Appendix A: RCH parenteral nutrition (PN) and SMOFlipid compatibility information
Important notes about administration of medicines with PN and/or fat emulsion
Compatibility information is for use with RCH Standard 2-in-1 PN solutions and SMOFlipid infusions only.
Compatibility information is lacking for PN solutions and fat emulsions with identical compositions to those used at the RCH; tables are extrapolated from available data and are provided as guidance only. Seek advice from Pharmacy if non-standard PN solutions or fat emulsions are prescribed. Note: RCH pharmacists can only provide compatibility advice for medicines administered within RCH.
Unless otherwise stated, compatibility information applies only to the specified brands, concentrations and diluents recommended in these guidelines.
When medicines are concurrently infused with PN solutions or fat emulsions, the lines must be monitored for signs of incompatibility (e.g. cloudiness, colour changes, precipitation, or splitting of the fat emulsion). Consider the use of appropriate in-line filters.
This list includes medicines that are commonly used in conjunction with PN solutions and/or SMOFlipid infusions at RCH and is not intended to be exhaustive. For medicines not listed in this table, the medicine should be treated as INCOMPATIBLE with PN solutions and/or fat emulsions. For further information or queries, seek advice from Pharmacy.
*Co-infusion of PN solutions or fat emulsions with inotropic agents can result in pulsatile flow of inotropic agents, which may cause haemodynamic instability and cloud the clinical picture. Compatible inotropic agents should only be co-infused with PN solutions or fat emulsions if there is no alternative line access.
“C” Compatible; “I” Incompatible; “–” Insufficient data
| Aciclovir | I | C (5 mg/mL or weaker in sodium chloride 0.9%) |
|
| *Adrenaline (epinephrine) | C | – | |
| Alprostadil | C (5 mcg/mL or weaker) |
I | |
| Amphotericin B | I | I | |
| Benzylpenicillin | C | C (100 mg/mL or weaker) |
|
| Caffeine Citrate | C | I | |
| Calcium Chloride | I | I | |
| Calcium Folinate | C (2 mg/mL or weaker) |
– | |
| Calcium Gluconate | I | I | |
| cefaZOLin | C (20 mg/mL or weaker) |
I | |
| cefOTAXIME | C | C (100 mg/mL or weaker) |
|
| cefOXITIN | C | – | Short administration time possible with cefoxitin; hold SMOFlipid if administering cefoxitin. |
| cefTAZIDIME | C | – | Short administration time possible with ceftazidime; hold SMOFlipid if administering ceftazidime. |
| cefTRIAXONE | I | I | |
| ciclosPORIN | I | I | |
| ciPROFLOXAcin | I | – | |
| Clindamycin | C | – | Bring both clindamycin and PN to room temperature before administration. |
| Desferrioxamine | I | I | |
| dexAMETHASOne | C | – | |
| dexMEDETOMIDine 4 mcg/mL or weaker | C | C | |
| DIAzepam | I | I | |
| Digoxin | C (25 mcg/mL or weaker) |
– | Short administration time possible with digoxin; hold SMOFlipid if administering digoxin. |
| *Dobutamine | C | C | |
| *Dopamine | C (2 mg/mL or weaker) |
C | Variable results reported when co-infusing dopamine with PN and SMOFlipid concurrently. Administer dopamine with PN and hold SMOFlipid. |
| Enalaprilat | C (0.1 mg/mL or weaker) |
– | Short administration time possible with enalaprilat; hold SMOFlipid if administering enalaprilat. |
| ERYthromycin | C | – | |
| Fentanyl | C | – | |
| flucONAZOLe | C | – | |
| Furosemide | I | C (10 mg/mL only) |
|
| Ganciclovir | I | I | |
| Gentamicin | C | I | |
| Heparin Sodium | – | C (500 units/mL only) |
|
| Hydrocortisone | C | – | Short administration time possible with hydrocortisone; hold SMOFlipid if administering hydrocortisone. |
| HYDROmorphone | C (0.5 mg/mL or weaker) |
C (2.5 mg/mL or weaker in glucose 5%) |
Variable results reported when co-infusing hydromorphone with PN and SMOFlipid concurrently. Administer hydromorphone with PN and hold SMOFlipid. |
| Imipenem + Cilastatin | C | – | When co-infusing PN with imipenem + cilastatin, add drug as proximal to patient as possible. |
| Insulin, Neutral | C | C | |
| Iron Polymaltose | – | I | |
| Ketamine | I | C (10 mg/mL or weaker) |
|
| Lidocaine | I | – | |
| Magnesium Chloride | – | I | |
| Magnesium Sulfate | – | I | |
| Meropenem | C | I | |
| Methylprednisolone Sodium Succinate | C (5 mg/mL or weaker) |
– | |
| Metronidazole | C | C | |
| Midazolam | C (0.5 mg/mL or weaker) |
– | |
| *Milrinone | C | C | |
| Morphine Hydrochloride | C (0.2 mg/mL or weaker) |
C (0.5 mg/mL or weaker) |
|
| Morphine Sulfate | C | C (0.5 mg/mL or weaker) |
|
| *Noradrenaline (norepinephrine) | C | – | |
| Octreotide (Short-Acting) | C (25 microgram/mL or weaker) |
I | |
| Pantoprazole | I | I | |
| Phenobarbital | C (5 mg/mL or weaker) |
C (20 mg/mL only in sodium chloride 0.9%) |
|
| Phenytoin | I | I | |
| Phosphate, Potassium and Sodium salts | I | – | |
| Phosphate, Potassium Dihydrogen | I | – | |
| Piperacillin + Tazobactam | C | C | |
| Sildenafil | I | C | |
| Sodium Bicarbonate | I | – | |
| Sodium Calcium Edetate | I | I | |
| TACrolimus | C | – | |
| Tobramycin | C | I | |
| trimETHOPRIM + Sulfamethoxazole | C (0.8 mg/mL of trimethoprim or weaker) |
– | |
| Vancomycin | C | C | Variable results reported when co-infusing vancomycin with PN and SMOFlipid concurrently. Administer vancomycin with PN and hold SMOFlipid. |
| Vecuronium | C | I | |
| Voriconazole | I | I | |
| Medication | Admixture Type | Additional Comments | |
| PN | SMOFlipid | ||