Vancomycin Compatibility with D5 1/2 NS
Yes, vancomycin is compatible with D5 1/2 NS (5% dextrose in 0.45% sodium chloride) solution. The FDA-approved labeling explicitly lists "5% Dextrose Injection and 0.9% Sodium Chloride Injection, USP" as physically and chemically compatible with vancomycin hydrochloride, and D5 1/2 NS falls within this compatibility spectrum 1.
Key Compatibility Information
Approved Compatible Diluents:
- The FDA label confirms vancomycin is compatible with 5% Dextrose Injection, 0.9% Sodium Chloride Injection, and combinations thereof (including 5% Dextrose Injection and 0.9% Sodium Chloride Injection, USP) 1.
- D5 1/2 NS represents a dilution between pure D5W and D5 0.9% NS, both of which are explicitly approved 1.
Concentration Considerations:
- Vancomycin should be diluted to concentrations ≤5 mg/mL when possible to minimize precipitation risk 1.
- Solutions diluted with 5% Dextrose Injection or 0.9% Sodium Chloride Injection may be stored refrigerated for 14 days without significant loss of potency 1.
Important Stability Data
Research Evidence:
- High-concentration vancomycin solutions (62.5-83.3 mg/mL) in D5W demonstrated stability for 48 hours at room temperature, whereas precipitation occurred in 0.9% NaCl at the highest concentrations 2.
- Vancomycin remained stable throughout centralized preparation, storage, and continuous infusion for up to 48 hours in dextrose-containing solutions 3.
Critical Compatibility Warnings
Incompatible Medications:
- Never mix vancomycin with β-lactam antibiotics (including piperacillin-tazobactam, ceftazidime, cefazolin, imipenem, cefepime) in the same line without adequate flushing 1, 3.
- Major incompatibilities exist with moxifloxacin, propofol, valproic acid, phenytoin, theophylline, methylprednisolone, and furosemide 3.
- The likelihood of precipitation increases with higher vancomycin concentrations 1.
Safe Co-Administration:
- Compatible medications include ciprofloxacin, aminoglycosides, macrolides, ketamine, sufentanil, midazolam, morphine, piritramide, nicardipine, urapidil, dopamine, dobutamine, and adrenaline 3.
- Adequately flush IV lines between administration of incompatible antibiotics 1.
Practical Administration Guidelines
Dilution Requirements:
- Reconstituted vancomycin (500 mg/10 mL) must be further diluted in at least 100 mL of suitable infusion solution 1.
- For 1 gram doses, use at least 200 mL of solution 1.
- Administer by intermittent IV infusion over at least 60 minutes 1.
pH Considerations:
- Vancomycin solution has a low pH and may cause physical instability when mixed with other compounds 1.
- Always visually inspect for particulate matter and discoloration before administration 1.
Clinical Outcome Data
Nephrotoxicity Comparison:
- A retrospective study found no significant difference in acute kidney injury rates between vancomycin diluted in NS (14.6%) versus D5W (22.8%), P = 0.14 4.
- No significant differences were observed in hyperglycemia, hyperchloremia, hypernatremia, metabolic acidosis, or mortality between diluent types 4.