King Guide Online Edition
Frequently Asked Questions

Types of Compatibility

Many studies on the compatibility of parenteral admixtures have used precipitation, effervescence, color change, and related visual methods as the criteria for deciding if a combination is compatible. These changes that are detected by the unaided eye are termed physical or visual incompatibilities. Physically incompatible combinations of parenterals should not be administered.Some studies on the compatibility of parenteral admixtures have investigated the change in potency or stability of the admixed drugs. These changes that are not visible with the unaided eye are termed nonvisual or chemical incompatibility. Stability, per se, has been defined as a product or combination of drugs that retain at least 90% of its original potency during the life of the product. Therefore a mixture is rated chemically incompatible(or unstable) if it loses more than 10% of its original concentration. Chemically incompatible combinations of parenterals should not be administered.

Conflicting Reports

Contradictory results have been reported over the years in research studies on parenteral drug admixture compatibility. Some of these conflicting reports may be attributed to the concentrations used in a particular study, the order of mixing, adjuvants included in the formulations, materials from which contained may be fabricated, and unavoidable differences in various lots of the same drug product. Variations in permissible pH ranges of some infusion fluids may also contribute to the problem of conflicting reports. In addition some combinations may be physically (i.e., visually) compatible yet be chemically (i.e., nonvisually) incompatible. The symbol in the grid for conflicting data is Ø. The reader should use caution when deciding on the appropriateness of a given admixture if conflicting data has been reported.

How do I Search?

Start by typing the first few letters of a drug. A list will pop up that shows the drugs that start with the letters typed so far. If the drug you want is highlighted, press enter, or if you see the drug you want, click on it.

Infusion Fluid Abbreviations

Abbreviation  Definition
UNSP Reports data for direct admixture without dilution, or those combination for which an infusion fluid was not specified in the original research report. The reader should refer to the written entries for details on dose, concentration, temperature, etc.
BWFI Bacteriostatic Water For Injection, U.S.P.
SWFI Sterile Water For Injection, U.S.P.
D5W Dextrose 5% in Water (5% Dextrose Injection, U.S.P.)
D2.5½S Dextrose 2.5% in 0.45% Sodium Chloride, U.S.P.
D5.33S Dextrose 5% in 0.3% Sodium Chloride, U.S.P.
D5.45S Dextrose 5% in 0.45% Sodium Chloride, U.S.P.
D10W Dextrose 10% in Water (10% Dextrose Injection, U.S.P.)
D20W Dextrose 20% in Water (20% Dextrose Injection, U.S.P.)
D5LR Dextrose in Lactated Ringer's® Solution (5% Dextrose in Lactated Ringer's® Injection)
D5¼S Dextrose 5% in 1/4 Strength Saline (5% Dextrose and 0.22% Sodium Chloride Injection, U.S.P.)
D5½S Dextrose 5% in 1/2 Strength Saline (5% Dextrose and 0.45 % Sodium Chloride Injection, U.S.P.)
D5NS Dextrose 5% in Normal Saline (5% Dextrose and 0.9% Sodium Chloride Injection, U.S.P.)
D5R Dextrose 5% in Ringer's® Injection (5% Dextrose in Ringer's® Injection)
D10NS Dextrose 10% in Normal Saline (10% Dextrose and 0.9% Sodium Chloride Injection, U.S.P.)
IS10S Invert Sugar 10% in Saline (10% Invert Sugar in 0.9% Sodium Chloride Injection)
IS10W Invert Sugar 10% in Water for Injection, U.S.P.
LR Lactated Ringer's® Injection, U.S.P.
Pr Hyd Protein Hydrolysate (Protein Hydrolysate Injection, U.S.P.)
R Ringer's® Injection, U.S.P.
NS Sodium Chloride 0.9% (Normal Saline) (0.9% Sodium Chloride Injection, U.S.P.)
SOD CL 5 Sodium Chloride 5% (5% Sodium Chloride Injection)
SL Sodium Lactate, 1/6 Molar (M/6 Sodium Lactate Injection, U.S.P.)

Compatibility Symbols

The special grid included on monograph pages allows for quick reporting of compatibility C, incompatibility X, or conflicting data Ø. In some instances conflicting results have been reported in the literature for a particular admixture. These contradictory reports are noted with a Ø, and are described in the written entries.

NOTE:
Absence of a notation in the grid does not imply that the combination is compatible. Rather, it means that no information has been reported for that particular combination. The presence of other symbols in the grid, such as # and *, are included to help the reader locate the specific written entry about the drug combination, and the reference that pertains to that entry.

Symbol Definition
X Incompatible
C Compatible
Ø Conflicting Reports
NA or blank No Information Available (do not mix)

I do not see the drug in the list?

There is no information in the King Guide to Parenteral Admixtures for the drug. The list you see is a list of drugs that are in the King Guide or a list of drugs that there is information on in combination with the first drug. Therefore, if it is not in the list, there is no information available.

Where do I find information for infusion fluids?

Fluids With A Single Drug:
Put a single drug in the 'Search List'. Compatibility and stability data for the drug in 12 fluids is displayed under various sections titled 'Stability', 'Uncombined', 'Lifecare', and etc.

Fluids With Multiple Drugs: Put up to 10 drugs in the 'Search List'. The resulting screen displays every combination of the drugs you selected in tables for each method of mixing (y-site, syringe, admixture). To view the fluids and dosages used to determine compatibility, click any symbol in the table.

How can I determine compatibility of several drugs at once?

Put up to 10 drugs in the 'Search List'. The screen displays every combination of the drugs you selected in tables for each method of mixing (y-site, syringe, admixture). To view the complete monograph including the fluids and dosages used to determine compatibility, click any row in the table.

NOTE:

Most drug research and studies report compatibility of two drugs. The compatibility of two or more drugs in the same IV line/container should not be inferred from information presented in King Guide, unless data on that specific combination has actually been reported in the monograph. That is, if King Guide reports that drug A is compatible with drug B, and that drug A is compatible with drug C, one must not assume that drug A plus drug B plus drug C would be compatible in the same container or IV line.

Although situations may occur that necessitate using individual clinical and scientific judgment to decide on the advisability of co-mixing drugs, the practitioner is cautioned that the safest approach is to rely upon published data, rather than assuming compatibility.

In the absence of valid published research data on a given combination, all possible avenues should be explored in lieu of admixture, such as consideration of alternative routes of administration and alternative ways of administering the same drugs intravenously. If the practitioner decides to prepare and administer an admixture without supporting data on stability and compatibility, careful evaluation of the resultant admixture and monitoring of the patient is mandatory.

Where do I find compatibility information for Y-Site administration?

Single Drug: Put a single drug in the 'Search List' then click one of the method of mixing buttons in the center column; 'Y-Site', 'Syringe' or 'Admixture'. The compatibility table results lists every drug there is information on with the first drug along with a grid of 12 fluids with symbols that indicate compatibility for the drug combination in that fluid. Click on any row in the table to view the complete text of the monograph for the drug combination.

Multiple Drugs: Put up to 10 drugs in the 'Search List'. The resulting screen displays every combination of the drugs you selected in tables for each method of mixing (y-site, syringe, admixture). To view the fluids and dosages used to determine compatibility, click any row in the table. Each monograph specifies (if available) the routes, temperatures, dosages, and containers used in the study.

What is the meaning of the infusion fluid column 'UNSP'?

The word Unspecified is currently used as the miscellaneous category of certain infusion fluids in our compatibility tables. Initially, it was a column that we used to show results of published reports on the compatibility of 2 drugs in which the authors did not specific an infusion fluid, hence the word, unspecified. We have continued to use that "shorthand" but have expanded the meaning of the column heading Unspecified to include any other infusion fluid that is not already shown as a column heading. (Space and formatting limitations restricted us to column headings for 11 fluids).

For example, the compatibility of 2 drugs in SWFI or BWFI would be reported with a symbol in the unspecified column. Or, if drug A was diluted in NS and drug B was diluted in SWFI, then we would indicate their compatibility with a symbol in both the NS and SWFI columns.

We strive to include a statement and reference along with the column designation to provide more specific information when available.

How do I find compatibility of electrolytes with IV drugs?

King Guide to Parenteral Admixtures provides monographs for individual drugs in combination with many other drugs, including specific electrolytes, e.g., potassium chloride. These monographs also provide stability information with a variety of infusion fluids, some of which contain electrolytes. Examples include various ringer's solutions, various saline concentrations, and others. In addition, major electrolytes are listed as individual monographs, with data on combining with other drugs. For example, calcium chloride, calcium gluconate, potassium acetate, potassium chloride; potassium phosphate, etc. These monographs provide data on compatibility with a variety of parenteral drugs. However, we do not provide a monograph, Electrolytes. Rather, one must search by the specific name.

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