Journal of Cystic Fibrosis
Volume 5, Issue 4 , Pages 205-213, December 2006

Inhalation solutions – which one are allowed to be mixed? Physico-chemical compatibility of drug solutions in nebulizers

  • Wolfgang Kamin

      Affiliations

    • Kinderklinik und Kinderpoliklinik der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, D-55101 Mainz, Germany
    • Corresponding Author InformationCorresponding author. Tel.: +49 6131 17 2602; fax: +49 6131 17 5597.
    • ,
  • Astrid Schwabe

      Affiliations

    • Apotheke der Unikliniken Mainz, Langenbeckstr. 1, D-55131 Mainz, Germany
    • Tel.: +49 6131 17 4224; fax: +49 6131 17 5564.
    • ,
  • Irene Krämer

      Affiliations

    • Apotheke der Unikliniken Mainz, Langenbeckstr. 1, D-55131 Mainz, Germany
    • Tel.: +49 6131 17 7209; fax: +49 6131 17 5525.

Received 20 October 2005; received in revised form 21 December 2005; accepted 16 March 2006.

Abstract 

Therapy of chronic respiratory diseases often involves inhalation therapy with nebulizers. Patients often attempt to shorten the time consuming administration procedure by mixing drug solutions/suspensions for simultaneous inhalation. This article considers the issue of physico-chemical compatibility of admixtures of drug solutions/suspensions in nebulizers.

A search of databases, prescribing information and primary literature was conducted to locate literature concerning the physico-chemical compatibility of inhalation solutions/suspensions. This was supplemented by telephone interviews.

Admixtures of albuterol with ipratropium and/or cromolyn, of albuterol and budesonide, or tobramycin, or colistin are physico-chemically compatible. Physico-chemical compatibility has been demonstrated for admixtures of cromolyn with albuterol and/or ipratropium and for admixtures of cromolyn and budesonide. Admixtures of budesonide with ipratropium and/or fenoterol, and admixtures of budesonide and albuterol, or cromolyn are physico-chemically compatible. Both cromolyn and colistin are incompatible with benzalkonium chloride. Admixtures should be prepared from inhalation solutions/suspensions formulated without preservatives.

Besides studies of the physico-chemical compatibility, the aerodynamic behaviour of physico-chemical mixtures needs to be studied before a final recommendation of simultaneous nebulization of compatible admixtures can be made.

Keywords: Compatibility, Inhalation solutions, Nebulizer, Review

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PII: S1569-1993(06)00041-5

doi:10.1016/j.jcf.2006.03.007

Journal of Cystic Fibrosis
Volume 5, Issue 4 , Pages 205-213, December 2006

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