-Original-

Y-site Injection Physical Compatibility of Remdesivir with Select Intravenous Drugs Used in Palliative Care and for Treating Coronavirus Disease 2019

Masayoshi Kondo, Mai Gempei, Kei Watanabe, Masato Yoshida, Naoya Tagui, Shouhei Fukao, Kazutoshi Sugaya and Hisamitsu Takase

Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan

Background: No compatibility tests are available for remdesivir other than 0.9% sodium chloride. In this study, we aimed to evaluate the physical compatibility of remdesivir with drugs used in palliative care and COVID-19 treatment.
Methods: Remdesivir was tested for compatibility with 10 different drugs (fentanyl, morphine, hydromorphone, oxycodone, heparin, furosemide, octreotide, acetated Ringer's injection, 2-in-1 peripheral parenteral nutrition, and 2-in-1 total parenteral nutrition). Remdesivir was formulated to a final concentration of 1 mg/mL, and the other drugs were prepared at clinical concentrations. Three test solutions were used for compatibility testing, with remdesivir and the target drugs compounded in a 1:1 ratio. Appearance measurements, including Tyndall effect, turbidity, and pH, were performed immediately after mixing and at 1 h and 4 h after mixing. Changes in appearance, including the Tyndall effect, turbidity (turbidity change of ≥ 0.5 nephelometric turbidity unit [NTU] based on control solution for each test drug), and pH (a change of ≥ 10% based on the pH immediately after mixing) were used to determine physical compatibility.
Results: All the drugs tested were compatible with remdesivir. The combination of remdesivir and furosemide produced the highest turbidity (0.23 ± 0.03 NTU) 1 h after mixing. The lowest and highest pH values were observed at 4 h after mixing for the combinations of remdesivir and morphine (3.23 ± 0.02) and remdesivir and furosemide (8.81 ± 0.06).
Conclusions: The drugs tested in this study show Y-site physical compatibility with remdesivir.

J Nippon Med Sch 2023; 90: 381-386

Keywords
coronavirus disease 2019, remdesivir, compatibility, palliative care

Correspondence to
Masayoshi Kondo, Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo 206-8512, Japan
kondomasayoshi@nms.ac.jp

Received, February 2, 2023
Accepted, May 1, 2023