n/a n/a n/a 2 d 14 d n/a n/a n/a n/a 7 d35 d 80 dn/a 35 d 364 d5 d n/a 35 d n/a5 d 5 d n/a n/a 5 d n/a24 h n/a n/a n/a24 h 10 d n/a n/a n/a n/a7 d n/a n/a12 h n/a n/a 80 d n/a n/a 10 dn/a 364 d n/a n/a n/a n/a n/a 14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 h n/a n/a n/a 7 d 24 h Room Refrig Frozen Room Refrig a a a a a a a a a a a a a a a a a Osmolality (mOsm/kg) pH 10 mg/mL NS n/a ≤ Drug unspec. 1, 10 mg/mL NS n/a unspec. 1, 10 mg/mL NS n/a SYSYSYSY 0.28, 1.4 mg/mLSY 1, 5 mg/mLGEN 1, 5, 10 mg/mLSY 2.44 mg/mLSY 2.59 mg/mL NSSYSY 8.33 mg/mL D5W, NS D5W 8.33 mg/mL n/a SY n/a D5W 1.4, 4, 7 mg/mL n/a NS 5.8 mg/mL n/a 2.2 mg/mL NS n/a RC D5W NS 336 313 NS 1–6 mg/mL n/a NSunspec.unspec. n/a 2–5 mg/mL n/a 5 mg/mL NS, D5W n/a NS NS n/a n/a Manufacturer Concentration Diluents

ST/LT ST/LT ® ®

/ TM ® Braun) Braun)

CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser (B. (B. Homepump Ganciclovir Sodium Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Unspecified AccuFlo (Leventon) Easypump Homepump Eclipse C-Series (Halyard) 199 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 199 22/05/17 1:55 PM Ganciclovir Sodium (cont’d) 7 2 2 2 2 1 n/a Body Temp Refer. Administer by 1,6 e n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a Storage Conditions b f f f c 14 d 28 d 28 d TemperatureTemp Post-thaw The manufacturer states that consideration should 6 b d d 2 d 3 d 42 d 42 d 7 d n/a7 d 35 d n/a 63 d n/a 7 d Room Refrig Frozen Room Refrig a

a a a a a a 6 Bethlehem, PA: B. Braun USA; September 2015.

6 Osmolality (mOsm/kg) pH . Irvine, CA: Halyard Health; March 2015. Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. . Barcelona, Spain: Leventon SAU; October 2015. Ganciclovir sodium is incompatible with diluents and solutions containing parabens. 6 HealthTek ST/LT Elastomeric Infusion System.

® 6 Elastomeric Infusion System. TM Ontario, Canada: Baxter Corporation; October 2008.

1 Elastomeric Pump (ES.H.00.730-10) ® Drug Stability in Plastic Syringes. Do not use if discoloration is noted. Drug Normal saline. unspec. 1, 10 mg/mL NS n/a SYRC 1–6 mg/mL 1–6 mg/mL D5W, NS D5W, NS n/a n/a SYRCSY 1 mg/mL 1, 5 mg/mL 1–6 mg/mL D5W NS D5W, NS n/a n/a n/a Manufacturer Concentration Diluents [package insert]. South San Francisco, CA: Genentech USA, Inc. A member of the Roche Group; February 2010. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® ®

® g Medical) Medical) Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser SMARTeZ Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using B. Braun’s AccuFlo Following 28 d refrigerated. Manufacturer extrapolated data from other sources. Special attention should be paid to drug's potential for precipitation depending on preparation, storage conditions, concentration, pH, and diluent. Special attention should be paid to drug's potential for precipitation Following 63 d frozen. pH of 50 mg/mL reconstituted in W is approximately 11. Protected from light. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Inspect for possible crystal formation in D5W; redissolves with gentle shaking and warming to ambient room temperature. Inspect for possible crystal formation in D5W; redissolves with Manufacturer recommends use within 24 h of dilution to reduce risk of bacterial contamination. Manufacturer recommends use within 24 h of dilution to reduce 8. 9. 7. 5. 6. Cytovene IV infusion only. Do not refrigerate reconstituted solution (50 mg/mL); it is stable for 12 h at room temperature. 4. Rapp RP, Hatton J, Record K. Notes a b c d e f g h i Flush Compatibility: (Epic Special Considerations: SMARTeZ References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. be given to handling and disposal according guidelines for antineoplastic drugs. Ganciclovir Sodium (cont’d) INTERMATE (Baxter) 200 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 200 22/05/17 1:55 PM Gemcitabine Hydrochloride 1 2 2 3 d a, Body Temp Refer. n/a n/a n/a n/a 1, 2 n/a n/a n/an/a n/a n/a 1, 2 n/a n/a 1, 2 Storage Conditions b b a, a, b a, 35 d 35 d TemperatureTemp Post-thaw

2 1999; 39:509–13. 27 d n/a n/a n/a n/a n/a 35 d 35 d 27 d35 d n/a 7 d 7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d Room Refrig Frozen Room Refrig c c c c c c c c J Am Pharm Assoc.

1,2 Osmolality (mOsm/kg) pH

2 Ontario, Canada: Baxter Corporation; October 2008.

1 Avoid refrigeration of reconstituted solutions due to the potential for crystallization. Drug Heparin lock flush and normal saline. LI 7.5, 25 mg/mL NS n/a LILI 0.1, 10 mg/mLLI 38 mg/mLLI D5W, NSLI 7.5, 25 mg/mL n/a 38 mg/mL 3–40 mg/mL NS NS n/a NS, W NS n/a n/a n/a LI 0.1, 10, 38 mg/mL D5W, NS n/a Manufacturer Concentration Diluents e Intermate/Infusor Drug Stability Information. CONTAINER OTHER INFUSION CONTAINERS Stored at 32°C in the dark to simulate ambulatory infusion conditions. Stored at 32°C in the dark to simulate ambulatory infusion conditions. Reconstituted solution may develop non-redissolving crystals when stored at 4°C. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Protected from light. pH of reconstituted solution is 2.7–3.3. Special Considerations: 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 February. 3. Gemcitabine Hydrochloride Chloride Polyvinyl (PVC) Syringes, Plastic Glass INTERMATE (Baxter) Flush Compatibility: c d e References 1. hydrochloride solutions. Xu Q, Zhang Y, Trissel LA. Physical and chemical stability of gemcitabine Notes a b 201 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 201 22/05/17 1:55 PM Gentamicin Sulfate 1 5 7 7 2 1 1 1 1 6 1 1 9 9 9 1 f Body Temp Refer. continued on next page n/a n/a n/a n/a 30 dn/a n/a n/a n/a n/a n/a n/a Storage Conditions e a a 17 d 10 d 17 d TemperatureTemp Post-thaw e a a 2 d 14 d n/a n/a n/a n/a 2 d 14 d n/a n/a n/a n/a 10 24 h n/a n/a n/a n/a n/a 24 h 28 d n/a n/a n/a n/a 17 d 24 h24 h n/a48 h 24 h 30 d 48 h 30 d 24 hn/a n/a n/a n/a30 d 12 w n/a n/a n/a 30 d n/a48 h n/a n/a 30 d n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 24 h n/a 17 d 30 d48 h n/a 17 d 4 d 30 d 2 d n/a n/a n/a n/a n/a 28 d n/a n/a n/a Room Refrig Frozen Room Refrig c c c c c c c c c c c c c c c 1 c 1 c 1 c Osmolality (mOsm/kg) pH D5W, NS n/a h Drug unspec. 4.8 mg/mL NS n/a SO 0.8–2.4 mg/mL NS n/a unspec. 1 mg/mL NS 278 unspec. 1 mg/mL NS 278 SCSCLYES 0.8 mg/mL 1 mg/mLES 1.2 mg/mLunspec. 2.4 mg/mL ES 10 mg/mL 1.3 mg/mLunspec. D5W 40 mg/mL D5W, NS 30 mg/mL D5W, NS 285 262, 278 n/a SC NS D5W, NS 257, 280 unspec. unspec.unspec. 5.45 mg/mL NS n/a unspec. 0.5–5 mg/mL n/a 0.8–2.4 mg/mL 5 mg/mL n/a unspec. D5W D5W, NS 0.8 mg/mL NS n/a n/a D5W, NS n/a n/a NS 315 Manufacturer Concentration Diluents g

ST/LT ST/LT ® ®

/ TM Cassette Cassette ® ® Braun)

CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser CADD (B. (B. Braun) Homepump Gentamicin Sulfate Chloride Polyvinyl (PVC) Syringes, Glass Syringes, Plastic Syringes, Polypropylene AccuFlo (SIMS Deltec) (Leventon) Easypump Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) 202 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 202 22/05/17 1:55 PM Gentamicin Sulfate (cont’d) 8 2 2 2 2 Body Temp Refer. n/a n/a n/a n/a Storage Conditions a 14 d TemperatureTemp Post-thaw a 2 d n/a48 h 10 d24 h 10 d n/an/a 10 d 32 d n/a n/a n/a 24 h n/a n/a n/a 30 d 24 h n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig c c c c c Bethlehem, PA: B. Braun USA; September 2015. 1 c n/a Osmolality (mOsm/kg) pH

. Irvine, CA: Halyard Health; March 2015. 1 . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM W

Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. 1 . Barcelona, Spain: Leventon SAU; October 2015. HealthTek ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Incompatible with heparin. 1 Elastomeric Pump (ES.H.00.730-10) ® Drug Stability in Plastic Syringes. n/a Drug Normal saline. unspec. 1 mg/mL NS 278 LYRS, ESLYLY 0.25 mg/mL 0.5 mg/mL 0.5–5 mg/mL 0.5–5 mg/mL NS D5W D5W, NS n/a n/a n/a Manufacturer Concentration Diluents Stability Data for Drugs Using Elastomeric Infusion Pumps. ®

® g Medical) Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential.

Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory SMARTeZ Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using B. Braun’s AccuFlo With clindamycin phosphate 18 mg/mL. Stable 17 d at room temperature following refrigerated. Manufacturer extrapolated data from other sources. pH of undiluted injection is 3–5.5. commercial solutions in NS 4–4.5. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices After 30 d at –20°C and 4 5°C. 10. 10. 9. Note: 7. 8. Flush Compatibility: 6. Rapp RP, Hatton J, Record K. (Epic Gentamicin Sulfate (cont’d) INTERMATE (Baxter) SMARTeZ Special Considerations: Notes a c e f g h References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. 5. 203 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 203 22/05/17 1:55 PM Glycopyrrolate 1 2 2 1 d d a,b, a,b, 1999; Body Temp Refer. Pharm World Sci. n/a n/a n/an/a 16 d n/a n/a 9 d Storage Conditions b b a, a, n/a n/a n/a n/a n/a 30 d 30 d b b TemperatureTemp Post-thaw c a, a, 30 d 30 d Room Refrig Frozen Room Refrig n/a n/a 48 h Osmolality (mOsm/kg) pH D5½S, R NS n/aNS 3.46 n/a 3.46

1 a a

1 Because of the low pH of glycopyrrolate, admixture with alkaline drugs or solutions that result in an admixed pH above 6 will result in Because of the low pH glycopyrrolate, admixture with alkaline drugs or solutions that result in an Drug Normal saline. LEI 0.025 mg/mL LEI 0.025 mg/mL RB 0.0008 mg/mL D5W, NS, RB 0.2 mg/mL undiluted n/a 2–3 90 d 90 d n/a n/a n/a n/a Manufacturer Concentration Diluents 21:272–4. CONTAINER OTHER INFUSION CONTAINERS At 36°C. Protected from light. With buprenorphine (RKC) 0.084 mg/mL and haloperidol (ON) 0.104 mg/mL. At glycopyrrolate stability pH range of 2 to 6. Stability decreases rapidly as increases above 6 due hydrolysis. Flush Compatibility: Special Considerations: glycopyrrolate decomposition through hydrolysis. Glycopyrrolate Syringes, Polypropylene Cassette PVC (SIMS Deltec) Notes a b c d References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. haloperidol and glycopyrrolate mixture in a 0.9% sodium chloride solution. Jäppinen A, Kokki H, Naaranlahti TJ, et al. Stability of buprenorphine, Unspecified 204 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 204 22/05/17 1:55 PM Granisetron Hydrochloride 1 1 7 1 8 8 1, 4, 6 1, 4, 6 n/a n/a Body Temp Refer. a a 7 d 7 d continued on next page 1996; 53:1174–6. a a n/a n/a n/a n/a 1, 2 n/an/a n/a n/a n/a n/a n/a n/a Storage Conditions d h h Am J Health-Syst Pharm. 14 d TemperatureTemp Post-thaw d n/a n/a 30 d15 d 3 d 15 d n/a n/a n/a n/a 1, 3 14 d 35 d 35 d n/a n/a n/a n/a 14 dn/a 14 d n/a n/a n/a 30 dn/a 3 d n/an/a 14 d n/a n/a 7 d n/a 14 d 7 d n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig c c c c c c c c c c c n/a n/a Osmolality (mOsm/kg) pH b g

1 D5W, NS D5W, NS

1 g b

1 Protect intact vials from freezing and light. Drug Heparin lock flush and normal saline. BESKB 0.056 mg/mL 1 mg/mL D5W, NS n/a undiluted n/a SKB 0.01, 0.04 mg/mL SKB 0.008–0.053 mg/mL SKBBE 0.05, 0.07, 0.1 mg/mL 0.15 mg/mLunspec.unspec. D5W, NS 0.02 mg/mLSKB n/a 0.02 mg/mLSKB D5W, NS 0.02 mg/mL 0.02 mg/mL n/a D5W NS n/a D5W n/a NS n/a n/a Manufacturer Concentration Diluents

® / ® CONTAINER OTHER INFUSION CONTAINERS Protected from light. With theoretical concentrations of 0.08 and 0.6 mg/mL dexamethasone sodium phosphate (AMR). Manufacturer extrapolated data from other sources. 30 d frozen followed by 7 refrigerated 3 at 20°C. pH of undiluted product is 4–6. With and without dexamethasone (SAB) 0.05–0.35 mg/mL. Syringes, Syringes, Special Considerations: Homepump Granisetron Hydrochloride Chloride Polyvinyl (PVC) Polypropylene Dosi-Fuser (Leventon) Homepump Eclipse C-Series (Halyard) Flush Compatibility: Notes a b c d g h References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 October. 2. with dexamethasone sodium phosphate for 14 days. Chin A, Moon YSK, Chung KC, et al. Stability of granisetron hydrochloride 205 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 205 22/05/17 1:55 PM Granisetron Hydrochloride (cont’d) Can J Hosp 1997; Int J Pharm. 1995; 52:1541–3. Am J Health-Syst Pharm. . Irvine, CA: Halyard Health; March 2015. . Barcelona, Spain: Leventon SAU; October 2015. Elastomeric Pump (ES.H.00.730-10) ® 2002; 55:27–38. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 154:95–102. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Pharm. Drug Stability Table-Dosi-Fuser Granisetron Hydrochloride (cont’d) Note: 3. of granisetron towards glass and plastics its stability under various storage conditions. Hourcade F, Sautou-Miranda V, Normand B, et al. Compatibility 4. 6. in a disposable elastomeric infusion device [Abstract]. Chung KC, Chin A, Gill MA. Stability of granisetron hydrochloride 7. and in combination with dexamethasone 0.9% sodium chloride 5% dextrose water solutions. Walker SE, Law S. Stability and compatibility of granisetron alone 8. 206 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_G.indd 206 22/05/17 1:55 PM Haloperidol Lactate 4 5 1 3 1, 3 2 1 1 i i b,g, b,g, Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a 16 d n/a n/a n/a 9 d Storage Conditions g g g f, b, b, 15 d n/a n/a n/a n/a n/a 30 d 30 d n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw g g h g f, b, g, b, c a a 15 d 38 d n/a n/a n/a n/a n/a 30 d 7 d 7 d 7 d Room Refrig Frozen Room Refrig d 4.7–5.62 4.7–5.62 d d d d Osmolality (mOsm/kg) pH

1 NS n/a n/a 15 d NS n/a NS n/aNS 3.46 n/a 3.46 30 d unspec. n/a f h b b c

1 n/a Drug Normal saline. Incompatible with heparin lock flush. MNON 0.1 mg/mL 0.104 mg/mL ON D5W 0.104 mg/mL n/a EST 0.208–0.624 mg/mL unspec. 0.2 mg/mL EST 0.208, 0.416, 0.624 mg/mL MNMN 0.1–0.75 mg/mL 0.1–3 mg/mL NS D5W n/a n/a Manufacturer Concentration Diluents CONTAINER OTHER INFUSION CONTAINERS pH of undiluted solution is 3–3.8. With buprenorphine 0.084 mg/mL (RKC) and glycopyrrolate 0.025 (LEI). With tramadol HCl 8.8–33.3 mg/mL (GRU) and hyoscine N-butylbromide 3.33–6.67 (BI). Visual testing only. With morphine sulfate 15 mg/mL. Protected from light. With tramadol HCl 8.33, 16.67, and 33.33 mg/mL (GRU). At 36°C. Flush Compatibility: Haloperidol Lactate Chloride Polyvinyl (PVC) Syringes, Polypropylene Cassette PVC (SIMS Deltec) Infusion Unspec. Pump Special Considerations: Notes a b c d Unspecified f g h i 207 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Haloperidol Lactate (cont’d) . 1999; . 1989; 7(12):1903–8. Pharm World Sci . 2005; 30(2):192–9. J Clin Oncol -butylbromide: retrospective clinical evaluation. N J Pain Symptom Manage . 2010; 13(3):273–7. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. J Palliat Med 21(6):272–4. 3. haloperidol, and glycopyrrolate mixture in a 0.9% sodium chloride solution. Jäppinen A, Kokki H, Naaranlahti TJ, et al. Stability of buprenorphine, References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. chronic cancer pain in the ambulatory setting: a report of 117 patients. Swanson G, Smith J, Bulich R, et al. Patient-controlled analgesia for Note: Haloperidol Lactate (cont’d) 4. for continuous subcutaneous infusion at home. Negro S, Martin A, Azuara ML, et al. Stability of tramadol and haloperidol 5. ternary admixtures of tramadol, haloperidol, and hyoscine Negro S, Martin A, Azuara ML, et al. Compatibility and stability of 208 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Heparin Sodium 1 1 1 1 1 1 4 1 1 3 2 1 1 1 1 1 1 e e Body Temp Refer. continued on next page n/a n/an/a n/a n/a n/a n/a 12 n/a n/a n/a n/a n/a Storage Conditions p k l n/a n/a n/a n/a n/a 14 d 14 d TemperatureTemp Post-thaw o i p n/a n/a n/a n/a n/a 30 d n/a 24 h24 hn/a n/a 24 h n/a 24 h n/a48 h 10 d n/a n/a n/a 7 dn/a n/a n/a n/a n/a3 w n/a n/a n/a n/a n/a 3 w n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 28 d 52 w n/a n/a7 d n/a 30 d n/a7 d n/a 14 d 7 d n/a 12 m n/an/a n/a12 m n/a 28 d n/a12 m n/a n/a n/a24 h 12 m n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig j j j j j j j j j j j j j j j j j j j Osmolality (mOsm/kg) pH n/a n/a D5LR D5LR n/a n/a NS n/a b c Drug SCN 40,000 units/mL undiluted n/a UPBRNUP 10 units/mLOR 7 units/mLunspec. 10 units/mLunspec. 5,000 units/mL 20, 40 units/mLunspec. LR, D5NS, 1 unit/mL ES 500 units/mL D5W, NS LR, D5NS, n/a D5W, NS undiluted 1,000 units/mLFUJ n/a n/a NSunspec. 5 units/mL undiluted 3,250 units/mLDIO n/a 384 DB 2 mg/mL DB NSLY NSDB 1 unit/mLDB 1 unit/mL n/a AH n/a 5 units/mL 10 units/mL 10 units/mL 35 units/mL D5W NS NS n/a D5W NS n/a NS n/a n/a n/a n/a Manufacturer Concentration Diluents

® m CONTAINER OTHER INFUSION CONTAINERS Heparin Sodium Glass Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene Plastic DEHP-Free Bags (Secure Medical) Dosi-Fuser (Leventon) INFUSOR (Baxter) Unspecified 209 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Heparin Sodium (cont’d) 8

5 Body Temp Refer. continued on next page Storage Conditions n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 11 n/a n/an/a n/a n/a n/a n/a n/a n/a 5, 10 n/a 5, 9 TemperatureTemp Post-thaw h h Room Refrig Frozen Room Refrig j jj d n 5 Osmolality (mOsm/kg) pH

1 Do not freeze. Use care when adding to large volume parenteral solutions, especially flexible containers; repeated inversion and agitation Do not freeze. Use care when adding to large volume parenteral solutions, especially flexible containers; Drug Heparin lock flush and normal saline. BRN 2 units/mL NS 360 (mOsm/L) 6.8–7.2 BRN 40, 50, 100 units/mL D5W 315 (mOsm/L) 4.5–7 HSPHSP 50, 100 units/mL 2 units/mL D5W 304 (mOsm/L) NS 378 (mOsm/L) Manufacturer Concentration Diluents

1 Braun)

COMMERCIAL PREPARATIONS (RTU) INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Manufacturer extrapolated data from other sources. Expiration date per manufacturer's label. Manufacturer recommends using the commercial product (CR3 container) within 7 d of removal overwrap. Expiration date per manufacturer's label. Manufacturer recommends Polyethylene syringes with polypropylene plungers (Injekt, Braun). Plastic syringes with rubber plungers exhibited possible leaching of rubber components. Polyethylene syringes with polypropylene plungers (Injekt, Braun). Plastic rubber exhibited possible leaching Tested at 27°C. Expiration date per manufacturer's label. Expiration date per manufacturer's label. Use within 30 d after removal from overwrap. Expiration date per manufacturer's label. Use within 30 d after At near-body temperature of 30°C; little loss by HPLC analysis; activity not evaluated. At near-body temperature of 30°C; little loss by HPLC analysis; May be followed by 7 d at room temperature. Concentration reported by MFR as 2 mg/mL (DIO). pH of undiluted injection and lock flush is adjusted to 5–7.5. Preceded by 24 h at room temperature. Stable an additional 14 d at 4°C. e h i j Special Considerations: the danger of overdosage due to after admixture provides an even distribution of heparin in the solution and a constant delivery concentration; it also eliminates pooling. Notes b c d Heparin Sodium (cont’d) Container Excel (B. Plastic Flexible Container (CR3) (Hospira) Plastic Flexible Container (PVC) (Hospira) Flush Compatibility: k l m n o p 210 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Heparin Sodium (cont’d) . 1996; 20(3):219–21. . St Paul, MN: Pharmacia Deltec; 1992. J Parent Enteral Nutr Barcelona, Spain: Leventon SAU; October 2015. . Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Pharmacia Deltec CADD Ambulatory Infusion Pump Systems. Stability Data in Pharmacia Deltec Medication Cassette Reservoirs Pharmacia Deltec CADD Ambulatory Infusion Pump Systems. Stability Intermate/Infusor Drug Stability Information Note: Heparin Sodium (cont’d) 5. Medical Communications Department [personal communication]. Lake Forest, IL: Hospira Inc.; April 2008. 8. Braun Medical, Inc.; September 2013. Heparin Sodium in Chloride [package insert]. Irvine, CA: B. 9. [package insert]. Lake Forest, IL: Hospira, Inc.; June 2012. Intravenous Solutions with Heparin Sodium in 0.9% Chloride 10. Intravenous Solutions with Heparin Sodium in Dextrose 5% [package insert]. Lake Forest, IL: Hospira, Inc.; February 2014. 11. Medical, Inc.; September 2013. Heparin Sodium in Dextrose [package insert]. Irvine, CA: B. Braun 12. 4. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 October. 2. 3. activity over time in parenteral nutrition solutions. Hensrud DD, Burritt MF, Hall LG. Stability of heparin anticoagulant 211 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Hydralazine Hydrochloride

2 1 3 Body Temp Refer. Int J Pharmaceut Compound. Storage Conditions 1981; 38:1308–14. n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 4 TemperatureTemp Post-thaw d d b, 52 d n/a n/a n/a n/a n/a 2 d n/a n/a n/a n/a n/a 24 h Room Refrig Frozen Room Refrig Am J Hosp Pharm. f e . 1982; 39:460–7. e e No loss over 7 h when infused through PVC tubing with a cellulose 3

2 Am J Hosp Pharm Osmolality (mOsm/kg) pH NS n/a

1 Hydralazine is not stable in D5W. 1 c

4 Hydralazine reacts with various metals. Contact with metal parts (e.g., stainless steel needles) should be minimized. Store at controlled room Hydralazine reacts with various metals. Contact metal parts (e.g., stainless steel needles) should Drug Heparin lock flush and normal saline. unspec. 0.35 mg/mL NS n/a AMR 0.2 mg/mL NS n/a 4.1–4.9 SISI 0.015 mg/mL 0.027 mg/mL NS n/a 5.1 1 w Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 2005; 9:399–401. propionate burette chamber. CONTAINER Protected from light. 10% loss due to sorption in Travenol (Viaflex) 0.9% sodium chloride PVC bags at 0.015 mg/mL. pH of undiluted product is 3.4–4.4. Syringes with polyethylene plungers. pH of solution decreased from 4.9 on day 0 to 4.1 after 2 days. pH of solution decreased from 4.9 on day 0 to 4.1 after 2 days. Syringes, Syringes, c d e f References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. in 0.9% sodium chloride injection or 5% dextrose for infusion. Gupta VD. Chemical stability of hydralazine hydrochloride after reconstitution 3. Kowaluk EA, Roberts MS, Blackburn HD, et al. Interactions between drugs and polyvinyl chloride infusion bags. Notes b 4. delivery systems. Kowaluk EA, Roberts MS. Interactions between drugs and intravenous Hydralazine Hydrochloride Chloride Polyvinyl (PVC) Polypropylene Note: Special Considerations: temperature; refrigeration may cause crystallization. Flush Compatibility: 212 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Hydrocortisone Sodium Succinate Int 3 3 Body Temp Refer. Storage Conditions 48 d n/a41 d n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw c c 6 d 7 d 7 d6 d 21 d 81 d n/a n/a n/a n/a n/a n/a n/a n/a 1, 2 1, 3 Room Refrig Frozen Room Refrig a ddd a d a a a Osmolality (mOsm/kg) pH W

1 n/a Drug . 2005; Jun 15 38(2):332–6. Heparin lock flush and normal saline. unspec.unspec. 1 mg/mL 1 mg/mLUPPH 10 mg/mL 50 mg/mL NS NS NS . 2000; 4(5):396–7. Manufacturer Concentration Diluents Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. J Pharm Compound J Pharm Biomed Anal CONTAINER A 50 mg/mL solution (AB) is 260–292 mOsm/kg. pH of reconstituted solution is 7–8. 8 d, if protected from light. Special Considerations: Notes a Hydrocortisone Sodium Succinate Polyolefin Chloride Polyvinyl (PVC) Syringes, Polypropylene Flush Compatibility: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed June 2016. 2. after reconstitution in 0.9% sodium chloride injection and storage polypropylene syringes for pediatric use. Das Gupta V, Ling J. Stability of hydrocortisone sodium succinate Note: 3. of hydrocortisone sodium succinate in PVC and non-PVC bags polypropylene syringes [Abstract]. Rigge DC, Jones MF. Shelf lives of aseptically prepared medicines—stability c d 213 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Hydromorphone Hydrochloride 5 5 3 1 1 1 5 5 2 5 5 1 2 1 4 1 1 4 4 6 1 Refer. h e,

j Body Temp 16 w continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a 5 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions o a a a a a a c a a c, j 91 d n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 32 d 32 TemperatureTemp Post-thaw b p p b a o a a 30 d 60 d30 d 60 d 91 d 7 dn/a 32 d 7 d 72 h n/a n/a n/a n/a n/a 7 d 42 d42 d 42 d 42 d7 d n/a n/a n/a n/a n/a n/a n/a n/a 7 d 7 d 42 d 42 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig f f f f f f f f f f f f f f f f n/a 4.5–4.7 n/a 28 d n/a 4.6–4.8 n/a 28 d n/a n/a 4.6–4.8 n/a 28 d n/a 4.6–4.8 n/a 28 d n/a 4.1–5.1 n/a 28 d n/a 4.6–5.4 n/a 28 d n/a n/a n/a Osmolality (mOsm/kg) pH n n l m g l m l,m, l,m, i i i NS NS NS NS NS NS NS NS NS NS g n n l,m, l,m, i i i l m l m 10, 50 mg/mL unspec. n/a 10, 50 mg/mL unspec. n/a d d Drug SZ 43 mg/mL KNunspec.KNSZ 1.5– 80 mg/mL 0.1 mg/mL 10 mg/mL 25 mg/mL NS NS n/a undiluted n/a n/a SZ 43 mg/mL KN 1 mg/mL D5W, NS n/a KN 3–10 mg/mL D5W n/a SZ 25 mg/mL SAB 0.02, 0.04 mg/mL SZKN 0.01 mg/mL SZ 0.02, 0.1 mg/mLSZ 0.2 mg/mL SZ 0.2 mg/mL NS 0.01 mg/mL n/a SZ 0.2 mg/mL KN 2, 10 mg/mL undiluted n/a KNunspec. 1, 5 mg/mL D5W, NS n/a KN 1 mg/mL D5W, NS n/a unspec. Manufacturer Concentration Diluents k

® CONTAINER OTHER INFUSION CONTAINERS Hydromorphone Hydrochloride Bags Non-DEHP (INTRAVIA, Baxter) Chloride Polyvinyl (PVC) Syringes, Plastic Polypropylene Brown Glass Vials (Leventon) INFUSOR (Baxter) Synchromed Pump Implanted (Medtronic) Syringes, Syringes, Dosi-Fuser Glass 214 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Hydromorphone Hydrochloride (cont’d) . 2009; . 2010; Can J Hosp Pharm Can J Hosp Pharm . 2004; 57:230b. Can J Hosp Pharm Barcelona, Spain: Leventon SAU; October 2015.

1 (cont’d)

Ontario, Canada: Baxter Corporation; October 2008.

1 Elastomeric Pump (ES.H.00.730-10). ® Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating the need for extended medication storage in BD Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating need for extended Normal saline and heparin lock flush.

7 Intermate/Infusor Drug Stability Information. 62(2):112b. There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. Accessed There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. June 5, 2016. 63:154–5. Drug Stability Table-Dosi-Fuser With bupivacaine (HSP) 20 mg/mL. Stored at 30°C. Compounded using hydromorphone hydrochloride powder. Under fluorescent light. Manufacturer extrapolated data from other sources. Stored at 37°C. With bupivacaine (HSP) 37.5 mg/mL. No adverse effects on pump were noted. Protected from light. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices 32 d refrigerated, followed by 3 at room temperature. With bupivacaine (AST) 2.5 mg/mL. pH range of undiluted product is 4–5.5. 7 d at room temperature, followed by 5 33°C. With bupivacaine (HSP) 0.01 mg/mL. With ketamine (SZ) 0.2, 0.6, and 1 mg/mL. Special Considerations: syringes. Notes a b c d e f 4. solutions in glass bottles, plastic syringes, and IV bags for pediatric use. Ensom MHH, DeCarie D, Leung K, et al. Stability of hydromorphone-ketamine g h i j k l m n o p References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 October. 2. 3. and hydromorphone in polypropylene syringes. Donnelly RF. Physical compatibility and chemical stability of bupivacaine Flush Compatibility: 5. bupivacaine with hydromorphone, morphine, and fentanyl [Letter]. Donnelly RF, Wong K, Spencer J. Physical compatibility of high-concentration Hydromorphone Hydrochloride 7. FDA Safety Alert for Human Medical Products: Compounded or Repackaged Drugs Stored in Becton-Dickinson (BD) 3 mL and 5 Syringes: Alert—Do Not Use Unless 6. 215 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Hydroxyzine Hydrochloride 1 1 1 Body Temp Refer. n/a n/a n/an/a n/a n/a n/a n/a Storage Conditions c c 12 m 12 m TemperatureTemp Post-thaw c c 10 d 10 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e n/a n/an/a 12 m n/a 12 m n/a Osmolality (mOsm/kg) pH bb b b d d

1 Drug n/a PFNF 12.5 mg/mL PF 50 mg/mL 12.5 mg/mL Manufacturer Concentration Diluents Normal saline. Incompatible with heparin lock flush. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER OTHER INFUSION CONTAINERS With atropine sulfate USP 1 mg/mL. With chlorpromazine HCl 6.25 mg/mL (ES) and meperidine 25 (WI). pH of undiluted solution is 3.5–6. Protected from light. Flush Compatibility: Special Considerations: Notes b c d e Hydroxyzine Hydrochloride Syringes, Plastic Syringe, Unspecified Syringes, Glass Reference 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. Note: 216 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ibuprofen 2 1

3 Body Temp Refer.

1,2 Storage Conditions TemperatureTemp Post-thaw 7 d 7 d n/a n/a n/a n/a 24 h n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a ); these have different physicochemical properties and clinical indications. ® Osmolality (mOsm/kg) pH 2006; 41(10):970–8. Hosp Pharm.

) with ibuprofen lysine (lysinate) (NeoProfen 4 mg/mL NS, D5W, LR n/a 4 mg/mL NS, D5W, LR n/a 1,2 ® ≤ ≤ contains arginine; vial stopper is latex free. Dilute to a final concentration of 4 mg/mL or less prior to infusion. contains arginine; vial stopper is latex free. Dilute to a final concentration of 4 mg/mL or ® Caldolor Drug Normal saline. CUP CUP Manufacturer Concentration Diluents (ibuprofen) injection [prescribing information]. Nashville, TN: Cumberland Pharmaceuticals Inc.; November 2015. ® CONTAINER pH of 100 mg/mL (undiluted) is approximately 7.4. Note a Special Considerations: 2. Pharmaceuticals Inc.; February 1, 2011. Professional Affairs [personal communication]. Nashville, TN: Cumberland 3. Cada DJ, Levien T, Baker DE. Ibuprofen lysine injection. References 1. Caldolor Flush Compatibility: Do not confuse ibuprofen (Caldolor Ibuprofen Unspecified IV Bag 217 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 217 22/05/17 1:55 PM Ibuprofen LYSINATE Body Temp Refer. ), which has different ® Storage Conditions n/a n/a n/a n/a n/a 2, 3 TemperatureTemp Post-thaw b 15 d Room Refrig Frozen Room Refrig 2005; 62:630–3. a 6.18 ± 0.2 Am J Health-Syst Pharm. n/a Osmolality (mOsm/kg) pH Do not confuse this preparation with ibuprofen injection (Caldolor 4 W 2006; 41(10):970–8. Hosp Pharm.

2 1 1, 4 mg/mL D5W, NS,

1 Stability is enhanced when protected from light. Drug Normal saline. c Manufacturer Concentration Diluents [package insert]. Lebanon, NJ: Recrodati Rare Diseases Inc.; December 2013. ® CONTAINER Exposed to and protected from light. pH of undiluted product is 7. Dexprofeno (ibuprofen), Laboratories Richmond, Argentina. Ibuprofen LYSINATE Ibuprofen LYSINATE Plastic Unspec. Container Flush Compatibility: Special Considerations: physicochemical properties and clinical indications. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 January. 3. in injection solutions. Volonté MG, Valora PD, Cingolani A, et al. Stability of ibuprofen 4. Cada DJ, Levien T, Baker DE. Ibuprofen lysine injection. c References 1. NeoProfen Notes a b 218 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 218 22/05/17 1:55 PM Ifosfamide 3, 4 2 4 4 6 4 2, 4 8 4, 5 6 6 4 7 d n b, h k h k, d Body Temp Refer. continued on next page n/a n/a n/a 2 d n/a n/a n/a n/a 2, 4 n/a n/a n/a 2 d n/a n/a n/a 7 d Storage Conditions d n k d k, 6 w n/an/a n/a n/a n/a n/a n/a n/a 9 d 6 w n/a n/a n/a n/a n/a n/a n/a n/a n/a 6 w n/a n/a n/a n/a TemperatureTemp Post-thaw o o c o o 9 d 28 d 28 d n/an/a n/a n/a n/a n/a n/a n/a 1, 4 n/a 8 d 7 d 8 d 8 d n/a n/a n/a n/a n/a 8 d n/a 14 d Room Refrig Frozen Room Refrig f f f f f f f f n/a n/a n/a n/a n/a 7 d n/a n/a 7 d n/a n/a 10 d n/a n/a n/a n/a n/a n/a n/an/a n/a n/a 14 d n/a 24 h n/a n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a 7 d Osmolality (mOsm/kg) pH g b a, m i i e NS W D5W, D5S, NS LR, NS NS D5W, D5S, ½S NS, LR, n/a n/a 10 d n/a n/a n/a n/a n/a W D5S, D5W, D5W, D5S, LR, NS NS LR, D5W, NS W NS NS m i i j g b a, j e Drug BI 80 mg/mL AM, BI 35–70 mg/mL unspec. 50 mg/mL FL 80 mg/mL unspec. 0.6–20 mg/mL AM, BIunspec. 70 mg/mL 0.6, 16 mg/mL AM 0.8–100 mg/mL unspec.FL 0.6–20 mg/mL SICunspec. 10 mg/mL 10, 20, 30 mg/mL 0.6, 20 mg/mL FLunspec. NS 20, 40, 80 mg/mL 0.8–100 mg/mL n/a NSAM n/a 20 mg/mL Manufacturer Concentration Diluents l

® 9000 9000 TM Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS Graseby Dosi-Fuser Glass Vials Unspecified Ifosfamide Chloride Polyvinyl (PVC) Syringes, Polypropylene CADD Deltec) (Pharmacia (Leventon) Cassette PVC (Graseby Medical) INFUSOR (Baxter) 219 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 219 22/05/17 1:55 PM Ifosfamide (cont’d) 2014; 1992; Cancer Chemother J Oncol Pharm Pract. Am J Hosp Pharm. 1998; 4:143–9. 1987; 238:476–8. Pharm J. J Oncol Pharm Practice. Barcelona, Spain: Leventon SAU; October 2015. Ontario, Canada: Baxter Corporation; October 2008. 4

1 Elastomeric Pump (ES.H.00.730-10). ® n/a Normal saline. 1990; 26:144–6. 20(1):51–7. Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. 49:1137–9. Pharmacol. With mesna 1:1 respectively (10, 20, and 30 mg/mL). Protected from light. With mesna (BI) 76 mg/mL or ifosfamide alone. Mesna stability not tested. At 30°C. At 35°C. Manufacturer extrapolated data from other sources. With mesna (AM) 20 mg/mL. With mesna 40 mg/mL. 7 d refrigerated, followed by 2 at 33°C. Solution stored in daylight at temperature range of 18–24°C; another solution also dark 27°C. With epirubicin 1 mg/mL. pH of solution is approximately 6. Do not reconstitute ifosfamide with BWFI containing benzyl alcohol. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. With mesna (AM) 0.4–100 mg/mL. Special Considerations: Notes a b c d e f g h i j k l m n o References 1. of home infusion therapy for cancer patients. Adams PS, Haines-Nutt RF, Bradford E, et al. Pharmaceutical aspects Ifosfamide (cont’d) Flush Compatibility: 8. 6. 7. of high-dose ifosfamide and mesna for prolonged 14-day continuous infusion. Zhang Y, Kewedia JD, Myers AL, et al. Physical and chemical stability 2. sodium chloride solution or water for injection in a portable iv pump cassette. Munoz M, Girona V, Pujol et al. Stability of ifosfamide in 0.9% 3. in aqueous solution and its suitability for continuous 7-day infusion by ambulatory pump. Radford JA, Margison JM, Swindell R, et al. The stability of ifosfamide 4. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 5. Graseby 9000 ambulatory infusion pump. Priston MJ, Sewell GJ. Stability of three cytotoxic drug infusions in the 220 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 220 22/05/17 1:55 PM Imipenem–Cilastatin Sodium 4 7 1 1 8 6 2 3 3 3 3 3

1,5 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/an/a n/an/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions

g c d e c g 3 d 72 h 72 48 h TemperatureTemp Post-thaw g g 1 d 3 d n/a n/a n/a n/a 1 d 6 h9 h 24 h n/a n/a10 h n/a n/a 1 d 3 dn/a n/a 24 h n/a n/a10 h n/a n/a18 h 24 h 18 h n/a 48 h n/a8 h 24 h 13 h n/a n/a 24 h n/a n/a n/a n/a Room Refrig Frozen Room Refrig a If an admixed dose is refrigerated prior to administration, shake 5 b a b a bb a a bb a b a b a bbb a b a a a a Osmolality (mOsm/kg) pH

1 Manufacturer suggests for vials: reconstitute vial with 10-mL diluent, shake well, and transfer resulting suspension to infusion solution Manufacturer suggests for vials: reconstitute vial with 10-mL diluent, shake well, and transfer resulting Drug Normal saline. unspec. 5 mg/mL NS MSD 5 mg/mL NS MSDMSD 2.5 mg/mL 2.5 mg/mLMSDunspec 5 mg/mL D5W NS unspec. 5 mg/mL 5 mg/mLMSDMSD NS MSD NS 2.5 mg/mLMSD 2.5 mg/mLMSD 2.5 mg/mL NS 5 mg/mL 5 mg/mL D5W NS NS D5W NS Manufacturer Concentration Diluents

ST/LT ST/LT

® ® ®

/ TM f ® Medical)

Braun)

CONTAINER OTHER INFUSION CONTAINERS Maximum solubility is 5 mg/mL at room temperature. Solubility lower temperatures. Dosi-Fuser (B. Flush Compatibility: Homepump (Epic (B. Braun) Imipenem–Cilastatin Sodium Glass Container AccuFlo (Leventon) Easypump Homepump Eclipse C-Series (Halyard) INTERMATE (Baxter) SMARTeZ vigorously upon removal from refrigerator and equilibrate to room temperature. Shake again just prior administration. Special Considerations: resulting mixture until clear. container. Repeat with additional 10 mL of diluent to ensure complete transfer vial’s contents the infusion solution. Agitate 221 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 221 22/05/17 1:55 PM Imipenem–Cilastatin Sodium (cont’d)

1 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Followed by 10 h at room temperature. When reconstituted and diluted as directed by the manufacturer, osmolality of mixture approximates that diluent. Followed by 13 h at room temperature. pH of the IV product is buffered to 6.5–8.5. Followed by 9 h at room temperature. Manufacturer extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Imipenem–Cilastatin Sodium (cont’d) 8. 5. Medical Services [personal communication]. North Wales, PA: Merck & Co. Inc.; January 2008. 6. Notes a c d e f g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. 3. 4. b 7. 222 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 222 22/05/17 1:55 PM Immune Globulin (Human) 4 2 4 Body Temp Refer. continued on next page n/a n/a n/a n/a 3, 24 n/a n/a n/a n/a 29 n/a n/a n/a n/a 28 n/a n/a n/a n/a n/a n/a n/a n/a 4, 24 n/a n/a n/a n/a 17 n/a n/a n/a n/a 3, 24 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4, 24 n/a n/a n/a n/a 30 n/a n/a n/a n/a 30 Storage Conditions z n n n n n n n n x n z x, n/a n/a n/a n/a n/a 25 15 d 24 h 14 d n/a n/a n/a n/a n/a 25 10 d 21 d 24 h n/a n/a n/a n/a n/a 21 14 d 24 h TemperatureTemp Post-thaw n n n n z n n n o o 14 d n/a 21 d 15 d 3 d 14 d 7 d n/a 24 h 2 h 2 h q 3 d 10 d Room Refrig Frozen Room Refrig 9 9 3 3 4 1, 1, 1, 1, 1 1, 1 1 1 1,20 1 4.8–5.1 4.6–5.1 4–4.5 4.8–5.1 6.4–6.8 4.6–5.1 6.4–7.2 6.4–7.2 4.6–5.2 5–6 24 24 9 3 9 3 1 Osmolality Osmolality (mOsm/kg) pH 20 27 420–500 240–300 n/a n/a 12 h 24 h n/a n/a n/a n/a 29 258 420–500 n/a n/a n/a 12 h 636, 1250 6.4–7.2 3%: 444, 498, 192; 192; 498, 444, 3%: 384; 690, 636, 6%: 576; 882, 828, 9%: 12%: 1020, 1074, 768 240–300 636, 1250 636, 1250 240–370 n/a n/a 12 h 636, 1250 6.4–7.2 n/a n/a n/a 12 h l m m m m i, i, m i, p l l l l k, k, k, k, W W W W W W W W 5% RTU 10% RTU 3%, 6%, 9%, 12% D5W, NS, W 10% RTU 5%, 10% 5% RTU 5%, 10% 5%, 10% 10% RTU 5%, 10% 20% RTU5% 380 RTU t h h a u b Drug d c d d c d BPL BA 5–10% BA CSL KED BABA 5–10% BPL BA BA BA BA CSL unspec. 5–10% GRI unspec. 5–10% Manufacturer Concentration Diluents

w y OTHER INFUSION CONTAINERS CONTAINER Syringe Syringe Glass (Baxter) Flexible Flexible Container (Unspecified) (Unspecified) Dosi-Fuser (Leventon) INTERMATE (Baxter) INTRAVIA PVC Immune Globulin (Human) Vinyl Ethylene Acetate (EVA) Gri-bag PVC (Grifols) 223 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 223 22/05/17 1:55 PM Immune Globulin (Human) (cont’d) 3 9 5 2 Body Temp Refer. continued on next page n/a n/a n/a n/a Storage Conditions n The optimal pH for IgIV in solution is 4–4.5; 8 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 22 n/a n/a n/a n/a n/a 6, 23 n/a n/a n/a n/a n/a 14 n/a n/a n/a n/a n/a18 13, n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 20 n/a n/a n/a n/a n/a TemperatureTemp Post-thaw n n n n q q 8 h n/a 24 h Room Refrig Frozen Room Refrig

1 1 q 1 1 q 4–4.6 5.1–6, 5.1–6, 4.5–5 6.4–6.8 Ig solutions should be at room temperature prior to administration. 1 26 Osmolality Osmolality (mOsm/kg) pH Due to the difference in stabilizers and Ig production methods, clinicians should use 11 510 240–300 4.6–5.1 ≤ 240–440 4.6–5 8 h 240–370 5–6 310–380 420–500 4.8–5.1 258 4–4.5 8 h 258 4–4.5 8 h 3%: 444, 498, 192; 192; 498, 444, 3%: 384; 690, 636, 6%: 576; 882, 828, 9%: 12%: 1020, 1074, 768 l m m m p i, i p p m i, i, 10% RTU 10% RTU 10% RTU 5%, 10% RTU 5%, 10% RTU 5% RTU 10% RTU 3%, 6%, 9%, 12% D5W, NS, W 10% RTU Unless stated otherwise, immune globulin (Ig) product manufacturers recommend immediate use (e.g., less than 3 h) when opened Unless stated otherwise, immune globulin (Ig) product manufacturers recommend immediate use (e.g., g v t h e a b f Drug c D5W, normal saline unless noted as incompatible with sodium chloride diluents. . ® BPH BA CSL GRI OCT BPL KED CSL GRI . Manufacturer Concentration Diluents ® DIF. . ® ® NF. -C. . ® ® ® . ® Gammagard S/D Flebogamma Gammaplex Privigen Carimune Gammagard Liquid Octagam Gamunex May dilute with D5W if necessary. data that are specific to the brand of Ig product. Do not freeze products or preparations. preparations with higher (e.g., physiologic) pH contain stabilizing agents. Notes a b c i d e h f g Flush Compatibility: Special Considerations: on sterility concerns and the or prepared outside an ISO Class 5 environment and/or stored at room temperature. These labeled statements are based primarily dating of IgIV solutions prepared in potential for Ig solutions to support microbial growth. Some organizations conduct extended sterility studies an ISO Class 5 environment. One published study demonstrated no bacterial or yeast growth over a 7 d period at 3°C. Unspecified Unspecified Container Immune Globulin (Human) (cont’d) Infusion Plastic Container (Unspecified) Bag Infusion (Unspecified) Sterile Sterile 224 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 224 22/05/17 1:55 PM Immune Globulin (Human) (cont’d)

4 1994; 51;1676–9. Am J Hosp Pharm. 2005; 62(suppl 3):S5–11. Barcelona, Spain: Leventon SAU; October 2015.

4 Am J Health-Syst Pharm. Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® (Immune Globulin Infusion, Human) 10% [package insert]. Westlake Village, CA: Baxter Healthcare Corporation; April 2014. System 3.0, which is a closed system. ® ® (Immune Globulin Intravenous, Human) [package insert]. Westlake Village, CA: Baxter Healthcare Corporation; April 2014. ® DIF (Immune Globulin Intravenous, Human) 5% [package insert]. Barcelona, Spain: Instituto Grifols, S.A.; April 2015. DIF (Immune Globulin Intravenous, Human) 10% [package insert]. Barcelona, Spain: Instituto Grifols, S.A.; January 2016. (Immune Globulin Injection, Human) 10% [package insert]. Fort Lee, NJ: Kedrion Biopharma, Inc.; September 2013. (Immune Globulin Intravenous, Human) 5% [package insert]. Raleigh, NC: Bio Products Laboratory, Ltd.; July 2015. ® ® ® TM

NF (Immune Globulin Intravenous, Human) [package insert]. Kankakee, IL: CSL Behring; September 2013. -C (Immune Globulin, Human) 10% [package insert]. Research Triangle Park, NC: Grifols Therapeutics; July 2014. (Immune Globulin Intravenous, Human) 5% [package insert]. Hoboken, NJ: Octapharma USA, Inc.; October 2013. (Immune Globulin Intravenous, Human) 10% [package insert]. Hoboken, NJ: Octapharma USA, Inc.; April 2015. ® ® (Immune Globulin Subcutaneous, Human) 20% [package insert]. Kankakee, IL: CSL Behring, LLC; January 2015. TM (Immune Globulin Intravenous, Human) 10% [package insert]. Kankakee, IL: CSL Behring, LLC; November 2013. ® ® (Immune Globulin Intravenous, Human) 10% [package insert]. Boca Raton, FL: Biotest Pharmaceuticals Corporation; June 2013. ® ® ®

® ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. May 2005; Boston, MA. Do not use NS as a diluent. Gri-bags used Gri-fill Dilution with IV fluids is not recommended. Manufacturer recommends use as soon vial is entered (i.e., promptly). Prepared outside of a laminar flow hood. Prepared in ISO Class 5 (hood) environment. Hizentra. Manufacturer of lyophilized Ig product provides diluent (W) for initial reconstitution and/or infusion. Diluent should be at room temperature prior to reconstitution. Manufacturer of lyophilized Ig product provides diluent (W) for Bivigam. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Manufacturer extrapolated data from other sources. Followed by 12 h at 25°C. Gammaked. To avoid excessive foaming, swirl—do not shake—to dissolve. l k 4. Gammagard S/D w 8. in intravenous immune globulin preparations [Abstract]. Pfeifer RW, Siegel J, Ayers LW. Assessment of microbial growth 3. Gammagard Liquid v 6. Octagam x y z References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD. American Society of Health-System Pharmacists. Accessed 2016 September. 2. Carimune m n o p q t 5. Gamunex u 11. 11. Shah S. Pharmacy considerations for the use of IGIV therapy. 9. Gammaplex Immune Globulin (Human) (cont’d) Note: 22. 22. Bivigam 14. 14. Privigen 21. 21. Hizentra 13. 13. Flebogamma 30. 30. 24. 24. Medical Information Department [personal communication]. Bannockburn, IL: Baxalta US Inc.; March 2016. 25. Medical Information Department [personal communication]. Raleigh, NC: Bio Products Laboratory, Ltd.; March 2016. 26. Medical Information Department [personal communication]. Boca Raton, FL: Biotest Pharmaceuticals; March 2016. 27. Medical Information Department [personal communication]. King of Prussia, PA: CSL Behring; March 2016. 28. Medical Information Department [personal communication]. Fort Lee, NJ: Kedrion Biopharma, Inc.; March 2016. 29. 20. 20. Gammaked 23. 23. Octagam 17. 17. immunoglobulins preparations with plastic containers. Poster presented at: FOCIS 5th Annual Meeting; Lopez M, Costa Jorquerea JI. Compatibility study of two intravenous 18. Flebogamma 225 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 225 22/05/17 1:55 PM Infliximab 5 4 5 5 Body Temp Refer.

3 m or less). µ n/a n/a n/a n/a Storage Conditions c n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw a a a 24 h n/a 14 d 24 h 24 h Room Refrig Frozen Room Refrig . 2012; 69:1509–12. b b b b b Osmolality (mOsm/kg) pH Am J Health-Syst Pharm

5 Use an infusion set with an in-line, sterile, non-pyrogenic, low-protein-binding filter (pore size of 1.2 Use an infusion set with in-line, sterile, non-pyrogenic, low-protein-binding filter (pore size of 1.2 Drug Normal saline. JN 0.4–4 mg/mL NS n/a CEN 0.4 mg/mL NS n/a JNJN 0.4–4 mg/mL 0.4–4 mg/mL NS NS n/a n/a Manufacturer Concentration Diluents [package insert]. Horsham, PA: Janssen Biotech, Inc.; October 2015. ® (PVC)

(EVA)

Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. microbiological contamination. CONTAINER OTHER INFUSION CONTAINERS pH of reconstituted solution 10 mg/mL in W is approximately 7.2. Product remains physically and biochemically stable for 24 h. Manufacturer recommends preparation under aseptic conditions and use within 3 h to ensure against Product remains physically and biochemically stable for 24 h. Manufacturer recommends preparation under aseptic conditions No loss of biological activity as measured by an indirect ELISA method. Polyvinyl Polyvinyl Chloride Infliximab Ethyl Vinyl Acetate Glass Polyethylene Flush Compatibility: Special Considerations: Notes a b 5. Scientific Affairs, LLC; August 2015. Medical Information [personal communication]. Titusville, NJ: Janssen Note: c References 3. Remicade 4. chloride bags. Ikeda R, Vermeulen LC, Lau E, et al. Stability of infliximab in polyvinyl 226 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 226 22/05/17 1:55 PM Interferon alfa-2b Body Temp Refer. n/a n/an/an/a n/a n/a n/a n/a n/a n/a 1, 2 n/a n/a 1, 3 1, 3 Storage Conditions i . 1995; 52:2128–30. c, h h . 1998; 55:1602–5. TemperatureTemp Post-thaw n/a 21 d n/an/a 42 dn/a 42 d n/a 42 d n/a n/a n/a 1, 3 Room Refrig Frozen Room Refrig f Am J Health-Syst Pharm pH Am J Health-Syst Pharm j

1 j f jjj f f f Osmolality (mOsm/kg)

1 W W BWFI RTU 1 c h h

4 Product is labeled in International Units (I.U.) The single-use vial powder for injection is to be reconstituted with the provided vial of W; Product is labeled in International Units (I.U.) The single-use vial powder for injection to be reconstituted Drug Normal saline. Incompatible with dextrose-containing solutions. SC 2 million I.U./mL SCSCSC 2 million I.U./mL 3 million I.U./mL 6 million I.U./mL Manufacturer Concentration Diluents (interferon alfa-2b, recombinant) [package insert]. Whitehouse Station, NY: Schering Corporation, a subsidiary of Merck and Co, Inc.; May 2015. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER With and without albumin 1 mg/mL. Contains albumin 1 mg/mL. Interferon alfa-2b is most stable between pH 6.9 and 7.5. Reconstituted vial, 10 million I.U. in 1 mL W, results an isotonic solution. Tested in polypropylene centrifuge tubes. 3. Appenheimer MM, Schepart BS, Poleon GP, et al. Stability of albumin-free interferon alfa-2b for 42 days. References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. alfa-2b diluted to 2 million units/mL. Schepart BS, Burns BA, Evans S, et al. Long-term stability of interferon h i j 4. Intron A Note: Special Considerations: injection are albumin-free. Refrigerate, each vial also contains human albumin, resulting in a final concentration of 1 mg/mL albumin. The solution multidose vials for and do not freeze product. Interferon alfa-2b Syringes, Polypropylene Flush Compatibility: Notes c f 227 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 227 22/05/17 1:55 PM Irinotecan Hydrochloride 2 Body Temp Refer. 2000; 6:115–21.

2 n/an/a n/a n/a n/a n/a n/a n/a 1, 2 Storage Conditions b a, b 28 d J Oncol Pharm Prac. TemperatureTemp Post-thaw a 7 d28 d n/a n/a n/a n/a n/a 1, 2 2 h14 d 4 d n/a n/a n/a n/a n/a 1, 2 Room Refrig Frozen Room Refrig c c c c c Osmolality (mOsm/kg) pH

2 n/a Drug Normal saline. RPR 0.4, 1 mg/mL NS n/a RPR 0.4, 1, 2.8 mg/mL NS, D5W n/a RPRRPR 2 mg/mL 2.8 mg/mL D5W, NS NS n/a n/a Manufacturer Concentration Diluents (PVC)

CONTAINER Refrigerated storage of irinotecan hydrochloride in normal saline is not recommended because occasional visible precipitation. Protected from light. pH of undiluted solution is 3–3.8. 2. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. c References 1. and diluted infusion solutions in PVC bags. Thiesen J, Kramer I. Physicochemical stability of irinotecan injection concentrate Irinotecan Hydrochloride Polyvinyl Chloride Flush Compatibility: Special Considerations: Notes a b 228 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_I.indd 228 22/05/17 1:55 PM Iron Sucrose 3 4 2 2 1 Body Temp Refer. Do not mix with other medications n/a n/a n/a n/a 2 Storage Conditions d 1 d TemperatureTemp Post-thaw d 1 d 1 d n/a n/a n/a n/a 1 d 7 d7 d 7 d n/a n/a n/a n/a n/a n/a1 d n/a n/a 1 d n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a a a a Do not dilute below 1 mg/mL. 2 Bethlehem, PA: B. Braun USA; September 2015. Osmolality (mOsm/kg) pH . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM

2 Concentration of iron sucrose is stated as mg/mL elemental iron. Drug

2 2 Normal saline. unspec. 1 mg/mL NS n/a unspec. 1 mg/mL NS n/a AMRAMR 2–10 mg/mL 1–2 mg/mLunspec. NS 1 mg/mL NS n/a n/a NS n/a Manufacturer Concentration Diluents Stability Data for Drugs Using Elastomeric Infusion Pumps. ® (iron sucrose injection) [package insert]. Shirley, NY: American Regent, Inc.; August 2015. (iron sucrose injection) [package insert]. Shirley, NY: American

® ® ®

TM Medical) Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential.

Braun) Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Stability Data for Drugs Using B. Braun’s AccuFlo

CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. pH range is 10.5–11.1. Easypump (B. Flush Compatibility: (Epic Special Considerations: Iron Sucrose Plastic Syringe and PVC Non-PVC Bag AccuFlo ST/LT (B. Braun) SMARTeZ Note: or parenteral nutrition. Notes a d References 1. 4. 3. 2. Venofer 229 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ketamine Hydrochloride 1 1 1 4 1 1 1 1 1 1 j n Body Temp Refer. continued on next page n/a n/a n/a 15 d Storage Conditions n 12 m n/a n/a n/a 12 m 15 d TemperatureTemp Post-thaw n Compatible with D5W, but stability data is 91 d 91 d n/a n/a n/a n/a 1, 6 12 m 12 6 d n/a n/a n/a n/a n/a 15 d 30 d n/a n/a n/a n/a n/a 6 d n/a n/a n/a n/a n/a 30 d 30 d n/a n/a n/a n/a 6 d n/a n/a n/a n/a n/a 6 d n/a n/a n/a n/a n/a 6 d n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig 1,5 4.2 30 d n/a n/a n/a n/a n/a 1, 2 5.5–7.5 4 d n/a n/a n/a n/a n/a 1, 3 4.5–4.8 7 d n/a n/a n/a n/a n/a 1, 4 4.5–4.8 7 d n/a4.5–4.8 n/a 7 d n/a n/a n/a n/a n/a n/a 1, 4 n/a n/a f f g Osmolality (mOsm/kg) pH k f l f g c f g a f h f h f h, m f g i f g d f g i f g b f g e f g c f g NS W NS NS NS NS NS NS NS NS NS NS NS NS h h h e m a c c l i d i b

1 Do not administer the 100 mg/mL product intravenously without further dilution. Drug Normal saline. SZ 2 mg/mL ABPD 10 mg/mL 1.33 mg/mL QISZ 1, 2, 4 mg/mL 0.2, 0.6, 1 mg/mL SZunspec. 0.2, 0.6, 1 mg/mL 1 mg/mLSZPD NS 0.2, 0.6, 1 mg/mL 25 mg/mL JN 1 mg/mL PD 1 mg/mL JN 1 mg/mL PD 10, 25 mg/mL PD 1 mg/mL PD 25 mg/mL Manufacturer Concentration Diluents

1,5

CONTAINER OTHER INFUSION CONTAINERS Also contains morphine sulfate (SAB) 1 mg/mL. Also contains morphine sulfate (AB) 2 mg/mL. Unspecified Ketamine Hydrochloride Polyolefin Chloride Polyvinyl (PVC) Syringes, Plastic Polypropylene Glass Medication Cassette (Deltec) Flush Compatibility: Special Considerations: unavailable. Notes a b Syringes, Syringes, 230 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_K.indd 230 22/05/17 1:55 PM Ketamine Hydrochloride (cont’d) Int J . 2009; Can J Hosp Pharm 2009; 62:28–33. Can J Hosp Pharm.

1 . 2002; 94:898–900. Anesth Analg

1 2002; 6:316–7. (ketamine hydrochloride injection) [package insert]. Rochester, MI: JHP Pharmaceuticals, LLC; March 2012. ® Pharmaceutic Compound. 62(2):112–8. Also contains butorphanol tartrate 50, 100, or 150 (HE) mcg/mL. Also contains morphine sulfate 1 or 10 (SAB) mg/mL. With hydromorphone (SZ) 0.2 mg/mL. Protected from light. Also contains morphine sulfate 1, 10, or 25 (SAB) mg/mL. Brown glass 100-mL bottle. Also contains morphine sulfate (SAB) 25 mg/mL. pH of undiluted solution is 3.5–5.5. Undiluted 10 mg/mL solution is 300 mOsm/kg, and undiluted 50 mg/mL solution is 387 mOsm/kg. Undiluted 10 mg/mL solution is 300 mOsm/kg, and undiluted At 40°C. Also contains morphine sulfate 2, 5, or 10 (SZ) mg/mL. With fentanyl (DB) 10 mcg/mL and droperidol (JN) 50 mcg/mL. With fentanyl (DB) 10 mcg/mL and droperidol (JN) 50 mcg/mL. 4. Ensom MHH, Decarie D, Leung K, et al. Stability of hydromorphone-ketamine solutions in glass bottles, plastic syringes, and IV bags for pediatric use. 3. solution. Schmid R, Koren G, Klein J, et al. The stability of a ketamine-morphine h i j k l m n References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. in water for injection and storage 1-mL tuberculin polypropylene syringes pediatric use. Gupta VD. Stability of ketamine hydrochloride injection after reconstitution 6. mixtures in polypropylene syringes. Donnelly RF. Physical compatibility and chemical stability of ketamine-morphine c d e f 5. Ketalar g Ketamine Hydrochloride (cont’d) 231 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_K.indd 231 22/05/17 1:55 PM Ketorolac Tromethamine 4 4 4 4 4 5 5 5 5 h f g g n/a 3, 4 n/a Body Temp Refer. c b continued on next page n/a 35 d b n/a n/a n/a 7 d Storage Conditions f n/a n/a n/a n/a 7 d n/a n/a n/a n/a 7 d n/a n/a n/a n/a 7 d TemperatureTemp Post-thaw h g g 48 h21 d n/a 21 d n/a n/a48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 4 n/a n/a n/a n/a 15 d 48 h48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 17 d n/a 28 d 28 d 28 d Room Refrig Frozen Room Refrig a 5.66–6.84 5.3–6.66.1–6.7 7 d 35 d 50 d 50 d n/a n/a n/a n/a n/a n/a n/a n/a 2, 4 2, 4 5.5–5.7 n/a n/a 3 m n/a 60 d ii i i i a a ii a ii a a i a i a i a i a Osmolality (mOsm/kg) pH NS, D5W NS, D5W NS, D5W e d e

4 4 0.06 mg/mL mg/mL 0.06 R 0.06 mg/mL mg/mL 0.06 R Protect from light. Drug Normal saline. SY RCRCRCSY 0.3, 0.6 mg/mL 0.6 mg/mL 0.6 mg/mL 0.6 mg/mL NS, D5W D5W NS D5S, D5W, NS, R RCRC 0.1, 0.3 mg/mL 0.2 mg/mL D5W D5W SY SYREC 0.6 mg/mL 0.5–1.5 mg/mL D5W, NS REC 0.5–8 mg/mL NS, D5W REC 1.5–8 mg/mL REC 1.5–8 mg/mL Manufacturer Concentration Diluents (PVC)

j CONTAINER OTHER INFUSION CONTAINERS With morphine HCl 0.1–1.6 mg/mL. Refrigerated 35 d after 15 frozen at –20°C. Stored 17 d at 25°C, followed by 7 33°C. With tramadol HCl 1.6–35 mg/mL. pH of undiluted solutions is 6.9–7.9. Thawed in a cycle-validated microwave oven. Stored 28 d at 25°C, followed by 7 33°C. Stored 28 d at 2–8°C, followed by 7 33°C. Polyvinyl Polyvinyl Chloride Ketorolac Tromethamine Ketorolac Tromethamine Polyolefin Glass INFUSOR (Baxter) Flush Compatibility: Notes a Special Considerations: b c d e f g h 232 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_K.indd 232 22/05/17 1:55 PM Ketorolac Tromethamine (cont’d) 2005; Ann Pharmacother. 1997; 1:206–7. Int J Pharm Compound. 2000; 53:263–9. Can J Hosp Pharm.

4 Ontario, Canada: Baxter Corporation; October 2008. 39:1654–8. Intermate/Infusor Drug Stability Information. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Undiluted solutions (15 mg/mL and 30 mg/mL) are isotonic. i j References 1. and waste reduction. Shi A, Walker SE, Law S. Stability of ketorolac tromethamine in IV solutions Ketorolac Tromethamine (cont’d) Ketorolac Tromethamine 4. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed November 5. 2. dextrose injection and 0.9% sodium chloride injection. Das Gupta V, Maswoswe J. Stability of ketorolac tromethamine in 5% 3. storage, and microwave thawing on the stability of ketorolac tromethamine. Hecq J, Boitquin LP, Vanbeckbergen DF, et al. Effect of freezing, long-term 233 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_K.indd 233 22/05/17 1:55 PM Leucovorin Calcium 8 2 2 2 6 3 3 3 4 7 3 3 5 b c c Body Temp Refer. continued on next page n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions g a a a g a a 14 d 4 d 4 d 7 d 7 d 4 d 7 d TemperatureTemp Post-thaw g a a a g a a 2 d n/a 2 d n/a n/a n/a 7 d n/a 2 d n/a n/a n/a 7 d 2 d 14 d n/a n/a n/a n/a 4 d 4 d 7 d n/a n/a 95 d n/a2 d 30 d n/a 4 d 7 d 7 d 7 d n/a n/a n/a n/a n/a 2 d n/a n/a n/a 24 h Room Refrig Frozen Room Refrig d d d d d d d d d d d d d d n/a Osmolality (mOsm/kg) pH

5 W

3 Leucovorin is also known as Folinic Acid. Drug Heparin lock flush and normal saline. unspec. 4 mg/mL NS n/a WY 2–20 mg/mL WY 2 mg/mL D5W, NS, W n/a unspec. 4 mg/mL NS n/a LE 0.1, 0.5, 1, 1.5 mg/mL D5W n/a LE 1, 1.5 mg/mL NS n/a LEWY 1 mg/mL 1.6 mg/mLunspec. 2–20 mg/mL NS D5WLELE n/a n/a D5W, NS 0.1, 0.5, 1, 1.5 mg/mL 1 mg/mL n/a D5W, NS n/a NS n/a unspec. 4 mg/mL NS n/a WY 0.2–2 mg/mL D5W, NS, W n/a Manufacturer Concentration Diluents

ST/LT ST/LT

® ® ® (PVC)

/ f ® Medical)

CONTAINER OTHER INFUSION CONTAINERS Special Considerations: Flush Compatibility: (Epic SMARTeZ (B. Braun) Homepump Leucovorin Calcium Polyolefin Polyvinyl Chloride Dosi-Fuser (Leventon) Easypump Glass Bottles Homepump Eclipse C-Series C-Series (Halyard) INFUSOR INFUSOR (Baxter) 234 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_L.indd 234 22/05/17 1:55 PM Leucovorin Calcium (cont’d) J Clin Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ®

3 2009; 34:423–8. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. Pharm Ther. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Drug Stability Table-Dosi-Fuser pH is 6.5–8.5. 2 d refrigerated, followed by 24 h at 33°C. Protected from light. 2 d refrigerated, followed by 7 at 33°C. Manufacturer extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are Leucovorin Calcium (cont’d) Note: Notes a b c d f g References 2. 3. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 November. 4. Lebitasy M, Hecq JD, Athanassopoulos A, et al. Effect of freeze-thawing on the long-term stability calcium levofolinate in 5% dextrose stored polyolefin infusion bags. 5. 6. 8. 7. 235 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_L.indd 235 22/05/17 1:55 PM Levofloxacin 1 2 4 Body Temp Refer. n/a n/a n/a n/a n/a n/a a b 26 w 6 m Storage Conditions a b 14 d 14 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw b a 3 d 72 h Room Refrig Frozen Room Refrig d d d d c

4 iso

n/a ~ Osmolality (mOsm/kg) pH 1 . Irvine, CA: Halyard Health; March 2015. D5LR, D5S, D5S, D5LR, D5W, NS Levofloxacin is incompatible with heparin. 1 Protect from light and freezing; avoid excessive heat. Infuse solution diluted to 5 mg/mL over at least 60 min (over at least 90 min for 60 min (over at least 90 for Protect from light and freezing; avoid excessive heat. Infuse solution diluted to 5 mg/mL over at least Drug Normal saline. OMJ 0.5, 5 mg/mL unspec. 5 mg/mLJN 5 mg/mL D5W, NS n/a D5W Manufacturer Concentration Diluents For RTU solutions, remove protective foil overwrap prior to administration. 1

® / ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) pH range of diluted solutions is 3.8–5.8; pH of 5 mg/mL in NS or D5W is 4.6–4.7. pH range of diluted solutions is 3.8–5.8; 5 mg/mL in NS Manufacturer(s) extrapolated data from other sources. Protected from light. Expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously prepared solutions. Expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously prepared Homepump Levofloxacin Chloride Polyvinyl (PVC) Homepump Eclipse C-Series (Halyard) Single-Use Container Flexible (Hospira) Flush Compatibility: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 July. 2. 4. June 2014. Levaquin [package insert]. Titusville, NJ: Janssen Pharmaceuticals Inc.; Note: Special Considerations: 750-mg doses). Notes a b c d 236 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_L.indd 236 22/05/17 1:55 PM Linezolid Body Temp Refer.

1 n/a n/a n/a 1, 4

1,3 Storage Conditions e f b, 12 m TemperatureTemp Post-thaw c b, 3 iso 4.8 Osmolality (mOsm/kg) pH Room Refrig Frozen Room Refrig . https://www.pfizermedicalinformation.com/en-us/document/73333. Accessed July 29, 2015.

a 4

1,3 Linezolid—IV Stability Under Various Conditions Administer IV over 30 to 120 minutes. Yellow color may intensify time without affecting stability. Drug Heparin lock flush and normal saline. PF 2 mg/mL RTU Manufacturer Concentration Diluents [package insert]. New York, NY: Pharmacia and Upjohn Co, a division of Pfizer, Inc.; November 2014. http://www.pfizer.com/products/product-detail/zyvox. Accessed July ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. (Pfizer)

pharmacy exposed to ambient room light. 29, 2015. COMMERCIAL PREPARATIONS (RTU) Expiration date per manufacturer's label; use within 30 d of foil overwrap removal. Studies support storage out of the overwrap for at least 25 d (less than 30 d) in a Expiration date per manufacturer's label; use within 30 d of foil overwrap removal. Studies support storage out the Temperature excursion stability studies conducted by Pfizer at 2–8°C. Temperature excursion stability studies conducted by Pfizer at RTU sterile isotonic solution. Inactive ingredients include sodium citrate, citric acid, and dextrose. Do not use the RTU bag in series connections. RTU sterile isotonic solution. Inactive ingredients include sodium citrate, citric acid, and dextrose. Do not use the bag in Protected from light and freezing. Physical and chemical stability was not significantly affected in temperature excursion studies conducted by Pfizer for three 24-h freeze-thaw cycles. Physical and chemical stability was not significantly affected in c e Special Considerations: Notes a f b Flush Compatibility: Linezolid Plastic Flexible Bag References 1. Zyvox 3. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 July. 4. Pfizer Medical Information. Note: 237 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_L.indd 237 22/05/17 1:55 PM Lorazepam 1 1 1 1 1 1 1 1 1, 3 1 1 g e, Body Temp Refer.

1 continued on next page n/a n/a n/a n/a n/a 5 d d e,g, d 35 d Storage Conditions g e, n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 35 d 7 d n/a n/a n/a n/a TemperatureTemp Post-thaw i g e, e f e,h, e j Room Refrig Frozen Room Refrig n/a n/a n/a n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH undiluted n/a n/a n/a n/a n/a n/a n/a n/a D5W, NS n/a n/a 28 h D5W n/a n/a 28 h D5W, LR, LR, D5W, NS NS n/a n/a 35 d D5W, NS n/a n/a 24 h D5W n/a n/a 28 h

1 h e, e b e f e a

1 Store product under refrigeration and protect from light and freezing. Room temperature storage excursions for 60 to 90 d are acceptable Store product under refrigeration and protect from light freezing. Room temperature storage excursions Drug Heparin lock flush and normal saline. WY 2 mg/mL WY 1 mg/mL WYAB 0.1 mg/mL 0.91 mg/mL LRWY n/a 2 mg/mL n/a 7 d 7 d n/a n/a n/a 72 h WY various WYWY 0.1 mg/mL 0.1 mg/mLWAY D5W, NS D5W 0.2, 0.5, 1 mg/mL n/aWY n/aWY n/a 1 mg/mL n/a 7 d 1 mg/mL 7 d n/a n/a n/a BWFI 7 d n/a n/a n/a 72 h n/a Manufacturer Concentration Diluents (PVC)

CONTAINER OTHER INFUSION CONTAINERS Manufacturer does not recommend freezing. Significant losses were noted when undiluted lorazepam 2 mg/mL was stored in polypropylene syringes. Prepared from 2 mg/mL commercial preparation. Significant losses due to sorption were noted when lorazepam dilutions (0.08 1 mg/mL) stored in PVC containers. Protected from light. Prepared from 4 mg/mL commercial preparation. Both the 2- and 4-mg/mL products contain the same concentration of solubilizing agents. Use of the 4 mg/mL concentration may result in over-dilution of the Both the 2- and 4-mg/mL products contain same concentration of solubilizing agents. Use 4 mg/mL may for demonstrated results. solubilizing agent, increasing the potential for precipitation of an admixture; compounding procedures should be consistent Notes a b d e f g Special Considerations: per manufacturer statements. Flush Compatibility: Syringes, Syringes, Polyvinyl Polyvinyl Chloride Lorazepam Polyolefin Bag Polypropylene Glass 238 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_L.indd 238 22/05/17 1:55 PM Lorazepam (cont’d) 2004; 61:1039–41. Am J Health-Syst Pharm. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. When prepared from 4 mg/mL commercial preparation, consistently precipitated. When prepared from 4 mg/mL commercial preparation, consistently 12% loss at 22°C in 7 d. Physically stable over 24 h and chemically stable for 48 h at room temperature. Physically stable over 24 h and chemically for 48 at room Lorazepam (cont’d) h i j References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 3. sodium chloride stored in polyolefin bags. Norenberg JP, Ahusim LE, Steel TH, et al. Stability of lorazepam in 0.9% Note: 239 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_L.indd 239 22/05/17 1:55 PM Meperidine Hydrochloride 5 1 1 2 1 1 1 1 1 f Body Temp Refer. continued on next page n/a n/a n/a 1, 3 c n/a n/a n/a n/a 12 w n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a Storage Conditions c a c c c Practitioners should consider the FDA Safety b, b, 5 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 28 d 1 y 1 y TemperatureTemp Post-thaw c c c c c b, b, 7 d 14 d 36 h24 d n/a n/a n/a n/a12 w n/a 12 w n/a n/a28 d n/a n/a n/a n/a n/a n/a n/a n/a 90 d 1 y 1 y Room Refrig Frozen Room Refrig e pH

e e e e e e e e 6 i n/a n/a Osmolality (mOsm/kg) Meperidine is known internationally as pethidine. 1

bb b b 1 0.25, 1, 10, 20, 30 mg/mL D5W, NS n/a 1, 40 mg/mL NS n/a n/a 30 d

1 Drug d Protect solutions from light, do not freeze. WI 10–100 mg/mL D5W, NS n/a REN 5, 20 mg/mL NS n/a n/a 21 d WIunspec.WI 2.5 mg/mL 1.2 mg/mLWYWI 25 mg/mL AB 5, 10 mg/mL NS 25 mg/mL D5W AGT n/a n/a D5W, NSSW n/a 10 mg/mL NS n/a Manufacturer Concentration Diluents Normal saline. h

1 Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS Preservative free (AB) product. Solution also contained chlorpromazine HCl 6.25 mg/mL and hydroxyzine 12.5 mg/mL. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of undiluted solution is 3.5–6. Stable for 4 d at room temperature following 14 refrigerated. Protected from light. Stored at 37°C. Undiluted 50 mg/mL solution is 302 mOsm/kg. Flush Compatibility: Special Considerations: Meperidine Hydrochloride Chloride Polyvinyl (PVC) Syringes, Glass Syringes, Plastic Polypropylene CADD (SIMS Deltec) Implantable Infusaid Pump INFUSOR (Baxter) Syringes, Syringes, Alert issued in 2015 when evaluating the need for extended medication storage BD syringes. Notes a b c d e h i f 240 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 240 22/05/17 1:55 PM Meperidine Hydrochloride (cont’d) 1994; 19:361–9. Ontario, Canada: Baxter Corporation; October 2008. J Clin Pharm Ther. 2005; 53:210–6. Pathologie Biologie. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. patient controlled analgesic devices. study. There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. Accessed There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. June 5, 2016. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. the stability of morphine sulphate and meperidine (pethidine) hydrochloride in plastic syringes for use Strong ML, Schaaf LJ, Pankaskie MS, et al. Shelf lives and factors affecting 5. solutions stored in patient-controlled analgesia devices: physicochemical and microbiological stability Laville I, Mercier L, Chachaty E, et al. Shelf lives of morphine and meperidine Meperidine Hydrochloride (cont’d) 6. FDA Safety Alert for Human Medical Products: Compounded or Repackaged Drugs Stored in Becton-Dickinson (BD) 3 mL and 5 Syringes: - Do Not Use Unless Note: 241 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 241 22/05/17 1:55 PM Meropenem 1 6 2 2 1 6 Body Temp Refer. continued on next page n/a n/a n/a 3, 9 n/a n/a n/a 3, 9 n/a n/a n/a 3, 9 m m m n/a n/a n/a n/a n/a n/a n/a n/a 15 33 d n/an/a n/a n/a n/a n/a n/a n/a 15 15 n/an/a n/a n/a n/a n/a n/a n/a 14 14 Storage Conditions n n n f i i 2 d 7 d 10 d 10 25 h 44 h 40 h 4 d 4 d TemperatureTemp Post-thaw i i d n n n 8 h 17 h 4 d 11 d 3 h8 h 13 h3 h 48 h8 h n/a 24 h n/a 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 6, 9 n/a 6, 9 21 h 13 h 3 d n/a n/a n/a n/a 22 hn/a 7 d n/a 7 d 5 d n/a n/a8 h n/a8 h n/a5 h n/a n/a12 h n/a8 h n/a n/a 7, 9 1 h n/a n/a 7, 9 15 h n/a n/a n/a n/a n/a n/a34 h n/a n/a n/a n/a 13 21 h n/a 13 13 h 10 d 3 d24 h n/a4 h 48 h n/a n/a24 h n/a 24 h n/a 48 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 11 n/a n/a n/a 11 n/a 6, 9 n/a 6, 9 20 h Room Refrig Frozen Room Refrig h h h h h h h h h h h h h h h h h h h h h h h h h n/a n/a n/a n/a Osmolality (mOsm/kg) pH D5W n/a NS n/a W W W W e e 50 mg/mL ≤ ZEN 22 mg/mL ZENZENZEN 50 mg/mL 50 mg/mL 50 mg/mL NS D5W n/a n/a unspec. 5 mg/mL NS n/a unspec. 20 mg/mL NS n/a ZENZENZENZEN 1 mg/mLHSP 4 mg/mLHSP 10, 20 mg/mLHSP 22 mg/mL ASZ, SZ, HSP, FRK NSASZ, SZ, HSP, FRK 10, 20 mg/mL 50 mg/mL NS NS 40 mg/mLASZ 50 mg/mL 50 mg/mL n/a NS n/a n/a NS NS 1–20 mg/mLASZ D5W n/a unspec. n/a n/a n/a unspec. NSZEN 5 mg/mLZEN 5 mg/mLZEN n/a 20 mg/mLASZ NS 2.5 mg/mL 2.5 mg/mL NS 2.5 mg/mL NS n/a NS n/a D5W n/a n/a n/a ASZ 10 mg/mL NS n/a Drug Manufacturer Concentration Diluents

® ®

TM Braun)

OTHER INFUSION CONTAINERS CONTAINER (B. Dosi-Fuser Syringes, Syringes, Polypropylene Polypropylene AccuFlo (Leventon) Meropenem Chloride Polyvinyl (PVC) Syringes, Plastic Unspecified ST/LT (B. Braun) Glass Easypump 242 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 242 22/05/17 1:55 PM Meropenem (cont’d) 8 8 8 8 Body

Temp Refer. 3 continued on next page

3 Meropenem is compatible 1,3 n/an/a n/a n/a n/a n/a n/a n/a 12 12 n/a n/an/a n/a n/a n/a n/a 9, 16 n/a 9, 16 Storage Conditions i g g

5 i 10 d 3 d 3 d n/a n/an/a n/a n/a n/a n/a 10 n/a n/a 5, 9 TemperatureTemp Post-thaw c i i j

16 n/a26 h 7 d 4 d n/a n/a n/a n/a n/a n/a n/a n/a 7, 9 n/a20 h 4 dn/a 4 d14 h n/a 5 d n/a 3 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 7, 9 13 h 21 h 34 h6 h 96 h n/a20 h 24 h 96 h 24 h n/a n/a n/a n/a 10 Room Refrig Frozen Room Refrig

h 3 h h h h h h h h h h h h h

3 Osmolality (mOsm/kg) pH

1,9 heparin. 1 10 Due to significant loss of potency, solutions in D5W should be freshly prepared and administered immediately. Due to significant loss of potency, solutions in D5W should be freshly prepared and administered Normal saline, ZENunspec. 4 mg/mL 5 mg/mL NS NS n/a n/a unspec.unspec.ZENunspec. 5–10 mg/mL 10 mg/mL 10, 20 mg/mL 20 mg/mL NS NS NS n/a NS n/a n/a n/a unspec. 20 mg/mL NS n/a unspec. 5 mg/mL NS n/a ZENZENZENZENZEN 5 mg/mL 5 mg/mL 5–40 mg/mL 10 mg/mL 20, 30 mg/mL NS NS NS NS NS n/a n/a n/a n/a n/a Drug Manufacturer Concentration Diluents / ®

l ® Medical)

product to be stored at room temperature for up 6 h prior administration. Storage at room temperature in D5W may result in greater than 10% loss in 6 h. Use within 2 h of preparation if stored at room temperature. Storage at room temperature in D5W may result greater than Heparin 1 and 20 units/mL was visually compatible with meropenem mg/mL. pH of reconstituted solution is 7.3–8.3. 22 mg/mL nominal concentration of meropenem, based on addition of 2,000 mg vial reconstituted with 40 mL diluent, added to 50 bag diluent. 22 mg/mL nominal concentration of meropenem, based on addition Attached to a portable infusion pump and stored in cold pouch whose frozen gel packs were replaced every 8 12 h. Solutions refrigerated for 96 h maintained chemical stability for up to an additional 6 h at room temperature. Solutions refrigerated for 96 h maintained chemical stability Actual study data revealed greater than 90% of initial concentration for 10 d. However, the authors recommended storage up to 7 d refrigerated, then Actual study data revealed greater than 90% of initial concentration After refrigerated storage for 3 d. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Manufacturer extrapolated data from other source(s). (Halyard) Flush Compatibility: (Epic Meropenem (cont’d) Homepump Eclipse INTERMATE (Baxter) Cassette PVC (SIMS Deltec) SMARTeZ Special Considerations: in Y-site infusion with NS or D5W potassium chloride 10 and 40 mmol/L at room temperature. c Notes b e Homepump d f g i j h l 243 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 243 22/05/17 1:55 PM Meropenem (cont’d) 1998; 51(4):156–68. . 2004; 61:1682–5. Can J Hosp Pharm. . 2015; 81(3):283–7. 2000; 57:992–5. Am J Health-Syst Pharm Minerva Anestesiologica Am J Health-Syst Pharm. 1996; 53:2853–5. Bethlehem, PA: B. Braun USA; September 2015.

1997; 54:412–21. 1997; 3:168–71. 15 Chester, NY: RMS Medical Products (data on file); July 2015. . Irvine, CA: Halyard Health; March 2015. Bethlehem, PA: B. Braun USA; April 2015. Am J Health-Syst Pharm. Eur Hosp Pharm. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. Am J Health-Syst Pharm. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System. TM

1 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Antibiotic Stability in Freedom 60 Syringe and Tubing System. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® I.V. (meropenem for injection) [product information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; April 2015. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. Chemical Stability Data for Drugs Using B. Braun's Easypump Stability Data for Drugs Using B. Braun's AccuFlo SMARTeZ Manufacturer labeling states Do Not Freeze. Storage in 60 mL luer-tip plastic syringes (BD) with tubing (RMS) attached and capped. Storage in 60 mL luer-tip plastic syringes (BD) with tubing (RMS) 16. 16. Kramer I. Stability of meropenem in elastomeric portable infusion devices. Meropenem (cont’d) Note: 4. drugs. Patel PR. Compatibility of meropenem with commonly used injectable 15. 15. Fugit KD, Anderson BD. 7. chloride bags and an elastomeric infusion device. Smith DL, Bauer SM, Nicolau DP. Stability of meropenem in polyvinyl 13. 13. of meropenem reconstituted in isotonic saline. Carlier M, Stove V, Verstraete AG, et al. Stability of generic brands 14. 5. Grant EM, Zhong MK, Ambrose PG, et al. Stability of meropenem in a portable infusion device cold pouch. 3. in saline and dextrose solutions compatibility with potassium chloride. Walker SE, Varrin S, Yannicelli D, et al. Stability of meropenem 6. Patel PR, Cook SE. Stability of meropenem in intravenous solutions. 8. 9. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed June 2016. 10. 11. m 2. References 1. Merrem n 12. 12. 244 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 244 22/05/17 1:55 PM Mesna 5 3, 5 4 7 6 6 o i h, f m m, Body Temp Refer. continued on next page n/a n/a n/a 9 d n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a 2 d n/a n/a n/a n/a Storage Conditions f k j i o n/a n/a n/a n/a n/a 2, 5 9 d 48 h 48 h TemperatureTemp Post-thaw d j i k 48 h 28 d9 d 28 d n/a n/a n/a n/an/a 1, 5 14 d 6 h n/a 7 d n/a n/a n/a 2 d n/a 7 d 24 h Room Refrig Frozen Room Refrig

5 l l l l l l l l l n/a Osmolality (mOsm/kg) pH g D5WW n/a NS n/a D5W n/a NS n/a NS n/a D5W n/a e e k b j a, g c

5 Multidose vials of mesna may be stored and used for up to 8 d after initial entry. Drug Normal saline. AM 0.4–100 mg/mL unspec. 40 mg/mL unspec. 0.4–100 mg/mL AWAM 3 mg/mL 20 mg/mL AM 0.54 mg/mL AST 100 mg/mL undiluted n/a AM 3.2 mg/mL Manufacturer Concentration Diluents n i

® 9000 9000 TM CONTAINER OTHER INFUSION CONTAINERS Although not specifically stated in this visual compatibility study, room temperature was inferred as the storage temperature. Although not specifically stated in this visual compatibility study, With ifosfamide 50 mg/mL. Stored at 35°C. With ifosfamide (AM) 0.8–100 mg/mL. Braun Omnifix popypropylene syringes used in study. With hydroxyzine hydrochloride 0.5 mg/mL. Solution also contained ifosfamide (AM) 20 mg/mL. Solution protected from light. Solution also contained cyclophosphamide (AM) 10.8 mg/mL. Expel air from syringes to slow the formation of dimesna. Mesna Syringes, Polypropylene Dosi-Fuser (Leventon) Glass Bottles Graseby Cassette PVC (Graseby Medical) INFUSOR (Baxter) Polyethylene Bag Flush Compatibility: Special Considerations: Notes a b c d e f g h i j 245 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 245 22/05/17 1:55 PM Mesna (cont’d) 2003; 37:1789–92. 1998; 4:143–9. Ann Pharmacother. 1987; 238:476–8. 1988; 45:2127. Pharm J. J Oncol Pharm Practice. Am J Hosp Pharm.

5 Barcelona, Spain: Leventon SAU; October 2015. Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. 7 d refrigerated, followed by 2 at 33°C. Manufacturer extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are Solution also contained cyclophosphamide (AM) 1.8 mg/mL. pH of undiluted solution is specific to the product, ranging from 6.5–7.3 or 7.5–8.5. k l Mesna (cont’d) m n o References 1. of home infusion therapy for cancer patients. Adams PS, Haines-Nutt RF, Bradford E, et al. Pharmaceutical aspects 7. 2. with various antineoplastic agents. Marquardt ED. Visual compatibility of hydroxyzine hydrochloride 4. 5. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 6. and mesna admixtures in polyethylene infusion bags. Menard C, Bourguignon Schlatter J, et al. Stability of cyclophosphamide 3. Graseby 9000 ambulatory infusion pump. Priston MJ, Sewell GJ. Stability of three cytotoxic drug infusions in the 246 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 246 22/05/17 1:55 PM Methadone Hydrochloride 1 Body Temp Refer. Storage Conditions n/a n/a n/a n/a n/a TemperatureTemp Post-thaw a 28 d Room Refrig Frozen Room Refrig b b Osmolality (mOsm/kg) pH

1 1 Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating the need for extended medication storage in BD Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating need for extended Drug Normal saline. LI 1, 2, 5 mg/mL NS n/a Manufacturer Concentration Diluents

2 There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. Accessed There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. June 5, 2016. CONTAINER pH of undiluted solution is 4.5–6.5. Solution stored exposed to light. Methadone Hydrochloride Chloride Polyvinyl (PVC) Flush Compatibility: Special Considerations: syringes. Notes a b References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. FDA Safety Alert for Human Medical Products: Compounded or Repackaged Drugs Stored in Becton-Dickinson (BD) 3 mL and 5 Syringes: Alert—Do Not Use Unless 247 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 247 22/05/17 1:55 PM Methotrexate Sodium 3 3 3 1 1 2 1 1 1 1 6 8 8 1 4 Body Temp Refer. continued on next page n/a n/an/a n/a n/a n/a a a n/a n/an/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a 1, 5 n/a n/a n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions h i b,j d b,j d b 105 d 105 d 105 d 105 d 105 d 105 d TemperatureTemp Post-thaw d h i b,j b,j d 1 d 10 d4 d n/a n/a n/a n/a n/a n/an/a n/an/a 30 d 14 d n/a 12 w 7 d n/a7 d 30 d n/a8 m 7 d70 d n/a n/a4 w n/a n/a n/a 3 m n/a n/a n/a n/a 10 d n/a 3 m10 d n/a n/a n/a n/a 105 d7 d n/a n/a n/a n/a n/a7 d n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig g g g g g g g g g g g g g g g ff g g Osmolality (mOsm/kg) pH undiluted undiluted NS n/a

1 c l e Protect from light, especially dilute solutions. Preserved isotonic product contains benzyl alcohol; do not use the preserved product for Protect from light, especially dilute solutions. Preserved isotonic product contains benzyl alcohol; do Drug Heparin lock flush and normal saline. BMS 1.25 mg/mL NS n/a BMSBMS 1.25–12.5 mg/mL 12.5 mg/mL NS NS n/a n/a unspec.unspec.LE 0.1, 1, 20 mg/mLunspec. 0.225, 24 mg/mLFA 1 mg/mLLE 0.5 mg/mL NSLE D5W, NSLE 1.25, 12.5 mg/mLBMS, AD n/a 2.5 mg/mL n/a 50 mg/mL various 50 mg/mL D5W NS NSunspec.TE 1.25–12.5 mg/mL n/a FA n/a n/a unspec.unspec. 2 mg/mL n/a 1.25, 12.5 mg/mL NS 1.25–12.5 mg/mL n/a NS NS NS n/a n/a n/a Manufacturer Concentration Diluents k

® / ® CONTAINER OTHER INFUSION CONTAINERS Special Considerations: intrathecal or high-dose therapy. Flush Compatibility: Homepump Methotrexate Sodium Chloride Polyvinyl (PVC) Syringes, Plastic Dosi-Fuser (Leventon) Glass Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) 248 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 248 22/05/17 1:55 PM Methotrexate Sodium (cont’d) 1994; 105:83–7. Int J Pharm. 1987; 22:685–7. Hosp Pharm. . Irvine, CA: Halyard Health; March 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Barcelona, Spain: Leventon SAU; October 2015. . HealthTek

1 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10).

® Drug Stability in Plastic Syringes 1 Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Manufacturer(s) extrapolated data from other sources. Protected from light. 105 d refrigerated, followed by 1 at room temperature. Concentrations not specified. Solution was thawed by microwave irradiation with no loss of potency. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Monoject or Plastipak syringes. pH of the undiluted solution is approximately 8.5. Undiluted solution is isotonic. 105 d refrigerated, followed by 7 at room temperature. Sabre or Steriseal plastic syringes; stability reduced due to water vapor permeability. 105 d refrigerated, followed by 4 at room temperature. Methotrexate Sodium (cont’d) Note: 8. h i j k l References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines for g 6. Rapp RP, Hatton J, Record K. Notes a b c d e f 3. 4. 5. with PVC bags after repackaging into two types of infusion admixtures. Benaji B, Dine T, Goudaliez F, et al. Compatibility study of methotrexate 249 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 249 22/05/17 1:55 PM Methylprednisolone Sodium Succinate 1 7 8 1 6 2 1 Body Temp Refer.

9 continued on next page n/a n/a n/a a n/a n/a n/a n/a n/a n/a n/a n/a 10 Storage Conditions f f 7 d 7 d TemperatureTemp Post-thaw f f n/a n/a 4 w n/a n/a n/a 2 h 24 h 7 d n/a n/a n/a n/a 2 h 7 d n/a n/a n/a n/a 2 h 7 d n/a n/a n/a n/a 4 d 21 d n/a n/a24 h n/a n/a 1, 4 24 h 7 d n/a n/a n/a n/a n/a n/a 12 m Room Refrig Frozen Room Refrig c c c d c d c d c d c d c d c e c n/a Osmolality (mOsm/kg) pH W

1 The manufacturer states that only Bacteriostatic Water for Injection with Benzyl Alcohol should be used for reconstitution. The manufacturer states that only Bacteriostatic Water for Injection with Benzyl Alcohol should be Drug Heparin lock flush and normal saline. UP 62.5 mg/mL unspec. 400 UP 4 mg/mL unspec. 10 mg/mL NS 317–319 unspec. 10 mg/mL NS 317–319 unspec. 10 mg/mL NS 317–319 UP 10 mg/mLHSP, UP 10 mg/mL NSunspec. 317–319 NS 10 mg/mL 317–319 NS 317–319 UP 4.6 mg/mL NS n/a Manufacturer Concentration Diluents

ST/LT ST/LT

® ® ®

/ TM ® Medical)

Braun)

CONTAINER OTHER INFUSION CONTAINERS Special Considerations: Flush Compatibility: Unspecified Glass Vials Dosi-Fuser (Epic (B. Braun) Easypump SMARTeZ (B. Homepump Methylprednisolone Sodium Succinate Chloride Polyvinyl Polypropylene AccuFlo (Leventon) Homepump Eclipse C-Series (Halyard) (PVC) Syringes, Syringes, 250 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 250 22/05/17 1:55 PM Methylprednisolone Sodium Succinate (cont’d)

1 Int J Pharm Bethlehem, PA: B. Braun USA; September 2015. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. . Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM 1 Elastomeric Pump (ES.H.00.730-10) ® 2001; 5(2):148–50. Stability Data for Drugs Using Elastomeric Infusion Pumps. ®

1 Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Chemical Stability Data for Drugs Using B. Braun’s Easypump Drug Stability Table-Dosi-Fuser SMARTeZ Compound. Stability Data for Drugs Using B. Braun’s AccuFlo Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Calculated osmolality for 5–20 mg/mL in NS ranges from 301–345 mOsm/kg. Calculated osmolality for 5–20 mg/mL in D5W ranges from 275–318 Calculated osmolality for 5–20 mg/mL in NS ranges from 301–345 mOsm/L. Stored at –20°C. pH of reconstituted preparation is 7–8. Manufacturer extrapolated data from other sources. 8. Methylprednisolone Sodium Succinate (cont’d) Note: 9. Methylprednisolone Sodium Succinate for Injection, USP [package insert]. Schaumburg, IL: APP Pharmaceuticals, LLC; January 2008. 10. 7. e 6. 4. Das Gupta V. Chemical stability of methylprednisolone sodium succinate after reconstitution in 0.9% chloride injection and storage polypropylene syringes. f References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. d Notes a c 251 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 251 22/05/17 1:55 PM Metoclopramide Hydrochloride 4 5 1 1 1 1 2 1 6 6 6 6 6 6 6 6 6 1 g e, b m n o p q r s t u g Body Temp Refer. continued on next page n/an/a n/a n/a w w 24 h 24 h w w n/a n/a n/a 7 d n/a n/a n/a 1 d n/a n/a n/a 3 d n/a n/a n/a 2 d n/a n/a n/a 3 d n/a n/a n/a 1 d n/a n/a n/a 2 d Storage Conditions b n p r o q s n/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a 6 d n/a n/a n/a n/a 7 d TemperatureTemp Post-thaw j m t u 7 d n/a n/a n/a n/a n/a 24 h 24 h n/a n/a n/a n/a 24 h24 h n/a n/a 2 w 21 d 4 w n/a n/a n/a n/a n/a 10 d 35 d 182 d 14 d 98 d n/a n/a n/a n/a 35 d n/a 154 d n/a 42 d n/a 112 d n/a 56 d n/a 140 d n/a 98 d 35 d 28 d Room Refrig Frozen Room Refrig k k k k k k k k k k k k k k k k k k n/a Osmolality (mOsm/kg) pH

1 unspec. n/a NS n/a D5W n/a D5W n/a D5W n/a D5W n/a D5W n/a D5W n/a D5W n/a D5W n/a D5W n/a D5W n/a undiluted 280 4.5–6.5 60 d 90 d n/a n/a n/a 7 d

1 d d a a l l l l l l l l l i f Do not freeze undiluted (5 mg/mL) product. Drug Heparin lock flush and normal saline. unspec. 1 mg/mL SO 2.5 mg/mL NS n/a RBRBSKB 0.2 mg/mLBA 0.2, 3.2 mg/mLAST 0.5 mg/mL 0.5 mg/mL 0.74 mg/mL SKB NS D5W 0.5 mg/mL n/a n/a NS n/a BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL BE 0.5 mg/mL RB 5 mg/mL Manufacturer Concentration Diluents

v CONTAINER OTHER INFUSION CONTAINERS Special Considerations: Deltec) Flush Compatibility: Metoclopramide Hydrochloride Polyvinyl Chloride (PVC) Syringes, Polypropylene INFUSOR (Baxter) Cassette PVC (Pharmacia MiniMed MiniMed Syringe (Travenol) 252 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 252 22/05/17 1:55 PM Metoclopramide Hydrochloride (cont’d) Int J Pharm 1989; 7(12):1903–8. J Clin Oncol. 1998; 23:67–72. . J Clin Pharm Ther. Ontario, Canada: Baxter Corporation; October 2008.

1 . 2005; 9(1):72–4. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Compound Intermate/Infusor Drug Stability Information. 35 d at 25°C, followed by 7 33°C. 2 w at –20°C, followed by 24 h room temperature. 112 d at 2–8°C, followed by 2 33°C. With fentanyl 0.037 mg/mL (DB) and midazolam 0.55 (RC). 56 d at 2–8°C, followed by 3 33°C. 182 d refrigerated, followed by 7 at 32°C. 42 d at 2–8°C, followed by 3 33°C. 154 d at 2–8°C, followed by 1 33°C. 28 d at 25°C, followed by 7 33°C. Protected from light. With morphine sulfate 1 mg/mL (EV). pH of undiluted solution is 4.5–6.5. Stored at 32°C to simulate wearing a portable infusion pump close to the body. Stored at 32°C to simulate wearing a portable infusion pump INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. 98 d at 2–8°C, followed by 2 33°C. 140 d at 2–8°C, followed by 1 33°C. 35 d at 25°C, followed by 6 33°C. With Luer-Lok tip caps (Burron). Stored at 25°C; pH remained constant 55 during study period. With morphine sulfate 2 mg/mL (EV). With morphine 15 mg/mL. 5. of fentanyl admixtures in polypropylene syringes Peterson GM, Miller KA, Galloway JG, et al. Compatibility and stability Notes a b d e f g i j k 4. chronic cancer pain in the ambulatory setting: a report of 117 patients. Swanson G, Smith J, Bulich R, et al. Patient-controlled analgesia for l m n o p q r s t u v w References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. diluted with 0.9% sodium chloride injection in polypropylene syringes at room temperature. Gupta VD. Chemical stability of metoclopramide hydrochloride injection Metoclopramide Hydrochloride (cont’d) 6. Note: 253 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 253 22/05/17 1:55 PM Metronidazole 5 6 8 2 4 9 7

1 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 10 Storage Conditions b b a a, a a, a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a 10 d n/a n/a n/a n/a n/a 10 d TemperatureTemp Post-thaw b b d d 24 h 10 d 24 h 24 h 10 d d 24 h 24 h 10 d Room Refrig Frozen Room Refrig g g g g g g iso 5.8 iso 5.5 n/a iso 5.8 Osmolality (mOsm/kg) pH f c a e

1 Short-term exposure to normal room light does not adversely affect stability. Direct sunlight should be avoided. Infuse over 1 h. Short-term exposure to normal room light does not adversely affect stability. Direct sunlight should Drug Heparin lock flush and normal saline. unspec. 5 mg/mL NS n/a unspec. 5 mg/mL NS n/a SE 5 mg/mL RTU iso HSP 5 mg/mLBA RTU 5 mg/mL RTU unspec. 5 mg/mL NS n/a unspec. 5 mg/mL RTU BRN 5 mg/mL RTU Manufacturer Concentration Diluents

ST/LT ST/LT

® ® ®

/ TM ® Medical)

Braun) Braun) Braun)

OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Special Considerations: Flush Compatibility: Dosi-Fuser (B. (Epic SMARTeZ Homepump Metronidazole AccuFlo (Leventon) Homepump Eclipse Premixed Flexible Container (Hospira) Premixed PAB Viaflex Premixed Container Plus (Baxter) (B. Easypump C-Series C-Series (Halyard) Container (B. 254 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 254 22/05/17 1:55 PM Metronidazole (cont’d)

1,5,6 Elastomeric Infusion System TM Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Stability Data for Drugs Using B. Braun’s AccuFlo contains no plasticizers. Expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously prepared solutions. Expiration date per manufacturer's label. Do not extrapolate commercial Manufacturer(s) extrapolated data from other sources. The premixed solution is isotonic (297 mOsm/L), buffered, and contains sodium 13.5 mEq/100 mL. The container is a copolymer of ethylene and propylene The premixed solution is isotonic (297 mOsm/L), buffered, and Metronidazole solution is susceptible to crystallization when refrigerated. The crystals redissolve on warming room temperature. The premixed solution is buffered, isotonic (310 mOsm/L) and contains sodium 14 mEq/100 mL. The plastic container is specially formulated PVC plastic. The premixed solution is buffered, isotonic (310 mOsm/L) and contains sodium 14 mEq/100 mL. plastic container specially pH of RTU metronidazole is 5.5 to 5.8 (range 4.5–7). The premixed solution is isotonic (314 mOsm/L), buffered, and contains sodium 14 mEq/100 mL. The plastic container is specially formulated PVC plastic. The premixed solution is isotonic (314 mOsm/L), buffered, and Metronidazole (cont’d) Note: 10. 10. Notes a b c d e f g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. 4. Metronidazole solution (Metronidazole Injection USP) [package insert]. Bethlehem, PA: B. Braun Medical Inc.; July 2015. 5. Metronidazole Injection USP Single Dose Flexible Container [package insert]. Lake Forest, IL: Hospira, Inc.; August 2014. 6. insert]. Deerfield, IL: Baxter Healthcare Corporation; October 2013. Metronidazole Injection USP in Plastic Container (Viaflex Plus) [package 7. 9. 8. 255 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 255 22/05/17 1:55 PM Micafungin Sodium 3 1 1 1 1 1 2 4 1 2 1 Body Temp Refer. continued on next page n/a n/an/a n/a n/a n/a n/a n/a n/an/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions g b f b b g n/a n/an/a n/an/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw b b b b b b 1 d 4 d n/a 10 d n/an/a 7 d 4 d 3 d 7 d24 h 7 d 15 d 2 d 24 h 2 d Room Refrig Frozen Room Refrig c c c c c c c c c c c c Osmolality (mOsm/kg) pH NS, D5W n/a NS, D5W n/a

1 e e Reconstitute only with NS or D5W; do not vigorously shake vial. Original vial is coated with light protective film. Dilute to final Reconstitute only with NS or D5W; do not vigorously shake vial. Original vial is coated light protective Drug

1 Normal saline, heparin. ASL 0.2, 1 mg/mL NS, D5W n/a unspec. 0.5, 2 mg/mL NS n/a ASLASLASLASL 0.125, 1 mg/mLASL 0.25, 3 mg/mL 0.25, 4 mg/mLASL 1 mg/mLASL NS 0.5, 1 mg/mLASL NS, D5WASL NS, D5W n/a 5 mg/mL n/a n/a LR, D5¼S 10 mg/mL NS n/a n/a D5W NS n/a n/a Manufacturer Concentration Diluents / ® ST/LT ST/LT

® (Halyard) ® a d CONTAINER OTHER INFUSION CONTAINERS Original product vial. Protected from light. Material type of IV bag not specified. pH of reconstituted solution in NS is 5–7. (B. Braun) Homepump Flush Compatibility: Micafungin Sodium IV Bag Polypropylene Syringes Vial Easypump Homepump Eclipse Special Considerations: the IV tubing or infusion drip concentration between 0.5 and 4 mg/mL prior to administration. Protect diluted solution from light. It is not necessary cover chamber. Do not mix with other drugs. Notes a d b c 256 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 256 22/05/17 1:55 PM Micafungin Sodium (cont’d) . 2015 Aug 15; 492(1–2):137–40. Int J Pharm Bethlehem, PA: B. Braun USA; September 2015.

3 ST/LT Elastomeric Infusion System. ®

2 (micafungin sodium) [package insert]. Northbrook, IL: Astellas Pharma US Inc.; June 2013. ® Chemical Stability Data for Drugs Using B. Braun’s Easypump Reconstituted/diluted per product labeling. Storage conditions include a solid refrigerator door (not glass or see through). Storage conditions include a solid refrigerator door (not glass or Stored for 4 d refrigerated followed by 1 at room temperature. e g f 3. References 1. Pharma Global Development, Inc.; October 2015. Medical Affairs [personal communication]. Northbrook, IL: Astellas 2. Mycamine Micafungin Sodium (cont’d) 5. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 4. at different concentrations in glass bottles and syringes. Briot T, Vrignaud S, Lagarce F. Stability of micafungin sodium solutions 257 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M1.indd 257 22/05/17 1:55 PM Midazolam Hydrochloride 2 4 2 2 2 2 2 2 2 2 2 4 2 1 2 2 2 BD d f b, g term Body Temp Refer. continued on next page n/a n/a n/an/a 36 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions b b c h 27 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 36 d 30 d n/a10 d n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 13 d 27 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 49 d n/a n/a n/a n/a n/a 23 d c c b TemperatureTemp Post-thaw l b b b e g l b, a, b, h b b 36 d n/a n/a n/a n/a n/a 13 d 24 h36 d 24 h n/a24 h n/a 24 h30 d n/a n/a24 h n/a n/a 24 h n/a n/a n/a n/a4 w n/a10 d 13 d n/a 10 d 28 d 49 d 23 d Room Refrig Frozen Room Refrig i pH i i k k i kkk i i k i k i i kk i i k i k i k i k i Osmolality (mOsm/kg) undiluted n/a NS NS NS n/a n/a 7 d D5W, NS h m

2 a n j Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating need for extended medication storage 2 Store product at controlled room temperature and protect from light. Admixtures do not require protection light for short Drug Heparin, normal saline. RC 5 mg/mL undiluted n/a RC 3 mg/mL NS RCRC 0.035 mg/mLRC 0.5 mg/mLRCHOS 0.035 mg/mLRC 0.5 mg/mL D5W, NS RC 1 mg/mL D5W, NS 0.035 mg/mL 0.5 mg/mL D5W, NS RCRC D5W, NS RC D5W D5W, NS 1 mg/mL 2 mg/mL n/a 3 mg/mLRC 3.2–3.4 0.5, 1.5 mg/ml 27 d NS NS RC 1 mg/mL RC 1 mg/mL NS HOS 1 mg/mL D5W n/a 3.2–3.4 27 d RC 0.1, 0.5 mg/mL Manufacturer Concentration Diluents

5 CONTAINER OTHER INFUSION CONTAINERS Midazolam Hydrochloride Glass Polyethylene Polyolefin Chloride Polyvinyl (PVC) Polypropylene Pump Elastomeric Reservoir (Baxter) Special Considerations: storage and administration. syringes. Syringe, Syringe, Unspecified Flush Compatibility: 258 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 258 22/05/17 1:55 PM Midazolam Hydrochloride (cont’d)

2002; J Pharm Practice Res. Practice Pharm J Am J Health-Syst Pharm.

2 ges: FDA Alert—Do Not Use Unless There There Unless Use Not Alert—Do FDA ges: oducts/ucm458955.htm. Accessed June 5, 2016. 2016. 5, June Accessed oducts/ucm458955.htm.

2 pH of 0.625, 1.25, and 1.67 mg/mL in NS is 3.6, 3.4, respectively. 3 2011; 68:1537–40. 32:65–8. Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalPr FDA Safety Alert for Human Medical Products: Compounded or Repackaged Drugs Stored in Becton-Dickinson (BD) 3 mL and 5 Syrin

Combined with tramadol hydrochloride 11.18 and 33.3 mg/mL, respectively. Tested at 40°C. Protected from light. Midazolam salt form unspecified. Combined with hydromorphone HCl 2 mg/mL and 20 mg/mL. Tested at 30°C. Combined with morphine tartrate 1 mg/mL and bupivacaine hydrochloride 4 mg/mL. Diluted in NS to 0.625, 1.25, and 1.67 mg/mL, osmolality is 274, 262, 259 mOsm/kg, respectively. Fluorescent light. Tested at 20°C and 32°C. Tested at 32°C. Tested exposed to light and also protected from in amber bags at room temperature. Benzyl alcohol added to a concentration of 1%. pH of undiluted solution (1 and 5 mg/mL) is 2.5–3.5. 5. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 3. Pharmaceuticals, Inc.; September 2012. Midazolam Injection, USP [package insert]. Schaumburg, IL: Sagent 4. hydrochloride injection 1 mg/mL solutions in polyvinyl chloride and polyolefin bags. Karlage K, Earhart Z, Green-Boeses et al. Stability of midazolam, l m n References 1. infusion. intravenous for combinations bupivacaine and midazolam, morphine, of compatibility and Stability al. et NG, Burgess NA, Sharley SP, Forgia La j k Midazolam Hydrochloride (cont’d) Notes a b c d e f g h i 259 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 259 22/05/17 1:55 PM Milrinone Lactate Int J Body Temp Refer. 1999; 56(1):63b. 1998; 2(2):168b. Am J Health-Syst Pharm. Storage Conditions n/a n/a n/a n/a n/a 11 n/a n/a n/a n/a n/a 10 Int J Pharm Compound. TemperatureTemp Post-thaw 14 d 14 d14 d7 d n/a 14 d n/a n/a n/a14 d 14 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 4 n/a 1, 2 n/a n/a 1, 3 1, 4 Room Refrig Frozen Room Refrig c c b c c c c c b n/a Osmolality (mOsm/kg) pH

D5W, LR, LR, D5W, NS, ½S 1,7,10,11 Plastic Container [package insert]. Deerfield, IL: Baxter Healthcare Corporation; January 2001.

® 1,3

Drug SWSWSW 400, 600, 800 mcg/mLSW 200 mcg/mL NS 400 mcg/mL HSP 400, 600, 800 mcg/mL n/a NS, D5W D5WBA 200 mcg/mL n/a n/a 200 mcg/mL D5W D5W n/a n/a 3.5 Avoid freezing, avoid excessive heat. Manufacturer Concentration Diluents 1,7,10,11 Heparin lock flush and normal saline. 1998; 2(3):246b. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Pharm Compound. CONTAINER COMMERCIAL PREPARATIONS (RTU) Expiration date per manufacturer's label when stored in the protective overwrap under labeled storage conditions. pH ranges from 3.2–4. Flush Compatibility: Milrinone Lactate Polyolefin Containers Polyvinyl Chloride (PVC) Plastic Flexible Container (Hospira) Plastic INTRAVIA Container (Baxter) Special Considerations: 3. lactate in the presence of 29 critical care drugs and 4 i.v. solutions. Akkerman SR, Zhang H, Mullins RE, et al. Stability of milrinone References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. injection and 0.9% sodium chloride injection. Wong F, Gill MA. Stability of milrinone lactate 200 mcg/mL in 5% dextrose Notes b c Note: 7. Inc.; February 2014. Milrinone Lactate Injection [package insert]. Lake Forest, IL: Hospira 10. Lake Forest, IL: Hospira Inc.; September 2014. Milrinone Lactate Injection in 5% Dextrose [package insert]. 11. Milrinone Lactate Injection in 5% Dextrose IntraVia 4. dextrose injection and 0.9% sodium chloride at concentrations of 400, 600, 800 mcg/mL. Nguyen D, Gill MA, Wong F. Stability of milrinone lactate in 5% 260 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 260 22/05/17 1:55 PM Mitomycin 1 5 5 5 6 Body Temp Refer. continued on next page n/a n/a n/a 2, 5

3,4 a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 3, 5 n/a n/a n/a n/a Storage Conditions b c c c 42 d 120 d 14 d Temperature Post-thaw Temp c b c 14 dn/a n/a 4 d n/a n/a n/a11 d n/a 5 d n/a6 d n/an/a n/an/a n/a 20 d n/a 5 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4, 5 n/a 4, 5 4, 5 15 d n/a6 d n/an/a n/an/a 8 w 15 d n/a 5 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4, 5 n/a 4, 5 4, 5 7 d Room Refrig Frozen Room Refrig d d d d d d d d d d d d d d n/a n/a n/a Osmolality (mOsm/kg) pH b W NS n/a W

5,6

6 a e

5 Unless buffered to a pH of approximately 7.8, avoid long-term storage in dextrose-containing solutions. Drug Heparin lock flush and normal saline. BRKYBR 0.5 mg/mL 0.6 mg/mL 0.6 mg/mL BMS BWFIBR NS 0.5 mg/mL n/a BR 50 mcg/mL n/a BRBR 20 mcg/mLAHC 40 mcg/mL 40 mcg/mL NS 0.5 mg/mL LR n/a LR NS n/a n/a n/a BRBRBRLCSA 20 mcg/mL 40 mcg/mL 40 mcg/mL 50 mcg/mL LR LR NS D5W n/a n/a n/a Manufacturer Concentration Diluents a precipitate forming in the solution. CONTAINER OTHER INFUSION CONTAINERS pH of reconstituted product is 6–8. Solutions buffered to achieve a pH of approximately 7.8. Further dilution is required prior to administration. Buffered and unbuffered solutions were frozen at –30°C for 4 w, then thawed. The unbuffered solutions were refrozen for another 4 w. Freezing at –20°C resulted in Buffered and unbuffered solutions were frozen at –30°C for 4 w, then thawed. The refrozen another Protected from light. Mitomycin Chloride Polyvinyl (PVC) Polypropylene Unspecified Bottles Glass Glass Vial Syringes, Syringes, Flush Compatibility: Special Considerations: e Notes a b c d 261 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 261 22/05/17 1:55 PM Mitomycin (cont’d) 1986; 8:286–8. 1995; 1:19–24. Pharm Weekbl Sci. 1987; 22:685–7. J Oncol Pharm Pract. Hosp Pharm. 1985; 42:1750–4. Am J Hosp Pharm. Mitomycin (cont’d) References 1. a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines for 5. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 6. Inc.; April 2011. Mitomycin for Injection [package insert]. Durham, NC: Accord Healthcare, 4. compatibility with heparin and glucocorticosteroids. Dorr RT, Liddil JD. Stability of mitomycin C in different infusion fluids: 2. of solutions mitomycin C in plastic minibags for intravesical use. Stolk LML, Fruijtier A, Umans R. Stability after freezing and thawing 3. admixtures. Quebbeman EJ, Hoffman NE, Ausman RK, et al. Stability of mitomycin 262 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 262 22/05/17 1:55 PM Mitoxantrone Hydrochloride 4 4 4 1 1 1 a Body Temp Refer. 1991; 44(3):143–51. n/a n/a n/a n/a 1, 5 Can J Hosp Pharm. Storage Conditions d n/a n/a n/a n/a 5 d 14 d 1987; 238:476–8. TemperatureTemp Post-thaw a d 8 d8 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2 d 7 d42 d 7 d 42 d28 d n/a14 d n/a 28 d n/a 14 d n/a n/a n/a n/a48 h n/a n/a7 d n/a n/a n/a n/a n/a n/a n/a n/a 1, 3 n/a 24 h 1, 2 n/a n/a Room Refrig Frozen Room Refrig Pharm J. b b b b b 3.43–3.65 b b b b

n/a n/a Osmolality (mOsm/kg) pH 1,5

1,5 W W Ontario, Canada: Baxter Corporation; October 2008.

1 Drug LELE 0.2 mg/mL 0.7 mg/mL NS n/a LE 0.1–0.5 mg/mL NS n/a LELEunspec. 0.02–0.5 mg/mLunspec. 2 mg/mL 0.2 mg/mL 0.2 mg/mL D5W, NSLEAPP n/a NS undiluted 0.02–0.5 mg/mL 2 mg/mL n/a n/a NS undiluted n/a n/a Manufacturer Concentration Diluents Do not freeze. Must be diluted prior to administration. Normal saline. Heparin may cause precipitation in the same admixture. c Intermate/Infusor Drug Stability Information. CONTAINER OTHER INFUSION CONTAINERS After penetration of vial stopper. Product does not contain preservatives. pH of undiluted concentrate is 3–4.5. Storage of 2 d at room temperature followed by 5 body temp (33°C). INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Flush Compatibility: Mitoxantrone Hydrochloride Polyvinyl Chloride (PVC) Plastic Syringes, Polypropylene Syringes, Glass INFUSOR (Baxter) Special Considerations: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. of home infusion therapy for cancer patients. Adams PS, Haines-Nutt RF, Bradford E, et al. Pharmaceutical aspects c d Notes a b 3. syringes and glass vials evaluation of chemical contamination. Walker SE, Lau DWC, DeAngelis C, et al. Mitoxantrone stability in 4. 5. Mitoxantrone Injection, USP (Concentrate) [package insert]. Schaumburg, IL: APP Pharmaceuticals, LLC; January 2008. 263 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 263 22/05/17 1:55 PM Morphine Sulfate 1 4 1 1 1 1 1 1 1 1 aa aa Body Temp Refer. continued on next page n/a n/a n/a 1, 3 cc n/a n/a n/a n/a 10 n/a n/a n/a n/a 10 n/a n/a n/a n/a 10 n/a n/a n/a n/a 10 n/a n/a n/a n/a 10 n/a n/a n/a n/a 10 6 w n/a n/a n/a 48 h Storage Conditions cc,mm cc,ll cc,kk cc,mm cc,ll cc,kk cc cc n/a n/a n/a n/a 48 h 6 w n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 7 n/a n/a n/a n/a n/a 1, 7 TemperatureTemp Post-thaw nn n,o,cc m,n,cc cc cc Room Refrig Frozen Room Refrig 7 d n/a n/a n/a n/a n/a 7 dn/a 7 d15 d n/a30 d 15 d n/a30 d n/a 14 w n/a n/a6 w n/a n/a n/a n/a n/a n/a n/a6 w n/a n/a n/a 60 d n/a n/a n/a n/a 60 d n/a n/a n/a 40 d 40 d n/a n/a n/a n/a 60 d 30 d 30 p pH e Osmolality (mOsm/kg) e p eeee p e p e p p e p e p p p e p e p NS n/a 3.3–3.7 n/a 28 d NS n/a 3.4–3.8 n/a 28 d NS n/a 4.5–6 n/a 28 d NS n/a 3.3–3.6 n/a 28 d NS n/a 3.4–3.8W n/a 28 d NS n/a 4–5.9 n/a 28 d NS n/a 5.4 30 d NS n/a 5.4 m kk kk o mm ll mm ll Concentration Diluents Drug SZ 43 mg/mL SZ 25 mg/mL SZ 0.01 mg/mL unspec. 1, 20 mg/mL NS SZ 43 mg/mL SZSZ 0.01 mg/mL AST 25 mg/mL AB, AH 20 mcg/mL LIunspec. 0.04, 0.4 mg/mLAH D5W, NS AH 2, 15 mg/mL 1, 2 mg/mLLI 5 mg/mL 10 mg/mL D5W, NS unspec.unspec. 1, 5 mg/mL D5W, NS 2 mg/mL undiluted 5 mg/mL D5W, NS NS NS unspec. 2, 10 mg/mL unspec. unspec. 50 mg/mL W, NS AST 20, 100 mcg/mL Manufacturer

(B. Braun) TM OTHER INFUSION CONTAINERS CONTAINER AccuFlo Medical (Q Plus Accufuser Technologies) Morphine Sulfate Bags Non-DEHP (INTRAVIA, Baxter) Bag Polypropylene (Mark II Polybag) Polyvinyl Chloride (PVC) Plastic Syringes, (Plastipak, BD) Syringes, Polypropylene 264 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 264 22/05/17 1:55 PM Morphine Sulfate (cont’d) 8 11 1 1 1 1 1 5 5 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 aa,oo pp bb,cc pp j l,y k,z r,s s,ee t,dd r,t t,u t,v t,x t,w t,ff t,gg t,hh Body Temp Refer. continued on next page n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a 1 d n/a n/a n/a 3 d n/a n/a n/a 2 d n/a n/a n/a 3 d n/a n/a n/a 1 d n/a n/a n/a 2 d Storage Conditions l,y s,ee t,u t,w t,gg q t,v t,ff t,hh n/a n/a n/a n/a n/a 13 n/a n/a n/a n/a n/a n/a n/a n/a n/a 7 d 14 d n/a n/a n/a n/a 7 d n/a n/a n/a n/a 7 d n/a n/a n/a n/a 7 d n/a n/a n/a n/a 6 d TemperatureTemp Post-thaw qq cc k,z r,s r,t t,dd t,x q Room Refrig Frozen Room Refrig 7 d n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a 14 d 14 dn/a 30 d n/a n/a n/a n/an/a n/a n/a 14 d n/a n/a n/a 16 d n/a n/a 14 d 7 d n/a n/a n/a n/a n/a 31 d 31 d n/a n/a n/a n/a 1, 14 n/a 120 d 12 d 12 d n/a n/a n/a 12 d 28 d 70 d4 d 99 d35 d n/a n/a n/a n/a n/a 182 d 28 d 35 d n/a 154 d n/a 42 d n/a 112 d n/a 56 d n/a 140 d n/a 98 d 35 d p pH 2.9–3.4 31 d 31 d n/a n/a n/a n/a 1, 14 e 155 4.75–4.95 n/a n/a n/a n/a n/a 30 d Osmolality (mOsm/kg) e p e e p e p ee p p e p ~ e p e p e p e p e p eee p p p e p e p e p e p e p e p e p e p e p e p NS n/a n/a 30 d D5W, NS NS RTU n/a n/a 6 w 6 w n/a n/a n/a n/a undiluted NS W D5W, NS D5W, NS D5W, NS D5W D5W D5W D5W D5W D5W D5W D5W D5W qq z ss qq y

tt oo s s t t t t t t t t t Concentration Diluents 0.1, 0.6, 1 mg/mL 10–40 mg/mL qq qq Drug unspec. 1, 20 mg/mL NS unspec. SAB 25, 50 mg/mL STE 0.025 mg/mL AGTSAB 1, 40 mg/mL 10 mg/mL unspec. NS 60 mg/mL NS ESunspec. 1, 10 mg/mL 1, 5 mg/mLunspec. NS NS 0.5, 15, 30 mg/mL NS CI 15 mg/mL unspec. unspec. 20 mg/mL NS STE 0.1–1.6 mg/mL unspec. 2, 15 mg/mL BABAEV 1–15 mg/mL 1–15 mg/mL 2 mg/mL D5W, NS D5W, NS EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL EV 2 mg/mL Manufacturer / ® jj C-Series (Halyard) ® (Leventon) (Leventon) ST/LT (B. Braun) ® ® Cassette (Pharmacia (Pharmacia Cassette ® Easypump Dosi-Fuser Homepump Morphine Sulfate (cont’d) Deltec) Cormed III Bag (Kalex) Homepump Eclipse Implantable Pump (Infusaid) INFUSOR (Baxter) CADD 265 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 265 22/05/17 1:55 PM Morphine Sulfate (cont’d) 1 1 6 1 9 1 1 1 ii f j i g h Body Temp Refer. continued on next page Storage Conditions n/a n/a n/a n/a n/a TemperatureTemp Post-thaw rr Room Refrig Frozen Room Refrig n/a n/a n/a n/a n/a 90 d 15 d 15 d n/a n/a n/a 15 d 7 d n/a n/a n/a n/a n/a 60 d n/a n/a n/a n/a n/a 8 w n/a n/a n/a n/a n/a 3 m n/a n/a n/a n/a n/a 3 m p pH e Osmolality (mOsm/kg) e p e p e p e p g e p h e p f e p W W unspec. unspec.

1 f h g

1 Concentration Diluents

1 Drug unspec. 2, 15 mg/mL unspec. 50 mg/mL unspec. 1, 20 mg/mL NS CTF 0.5, 1.5, 2.5 mg/mL NS unspec. 2 mg/mL WWunspec. 10, 25 mg/mL 10 mg/mL undiluted n/a undiluted 4.5 n/a n/a n/a n/a n/a 180 d WW 20 mg/mL Manufacturer Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating the need for extended medication storage in BD Practitioners should consider the FDA Safety Alert issued in 2015 when evaluating need for extended jj Heparin lock flush and normal saline. Deltec) (Epic Medical)

Morphine is light sensitive and should be protected from light with UV-protective coverings; stability data is for light-protected conditions only. Maximum Morphine is light sensitive and should be protected from with UV-protective coverings; stability data for light-protected ® 12 Solution also contained ropivacaine HCl (ASZ) 2 mg/mL. pH of undiluted solutions range from 2.5–7. Solution also contained ropivacaine HCl (ASZ) 1 mg/mL. With clonidine HCl (BI) 50 mcg/mL. Storage at 30°C. Osmolality of 7.5 mg/mL in NS is 236 mOsm/kg. 28 d at room temperature, followed by 7 33°C. With clonidine HCl 1.84 mg/mL. With bupivacaine HCl 25 mg/mL and clonidine 2 mg/mL. Stored at 31°C. 120 d refrigerated, followed by 7 at 33°C. Stored at 32°C. 8% concentration increase due to evaporation. Stored at 32°C. 8% concentration increase due to evaporation. solubility of morphine sulfate is 62.5 mg/mL. Refrigeration reduces the solubility, which can result in precipitation. Use only preservative-free diluents and drug solubility of morphine sulfate is 62.5 mg/mL. Refrigeration reduces the solubility, which can result in precipitation. Use only preservative-free products for intraspinal administration. Notes e Special Considerations: syringes. SMARTeZ Morphine Sulfate (cont’d) INTERMATE 200 (Baxter) Cassette PVC/Kalex (Pharmacia Pump EL Synchromed (Medtronic) Synchromed Pump (Medtronic) Pump Implantable 30 VIP (Fresenius) Flush Compatibility: f g h i j k l m n o p 266 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 266 22/05/17 1:55 PM Morphine Sulfate (cont’d) continued on next page 2002; 27:39–45. J Clin Pharm Ther. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. 1994; 19:361–9. Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Minneapolis, MN: Medtronic Neuromodulation 2014. http://professional.medtronic.com/wcm/groups/mdtcom_sg/@mdt/@neuro/ J Clin Pharm Ther. (WW) brand of preservative-free morphine sulfate. TM Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Synchromed Clinical Reference Guide. documents/documents/synchii-ref-guide.pdf. Accessed November 2015. Stability Data for Drugs Using B. Braun’s AccuFlo Intermate/Infusor Drug Stability Information. patient controlled analgesic devices. With 0.01 mg/mL bupivacaine HCl (HSP). Color changed to light brown after 5 days at 37°C. 28 d at room temperature, followed by 7 33°C. Morphine hydrochloride. Stored at 32°C. With 1 mg/mL baclofen. 98 d refrigerated, followed by 2 at 33°C. Slight yellow discoloration appeared after 30 d. 182 d refrigerated, followed by 7 at 33°C. Stored at 37°C. With 0.01, 20, and 37.5 mg/mL bupivacaine HCl (HSP). Protected from light. 140 d refrigerated, followed by 1 at 33°C. 112 d refrigerated, followed by 2 at 33°C. Tested with both preservative-free and preserved morphine sulfate 25 50 mg/mL. Manufacturer extrapolated data from other sources. Tested 10 mg/mL dilution of both preservative-free and preserved morphine sulfate 50 mg/mL. 14 d refrigerated, followed by 4 at room temperature. 154 d refrigerated, followed by 1 at 33°C. 56 d refrigerated, followed by 3 at 33°C. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. With 20 mg/mL bupivacaine HCl (HSP). Stability data is for Infumorph 42 d refrigerated, followed by 3 at 33°C. With 2 mg/mL ropivacaine HCl (AST). With 1.5–8 mg/mL ketorolac (Recordati). 35 d at room temperature, followed by 6 33°C. With 0.125 mg/mL droperidol (JN). 35 d at room temperature, followed by 7 33°C. With 0.5 mg/mL metoclopramide (BE). 5. 6. 7. with morphine, sufentanil, fentanyl or clonidine. Svedberg KO, McKenzie EJ, Larrivee-Elkins C. Compatibility of ropivacaine Morphine Sulfate (cont’d) q r s t u v w x y z aa bb cc dd ee ff gg hh ii 4. jj kk ll mm nn oo pp qq rr ss tt References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. the stability of morphine sulphate and meperidine (pethidine) hydrochloride in plastic syringes for use Strong ML, Schaaf LJ, Pankaskie MS, et al. Shelf lives and factors affecting 267 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 267 22/05/17 1:55 PM Morphine Sulfate (cont’d) . 1997; . 2010; 63:154–5. Int J Pharm (AMST) Can J Hosp Pharm (Oct) 1989; 42:195–200, 218–9. Can J Hosp Pharm. Bethlehem, PA: B. Braun USA; September 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Pump (ES.H.00.730-10). ® Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 153:13b. Accessed There Is No Suitable Alternative. August 18, 2015. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm458955.htm. June 5, 2016. Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ 14. 14. sulfate solutions in portable infusion pump casettes. Walker SE, Iazetta J. Stability of sulfite free high potency morphine 11. 11. of intrathecal admixtures containing baclofen and high concentrations morphine. Sitaram BR, Tsui M, Rawicki HB, et al. Stability and compatibility 12. 12. FDA Safety Alert for Human Medical Products: Compounded or Repackaged Drugs Stored in Becton-Dickinson (BD) 3 mL and 5 Syringes: Alert—Do Not Use Unless 13. Note: 10. 10. bupivacaine with hydromorphone, morphine, and fentanyl. Donnelly RF, Wong K, Spencer J. Physical compatibility of high-concentration Morphine Sulfate (cont’d) 8. 9. 268 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_M2.indd 268 22/05/17 1:55 PM Nafcillin Sodium 3 9 1 1 1 1 8 8 1 1 1 Body Temp Refer. continued on next page n/an/a n/a n/a n/a n/a 12 12 i i 30 d 30 d n/a n/a n/a n/a Storage Conditions i i g 14 d 24 h TemperatureTemp Post-thaw g i 24 h 3 d n/a n/a n/a n/a 3 dn/a 14 d2 d 10 d 30 d1 d 24 h 3 d n/a n/a n/a n/a 12 n/a n/a 3 d24 h 24 d7 d n/a n/an/a 15 d 30 d n/a n/a24 h n/a 24 h24 h n/a 96 h n/a n/a 9 m 96 h7 d 30 d n/a n/a n/a n/a 30 d n/a24 h 44 d n/a n/a n/a24 h n/a n/a n/an/a n/a n/a n/a n/a24 h n/a n/a 7 d n/an/a n/a 7 d n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 90 d n/a n/a 90 d n/a n/a n/a n/a3 d n/a 10 n/a n/a48 h 10 n/a 14 d n/a n/a 10 n/a 10 n/a 10 n/a 10 n/a n/a Room Refrig Frozen Room Refrig e e e e e e e e e e e e e e e e e e e e e Osmolality (mOsm/kg) pH n/a W Drug unspec. 5–50 mg/mL NS n/a unspec. 5–40 mg/mL NS n/a GSKGSKunspec. 5–40 mg/mL 10–40 mg/mL 5–50 mg/mL NS, D5W D5W NS n/a n/a n/a WYWYWY 20 mg/mLWY 20 mg/mLWY, BR 20 mg/mLWY, BR 250 mg/mL 8.33, 16.7, 33.33 mg/mLAPC NS NS 8.33, 16.7, 33.33 mg/mL D5WAPP D5W D5WAPP 10 mg/mLAPP unspec. 361 APP 312, 346, 415 334 2–30 mg/mL 289, 323, 392 APP 334 10–30 mg/mL n/a APP 10–30 mg/mL 10–200 mg/mL NS 10–250 mg/mL D5W, D5½S LR 250 mg/mL n/a D5W, D5½SMAR W, NS n/a n/a WY D5W, D5½S n/a n/a 20, 120 mg/mL W, NS n/a 80 mg/mL n/a NS n/a Manufacturer Concentration Diluents (Leventon) (Leventon) ST/LT ST/LT

® ® (B. Braun) TM Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS CADD (B. Braun) Easypump Nafcillin Sodium Chloride Polyvinyl (PVC) Syringe (Glass) Syringes, Plastic Syringes, Polypropylene Unspecified AccuFlo (Pharmacia Deltec) Dosi-Fuser 269 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_N.indd 269 22/05/17 1:55 PM Nafcillin Sodium (cont’d) 5 2 2 4 2 2 n/a Body Temp Refer. b

7 21 d continued on next page b 72 h d b, n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 11 Storage Conditions 40 mg/mL in NS. Clinicians may consider ≥ f a i 14 d 14 d 3 d TemperatureTemp Post-thaw a f i 3 d 48 h 24 h 3 d n/a n/a n/a n/a 1 d 24 hn/a 10 d 30 d 10 d 24 h 30 d n/a 24 h n/a n/a n/a Room Refrig Frozen Room Refrig e e e e e e e Osmolality (mOsm/kg) pH iso 6–8.5 n/a n/a D

1 Drug SKB 20 mg/mL BRBR 10 mg/mL 10–40 mg/mL D5W D5W n/a n/a unspec. 10 mg/mL NS n/a unspec. 5–50 mg/mL NS n/a BR 5 mg/mL D5W n/a BR 5–40 mg/mL D5W, NS n/a Precipitation was observed after 48 h in a solution incubated at 34° to 36°C, concentrations Manufacturer Concentration Diluents Heparin lock flush and normal saline. / ® C-Series C-Series (Baxter) j ® (Epic (Epic (Baxter) ® j COMMERCIAL PREPARATIONS (RTU) Thaw at room temperature or under refrigeration. Do not force thaw. Do not refreeze. Thaw at room temperature or under refrigeration. Do not force Expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded pH of reconstituted preparation is 6–8.5. 14 d refrigerated, followed by 48 h at room temperature. Stored for 24 h at 5°C, followed by 48 30°C. 14 d refrigerated, followed by 3 at room temperature. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Manufacturer extrapolated data from other sources. f g i j Notes a b d e limiting the concentration to 20 mg/mL or less in NS, and limiting the medication in each ambulatory pump reservoir container to a 24 h supply. limiting the concentration to 20 mg/mL or less in NS, and medication each ambulatory pump reservoir container Special Considerations: Homepump Nafcillin Sodium (cont’d) Homepump Eclipse INTERMATE Galaxy Bag (Baxter) Flush Compatibility: (Halyard) INFUSOR Medical) SMARTeZ 270 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_N.indd 270 22/05/17 1:55 PM Nafcillin Sodium (cont’d) 2005; 62:1347–8. Bethlehem, PA: B. Braun USA; September 2015. . Am J Health-Syst Pharm. . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; September 2015. Barcelona, Spain: Leventon SAU; October 2015. HealthTek ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, CA: Baxter Corporation; October 2008. Container (PL 2040 Plastic) [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; April 2015. ® Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using B. Braun’s AccuFlo Nafcillin Sodium (cont’d) Note: 12. 12. 9. 10. 10. Pharmaceuticals; February 2011. Nafcillin for injection, USP [package insert]. Schaumburg, IL: APP 11. 8. Rapp RP, Hatton J, Record K. 7. on nafcillin precipitation Chan V. Letters: influence of temperature and drug concentration 4. 5. Nafcillin Injection USP in Galaxy References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. 3. 271 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_N.indd 271 22/05/17 1:55 PM Octreotide Acetate 1 1 1 1 1 Body Temp Refer. Do not confuse octreotide n/a n/a n/a 3 h 60 d n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions h f d n/a n/a n/a n/a n/a 22 d 29 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw f a f d 96 h 48 h Room Refrig Frozen Room Refrig

1 c c c Osmolality (mOsm/kg) pH

1,3 Drug SZ 5, 50, 250 mcg/mL NS n/a SZ 200 mcg/mL undiluted n/a 3.9–4.5 n/a 60 d SZ 200 mcg/mL undiluted n/a 3.9–4.5 1 w SZSZ 1.5 mcg/mL 200 mcg/mL NS undiluted n/a n/a 3.9–4.5 1 w Manufacturer Concentration Diluents Store preservative-free single dose vials and preserved multi-dose vials refrigerated and protected from light. Store preservative-free single dose vials and preserved multi-dose refrigerated protected from Heparin lock flush and normal saline. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. CONTAINER Protected from light. Light conditions unspecified. At ambient room light. pH of undiluted solution is 3.9–4.5. Not protected from light. Special Considerations: acetate injection with the injectable depot suspension product, which must not be administered IV or SC. d f h References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 3. Pharmaceuticals, Inc.; January 2016. Octreotide Acetate Injection [package insert]. Schaumburg, IL: Sagent Note: Notes a c Unspecified Flush Compatibility: Octreotide Acetate Polyvinyl Chloride (PVC) Syringes, Polypropylene 272 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 272 22/05/17 1:55 PM Ondansetron Hydrochloride 1 1 1 1 1 1 1 1 1 1 1 1 3 8 f,h i e e n/a n/a Body Temp Refer. o o 14 d 14 d continued on next page o o n/a n/a n/a n/a 1, 4 n/a n/a n/a n/a 10 n/a n/a n/a n/a 1, 5 n/a n/a n/a n/a n/a n/a n/a 7 d n/a n/a n/a n/a 1, 9 90 d90 d 48 h 48 h n/a n/a n/a 24 h n/a n/a n/a n/a n/an/a n/a n/a n/a n/a 12 h n/a 1, 4 Storage Conditions c c l o j a s o f j i c 30 d 10 d 30 d 31 d 7 d n/a n/a n/a n/a 14 d 14 d 10 d 30 d TemperatureTemp Post-thaw s c j c o o i c a 48 h 28 d 28 d n/a n/a n/a n/a 1, 6 3 d 28 d n/a n/a n/a n/a 24 h n/a 14 d 3 d 3 d n/a n/a n/a n/a 7 d 28 d n/a n/a n/a n/a 48 h 31 d 7 d 48 h14 d 14 dn/a 14 d 3 m 120 d n/a 120 d n/a n/a n/a n/a n/a 48 h 48 h n/a 30 d 31 d 31 d n/a n/a n/a 7 d n/a 14 d 24 h 48 h Room Refrig Frozen Room Refrig k k k k k k k k k k k k k k k k k k k k k Osmolality (mOsm/kg) pH NS n/a NS n/a D5W n/a D5W n/a NS n/a NS n/a NS n/a D5W n/a r b, q d g g n n b Drug GL 0.15 mg/mL GL 0.15 mg/mL GL 0.75 mg/mL GL 0.1–0.7 mg/mL D5W, NS n/a GL 0.03–0.3 mg/mL D5W, NS n/a GL 0.75 mg/mL CERCER 0.1, 0.2, 0.4, 0.64 mg/mL 0.1, 0.2, 0.4, 0.64 mg/mL NS n/a GLGLGLGL 0.016, 0.08 mg/mLGL 0.03, 0.3 mg/mL 0.024, 0.096 mg/mL D5W, NS 0.08 mg/mL 0.1, 1 mg/mL D5W, NS D5W, LR, NS n/a n/a n/a NSunspec.unspec. 0.25, 0.5, 1 mg/mLGL 2 mg/mL n/a D5W, NSGL 0.1, 1 mg/mL n/a undiluted 0.24 mg/mL n/a CER NS 0.64 mg/mL n/a GL 0.03–0.3 mg/mL D5W, NS n/a GL 0.1–0.7 mg/mL D5W, NS n/a Manufacturer Concentration Diluents

p / ® C-Series (Halyard) (Baxter) (Leventon) ® (Epic Medical) ® ® -1 Cassette ® CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser Homepump Ondansetron Hydrochloride Polyvinyl Chloride (PVC) Syringes, Polypropylene Unspecified CADD (Pharmacia Deltec) Homepump Eclipse INTERMATE Polyester Container (CR3) SMARTeZ 273 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 273 22/05/17 1:55 PM Ondansetron Hydrochloride (cont’d)

Am J Health-Syst Pharm. 1992; 26:768–71. Ann Pharmacother . Irvine, CA: Halyard Health; March 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

1 . Ontario, Canada: Baxter Corporation; October 2008.

1 Elastomeric Pump (ES.H.00.730-10). ® 1997; 54:1065–8. n/a Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser SMARTeZ 1996; 53:1431–5. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Am J Health-Syst Pharm. Intermate/Infusor Drug Stability Information INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. With morphine sulfate (AST) 1 mg/mL or hydromorphone HCl (ES) 0.5 mg/mL. With morphine sulfate (AST) 1 mg/mL or hydromorphone HCl With meperidine HCl (WY) 4 mg/mL. Dexamethasone 0.2 and 0.4 mg/mL (ES). 90 d at –20°C, followed by 14 4°C, then 48 h 24°C. At 30°C to simulate infusion next body. With dexamethasone sodium phosphate (MSD) 0.23 mg/mL. At 32°C to simulate infusion next body. Exposed to light. pH of undiluted solutions is 3.3–4. 30 d refrigerated followed by 48 h at room temperature. With dexamethasone sodium phosphate (MSD) 0.4 mg/mL. Protected from light. Added to ondansetron ready-to-use CR3 polyester bags. 30 d refrigerated, followed by 24 h at 30°C. Manufacturer(s) extrapolated data from other sources. 14 d refrigerated, followed by 2 at room temperature. 10 d refrigerated, followed by 24 h at room temperature, followed by 12 h at 33°C. 10 d refrigerated, followed by 24 h at room temperature, 9. in large-volume parenteral solutions. Graham CL, Dukes GE, Kao C-F, et. al. Stability of ondansetron Ondansetron Hydrochloride (cont’d) Note: 10. 10. 8. 5. 6. and dexamethasone sodium phosphate in 0.9% chloride injection 5% dextrose injection. Evrard B, Ceccato A, Gaspard O, et al. Stability of ondansetron hydrochloride Special Considerations: Notes a b c d e f g h i j k l n o p q r s References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 3. 4. and dexamethasone sodium phosphate in infusion bags syringes for 32 days. Hagan RL, Mallett MS, Fox JL. Stability of ondansetron hydrochloride Flush Compatibility: 274 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 274 22/05/17 1:55 PM Oprelvekin (Interleukin-11) 2 Body Temp Refer. n/a n/a n/a n/a Storage Conditions a 24 h TemperatureTemp Post-thaw a 24 h 3 h 3 h n/a n/a n/a n/a 1, 2 Room Refrig Frozen Room Refrig 1 1 7 7 1 1 iso iso Osmolality (mOsm/kg) pH W W

2,3 Unreconstituted product should be stored at 2–8°C. Do not freeze or shake the reconstituted preparation. Avoid excessive or vigorous Unreconstituted product should be stored at 2–8°C. Do not freeze or shake the reconstituted preparation. Drug n/a WYWY 5 mg/mL 5 mg/mL Manufacturer Concentration Diluents [product information]. Philadelphia, PA: Wyeth Pharmaceuticals; October 2012. ®

1 b,c OTHER INFUSION CONTAINERS Original vials. Storage in syringes is not recommended. product in terms of quality, purity, or potency. Product remains physically and biochemically stable for 24 h after reconstitution. Manufacturer recommends use within 3 h to ensure against microbial contamination. Product remains physically and biochemically stable for 24 h after reconstitution. Manufacturer recommends use within 3 Manufacturer states that storage in the original vial up to 3 d at room temperature 25°C (77°F), 60% relative humidity, should not have an adverse effect on the Manufacturer states that storage in the original vial up to 3 d at room temperature 25°C (77°F), 60% relative humidity, should Oprelvekin (Interleukin-11) Vial Vial Flush Compatibility: Special Considerations: agitation. Notes a b c 2. Global Medical Communications [personal communication]. Philadelphia, PA: Wyeth; August 2002. 3. Medical Information Department [personal communication]. New York, NY: Pfizer, Inc.; January 2012. References 1. Neumega 275 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 275 22/05/17 1:55 PM Oritavancin Diphosphate Body Temp Refer.

2 n/a n/a n/a n/a 1, 2 Storage Conditions b 12 h TemperatureTemp Post-thaw b 6 h Room Refrig Frozen Room Refrig a Osmolality (mOsm/kg) pH

1 Reconstitute three 400-mg vials with 40 mL W per vial to provide a 10-mg/mL solution. To avoid foaming, gently swirl vials. Withdraw Reconstitute three 400-mg vials with 40 mL W per vial to provide a 10-mg/mL solution. To avoid foaming, Drug

Incompatible with heparin and normal saline. 1 TMC 1.2 mg/mL D5W n/a Manufacturer Concentration Diluents (oritavancin) [package insert]. Parsippany, NJ: The Medicines Company; January 2016. ®

2 CONTAINER Combined reconstituted and diluted storage time, including the 3 h infusion time, should not exceed 6 h at room temperature or 12 h if refrigerated. Combined reconstituted and diluted storage time, including the 3 h infusion should not exceed 6 at room temperature pH range is 3.1–4.3. References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. ORBACTIV b Notes a Special Considerations: over 3 h. Use only D5W for 120 mL D5W from a 1,000 bag, then add (1,200 mg) to the bag for final concentration of 1.2 mg/mL. Infuse dilution. Oritavancin Diphosphate Unspecified Flush Compatibility: 276 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 276 22/05/17 1:55 PM Oxacillin Sodium 2 2 4 9 8 8 8 1 1 5 5 1 1 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a 11 a a n/a n/a n/a n/a 10 n/a n/a n/an/a n/a n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a 12 Storage Conditions

a a j a a 10 d 7 d 10 d 2 w n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 12 12 TemperatureTemp Post-thaw a j j j a a 24 h 10 d 30 d 24 h n/a n/a 4 d 10 d n/a4 d 4 d n/a n/a 30 d 24 h n/a24 h 24 h n/a24 h n/a24 h 8 d 30 d92 h n/a 8 h 24 h 30 d84 h n/a 30 d42 h n/a n/an/a n/a n/a n/a n/a n/a n/a n/a 3 m n/a 3 d n/a 14 d n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e pH n/a 4 d n/a n/a 10 d n/a n/a n/a n/a n/a 4 d 10 d n/a n/a n/a n/a e e e e g Osmolality (mOsm/kg) g gg e g e g ggg e e e g e gggg e e e e g e W W W W Drug unspec. 10–100 mg/mL NS BR 10–80 mg/mL D5W, NS BR 40 mg/mL unspec. 10–100 mg/mL NS unspec. 10–100 mg/mL NS unspec. 10–30 mg/mL D5W unspec.unspec. 10–100 mg/mL 10–100 mg/mL NS D5W unspec. 10–80 mg/mL D5W, NS BRBRBR 1 mg/mLBR 10 mg/mLAUMAUM 8.33, 16.67, 33.33 mg/mLAUM NS 8.33, 16.67, 33.33 mg/mL 100 mg/mLBR D5W 200 mg/mL D5W, NS 200 mg/mL D5W 311, 345, 414 n/a 288, 322, 390 200 mg/mL 295 MAR NS D5W 120 mg/mL Manufacturer Concentration Diluents / i ®

f C-Series C-Series ® (Leventon) (Leventon) ST/LT ST/LT (Epic Medical) ® (B. Braun) ® ®

TM Cassette ® CONTAINER OTHER INFUSION CONTAINERS SMARTeZ CADD (B. Braun) (Halyard) Easypump Homepump Oxacillin Sodium Polyvinyl Chloride (PVC) Syringes, Plastic AccuFlo (SIMS Deltec) Dosi-Fuser Homepump Eclipse INTERMATE (Baxter) 277 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 277 22/05/17 1:55 PM Oxacillin Sodium (cont’d)

1 1 1 1 n/a 1, 3 Body Temp Refer. c 21 d c 48 h c Storage Conditions TemperatureTemp Post-thaw 24 hn/a n/a4 d 4 d n/a 7 d 30 d n/a 30 d n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e pH g Bethlehem, PA: B. Braun USA; September 2015.

12 Osmolality (mOsm/kg) iso 6–8.5 n/a n/a ggg e e e . Irvine, CA: Halyard Health; March 2015. (data on file). Chester, NY: RMS Medical Products; July 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998.

D 3 TM Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015.

HealthTek 1 ST/LT Elastomeric Infusion System. ®

1 Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; 2008. Elastomeric Pump (ES.H.00.730-10). Drug ® Drug Stability in Plastic Syringes. BA 20, 40 mg/mL BRunspec.unspec. 10–30 mg/mL 1, 10, 50 mg/mL 10–100 mg/mL D5W, NS D5W NS Manufacturer Concentration Diluents Oxacillin sodium can be extremely irritating to veins at higher concentrations. . Antibiotic Stability in Freedom 60 Syringe and Tubing System Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using B. Braun's AccuFlo COMMERICAL PREPARATIONS (RTU) capable of maintaining –20°C or colder. Do not refreeze after thawing. pH of 10 mg/mL is 7.4–7.94 in D5W and 7.73 NS. Manufacturer(s) extrapolated data from other sources. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Store in a freezer Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded 166 mg/mL (BR) in W is 596 mOsm/kg by freezing-point depression and 657 vapor pressure. 50 (BE) 381 D5W 396 NS. Portable reservoir is PVC material. Storage in 60-mL luer-tip plastic syringes (BD) with tubing (RMS) attached and capped. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Note: 12. 12. Fugit D, Anderson B 11. 11. 8. 9. 10. 10. Special Considerations: Notes a c 5. Rapp RP, Hatton J, Record K. Oxacillin Sodium (cont’d) Galaxy Bag (Baxter) Flush Compatibility: i j References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. 3. IL: Baxter Healthcare; January 2015. Oxacillin Injection, USP in Plastic Container [package insert]. Deerfield, 4. e f g Unspecified 278 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 278 22/05/17 1:55 PM Oxaliplatin 5 6 3 Body Temp Refer. n/a n/a n/a n/a Storage Conditions 2007; 64:1950–4. d TemperatureTemp Post-thaw Room Refrig Frozen Room Refrig Am J Health-Syst Pharm.

2 2009; 43:390–1. Osmolality (mOsm/kg) pH D5W n/a n/a 6 h 24 h n/a n/a n/a n/a D5W n/a n/a 28 d 28 d Ann Pharmacother. c b, a

2,3 Ontario, Canada: Baxter Corporation; October 2008. Drug SW 0.1–1 mg/mL SAVAVESAV 0.2, 1.3 mg/mLSAV 0.25 mg/mL D5WSAV 0.7 mg/mL 0.2, 1.3 mg/mL D5W n/a 0.2, 1.3 mg/mL D5W D5W n/a D5W n/a n/a n/a n/a n/a 14 d n/a 14 d n/a 90 d n/a n/a 90 d 30 d 14 d n/a n/a 30 d 14 d 14 d n/a n/a n/a n/a 14 d n/a n/a n/a n/a n/a 2, 5 n/a n/a n/a n/a n/a n/a 2, 4 n/a 1, 2 n/a 2, 5 SAV unspec. Manufacturer Concentration Diluents Do not freeze. use needles or sets containing aluminum. 2009; 66:1929–33. Incompatible with normal saline, heparinized saline flush, alkaline drugs, and chloride-containing solutions. Flush administration line with D5W Incompatible with normal saline, heparinized saline flush, alkaline drugs, and chloride-containing solutions. g [package insert]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; October 2015. [package insert]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. Am J Health-Syst Pharm. CONTAINER OTHER INFUSION CONTAINERS Followed by 9 d at 25°C. Protect from light. Total dose must be diluted in 250–500 mL D5W prior to administration. Avoid concentrations less than 0.1 mg/mL. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion Devices are Special Considerations: 6. Note: Oxaliplatin Polyethylene Polyolefin Polypropylene Polyvinyl Chloride (PVC) INTERMATE (Baxter) Unspecified Flush Compatibility: before and after oxaliplatin administration. Notes a b c d g References 1. containing 5% dextrose injection. Andre P, Cisternino S, Roy A, et al. Stability of oxaliplatin in infusion bags 5. in 5% dextrose injection stored polyvinyl chloride, polyethylene and polypropylene infusion bags. Eiden C, Philibert L, Bekhtari K, et al. Physicochemical stability of oxaliplatin 4. Junker A, Roy S, Desroches MC, et al. Stability of oxaliplatin solution. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 3. Eloxatin 279 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_O.indd 279 22/05/17 1:55 PM Oxytocin 1 1 Body Temp Refer. Storage Conditions n/an/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw b b 90 d 28 d Room Refrig Frozen Room Refrig a a a Osmolality (mOsm/kg) pH

1 Concentration Diluents

1 Protect from freezing. Drug Heparin lock flush and normal saline. APPAPP 0.08 units/mL 0.08 units/mL NS, D5W LR n/a n/a Manufacturer CONTAINER Protected from light. pH of undiluted product is 3–5. b Reference 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. Special Considerations: Oxytocin Chloride Polyvinyl (PVC) Flush Compatibility: Notes a 280 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Paclitaxel 2 1 1 1 9 8 7 1 i b b, b h n/a 1, 11 Body Temp Refer. n/a n/a continued on next page n/a n/a n/a 7 d n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions d k 7 d 7 d 7 d 7 n/a n/a n/a n/a 1 d TemperatureTemp Post-thaw d k i 7 d 3 d7 d 13 d5 d 20 d7 d n/a 8 d n/a 10 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 n/a 1, 6 n/a 1, 6 1, 6 3 d3 d 9 d 10 d n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 1, 6 1 d 1 d 7 d n/a n/a n/a n/a 1 d 1 d 3 d 3 d n/a n/a n/a 3 d 3 dn/a 13 d n/a n/a n/a n/a n/a n/a n/a n/a 3 d 1, 6 3 d3 d 16 d5 d 18 d n/a 5 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 n/a 1, 6 3 d3 d 12 d 12 d n/a n/a n/a n/a n/a n/a n/a n/a 1, 6 1, 6 Room Refrig Frozen Room Refrig a f f f f f f a a a a a f a f f a f f n/a Osmolality (mOsm/kg) pH c Drug MJ 1 mg/mL D5W TETETETE 0.3 mg/mL 0.3 mg/mL 1.2 mg/mL 1.2 mg/mL NS D5W NS D5W n/a n/a n/a n/a MAY 1.2 mg/mL D5W, NS n/a 3.5–4 4 d 12 d n/a n/a n/a n/a 1, 11 MAYMAYMAYMAY 0.3 mg/mL 0.3 mg/mL 0.75 mg/mL 0.75 mg/mL D5W NS D5W NS n/a n/a n/a n/a 3.5–4.1 8 d 3.6–3.9 3.4–4 4 d 3.5–3.9 28 d 6 d n/a 6 d 20 d 28 d n/a n/a 20 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 11 n/a 1, 11 1, 11 TETE 1.2 mg/mL 1.2 mg/mL NS D5W n/a n/a unspec. 1.2 mg/mL D5W, NS n/a unspec. 1.2 mg/mL D5W, NS n/a unspec. 1.2 mg/mL D5W, NS n/a FAU 0.3, 1.2 mg/mL D5W, NS n/a BR 0.1, 1 mg/mL D5W, NS n/a TEBMS 0.3 mg/mL 0.3, 1.2 mg/mL D5W, NS D5W, NS n/a n/a TETEBMS 0.3 mg/mL 0.3 mg/mL 0.4, 1.2 mg/mL NS D5W D5W n/a n/a n/a TETE 1.2 mg/mL 1.2 mg/mL NS D5W n/a n/a Manufacturer Concentration Diluents

(B. Braun) e ST/LT (B. Braun) (Epic Medical) (Baxter) ® (Fresenius Kabi) ® j g (B. Braun) TM CONTAINER OTHER INFUSION CONTAINERS Glass Polyolefin SMARTeZ Easypump Paclitaxel Ethylvinyl Acetate (EVA ) Polyethylene Polyolefin (McGaw) AccuFlo Polyolefin 281 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 281 22/05/17 1:55 PM Paclitaxel (cont’d) . 2006; 12:129–34. Since the mechanism of 3,4,5 1997; 1:49–53. Europ J Hosp Pharm Sci

10 ). These have different physicochemical . 2006; 12:211–22. ® 1997; 17(5 suppl):133S–9S. Precipitation is sporadic and unpredictable. Containers 1 Int J Pharm Compound. 1993; 50:2518, 2521. Precipitants, which may form during refrigeration of vials, 1 J Oncol Pharm Practice Pharmacotherapy. Bethlehem, PA: B. Braun USA; September 2015. Am J Hosp Pharm. . Bethlehem, PA: B. Braun USA; April 2015. 1994; 51:1473. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016.

1 ST/LT Elastomeric Infusion System. ® Am J Hosp Pharm.

1 Elastomeric Infusion System TM

6 3.5–4.2. ~ Precipitation may be exacerbated by the use of peristaltic pumps. Volumetric pumps may reduce this problem. Precipitation may be exacerbated by the use of peristaltic pumps. Volumetric pumps reduce Heparin lock flush and normal saline. Stability Data for Drugs Using Elastomeric Infusion Pumps. ® low density polyethylene bag. Melsungen, Germany; B Braun Melsungen AG. ® polyolefin bag. Berkshire, UK: Baxter Healthcare. ® Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Author recommends maximum 7 d stability due to unpredictability of precipitation. Studies showed stability up to 14 d. Author recommends maximum 7 d stability due to unpredictability At 32°C. Protected from light. Ecoflac pH of 0.6, 1.2 mg/mL in D5W, NS, or D5LR is 4.4–5.6. Manufacturer extrapolated data from other sources. Solution contains 20 or 25% ethanol. Viaflo pH range of tested solutions was Freeflex infusion bag, Fresenius Kabi, Ltd. Although physically compatible and stable for 3 d, unknown material leached from EVA container by 24 h. Although physically compatible and stable for 3 d, unknown material Special Considerations: Flush Compatibility: this irregular precipitation has not been identified, care and vigilance are required throughout the infusion. and administration sets should not contain DEHP plasticizer. Administer through a 0.22-micron filter. 3. Woloschuk DM. Drug precipitation and peristaltic pumps. should dissolve upon warming to room temperature. Discard if product remains cloudy or insoluble precipitate forms. properties, dosing, preparation, administration procedures, and clinical applications. Notes a b c d e f h i j k References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. admixture of paclitaxel for long-term infusion. Trissel LA, Xu Q, Martinez JF. Compounding an extended-stability g 4. during infusion by pump. Pfeifer RW, Hale KN, Cronquist SE, et al. Precipitation of paclitaxel 5. on preparation and administration. Trissel LA. Pharmaceutical properties of paclitaxel and their effects 10. 10. Care, LLC; March 2015. Paclitaxel Injection, USP [package insert]. Paramus, NJ: WG Critical 11. paclitaxel infusion under simulated storage and clinical-use conditions. Kattige A. Long-term physical and chemical stability of a generic Do not confuse paclitaxel injection, USP, with protein-bound particles for injectable suspension (Abraxane Paclitaxel (cont’d) 6. Donyai P, Sewell GJ. Physical and chemical stability of paclitaxel infusions in different container types. 8. 7. 9. 282 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 282 22/05/17 1:55 PM Pantoprazole Sodium 4 2 2 4 6 4 4 2 2 Body Temp Refer. continued on next page

1,5 n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a 2, 3 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 3, 7 n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a 2, 3 2, 3 n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions d d d d g e f b, a, a b, b, b, a a a, a,

a a 28 d 10 d 21 d 7 d 28 d 4 d 14 d 21 d 14 d 20 d 11 d TemperatureTemp Post-thaw g a, a a e f b a a b a b a, a, Room Refrig Frozen Room Refrig 28 h 7 d 1 d 48 h 24 h 6 h 8 h c,h h h h h h h h

5 Osmolality (mOsm/kg) pH NS n/a NSD5W n/a n/a D5W n/a n/a 3 d NS n/a n/a 3 d NS n/a n/a 4 d NS n/a n/a n/a 28 d NSD5WNS n/a n/a n/a D5W n/a D5W n/a n/a 2 d a a

1 b a a a a a b b a b

0.8 mg/mL 0.8 mg/mL 0.8 mg/mL 0.8 mg/mL 0.4, 0.8 mg/mL 4 mg/mL 4 mg/mL 0.16 mg/mL 0.16 mg/mL 0.16–0.8 mg/mL 0.16–0.8 mg/mL 0.4 mg/mL 1,3 in NS is 9–10.5. a Solution is 10.05; pH of 10% aqueous solution 10.85. I.V. a ® IV a a a a a a a ® a Drug Do not freeze reconstituted product. The U.S. and Canadian formulations of pantoprazole sodium contain EDTA. Do not freeze reconstituted product. The U.S. and Canadian formulations of pantoprazole sodium contain b b b b ALT ALT ALT SZ PH 0.4 mg/mL D5W, NS n/a n/a 2 d n/a n/a n/a n/a n/a SZ WY ALT ALT ALT SZ ALT SZ Normal saline. Manufacturer Concentration Diluents CONTAINER Protected from light. Formulated without EDTA. pH of 1% aqueous Panto Stored at 4°C for 20 d, followed by 6 h 23°C. Formulated with EDTA. pH of reconstituted Protonix Stored at 4°C for 10 d, followed by 28 h 23°C. Stored at 4°C for 11 d, followed by 8 h 23°C. Notes a b c Special Considerations: Syringes, Syringes, Unspecified Flush Compatibility: d e f g h Pantoprazole Sodium Chloride Polyvinyl (PVC) Polypropylene 283 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 283 22/05/17 1:55 PM Pantoprazole Sodium (cont’d)

b 2009; 62(2):135–41. . 2006; 22:95–8. 2011; 64(3):192–8. Can J Hosp Pharm. J Pharm Technol 2005; 62:2410–2. Can J Hosp Pharm. Am J Health-Syst Pharm. IV [prescribing information]. Philadelphia, PA: Wyeth Pharmaceuticals; December 2014. ® IV [product monograph]. Oakville, ON: Takeda Canada, Inc.; April 2015. ® 6. and pantoprazole sodium diluted for intravenous infusion. Carpenter JF, McNulty MA, Dusci LJ, et al. Stability of omeprazole sodium 5. Panto Pantoprazole Sodium (cont’d) 3. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 4. chloride minibags, and polypropylene syringes. Donnelly RF. Stability of pantoprazole sodium in glass vials, polyvinyl 2. in 0.9% sodium chloride or 5% dextrose at 4°C and 23°C. Walker S, Iazzetta J, Law S. Extended stability of pantoprazole for injection 7. in polypropylene syringes. Johnson CE. Stability of pantoprazole in 0.9% sodium chloride injection References 1. Protonix 284 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 284 22/05/17 1:55 PM Pemetrexed Disodium Body Temp Refer.

1 n/a n/a n/a 1, 4 f n/a n/a n/a n/a 2, 4 n/a Storage Conditions c c a, TemperatureTemp Post-thaw . 2005; 39:2026–8. 2 d 31 d 48 hh 24 Room Refrig Frozen Room Refrig . 2006; 40:1082–5. b b b 2006; 40:1289–92. Ann Pharmacotherapy

5 Ann Pharmacotherapy n/a Osmolality (mOsm/kg) pH 3 d . Ann Pharmacotherapy. 5 NS n/a 5

4 e

4 Incompatible with calcium-containing solutions (e.g., LR). Drug Normal saline, heparin. LILI 2, 10, 20 mg/mL 25 mg/mL NS, D5W Manufacturer Concentration Diluents [package insert]. Indianapolis, IN: Eli Lilly and Company; September 2013. [package insert]. Indianapolis, IN: Eli Lilly and Company; September ® CONTAINER Manufacturer recommends reconstitution and dilution only with NS. Manufacturer recommends reconstitution and dilution only with The pH of reconstituted product is 6.6–7.8. Further dilution is required prior to administration. Although no drug loss occurred in 31 d, unidentified microparticulates developed during refrigerated storage exceeding 24 h in PVC bags. Although no drug loss occurred in 31 d, unidentified microparticulates developed during refrigerated storage exceeding 24 h Protected from light. Due to development of substantial microparticulates, avoid freezing in PVC bags. Due to development of substantial microparticulates, avoid freezing Pemetrexed Disodium Chloride Polyvinyl (PVC) Polypropylene Flush Compatibility: c d Special Considerations: e Notes a f Syringes, Syringes, b References 1. in infusion solutions. Zhang Y, Trissel LA. Physical and chemical stability of pemetrexed 4. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 5. ALIMTA 3. bags Zhang Y, Trissel LA. Physical instability of frozen pemetrexed in PVC 2. solutions in plastic syringes. Zhang Y, Trissel LA. Physical and chemical stability of pemetrexed 285 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 285 22/05/17 1:55 PM Penicillin G Potassium 1 1 6 1 1 1 5 6 1 4 1 5 2 8 Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a 10 n/a n/a n/a n/a n/a n/a 10 e a a a n/a n/a n/a n/a 25 d n/a n/a n/a n/a 30 d 30 d 30 d 24 h n/a n/a 10 30 d Storage Conditions a a a a d g 4 d 24 h 24 h 7 d 10 d TemperatureTemp Post-thaw a a g a a 3 d3 d n/a 14 d n/a n/a n/a n/a n/a n/a n/a n/a 1, 11 1, 11 n/a 48 h n/a n/a n/a n/a 24 h 24 h n/a n/a n/a n/a 4 d 4 d 24 h 24 h 30 d n/a n/a n/a 48 h 48 h n/a n/a n/a n/a 24 h 24 h 30 d 24 h n/a n/a 24 h 24 h 24 h 30 d n/a n/a n/a 24 h 24 h 24 h n/a n/a n/a n/a 1 d 4 d n/a n/a n/a n/a n/a 24 h n/a n/a n/a n/a 24 h 24 h 2 d 2 d 10 24 h 1 d 4 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig c c c c c c c c c c c c c c c c c c c n/a n/a Osmolality (mOsm/kg) pH W W Drug unspec. 100,000 units/mL NS 527 unspec. 40,000 units/mL D5W, NS n/a PD 20,000 units/mL NS n/a unspec. 33,333 units/mL NS, D5W 378, 355 unspec. 100,000 units/mL D5W 501 SQ 10,000 units/mL D5W n/a unspec. 20,000 units/mL NS n/a unspec. 16,667 units/mL NS, D5W 328, 304 MARPF 100,000 units/mL 10,000 units/mLunspec. 10,000 units/mL D5W n/a D5W n/a MAR 200,000 units/mL SQ 5,000 units/mL NS, D5S n/a unspec. 20,000 units/mL NS n/a SQ 10,000 units/mL NS n/a PF 20,000–60,000 units/mL D5W n/a unspec.PF 20,000–100,000 units/mL 100,000 units/mL NS n/a NS, D5W n/a n/a unspec. 20,000 units/mL NS n/a Manufacturer Concentration Diluents f

ST/LT ST/LT ® ®

/ TM Cassette Cassette ® ® Braun)

CONTAINER OTHER INFUSION CONTAINERS Dosi-Fuser Unspecified (B. Polyvinyl Chloride Chloride Polyvinyl (PVC) Syringes, Plastic AccuFlo (SIMS Deltec) (Leventon) CADD Homepump Penicillin G Potassium Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) (B. Braun) Easypump 286 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 286 22/05/17 1:55 PM Penicillin G Potassium (cont’d) 2 2 2 9 Am J n/a 1, 3 Body Temp Refer. b 14 d b 24 h b n/a n/a n/a n/a Storage Conditions a 4 d TemperatureTemp Post-thaw a 24 h 10 d 30 d 24 h n/a n/a 1 d 24 h n/a n/a n/a n/a n/a 24 h n/a 30 d 24 h n/a n/a Room Refrig Frozen Room Refrig c c c c c Bethlehem, PA: B. Braun USA; September 2015. 300 5.5–8 n/a n/a Osmolality (mOsm/kg) pH . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM D Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. [package insert]. Deerfield, IL: Baxter Healthcare; March 2012.

1 ST/LT Elastomeric Infusion System. . Health Tek ®

1 Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes n/a Drug Heparin lock flush and normal saline. 1997; 54:1068–70. PF 100,000 units/mL D5W, NS n/a unspec. 20,000 units/mL NS n/a PF 20,000–100,000 units/mL D5W n/a PF 20,000–100,000 units/mL NSvarious n/a 20,000, 40,000, 60,000 units/mL Manufacturer Concentration Diluents 1 Stability Data for Drugs Using Elastomeric Infusion Pumps. ®

® f Medical) Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential.

Chemical Stability Data for Drugs Using B. Braun’s Easypump Stability Data for Drugs Using B. Braun’s AccuFlo Penicillin G Potassium Injection USP in PL 2040 Plastic Container Intermate/Infusor Drug Stability Information. Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory SMARTeZ Drug Stability Table-Dosi-Fuser Health-Syst Pharm. COMMERCIAL PREPARATIONS (RTU) Stored at 4°C. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer's label. Do not extrapolate commercial premix stability data to extemporaneously compounded Frozen at –7°C. Manufacturer extrapolated data from other sources. pH of reconstituted powder for injection is 6–8.5. Storage for 7 d at 2–8°C followed by 24 h 25°C. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices 8. d e 4. 3. f g References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. 5. 6. Rapp RP, Hatton J, Record K. 9. 10. 10. Special Considerations: Notes a b c 11. 11. penicillin G potassium, sodium, and tobramycin sulfate in polyvinyl chloride drug reservoirs. Stiles ML, Allen LV. Stability of nafcillin sodium, oxacillin Note: Flush Compatibility: (Epic SMARTeZ INTERMATE INTERMATE (Baxter) Bag Galaxy (Baxter) Penicillin G Potassium (cont’d) 287 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 287 22/05/17 1:55 PM Penicillin G Sodium 1 3 1 1 1 1 1, 4 b 12 h Body Temp Refer. b continued on next page

1 n/a n/a n/a n/a 12 h b g 4 w n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions e a g 3–7 d TemperatureTemp Post-thaw n/a 21 d n/a n/a n/a3 d n/a n/an/a 1, 2 n/a 7 d n/a n/an/a 21 dn/a n/a 28 d n/an/a 28 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 2 n/a 1, 2 1, 2 n/a 56 d n/an/a 48 hn/a n/a n/a n/a 39 d n/a 30 d n/a n/a 31 d n/a n/a Room Refrig Frozen Room Refrig c c c c c c c c c c c c n/a n/a Osmolality (mOsm/kg) pH

4 W NS n/a W

1 a

1 1 The calculated osmolality of 100,000 units/mL is 502 mOsm/kg in D5W and 529 mOsm/kg in NS. The osmolality of 50,000 units/mL is 394 The calculated osmolality of 100,000 units/mL is 502 mOsm/kg in D5W and 529 NS. Drug Heparin lock flush and normal saline. TEGL 2,500; 50,000 units/mL 20,000 units/mL D5W, NSunspec. n/a 100,000; 200,000 units/mL unspec. 10,000 units/mLTETETEunspec. 2,500 units/mL 2,500 units/mL D5W 50,000 units/mL unspec. n/a NS D5W D5W, NS n/a n/a n/a unspec. n/a GLAYunspec. 20,000; 80,000 units/mL 180,000 units/mL 50,000 units/mL NS D5W n/a 394 Manufacturer Concentration Diluents

® f Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS Little loss after 30 d at –20°C; 12–16% penicillin loss after 30 d frozen when followed by 4 d refrigerated, then 24 h at 37°C. Penicillin G sodium should not be Little loss after 30 d at –20°C; 12–16% penicillin frozen when followed by 4 refrigerated, then 24 h 37°C. administered for more than 12 h after a cycle of freezing and thawing. After reconstitution. Reconstituted with citrate buffer (pH 6.5–7.5). Reconstituting with citrate buffers having pH values of 6.5, 7, and 7.5 increases stability. Reconstituted with citrate buffer (pH 6.5–7.5). Reconstituting buffers having pH values of 6.5, 7, and 7.5 increases pH of solutions range from 5–7.5. Manufacturer extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Special Considerations: mOsm/kg in D5W and 421 NS. Penicillin G Sodium Chloride Polyvinyl (PVC) CADD Deltec) (Pharmacia Dosi-Fuser (Leventon) INTERMATE (Baxter) Vial Flush Compatibility: Notes a e f g b c 288 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 288 22/05/17 1:55 PM Penicillin G Sodium (cont’d) . 1989; Am J Health-Syst Pharm . 2014; 71:669–73. Barcelona, Spain: Leventon SAU; October 2015. Am J Health-Syst Pharm Elastomeric Pump (ES.H.00.730-10). ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. 46:1408–12. containers and elastomeric pump containers. Drug Stability Table-Dosi-Fuser Penicillin G Sodium (cont’d) Note: References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 January. 2. diluted with 0.9% sodium chloride injection or 5% dextrose and stored in polyvinyl bag Hossain MA, Friciu M, Aubin S, et al. Stability of penicillin G sodium 4. and penicillin G sodium in portable pump reservoirs [Abstract]. Stiles ML, Tu YH. Stability of cefazolin sodium, cefoxitin ceftazidime, 3. 289 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 289 22/05/17 1:55 PM Pentamidine Isethionate 3 3 3 1 3 3 5 3 3 3 3 2 2 2 2 Body Temp Refer. continued on next page n/a n/a n/a a Storage Conditions

4 TemperatureTemp Post-thaw n/an/a 30 d48 h 30 d 120 d n/a n/a 120 d n/a n/a n/an/a n/a n/a n/a 30 dn/a n/a n/a 90 d 30 d n/a n/a 90 d n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig

1 b b

1 n/a n/a n/a n/a 90 d n/a n/a n/a cc b b cn/ac b n/a b n/a 48 h 90 d 90 d n/a n/a n/a n/a 10 d n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH

1 W W W W W

1 Do not use sodium chloride 0.9% to reconstitute as precipitation will occur. Drug Normal saline. APPAPPLY 0.842, 29.74 mg/mL 0.86, 29.14 mg/mL 1, 2 mg/mL NS n/a D5W, NS n/a n/a n/a n/a n/a 48 h n/a 90 d n/a n/a n/a n/a n/a n/a n/a APP 0.8–29.54 mg/mLAPPAPPLY D5W 0.8–96.65 mg/mL 0.933–91 mg/mL APP 5 mg/mL n/aAPPAPP D5W APP 0.7–30.7 mg/mL n/a 0.93, 2.9, 93.9 mg/mL LY 50 mg/mL LY 91.9, 97.96 mg/mLLY n/a NSLY NS 2 mg/mL 30 d 2–6 mg/mL 90 d D5W 2–6 mg/mL 286 3 mg/mL n/a n/a NS D5W NS n/a n/a n/a n/a n/a 90 d n/a n/a n/a n/a n/a 24 h 24 h 10 d n/a 10 d n/a 30 d n/a 10 d 24 h n/a 30 d n/a 24 h n/a n/a n/a n/a n/a Manufacturer Concentration Diluents d CONTAINER OTHER INFUSION CONTAINERS INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of reconstituted solutions at 60–100 gm/mL is 5.4 in W and 4.09–4.38 D5W. Frozen stability was 89.5% of initial concentration at 120 d at 0.8965 mg/mL, 90% or greater of initial concentration at 120 d at 2.444 mg/mL. Frozen stability was 89.5% of initial concentration at 120 d 0.8965 mg/mL, 90% or greater Osmolality of 100 mg/mL is 160 mOsm/kg in W and 455 D5W. c Notes a b d Reconstituted solution should be protected from light. Keep at room temperature (22°C to 30°C) avoid crystallization. Pentamidine Isethionate Chloride Polyvinyl (PVC) Syringes, Plastic Glass Vials INTERMATE (Baxter) Flush Compatibility: Special Considerations: For intravenous administration, give diluted in 50–250 mL D5W and infuse over 60–120 min. 290 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 290 22/05/17 1:55 PM Pentamidine Isethionate (cont’d) and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM HealthTek Ontario, CA: Baxter Corporation; 2008. Drug Stability in Plastic Syringes. 300 [prescribing information]. Schaumburg, IL: APP Pharmaceuticals; March 2008. ® Intermate/Infusor Drug Stability Information. Pentamidine Isethionate (cont’d) References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 2. 3. Cooper C [personal communication]. Medical Information and Safety. Melrose Park, IL: American Pharmaceutical Partners; October 14, 2002. 4. Pentam 5. Rapp RP, Hatton J, Record K. 291 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 291 22/05/17 1:55 PM Pertuzumab

1 2 2 2 2 2 1 1 2 Body 2013; Temp Refer. J Pharm Sci. Storage Conditions 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a24 h n/a n/a n/a n/a n/a 24 h n/a n/a n/a n/a 24 h n/a n/a n/a n/a TemperatureTemp Post-thaw d d d d d d 24 h 24 h 24 h 24 h 24 h n/a 24 h n/a n/an/a n/a 24 h n/a n/a n/a n/a n/a 24 h Room Refrig Frozen Room Refrig b b b b b b b b

1 Osmolality (mOsm/kg) pH NS n/a NS n/a NS n/a NS n/a NS n/a e c c a a

2 2 1.5 mg/mL 2.7 mg/mL 3 mg/mL NS n/a 1.5 mg/mL NS2.7 mg/mL n/a 3 mg/mL NS n/a

1 ~ ~ ~ ~ ~ ~

2 Do not mix with dextrose 5% solution. Do not administer as IV push or bolus. Do not mix with other drugs. Do not freeze; do shake. Do not mix with dextrose 5% solution. administer as IV push or bolus. other Drug Normal saline. 1.5 mg/mL (calc.). 2.3 mg/mL (calc.). GEN unspec. GEN unspec. GEN GEN GEN GEN GEN GEN Manufacturer Concentration Diluents ~ ~

2 (pertuzumab) injection [package insert]. South San Francisco, CA: Genentech, Inc.; March 2016. ® 102:794–812. CONTAINER Stored at 30ºC. pH of product at 30 mg/mL is 6. With trastuzumab Concentrations will vary; calculated dosage should be added to 250 mL NS IV bag. With trastuzumab 2. of pertuzumab and trastuzumab admixtures in IV infusion bags for coadministration. Glover ZWK, Gennaro L, Yadav S, et al. Compatibility and stability References 1. Perjeta c b d e Pertuzumab Polyolefin Chloride Polyvinyl (PVC) Flush Compatibility: Special Considerations: Notes a 292 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 292 22/05/17 1:55 PM Piperacillin Sodium–Tazobactam Sodium 2 5 9 1 1 4 4 1 1 1 3 n/a Body Temp Refer. c 14 d continued on next page c 24 h n/a n/a n/a n/a 11 c n/a n/a n/a n/a 3, 13 n/a n/a n/a n/a 10 Storage Conditions h h l 7 d 17.7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 11 28 d5.8 d n/a n/a n/a n/a n/a n/a n/a n/a 7 d 28 d TemperatureTemp Post-thaw m m h m l h h 2.8 d 3.8 d 72 h n/a n/a 24 h Room Refrig Frozen Room Refrig e e e e e e iso Osmolality (mOsm/kg) pH NS n/a NS n/a D5W, NS n/a D D5W, NS, W n/a k k j j g unspec. 40–61 mg/mL NS n/a n/a n/a 14 d n/a n/a n/a n/a 11 k , WY j Drug PF 18 mg/mL D5W n/a n/a 7 d LE 10–80 mg/mL D5W, NS n/a n/a 24 h 7 d 30 d 24 h n/a n/a unspec. 10–80 mg/mL NS n/a n/a 1 d 28 d n/a n/a n/a n/a unspec. 10–80 mg/mL NS n/a n/a 24 h 28 d n/a n/a n/a n/a WYWY 40 mg/mL 20, 80 mg/mL unspec. 150, 200 mg/mLPF D5W, NS PF n/a 10–80 mg/mL n/aunspec.unspec. D5W, NS 10–80 mg/mL 24 h 18 mg/mL n/a 7 dHSP NS 30 d n/a n/a D5W 7 d n/a 24 h WY n/a n/a n/a 40, 60 mg/mL n/a 24 h 7 d 28 d n/a n/a n/a n/a n/a n/a n/a n/a n/a WYunspec. 80 mg/mL 40 mg/mL D5W, NS n/a n/a n/a n/a 30 d n/a n/a n/a unspec. 10–80 mg/mL NS n/a n/a 1 d Manufacturer Concentration Diluents / i ® Braun)

ST/LT ST/LT

® ® ® (B. TM Medical)

Braun)

CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) Dosi-Fuser (B. Homepump Piperacillin Sodium–Tazobactam Sodium Piperacillin Sodium–Tazobactam Polyolefin Chloride Polyvinyl (PVC) Polypropylene AccuFlo (Leventon) Easypump Homepump Eclipse INTERMATE (Baxter) Plastic Bag, IV Galaxy Bag Syringes, Syringes, (Epic SMARTeZ C-Series (Halyard) 293 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 293 22/05/17 1:55 PM Piperacillin Sodium–Tazobactam Sodium (cont’d) The compatibility profile of generic 12 brand was reformulated in 2006 to include EDTA (a metal- in 2006 brand was reformulated ® 3,13 3,13 Zosyn 3,13 . Bethlehem, PA: B. Braun USA; September 2015. 13 (piperacillin/tazobactam) FOR INJECTION single dose and pharmacy bulk vials [product ® . Irvine, CA: Haylard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. 1 ST/LT Elastomeric Infusion System 2008;4(2):303–14. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Healthcare Corporation; October 2008. brand. Generic formulations do not contain EDTA. Compatibility tests conducted prior to 2007 evaluated the non-EDTA brand. Generic formulations do not contain EDTA. Compatibility tests conducted prior ® Elastomeric Pump (ES.H.00.730-10). ® 1 Stated concentrations represent piperacillin content. Stability data applies to both components. Heparin lock flush and normal saline. Therapeutics and Clinical Risk Management Stability Data for Drugs Using Elastomeric Infusion Pumps. ® (piperacillin/tazobactam) INJECTION single dose GALAXY containers; ZOSYN ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. aminoglycosides. Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump information]. Philadelphia, PA: Wyeth Pharmaceuticals Inc., a subsidiary of Pfizer, Inc.; December 2015. information]. Philadelphia, PA: Wyeth Pharmaceuticals Inc., a subsidiary Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo SMARTeZ Intermate/Infusor Drug Stability Information. Exposed to light. Manufacturer extrapolated data from other sources. pH of WY products is 5.5–6.8. EDTA formulation. Frozen expiration date per manufacturer’s label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Frozen expiration date per manufacturer’s label. Do not extrapolate commercial premix stability data to extemporaneously compounded Reconstituted per manufacturer labeling; dose diluted in 50–150 mL NS, D5W, or up to 50 W. Reconstituted per manufacturer labeling; dose diluted in 50–150 Non-EDTA formulation. Chemically stable for up to 24 h at room temperature and 7 d refrigerated in IV bags (unspecified). INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Flush Compatibility: 12. 12. Desai NR, Shah SM, Cohen J, et al. Zosyn (piperacillin/tazobactam) reformulation: Expanded compatibility and coadministration with lactated Ringer’s solutions selected Piperacillin Sodium–Tazobactam Sodium (cont’d) Piperacillin Sodium–Tazobactam 13. 13. Lake Forest, IL: Hospira Worldwide, Inc.; November 2009. Piperacillin and Tazobactam for Injection [product information]. Note: Special Considerations: tubing) when used with compatible Manufacturer labeling states that piperacillin–tazobactam is stable in glass and plastic containers (plastic syringes, IV bags, diluents. Stability is not affected when administered through an ambulatory infusion pump. 11. 11. formulations is not equivalent to Zosyn 9. chelating agent) and sodium citrate (a buffer) to provide for consistent potency and minimal particulate development in commercially available diluents; this also chelating agent) and sodium citrate (a buffer) to provide for consistent potency minimal particulate development in commercially improved the EDTA-containing formulation compatibility with calcium-containing diluents and certain aminoglycosides. 4. 5. formulation. Non-EDTA formulations are incompatible with Lactated Ringer’s Solutions. Notes c e h i j k l 10. 10. m References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. 3. ZOSYN g 294 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_P.indd 294 22/05/17 1:55 PM Quinupristin–Dalfopristin 3 Body Temp Refer. n/a n/a n/a n/a Storage Conditions b 1 54 h TemperatureTemp Post-thaw b Room Refrig Frozen Room Refrig Osmolality (mOsm/kg) pH . Irvine, CA: Halyard Health; March 2015. D5W n/a n/a 5 h 54 h n/a n/a n/a n/a 1, 2 1 a Drug Incompatible with all saline-containing solutions. Reconstituted solution may foam; allow foam to dissipate to a clear solution prior Incompatible with all saline-containing solutions. Reconstituted solution may foam; allow foam to DSM various unspec. 2 mg/mL D5W n/a n/a 5 h Manufacturer Concentration Diluents Not compatible with normal saline or heparin. Flush D5W before and after administration. / ®

1 IV [package insert]. New York, NY: Pfizer Injectables; October 2013. ® ® Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. Concentration of combined agents in 100 to 750 mL diluent. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 3. b References 1. Synercid Special Considerations: used for central line infusions. If moderate further dilution. Do not freeze. Infuse intravenously diluted in D5W over 60 min. Dilute 250 mL D5W; 100 may be the infusion site, or by a to severe venous irritation occurs following peripheral administration, consider increasing infusion volume 500–750 mL, changing central line. Notes a Flush Compatibility: Homepump Quinupristin–Dalfopristin Unspecified Homepump Eclipse C-Series (Halyard) 295 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_Q.indd 295 22/05/17 1:55 PM Ranitidine Hydrochloride 6 1 1 1 1 1 1 1 1 1 1 1 6 1 1 1 2 1 1 5 3 b,d Body 24 h Temp Refer. a continued on next page n/a n/a n/a n/a 24 h n/a n/a n/a n/a n/a n/a c c a c 30 d 30 d 12 w 60 d n/a n/a n/a n/a Storage Conditions c c c g d 30 d n/an/a n/a n/a n/an/a n/a n/a 30 d n/a n/a n/a n/a 14 d n/a n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a n/a TemperatureTemp Post-thaw e e e e c e c e c 48 h 7 dn/a 30 d28 d n/a n/an/a 60 d n/a18 d 7 d 92 dn/a n/a 66 d n/an/a 14 d n/a 7 d n/a n/a n/a n/a n/a n/a 100 d n/a n/a n/a n/a n/a n/a n/a7 d n/a 30 d n/a 10 d n/a 72 h 91 d n/a n/a n/a7 d n/a 48 h 48 h 24 h 48 h 14 d 3 m n/a n/a n/a Room Refrig Frozen Room Refrig f f f f f f f f f f f f f j j f Osmolality (mOsm/kg) pH NS, D5W, D10W, LR n/a n/a 48 h n/a n/a n/a n/a n/a D5W, NS 258, 282 i j Drug GLGLGLGL 0.05, 2 mg/mLGL 0.5, 1, 2 mg/mLGL D5W, NS 0.5, 1, 2 mg/mL D5½S, NS, D5W, D10W, D5LRGL 0.5, 1, 2 mg/mL n/a D5W, NS, D5½S, D10WGL 1 mg/mL D5W, NSGL 1 mg/mL n/a 1 mg/mL 1.5 mg/mL D5W, NS 2 mg/mL D5W, NS n/a D5W, NS D5W, NS n/a D5W, NS n/a 260, 302 260, 302 n/a n/a 257, 294 n/a 10 d n/a n/a n/a n/a GL 0.05–2 mg/mL NS n/aGL n/a 28 d 0.5–2 mg/mL D5W, NS n/a n/a 7 d GLGLGL 0.441 mg/mL 0.05 mg/mL D5W 0.05 mg/mL D5W, D5½S D10W n/a n/a GLunspec. n/a 0.83 mg/mL 2.5 mg/mL n/aGL 2 d BWFIunspec. 0.5 mg/mL 0.5–2 mg/mL D5W, NSGL D5W, NSGLGSK n/a 0.05, 0.1 mg/mL 0.1 mg/mL NS unspec. n/a NS n/a n/a 7 d n/a n/a Manufacturer Concentration Diluents

® / ® CONTAINER OTHER INFUSION CONTAINERS Homepump Ranitidine Hydrochloride Polyolefin Chloride Polyvinyl (PVC) Syringes, Plastic Polypropylene Dosi-Fuser (Leventon) Homepump Eclipse C-Series (Halyard) Unspecified Syringes, Syringes, 296 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_R.indd 296 22/05/17 1:55 PM Ranitidine Hydrochloride (cont’d) 5 . Irvine, CA: Halyard Health; March 2015. and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. TM . Barcelona, Spain: Leventon SAU; October 2015. 1 HealthTek 1,5 Elastomeric Pump (ES.H.00.730-10) ® Drug Stability in Plastic Syringes. n/a Heparin lock flush and normal saline. [prescribing information]. Cary, NC: Covis Pharmaceuticals; June 2013. [prescribing information]. Cary, NC: Covis Pharmaceuticals; ® injection is stable for 48 h at room temperature when added to or diluted with most commonly used IV solutions including D5W, D10W, LR, or NS. injection is stable for 48 h at room temperature when added to or diluted with most commonly used IV solutions including ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Stability Data for Drugs Using Homepump Disposable Ambulatory Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory 7 d at 3°C followed by 24 h 30°C. 24 h at 30°C. Tested under light. 30 d frozen followed by 24 h at 3°C 30°C to simulate use conditions in infusion pump reservoirs. Manufacturer(s) extrapolated data from other sources. Stored under refrigeration for 24 h followed by 24 h at 25°C with or without protection from light. Stored under refrigeration for 24 h followed by at 25°C with pH of undiluted solution is 6.7–7.3. Zantac Prepared in 60-mL diluent. Flush Compatibility: Ranitidine Hydrochloride (cont’d) Note: 6. 5. Zantac Special Considerations: Notes a b c d e f g i j References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. 3. Rapp RP, Hatton J, Record K. 297 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_R.indd 297 22/05/17 1:55 PM Rituximab 2 1 1 2 Body Temp Refer. 1 n/an/a n/an/a n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions c c a a 24 h 24 h TemperatureTemp Post-thaw a a n/a24 h 14 d 24 h n/a 14 d Room Refrig Frozen Room Refrig b b b b b 2013;70(5):436–8. Osmolality (mOsm/kg) pH 2 Am J Health-Syst Pharm. 1 1 1 Drug Do not freeze or shake. Protect vials from direct sunlight. Keep vials refrigerated. Do not mix or dilute with other drugs. Do not freeze or shake. Protect vials from direct sunlight. Keep refrigerated. mix dilute GENBiogen/GEN 1–4 mg/mL 10 mg/mLBiogen/GENGEN 1–4 mg/mL 1.5 mg/mL NS, D5W undiluted NS, D5W n/a n/a n/a NS n/a Manufacturer Concentration Diluents Normal saline. [prescribing information]. South San Francisco, CA: Genentech USA; August 2014. ® CONTAINER The pH of undiluted product is 6.5. preservatives, store diluted solutions under refrigeration. Product labeling states that diluted solutions are chemically stable for 24 h under refrigeration and an additional 24 h at room temperature; however, due to lack of Product labeling states that diluted solutions are chemically stable for 24 h under refrigeration and an additional at room Stability was defined as average retention of at least 85% initial activity. Special Considerations: Rituximab Glass Polyethylene Bag Chloride Polyvinyl (PVC) Flush Compatibility: References 1. Rituxan c 2. rituximab. Zhang Y, Vermeulen LC, Kolesar JM. Stability of stock and diluted Notes a b 298 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_R.indd 298 22/05/17 1:55 PM Ropivacaine Hydrochloride 4 4 8 8 1 1 6 1 1 1 1 7 c c g g g,l Body Temp Refer. continued on next page n/a n/a n/a 7 d n/a n/a n/a 7 d n/a n/a n/a 7 d Storage Conditions g g g,l TemperatureTemp Post-thaw n/a 120 d 7 d 120 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 30 d n/a 120 d n/a n/a n/a n/a n/a 30 d n/a 120 d 51 d 51 d n/a n/a n/a7 d 7 d n/a 30 d 30 d n/a n/a n/a51 d n/a n/a 51 d n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a 35 d Room Refrig Frozen Room Refrig d k 4.9–5.1 15 d 15 d n/a n/a n/a n/a 3.46 1 5 k f d f d f d f d f d f d f f d ff d f d d 1030 Osmolality (mOsm/kg) pH k NS unspec. NS NS NS NS n/a NS NS i e e a e k h b b Drug Ropivacaine hydrochloride solubility is reduced above pH of 6. AST 2 mg/mL unspec. 2 mg/mL NS AST 1–10 mg/mL NS ASZ 2 mg/mL ASZQI 1.5 mg/mL ASZ 1–2 mg/mL ASZ 1 mg/mL AST 1.5 mg/mL 1.2 mg/mL ASZunspec. 1.5 mg/mL 1–10 mg/mLASZ NS 7.5 mg/mL n/a Manufacturer Concentration Diluents j

® CONTAINER OTHER INFUSION CONTAINERS Ropivacaine Hydrochloride Acetate Ethyvinyl (EVA) Polyolefin Bag Polypropylene Bag Chloride Polyvinyl (PVC) Polypropylene Glass (Leventon) INFUSOR (Baxter) II SynchroMed (Medtronic) Syringes, Syringes, Dosi-Fuser Flush Compatibility: Special Considerations: Ropivacaine vials, ampules, bottles, and bags are preservative free and are intended for single-use only. Commercially available continuous (epidural) infusion Ropivacaine vials, ampules, bottles, and bags are preservative free intended for single-use only. Commercially available infiltration, and major nerve block. preparations should not be left in place for more than 24 h. Ropivacaine is indicated epidural injection or infusion, local Unintended intravenous injection or infusion may result in cardiac arrhythmia arrest. 299 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_R.indd 299 22/05/17 1:55 PM Ropivacaine Hydrochloride (cont’d) . 2014 Jul; 17:472–82. 17:472–82. Jul; 2014 . 2015; 22:7–11. Neuromodulation Eur J Hosp Pharm.

1,5 . Barcelona, Spain: Leventon SAU; October 2015. Ontario, Canada: Baxter Corporation; October 2008. 1 Elastomeric Pump (ES.H.00.730-10) ® [package insert]. Lake Zurich, IL: Fresenius Kabi USA, LLC; January 2015. ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. Dupoiron D, Richard H, Chabert-Desnot V, et al. In vitro stability of low-concentration ziconotide alone or in admixtures intrathecal pumps.

pH of the undiluted solution is 4–6.5. Solutions of ropivacaine hydrochloride 1 mg/mL tested with: morphine sulfate (AST) 20 mcg/mL; sufentanil citrate (JN) 0.4 mcg/mL; fentanyl citrate (JN) 1 mcg/mL; Solutions of ropivacaine hydrochloride 1 mg/mL tested with: morphine sulfate (AST) 20 mcg/mL; sufentanil citrate (JN) 0.4 Combined with morphine sulfate (Stellorphine) 0.025 mg/mL. ropivacaine hydrochloride and 16 mg/mL methylprednisolone acetate. and clonidine hydrochloride (BI) 5 and 50 mcg/mL in Mark II Polybags. Solutions of ropivacaine hydrochloride 2 mg/mL tested with: morphine sulfate (AST) 20 and and clonidine hydrochloride (BI) 5 50 mcg/mL in Mark II Polybags. Solutions of ropivacaine 2 mg/mL tested 5 mcg/mL in Mark II Polybags. 100 mcg/mL; sufentanil citrate (JN) 0.4 and 4 fentanyl 1 10 clonidine hydrochloride (BI) ziconotide concentration decreased to 53.4% after 35 days, ropivacaine, morphine, and clonidine remained stable. Combined with fentanyl citrate (CUR) 3 mcg/mL, tested at 20°C and 4°C. Combined with fentanyl citrate (CUR) 3 mcg/mL, tested at 20°C Solution prepared with 3 mL ropivacaine hydrochloride 2 mg/mL and 2 mL 40 mg/mL methylprednisolone acetate (PHU), for a final concentration of 1.2 mg/mL Solution prepared with 3 mL ropivacaine hydrochloride 2 mg/mL and 40 methylprednisolone acetate (PHU), for Tested in vitro combined with morphine sulfate (LAV) 7.5 mg/mL, clonidine hydrochloride (BI) 15 mcg/mL, and ziconotide (EIS) 0.1, 0.25, 0.5, 0.75 mcg/mL. While Tested in vitro combined with morphine sulfate (LAV) 7.5 mg/mL, Tested at 30°C in the dark. 120 days refrigerated, followed by 7 d at 33°C. Commercially available solutions of ropivacaine hydrochloride are isotonic. Commercially available solutions of ropivacaine hydrochloride Manufacturer extrapolated data from other sources. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. Combined with 50 mcg/mL butorphanol tartrate (HE). Ropivacaine Hydrochloride (cont’d) Note: Notes a b c d 7. 8. e f l References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 August. 4. 5. Naropin g h i j k 6. containing butorphanol tartrate and ropivacaine hydrochloride. Chen F, Li P, Zhou B, et al. Stability of an epidural analgesic admixture 300 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_R.indd 300 22/05/17 1:55 PM Sargramostim 1 1 1 Body Temp Refer. n/a n/a n/a n/a 1, 3 Storage Conditions c TemperatureTemp Post-thaw n/a 30 d n/a n/a n/a n/a n/a 21 d n/a n/an/a n/a 20 d n/a n/a 14 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig b b b b b 3 3 n/a n/a n/a n/a Osmolality (mOsm/kg) pH d d d W 2 500 mcg/mL undiluted 500 mcg/mL250 mcg/mL 250 mcg/mL RTU BWFI 3 Store liquid, reconstituted, and lyophilized product at 2°C to 8°C. Do not freeze. Dilute for intravenous infusions only with NS. Store liquid, reconstituted, and lyophilized product at 2°C to 8°C. Do not freeze. Dilute for intravenous e e f f Drug Heparin flush, normal saline. SAV SAV SAV SAV Manufacturer Concentration Diluents [prescribing information]. Bridgewater, NJ: Sanofi-Aventis U.S., LLC; April 2013. [prescribing information]. Bridgewater, NJ: Sanofi-Aventis ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. g CONTAINER OTHER INFUSION CONTAINERS Do not administer preparations containing benzyl alcohol (including BWFI) to neonates. Do not administer preparations containing benzyl alcohol (including pH of liquid product is 6.7–7.7. reconstituted lyophilized 7.1–7.7. Liquid formulation (500 mcg/mL), preserved with 1.1% benzyl alcohol. Liquid formulation (500 mcg/mL), preserved with 1.1% benzyl Storage under refrigeration after initial vial entry. Product (manufacturer) vial. Lyophilized formulation (250 mcg), contains no preservatives. Notes b Special Considerations: membrane filter. Liquid product Concentrations below 10 mcg/mL require the addition of albumin 1 mg per mL solution. Do not infuse through an inline contains 1.1% benzyl alcohol. c d Flush Compatibility: Sargramostim Syringes, Plastic Vial Note: e f g References 1. Medical Information Services [personal communication]. Cambridge, MA: Genzyme; January 20, 2016. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 3. Leukine 301 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_S.indd 301 22/05/17 1:55 PM Sufentanil Citrate 1, 2 1, 5 1 1, 3 1, 3 1, 2 1 7 1 1 d s d,h c,d d q Body Temp Refer. n/a n/a 2 n/a Intraspinal 1 r continued on next page n/a 70 d r Storage Conditions 10 d n/a n/a n/a 10 d n/a n/a n/a n/a n/a 1, 6 n/a n/a n/a n/a n/a 1, 6 TemperatureTemp Post-thaw s j,k j,k 14 d 14 d n/a n/a n/a n/a n/a10 d 10 d n/a n/a n/a n/a 1, 5 n/a 30 d n/a n/a n/a 30 d n/a n/a24 h 4 m n/a n/a n/a n/a n/a 43 d 43 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig m m m m m m m n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 40 d n/a 4.9 30 d n/a 5.3 30 d n/a Osmolality (mOsm/kg) pH o p g l i n NS NS unspec. undiluted NS NS Sufentanil adsorbs to PVC-lined containers, sets, and filters polyethylene tubing. 1 i f f n g l o p 1 Drug Store product protected from light. JCJN 50 mcg/mL 5 mcg/mL undiluted n/a NS n/a 5.9–6.5 n/a 21 d n/a n/a n/a 21 d JNJN 20 mcg/mL 20 mcg/mL NS n/a JNJN 5 mcg/mL 5 mcg/mL NS n/a 5.1–5.4 n/a 21 d n/a n/a n/a JNJNJN 0.4 mcg/mL JN 1 mcg/mL 12 mcg/mL 2 mcg/mLJN 5 mcg/mL NSJN n/a D5WBB n/a 5 mcg/mL 1 mg/mL 4.5–5.5 n/a NS 30 d n/a n/a n/a n/a 5.7–6.3 30 d n/a 21 d n/a n/a n/a 21 d JN 4 mcg/mL Manufacturer Concentration Diluents Normal saline.

® II

Cassette Cassette ® CONTAINER OTHER INFUSION CONTAINERS infusion requires the use of preservative-free diluents and drug products. Special Considerations: Glass Flush Compatibility: Sufentanil Citrate Polyproplylene (Mark II Polybag) Chloride Polyvinyl (PVC) Polypropylene CADD (SIMS Deltec) Polyethylene-High Density (Eur. Ph.) Synchromed Pump Implantable (Medtronic) Syringes, Syringes, 302 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_S.indd 302 22/05/17 1:55 PM Sufentanil Citrate (cont’d) Ann 1992;14(4):196–200. 1995;1(1):12–4. EHP. 2002;27:39–45. Pharm Weekly. J Clin Pharm Ther. 6 7 1993;15(6):269–75. 1 7 Pharm World Sci. 1 6 5 . 2004;38:1836–9. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. simulated infusion by an epidural catheter. Pharmacother pH of the undiluted solution is 3.5–6. Drug powder dissolved in ziconotide acetate 25 mcg/mL injection. Studied at 32°C. 10% loss of ziconotide at 33 d; no sufentanil 40 d. With ropivacaine HCl [ASZ] 2 mg/mL. 10% loss of sufentanil, 5% bupivacaine at 32°C. With bupivacaine HCl [AST] 40 mcg/mL. bupivacaine HCl. Protected from light. 5% loss in 7 d. With bupivacaine HCl [AST] 2 mg/mL. Sufentanil concentration decreases below acceptable limits in the absence of bupivacaine additive due to stabilizing effect and buffering capacity Sufentanil concentration decreases below acceptable limits in Thawed in a validated cycle microwave prior to refrigerated storage for up 70 d. Diluted with bupivacaine HCl 5 mg/mL to a final concentration of bupivacaine HCl 3 mg/mL. Diluted with bupivacaine HCl 5 mg/mL to a final concentration Storage at 30°C. Combined with levobupivacaine [ABV] 1.25 mg/mL. Solution also contained ropivacaine HCl [ASZ] 1 mg/mL (diluted in NS) or 2 mg/mL. Solution also contained ropivacaine HCl [ASZ] 1 mg/mL (diluted Notes c d f g h i j k l n o m p q s References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. a portable pump reservoir, glass container, and polyethylene container. Roos PH, Glerum JH, Meilink JW. Stability of sufentanil citrate in 3. Roos PJ, Glerum J, Schroeders MJH. Effect of glucose 5% solution and bupivacaine hydrochloride on absorbance sufentanil citrate in a portable pump reservoir during storage r Note: Sufentanil Citrate (cont’d) 7. citrate with levobupivacaine HCl in NaCl 0.9% infusion after microwave freeze-thaw treatment. Boitquin LP, Hecq JD, Vanbeckbergen DF, et al. Stability of sufentanil 5. citrate and sufentanil citrate/bupivacaine mixture in portable infusion pumps. Brouwers JRB, Van Doorne H, Meevis RF, et al. Stability of sufentanil 6. with morphine, sufentanil, fentanyl or clonidine. Svedberg KO, McKenzie EJ, Larrivee-Elkins C. Compatibility of ropivacaine 303 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_S.indd 303 22/05/17 1:55 PM Tedizolid Phosphate 2 Body Temp Refer. n/a n/a n/a n/a 1, 2 n/a n/a n/a n/a 1, 2 Storage Conditions a a 24 h 24 h TemperatureTemp Post-thaw a a 2 Room Refrig Frozen Room Refrig n/a n/a 24 h Osmolality (mOsm/kg) pH W 1 Drug MSD 50 mg/mL MSD 0.8 mg/mL NS n/a n/a 24 h Reconstitute only with W and dilute only with NS. Gently swirl; do not shake during or after reconstitution or dilution to avoid foaming. Do Reconstitute only with W and dilute NS. Gently swirl; do not shake during or after reconstitution Manufacturer Concentration Diluents Normal saline. (tedizolid phosphate) injection [product labeling]. Whitehouse Station, NJ: Merck and Co, Inc.; July 2015. (tedizolid phosphate) injection [product labeling]. Whitehouse ® b CONTAINER Product (manufacturer) vial. Total time from reconstitution to administration should not exceed 24 h at room or refrigerated temperature. Special Considerations: containing divalent ions. Infuse over 1 h. not invert vial to withdraw; withdraw using needle long enough reach the bottom of vial. Incompatible with solutions Note a Flush Compatibility: Vial Tedizolid Phosphate Tedizolid IV Bag (Unspec.) b References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Sivextro 304 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 304 22/05/17 1:55 PM Telavancin Hydrochloride 2 5 5 Body Temp Refer. n/an/a n/a n/a n/a n/a 2, 4 2, 4 n/a n/a n/a 1, 3 c c c n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 32 d n/a n/a n/a n/a 1, 2 Storage Conditions c c c b b 7 d 7 d 1 2015 Jul; 50(7):609–14. TemperatureTemp Post-thaw b b 2 dn/a 14 d n/a n/a n/a 32 d 32 d n/a 8 d n/a 8 d 12 h 12 h 2015 Oct 22; 77:99–104. Room Refrig Frozen Room Refrig d Hosp Pharm. e e e e e e d 2 Curr Ther Res Clin Exp. n/a n/a Osmolality (mOsm/kg) pH i i NS, D5W, LR n/a a 1 1 Drug 1,2 ASL 0.6, 8 mg/mL NS, D5W, LR ASL 0.6, 8 mg/mL NS, D5W, LR ASLBVBV 0.6, 8 mg/mLASL 0.6, 8 mg/mL NS, D5W, LR 0.6, 8 mg/mL D5W, NS n/a 0.6, 8 mg/mL D5W, NS n/a n/a ASL 15 mg/mL D5W, NS, W n/a Manufacturer Concentration Diluents Store original vials at refrigerated temperature. Excursions to ambient temperature are acceptable; avoid excessive heat. Reconstitute with Store original vials at refrigerated temperature. Excursions to ambient temperature are acceptable; avoid Braun) Normal saline.

2 (Halyard) g ® 1 (telavancin) for injection [prescribing information]. South San Francisco, CA: Theravance Biopharma Antibiotics, Inc.; May 2016. (telavancin) for injection [prescribing information]. South San ® Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. h CONTAINER OTHER INFUSION CONTAINERS pH of reconstituted solution in vial is 4–5. Total time in vial plus the infusion bag should not exceed 12 h at room temperature and 7 d refrigerated. Product (manufacturer) vial. pH diluted (per package insert) to 0.6 mg/mL was 4.6–5.7; 8 4.4–4.9. When mixed according to the package insert. Protected from light. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Reconstituted with W then diluted to 0.6 mg/mL in LR; reconstituted with NS then diluted to 8 mg/mL in LR. Reconstituted with W then diluted to 0.6 mg/mL in LR; reconstituted d c Note: e g h i References 1. VIBATIV 2. South San Francisco, CA: Medical Information, Theravance Biopharm, Inc.; September 15, 2015. Medical information: Televancin Stability [personal communication]. 3. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 4. drug product in frozen intravenous bags. Gu Z, Wong A, Raquinio E, et al. Stability of reconstituted telavancin 5. in elastomeric pumps. Sand P, Aladeen T, Kirkegaard et al. Chemical stability of telavancin b Special Considerations: NS, W, or D5W. Notes a Telavancin Hydrochloride Telavancin Polyvinyl Chloride (PVC) PVC-Free (PAB) Bag (B. Unspecified IV Bag Homepump Eclipse INTERMATE (Baxter) Flush Compatibility: Vial 305 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 305 22/05/17 1:55 PM Thiotepa 2 2 2 1 2 2 Body Temp Refer. 3 2 n/a n/a n/an/a n/a n/a n/a n/a Storage Conditions a a 1987; 22:685–7. TemperatureTemp Post-thaw 24 h3 d 48 h n/a 14 d n/a n/a n/a n/a n/a n/a n/a 3 d7 d 14 dn/a n/a n/a 48 h n/a n/a24 h n/a n/a 24 h n/a n/a n/a Room Refrig Frozen Room Refrig Hosp Pharm. b c b , hypotonic cc b Osmolality (mOsm/kg) pH c b cc b c b b 2,3 W 3 , 2 2 5.5–7.5. ~ d 10 mg/mL in W is 3 ~ Reconstituted solution should be clear. Filtration through a 0.22-micron filter prior to administration eliminates haze and does not affect Reconstituted solution should be clear. Filtration through a 0.22-micron filter prior to administration Drug Heparin lock flush and normal saline. IMM 5 mg/mL D5W IMMunspec.IMM 5 mg/mLIMM 0.25 mg/mL 0.5 mg/mLIMM 1, 3 mg/mL D5W NS 10 mg/mL NS NS 277 269 Manufacturer Concentration Diluents CONTAINER Dilute prior to administration. pH of reconstituted solution Stored at 8°C. Dilutions of 0.5 and 1 mg/mL in NS are 277 269 mOsm/kg, respectively. 3 5 hypotonic. Thiotepa Polyolefin Bag Chloride Polyvinyl (PVC) Syringes, Plastic Flush Compatibility: Special Considerations: at 2°C to 8°C. potency. Do not use solutions that are grossly opaque or contain precipitate after filtration. Dilute prior to administration. Store Protect intact vials and reconstituted solutions from light until used. Notes a b d c References 1. a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines for 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 3. Pharmaceuticals; February 2015. Thiotepa for Injection, USP [package insert]. Eatontown, NJ: West-Ward 306 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 306 22/05/17 1:55 PM Tigecycline 1 3 Body Temp Refer. There is no published data to 1 n/a n/a n/a n/a Storage Conditions d 48 h TemperatureTemp Post-thaw c Room Refrig Frozen Room Refrig The use of W for reconstitution is not recommended. 3 Osmolality (mOsm/kg) pH 1 D5W, NS n/a n/a 18 h 2 . https://www.pfizermedicalinformation.com/en-us/document/80336. Accessed July 29, 2015. 1 b 1 Tygacil - Stability and Compatibility The reconstituted solution should be yellow to orange in color; if not, the discarded. Drug Heparin lock solution and normal saline. WY 0.5 mg/mL Manufacturer Concentration Diluents (tigecycline) [package insert]. Philadelphia, PA: Wyeth Pharmaceuticals Inc., a subsidiary of Pfizer Inc.; June 2016. 1 ® a IV bag. CONTAINER Following immediate transfer of reconstituted solution into the IV bag. Following immediate transfer of reconstituted solution into the Maximum concentration for IV bag should be 1 mg/mL. Unspecified type of infusion bag. The solution may be stored for up to 24 h at room temperature, not to exceed 25°C, including up to 6 h reconstituted in the vial, and the remaining time in The solution may be stored for up to 24 h at room temperature, not exceed 25°C, including 6 reconstituted in the Special Considerations: Tigecycline IV Bag Flush Compatibility: support stability or compatibility using syringes, elastomeric infusion devices, vial connector systems. Notes a b c d References 1. Tygacil 2. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 July. 3. Pfizer Medical Information. 307 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 307 22/05/17 1:55 PM Tobramycin Sulfate 3 2 6 5 1 1 1 7 7 1 9 9 9 3 1 Body Temp Refer. continued on next page n/a n/a n/a n/a n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/an/a n/a n/a n/a n/a n/a n/a Storage Conditions j j i c d d 19 d 14 d 14 d 60 d 10 d 14 d TemperatureTemp Post-thaw j j c i d d 24 h 14 d n/a n/a n/a n/a 21 d 24 h 14 d n/a n/a n/a n/a 24 h 14 d n/a n/a n/a n/a 48 h n/an/an/a n/a n/a14 d n/a n/a 28 d12 d 30 d60 d n/a n/a 24 h n/a n/a n/a n/a n/a 24 h 7 d 7 d 14 d 30 d24 h 24 h 7 d n/a n/a n/a n/a n/a n/a 3 d 14 d n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a a a a 1 a h a h a h a hh a a hhh a a a h a Osmolality (mOsm/kg) pH D5W, D5S, D5S, D5W, NS Drug LI 0.8–2.4 mg/mL NS unspec. 0.2, 0.75, 10 mg/mL NS unspec. 0.2, 0.75, 10 mg/mL NS LIDILI 0.2, 1 mg/mL APPAPP 2.4 mg/mLLI 3.2 mg/mL 12.5 mg/mL 12.5 mg/mL 40 mg/mL D5W, NS D5W NS, Wunspec. D5Wunspec. n/a unspec. n/a 0.5–4.8 mg/mL unspec. 0.8–2.4 mg/mL n/a 1 and 5 mg/mL n/a unspec.unspec. D5W, NS 0.2 mg/mL NS 0.8 mg/mL NS NS NS n/a 315 MAR 1, 10 mg/mL NS Manufacturer Concentration Diluents g f

ST/LT ST/LT ® ®

/ TM Cassette Cassette ® ® Braun)

CONTAINER OTHER INFUSION CONTAINERS CADD (B. (B. Braun) Homepump Tobramycin Sulfate Tobramycin Chloride Polyvinyl (PVC) Syringes, Plastic AccuFlo (SIMS Deltec) (Leventon) Easypump Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) Dosi-Fuser 308 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 308 22/05/17 1:55 PM Tobramycin Sulfate (cont’d) 8 8 2 2 2 2 2 2 2

1 Body Temp Refer. ing point depression and 213 213 and depression point ing 2.5 mg/mL in D5W is is D5W in mg/mL 2.5 n/a n/a n/a n/a n/a n/a n/a n/a Storage Conditions d d 14 d 7 d 7 d n/a7 d n/a7 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw d d e e e 24 h 24 h 24 h48 h n/a24 h n/an/a 10 d48 h n/a n/a 10 d24 h n/an/a n/a n/a n/a n/a n/a n/a n/a 30 d n/a 24 h n/a n/a n/a Room Refrig Frozen Room Refrig a a a a Bethlehem, PA: B. Braun USA; September 2015.

7 1 a hhhh a a a a Osmolality (mOsm/kg) pH . Irvine, CA: Halyard Health; March 2015. . Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. 1 . Barcelona, Spain: Leventon SAU; October 2015. ST/LT Elastomeric Infusion System. ® Elastomeric Infusion System TM Ontario, Canada: Baxter Corporation; October 2008. 1 Elastomeric Pump (ES.H.00.730-10) ®

1 n/a Drug Normal saline. Incompatible with heparin. unspec. 0.8 mg/mL NS 315 unspec. 0.2 mg/mL NS n/a LILILILI 0.5 mg/mLLI 0.5 mg/mLLI 0.5–4.8 mg/mLLI 0.5–4.8 mg/mL 0.5–5 mg/mL 0.5–5 mg/mL 4.8 mg/mL D5W, NS NS D5W n/a D5W NS n/a D5W D5W n/a Manufacturer Concentration Diluents Stability Data for Drugs Using Elastomeric Infusion Pumps. ®

® g Medical) Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential.

Drug Stability Table-Dosi-Fuser Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Chemical Stability Data for Drugs Using B. Braun’s Easypump SMARTeZ Stability Data for Drugs Using B. Braun’s AccuFlo Manufacturer extrapolated data from other sources. The osmolality of tobramycin sulfate 1 mg/mL in D5W is 254 mOsm/kg, and 288 mOsm/kg NS. 261 mOsm/kg, and 283 mOsm/kg in NS. The osmolality of tobramycin sulfate 10 mg/mL (unspecified diluent) is 133 by freez mOsm/kg by vapor pressure. Following 7 d refrigerated. pH of the undiluted solution is 3–6.5. 19 d refrigerated followed by 21 at room temperature. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices PVC portable pump reservoir. Storage in 60 mL luer-tip plastic syringes (BD) with tubing (RMS) attached and capped. Primary reference authors note that the manufacturer does not recommend storage in plastic syringes due to possible incompatibility with plunger heads. Primary reference authors note that the manufacturer does not Note: c d e f g h 9. Special Considerations: Notes a j Flush Compatibility: (Epic Tobramycin Sulfate (cont’d) Tobramycin INTERMATE (Baxter) SMARTeZ References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. 3. 5. i 7. and Tubing System. Chester, NY: RMS Medical Products (data on file); July 2015. Fugit KD, Anderson BD. Antibiotic Stability in Freedom 60 Syringe 8. 6. 309 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 309 22/05/17 1:55 PM Tocilizumab

1 1 Body Temp Refer. n/a n/a n/a n/a Storage Conditions d,e 24 h TemperatureTemp Post-thaw d 24 h Room Refrig Frozen Room Refrig c

1 Osmolality (mOsm/kg) pH

1 NS n/a

1 b

1 For preparation of final administration solution, withdraw a volume of NS equal to the volume of the dose of tocilizumab, then slowly add For preparation of final administration solution, withdraw a volume NS equal to the Drug

Normal saline. 1 GEN unspec. Manufacturer Concentration Diluents [prescribing information]. South San Francisco, CA: Genentech; November 2014. a ® CONTAINER Protected from light. Follow dilution instructions in 50 mL or 100 NS specific to dosing and indication. Allow to reach room temperature prior infusion. Diluted solutions are compatible with polypropylene, polyethylene, and polyvinyl chloride infusion bags and polypropylene, polyethylene, and glass infusion bottles. Diluted solutions are compatible with polypropylene, polyethylene, and polyvinyl chloride infusion bags pH of undiluted 20 mg/mL solution is approximately 6.5. Tocilizumab Tocilizumab Unspecified Flush Compatibility: Special Considerations: the medication to infusion bag or bottle; mix gently and avoid foaming. Notes a c b e d Reference 1. Actemra 310 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 310 22/05/17 1:55 PM Topotecan Hydrochloride 3, 4 1, 4 c b a, Body Temp Refer. 1997; 16:199–205. 1999; 5:75–82. 1998; 55:1584–7. J Pharm Biomed Anal. n/a n/a n/a 5 d n/an/a n/a n/a n/an/a n/a n/a n/a n/a 2, 4 n/a 3, 4 n/an/a 2, 4 n/a n/a n/a 3, 4 n/a n/a n/a n/a 2, 4 Storage Conditions a a a a a a J Oncol Pharm Practice. 28 d 28 d n/a n/a n/a n/a28 d n/a 3, 4 TemperatureTemp Post-thaw a a f a Am J Health-Syst Pharm. 28 d 24 h 7 d 28 d 17 d 24 h 7 d 28 d 24 h 7 d 28 d 28 d n/a n/a n/a 28 d Room Refrig Frozen Room Refrig d d d d d d d d d n/a n/a Osmolality (mOsm/kg) pH W W 4,5 5 4 Drug SKB 10, 25, 50 mcg/mL D5W, NS n/a SKBSKBSKB 50 mcg/mLSKB 10, 25, 50 mcg/mL 10 mcg/mL 25, 50 mcg/mL D5W, NS D5W, NS n/a SKB n/a NS D5W, NS n/a 1,000 mcg/mL n/a SKB 1,000 mcg/mL SKB 50 mcg/mL NS, D5W n/a Store unopened vials in original carton to protect from light. Manufacturer recommends use immediately after reconstitution because the Store unopened vials in original carton to protect from light. Manufacturer recommends use immediately Manufacturer Concentration Diluents e Normal saline. [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; June 2015.

® Craig SB, Bhatt UH, Patel K. Stability and compatibility of topotecan hydrochloride for injection with common infusion solutions containers.

CONTAINER OTHER INFUSION CONTAINERS pH of reconstituted product is 2.5–3.5. 5 d at 37°C following storage room temperature. INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INFUSOR Portable Elastomeric Infusion System devices are no Protected from light. Stored at 30°C. 10% loss in 17 d due to photodegradation in mixed daylight and fluorescent light. 10% loss in 17 d due to photodegradation mixed daylight and 2. e f References 1. and stability of topotecan hydrochloride injection. Patel K, Craig SB, McBride MG, et al. Microbial inhibitory properties Special Considerations: product contains no antibacterial preservative. Notes a b c d 4. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October. 5. Hycamtin Flush Compatibility: 3. chloride bags and elastomeric portable infusion devices. Kramer I, Thiesen J. Stability of topotecan infusion solutions in polyvinyl Topotecan Hydrochloride Topotecan Polyolefin Polyvinyl Chloride (PVC) Glass Bottles INFUSOR LV-2 (Baxter) Glass Vials 311 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 311 22/05/17 1:55 PM Trastuzumab 1 2 2 2 2 1 2 2 1 Body Temp Refer. 2013; 102:794–812. J Pharm Sci. ); these have different ® n/a n/a n/a n/a Storage Conditions b 1 24 h n/a n/a n/a n/a 24 h n/a n/a n/a n/a 24 h n/a n/a n/a n/a 24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a TemperatureTemp Post-thaw h h e e e, e e e, Room Refrig Frozen Room Refrig n/a 28 d 24 h 24 h 24 h 24 h n/a 24 h n/a n/a n/a n/a 24 h 24 h n/a 24 h n/a n/a n/a n/a d 6 ~ d d d d d d d d ) with ADO-Trastuzumab Emtansine (Kadcyla ® 1 n/a Osmolality (mOsm/kg) pH 1 Do not mix with dextrose 5% solution; dilute required dosage of reconstituted solution 1 b NS n/a NS n/a NS n/a NS n/a NS n/a 1 g g f Do not confuse Trastuzumab (Herceptin 1 a a 2 2 2.3 mg/mL 2.3 mg/mL 1.5 mg/mL 3 mg/mL NS n/a 1.5 mg/mL3 mg/mL NS n/a NS n/a 1 ~ ~ ~ ~ ~ ~ Do not freeze reconstituted or diluted solutions. Drug Normal saline. 2.7 mg/mL (calc.). GEN GEN GEN unspec. GEN GEN GENGEN unspec. GEN GEN 21 mg/mL BWFI 1.5 mg/mL (calc.). Manufacturer Concentration Diluents ~ ~ 2 (trastuzumab) [package insert]. South San Francisco, CA: Genentech Inc.; March 2016. ® Do not mix with other medications. 1 Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Glover ZWK, Gennaro L, Yadav S, et al. Compatibility and stability of pertuzumab trastuzumab admixtures in IV infusion bags for coadministration.

CONTAINER OTHER INFUSION CONTAINERS pH of product reconstituted with W or BWFI to 21 mg/mL is approximately 6. pH of product reconstituted with W or BWFI to 21 mg/mL is approximately Bacteriostatic Water for Injection. If reconstituted with preservative-free W, use immediately and discard unused portion. Protected from light. Stored at 30°C. Concentrations will vary; calculated dosage should be added to 250 mL NS IV bag. With pertuzumab With pertuzumab g h References 1. Herceptin 2. f e d Note: b Special Considerations: physicochemical properties and clinical indications. Notes a Flush Compatibility: in 250 mL of NS. Do not shake vial during reconstitution. Gently invert IV bag to mix solution. Do not administer undiluted solutions; do not administer IV push in 250 mL of NS. Do not shake vial during reconstitution. Gently invert IV bag to mix solution. administer undiluted solutions; or bolus. Trastuzumab Polyethylene Bag Polyolefin Bag Chloride Polyvinyl (PVC) Vial 312 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 312 22/05/17 1:55 PM Treprostinil Sodium 2 2 2 4 1, 4 2 2 2 4 1, 4 1, 3 2 b a a a a a a a a Body Temp Refer. continued on next page n/a n/a 60 d b 60 d

2 Storage Conditions b TemperatureTemp Post-thaw n/a n/a n/a n/a n/a 72 h n/a n/a n/a n/a n/a 72 h n/a n/a n/a n/a n/a 48 h n/a n/a n/a n/a n/a 48 h 60 d 60 d n/a n/a n/a n/a n/a 72 h n/a n/a n/a n/a n/a 48 h n/a n/a n/a n/a n/a 48 h n/a n/a n/a n/a n/a 48 h Room Refrig Frozen Room Refrig 1 1 1 1 c c c c c c n/a n/a 14 d n/a n/a n/a n/a 48 h n/a n/an/a 14 d n/a n/a n/a 14 d n/a n/a n/a n/a 48 h n/a n/a 48 h Osmolality (mOsm/kg) pH d d d 2 0.004 mg/mL sterile diluent 0.004 mg/mL 0.004 mg/mL W, NS n/a sterile diluent 0.004 mg/mL sterile diluent ≥ ≥ ≥ ≥ 1 Drug Do not interrupt infusion. UTC UTC 1, 2.5, 5, 10 mg/mL undiluted n/a 6–7.2 UTC 1, 2.5, 5, 10 mg/mL undiluted n/a 6–7.2 UTC 0.02, 0.13 mg/mL D5W n/a UTC 0.02, 0.13 mg/mL D5W n/a UTC 0.004, 0.13 mg/mLUTC W, NSUTC n/a UTCUTC 1, 2.5, 5, 10 mg/mLUTC undilutedUTC 0.004, 0.13 mg/mL n/a 1, 2.5, 5, 10 mg/mL W, NS 6–7.2 undiluted n/a n/a 6–7.2 Manufacturer Concentration Diluents n/a CONTAINER OTHER INFUSION CONTAINERS High-pH glycine diluent (Sterile Diluent for Remodulin, Sterile Diluent for Flolan, or Sterile Epoprostenol Sodium). High-pH glycine diluent (Sterile Diluent for Remodulin, Sterile Samples stored in refrigerator, freezer, and incubator were protected from light. Tested at 40°C. pH of undiluted solution is 6–7.2. Syringes, Syringes, d Flush Compatibility: Special Considerations: Notes a b c Treprostinil Sodium Treprostinil Chloride Polyvinyl (PVC) Polypropylene Glass Plastic MiniMed Pump Syringe Reservoir Polypropylene Sims Deltec Cassette Syringes, Glass 313 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 313 22/05/17 1:55 PM Treprostinil Sodium (cont’d) 2003; 2004; 8(3):230. Am J Health-Syst Pharm. Int J Pharm Compound. [package insert]. Research Triangle Park, NC: United Therapeutics Corp.; December 2014. ® 60(May 1):916. Treprostinil Sodium (cont’d) Treprostinil 4. of treprostinil sodium after dilution in common intravenous diluents. Phares KR, Weiser WE, Miller SP, et al. Stability and preservative effectiveness 3. sodium injection packaged in plastic syringe pump reservoirs. Xu QA, Trissel LA, Pham L. Physical and chemical stability of treprostinil References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. Remodulin 314 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_T.indd 314 22/05/17 1:55 PM Valproate Sodium 2 2 1 2 1 Body Temp Refer. 1,2 Storage Conditions TemperatureTemp Post-thaw 6 d n/a6 d24 h n/a n/a n/a n/a n/a6 d n/a n/a24 h n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig a a a a a a Osmolality (mOsm/kg) pH 1,2 2 Administer IV over at least 60 min with maximum rate of 20 mg/min, diluted in at least 50 mL of a compatible solution. Administer IV over at least 60 min with maximum rate of 20 mg/min, diluted in 50 mL a compatible Drug Normal saline. SWSWABV 1.6 mg/mL 1.6 mg/mLSW unspec.ABV D5W, NS, LR 1.6 mg/mL n/a unspec. D5W, LR, NS n/a D5W, NS, LR n/a D5W, NS, LR n/a D5W, NS, LR n/a Manufacturer Concentration Diluents CONTAINER OTHER INFUSION CONTAINERS pH of undiluted solution is 7.6. References 1. North Chicago, IL: AbbVie Inc.; September 2015. Depacon (valproate sodium), for intravenous injection [package insert]. 2. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 October Special Considerations: Note a Valproate Sodium Valproate Polyethylene (Polyolefin) Chloride Polyvinyl (PVC) Glass Flush Compatibility: 315 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 315 22/05/17 1:56 PM Vancomycin Hydrochloride 3 3 8 7 7 3 2 1 1 5 1 5 1 1 Body Temp Refer. continued on next page n/a n/a n/a 10 d n/a n/a n/a n/a n/a n/a n/a n/a 30 d n/a n/a n/a n/a 10 Storage Conditions d d d b 63 d 17 d n/a n/a n/a n/a 84 d n/a n/a n/a n/a 10 d 14 d TemperatureTemp Post-thaw a d d f d 24 h 28 d n/a n/a n/a n/a 24 h 14 d n/a n/a n/a n/a 17 d 63 d 63 d n/a n/a n/a 1, 11 24 h 14 d n/a n/a n/a n/a 24 h2 d 14 d n/a 30 d n/a n/a n/a n/a n/a n/a n/a 17 h 3 d 17 dn/a n/a24 h 58 d n/a29 d 17 d n/a24 h n/a 17 d n/a 17 d14 d n/a n/a 17 d n/a 6 m n/a n/a n/a n/a n/a n/a4 d n/a 30 d24 h n/a3 d 3 d n/a 28 d n/a 31 d n/a n/a n/a n/a 10 Room Refrig Frozen Room Refrig e e e e e e e e e e e e e e 1 e , 291 1 e 1 e 1 e 1 1 e Osmolality (mOsm/kg) pH Drug unspec. 5, 10, 15 mg/mL NS n/a unspec. 15 mg/mL NS n/a unspec. 5 mg/mL NS 291 LI 10–20 mg/mL D5W n/a unspec. 5 mg/mL NS 291 unspec. 5 mg/mL NS 291 LILILI 5 mg/mLunspec.LI 5 mg/mLunspec. 5, 10 mg/mL 8.33 mg/mLunspec. 16.67 mg/mL 10 mg/mL D5W, NS 5 mg/mL D5W, NS D5W D5W, NS 249 D5W, NSAB 249, 291 264, 287 D5W, NS, W 249, n/a 274, 297 LI, LY n/a D5W, NSLI, LY 20, 40 mg/mLLI, LY 249, 291 10–20 mg/mL 10–20 mg/mL 20 mg/mL D5Wunspec. D5W, NS D5W 5 mg/mL n/a n/a D5W, NS n/a n/a D5W 249 Manufacturer Concentration Diluents g Braun)

ST/LT ST/LT ® ® (B. / TM Cassette Cassette ® ® CONTAINER OTHER INFUSION CONTAINERS CADD (B. Braun) Homepump Vancomycin Hydrochloride Vancomycin Glass Chloride Polyvinyl (PVC) Syringes, Plastic Syringes, Polypropylene AccuFlo (SIMS Deltec) Dosi-Fuser (Leventon) Easypump Homepump Eclipse C-Series (Halyard) INFUSOR (Baxter) 316 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 316 22/05/17 1:56 PM Vancomycin Hydrochloride (cont’d) 1 9 2 2 2 6 n/a Body Temp Refer. c 30 d c . 1986; 43:1729–31. 72 h n/a n/a n/a n/a c Storage Conditions d Am J Hosp Pharm 14 d TemperatureTemp Post-thaw d 24 h 24 hn/a 10 dn/a 30 d n/a 10 d 24 h 31 d n/a n/a 24 h n/a n/a n/a n/a n/a n/a Room Refrig Frozen Room Refrig e e e e Bethlehem, PA: B. Braun USA; September 2015. 1 e n/a iso 3–5 n/a n/a Osmolality (mOsm/kg) pH . Irvine, CA: Halyard Health; March 2015. Bethlehem, PA: B. Braun USA; April 2015. Pluak Daeng, Thailand: Epic Medical Pte. Ltd.; March 2016. Barcelona, Spain: Leventon SAU; October 2015. W D ST/LT Elastomeric Infusion System. . HealthTek™ and University of KY Lexington. Chester, NY: Repro-Med Systems Inc.; 1998. ® Ontario, Canada: Baxter Corporation; October 2008. 1 Elastomeric Pump (ES.H.00.730-10). ® Drug Stability in Plastic Syringes Drug Administer higher concentrations via a central line to avoid irritation; administration durations >90 min may be required if Redman Administer higher concentrations via a central line to avoid irritation; administration durations >90 unspec. 5 mg/mL NS 291 LILILI 10–20 mg/mL 10–20 mg/mL 15 mg/mL BA D5W, NS D5W n/a 5 mg/mL n/a Normal saline. Incompatible with heparin. Low concentration heparin/vancomycin lock solution compatibility data is available in the literature. the in available is data compatibility solution lock heparin/vancomycin concentration Low heparin. with Incompatible saline. Normal Manufacturer Concentration Diluents Stability Data for Drugs Using Elastomeric Infusion Pumps. ®

® g Medical) Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential.

Drug Stability Table-Dosi-Fuser Chemical Stability Data for Drugs Using B. Braun’s Easypump Intermate/Infusor Drug Stability Information. Infusion Systems Stability Data for Drugs Using Homepump Disposable Ambulatory Stability Data for Drugs Using B. Braun’s AccuFlo™ Elastomeric Infusion System. Stability Data for Drugs Using B. Braun’s AccuFlo™ Elastomeric Infusion SMARTeZ temperature or under refrigeration. Do not force thaw. refreeze. COMMERCIAL PREPARATIONS (RTU) Manufacturer extrapolated data from other sources. Stable for 48 h warmed to room temperature after refrigeration. pH of a 5% solution in W is 2.5–4.5. Chemical degradation was dependent on the diluent. This is shortest time in which drug degraded 10%. Frozen expiration date per manufacturer’s label. Do not extrapolate commercial premix stability data to extemporaneously compounded solutions. Thaw at room Frozen expiration date per manufacturer’s label. Do not extrapolate commercial premix stability data to extemporaneously compounded INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Following 17 d refrigerated storage. 11. 11. in 5% dextrose and 0.9% sodium chloride injections [Abstract]. Das Gupta V, Stewart KR. Stability of vancomycin hydrochloride Note: 10. 10. Special Considerations: syndrome develops. Notes a b c d e 5. Rapp RP, Hatton J, Record K. 6. Vancomycin injection USP in Galaxy Plastic Container [package insert]. Deerfield, IL: Baxter Healthcare; October 2011. 7. f g References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 2. 3. 8. 9. (Epic Vancomycin Hydrochloride (cont’d) Vancomycin INTERMATE (Baxter) SMARTeZ Galaxy Bag (Baxter) Compatibility: Flush 317 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 317 22/05/17 1:56 PM VinBLAStine Sulfate 7 7 4 6 5 6 1 2 e a, c Body Temp Refer. continued on next page n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4, 6 n/a n/a n/a 2 d n/a n/a n/a n/a Storage Conditions a a a c a 31 d 21 d n/a n/a n/a n/a 8 d 30 dn/a n/a n/a n/a n/a n/a n/a n/a n/a 3, 6 TemperatureTemp Post-thaw e a a a a, a 21 d 21 dn/a n/a 21 d n/a n/a n/a 21 d 21 d n/a 77 d n/a8 d 7 d 30 d n/a30 d n/a23 d n/a n/a n/a Room Refrig Frozen Room Refrig b b b b b b b b b b b “FOR INTRAVENOUS USE ONLY—FATAL IF GIVEN BY OTHER n/a n/a Osmolality (mOsm/kg) pH W f 6 2 6 Drug Affix special warning sticker to individual dosage container stating: LILI 1 mg/mL 1 mg/mL NS n/a LI 0.15–0.5 mg/mLLI NS 0.02 mg/mL n/a D5W, LR, NS n/a LI 0.015 mg/mL NS n/a LILIDBLI 0.1 mg/mLDB 0.15 mg/mL 1 mg/mL 1 mg/mL 1 mg/mL NS, D5W NS n/a NS n/a unspec. n/a n/a Heparin lock flush and normal saline. Manufacturer Concentration Diluents d

6 ®

OTHER INFUSION CONTAINERS CONTAINER INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices pH of undiluted solution is 3.5 to 5. Manufacturer extrapolated data from other sources. Protected from light. 77 d refrigerated, followed by 2 at 33°C. Reconstituted with accompanying bacteriostatic diluent. Glass Vials Special Considerations: Flush Compatibility: ROUTES” Notes a b Dosi-Fuser (Leventon) INFUSOR (Baxter) Test Polypropylene Tubes c d e f VinBLAStine Sulfate VinBLAStine Chloride Polyvinyl (PVC) Syringes, Polypropylene 318 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 318 22/05/17 1:56 PM VinBLAStine Sulfate (cont’d) 1989; 43:84–7. 1996; 135:413–4. J Parent Sci Technol. 1987; 22:685–7. Hosp Pharm. Boll Chim Farmaceutico. 1990; 12:53–4,60. Br J Pharm Pract. Barcelona, Spain: Leventon SAU; October 2015. Ontario, Canada: Baxter Healthcare Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). ® Intermate/Infusor Drug Stability Information. Drug Stability Table-Dosi-Fuser VinBLAStine Sulfate (cont’d) VinBLAStine 5. 6. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 7. 4. anticancer drugs in three commonly used infusion fluids. Beijnen JH, Vendrig DEMM, Underberg WJM. Stability of vinca alkaloid 3. sodium chloride in polypropylene syringes. Girona V, Prat J, Pujol M, et al. Stability of vinblastine sulphate in 0.9% References 1. a continuous infusion chemotherapy program. Vyas HM, Baptista RJ, Mitrano FP, et al. Drug stability guidelines for 2. injections. Weir PJ, Ireland DS. Chemical stability of cytarabine and vinblastine 319 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 319 22/05/17 1:56 PM VinCRIStine Sulfate 6, 8 9 9 2 1, 6 6, 8 6 4, 6 1, 6 3 3 6, 8 f f c, c, f l c b b Body Temp Refer. continued on next page n/a n/a n/an/an/a 124 h n/a n/a n/an/a n/a n/a n/a n/a n/a 6, 7 n/a 5, 6 n/a n/an/a n/a 6, 7 n/a n/a n/a n/a n/a n/a n/a n/a 2, 6 n/a n/a n/a 7 d n/a n/a n/a 124 h n/a n/a n/a 4 d n/a n/a n/a 4 d Storage Conditions c c n c c c c c e c e b, b, 7 d 7 d 29 d 21 d TemperatureTemp Post-thaw n c e e n/a 124 h 2 d n/a 7 d 2 d 10 d 21 d 25 dn/a n/a 21 d n/a n/a n/a 21 d n/a 14 d n/a 7 d n/a 124 h n/a 7 d 14 d n/a n/a n/a n/a 14 d 10 dn/a n/a 29 d n/a n/a n/a n/a n/a n/a n/a n/a n/a 124 h n/a n/a n/a 124 h Room Refrig Frozen Room Refrig i i i i i i i i i i i i i i i i i “FOR INTRAVENOUS USE ONLY—FATAL IF GIVEN BY OTHER n/a n/a n/a n/a n/a n/a n/a n/a Osmolality (mOsm/kg) pH k , NS k g a j a d h NS NSNS n/a n/a W W NS NS NS D5½S NS 6 h a j a k d g 10, 20, 40, 60, 80, 120 mcg/mL mcg/mL 120 80, 60, 40, 20, 10, mcg/mL 150 100, 50, 25, Drug Affix special warning sticker to individual dosage container stating: LI 36 mcg/mL LI 10 mcg/mL LILI 5 mcg/mL LILILI 20 mcg/mL 36 mcg/mL LILILI 40–200 mcg/mL D5W, NSFAU 1,000 mcg/mL n/a 1,000 mcg/mL 200 mcg/mL NS NSLI n/a LI n/a 20 mcg/mL 33 mcg/mL D5W, LR, NS n/a LI 16 mcg/mL LILI 40–200 mcg/mL 200 mcg/mL NS NS n/a n/a Heparin lock flush and normal saline. Manufacturer Concentration Diluents m

6,7,10 ®

PVC PVC TM Cassette Cassette CONTAINER OTHER INFUSION CONTAINERS VinCRIStine Sulfate VinCRIStine Polyolefin Bags Chloride Polyvinyl (PVC) Polypropylene (BD) Dosi-Fuser (Leventon) Glass Vials Graseby (Graseby Medical) INFUSOR (Baxter) Test Polypropylene Tubes Unspecified Special Considerations: ROUTES.” 9000 Syringes, Syringes, Flush Compatibility: 320 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 320 22/05/17 1:56 PM VinCRIStine Sulfate (cont’d) 1996; 1991; 77:279–85. 1989; 43:84–7. Int J Pharm. Am J Health-Syst Pharm. 2001; 36:740–5. 1998; 4(3):143–9. J Parent Sci Technol. Hosp Pharm. J Oncol Pharm Practice. Barcelona, Spain: Leventon SAU; October 2015. 1 Ontario, Canada: Baxter Corporation; October 2008. Elastomeric Pump (ES.H.00.730-10). 10 ® 2001; 58:594–8. Drug Stability Table-Dosi-Fuser Am J Health-Syst Pharm. Intermate/Infusor Drug Stability Information. 53:1171–3. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. With doxorubicin (PHU) 400 mcg/mL and etoposide phosphate (BMS) 2,000 mcg/mL. With doxorubicin (PHU) 400 mcg/mL and etoposide phosphate Stored for 7 d at 4°C, followed by 4 35°C. Manufacturer extrapolated data from other sources. With doxorubicin (PHU) 2 mg/mL. Stored at 4°C for 7 d, followed by 2 d room temperature (23°C). With doxorubicin (NY) 1.67 mg/mL. With doxorubicin (FA) 1.4 mg/mL. Solutions protected from light. With doxorubicin (PHU) 120 mcg/mL and etoposide phosphate (BMS) 600 mcg/mL. With doxorubicin (PHU) 120 mcg/mL and etoposide phosphate At 35–40°C. With doxorubicin (PHU) 240 mcg/mL and etoposide phosphate (BMS) 1,200 mcg/mL. At 30 and 37°C. pH of undiluted solution is 4–5. VinCRIStine Sulfate (cont’d) VinCRIStine 10. IL: Hospira, Inc.; July 2013. VinCRIStine Sulfate Injection, USP [package insert]. Lake Forest, 9. 5. of vinblastine, vincristine, vindesine and vinorelbine with PVC infusion bags. Dine T, Luyckx M, Cazin JC, et al. Stability and compatibility studies 6. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 September. 7. sulfate used as a deterrent to inadvertent intrathecal injection. Trissel LA, Zhang Y, Cohen MR. The stability of diluted vincristine 8. of vincristine sulfate, doxorubicin hydrochloride, and etoposide phosphate in 0.9% sodium chloride injection. Yuan P, Grimes GJ, Shankman SE, et al. Compatibility and stability 3. 4. Graseby 9000 ambulatory infusion pump. Priston MJ, Sewell GJ. Stability of three cytotoxic drug infusions in the 2. anticancer drugs in three commonly used infusion fluids. Beijnen JH, Vendrig DEMM, Underberg WJM. Stability of vinca alkaloid Notes a b j k l m n References 1. hydrochloride and vincristine sulfate in two portable infusion-pump reservoirs. Nyhammar EK, Johansson SG, Seiving BE. Stability of doxorubicin c d e f g h i 321 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 321 22/05/17 1:56 PM Vinorelbine Tartrate 1 3 Body Temp Refer. 1991; 77:279–85. Int J Pharm. n/an/a n/a n/a n/a n/a n/a n/a 1, 2 1, 2 n/a n/a n/a n/a Storage Conditions d a a 21 d TemperatureTemp Post-thaw d n/an/a 7 d 5 d 3 d 24 h n/a 24 h n/a n/a n/a n/a24 h n/a n/a n/a n/a 1, 4 Room Refrig Frozen Room Refrig c c c c c c If dispensed in a syringe containing an individual dosage, label the with Osmolality (mOsm/kg) pH 4 1 1 Ontario, Canada: Baxter Corporation; October 2008. 1 Store vials protected from light, refrigerate, do not freeze. Drug Normal saline; heparin lock flush at concentrations up to 2 mg/mL vinorelbine, haze and/or precipitate forms at concentrations >2 mg/mL Normal saline; heparin lock flush at concentrations up to 2 mg/mL vinorelbine, haze and/or precipitate PIFPIFGWPIF 0.5 mg/mL 0.5 mg/mLPIF 0.5, 2 mg/mL D5W 0.5–2 mg/mL NS D5W, NS 1.5–3 mg/mLPIF D5W, D5½S, NS, ½S, R, LR n/a D5W, NS 0.1–2 mg/mL n/a n/a D5W, NS n/a n/a n/a 24 h 24 h n/a n/a n/a n/a 1, 4 Manufacturer Concentration Diluents WARNING - FOR IV USE ONLY. FATAL if given intrathecally. e Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. CONTAINER OTHER INFUSION CONTAINERS 21 d refrigerated, followed by 24 h at room temperature. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Solutions protected from light. pH of undiluted solution is 3.5. Vinorelbine Tartrate Vinorelbine Chloride Polyvinyl (PVC) Syringes, Polypropylene INTERMATE (Baxter) Flush Compatibility: Special Considerations: vinorelbine with 100 u/mL heparin sodium. this statement: 3. 4. Inc.; March 2014. Navelbine [package insert]. Parsippany, NJ: Pierre Fabre Pharmaceuticals Note: d e References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 July. 2. of vinblastine, vincristine, vindesine and vinorelbine with PVC infusion bags. Dine T, Luyckx M, Cazin JC, et al. Stability and compatibility studies Notes a c 322 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 322 22/05/17 1:56 PM Voriconazole

2 1 3 1 2 Body Temp Refer. . 2006; 63:1423–6. The Brazilian Journal of Infectious Diseases n/a n/a n/a n/a 1, 4 n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 4 n/a n/a n/a n/a Storage Conditions a,c b c a,c c Am J Health-Syst Pharm 6 d 9 d 24 h 8 d 11 d TemperatureTemp Post-thaw b,c,d b,c,d c c Room Refrig Frozen Room Refrig b 3 n/a n/a Osmolality (mOsm/kg) pH 3 NS, LR, D5LR, D5½S, D5½S, D5LR, LR, NS, D5W, ½S, D5S 1 Reconstitute vial to 10 mg/mL with 19 mL W; then dilute for infusion to 0.5–5 mg/mL; manufacturer recommends removing and discarding Reconstitute vial to 10 mg/mL with 19 mL W; then dilute for infusion 0.5–5 mg/mL; manufacturer Drug Saline. PFPF 4 mg/mL 0.5–5 mg/mL D5W n/a n/a n/a 15 d n/a n/a n/a n/a PFPF 2 mg/mL 2 mg/mL NS D5W n/a n/a n/a n/a n/a 4 d 32 d n/a n/a n/a n/a PF 0.5 mg/mL D5W n/a 4.2–4.4 <2 d PFPF 2 mg/mL NS 0.5 mg/mL NS n/a n/a n/a 8 d 5.6–5.9 <2 d Manufacturer Concentration Diluents (voriconazole) [package insert]. New York, NY: Pfizer USA; February 2015. (voriconazole) [package insert]. New York, NY: Pfizer USA; ® 2008; 12(5):400–4. CONTAINER Based on analysis at time 0 and 2 d interval post preparation. Manufacturer recommends using immediately or within 24 h if refrigerated. There was evidence of drug sorption by PVC bags at the end stability study. Protected from light. Unspecified Flush Compatibility: Voriconazole Polyolefin Bag Chloride Polyvinyl (PVC) Special Considerations: volume of infusion diluent at least equal to the volume of 10 mg/mL concentrate to be added in order to achieve recommended final concentration range. Do not volume of infusion diluent at least equal to the 10 mg/mL concentrate be added in order achieve recommended use vial if vacuum does not draw in diluent. Do dilute with sodium bicarbonate 4.2% infusion. Notes a b 4. in 0.9% sodium chloride and 5% dextrose injection. Sahraoui L, Chiadmi F, Schlatter J, et al. Stability of voriconazole injection c d References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2015 December. 2. infections: stability of voriconazole infusion solutions in PVC bags. Adams A, Morimoto L, Meneghini et al. Treatment of invasive fungal 3. Vfend 323 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Part2_Mono_V.indd 323 22/05/17 1:56 PM Ziconotide Acetate 1 1, 8 4 1 1 6 6 1 1, 8 1 5 4 1, 7 7 1, 5 4 4 3 7 3 3 s s s s m h, l k e i g j, d d g h s f q Body Temp Refer. continued on next page n/a n/an/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1, 8 n/an/a n/an/a n/a n/a n/a n/a n/a n/a n/a 1, 8 22 d 1, 8 n/an/a n/a n/a n/a n/a n/a 28 d n/a n/an/a n/a n/a n/a n/a 1, 8 30 d Storage Conditions r r p d e, e f g j d f, h TemperatureTemp Post-thaw n/a n/a n/a n/a n/a 33 d n/a n/a n/a n/a n/a 8 d n/a n/a n/a n/a n/a 12 d n/a n/a n/a n/a n/a 19 d n/a 28 d n/a n/a n/a n/a n/a 34 d n/a n/a n/a n/a n/a 19 d n/a 25 d n/a n/a n/a n/a n/a 26 d n/an/a 25 d n/a 17 d 22 d n/a n/a n/a n/a n/a 20 d n/a n/a n/a n/a n/a 28 d n/an/a 30 d 28 d n/a 17 d n/a n/a n/a n/a n/a 22 d n/a 24 h n/a n/a n/a n/a 1, 2 n/a 30 d n/a n/a n/a n/a n/a 105 d n/an/a n/a n/a n/a n/a n/a n/a n/a n/a 6 d 158 d n/a n/a n/a n/a n/a 53 d Room Refrig Frozen Room Refrig c c c h h j j c c c c c c c c c c c 6 c 6 c c c c c c n/a n/a n/a 5.8 n/a n/a n/a 1,030 3.46 n/a 30 d n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 5.8 n/a 4–5 n/a n/a 4–5 n/a Osmolality (mOsm/kg) pH s s s p b b,o, s s h, NS j, NS undiluted undiluted NS p n r e r f h m m j f f l l de, d k k e e n f, i i efg e f g d d jd j d o g g h h q q o Drug ELN 25 mcg/mL ELN 25 mcg/mL ELN 25 mcg/mL ELN 25 mcg/mL ELN 25 mcg/mL EISELNELN 0.1, 0.25, 0.5, 0.75 mcg/mL 25 mcg/mL NS 25 mcg/mL 308 6.11 n/a 30 d n/a n/a n/a n/a ELN 25 mcg/mL ELN 25 mcg/mL ELN 25 mcg/mL ELN 25 mcg/mL ELN 25 mcg/mL ELNELNELN 25 mcg/mL 25 mcg/mL 25 mcg/mL ELN 25 mcg/mL ELNELN 25 mcg/mL 25 mcg/mL ELN 25 mcg/mL ELN 100 mcg/mL EIS 0.1, 0.25, 0.5, 0.75 mcg/mL ELN 25 mcg/mL JZELN unspec. 25 mcg/mL ELN 25 mcg/mL Manufacturer Concentration Diluents

II II ® r CONTAINER OTHER INFUSION CONTAINERS Ziconotide Acetate Syringes, Plastic Synchromed Pump Implantable (Medtronic) Unspecified Vial, Plastic 324 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ziconotide Acetate (cont’d) 2007; 2007; 1,2 continued on next page Neuromodulation Journal of Pain and Symptom Neuromodulation pumps; refill new pump within 14 d due to initial ® For intrathecal use only with SynchroMed II Infusion System 1,2 2 external microinfusion device. Follow manufacturer specifications for device fills and ® baclofen 1.5 mg/mL. ® 1 2 Refrigerate diluted and undiluted product. Protect from light freezing. Normal saline. 2008; 36(1):e4–e6. [package insert]. Palo Alto, CA: Jazz Pharmaceuticals, Inc.; February 2013. ® 1,2 Management 10:S1–5. 10(s1):12–7. With sufentanil citrate (powder) 1 mg/mL (BB). With ropivicaine 7.5 mg/mL (ASZ), morphine sulfate (LAV), and clonidine 15 mcg/mL (BI). With clonidine HCl (dissolved powder) 2 mg/mL (BB). With clonidine HCl (dissolved powder) 2 mg/mL (BB) and morphine sulfate 35 (BB). Diluted with preservative-free NS. Diluted from commercial formulation (in vitro study). Undiluted commercial formulation (in vitro study). With commercial Lioresal Intrathecal With hydromorphone HCl (dissolved powder) 35 mg/mL (BB). With morphine sulfate (dissolved powder) 10 mg/mL (BB). pH of undiluted solution is 4–5. With bupivacaine HCl (dissolved powder) 5 mg/mL (BB). Data is from previously exposed (i.e. rinsed and/or infused) pumps tested in vitro. Data is from previously exposed (i.e. rinsed and/or infused) pumps Data is from polymethylpentene HPLC control vials. With morphine sulfate (dissolved powder) 35 mg/mL (BB). With baclofen (dissolved powder) 2 mg/mL (BB). With morphine sulfate (powder) 20 mg/mL (BB). With fentanyl citrate (dissolved powder) 1 mg/mL (BB). 3. stability of ziconotide solutions during simulated intrathecal administration. Shields DE, Liu W, Gunning K, et al. Statistical evaluation of the chemical Ziconotide Acetate (cont’d) 4. combining ziconotide with baclofen during simulated intrathecal administration. Shields D, Montenegro N, Aclan J. Chemical stability of admixtures i j k l m n o p q r s References 1. ASHP’s Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed 2016 June. 2. Prialt d e f g h refills. Due to implanted reservoir volumes and rate limitations associated with intrathecal (IT) infusion devices, polytherapy (combinations of medications) is not Due to implanted reservoir volumes and rate limitations associated with intrathecal (IT) infusion devices, polytherapy (combinations when preparing and administering uncommon; practitioners should be experienced with pharmacology, physicochemical parameters, and sterility requirements IT infusions. Notes b c 5. combining ziconotide and bupivacaine during simulated intrathecal administration. Shields D, Montenegro R, Aclan J. Chemical stability of an admixture drug sorption onto internal device surfaces; subsequent refills with undiluted drug should be at least every 84 d, or with diluted drug at least every 40 d. drug sorption onto internal device surfaces; subsequent refills with undiluted should be at least every 84 d, or diluted Use ziconotide 5 mg/mL in preservative-free NS for initial fill of CADD-Micro Special Considerations: (Medtronic) and CADD-Micro Ambulatory Infusion Pump (Smiths Medical MD). Use ziconotide 25 mcg/mL (undiluted) for initial priming, rinsing, and first fill of drug-naïve (new) Synchromed Flush Compatibility: 325 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Ziconotide Acetate (cont’d) 2014; 17:474-82. Neuromodulation stability of low-concentration ziconotide alone or in admixtures intrathecal pumps. In vitro . 2007; 10:S6–11. . 2005; 4:257–63. Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Neuromodulation Neuromodulation 7. hydrochloride admixtures with and without morphine sulfate during simulated intrathecal administration. Shields D, Montenegro R. Chemical stability of ziconotide-clonidine 8. combining ziconotide with morphine or hydromorphone during simulated intrathecal administration. Shields D, Montenegro R, Ragusa M. Chemical stability of admixtures Note: Ziconotide Acetate (cont’d) 6. Dupoiron D, Richard H, Chabert-Desnot V, et al. 326 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Zidovudine

4 2 1 3 Body Temp Refer. n/a n/a n/a n/a Storage Conditions d 10 d TemperatureTemp Post-thaw d 8 d 8 d n/a n/a n/a n/a 8 d 8 d n/a24 h n/a n/a n/a Room Refrig Frozen Room Refrig b b b b

1 Osmolality (mOsm/kg) pH . Barcelona, Spain: Leventon SAU; October 2015. 1 1 Ontario, Canada: Baxter Corporation; October 2008. 1 Elastomeric Pump (ES.H.00.730-10) ® Dilute in D5W to a concentration no greater than 4 mg/mL. Drug Heparin lock flush and normal saline. WEL 4 mg/mL D5W, NS n/a BW 4 mg/mLVIIV 1–4 mg/mL D5W, NS n/a D5W n/a Manufacturer Concentration Diluents c

(zidovudine) injection [package insert]. Research Triangle Park, NC: ViiV Healthcare; December 2014. ® ®

Reference numbers and notes may not be sequential. Some references or notes from previous editions have been deleted. Reference numbers and notes may not be sequential. Intermate/Infusor Drug Stability Information. Drug Stability Table-Dosi-Fuser CONTAINER OTHER INFUSION CONTAINERS Manufacturer extrapolated data from other sources. pH of undiluted solution is 5.5. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. 4. Retrovir Note: c d References 1. ASHP's Interactive Handbook on Injectable Drugs, 2015. Bethesda, MD: American Society of Health-System Pharmacists. Accessed January 2016. 2. 3. The drug is chemically stable for longer periods. Notes b Flush Compatibility: Zidovudine Chloride Polyvinyl (PVC) Dosi-Fuser (Leventon) INTERMATE/ INFUSOR (Baxter) Manufacturer recommends that diluted zidovudine be used within 8 h at room temperature or 24 h if refrigerated, as there is no preservative in the formulation. Manufacturer recommends that diluted zidovudine be used within 8 h at room temperature or 24 if refrigerated, as there Special Considerations: 327 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) Zoledronic Acid

5 1 1,2,3 e Body Temp Refer. n/a n/a n/a n/a 3, 4 n/a n/a n/a n/a Storage Conditions c c 3 24 h 24 h 24 h n/a24 h n/a n/a24 h n/a n/a n/a n/a n/a n/a n/a n/a 1, 2 n/a 1, 2 1, 2 TemperatureTemp Post-thaw c c a a a Room Refrig Frozen Room Refrig 1,3 d n/a 6–7 n/a n/a Osmolality (mOsm/kg) pH b f 4 1,3 Ontario, Canada: Baxter Corporation; October 2008. 1,3 pH of 0.05 mg/mL RTU is 6–7. Drug 1 brand of zoledronic acid solution contains 5,100 mg mannitol and 24 sodium citrate. brand of zoledronic acid solution contains 4,950 mg mannitol and 30 sodium citrate. ® ® NVS 0.04 mg/mL D5W n/a n/a 24 h n/a n/a n/a n/a 24 h NVS 0.05 mg/mL RTU NVSNVSNVS 0.03–0.04 mg/mL 0.03–0.04 mg/mL NS, D5W 0.03–0.04 mg/mL NS, D5W n/a NS, D5W n/aNVS n/a n/a n/a 0.04 mg/mL n/a RTU Manufacturer Concentration Diluents Infuse in a separate line from all other medication. Do not mix with calcium or other divalent cation-containing solutions (e.g., LR). Infuse in a separate line from all other medication. Do not mix with calcium or divalent cation-containing Normal saline. 1,2 g h [package insert]. East Hanover, NJ: Novartis Pharmaceuticals; December 2016. [material safety data sheet]. East Hanover, NJ: Novartis Pharmaceuticals; August 2007. [material safety data sheet]. East Hanover, NJ: Novartis Pharmaceuticals; [package insert]. East Hanover, NJ: Novartis Pharmaceuticals; April 2015. [package insert]. East Hanover, NJ: Novartis Pharmaceuticals; ® ® ® Intermate/Infusor Drug Stability Information. not exceed 24 h. CONTAINER OTHER INFUSION CONTAINERS COMMERCIAL PREPARATIONS (RTU) pH of 0.7% solution in W is 2. Each 100 mL of RTU Reclast Single-use bottle. 24 h at 33°C following 25°C. Manufacturer recommends immediate use after dilution if not refrigerated; time between reconstitution, dilution, refrigerated storage, and end of administration must Manufacturer recommends immediate use after dilution if not refrigerated; time between reconstitution, dilution, refrigerated Expiration date per manufacturer’s label. After opening, may be refrigerated for 24 h prior to administration. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices are no longer available in the United States. INTERMATE/INFUSOR Portable Elastomeric Infusion System devices Each 100 mL of RTU Zometa e f g h References 1. Zometa 5. 4. Reclast 2. Medical Information, Communication, and Education [personal communication]. East Hanover, NJ: Novartis Pharmaceuticals; February 29, 2008. 3. Reclast Special Considerations: d c Flush Compatibility: Administer solutions at room temperature. Notes a b Zoledronic Acid Polyethylene Bag Polypropylene Bag Polyvinyl Chloride (PVC) INFUSOR (Baxter) Single Use Bottle 328 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org) EXTENDED STABILITY FOR PARENTERAL DRUGS

PART III

Appendix A: Manufacturer and Compendium Abbreviations

Appendix B: Glossary of Terms

Index

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Manufacturer and Compendium Abbreviations

AAB Apoteket AB AB Abbott ABV AbbVie ACT Actelion AD Adria AGT Aguettant AH Allen & Hanburys AHC Accord Healthcare ALT Altana-Nycomed AM Asta Medica AMG Amgen AMR American Regent APC Apothecon APO Apotex APP American Pharmaceutical Partners AS Arnar-Stone ASH Ash-Stevens ASL Astellas ASM AstraMedica AST Astra ASZ AstraZeneca AUM AuroMedics AVE Aventis AW Asta Werke AY Ayerst BA Baxter BAY Bayer BB B & B Pharmaceuticals BD Becton, Dickinson and Company BE Beecham BED Bedford BEL R. Bellon BGD Biogen-Idec BI Boehringer Ingelheim BMS Bristol-Myers Squibb BPH Biotest Pharmaceuticals BPL Bio Products Laboratories BR Bristol BRN B Braun BV Ben Venue BW Burroughs Wellcome BX Berlex CAD Cadence CAN Cangene bioPharma, Inc. CE Carlo Erba CEN Centocor

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CER Cerenex CET Cetus CG Ciba Geigy CGC Ciba Geigy Canada, LTD CHI Chiron CI Ciba COV Covis Pharmaceuticals CPF Coop. Pharmaceutique Francaise CSL CSL Behring CTF Centafarm CUB Cubist Pharmaceutical CUP Cumberland Pharmaceuticals CUR Curomed DB David Bull Laboratories DI Dista DIO Diosynth DSM DSM Pharmaceuticals DU DuPont EIS Eisai Pharmaceuticals EL Enzon, Inc. ELN Elan Pharmaceuticals ES Elkins-Sinn EST Esteve EV Evans FA Farmitalia FAU Faulding FL Funk Labs FOR Forest FRK Fresenius Kabi FUJ Fujisawa GEN Genentech GG Geigy GIL Gilead GL Glaxo GNS Gensia GRI Grifols Biologicals GSK GlaxoSmithKline GW Glaxo Wellcome HC Hillcross HE Hengrui Medicine Co. HMR Hoechst Marion Roussel HO Hoechst-Roussel HSP Hospira ICN ICN Pharmaceuticals IMM Immunex JC Janssen-Cilag JN Janssen JZ Jazz Pharmaceuticals KED Kedrion Biopharmaceutics

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KN Knoll KY Kyowa LAV Lavoisier Pharmaceutical LCSA Laboratoire Choay Societe Anonyme LE Lederle LEI Leiras, Finland LI Lilly LUN Lundbeck LY Lyphomed LZ Labaz Laboratories MAR Marsam MAY Mayne Pharma MB May & Baker ME Merck MG McGaw MI Miles MIL Millennium MJ Mead Johnson MN McNeil MON Monarch MSD Merck Sharp & Dohme NF National Formulary NNO Novo-Nordisk NOV Novo NP Nycomed-Pharma NVS Novartis NY Nycomed OB Ortho Biotech OCT Octapharma OMJ OMJ Pharmaceuticals OMN Ortho McNeil Pharmaceuticals ON Orion OR Organon ORT Ortho PAD Paddock PD Parke-Davis PF Pfizer PH Pharmacia PHU Pharmacia-Upjohn PIF Pierre-Fabre PX Pharmax QI Qilu Pharmaceutical Co. QU Quad RB Robins RC Roche REC Recordati REN Renaudin RMS Repro-Med Systems ROX Roxane Labs

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RP Rhône-Poulenc RPR Rhône-Poulenc-Rorer RR Roerig RS Roussel SAB Sabex SAV Sanofi-Aventis SC Schering SCN Schein SE Searle SEQ Sequus SGT Sarget SH Spectrum Healthcare SHI Shionogi SI Sigma SIC Sicor SIT Sigma Tau SKB SmithKline Beecham SKF Smith Kline & French SO SoloPak SQ Squibb SS Sanofi Synthelabo STE Stella STU Stuart SW Sanofi Winthrop SY Syntex SZ Sandoz TAL Talecris TE Teva TLP Therabel Lucien Pharma TMC The Medicines Company UN Unknown UP Upjohn UTC United Therapeutics WAS Wasserman WAY Wyeth-Ayerst WEL Wellcome WI Winthrop WL Warner Lambert WY Wyeth XGN X-Gen ZEN Zeneca ZNS Zeneus Pharma

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Glossary of Terms

Beyond-Use Date: The date assigned by the pharmacist and placed on the prescription label after which a compounded preparation can no longer be used. This date is based on the pharmacist's knowledge of chemical stability, use of a validated sterile preparation compounding process, and anticipated conditions for delivery, storage, and administration. Controlled Room Temperature: Maintained thermostatically between 20°C–25°C; mean kinetic temperature ≤25°C; some excursions between 15°C–30°C; spikes above 40°C if product manufacturer instruction permits. Extended Stability: The maximum time period in which 90% or greater of a labeled active ingredient is measurable in the solution and container specified, under the stated storage conditions. An exception applies to coagulation factors, which are considered stable when at least 80% of the factor activity is retained. Inference: The decision to assume that when drugs with well-established stabilities in common container materials, such as PVC and glass, are repeatedly determined to exhibit the same stabilities in containers made of a newer material, such as EVA (with no adverse influence of the container on the stabilities of those drugs being found), then additional drugs of similar compositions will also exhibit stabilities unaltered by this newer container material. Interpolation: The practice of assuming that data, which demonstrates drug stability at a higher concentration and a lower concentration, supports stability at concentrations between the two. Preparation: A compounded sterile preparation (CSP) that is a sterile drug or nutrient prepared in a licensed pharmacy or other healthcare-related facility pursuant to the order of a licensed prescriber, which may or may not contain sterile products. Product: A commercially manufactured sterile drug or nutrient that has been evaluated for safety and efficacy by the U.S. Food and Drug Administration (FDA). Products are accompanied by full prescribing information, which is commonly known as the FDA-approved manufacturer's labeling or product package insert. Stability: The length of time that the preparation retains the labeled potency of the active ingredient(s) under the labeled storage conditions.

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BIng_Part3_App.indd 336 22/05/17 1:56 PM Index EXTENDED STABILITY FOR PARENTERAL DRUGS

A Bortezomib, 78 Coagulation factor IX, 129–130 Bumetanide, 79 Coagulation factor X, 131 Abbreviations, xii Bupivacaine hydrochloride, Coagulation factor XIII, 132 Accreditation Commission for 80–82 Colistimethate sodium, 133–134 Home Care (ACHC), 6, 30 Combination drugs, 4 Acetaminophen, 55 Commercially prepared solutions, Acyclovir sodium, 56–57 C 6–7, 16, 29 Additives, 29 Calcitriol, 83 Community Health Accreditation ADO-trastuzumab emtansine, 58 Calcium, 26, 27 Program (CHAP), 6 Albumin, 29 Calcium gluconate, 28 Compatibility Aldesleukin, 59 Calcium phosphate flush, xi Ambulatory infusion, 13, 17 solubility, 24, 25, 27–28 Compatibility, drug, 11 American Society for Parenteral temperature, 24 Compounding Quality Act of and Enteral Nutrition (ASPEN) Carboplatin, 84–85 2013, 6 product formulation and Caregiver education, 19 Concentration dependence, 4 substitutions, 23 Carnitine, 31 Container, 12, 15, 16, 24 Safe Practices for Parenteral Caspofungin acetate, 86–87 Copper, 33 Nutrition, 29–30 Catheter lock (ethanol), 175 Co-trimoxazole, 135 American Society of Health- Catheter occlusion, 8 Cyclophosphamide, 136–137 System Pharmacists (ASHP) Catheters, 8–11 Cyclosporine, 138 Guidelines on Compounding Cefazolin sodium, 88–90 Cytarabine, 139–140 Sterile Preparations, 5 Cefepime hydrochloride, 91–93 Guidelines on Home Infusion Cefotaxime sodium, 94–96 D Pharmacy Services, 5 Cefotetam disodium, 97–98 quality assurance, 5 Cefoxitin sodium, 99–100 Dacarbazine, 141 Amikacin sulfate, 60–61 Ceftaroline fosamil, 101 Dalbavancin, 142 Amino acids Ceftazidime, 102–104 Daptomycin, 143–144 stability factors of, 24, 26 Ceftolozane-tazobactam, 105 DAUNOrubicin hydrochloride with cysteine, 28 Ceftriaxone sodium, 106–108 (daunomycin), 145 ® Aminosyn , 29 Cefuroxime sodium, 109–111 Deferoxamine mesylate, 146–148 Amiodarone hydrochloride, 62 Centers for Disease Control Dexamethasone sodium Amphotericin B, 63 and Prevention (CDC), phosphate, 149–150 Amphotericin B lipid complex, 64 Guidelines for the Prevention of Dextrose, 24–27, 29 Amphotericin B liposomal, 65 Intravascular Catheter-Related Dextrose 5% in Lactated Ringers, Ampicillin sodium, 66–67 Infections, 30 8 Ampicillin sodium–sulbactam Centers for Medicare & Medicaid Dextrose 5% in water (D5W), xi, sodium, 68–69 Services, certification 8, 11 Antibiotic locks (ABL), 19 requirements of, 6 Dextrose 10% in water, 8 Ascorbic acid, 25 Central venous access device Dextrose concentration, 27 Automated dispensing systems (CVAD), 9–10 DimenHYDRINATE, 151 (ADS), 17 CHAP (Community Health DiphenhydrAMINE Azithromycin, 70 Accreditation Program), 6 hydrochloride, 152 Aztreonam, 71–72 Chlorpromazine hydrochloride, Divalent cations, 27 112 DOBUTamine hydrochloride, 153 B Chromium, 31 Docetaxel, 154 Cidofovir, 113 Dolasetron mesylate, 155 Baclofen, 73–74 Cimetidine, 32 DOPamine hydrochloride, Bevacizumab, 75 Ciprofloxacin, 114–115 156–157 Beyond-use date Circulatory system, 10 Doripenem, 158–160 assignment, 11–12 CISplatin, 116–117 DOXOrubicin hydrochloride, point-of-care activated devices, Cladribine, 118 161–163 18 Clindamycin phosphate, 119–120 Doxycycline hyclate, 164–165 quality of assurance, 5 Clonidine hydrochloride, Drug-bag delivery systems, 17 site of care considerations, 121–123 Drug compatibility, 11 12–13 Coagulation factor VIIa Drug delivery process and control, Bleomycin sulfate, 76 recombinant, 124 18–19 Blinatumomab, 77 Coagulation factor VIII, 125–128 Drug delivery systems, 15–18

337 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Index.indd 337 22/05/17 1:54 PM Index EXTENDED STABILITY FOR PARENTERAL DRUGS

Dual-chambered bag, 17 Fosphenytoin sodium, 196 Interferon alfa-2b, 227 Duplex® system, 17 Freezing parenteral preparations, Interleukin-11, 275 7 Intralipid®, 27 Furosemide, 197–198 Intravenous Nursing Society E (INS), xi Irinotecan hydrochloride, 228 Elastomeric reservoirs, 16–17 G Iron, 36 Electrolytes, 29 Iron dextran, 28 Enoxaparin sodium, 166 Ganciclovir sodium, 199–200 Iron sucrose, 229 Epirubicin hydrochloride, Gemcitabine hydrochloride, 201 IV bag, 15 167–168 Gentamicin sulfate, 202–203 Epoetin alfa, 169 Glycopyrrolate, 204 Epoprostenol sodium, 170–171 Granisetron hydrochloride, Ertapenem sodium, 172–173 205–206 J Erythromycin lactobionate, 174 Groshong catheters, xi Joint Commission, The (TJC), 6, 30 Ethanol (catheter lock), 175 Ethanol lock therapy (ELT), 19 Ethyl vinyl acetate (EVA) H K containers, 16 Haloperidol lactate, 207–208 Ketamine hydrochloride, Etoposide, 176–178 Handling tips, 24, 25 230–231 Etoposide phosphate, 179–180 Health and Human Services, Ketorolac tromethamine, Extemporaneous compounding, Department of, 15 232–233 6–7, 29 Heparin, 27, 36 Extended stability, 3 Heparinized saline, xi Extravasation, 8 Heparin lock flush, xi Heparin sodium, 209–211 L Home infusion Labeling instructions, 11 F beyond-use dating Latex allergy, 15 Laws, regulations, 6 Famotidine, 34, 181 considerations, 12–13 Length of therapy, 14 FDAMA (Food and Drug changes in, vii Leucovorin calcium, 234–235 Administration Modernization Hospice infusion, 12–13 Levofloxacin, 236 Act), 5–6 Hydralazine hydrochloride, Light, 24 Fentanyl citrate, 182–184 212 Light protection, 19 Ferric carboxymaltose, 185 Hydrocortisone sodium succinate, Linezolid, 237 Filgrastim, 186 213 Lipid emulsions, 24, 25, 26 Final concentration, 12 Hydromorphone hydrochloride, Liposyn®, 29 Flexible plastic containers, 15, 16 214–215 Long-term care, 13 Floxuridine, 187 Hydroxyzine hydrochloride, 216 Lorazepam, 238–239 Fluconazole, 188–189 Fludarabine phosphate, 190 Fluorouracil, 191–193 I Flush compatibility, xi Ibuprofen, 217 M Folic acid, 35 Ibuprofen LYSINATE, 218 Magnesium, 26 Food, Drug and Cosmetic Act Ifosfamide, 219–220 Manganese, 37 (FDCA), exemptions to, 6 Imipenem–cilastatin sodium, Medicare certification Food and Drug Administration 221–222 requirements, 6 (FDA) Immune globulin (human), Meperidine hydrochloride, 503A compounders, 6 223–225 240–241 PVC cautions, 15 Implanted infusion devices, 17 Meropenem, 242–244 quality assurance, 4 Implanted port, 10 Mesna, 245–246 safety alert on calcium and Incompatibility, 3–4 Methadone hydrochloride, 247 phosphates additions, 27 Independence of chemical Methotrexate sodium, 248–249 syringe cautions, 16 stability, 4 Methylprednisolone sodium Food and Drug Administration Infant patients, 13–14 succinate, 250–251 Modernization Act (FDAMA), Infiltration, 8 Metoclopramide hydrochloride, 5–6 Infliximab, 226 252–253 Formulation factors, 25–29 Inpatient acute care, 12 Metronidazole, 254–255 Foscarnet sodium, 194–195 Instability, 3 Micafungin sodium, 256–257 338 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Index.indd 338 22/05/17 1:54 PM Index EXTENDED STABILITY FOR PARENTERAL DRUGS

Midazolam hydrochloride, Pemetrexed disodium, 285 Standards of practice, 6 258–259 Penicillin G potassium, 286–287 State laws, regulations, 6 Midline catheter, 11 Penicillin G sodium, 288–289 Sterility, 4–5, 12 Milrinone lactate, 260 Pentamidine isethionate, 290–291 Storage Minerals, 28 Peripherally inserted central commercial IV solutions, 15 Mitomycin, 261–262 catheter (PICC), 10 conditions, xi Mitoxantrone hydrochloride, 263 Peripheral short catheter, 11 lipid emulsions, 27 Morphine sulfate, 264–268 Pertuzumab, 292 stability, 19 pH, 8, 24, 27 Subacute care, 13 Phlebitis, chemical, 8 Sufentanil citrate, 302–303 N Piperacillin sodium–tazobactam Sulfites, 24 Nafcillin sodium, 269–271 sodium, 293–294 Syringes, 16 Neonatal patients, 13–14 Polyvinyl chloride (PVC) Non-central vascular access containers, 15–16 device (VAD), 11 Positive displacement catheter T caps, xi Non-formulation factors, 23–25 Tedizolid phosphate, 304 Published studies, 26 Nonsterile ingredients, 7 Telavancin hydrochloride, 305 Temperature O Q lipid emulsions storage, 27 Octreotide acetate, 272 Quality assurance, 4–5 ranges, xi Ondansetron hydrochloride, Quinupristin–dalfopristin, 295 stability effects of, 24 273–274 Therapy, length of, 14 Oprelvekin, 275 Thiamine, 24 Oritavancin diphosphate, 276 R Thiotepa, 306 OSHA regulations, 30 Ranitidine hydrochloride, Ticarcillin disodium–clavulanate Osmolality, 7–8 296–297 potassium, 4 Osmolarity, 7–8 Regulations, state, 6 Tigecycline, 307 Oxacillin sodium, 277–278 Rituximab, 298 Tobramycin sulfate, 308–309 Oxaliplatin, 279 Ropivacaine hydrochloride, Tocilizumab, 310 Oxygen, 24 299–300 Topotecan hydrochloride, 311 Oxytocin, 280 Total Nutrient Admixtures (TNAs), 24 S Trace elements/metals, 26, 28, 29, 38 P Saline, normal (NM), 8 Trastuzumab, 312 Paclitaxel, 281–282 Saline-Administration-Saline- Treprostinil sodium, 313–314 Pantoprazole sodium, 283–284 Heparin (SASH), xi Trimethoprim–sulfamethoxazole, Parenteral administration Sargramostim, 301 135 considerations for selecting Selenium, 38 Trivalent cations, 27 methods and devices Shelf life stability, 3 Tryptophan, 24 length of therapy, 14 Sodium bisulfite, 26 patient/caregiver administration, Sodium chloride, 8, 26 14 Sodium glycerophosphate, 28 patient circumstances, 14 Stability U specific drug delivery systems, beyond-use dates and United States Pharmacopeia 15–18 considerations for, 11 (USP) routes of, 12 container type, material, 12, Chapter 729 Globule Size Parenteral nutrition 15, 16, 24 Distribution in Lipid Injectable drug additives, 29 defined, 3 Emulsions, 30 formulation factors, 25–29 external factors, 18–19 Chapter 797 Pharmaceutical handling, 24, 25 factors affecting, 3 Compounding—Sterile minerals, trace elements, 28 formulation factors, 25–29 Preparations, 5, 7, 11, 30 non-formulation factors, non-formulation factors, Chapter 1206 Sterile Drug 23–25 23–25 Products for Home Use, 5 product factors, 24, 25 published studies summary, quality assurance, 5 Patient education, 19 26 standards, 5 Pediatric patients, 13–14 risk questions, 23 temperature ranges, xi 339 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Index.indd 339 22/05/17 1:54 PM Index EXTENDED STABILITY FOR PARENTERAL DRUGS

Vitamin B1, 40 V Vitamin B2, 41 W Valproate sodium, 315 Vitamin B3, 42 Water, sterile, 8 Vancomycin hydrochloride, Vitamin B5, 42 316–317 Vitamin B6, 43 Vascular access device (VAD), 8–11 Vitamin B12, 43 Z Venous access devices, 9–10 Vitamin C, 24, 25, 44 Ziconotide acetate, 324–326 Vial-bag connectors, 17–18 Vitamin D, 45 Zidovudine, 327 VinBLAStine sulfate, 318–319 Vitamin E, 46 Zinc, 47 VinCRIStine sulfate, 320–321 Vitamin K, 47 Zoledronic acid, 328 Vinorelbine tartrate, 322 Vitamins, 26, 28, 29 Vitamin A, 39 Voriconazole, 323

340 Purchased by [email protected], Anna Cunningham From: ASHP eBooks (digital.ashp.org)

Bing_Index.indd 340 22/05/17 1:54 PM