Drugs Not Recommended for Infusion in Dextrose IV
Several medications should not be infused in dextrose-containing solutions due to physical incompatibility, chemical degradation, or reduced efficacy. Based on the available evidence, these incompatibilities can lead to precipitation, reduced drug effectiveness, or potential patient harm 1, 2.
Key Incompatible Drug Categories
Antibiotics
- Cephalosporins including cefazolin, cefepime, ceftaroline fosamil, ceftazidime, ceftriaxone, and cefuroxime should not be administered in dextrose solutions 2
- Penicillins including ampicillin-sulbactam, piperacillin-tazobactam (in 5% dextrose only), and penicillin G potassium (in 5% dextrose only) are incompatible with dextrose solutions 3, 2
- Other antimicrobials including azithromycin (in 5% dextrose only), colistimethate sodium, and tedizolid should be avoided in dextrose solutions 2
Antifungals
- Amphotericin B (all formulations: deoxycholate, lipid complex, and liposome) is incompatible with dextrose solutions 2
- Micafungin should not be administered in dextrose solutions 2
Cardiovascular Drugs
- Amiodarone shows significant sorption to PVC infusion bags when prepared in dextrose solutions, with up to 40% loss of drug concentration after 120 hours 4
- Furosemide is physically incompatible with dextrose solutions 2
Other Critical Medications
- Propofol forms an unstable emulsion when mixed with dextrose solutions 2, 5
- Phenytoin and fosphenytoin precipitate in dextrose solutions 2, 6
- Sodium bicarbonate and phosphate solutions (both sodium and potassium) are incompatible with dextrose 2
- Methylprednisolone should not be administered in dextrose solutions 2
Clinical Implications and Recommendations
Prevention Strategies
- When multiple IV medications are required, consider using a multilumen infusion device like Edelvaiss Multiline-8, which has been shown to prevent physical drug incompatibilities in 49% of tested drug combinations 7
- For drugs requiring dextrose-free administration, use normal saline (0.9% sodium chloride) or other compatible solutions as specified in the drug's administration guidelines 1, 2
Special Considerations for Specific Medications
- For iron preparations (iron dextran, ferric sodium gluconate), administration in normal saline is preferred over dextrose solutions 1
- When administering vasoactive drugs like epinephrine, norepinephrine, or phenylephrine, avoid mixing with dextrose if possible, as these critical medications should be administered through dedicated lines 1
Alternative Solutions
- When balanced electrolytes are needed without dextrose, consider PlasmaLyte, which contains no glucose but provides electrolytes that closely mimic human plasma 8
- For patients requiring both balanced electrolytes and dextrose, consider separate administration of PlasmaLyte and dextrose solution, or choose alternative solutions 8
Common Pitfalls to Avoid
- Never mix incompatible drugs in the same IV line or solution, even temporarily, as precipitation can occur immediately 2, 5
- Be aware that some incompatibilities are not immediately visible - precipitation or degradation may occur over time 4
- Remember that Y-site administration (where two separate IV lines meet near the patient) can still result in drug incompatibilities if the medications are not compatible 2, 5
- Always check compatibility charts or consult with a pharmacist when uncertain about specific drug-solution compatibility 1, 2
By understanding these incompatibilities and following appropriate administration guidelines, clinicians can prevent potential adverse events related to inappropriate IV drug administration in dextrose solutions.