Effect of pH and Additives on the Compatibility between Vancomycin and Furosemide Injections

• Published in: YAKUGAKU ZASSHI Vol. 138; no. 6; pp. 853 - 860
• Main Authors: Munakata, Chie, Fuchigami, Yuki, Makizoe, Takayuki, Miura, Yusuke, Yamaoka, Mariko, Sasahara, Satomi, Hata, Katsutomo, Tachiki, Hidehisa, Sasaki, Hitoshi, Hagimori, Masayori, Kawakami, Shigeru
• Format: Journal Article
• Language: English; Japanese
• Published: Japan The Pharmaceutical Society of Japan 01.06.2018; Pharmaceutical Society of Japan
• Subjects: compatibility; furosemide; generic drug; vancomycin; furosemide; generic drug; vancomycin; compatibility
• ISSN: 0031-6903; 1347-5231
• DOI: 10.1248/yakushi.18-00004

The physicochemical compatibility between injections of different agents is very important. An injection of the antibiotic vancomycin (VCM) is acidic and its standard pH range is 2.5-4.5. In clinical treatments, VCM injections are often used with Lasix® (furosemide) injections. The Lasix® injection is alkaline and its standard pH range is 8.6-9.6. Therefore, mixing VCM injections with Lasix® injections may cause compatibility problems. We evaluated the effect of pH on the compatibility between VCM (original and two generic) and Lasix® injections. Compatibility was not observed in non-pH-adjusted VCM with Lasix® injections, but white crystals appeared when VCM injections adjusted to pH 2.5 experimentally were mixed with a Lasix® injection, suggesting that the acidic condition of VCM injections cause compatibility. However, the residual rates of VCM did not change after 24 h in all mixtures. We analyzed the crystals by mass spectrometry and 1H-NMR, and identified them to comprise furosemide.