RCH parenteral nutrition (PN) and fat emulsion 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 fat emulsion 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 are prescribed. Note: RCH pharmacists can only provide compatibility advice for medicines administered within the RCH. Unless otherwise stated, compatibility information applies only to the medicine concentrations 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. For medicines not listed in this table, refer to incompatibility information or contact Pharmacy. If no further information is available, the medicine should be treated as INCOMPATIBLE with PN solutions and/or fat emulsions. * 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.
Medicines COMPATIBLE with PN solutions 
*Adrenaline (epinephrine)
Alprostadil 15 microgram/mL or weaker
Benzylpenicillin
Caffeine Citrate
Calcium Folinate 2 mg/mL or weaker
Cefazolin 20 mg/mL or weaker
Cefotaxime
Cefoxitin
Ceftazidime
Clindamycin
Dexmedetomidine
Dexamethasone
Digoxin
*Dobutamine
*Dopamine 3.2 mg/mL or weaker
Enalaprilat 0.1 mg/mL or weaker
Erythromycin
Fentanyl
Fluconazole
Furosemide (frusemide) 10 mg/mL only
Gentamicin 1.6 mg/mL or stronger
Heparin sodium 500 units/mL or weaker
Hydrocortisone
Hydromorphone 0.5 mg/mL or weaker
Imipenem + Cilastatin
Insulin, neutral (Actrapid and Humilin R only) 1 unit/mL or weaker
*Isoprenaline 4 microgram/mL or weaker
Lidocaine (lignocaine) 4 mg/mL or weaker
Meropenem
Methylprednisolone sodium succinate 5 mg/mL or weaker
Metronidazole
*Milrinone 0.4 mg/mL or weaker
Morphine sulfate
Morphine hydrochloride 0.1 mg/mL or weaker
*Noradrenaline (norepinephrine)
Octreotide 25 microgram/mL or weaker
Phenobarbital (phenobarbitone) 5 mg/mL or weaker
Piperacillin + Tazobactam 40 mg/mL (of piperacillin) or weaker (all listed brands except Tazocin EF)
Tacrolimus
Tobramycin
Trimethoprim + Sulfamethoxazole 0.8 mg/mL (of trimethoprim) or weaker
Vancomycin
Vecuronium
Medicines COMPATIBLE with fat emulsion Listed medicines are considered compatible with fat emulsion when co-infused with PN solutions via Y-site. 
Caffeine Citrate 10 mg/mL or weaker
Calcium Folinate 2 mg/mL or weaker
Cefazolin 20 mg/mL or weaker
Cefoxitin 20 mg/mL or weaker
Ceftazidime 40 mg/mL or weaker
Ciclosporin 2 mg/mL or weaker
Ciprofloxacin
Clindamycin
Dexmedetomidine
Dexamethasone
Digoxin
*Dobutamine 4 mg/mL or weaker
Enalaprilat 0.1 mg/mL or weaker
Erythromycin
Fentanyl
Fluconazole
Furosemide (frusemide) 10 mg/mL only
Gentamicin
Hydrocortisone 1 mg/mL or weaker
Imipenem + Cilastatin
Insulin, neutral (Actrapid and Humilin R only) 1 unit/mL or weaker
*Isoprenaline 4 microgram/mL or weaker
Lidocaine (lignocaine) 4 mg/mL or weaker
Meropenem
Methylprednisolone sodium succinate 5 mg/mL or weaker
Metronidazole
Morphine sulfate
*Noradrenaline (norepinephrine)
Piperacillin + Tazobactam 40 mg/mL (of piperacillin) or weaker (all listed brands except Tazocin EF)
Tacrolimus
Tobramycin
Trimethoprim + Sulfamethoxazole 0.8 mg/mL (of trimethoprim) or weaker
Vancomycin