Polymixin b compatible solution
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Here is a comprehensive compatibility reference for Polymyxin B Sulfate (IV/parenteral use):
Polymyxin B — Compatible Solutions & Drugs
IV Diluent (Solution) Compatibility
| Solution | Status |
|---|---|
| Dextrose 5% in Water (D5W) | ✅ Compatible — preferred diluent |
| Sodium Chloride 0.9% (NS) | ✅ Compatible (<10% loss in 24 hr at 4°C and 25°C) |
| TPN (2-in-1 admixture) | ✅ Compatible — no polymyxin loss in 24 hr at 29°C |
Standard IV preparation: Dissolve 500,000 units in 300–500 mL D5W → ~1,000–1,667 units/mL; infuse over 60–90 minutes (never <30 min due to neuromuscular blockade risk).
Additive (Admixture) Compatibility
✅ Compatible
| Drug |
|---|
| Amikacin sulfate (in D5W, NS, LR, and multiple solutions) |
| Ascorbic acid injection |
| Colistimethate sodium |
| Diphenhydramine HCl |
| Erythromycin lactobionate |
| Hydrocortisone sodium succinate |
| Lincomycin HCl |
| Penicillin G potassium |
| Penicillin G sodium |
| Phenobarbital sodium |
| Ranitidine HCl |
❌ Incompatible
| Drug | Reason |
|---|---|
| Amphotericin B | Haze develops over 3 hr in D5W |
| Chloramphenicol sodium succinate | Precipitate forms within 1 hr |
| Chlorothiazide sodium | Yellow color produced |
| Heparin sodium | Precipitates immediately (D5W); haze over 3 hr (NS) |
| Magnesium sulfate | Physically incompatible |
Y-Site Compatibility
| Drug | Status |
|---|---|
| Esmolol HCl | ✅ Compatible (24 hr at 22°C) |
| Imipenem-cilastatin-relebactam | ✅ Compatible (2 hr at 20–25°C) |
| Sulbactam-durlobactam | ✅ Compatible (4 hr at 20–22°C) |
| Cefiderocol | ❌ Incompatible (high turbidity/haze + gas bubbles) |
IM Reconstitution Diluents
| Diluent | Status |
|---|---|
| Sterile Water for Injection | ✅ |
| Sodium Chloride 0.9% | ✅ |
| Procaine HCl 1% or 2% | ✅ (for pain reduction at injection site) |
Stability Considerations
- pH: Maximum stability at pH 3.4. Stable across pH 2–7; alkaline solutions significantly accelerate decomposition — avoid alkaline diluents.
- Storage after reconstitution: Refrigerate (2–8°C); discard unused portions after 72 hours.
- Light: Protect from light before reconstitution.
Key Incompatibilities to Avoid in Practice
- Heparin — a very common flush/infusion agent; causes immediate precipitation. Flush lines thoroughly before and after polymyxin B.
- Amphotericin B — often co-prescribed in critically ill patients; must be given via separate line.
- Cefiderocol — important to note given both are used for MDR gram-negative infections.
(Sources: ASHP Injectable Drug Information, Drugs.com Monograph, Canadian Product Monograph)
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