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Roche M, Danel C, Simon N, Kouach M, Bouchfaa M, Berneron C, Odou P, Lannoy D. Cistracurium Besylate 10 mg/mL Solution Compounded in a Hospital Pharmacy to Prevent Drug Shortages: A Stability Study Involving Four Degradation Products. Pharmaceutics 2023; 15:pharmaceutics15051404. [PMID: 37242646 DOI: 10.3390/pharmaceutics15051404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Stability study of a 10 mg/mL injectable cisatracurium solution stored refrigerated in amber glass ampoules for 18 months (M18). METHODS 4000 ampoules were aseptically compounded using European Pharmacopoeia (EP)-grade cisatracurium besylate, sterile water for injection, and benzenesulfonic acid. We developed and validated a stability-indicating HPLC-UV method for cisatracurium and laudanosine. At each stability study time point, we recorded the visual aspect, cisatracurium and laudanosine levels, pH, and osmolality. Sterility, bacterial endotoxin content, and non-visible particles in solution were checked after compounding (T0) and after M12 and M18 of storage. We used HPLC-MS/MS to identify the degradation products (DPs). RESULTS During the study, osmolality remained stable, pH decreased slightly, and the organoleptic properties did not change. The number of non-visible particles remained below the EP's threshold. Sterility was preserved, and bacterial endotoxin level remained below the calculated threshold. Cisatracurium concentration remained within the ±10% acceptance interval for 15 months and then decreased to 88.7% of C0 after M18. The laudanosine generated accounted for less than a fifth of the cisatracurium degradation, and three DPs were generated-identified as EP impurity A, impurities E/F, and impurities N/O. CONCLUSION Compounded 10 mg/mL cisatracurium injectable solution is stable for at least 15 months.
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Affiliation(s)
- Marine Roche
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
- CHU Lille, Institut de Pharmacie, F-59000 Lille, France
| | - Cécile Danel
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
- CHU Lille, Institut de Pharmacie, F-59000 Lille, France
| | - Nicolas Simon
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
- CHU Lille, Institut de Pharmacie, F-59000 Lille, France
| | - Mostafa Kouach
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
| | - Myriam Bouchfaa
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
- CHU Lille, Institut de Pharmacie, F-59000 Lille, France
| | | | - Pascal Odou
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
- CHU Lille, Institut de Pharmacie, F-59000 Lille, France
| | - Damien Lannoy
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University Lille, F-59000 Lille, France
- CHU Lille, Institut de Pharmacie, F-59000 Lille, France
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Engel J, Lazar N. Guidelines for the Establishment of Appropriate beyond Use Dating of Sterile Compounded Admixtures. Hosp Pharm 2016; 51:654-655. [DOI: 10.1310/hpj5108-654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To support compounding of products that are sterile and chemically stable, beyond use dating of admixtures must include a thorough evaluation of appropriate resources. In most instances, resources provide documentation of a specific compounded admixture, at a specific concentration and storage parameters, that does not coincide with current operations or patient-specific requirements. To meet the operational demands of a pharmacy, institutions employ a referenced guideline approach to guide decision making for safe sterile admixing. Often these guidelines are established and maintained at individual practicing locations with varying levels of detail and accuracy. In an effort to improve sterile compounding across a multihospital system, we developed and implemented beyond use dating guidelines to improve consistency and patient safety while meeting regulatory concerns.
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Affiliation(s)
- Jamin Engel
- Sentara RMH Medical Center, Harrisonburg, Virginia
| | - Nicole Lazar
- Sentara Norfolk General Hospital, Norfolk, Virginia
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Zuo M, Gao J, Zhang X, Cui Y, Fan Z, Ding M. Capillary electrophoresis with electrochemiluminescence detection for the simultaneous determination of cisatracurium besylate and its degradation products in pharmaceutical preparations. J Sep Sci 2015; 38:2332-9. [DOI: 10.1002/jssc.201500092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/03/2015] [Accepted: 04/03/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Ming Zuo
- Key Laboratory of Clinical Laboratory Diagnostics, Ministry of Education; College of Laboratory Medihaocine, Chongqing Medical University; Chongqing China
| | - Jieying Gao
- Key Laboratory of Clinical Laboratory Diagnostics, Ministry of Education; College of Laboratory Medihaocine, Chongqing Medical University; Chongqing China
| | - Xiaoqing Zhang
- Key Laboratory of Clinical Laboratory Diagnostics, Ministry of Education; College of Laboratory Medihaocine, Chongqing Medical University; Chongqing China
| | - Yue Cui
- Key Laboratory of Clinical Laboratory Diagnostics, Ministry of Education; College of Laboratory Medihaocine, Chongqing Medical University; Chongqing China
| | - Zimian Fan
- Key Laboratory of Clinical Laboratory Diagnostics, Ministry of Education; College of Laboratory Medihaocine, Chongqing Medical University; Chongqing China
| | - Min Ding
- Key Laboratory of Clinical Laboratory Diagnostics, Ministry of Education; College of Laboratory Medihaocine, Chongqing Medical University; Chongqing China
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Pignard J, Bourdeaux D, Kauffmann S, Constantin JM, Sautou V. [Physicochemical stability study of injectable solutions of cisatracurium besilate in clinical conditions]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2014; 33:304-9. [PMID: 24784917 DOI: 10.1016/j.annfar.2014.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the stability of cisatracurium besilate solution stored at 5°C and 25°C. MATERIALS AND METHODS Cisatracurium solutions at 2, 5 and 0.1mg/mL in 0.9 % sodium chloride or 5 % glucose were exposed to 5°C and 25°C under 60 % relative humidity for seven days. The physicochemical stability was assessed at 24, 48hours and seven days with dosage of the active substance, detection of degradation products and a possible racemization, measuring pH, osmolality and turbidity, assessment of coloration, visible particles and invisible particles count. RESULTS Cisatracurium besilate present good stability for 24hours at 5°C and 25°C for concentrations between 0.1 and 5mg/mL. Beyond 24hours, the solutions at 2 and 5mg/mL remained stable for seven days at 5°C. At 25°C, potentially toxic degradation products appear in solutions of 0.1mg/mL between 24 and 48hours. No racemization was detected, the drug remains in its active form cis. CONCLUSION Cisatracurium solutions at 2 and 5mg/mL may be stored at 5°C or 25°C for seven days. It's advisable to keep the solutions in a dilution of 0.1mg/mL in 0.9 % sodium chloride or 5 % glucose in the refrigerator. No diluted solution should be stored at room temperature beyond 24hours.
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Affiliation(s)
- J Pignard
- Pôle pharmacie, CHU G.-Montpied, rue Montalembert, 63003 Clermont-Ferrand, France
| | - D Bourdeaux
- Pôle pharmacie, CHU G.-Montpied, rue Montalembert, 63003 Clermont-Ferrand, France; Université d'Auvergne, EA 4676C-Biosenss, UFR médecine-pharmacie, place Henri-Dunant, 63001 Clermont-Ferrand, France
| | - S Kauffmann
- Pôle bloc chirurgical, chirurgie et anesthésie-réanimation, CHU G.-Montpied, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J M Constantin
- Pôle ressources interventionnelles - anesthésie-réanimation, CHU Estaing, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - V Sautou
- Pôle pharmacie, CHU G.-Montpied, rue Montalembert, 63003 Clermont-Ferrand, France; Université d'Auvergne, EA 4676C-Biosenss, UFR médecine-pharmacie, place Henri-Dunant, 63001 Clermont-Ferrand, France.
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De Winter S, Vanbrabant P, Vi NT, Deng X, Spriet I, Van Schepdael A, Gillet JB. Impact of Temperature Exposure on Stability of Drugs in a Real-World Out-of-Hospital Setting. Ann Emerg Med 2013; 62:380-387.e1. [DOI: 10.1016/j.annemergmed.2013.04.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 04/08/2013] [Accepted: 04/22/2013] [Indexed: 11/15/2022]
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Lorne E, Nuzzo D, Suzanne S, Walczak KA, Perret C, Laigle C, Mattei N, Dimov E, Petiot S, Godart J, Pila C, Verdier MC, Chourbagi C, Diouf M, Friggeri A, Mahjoub Y, Dupont H. [Storage at room temperature does not change cisatracurium onset time: a prospective, randomized, double-blind controlled study]. ACTA ACUST UNITED AC 2012; 31:783-7. [PMID: 22784474 DOI: 10.1016/j.annfar.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/14/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Storage of cisatracurium at room temperature seems to have no effect on its degradation in vitro contrary to the recommendations of storage at +4°C. The purpose of this study was to evaluate the influence of cisatracurium' s storage temperature on its onset time. STUDY DESIGN Prospective, randomized, double-blind trial study. PATIENTS AND METHODS Thirty patients were enrolled. The control group consisted of 15 patients receiving cisatracurium (0.15mg/kg) stored at room temperature and the intervention consisted of 15 patients receiving cisatracurium (0.15mg/kg) stored at +4°C. The primary endpoint was to compare cisatracurium onset time depending on the storage temperature. RESULTS Cisatracurium onset time was 235 (180-292) seconds in the "room temperature" group vs. 240 (210-292) seconds in the "refrigerated" group. There was no difference between the onset of cisatracurium depending on the temperature of storage (p=0.51). Subgroups analysis in the "room temperature" group did not show any difference in cisatracurium onset depending on whether it was stored at room temperature for one, two or three weeks. Excellent intubation score was obtained for 100% of the patients. CONCLUSION This study demonstrated that cisatracurium's storage at room temperature had no influence on its onset time. It provides an argument for the preservation of cisatracurium at room temperature for a period not exceeding 21 days. Monitoring the onset of curarization may increase the quality score of intubation.
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Affiliation(s)
- E Lorne
- Pôle anesthésie-réanimation-médecine d'urgence, CHU d'Amiens, place Victor-Pauchet, 80000 Amiens, France.
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Adams WA, Mark Senior J, Jones RS, Williams JM, Gleed RD. cis-Atracurium in dogs with and without porto-systemic shunts. Vet Anaesth Analg 2006; 33:17-23. [PMID: 16412128 DOI: 10.1111/j.1467-2995.2005.00231.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the non-depolarizing neuromuscular blocking drug cis-atracurium in dogs with porto-systemic shunts, and to compare it in clinically normal animals. ANIMALS Thirteen dogs of mixed breed and sex, aged between 3 and 31 months old, weighing 2.2-25.5 kg, with ASA physical status II-IV, and undergoing surgical attenuation of porto-systemic shunt. A control group of 11 bitches of mixed breed, between 8 and 60 months old, and weighing 4.5-41.0 kg, all ASA physical status I, undergoing routine ovarohysterectomy were also studied. MATERIALS AND METHODS Pre-anaesthetic medication was an opioid analgesic, given either alone or in combination with acepromazine. Following induction of general anaesthesia with intravenous (IV) propofol and oro-tracheal intubation, anaesthesia was maintained using isoflurane in either oxygen or oxygen and nitrous oxide. Ventilation was controlled. The train of four (TOF) technique was used to monitor neuromuscular blockade. An initial dose of 0.1 mg kg(-1)cis-atracurium was given IV and additional doses of 0.03 mg kg(-1)cis-atracurium were administered when at least one twitch of the TOF was present. RESULTS Except for one dog that was killed during surgery because its anomaly was inoperable, all animals recovered satisfactorily from anaesthesia and surgery. In dogs with porto-systemic shunt, onset of neuromuscular blockade was 3.1 +/- 1.1 minutes (mean +/- SD) and in control dogs was 3.4 +/- 0.7 minutes (not significantly different). Neuromuscular blockade lasted 34 +/- 13 minutes in dogs with porto-systemic shunt and 29 +/- 17 minutes in control dogs (not significantly different). CONCLUSIONS The presence of porto-systemic shunt did not affect the rate of onset or duration of action of cis-atracurium. CLINICAL RELEVANCE cis-Atracurium may have a use in veterinary anaesthesia for producing neuromuscular blockade in dogs with hepatic insufficiency, including those with porto-systemic shunt.
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Affiliation(s)
- Wendy A Adams
- University Department of Anaesthesia, University Clinical Departments, Liverpool, UK.
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