Summary of common drug compatibility taboos, if you miss it, you won't find it! Collect it.

Overview of common drug compatibility taboos

Compatibility taboo refers to the incompatibility of drugs in vitro. Direct physical or chemical interaction will affect the efficacy of drugs or produce toxic reactions. General incompatibility is divided into physical (rare) and chemical (common) categories.

When several injections are used together in clinic, if there are incompatibility. It will reduce or invalidate the curative effect and even cause adverse drug reactions, which should be avoided.

1, water-soluble vitamin injection +kcl

Analysis: Adding strong electrolyte can produce the same ion effect, point neutralization, salting out, etc., and reduce the solubility of organic acid salts (pantothenic acid, vitamin C, glycine, ethylenediamine tetraacetic acid, etc.). ), organic alkali salts (vitamin B 1, vitamin B6, etc. ) and methyl paraben, thereby precipitating from the solution and increasing insoluble particles.

2. Furosemide+Dopamine+Glucose Injection

Analysis: Furosemide is a sodium salt injection with high alkalinity, and sodium chloride injection should be used instead of glucose injection for intravenous injection. Clinically, it is often combined with dopamine to enhance its diuretic effect, but it is reported that the color of the two drugs changes slightly after mixing.

It is suggested that the two drugs should be used separately in clinic, and continuous infusion is not suitable. It is best to infuse 0.9% normal saline in the middle, that is, the infusion order is dopamine → normal saline → furosemide.

3. Dexamethasone+Vitamin B6

Analysis: The concentrated solution of two drugs mixed in the same container may produce turbidity or precipitation. VitB6 is a salt made of water-soluble substances, which does not precipitate itself due to the change of PH value, but can cause dexamethasone phosphate and other salts made of water-insoluble acidic substances to precipitate.

4. Polyene phosphatidylcholine+potassium chloride

Analysis: Polyene phosphatidylcholine is a clear colloidal solution and cannot be mixed with any other injection. If intravenous infusion is to be prepared, it can only be diluted with electrolyte-free glucose solution, and electrolyte solution is strictly prohibited to avoid its stability being destroyed.

5、Vitc+vitk 1

Analysis: VitK 1 can be destroyed and invalidated by VitC.

Usage: VitK 1 can be used by liver to synthesize prothrombin VII, IX and X factors. VitC can participate in redox and glucose metabolism in vivo, increase capillary density and reduce its permeability and brittleness, accelerate blood coagulation and stimulate hematopoietic function. From pharmacological and pathological analysis, the combination of the two drugs is beneficial.

Contraindications of compatibility: VitC has strong reducibility, and redox reaction can occur after mixing with quinone drug VitK 1, which reduces the curative effect of VitK 1.

6. insulin+vitamin c

Analysis: VitC is highly reductive and mixed with insulin, which leads to insulin inactivation.

7. Ceftriaxone+Calcium Gluconate

Analysis: The combination of ceftriaxone sodium and calcium-containing drugs (including calcium-containing solutions) may cause fatal adverse events. Therefore, it is not advisable to mix them or use them at the same time. Even if different administration methods are used in different parts, it is not advisable to use calcium-containing drugs within 48 hours after ceftriaxone is used.

8, vitk 1+ potassium chloride

Analysis: It is reported that vitamin K 1 is incompatible with potassium chloride, which can reduce the content of vitamin K 1 by more than 30%.

9. Aminophylline injection+Ambroxol injection+α chymotrypsin.

Analysis: The PH value of aminophylline is close to 9.6, with strong alkalinity. Ambroxol can lead to precipitation of free alkali in solution with pH > 6.3. The aqueous solution of α -chymotrypsin for injection is the most stable at pH 3 ~ 4. Aminophylline+ambroxol and aminophylline+α-chymotrypsin injection should not be mixed and compatible.

10, vitamin c+ inosine

Analysis: physical and chemical incompatibility, mixed infusion in the same bottle reduces the curative effect and increases the adverse reactions.

1 1, calcium gluconate injection+dexamethasone sodium phosphate injection

Analysis: Calcium gluconate contains divalent calcium ions, and dexamethasone sodium phosphate is used for stratification. Phosphate reacts with calcium to form calcium phosphate precipitate, which cannot be mixed.

12, omeprazole ++vitC

Analysis: Omeprazole has the chemical structure of sulfinyl benzimidazole and is weakly alkaline. Very unstable under acidic conditions, easy to change color or polymerize and precipitate. The solution prepared by this product shall not be mixed with other drugs or used in the same infusion.

13, omeprazole +5% glucose

Analysis: Omeprazole has the chemical structure of sulfinyl benzimidazole and is weakly alkaline. Very unstable under acidic conditions, easy to change color or polymerize and precipitate. NS should be used as the solvent.

14, β -lactams are incompatible with acidic or alkaline drugs.

Analysis: Cephalosporins (especially the first generation cephalosporins) should not be combined with high-efficiency diuretics (such as furosemide) to prevent serious renal damage. Methicillin in penicillin is also incompatible with it.

15, cefoxitin sodium and most cephalosporins have antagonistic effects, and the combination can weaken the antibacterial effect. Compatibility with aztreonam has antagonistic effect in vivo and in vitro.

16, aminoglycosides should not be compatible with drugs with ototoxicity (such as erythromycin) and nephrotoxicity (such as potent diuretics, cephalosporins, dextran, sodium alginate, etc.). ), nor with muscle relaxants or drugs with this effect (such as diazepam, etc.). ) to prevent toxicity from strengthening. These drugs are also mutually incompatible.

17, aminoglycosides (such as amikacin, netilmicin, etc. ) mixed with β -lactam antibiotics (such as penicillins and cephalosporins) can lead to mutual inactivation and reduce the curative effect. During continuous infusion, 0.9% normal saline should be infused halfway to flush the catheter. At the same time, the combination of these two drugs often increases nephrotoxicity.

18, when carbamazepine is combined with phenobarbital and phenytoin sodium, it can accelerate the metabolism of carbamazepine and reduce its concentration; Nicotinamide, antidepressants, macrolide antibiotics, isoniazid, cimetidine and other drugs can increase the plasma concentration of carbamazepine and make it prone to toxic reactions. In addition, when lithium salt, thiazine and carbamazepine are used together, it is easy to cause symptoms of nervous system poisoning. Carbamazepine can also weaken the anticoagulant effect of warfarin. When combined with oral contraceptives, vaginal bleeding and contraceptive failure will occur. So pay special attention when sharing.

19. Drugs that inhibit intestinal flora can inhibit the decomposition of sulfasalazine in the intestine, thus affecting the dissociation of 5-aminosalicylic acid, which may reduce the curative effect, especially various broad-spectrum antibacterial drugs.

20, alkaline drugs, anticholinergic drugs, H2 receptor blockers can reduce the acidity of gastric juice, reduce the absorption of quinolones, should be avoided.

2 1. Tetracyclines should not be compatible with antacids, calcium salts, iron salts and other drugs containing heavy metal ions, so as to avoid complex reactions and block the absorption of tetracycline drugs. Milk has a similar effect.

22, codeine central analgesic and central depressant, can produce additive effect.

23. Dextromethorphan combined with monoamine oxidase inhibitor can cause high fever, coma and even death.

24. Ephedrine and monoamine oxidase inhibitors can cause hypertension.

25, morphine and chlorpromazine injection. Pethidine should not be used with promethazine for many times to avoid respiratory depression; Combined with monoamine oxidase inhibitor (MAOI), it can cause excitement, high fever, sweating and unconsciousness. Fentanyl also has this reaction.

26. Antidepressants should not be combined with MAOI. Because of their similar effects, both of them have antidepressant effects, and they must be used in small amounts when combined. In addition, it is not suitable for use with adrenocortical drugs. Antidepressants can enhance the pressor effect of adrenergic drugs.

27, tramadol and monoamine oxidase inhibitors. Because their functions are opposite to each other and cancel each other out.

28. Levodopa is prohibited from being combined with monoamine oxidase inhibitors, ephedrine, reserpine and adrenergic drugs. Carbidopa should not be combined with amantadine, benzothiophene, proanthocyanidins and trihexyphenidyl.

29. Cimetidine should not be used with antacids and metoclopramide. If they must be used together, the interval should be 1 hour. In addition, it should not be compatible with theophylline, benzodiazepines, digoxin, quinidine, caffeine, warfarin anticoagulant, captopril and aminoglycosides.

30, enzyme digestion drugs should not be combined with antacids, otherwise, its activity will be reduced.

3 1, gastric motility drugs (domperidone and cisapride) should not be combined with anticholinergic drugs, and their effects cancel each other out.

32. Smecta can affect the absorption of other drugs. If they must be used together, other drugs should be taken 1 hour before taking this product.

33, iron agent should not be combined with drugs such as calcium, phosphate, tannic acid, antacid and strong tea, otherwise it can form precipitation and affect its absorption; Combined with tetracycline, it can affect the absorption of the other side.

34. Verapamil should not be combined with beta blockers, otherwise it will cause hypotension, bradycardia, conduction block and even cardiac arrest.

35. Macrolides can inhibit the normal metabolism of theophylline. The combination of two drugs can lead to abnormal increase of theophylline blood concentration, leading to poisoning and even death. Therefore, the plasma concentration of theophylline should be monitored to prevent accidents.

Clarithromycin can make digoxin, theophylline, oral anticoagulants, ergotamine or dihydroergotamine and triazolam all show stronger effects, and it can also have similar metabolic blocking effects on carbamazepine, cyclosporine A, barbital and phenytoin sodium. To enhance the effect. In addition, fluoroquinolones can also inhibit theophylline metabolism.

Second, the list of contraindications for pregnant women

When pregnant women take drugs, some drugs can break through the placental barrier and enter the fetus, which will affect the growth and development of the fetus to varying degrees, such as abortion, fetal malformation, congenital diseases, and even lead to fetal death. Therefore, medication safety during pregnancy is very important.

The US Food and Drug Administration (FDA) issued the classification standard of pregnancy risk:

Level a

Comparative study shows that it is harmless. It has been proved that such drugs have no adverse effects on human fetuses and are the safest.

Class b

Evidence that is harmless to humans. Animal experiments are harmful to fetal animals, but it has not been proved to be harmful to fetal animals or harmless to fetal animals in humans, but it has not been fully studied in humans.

Class c

Harmfulness cannot be ruled out. Animal experiments may be harmful to fetal animals or lack of research, and there is still a lack of relevant research in human beings, but the benefits to pregnant women outweigh the harm to the fetus.

Class d

Harmful to the fetus. Market research or research has proved that it is harmful to the fetus, but the benefits to pregnant women exceed the harm to the fetus.

X-class

Prohibited during pregnancy. In human or animal research, or market research, it shows that the harm to the fetus is greater than the benefit to the pregnant woman, which belongs to the banned drugs during pregnancy.

Grade standard of commonly used drugs:

1, antihistamines: chlorpheniramine (b), cimetidine (b), diphenhydramine (b), promethazine (c)

2, anti-infective drugs:

1. Insect repellent: gentian violet (C)

2. antimalarial drug: chloroquine (D)

3. Antitrichomonal drug: metronidazole (B)

4. Antibiotics: amikacin (C), gentamicin (C), kanamycin (D), neomycin (D), cephalosporin (B), streptomycin (D), penicillin (B), tetracycline (D), oxytetracycline (D), chlortetracycline (D) and bacitracin.

5. Anti-tuberculosis drugs: ethambutol (b), isoniazid (c), rifampicin (c) and p-aminosalicylic acid (c).

6. Antifungal drugs: clotrimazole (C), miconazole (C) and nystatin (B)

7. Antiviral drugs: amantadine (c), cytarabine (c), ribavirin (x), azido thymidine (c) and acyclovir (c).

3, anti-tumor drugs:

Bleomycin (D), cyclophosphamide (D), tumor killer (D), cisplatin (D), cytarabine (D), gentamicin (D), thiotepa (D), daunorubicin (D), adriamycin (D), fluorouracil (D), nitrogen mustard (D) and melphalan (D).

4, autonomic nervous system drugs:

1. Choline mimics: acetylcholine (c) and neostigmine (c)

2. anticholinergic drugs: atropine (c), belladonna (c) and propofol (c)

3. Adrenomimetic drugs: epinephrine (c), norepinephrine (d), ephedrine (c), isoproterenol (c), m-hydroxylamine (d), dopamine (c), dobutamine (c), m-hydroxysalbutamol (b) and oxybupropion (b).

5, central nervous system drugs:

1. Central stimulant: caffeine (b)

2. Antipyretic and analgesic drugs: acetylsalicylic acid (C/D), phenacetin (B) and sodium salicylate (C/D).

3. Non-steroidal anti-inflammatory drug: indomethacin (B/D)

4. Analgesics: codeine (B/D), morphine (B/D), opium (B/D), pethidine (B/D) and naloxone (c).

5. Sedative and hypnotic drugs: pentobarbital (c), pentobarbital (c), phenobarbital (b), chloral hydrate (c), ethanol (D/X), diazepam (d) and nitrodiazepam (c).

6. Antipsychotics: droperidol (C) and chlorpromazine (C)

7. antidepressant: doxepin (c)

6, cardiovascular system drugs:

1. cardiac glycosides: digitalis (b), digoxin (b), digitoxin (b) and quinidine (c).

2. antihypertensive drugs: clonine (c), methyldopa (c), hydralazine (b), sodium nitroprusside (d) and prazosin (c).

3. Vasodilators: isoamyl nitrite (c), dipyridamole (c), isosorbide nitrate (c) and nitroglycerin (c).

7. Diuretics: hydrochlorothiazide (D), uric acid (D), furosemide (C), mannitol (C) and triamterene (D).

8. Digestive system medicine: Compound Camphor Tincture (B/D)

9. Hormones:

1. Adrenal cortical hormones: cortisone (D), betamethasone (C), dexamethasone (C) and prednisone (B).

2. Estrogen: diethylstilbestrol (X), estradiol (D) and oral contraceptives (D)

3. Progesterone: progesterone

4. hypoglycemic agents: insulin (b), chlorosulfonylurea (d) and methylsulfonylurea (d)

5. Antithyroid drugs: propylthiouracil (D) and tabazole (D)

Three, intravenous drip drug compatibility taboo table

Intravenous drip is a common clinical treatment method, but there are some incompatibility between many intravenous drip drugs, which need pharmacists to master and apply to their work!

Tips: Click on the picture to enlarge the collection!

Four. Taboo list of compatibility of Chinese and western medicines

Compatibility taboo refers to the physical and chemical reactions such as neutralization, hydrolysis, destruction and invalidation of drugs when two or more drugs are mixed or made into preparations. At this time, turbidity, precipitation, gas production, discoloration and other phenomena may occur.

The taboo of physical compatibility is that some drugs will change physically when mixed together, that is, change the physical properties such as solubility and appearance of the original drugs, which brings difficulties to the application of drugs.

Taboo of chemical compatibility means that some drugs will react chemically together, which will not only change the characteristics of drugs, but also make drugs ineffective, ineffective or poisoned, and even cause combustion or explosion.

Taboo list of compatibility between Chinese and western medicine, please collect!