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

J Cyst Fibros. 2006 Dec;5(4):205-13. doi: 10.1016/j.jcf.2006.03.007. Epub 2006 May 5.

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.

Publication types

  • Review

MeSH terms

  • Acetylcysteine / administration & dosage
  • Acetylcysteine / pharmacology
  • Administration, Inhalation
  • Albuterol / administration & dosage
  • Albuterol / pharmacology
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / pharmacology
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / pharmacology
  • Asthma / drug therapy*
  • Bronchodilator Agents / administration & dosage*
  • Bronchodilator Agents / pharmacology
  • Budesonide / administration & dosage
  • Budesonide / pharmacology
  • Colistin / administration & dosage
  • Colistin / pharmacology
  • Cromolyn Sodium / administration & dosage
  • Cromolyn Sodium / pharmacology
  • Cystic Fibrosis / drug therapy*
  • Deoxyribonuclease I / administration & dosage*
  • Deoxyribonuclease I / pharmacology
  • Drug Therapy, Combination*
  • Expectorants / administration & dosage*
  • Expectorants / pharmacology
  • Humans
  • Ipratropium / administration & dosage
  • Ipratropium / pharmacology
  • Nebulizers and Vaporizers*
  • Respiratory Therapy / methods
  • Tobramycin / administration & dosage
  • Tobramycin / pharmacology

Substances

  • Anti-Asthmatic Agents
  • Anti-Bacterial Agents
  • Bronchodilator Agents
  • Expectorants
  • Budesonide
  • DNASE1 protein, human
  • Deoxyribonuclease I
  • Ipratropium
  • Cromolyn Sodium
  • Albuterol
  • Tobramycin
  • Acetylcysteine
  • Colistin