NOTE Aerosolized medications 227 Am J Health-Syst Pharm—Vol 67 Feb 1, 2010 NOTE Mixing and compatibility guide for commonly used aerosolized medications DAVID K. BURCHETT, WILLIAM DARKO, JAMES ZAHRA, JOHN NOVIASKY, LUKE PROBST, AND ADRIENNE SMITH DAVID K. BURCHETT, PHARM.D., was Pharm.D. Candidate, Albany College of Pharmacy, Albany, NY, at the time of writing. WILLIAM DARKO, PHARM.D., is Assistant Professor of Medicine, Department of Medicine, Section of Clinical Pharmacology, and Adjunct Associate Professor of Pharmacy Practice, Department of Pharmaceutical Care Services; JAMES ZAHRA, B.S.PHARM., is Adjunct Assistant Professor of Pharmacy Practice, Senior Pharmacist, and Intravenous Laboratory Coordinator, Department of Pharmaceutical Care Services; JOHN NOVIASKY, PHARM.D., is Assistant Professor of Medicine, Depart- ment of Medicine, Section of Clinical Pharmacology, and Associate Director, Clinical Services and Research, Department of Pharma- ceutical Care Services; LUKE PROBST, PHARM.D., BCPS, is Assistant Professor of Medicine, Department of Medicine, Section of Clinical Pharmacology, and Associate Director, Pediatric Clinical Services, Department of Pharmaceutical Care Services; and ADRIENNE SMITH, PHARM.D., BCOP, was Assistant Professor of Medicine, Department of Medicine, Section of Clinical Pharmacology, and Department of Pharmaceutical Care Services, SUNY Upstate Medical University Hospital, Syracuse, at the time of writing. Address correspondence to Dr. Darko at SUNY Upstate Medi- cal University Hospital, 750 East Adams Street, Syracuse, NY 13210 (darkow@upstate.edu). The authors have declared no potential conflicts of interest. Copyright © 2010, American Society of Health-System Pharma- cists, Inc. All rights reserved. 1079-2082/10/0201-0227$06.00. DOI 10.2146/ajhp080261 Purpose. A mixing and compatibility guide for commonly used aerosolized medica- tions was developed. Summary. Compatibility guides for inject- able drugs are available as a reference for pharmacists, nurses, and medical person- nel. These charts are commonly used in hospitals and other health care institutions and provide a quick, easy reference for compatibility of frequently used intrave- nous medications. Respiratory therapists are frequently directed to administer various aerosolized medications and are often faced with the challenge of uncertain compatibility of these drugs when mixed together. However, there appear to be limited data regarding the compatibility of these aerosolized admixtures. After a care- ful review of the literature, a compatibility chart was developed that should provide significant value to pharmacists, nurses, and respiratory therapists who administer aerosolized medications. The authors of a recently published evaluation of the com- patibility of common inhalation solutions summarized their findings in a concise table. This table served as a template to develop a more comprehensive mixing and compatibility guide in the form of an easy-to-use reference chart, which includes additional agents, compatibility references on the chart, and compatibility information for pharmacists, nurses, physicians, and respiratory therapists. Conclusion. A compatibility guide for aerosolized medications was developed for use by staff who administer these agents. Index terms: Aerosols; Compounding; Guidelines; Incompatibilities; Stability Am J Health-Syst Pharm. 2010; 67:227-30 C ompatibility references of i.v. medications provide easily ac- cessible information to guide the safe administration of parenteral therapy. 1,2 On the other hand, com- patibility information for inhaled aerosolized medications is limited. 3,4 A compatibility chart can po- tentially save time by answering the most common questions about admixtures. A chart can provide a quick and easy reference for medical personnel about compatibility of fre- quently used i.v. medications, includ- ing chemotherapy agents, antibiotics, vasopressors, and other drugs. Locating this information can be very challenging, as it often can be found only in the primary literature. Trials are heterogeneous, and results can be confusing, even contradic- tory. 3 A careful review of which inha- lation admixtures were tested and the methods used for testing is critical when reading these published trials. Trissel’s Stability of Compounded Formulations 5 and Trissel’s 2 Clini- cal Pharmaceutics Database 6 provide comprehensive data on several aero- solized drugs, including compat- ibility and stability data for various admixtures. These references are relatively unfamiliar to nurses, re- spiratory therapists, and physicians. There is no aerosolized admixture counterpart to the parenteral i.v. ad- mixture chart.