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Compatibility of Treprostinil and Dopamine during Y-site Administration

Anna Bustin

Gagan Kaushal

Brian Hanna

E. Ramsey

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Conference: 2017 PH Professional Network Symposium

Release Date: 10.06.2017

Presentation Type: Abstracts

File Download: 2017 PHPN Abstract 1027

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Abstract presented at the 2017 PH Professional Network Symposium held in Bethesda, MD on October 5-7, 2017

Purpose

The primary objective of this study was to evaluate the physical and chemical compatibilities of treprostinil and dopamine via simulated Y-site administration. The secondary objective was to identify any reports of line associated events in patients that necessitated Y-site administration of these medications due to limited IV access and acute clinical requirements.

Background

Intravenous treprostinil is a synthetic prostacyclin analog used to treat pulmonary hypertension (PH). During acute exacerbations of PH dopamine may also be required for cardiac support. In patients with limited intravenous access, it may be necessary to infuse these medications via Y-site. However, there is a lack of compatibility information available for treprostinil and dopamine, thus making it difficult for pharmacists to safely provide recommendations regarding administration.

Methods

Sterile preparations of treprostinil (4,000 ng/ml, 76,000 ng/mL, and 500,000 ng/mL) were mixed in equal parts with dopamine (0.6 mg/mL, 3.2 mg/mL, 6 mg/mL, and 40 mg/mL) to simulate Y-site administration. Samples were withdrawn from the resulting mixtures at time 0, 1 hour, 2 hours, and 4 hours and subjected to physical compatibility and chemical stability testing. The physical stability of the admixtures was assessed in triplicate for each sample by visual examination (particulate matter, haze, and color change), turbidity measurements (nephelometry), and pH measurements. Drug concentration in all samples was also assessed by liquid chromatography mass spectrophotometry (LCMS) for treprostinil and high performance liquid chromatography (HPLC) for dopamine. Chemical stability tests were conducted on 2 separate days with 2 samples assessed each day. To assess for line associated events (infiltrates, loss of line, inability to flush +\- the use of medi cations to restore patency) a retrospective review of existing medical records of patients that received treprostinil and dopamine via Y-site from January 2011 until October 2015 was completed 

Results

The results are listed in table 1 and were consistent at all time periods studied.

Complete data was available from 12 patients who received treprostinil and dopamine via Y-site. One patient, receiving treprostinil 4,000 ng/mL and dopamine 6 mg/mL, experienced a transient inability to flush the line but no change in therapy or clinical status occurred.

Conclusion

Data confirms that treprostinil 4,000 ng/mL and 76,000 ng/mL in normal saline are stable for 4 hours when administered via simulated Y-site with dopamine 0.6 mg/mL, 3.2 mg/mL, 6 mg/mL, and 40 mg/mL. Only dopamine at 0.6 mg/mL is stable with treprostinil of 500,000 ng/ml. These findings will enable pharmacists to provide precise information to the health-care team regarding the Y-site compatibility of these commonly co-administered medications.