IV compatibility drug

1. LISA CAYO, PHARMD
Clinical Pharmacist Specialist
Detroit Receiving Hospital
Detroit, Michigan
T
he number of available IV
medications continues to
expand. Many hospitals
have experienced increases
in patient acuity and a rise in
the number of medications
administered to each patient.
This increases the likelihood that
multiple IV medications will need
to be administered concurrently.
Separate IV access sites for drug
administration are not always
practical, and an increase in the
number of sites can increase the
risk for infectious complications.
These factors contribute to the escalating complex-
ity of IV drug administration and have resulted in an
ever-expanding number of possible incompatibilities.
The potential for serious and life-threatening adverse
drug events exists when incompatible medications are
infused together. Therefore, it is important to verify
drug compatibility before coadministration. A clear
and concise compatibility chart can be a useful tool to
help deliver safe, high-quality IV therapy to patients;
in some settings, it is considered a preferred reference
source due to ease of use.
A chance of incompatibility exists whenever any
IV medication is combined with another. A change
in pH is the primary characteristic involved in drug
incompatibilities. However, compatibility depends
on many factors including concentration, tempera-
ture, storage vehicle, order of mixing, and adminis-
tration technique. Incompatibility also can be caused
by excipients in a medication.
Compatibility of
Commonly Used IV Drugs
Text continues on page 8
PRINTER-FRIENDLY VERSION AVAILABLE AT PHARMACYPRACTICENEWS.COM
1
P HARMACY P RACT ICE NE WS • DE CE MB E R 2021
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

2. See KEY on page 8.
Table. Compatibility of Selected IV Drugs (Acetaminophen through Dextrose 5% in water)
Acetaminophen
Acyclovir
Amikacin
Amiodarone
a
Ampicillin
b
Ampicillin-sulbactam
Anidulafungin
Argatroban
Azithromycin
Aztreonam
Bivalirudin
Bumetanide
Calcium
chloride
Calcium
gluconate
Caspofungin
Cefazolin
Cefepime
Ceftaroline
Ceftazidime-avibactam
Ceftolozane-tazobactam
Ceftriaxone
Ciprofloxacin
Cisatracurium
Clindamycin
Daptomycin
Dexmedetomidine
Dextrose
5%
in
water
Acetaminophen I N N N N N N N N N N N N N C N N N N C N N C N N C Acetaminophen
Acyclovir I C I C I C C C I C C C C N C I C N N C I N C I C C Acyclovir
Amikacin N C C N N C C N C C C C C C C C C N C C N C C C C C Amikacin
Amiodaronea
N I C I I C N I N I N C N C N C C N C N C C C C C C Amiodaronea
Ampicillinb
N C N I N C C C N C N N N I N N N N N N N N N C C I Ampicillinb
Ampicillin-sulbactam N I N I N C C C N C N N N I N C N N C N I N N C C A Ampicillin-sulbactam
Anidulafungin N C C C C C C C C C C C C C C C N N C C C C C N C C Anidulafungin
Argatroban N C C N C C C C C C C C C C C I N N N C C C C C C C Argatroban
Azithromycin N C N I C C C C N C C C C N C C C N C N N C N C C C Azithromycin
Aztreonam N I C N N N C C N C C C C C C C N C C C C C C C C C Aztreonam
Bivalirudin N C C I C C C C C C C C C I C C N N N C C C C C C C Bivalirudin
Bumetanide N C C N N N C C C C C C C C C C C N C C N C C C C C Bumetanide
Calcium chloride N C C C N N C C C C C C C C I N C N C I N N C C C C Calcium chloride
Calcium gluconate N C C N N N C C C C C C C C C C C N C I C C C C C C Calcium gluconate
Caspofungin N N C C I I C C N C I C C C I I I N I I C C I C C I Caspofungin
Cefazolin C C C N N N C C C C C C I C I N N N C C N N C C C C Cefazolin
Cefepime N I C C N C C I C C C C N C I N N N C N I N C C C C Cefepime
Ceftaroline N C C C N N N N C N N C C C I N N N C N C C C N N C Ceftaroline
Ceftazidime-avibactam N N N N N N N N N C N N N N N N N N N N N N N C C C Ceftazidime-avibactam
Ceftolozane-tazobactam N N C C N C C N C C N C C C I C C C N C C C N C C C Ceftolozane-tazobactam
Ceftriaxone C C C N N N C C N C C C I I I C N N N C N C I C C C Ceftriaxone
Ciprofloxacin N I N C N I C C N C C N N C C N I C N C N C I C C C Ciprofloxacin
Cisatracurium N N C C N N C C C C C C N C C N N C N C C C C C C C Cisatracurium
Clindamycin C C C C N N C C N C C C C C I C C C N N I I C C C C Clindamycin
Daptomycin N I C C C C N C C C C C C C C C C N C C C C C C C I Daptomycin
Dexmedetomidine N C C C C C C C C C C C C C C C C N C C C C C C C C Dexmedetomidine
Dextrose 5% in water C C C C I A C C C C C C C C I C C C C C C C C C I C Dextrose 5% in water
Diltiazem N N C C N N C C C C C C C C C C I C N C C C C C C C C Diltiazem
Diphenhydramine C N C C I N C C C N C C C C C I I C N C I C C C C C C Diphenhydramine
Dobutamine N I C N I I C C C C N N C N C I N N N C I C C C C C C Dobutamine
Dopamine N I C C N N C C C C C C C C C I N C C C C C C C C C C Dopamine
Doripenem N C C C N N C N C N N C N C C N N C N C N C N N C N C Doripenem
Doxycycline N C C C I I C C C C C C C C C I N N N C C N C C C C C Doxycycline
Epinephrine N I C C N N C C C C C C C C C C N N N C C N C C C C C Epinephrine
Eptifibatide N I C N C C C C C C C C C C N C C N N C C C C C C N N Eptifibatide
Ertapenem N C C I N N I C C C C C C C I N N N C C N C C N C C I Ertapenem
Esmolol C I C C N N C C C C C C C C C C C N N C C I C C C C C Esmolol
Famotidine N C C C N N C C N C N C C C C N I C N C N N C C C C C Famotidine
Fentanyl N C C N N N C C N C C C C C C C N C N C C N C C C C C Fentanyl
Fluconazole N C C C I N C C C C C C C N C C C C N N N C C N C C C Fluconazole
Furosemide N C C N N N C C N C C C C C I C C C C C C I N C C C C Furosemide
Gentamicin C N C C N N C C N C C C C C C C N C C C C C C C C C C Gentamicin
Heparin C C I I N N C C C C C C C C I C C C C C C I N C C C C Heparin
Hydrocortisone C C C I N I C C C C C C N N C C C C N C C N C C N C C Hydrocortisone
MCMAHON PUBLISHING • 2021
2
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

3. Table. Compatibility of Selected IV Drugs (Acetaminophen through Dextrose 5% in water)
Acetaminophen
Acyclovir
Amikacin
Amiodarone
a
Ampicillin
b
Ampicillin-sulbactam
Anidulafungin
Argatroban
Azithromycin
Aztreonam
Bivalirudin
Bumetanide
Calcium
chloride
Calcium
gluconate
Caspofungin
Cefazolin
Cefepime
Ceftaroline
Ceftazidime-avibactam
Ceftolozane-tazobactam
Ceftriaxone
Ciprofloxacin
Cisatracurium
Clindamycin
Daptomycin
Dexmedetomidine
Dextrose
5%
in
water
Hydromorphone C C C C N C C C C C C C C C C N C C N C C C C C C C C Hydromorphone
Imipenem-cilastatin-
relebactam
N C C N N C C N C C N C C C C N N N N C N N C C N C C Imipenem-cilastatin-
relebactam
Insulin, regularc
N C N N N N C C N C C C C C C C C C N C C N C C C C N Insulin, regularc
Ketamine C I C N I N N N N N N N N C N C C N N N N N N C N N C Ketamine
Labetalol C I C C N N C C C C N C C C C N I I N C I C C N C C C Labetalol
Lactated Ringer’s C C C N N C N C C C N C C C N C C C C N I N I C C C C Lactated Ringer’s
Levofloxacin N I C I C C C C N C C C N C C I C C N C C N C C C C C Levofloxacin
Linezolid N C C C C C C C C C C C C C C C C N C C N C C C C C C Linezolid
Lorazepam C C C C I I C C C I N C C C N C C C N C C C C C C C N Lorazepam
Magnesium sulfate C C C N N N I C C C C C I C C N I N C N I I C C C C C Magnesium sulfate
Mannitol C C C C C N C C C C C C C C C C I C N C C N C C C C N Mannitol
Meropenem N N C I N N C C C C C N C N C C N N C C C I N C C C N Meropenem
Meropenem-vaborbactam N N C I N C I N C C N C I C I C C I C C C I C N I C N Meropenem-vaborbactam
Methylprednisolone C C C N N I C C C C C C I I I C C C N C C I N C C C N Methylprednisolone
Metoclopramide C N C C N N C C C C C C C C C C I C N C C C C C C C C Metoclopramide
Metronidazole i C C C C C C C C I C C C C N C C C N C C C C C I C N Metronidazole
Micafungin N N N I N N N N N N N C C C N N N N N C N N I N N N C Micafungin
Midazolam C I C C I I C C I C C N C C C C I C N C C C C N C C C Midazolam
Morphine sulfate C N C C N N C C N C C C C C C C N C N C C N C C C C C Morphine sulfate
Mycophenolate N I C C I I C C I I C C C I C I N N N C I C C I C C C Mycophenolate
Nicardipine N I C C I I C C I C C C C C C C N N N I C C C N C C C Nicardipine
Nitroglycerind
N C C C N N C C C C C C C C C C N N N C C N C C I C C Nitroglycerind
Nitroprussidee
N I C N N N C C C C C C C C I C N N N C C N N C C C C Nitroprussidee
Norepinephrine N N C N N N C C N C C C C C C C N C C C C C C C C C C Norepinephrine
Octreotide N C C C C C C C C C C C C C C C C N N C C C C C C C C Octreotide
Ondansetron C I C C I I C C C C C C C C C C I C N C N C C C C C C Ondansetron
Pantoprazole N N N N C C C C C I N C I N N N I C N C C I I N I I C Pantoprazole
Penicillin G N C C C C N N N N C N C C C N C N N N C C N N C N N C Penicillin G
Phenylephrine N I C C N N C C C C C C C C C C N N C C C N C C C C C Phenylephrine
Phenytoin I I I I I I I I I I I I I I I I I N N I I I N I I I I Phenytoin
Piperacillin-tazobactam C I C I N N C C N C C C C C I N C N N C N I N C C C C Piperacillin-tazobactam
Potassium chloride C C C N N N C C N C C C C C C C C C C C C C C C C C C Potassium chloride
Potassium phosphate N I N I N N I C C N C N I I I N N I C C N I N N C C C Potassium phosphate
Propofol I C I N C N N N N C N C I C N C N C N I C I N C N C C Propofol
Sodium bicarbonate N C C I N N I C C C C C I I I C C C C C C N N C C C C Sodium bicarbonate
Sodium chloride 0.9% C C C N C C C C C C C C C C C C C C C C C C C C C C C Sodium chloride 0.9%
Tacrolimus N I C C N N C C C C C C C C C C I N N C C C C C C C C Tacrolimus
Tirofiban N C C C C C C C C C C C C C C C C N N N C C C C C C C Tirofiban
Tobramycin N C C C N N C C N C C C C C C I N C C C I C C C C C C Tobramycin
TMP-SMX N C I I I I C C C N C I I I I I C C N N I N N I C C N TMP-SMX
Vancomycin C C C C N N C C C N I C C C C N N N N N N C C C I C C Vancomycin
Vasopressin N C C C N N C C C C C C C C C C C C C C C C C C C C C Vasopressin
Vecuronium N I C C C C C C C C C C C C C C I N C C C C N C C C C Vecuronium
Voriconazole N C C C C C C C C C C C C C C C I C N N C C C C C C C Voriconazole
a
Infusions exceeding 2 hours must be administered in glass or polyolefin containers. b
Unstable in solutions containing dextrose.
c
Adsorbs to containers, tubing, and filters with which it comes into contact. d
Use non-PVC containers (eg, polyolefin or glass). e
Protect from light.
P HARMACY P RACT ICE NE WS • DE CE MB E R 2 021 3
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

4. See KEY on page 8.
Table. Compatibility of Selected IV Drugs (Diltiazem through Metoclopramide)
Diltiazem
Diphenhydramine
Dobutamine
Dopamine
Doripenem
Doxycycline
Epinephrine
Eptifibatide
Ertapenem
Esmolol
Famotidine
Fentanyl
Fluconazole
Furosemide
Gentamicin
Heparin
Hydrocortisone
Hydromorphone
Imipenem-cilastatin-relebactam
Insulin,
regular
c
Ketamine
Labetalol
Lactated
Ringer’s
Levofloxacin
Linezolid
Lorazepam
Magnesium
sulfate
Mannitol
Meropenem
Meropenem-vaborbactam
Methylprednisolone
sod.
succ.
Metoclopramide
Acetaminophen N C N N N N N N N C N N N N C C C C N N C C C N N C C C N N C C Acetaminophen
Acyclovir N N I I C C I I C I C C C C N C C C C C I I C I C C C C N N C N Acyclovir
Amikacin C C C C C C C C C C C C C C C I C C C N C C C C C C C C C C C C Amikacin
Amiodaronea
C C N C C C C N I C C N C N C I I C N N N C N I C C N C I I N C Amiodaronea
Ampicillinb
N I I N N I N C N N N N I N N N N N N N I N N C C I N C N N N N Ampicillinb
Ampicillin-sulbactam N N I N N I N C N N N N N N N N I C C N N N C C C I N N N C I N Ampicillin-sulbactam
Anidulafungin C C C C C C C C I C C C C C C C C C C C N C N C C C I C C I C C Anidulafungin
Argatroban C C C C N C C C C C C C C C C C C C N C N C C C C C C C C N C C Argatroban
Azithromycin C C C C C C C C C C N N C N N C C C C N N C C N C C C C C C C C Azithromycin
Aztreonam C N C C N C C C C C C C C C C C C C C C N C C C C I C C C C C C Aztreonam
Bivalirudin C C N C N C C C C C N C C C C C C C N C N N N C C N C C C N C C Bivalirudin
Bumetanide C C N C C C C C C C C C C C C C C C C C N C C C C C C C N C C C Bumetanide
Calcium chloride C C C C N C C C C C C C C C C C N C C C N C C N C C I C C I I C Calcium chloride
Calcium gluconate C C N C C C C C C C C C N C C C N C C C C C C C C C C C N C I C Calcium gluconate
Caspofungin C C C C C C C N I C C C C I C I C C C C N C N C C N C C C I I C Caspofungin
Cefazolin C I I I N I C C N C N C C C C C C N N C C N C I C C N C C C C C Cefazolin
Cefepime I I N N N N N C N C I N C C N C C C N C C I C C C C I I N C C I Cefepime
Ceftaroline C C N C C N N N N N C C C C C C C C N C N I C C N C N C N I C C Ceftaroline
Ceftazidime-avibactam N N N C N N N N C N N N N C C C N N N N N N C N C N C N C C N N Ceftazidime-avi...
Ceftolozane-tazobactam C C C C C C C C C C C C N C C C C C C C N C N C C C N C C C C C Ceftolozane-tazo...
Ceftriaxone C I I C N C C C N C N C N C C C C C N C N I I C N C I C C C C C Ceftriaxone
Ciprofloxacin C C C C C N N C C I N N C I C I N C N N N C N N C C I N I I I C Ciprofloxacin
Cisatracurium C C C C N C C C C C C C C N C N C C C C N C I C C C C C N C N C Cisatracurium
Clindamycin C C C C N C C C N C C C N C C C C C C C C N C C C C C C C N C C Clindamycin
Daptomycin C C C C C C C C C C C C C C C C N C N C N C C C C C C C C I C C Daptomycin
Dexmedetomidine C C C C N C C N C C C C C C C C C C C C N C C C C C C C C C C C Dexmedetomidine
Dextrose 5% in water C C C C C C C N I C C C C C C C C C C N C C C C C N C N N N N C Dextrose 5% in ...
Diltiazem C C C C C C C C C C C C I C N N C C N N C N C C C C C C C N C Diltiazem
Diphenhydramine C C C C C C C C C C C C I C N N C C I C C C C C C C C C I I C Diphenhydramine
Dobutamine C C C C C C C I C C C C N C N I C C N C C C C C C C C N I C C Dobutamine
Dopamine C C C C C C C C C C C C N C C C C C N C C C C C C C C C C C C Dopamine
Doripenem C C C C N N N N C C C C C C C C C N C N C N C C C C C N C C C Doripenem
Doxycycline C C C C N C C C C C C C I C I I C C C N C C C C C C C N C I C Doxycycline
Epinephrine C C C C N C C C C C C C C C C C C C N C C C C C C C C C C C C Epinephrine
Eptifibatide C C C C N C C C C C C C I C C C C C N N C N C C C C C C C C C Eptifibatide
Ertapenem C C I C N C C C C C N C C C C C C N C N C C C C C C C C C C C Ertapenem
Esmolol C C C C C C C C C C C C I C C N C C C N C C C C C C C C C N C Esmolol
Famotidine C C C C C C C C C C C C N C C C C C N N C C C C C C C N C N C Famotidine
Fentanyl C C C C C C C C N C C C C C C C C C C N C C C C C C C C C C C Fentanyl
Fluconazole C C C C C C C C C C C C N C C C C C C N C C C C C C C C N C C Fluconazole
Furosemide I I N N C I C I C I N C N N C C C C N I N C I C C N C C C C N Furosemide
Gentamicin C C C C C C C C C C C C C N N N C C N C C C C C C C C C C C C Gentamicin
Heparin N N N C C I C C C C C C C C N C C C C I N N I C C C C C C N C Heparin
Hydrocortisone N N I C C I C C C N C C C C N C C C C C I C C C C N C C C N C Hydrocortisone
Hydromorphone C C C C C C C C C C C C C C C C C N C N C C C C C C C C C C C Hydromorphone
MCMAHON PUBLISHING • 2021
4
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

5. Table. Compatibility of Selected IV Drugs (Diltiazem through Metoclopramide)
Diltiazem
Diphenhydramine
Dobutamine
Dopamine
Doripenem
Doxycycline
Epinephrine
Eptifibatide
Ertapenem
Esmolol
Famotidine
Fentanyl
Fluconazole
Furosemide
Gentamicin
Heparin
Hydrocortisone
Hydromorphone
Imipenem-cilastatin-relebactam
Insulin,
regular
c
Ketamine
Labetalol
Lactated
Ringer’s
Levofloxacin
Linezolid
Lorazepam
Magnesium
sulfate
Mannitol
Meropenem
Meropenem-vaborbactam
Methylprednisolone
sod.
succ.
Metoclopramide
Imipenem-cilastatin-
relebactam
C C C C N C C C N C C C C C C C C N C N C N C C N C N N N C C Imipenem-cilastatin-
relebactam
Insulin, regularc
N I N N C C N N C C N C C N N C C C C I I C N C C C C C C C C Insulin, regularc
Ketamine N C C C N N C N N N N N N I C I C N N I N I N N N C N I N N N Ketamine
Labetalol C C C C C C C C C C C C C N C N I C C I N C C C C C C C C C C Labetalol
Lactated Ringer’s N C C C N C C N C C C C C C C N C C N C I C C C N C N N N N C Lactated Ringer’s
Levofloxacin C C C C C C C C C C C C C I C I C C C N N C C C N N C N C C C Levofloxacin
Linezolid C C C C C C C C C C C C C C C C C C C C N C C C C C C C C N C Linezolid
Lorazepam C C C C C C C C C C C C C C C C C C N C N C N N C C C C C C C Lorazepam
Magnesium sulfate C C C C C C C C C C C C C N C C N C C C C C C N C C C C C I C Magnesium sulfate
Mannitol C C C C C C C C C C C C C C C C C C N C N C N C C C C C C C C Mannitol
Meropenem C C N C N N C C C C N C C C C C C C N C I C N N C C C C N C C Meropenem
Meropenem-vaborbactam C I I C C C C C C C C C N C C C C C N C N C N C C C C C N C C Meropenem-vabor...
Methylprednisolone N I C C C I C C C N N C C C C N N C C C N C N C N C I C C C C Methylprednisolone
Metoclopramide C C C C C C C C C C C C C N C C C C C C N C C C C C C C C C C Metoclopramide
Metronidazole C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C Metronidazole
Micafungin I N I C C N I C N C N N N C N C N C C I N I C I N C C N N C N N Micafungin
Midazolam C C N C C C C C I C C C C N C C N C C N C C N C C C C C I I N C Midazolam
Morphine sulfate C C C C C C C C C C C C C N C C C C C N C C C C C C C C C C C C Morphine sulfate
Mycophenolate C C C C N C C I N C C C C I C I I C N C N C N C C C C C I N I C Mycophenolate
Nicardipine C C C C N C C C I C C C C I C N N C N N N C N C C N C C I I N C Nicardipine
Nitroglycerind
C C C C N C C C C C C C C N C C C C C C N C N I C C C C I C C C Nitroglycerind
Nitroprussidee
C I N C N C C C C C C C C C C C C C N C N C C I C C C C C N C C Nitroprussidee
Norepinephrine C C C C C C C N C C C C C N C C C C C N N C C C C C C C C C C C Norepinephrine
Octreotide C C C C N C C C C C C C C C C C C C N C N C C C C C C C C C C C Octreotide
Ondansetron C C C C C C C C I C C C C I C C C C C N N C C C C I C C N I N C Ondansetron
Pantoprazole I I I N C C N N C I I I I N N N N N C N N I C I I I N N N C I N Pantoprazole
Penicillin G C C I C N I C N N C C C C C C C C C N C C N C N N N C C N C C C Penicillin G
Phenylephrine C C C C C C C C C C C C C N C C C C C I N C C C C C C C N C C C Phenylephrine
Phenytoin I I I I N I I I I N N I N I I I I I I I I I I I I I I I I I I I Phenytoin
Piperacillin-tazobactam I C I C N I C C N C I C C C N C C C N I C I N I C C C C C C C C Piperacillin-tazo...
Potassium chloride C C C C C C C C C C C C C C C C C C N C C C C C C C C C C C N C Potassium chloride
Potassium phosphate C N I N I N N C C C C N N I N N N C C N I C I N C I N N I C N C Potassium ...
Propofol N C N N I C N N N C C C C C I C C C N C C C N I N C N C N N I I Propofol
Sodium bicarbonate N I I I C I I C C C C C C C C C C I N C I N N C C C C C C C C C Sodium bicarbonate
Sodium chloride 0.9% C C C C C C C C C C C C C C C C C C C C C C N C C N C N N C C C Sodium chloride ...
Tacrolimus C C C C C C C N C C C C C N C C C C N C N C N C C C C C C N C C Tacrolimus
Tirofiban C C C C N C C C C C C C C C C C C C N C N C N C C C C C C N C C Tirofiban
Tobramycin C C C C C C C C C C C C C C C I N C C N C C C C C C C C C C C C Tobramycin
TMP-SMX C I I I N I I C C N I I I I I I I C N I I N N C N C N I C N I I TMP-SMX
Vancomycin C C C C C C C C C C C C C I C I N C C C N C C C C C C C N C N C Vancomycin
Vasopressin C C C C N C C N C C C C C N C C C C C N N C C C C C C C C C C C Vasopressin
Vecuronium C C C C N C C C C C C C C I C C C C N C N C C C C C C C C C I C Vecuronium
Voriconazole C C C C C C C N C C C C C C C C C N C C N C C C C C C C C N C C Voriconazole
a
Infusions exceeding 2 hours must be administered in glass or polyolefin containers. b
Unstable in solutions containing dextrose.
c
Adsorbs to containers, tubing, and filters with which it comes into contact. d
Use non-PVC containers (eg, polyolefin or glass). e
Protect from light.
P HARMACY P RACT ICE NE WS • DE CE MB E R 2 021 5
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

6. See KEY on page 8.
Table. Compatibility of Selected IV Drugs (Metronidazole through Voriconazole)
Metronidazole
Micafungin
Midazolam
Morphine
sulfate
Mycophenolate
Nicardipine
Nitroglycerin
d
Nitroprusside
e
Norepinephrine
Octreotide
Ondansetron
Pantoprazole
Penicillin
G
potassium
Phenylephrine
Phenytoin
Piperacillin-tazobactam
Potassium
chloride
Potassium
phosphate
Propofol
Sodium
bicarbonate
Sodium
chloride
0.9%
Tacrolimus
Tirofiban
Tobramycin
TMP-SMX
Vancomycin
Vasopressin
Vecuronium
Voriconazole
Acetaminophen I N C C N N N N N N C N N N I C C N I N C N N N N C N N N Acetaminophen
Acyclovir C N I N I I C I N C I N C I I I C I C C C I C C C C C I C Acyclovir
Amikacin C N C C C C C C C C C N C C I C C N I C C C C C I C C C C Amikacin
Amiodaronea
C I C C C C C N N C C N C C I I N I N I N C C C I C C C C Amiodaronea
Ampicillinb
C N I N I I N N N C I C C N I N N N C N C N C N I N N C C Ampicillinb
Ampicillin-sulbactam C N I N I I N N N C I C N N I N N N N N C N C N I N N C C Ampicillin-sulbactam
Anidulafungin C N C C C C C C C C C C N C I C C I N I C C C C C C C C C Anidulafungin
Argatroban C N C C C C C C C C C C N C I C C C N C C C C C C C C C C Argatroban
Azithromycin C N I N I I C C N C C C N C I N N C N C C C C N C C C C C Azithromycin
Aztreonam I N C C I C C C C C C I C C I C C N C C C C C C N N C C C Aztreonam
Bivalirudin C N C C C C C C C C C N N C I C C C N C C C C C C I C C C Bivalirudin
Bumetanide C C N C C C C C C C C C C C I C C N C C C C C C I C C C C Bumetanide
Calcium chloride C C C C C C C C C C C I C C I C C I I I C C C C I C C C C Calcium chloride
Calcium gluconate C C C C I C C C C C C N C C I C C I C I C C C C I C C C C Calcium gluconate
Caspofungin N N C C C C C I C C C N N C I I C I N I C C C C I C C C C Caspofungin
Cefazolin C N C C I C C C C C C N C C I N C N C C C C C I I N C C C Cefazolin
Cefepime C N I N N N N N N C I I N N I C C N N C C I C N C N C I I Cefepime
Ceftaroline C N C C N N N N C N C C N N N N C I C C C N N C C N C N C Ceftaroline
Ceftazidime-avibactam N N N N N N N N C N N N N C N N C C N C C N N C N N C C N Ceftazidime-avibactam
Ceftolozane-tazobactam C C C C C I C C C C C C C C I C C C I C C C N C N N C C N Ceftolozane-tazobactam
Ceftriaxone C N C C I C C C C C N C C C I N C N C C C C C I I N C C C Ceftriaxone
Ciprofloxacin C N C N C C N N C C C I N N I I C I I N C C C C N C C C C Ciprofloxacin
Cisatracurium C I C C C C C N C C C I N C N N C N N N C C C C N C C N C Cisatracurium
Clindamycin C N N C I N C C C C C N C C I C C N C C C C C C I C C C C Clindamycin
Daptomycin I N C C C C I C C C C I N C I C C C N C C C C C C I C C C Daptomycin
Dexmedetomidine C N C C C C C C C C C I N C I C C C C C C C C C C C C C C Dexmedetomidine
Dextrose 5% in water N C C C C C C C C C C C C C I C C C C C C C C C N C C C C Dextrose 5% in water
Diltiazem C I C C C C C C C C C I C C I I C C N N C C C C C C C C C Diltiazem
Diphenhydramine C N C C C C C I C C C I C C I C C N C I C C C C I C C C C Diphenhydramine
Dobutamine C I N C C C C N C C C I I C I I C I N I C C C C I C C C C Dobutamine
Dopamine C C C C C C C C C C C N C C I C C N N I C C C C I C C C C Dopamine
Doripenem C C C C N N N N C N C C N C N N C I I C C C N C N C N N C Doripenem
Doxycycline C N C C C C C C C C C C I C I I C N C I C C C C I C C C C Doxycycline
Epinephrine C I C C C C C C C C C N C C I C C N N I C C C C I C C C C Epinephrine
Eptifibatide C C C C I C C C N C C N N C I C C C N C C N C C C C N C N Eptifibatide
Ertapenem C N I C N I C C C C I C N C I N C C N C C C C C C C C C C Ertapenem
Esmolol C C C C C C C C C C C I C C N C C C C C C C C C N C C C C Esmolol
Famotidine C N C C C C C C C C C I C C N I C C C C C C C C I C C C C Famotidine
Fentanyl C N C C C C C C C C C I C C I C C N C C C C C C I C C C C Fentanyl
Fluconazole C N C C C C C C C C C I C C N C C N C C C C C C I C C C C Fluconazole
Furosemide C C N N I I N C N C I N C N I C C I C C C N C C I I N I C Furosemide
Gentamicin C N C C C C C C C C C N C C I N C N I C C C C C I C C C C Gentamicin
Heparin C C C C I N C C C C C N C C I C C N C C C C C I I I C C C Heparin
Hydrocortisone C N N C I N C C C C C N C C I C C N C C C C C N I N C C C Hydrocortisone
Hydromorphone C C C C C C C C C C C N C C I C C C C I C C C C C C C C N Hydromorphone
MCMAHON PUBLISHING • 2021
6
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

7. Table. Compatibility of Selected IV Drugs (Metronidazole through Voriconazole)
Metronidazole
Micafungin
Midazolam
Morphine
sulfate
Mycophenolate
Nicardipine
Nitroglycerin
d
Nitroprusside
e
Norepinephrine
Octreotide
Ondansetron
Pantoprazole
Penicillin
G
potassium
Phenylephrine
Phenytoin
Piperacillin-tazobactam
Potassium
chloride
Potassium
phosphate
Propofol
Sodium
bicarbonate
Sodium
chloride
0.9%
Tacrolimus
Tirofiban
Tobramycin
TMP-SMX
Vancomycin
Vasopressin
Vecuronium
Voriconazole
Imipenem-cilastatin-
relebactam
C C C C N N C N C N C C N C I N N C N N C N N C N C C N C Imipenem-cilastatin-
relebactam
Insulin, regularc
C I N N C N C C N C N N C I I I C N C C C C C N I C N C C Insulin, regularc
Ketamine C N C C N N N N N N N N C N I C C I C I C N N C I N N N N Ketamine
Labetalol C I C C C C C C C C C I N C I I C C C N C C C C N C C C C Labetalol
Lactated Ringer’s C C N C N N N C C C C C C C I N C I N N N N N C N C C C C Lactated Ringer’s
Levofloxacin C I C C C C I I C C C I N C I I C N I C C C C C C C C C C Levofloxacin
Linezolid C N C C C C C C C C C I N C I C C C N C C C C C N C C C C Linezolid
Lorazepam C C C C C N C C C C I I N C I C C I C C N C C C C C C C C Lorazepam
Magnesium sulfate C C C C C C C C C C C N C C I C C N N C C C C C N C C C C Magnesium sulfate
Mannitol C N C C C C C C C C C N C C I C C N C C N C C C I C C C C Mannitol
Meropenem C N I C I I I C C C N N N N I C C I N C N C C C C N C C C Meropenem
Meropenem-vaborbactam C C I C N I C N C C I C C C I C C C N C C N N C N C C C N Meropenem-vaborbactam
Methylprednisolone C N N C I N C C C C N I C C I C N N I C C C C C I N C I C Methylprednisolone
Metoclopramide C N C C C C C C C C C N C C I C C C I C C C C C I C C C C Metoclopramide
Metronidazole N C C C C C C C C C I N C I C C C I C N C C C C C C C C Metronidazole
Micafungin N I I I I C C C I I N N C I N C C N N C C N N N N C I N Micafungin
Midazolam C I C C C C C C C C N C C I I C C N I C C C C I C C C C Midazolam
Morphine sulfate C I C C C C C C C C N C C I C C N N C C C C C N C C C C Morphine sulfate
Mycophenolate C I C C C C I C C C I N C I I C I N I N C C C I C C C C Mycophenolate
Nicardipine C I C C C C C C C C I C C I I C N N I C C C C N C C C C Nicardipine
Nitroglycerind
C C C C C C C C C C N C C I C C N C C C C C C I C C C C Nitroglycerind
Nitroprussidee
C C C C I C C C C C N C C I C C C C C C C C C I C C C I Nitroprussidee
Norepinephrine C C C C C C C C C C N C C I C C N C I C C C C I C C C C Norepinephrine
Octreotide C I C C C C C C C C N N C I C C C N C C C C C C C C C C Octreotide
Ondansetron C I C C C C C C C C I C C I C C C N I C C C C I C C C C Ondansetron
Pantoprazole I N N N I I N N N N I N C I N C I N N C N C N N N C I I Pantoprazole
Penicillin G N N C C N C C C C N C N C I N C N N N C C N C I N C N N Penicillin G
Phenylephrine C C C C C C C C C C C C C I C C N N C C C C C I C C C C Phenylephrine
Phenytoin I I I I I I I I I I I I I I I I N I I N I I I I I I I I Phenytoin
Piperacillin-tazobactam C N I C I I C C C C C N N C I C C N C C C C I C N C I C Piperacillin-tazobactam
Potassium chloride C C C C C C C C C C C C C C I C N C C C C C C I C C C C Potassium chloride
Potassium phosphate C C C N I N N C N C C I N N N C N N N C C C N N N C C C Potassium phosphate
Propofol I N N N N N C C C N N N N N I N C N C N N N I N N N N N Propofol
Sodium bicarbonate C N I C I I C C I C I N N C I C C N C C C C C I C C C N Sodium bicarbonate
Sodium chloride 0.9% N C C C N C C C C C C C C C N C C C N C C C C N C C C C Sodium chloride 0.9%
Tacrolimus C C C C C C C C C C C N C C I C C C N C C C C N C C C C Tacrolimus
Tirofiban C N C C C C C C C C C C N C I C C C N C C C C C C C C C Tirofiban
Tobramycin C N C C C C C C C C C N C C I I C N I C C C C I C C C C Tobramycin
TMP-SMX C N I N I N I I I C I N I I I C I N N I N N C I I N C C TMP-SMX
Vancomycin C N C C C C C C C C C N N C I N C N N C C C C C I C C C Vancomycin
Vasopressin C C C C C C C C C C C C C C I C C C N C C C C C N C C C Vasopressin
Vecuronium C I C C C C C C C C C I N C I I C C N C C C C C C C C C Vecuronium
Voriconazole C N C C C C C I C C C I N C I C C C N N C C C C C C C C Voriconazole
a
Infusions exceeding 2 hours must be administered in glass or polyolefin containers. b
Unstable in solutions containing dextrose.
c
Adsorbs to containers, tubing, and filters with which it comes into contact. d
Use non-PVC containers (eg, polyolefin or glass). e
Protect from light.
P HARMACY P RACT ICE NE WS • DE CE MB E R 2 021 7
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.

8. Three types of incompatibilities are commonly dis-
cussed: physical, chemical, and therapeutic. Physical
incompatibilities are the most easily detected and are
evidenced by visible changes, such as particulate for-
mation, haze, precipitation, color change, and gas evo-
lution. Chemical incompatibilities are those that result
in decomposition of a drug. Loss of potency of greater
than 10% over the defined testing period is considered
chemical incompatibility. Most chemical incompati-
bilities can be detected only with a suitable analyti-
cal method. Therapeutic incompatibilities, in which a
drug combination results in undesirable antagonistic
or synergistic pharmacologic activity, are beyond the
scope of most compatibility references.
The purpose of this chart is to provide concise,
easily accessible, Y-site compatibility data. Although
there are differing types of incompatibilities, the type
of incompatibility or compatibility is not specified in
this chart. A designation of “compatible” indicates
that the combination evaluated appears to be com-
patible based on the tests performed, whether these
tests measured physical, chemical, or both types of
compatibility. All conditions that may affect compat-
ibility cannot be included in such a format, and it is
not possible to predict all incompatibilities that may
arise, but it is hoped that the information provided
may help clinicians minimize their occurrence. Con-
tinuing research adding to the existing body of knowl-
edge on IV compatibilities is vital.
Suggested Reading
Allen LV Jr. Intravenous admixture preparation considerations,
part 2: incompatibilities and factors involved. Int J Pharm Compd.
2020;24(1):44-50.
Allen LV Jr. Intravenous admixture preparation considerations, part 3:
methods and techniques to decrease incompatibilities. Int J Pharm
Compd. 2020;24(2)121-126.
American Society of Health-System Pharmacists. ASHP Injectable
Drug Information. 2021 Edition. 2021.
Bertsche T, Mayer Y, Stahl R, et al. Prevention of intravenous drug
incompatibilities in an intensive care unit. Am J Health Syst Pharm.
2008;65(19):1834-1840.
Cohen MR, Smetzer JL. ISMP medication error report analysis–drug
stability and compatibility; proper use of single-dose vials; what drugs
are present on nursing units?; Arixtra–not a hemostat; Pradaxa-Plavix
mix-up. Hosp Pharm. 2012;47(8):578-582.
Foushee J, Meredith P, Fox L, et al. Y-site physical compatibility of
hydrocortisone continuous infusions with admixtures used in critically
ill patients. Am J Health Syst Pharm. 2020;77(14):1144-1148.
Kanji S, Lam J, Johanson C, et al. Systematic review of physical and
chemical compatibility of commonly used medications adminis-
tered by continuous infusion in intensive care units. Crit Care Med.
2010;38(9):1890-1898.
Lessard JJ, Caron E, Scherer H, et al. Compatibility of Y-site injection
of meropenem trihydrate with 101 other injectable drugs. Hosp Pharm.
2020;55(5):332-337.
Lexicomp Wolters Kluwer. Trissels 2 Clinical Pharmaceutics
Database. Accessed September 2021. www.wolterskluwer.com/
en/solutions/lexicomp/resources/lexicomp-user-academy/
trissels-iv-compatibility-databases
Newton DW. Crux of drug compatibility and incompatibility.
Am J Health Syst Pharm. 2010;67(2):108-112.
Odulyale MS, Patel N, Borthwick M, et al. Co-administration of multiple
intravenous medicines: intensive care nurses’ views and perspectives.
Nurs Crit Care. 2020;25(3):156-164.
Vallee M, Barthelemy I, Friciu M, et al. Compatibility of lactated Ringer’s
injection with 94 selected intravenous drugs during simulated Y-site
administration. Hosp Pharm. 2021;56(4):228-234.
A = Physically compatible for at least 2 hours
C = Physically compatible
I = Incompatible
N = Information on compatibility is not available or not adequate
KEY
Text continued from page 1
8 MCMAHON PUBLISHING • 2021
C
o
p
y
r
i
g
h
t
©
2
0
2
1
M
c
M
a
h
o
n
P
u
b
l
i
s
h
i
n
g
G
r
o
u
p
u
n
l
e
s
s
o
t
h
e
r
w
i
s
e
n
o
t
e
d
.
A
l
l
r
i
g
h
t
s
r
e
s
e
r
v
e
d
.
R
e
p
r
o
d
u
c
t
i
o
n
i
n
w
h
o
l
e
o
r
i
n
p
a
r
t
w
i
t
h
o
u
t
p
e
r
m
i
s
s
i
o
n
i
s
p
r
o
h
i
b
i
t
e
d
.