Y-site Administration of Imipenem/Cilastatin/Relebactam With Common Intravenous Medications

• Published in: Clinical therapeutics 2020-03, Vol.42 (3), p.475-485
• Main Authors: Ghazi, Islam M., El Nekidy, Wasim S., Sood, Ayush, Dulku, Amanpreet, Patel, Radha, Patel, Krishna, Li, Pengfei
• Format: Article
• Language: English
• Subjects: Admixtures; Antibiotics; Compatibility; Drugs; Imipenem; imipenem/cilastatin/relebactam; Infections; Inserts; Intravenous administration; Laboratories; Light; Multidrug resistance; Packaging; Patients; Pharmaceutical industry; Physical characteristics; Physical compatibility; Physical properties; simultaneous adminitration; Turbidity; Urinary tract; Ventilator-associated pneumonia; Y-site administration
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2020.01.017

Imipenem/cilastatin/relebactam has shown efficacy in complicated intra-abdominal and urinary tract infections in the RESTORE IMI-1 study, and it was recently approved by the US Food and Drug Administration. A press release announced that another Phase III study (RESTORE IMI-2) in patients with hospital-acquired and ventilator-associated pneumonia has met the primary end point. Critically ill patients with multidrug-resistant infections are expected to receive several pharmaceutical intravenous drugs while admitted in hospitals, warranting the need for Y-site compatibility studies. This study was conducted to evaluate the physical compatibility of imipenem/cilastatin/relebactam for injection during Y-site administration with common injectable intravenous medications. Imipenem/cilastatin/relebactam was prepared to the concentration of 5 mg/mL, and other intravenous tested drugs were reconstituted as per the package inserts. Y-site was simulated as a 2-drug combination by mixing 5 mL of each in a glass tube, with reversing of the order of mixing; physical characteristics were recorded, and pH changes and turbidity were measured at time intervals. Imipenem/cilastatin/relebactam was found to be compatible with a wide range of intravenous medications, facilitating co-administration with various IV medications. The compatibility reported is limited to a 2-h observation period in this study to adequately cover imipenem/cilastatin/relebactam infusion time. In addition, it is based on the measured turbidity with no chemical assay of the components of the admixture.