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Current Pharmaceutical Analysis

Editor-in-Chief

ISSN (Print): 1573-4129
ISSN (Online): 1875-676X

Research Article

Stability Study and Simultaneous Determination of Norepinephrine, Moxifloxacin, and Piperacillin + Tazobactam Mixtures Applied in Intensive Care Medicine

Author(s): Jéssica Pires Schmidt* and Martin Steppe

Volume 19, Issue 4, 2023

Published on: 31 March, 2023

Page: [307 - 316] Pages: 10

DOI: 10.2174/1573412919666230315151351

Price: $65

Abstract

Background: In intensive care units intravenous medicine may be used in simultaneous infusion in the same intravenous site. Sometimes, the physical compatibility and stability of the combined solutions are unknown.

Objective: The objective was to develop, optimize and validate a simple, fast and sensitive stability- indicating high-performance liquid chromatography (HPLC) for simultaneous quantification of binary mixtures of norepinephrine, piperacillin + tazobactam, moxifloxacin for intravenous (IV) administration in different diluents and physical compatibility with mannitol.

Methods: The HPLC method was performed on a C18LUNA (4.6x250 mm 5-Micron) column, using acetonitrile: methanol: phosphate buffer pH 3.0 (20:30:50) as eluent and validated according to ICH guidelines and applied to mixtures of norepinephrine, moxifloxacin, piperacillin, tazobactam and mannitol at 0, 2, 6, 9 and 24 h. The substances and their mixtures were also evaluated by visual inspection and pH over time.

Results: The analytical method developed was specific, linear, precise, accurate and robust. No visual changes were observed in the mixtures over time, maintaining the pH values (except for piperacillin + tazobactam which changed 0.5 in 24 h) and losses of less than 10% of content over the 24 h under analyzed conditions.

Conclusion: The proposed method is suitable for simultaneous analysis of norepinephrine, moxifloxacin, piperacillin and tazobactam. All tested mixtures were compatible and stable for up to 24h, which is an important result for increasing patient safety in clinical practice since it has not been reported in the literature yet. The method can be further investigated and used for different concentration and diluent combinations.

Keywords: High-performance liquid chromatography, compatibility study, norepinephrine, moxifloxacin, piperacillin + tazobactam, mannitol.

Graphical Abstract
[1]
Moraes, C.G.; Silva, D.; Bueno, D. Analysis of intravenous drug incompatibilities in the adult intensive care unit of the Hospital de Clínicas de Porto Alegre. Revista HCPA, 2011, 31(1), 31-38.
[2]
Kanji, S.; Lam, J.; Johanson, C.; Singh, A.; Goddard, R.; Fairbairn, J.; Lloyd, T.; Monsour, D.; Kakal, J. Systematic review of physical and chemical compatibility of commonly used medications administered by continuous infusion in intensive care units. Crit. Care Med., 2010, 38(9), 1890-1898.
[http://dx.doi.org/10.1097/CCM.0b013e3181e8adcc] [PMID: 20562698]
[3]
Benlabed, M.; Perez, M.; Gaudy, R.; Genay, S.; Lannoy, D.; Barthélémy, C.; Odou, P.; Lebuffe, G.; Décaudin, B. Clinical implications of intravenous drug incompatibilities in critically ill patients. Anaesth. Crit. Care Pain Med., 2019, 38(2), 173-180.
[http://dx.doi.org/10.1016/j.accpm.2018.04.003] [PMID: 29680262]
[4]
López-Cabezas, C.; Guerrero, L.; Molas, G.; Anglada, H.; Soy, D. Physicochemical compatibility of high concentration drugs usually Y-site administered in intensive care units. Eur. J. Hosp. Pharm. Sci. Pract., 2015, 22(2), 107-112.
[http://dx.doi.org/10.1136/ejhpharm-2014-000539]
[5]
Soares, D.B.; Nascimento, M.M.G.; Rosa, M.B.; Pereira, M.L. Incompatibility between intravenous drugs in an adult intensive care unit of a large Brazilian hospital. J. Appl. Pharm. Sci., 2017, 4(1), 19-27.
[6]
Leopoldino, R.W.; Costa, H.T.; Costa, T.X.; Martins, R.R.; Oliveira, A.G. Potential drug incompatibilities in the neonatal intensive care unit: a network analysis approach. BMC Pharmacol. Toxicol., 2018, 19(83), 01-06.
[7]
Maison, O.; Tardy, C.; Cabelguenne, D.; Parat, S.; Ducastelle, S.; Piriou, V.; Lepape, A.; Lalande, L. Drug incompatibilities in intravenous therapy: Evaluation and proposition of preventive tools in intensive care and hematology units. Eur. J. Clin. Pharmacol., 2019, 75(2), 179-187.
[http://dx.doi.org/10.1007/s00228-018-2602-6] [PMID: 30543036]
[8]
Giorgi, I.; Guignard, B.; Fonzo-Christe, C.; Bonnabry, P. Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units. Pharm. World Sci., 2010, 32(4), 520-529.
[http://dx.doi.org/10.1007/s11096-010-9403-z] [PMID: 20556656]
[9]
Novafarma. Norepinephrine Hemitartrate. ANVISA Electronic Leaflet. Available from: http://www.anvisa.gov.br/datavisa/fila_bula/frmVisualizarBula.asp?pNuTransacao=3657012018&pIdAnexo=10532821
[10]
Rhodes, A.; Evans, L.E.; Alhazzani, W.; Levy, M.M.; Antonelli, M.; Ferrer, R.; Kumar, A.; Sevransky, J.E.; Sprung, C.L.; Nunnally, M.E.; Rochwerg, B.; Rubenfeld, G.D.; Angus, D.C.; Annane, D.; Beale, R.; Bellinghan, G.J.; Bernard, G.R.; Chiche, J.D.; Coopersmith, C.; De Backer, D.P.; French, C.J.; Fujishima, S.; Gerlach, H.; Hidalgo, J.L.; Hollenberg, S.M.; Jones, A.E.; Karnad, D.R.; Kleinpell, R.M.; Koh, Y.; Lisboa, T.C.; Machado, F.R.; Marini, J.J.; Marshall, J.C.; Mazuski, J.E.; McIntyre, L.A.; McLean, A.S.; Mehta, S.; Moreno, R.P.; Myburgh, J.; Navalesi, P.; Nishida, O.; Osborn, T.M.; Perner, A.; Plunkett, C.M.; Ranieri, M.; Schorr, C.A.; Seckel, M.A.; Seymour, C.W.; Shieh, L.; Shukri, K.A.; Simpson, S.Q.; Singer, M.; Thompson, B.T.; Townsend, S.R.; Van der Poll, T.; Vincent, J.L.; Wiersinga, W.J.; Zimmerman, J.L.; Dellinger, R.P. Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med., 2017, 45(3), 486-552.
[11]
Hoellein, L.; Holzgrabe, U. Ficts and facts of epinephrine and norepinephrine stability in injectable solutions. Int. J. Pharm., 2012, 434(1-2), 468-480.
[http://dx.doi.org/10.1016/j.ijpharm.2012.05.017] [PMID: 22613065]
[12]
Kaushal, G.; Sayre, B.E.; Prettyman, T. Stability-indicating HPLC method for the determination of the stability of extemporaneously prepared norepinephrine parenteral solutions. J. Liq. Chromatogr. Relat. Technol., 2012, 35(18), 2533-2544.
[http://dx.doi.org/10.1080/10826076.2011.636472]
[13]
Eurofarma. Piperacillin sodium + tazobactam sodium. Electronic Bulletin ANVISA. Available from: http://www.anvisa.gov.br/datavisa/fila_bula/frmVisualizarBula.asp?pNuTransacao=3976702018&pIdAnexo=10545223
[14]
Viola, A.; Ferrazzano, L.; Martelli, G.; Cerisoli, L.; Ricci, A.; Tolomelli, A.; Cabri, W. Novel insights into the chemistry of an old medicine: A general degradative pathway for penicillins from a piperacillin/tazobactam stability study. Eur. J. Pharmaceut. Sci., 2019, 136, 1-09.
[15]
Kommana, R.; Kannabattula, G.; Gurrala, S.; Yeradesi, V.R.; Durga, P.A. Quantification and stress degradation studies of cefepime/tazobactam in dry injection form by an RP-HPLC method. Braz. J. Pharm. Sci., 2014, 50(4), 895-901.
[http://dx.doi.org/10.1590/S1984-82502014000400025]
[16]
Nichols, K.; Chung, E.K.; Knoderer, C.A.; Buenger, L.E.; Healy, D.P.; Dees, J.; Crumby, A.S.; Kays, M.B. Population pharmacokinetics and pharmacodynamics of extended-infusion piperacillin and tazobactam in critically ill children. Antimicrob. Agents Chemother., 2016, 60(1), 522-531.
[http://dx.doi.org/10.1128/AAC.02089-15] [PMID: 26552978]
[17]
Guimarães, D.O.; Momesso, L.S.; Pupo, M.T. Antibiotics: therapeutic importance and perspectives for the discovery and development of new agents. Quim. Nova, 2010, 33(3), 667-679.
[http://dx.doi.org/10.1590/S0100-40422010000300035]
[18]
Ahmad, I.; Bano, R.; Musharraf, S.G.; Ahmed, S.; Sheraz, M.A.; ul Arfeen, Q.; Bhatti, M.S.; Shad, Z. Photodegradation of moxifloxacin in aqueous and organic solvents: A kinetic study. AAPS PharmSciTech, 2014, 15(6), 1588-1597.
[http://dx.doi.org/10.1208/s12249-014-0184-x] [PMID: 25139764]
[19]
Zhou, J.; Li, M.; Luo, L.; Gao, H.; Zheng, F. Photodegradation of moxifloxacin hydrochloride solutions under visible light irradiation: identification of products and the effect of pH on their formation. AAPS PharmSciTech, 2018, 19(3), 1182-1190.
[http://dx.doi.org/10.1208/s12249-017-0929-4] [PMID: 29256152]
[20]
Eurofarma. Moxifloxacin hydrochloride. ANVISA Electronic Leaflet. Available from:http://campanhas.eurofarma.com.br/pneumo/public/download/bula-moxifloxacino.pdf
[21]
Mody, V.; Shah, S.; Patel, J.; Thomas, M.C. Compatibility of norepinephrine bitartrate with levofloxacin and moxifloxacino during simulated Y-site administration. Int. J. Pharm. Compd., 2016, 20(3), 236-238.
[PMID: 28333664]
[22]
Gentile, K.A.; Hmuro, H.S.; Rojas, S.S.O.; Veiga, V.C.; Amaya, L.E.C.; Carvalho, J.C. Management of patients with traumatic brain injury. Brazil. J. Intern. Med., 2011, 9(1), 74-82.
[23]
Farma, J.P. Bula do Manitol. Available from: http://pro.consultaremedios.com.br/bula/manitol-jp-farma
[24]
States, U. The United States Pharmacopeia 2021:USP 44. The national formulary: NF 39. Rockville,Md United States Pharmacopeial Convention Copyright©. The United States Pharmacopeial Convention; 1 Twinbrook Parkway: Rockville, Md 2, 2021.
[25]
Tremblay, M.; Lessard, M.R.; Trépanier, C.A.; Nicole, P.C.; Nadeau, L.; Turcotte, G. Stability of norepinephrine infusions prepared in dextrose and normal saline solutions. Can. J. Anaesth., 2008, 55(3), 163-167.
[http://dx.doi.org/10.1007/BF03016090] [PMID: 18310626]
[26]
Razzaq, S.N.; Ashfaq, M.; Khan, I.U.; Mariam, I.; Razzaq, S.S.; Azeem, W. Simultaneous determination of dexamethasone and moxifloxacin in pharmaceutical formulations using stability indicating HPLC method. Arab. J. Chem., 2017, 10(3), 321-328.
[http://dx.doi.org/10.1016/j.arabjc.2014.11.016]
[27]
Ramalingam, P.; Rajendran, K. Detection of stability and degrada-tion of piperacillin and tazobactam in injectables from in-patient wards and pharmacy by RP-HPLC method. Gulf Med. J., 2014, 3(1), 132-141.
[28]
Tamboli, S.R.; Patil, D.D. RP-HPLC method for simultaneous estimation of cefepime hydrochloride and tazobactam sodium in bulk and pharmaceuticals. Journal of Chemistry, 2013, 2(1), 01-06.
[http://dx.doi.org/10.1155/2013/208057]
[29]
National Health Surveillance Agency. RDC No. 166, of July 24, 2017. Provides for the validation of analytical methods and other measures. Official Gazette of the Federative Republic of Brazil, Brasilia, 2017.
[30]
ICH. International conference on harmonisation of technical requirements for Registration of pharmaceuticals for human use. ICH -Q2(R1)Validation of analytical Procedures: text and methodology, 1994.
[31]
Van Schoors, J.; Brouwer, H.J.; Maes, K.; Michotte, Y.; Van Eeckhaut, A. Ion-pair ultra-high performance liquid chromatographic analysis of monoamines: Peak-splitting at high flow rates. J. Chromatogr. A, 2013, 1321, 73-79.
[http://dx.doi.org/10.1016/j.chroma.2013.10.070] [PMID: 24238712]
[32]
Rodrigues-Silva, C.; Maniero, M.G.; Peres, M.S.; Guimarães, J.R. Occurrence and degradation of quinolones by advanced oxidative processes. Quim. Nova, 2014, 37(5), 868-885.
[33]
Cintrón, J.M.; Risley, D.S. Hydrophilic interaction chromatography with aerosol-based detectors (ELSD, CAD, NQAD) for polar compounds lacking a UV chromophore in an intravenous formulation. J. Pharm. Biomed. Anal., 2013, 78-79, 14-18.
[http://dx.doi.org/10.1016/j.jpba.2013.01.022] [PMID: 23434524]
[34]
Marsilio, N.R.; Silva, Dd.; Bueno, D. Drug incompatibilities in an adult intensive care unit of a university hospital. Rev. Bras. Ter. Intensiva, 2016, 28(2), 147-153.
[PMID: 27410410]
[35]
Prelhacoski, D.; Silva, D.M.; Comarella, L. Drug incompatibility in a pediatric intensive care unit. Revista Uniandrade, 2015, 16(2), 73-81.
[http://dx.doi.org/10.18024/1519-5694/revuniandrade.v16n2p73-81]
[36]
Gaetani, M.; Frndova, H.; Seto, W.; Parshuram, C. Concurrent intravenous drug administration to critically ill children: Evaluation of frequency and compatibility. J. Crit. Care, 2017, 41, 198-203.
[http://dx.doi.org/10.1016/j.jcrc.2017.05.027] [PMID: 28577476]

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