Review of drug stability in parenteral nutrition admixtures

SummaryBackground and aimsThe addition of drugs to parenteral nutrition admixtures (PNA) or simultaneous Y-site administration is a concern in daily practice. We present a literature review studies on the physicochemical stability of drugs using both methods.MethodsWe performed a search of electronic databases and publications about drug stability in PNA. We prioritized studies that used two methods for obtaining samples: the reproduction of clinical administration conditions or centrifugation.ResultsForty-two studies met all inclusion criteria and covered a total of 118 drugs with the following characteristics: simultaneous Y-site administration [20 studies and 115 drugs], and administration in PNA [24 studies and 13 drugs]. Eighty drugs administered in PNA via Y-site were compatible and 26 incompatible, while 9 results depended on the study conditions. Twelve out of 13 drugs included in the PNA were compatible for more than 24 h at room temperature.ConclusionsThe results of drug stability tests depend on the sampling methodology. Most of the results were obtained by the centrifugation method. Although the clinical method is much more reliable and offers a higher reproducibility of physicochemical stability, we found it was used by very few studies.