Is Zosyn (piperacillin/tazobactam) compatible with Normal saline (0.9% Sodium Chloride Injection) for intravenous administration?

Compatibility of Zosyn (Piperacillin/Tazobactam) with Normal Saline

Zosyn (piperacillin/tazobactam) is compatible with normal saline (0.9% sodium chloride) for intravenous administration, as explicitly stated in the FDA drug labeling. 1

Compatibility Information

According to the FDA drug labeling for piperacillin/tazobactam, 0.9% sodium chloride is specifically listed as a compatible diluent for both:

• Reconstitution of the medication
• Further dilution for intravenous administration 1

The drug label clearly states that 0.9% sodium chloride for injection is among the compatible intravenous solutions for single-dose vials of piperacillin/tazobactam 1.

Important Administration Guidelines

When administering Zosyn with normal saline, follow these guidelines:

1. Reconstitution: First reconstitute Zosyn with a compatible diluent (including 0.9% sodium chloride)

   • 2.25g vial: Use 10mL diluent
   • 3.375g vial: Use 15mL diluent
   • 4.5g vial: Use 20mL diluent 1

2. Dilution: Further dilute the reconstituted solution to a recommended volume of 50-150mL using 0.9% sodium chloride 1

3. Administration: Infuse over at least 30 minutes 1

Incompatible Solutions

While normal saline is compatible with Zosyn, it's important to note that:

• Lactated Ringer's solution is NOT compatible with piperacillin/tazobactam (explicitly stated in the FDA label in capital letters) 1
• Zosyn should not be mixed with other drugs in a syringe or infusion bottle unless compatibility has been established 1
• Solutions that significantly alter pH or contain only sodium bicarbonate are not chemically stable with Zosyn 1
• Zosyn should not be added to blood products or albumin hydrolysates 1

Y-Site Compatibility Considerations

When administering Zosyn through Y-site connections:

• Vancomycin at concentrations ≤7 mg/mL is compatible with piperacillin-tazobactam in normal saline 2
• Higher concentrations of vancomycin (≥8 mg/mL) can form precipitates with piperacillin-tazobactam 2
• Y-site incompatibility is more likely when 5% dextrose is used as the diluent compared to 0.9% sodium chloride 3

Clinical Context

Normal saline is frequently used in clinical practice for fluid resuscitation and as a diluent for medications. In patients requiring antibiotic therapy with Zosyn:

• Normal saline is appropriate for both reconstitution and dilution of piperacillin/tazobactam 1
• For patients with sepsis or septic shock, balanced crystalloids might be preferred over normal saline for large volume fluid resuscitation due to potential renal benefits 4, but normal saline remains compatible with Zosyn for drug administration

By following these guidelines, Zosyn can be safely and effectively administered using normal saline as the diluent.