PRINTER-FRIENDLY VERSION AT PHARMACYPRACTICENEWS.

COM

Compatibility of
A

Commonly Used
Intravenous
Drugs

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LISA CAYO, PHARMD

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Clinical Pharmacy Coordinator

Garden City Hospital
Garden City, Michigan

he number of available IV

medications continues to expand.

In addition, many institutions

have observed an increase in patient

acuity, as well as a rise in the number of

medications administered to each patient.
These factors have resulted in a seemingly
endless number of possible combinations
of IV medications and, along with these
combinations, potential incompatibilities.

compatibility information for dozens of commonly

used drugs. The purpose of this chart is to provide data
in an organized, concise format so that compatibility
information can be accessed quickly and conveniently.
A clear and concise compatibility chart can be a useful tool in helping health care professionals deliver safe,
high-quality IV therapy to patients. Obviously, all conditions that may affect compatibility cannot be included in such a format; however, the importance of these
factors should not be overlooked.

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A chance of incompatibility exists whenever one

or more medications are combined or added to an IV
fluid. It is important to recognize that compatibility is
not just a function of the drugs themselves, but also is
dependent upon a variety of factors, including concentration, temperature, storage vehicle, infusion solution,
order of mixing, and administration technique. Compatibility differences have been reported for different
brands of the same drug.
The table on the following pages provides

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Acyclovir

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Amikacin

Gentamicin

Argatroban

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Bumetanide

Calcium gluconate

Cefazolin

Cefepime

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Cefotaxime

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Cefotetan

Ceftazidime

Ceftizoxime

Ceftriaxone

Ciprofloxacin

Clindamycin

Dexamethasone

D5W

Diazepam

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Bivalirudin

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N

N
C

Diltiazem

Diphenhydramine

Dobutamine

Dolasetron

Dopamine

Doripenem

Doxycycline

Enalaprilat

Epinephrine

Eptifibatide

Esmolol

Esomeprazole

Famotidine

Fentanyl

Fluconazole

Furosemide

Gatifloxacin

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N

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C

Testing was performed with ethylenediaminetetra-acetic acid (EDTA)-containing formulation.

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KEY
A = Physically compatible for at least 2 hours
C = Physically compatible

I = Incompatible
N = Information on compatibility is not available or conflicting

E = Physically compatible for at least 2 minutes

G = Physically compatible in glass bottle only
H = Physically compatible for at least 1 hour

Gatifloxacin

C
C

Ampicillin-sulbactam

Furosemide

Fluconazole

Fentanyl

Famotidine

Esomeprazole

Esmolol

Eptifibatide

Epinephrine

Enalaprilat

Doxycycline

Doripenem

Dopamine

Dolasetron

Dobutamine

Diphenhydramine

Diltiazem

Diazepam

Dextrose 5% in water

Dexamethasone

Clindamycin

Ciprofloxacin

Ceftriaxone

Ceftizoxime

Ceftazidime

Cefotetan

Cefotaxime

Cefepime

Cefazolin

Calcium gluconate

Bumetanide

Bivalirudin

Aztreonam

I
N

Aztreonam

Azithromycin

C
I

Azithromycin

Argatroban

Ampicillin-sulbactam

Ampicillin

Ampicillin

(continued)

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Amiodarone

Amiodarone

Amikacin

Acyclovir

Table. Compatibility of Selected IV Drugs

R = Physically compatible for 24 hours under refrigeration

S = Physically compatible in 0.9% sodium chloride

I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G

I
I

I
C

Morphine sulfate

Nafcillin

Nitroglycerin

Nitroprusside

Acyclovir

Amikacin

Amiodarone

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Phenytoin

Phenylephrine

Pantoprazolea
N

Ondansetron
I

Norepinephrine
N

Heparin

Vasopressin

Midazolam

Vancomycin

Metronidazole

TMP-SMX

Metoclopramide

Tobramycin

Methylprednisolone sod. Succ.

Tigecycline

Meropenem

Ticarcillin-clavulanate

Mannitol

Sodium chloride 0.9%

Magnesium sulfate

Sodium bicarbonate

Lorazepam

Ringers, lactated

Linezolid

Propofol

Levofloxacin

Prochlorperazine

Labetalol

Potassium chloride

Insulin, regular

Piperacillin-tazobactam

Imipenem-cilastatin

Penicillin G Potassium

Hydromorphone

Granisetron

Hydrocortisone Sod. Succ.

Co

Ampicillin

Ampicillin-sulbactam

Argatroban

Azithromycin

Aztreonam

Bivalirudin

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Bumetanide

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Calcium gluconate

Cefazolin

Cefepime

Cefotaxime

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Cefotetan

Ceftazidime

Ceftizoxime

Ceftriaxone

Ciprofloxacin

Clindamycin

Dexamethasone

D5W

Diazepam

Diltiazem

Diphenhydramine

Dobutamine

Dolasetron

Dopamine

Doripenem

Doxycycline

Enalaprilat

Epinephrine

Eptifibatide

Esmolol

Esomeprazole

Famotidine

Fentanyl

Fluconazole

Furosemide

Gatifloxacin

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Table continues on page 4.

I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G

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Ampicillin

Ampicillin-sulbactam

Argatroban

Azithromycin

Aztreonam

Bivalirudin

Bumetanide

Calcium gluconate

Cefazolin

Cefepime

Cefotaxime

Cefotetan

Ceftazidime

Ceftizoxime

Ceftriaxone

Ciprofloxacin

Clindamycin

Dexamethasone

Dextrose 5% in water

Diazepam

Diltiazem

Diphenhydramine

Dobutamine

Dolasetron

Dopamine

Doripenem

Doxycycline

Enalaprilat

Epinephrine

Eptifibatide

Esmolol

Esomeprazole

Famotidine

Fentanyl

Fluconazole

Furosemide

Gatifloxacin

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Imipenem-cilastatin

Insulin, regular

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Granisetron

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Heparin

Hydrocortisone

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Hydromorphone

Gentamicin

Amiodarone

Gentamicin

Amikacin

(continued)

Acyclovir

Table. Compatibility of Selected IV Drugs

se

Linezolid

Lorazepam

Magnesium sulfate

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Mannitol
Meropenem

Methylprednisolone

Metoclopramide

Metronidazole

Midazolam

Morphine sulfate

Nafcillin

Nitroglycerin

Nitroprusside

Norepinephrine

Ondansetron

Pantoprazolea

Penicillin G

Phenylephrine

Phenytoin

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Piperacillan-tazobactam I

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Labetalol

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Levofloxacin

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Potassium chloride

Prochlorperazine

Propofol

Ringers, lactated

Sodium bicarbonate

Sodium chloride 0.9%

Ticarcillin-clavulanate

Tigecycline

Tobramycin

TMP-SMX

Vancomycin

Vasopressin

Testing was performed with ethylenediaminetetra-acetic acid (EDTA)-containing formulation.

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I N D E P E N D E N T LY D E V E L O P E D B Y M C M A H O N P U B L I S H I N G

Vasopressin

Vancomycin

TMP-SMX

Tobramycin

Tigecycline

Ticarcillin-clavulanate

Sodium chloride 0.9%

Sodium bicarbonate

Ringers, lactated

Propofol

Prochlorperazine

Potassium chloride

Piperacillin-tazobactam

Phenytoin

Phenylephrine

Penicillin G Potassium

Pantoprazolea

Ondansetron

Norepinephrine

Nitroprusside

Nitroglycerin

Nafcillin

Morphine sulfate

Midazolam

Metronidazole

Metoclopramide

Methylprednisolone sod. Succ.

Meropenem

Mannitol

Magnesium sulfate

Lorazepam

Linezolid

Levofloxacin

Labetalol

Gentamicin

Granisetron

Heparin

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Insulin, regular

Imipenem-cilastatin

Hydromorphone
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Hydrocortisone Sod. Succ.

Heparin

Granisetron

Hydrocortisone

Hydromorphone

Imipenem-cilastatin

Insulin, regular

Labetalol

Levofloxacin

.R

Linezolid

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Lorazepam

Magnesium sulfate

Mannitol

Meropenem

Methylprednisolone

Metoclopramide

Metronidazole

Midazolam

Morphine sulfate

Nafcillin

Nitroglycerin

Nitroprusside

Norepinephrine

Ondansetron

Pantoprazolea

Penicillin G

Phenylephrine

Phenytoin

Piperacillin-tazobactam

Potassium chloride

Prochlorperazine

Propofol

Ringers, lactated

Sodium bicarbonate

Sodium chloride 0.9%

Ticarcillin-clavulanate

Tigecycline

Tobramycin

TMP-SMX

Vancomycin

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P H A R M AC Y P R AC T I C E N E WS S E P T E M B E R 2 0 0 9

Three types of incompatibilities are commonly discussed: physical, chemical, and therapeutic. Physical
incompatibilities are the most easily detected and are
evidenced by visible changes such as particulate formation, haze, precipitation, color change, or gas evolution. 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 incompatibilities can be detected only with a suitable analytic
method. Therapeutic incompatibilities, in which a drug
combination results in undesirable antagonistic or synergistic pharmacologic activity, are beyond the scope of
most compatibility references.
Despite the differing nature of compatibilities, the
type of incompatibility or compatibility is not specified in this chart. A designation of compatible indicates that the combination evaluated appears to be

compatible based on the tests performed, whether

these tests measured physical, chemical, or both types
of compatibility.
While it is not possible to predict all incompatibilities
that may arise, it is hoped that their occurrence may be
minimized. Continuing research to add to the existing
body of knowledge of IV compatibilities is vital.

Suggested Readings

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Brammer MK, Chan P, Heatherly K, et al. Am J Health-Syst Pharm.

2008;65:1261-1265.

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Data on file, Sanofi-Aventis.

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Data on file, Wyeth Pharmaceuticals.

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DRUGDEX System (Intranet database). Version 5.1. Greenwood Village, CO: Thomson Healthcare.

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Trissel LA, ed. Handbook on Injectable Drugs. 15th ed. Bethesda, MD:
American Society of Health-System Pharmacists; 2009.

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