Co-Administration of Drugs and Parenteral Nutrition: In Vitro Compatibility Studies of Loop Diuretics for Safer Clinical Practice

Abstract

Parenteral nutrition (PN) admixtures are prone to interacting with drugs administered intravenously via a common catheter. This may cause a threat to a patient's health and life. The literature that has been reported on the compatibility of loop diuretics with PN presents conflicting results. This work aimed to study the compatibility of furosemide and torsemide with PN used in clinical practice. Undiluted solutions of drugs were mixed with PN at various ratios determined by flow rates. In order to assess compatibility, visual control was followed by pH measurement, osmolality, mean emulsion droplet diameter (MDD), and zeta potential upon mixing and at 4 h of storage. No macroscopic changes that indicated lipid emulsion degradation were observed. After the addition of the drugs, the value of pH ranged from 6.37 ± 0.01 to 7.38 ± 0.01. The zeta potential was in reverse proportion to the drug concentration. The addition of the drugs did not affect the MDD. It may be suggested that the co-administration of furosemide or torsemide and PN caused no interaction. The absence of such signs of unwanted interactions allowed for the co-administration of the mentioned loop diuretics and PN at each of the studied ratios.

Keywords: Y-site administration; compatibility; drug interactions; loop diuretics; parenteral nutrition.

Figure 1

Calculation of the sample preparation.

Figure 2

The pH values of drug–PN samples upon preparation and 4 h later (black and red signs), and PN upon preparation (gray bars). The upper part refers to FUR:PN samples in three different ratios, whereas the down part refers to TOR:PN samples in two ratios. FUR, furosemide; PN, parenteral nutrition admixture; TOR, torsemide; Blank, PN without drug.

Figure 3

The zeta potential values of drug–PN samples upon preparation and 4 h later (black and red signs), and PN upon preparation (blue signs). The upper part refers to FUR:PN samples in three different ratios, whereas the down part refers to TOR:PN samples in two ratios. FUR, furosemide; PN, parenteral nutrition admixture; TOR, torsemide; Blank, PN without drug.

Figure 4

The osmolality of drug–PN samples upon preparation and 4 h later (black and red signs), and PN upon preparation (gray signs). The upper part refers to FUR:PN samples in three different ratios, whereas the down part refers to TOR:PN samples in two ratios. FUR, furosemide; PN, parenteral nutrition admixture; TOR, torsemide; Blank, PN without drug.