Molcule Ketorolac Ketorolac Ketorolac Ketorolac Ketorolac Levofolinate Calcique Ondansetron + Dexamethasone Piperacilline + Tazobactam Sufentanil + levobupivacaine Tramadol Vancomycine 10 mg 10 mg 20 mg 30 mg 30 mg

Dosage/ 100 ml

Poche polyolefine polyolefine polyolefine polyolefine polyolefine polyolefine polyolefine pvc pvc pvc polyolefine
Stockage - 20C 15 jrs 15 jrs 90 jrs 15 jrs 15 jrs 95 jrs 90 jrs 90 jrs 120 jrs 120 jrs 105 jrs
Conditions Optimales Optimales Optimales Optimales Optimales Optimales Optimales Optimales Optimales Optimales Optimales
Cycle 270 W 800 W 270 W 270 W 800 W 270 W 270 W 270 W 270 W 270 W 270 W
Stockage 4C 35 jrs au moins 35 jrs au moins 60 jrs 35 jrs au moins 35 jrs au moins 30 jrs 30 jours au moins 35 jrs 70 jrs 60 jrs 56 jrs
400 mg/250 ml 8 mg + 10 mg 4g 0,6 mg + 625 mg/ 500 ml NaCl 0,9 % 100 mg 500 mg

16 molcules

6 anti-infectieux (ATC J)
Cefepime, ceftriaxone, cefuroxime, piperacilline + tazobactam, vancomycine
2 anesthsiques et 1 analgsique (ATC N)
Levobupicacaine, sugnetanil Tramadol
2 anti-inflammatoires (ATC M)

Diclofenac, ketorolac

2 divers (ATC V)
Folinate sodique, levofolinate calcique

1 anti-mtique ( ATC A)

ondansetron
1 corticostroide ( ATC H)

dexamethasone

1 antinoplasique (ATC L)

fluorouracile

Mdications congeles/ dcongeles par micro-ondes

n n n n n n

Ann Pharmacother Ann Pharm Fr Can J Hosp Pharm Eur J Hosp Pharm Int J Pharm Compound J Clin Pharm Ther

:4 :1 :2 :5 :2 :1

31/01/2011
This issue of the EJHP-Science contains two papers of drug stability from the prolific group at the University Hospital of Mont-Godinne, Yvoir, Belgium. (G. Sewell, 2006) Jean-Daniel Hecq et al from the University Hospital of Mont-Godinne in Belgium, the most important team currently publishing stability studies in Europe. (J. Vigneron, Stabilis Newsletter, June 2009)
"You and your colleagues are among the most active researchers in Clinical Pharmaceutics in the world since the Americans have nearly abandoned the field (or been thrown out like me). It is now up to you and people like you to keept the research alive." (L. Trissel, 23/12/2009)
Cefuroxime 1,5 g/100 ml dextrose 5 % en poches de polyolefine

Stockage -30C

Conditions de conglation
Cycle de dconglation 270 W 800 W 270 W 800 W

Stockage 4C

98 jours 98 jours 98 jours 98 jours
Optimales Optimales Minimales Minimales
23 jours 21 jours 21 jours 18 jours
Ketorolac 10 mg/100 ml dextrose 5 % en poches de polyolefine
Stockage -30C Conditions de conglation Optimales Optimales Cycle de dconglation 270 W 800 W Stockage 4C

15 jours 15 jours

35 jours au moins 35 jours au moins
Ketorolac 30 mg/100 ml dextrose 5 % en poches de polyolefine

Il faut cependant n se doter de conglateurs ( conglation, stockage) n acqurir un ou plusieurs fours micro-ondes n valider un cycle de dconglation par volume de poche dcongeler n monitorer les tempratures des conglateurs et frigos n faire vrifier rgulirement le bon fonctionnement des HFL n raliser le contrle microbiologique des productions.
Il ne faut pas, pour autant, ngliger les travaux des units de recherche et dveloppement des industries pharmaceutiques qui ont fait de l'administration intraveineuse leur domaine de prdilection, permettant ainsi certaines d'entre elles de proposer des "kits de reconstitution".
Le choix est rarement entre le bien et le mal mais entre le pire et le moindre mal

Machiavel (1469 - 1527)

Ils ne savaient pas que ctait impossible, alors ils lont fait !

Mark Twain (1835 1910)

Une injection mdicamenteuse est la consquence d une injonction mdicale

Pierre Dac, 1972

Services mdicaux

Chirurgie

Patient
Services mdico-techniques

Services non mdicaux

Pharmacie Hospitalire

Rfrences

Rollin C, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L Effects of freezing and microwave thawing on the stability an ondansetron / dexamethasone mixture stored in dextrose 5% polyolefin bags. Annals of Pharmacotherapy 2011;45:Franois J, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L Effect of Freezing, Long-Term Storage and Microwave Thawing on the Stability of a Mixture of Diclofenac and Sodium Bicarbonate in Glucose 5% Polyolefin Bags Annales Pharmaceutiques Franaises 2009 ;67 :427-432 Lebitasy M, Hecq JD, Athanassopoulos A, Vanbeckbergen D, Jamart J, Galanti L Effect of Freezing, microwave thawing, and long-term storage on the stability of calcium levofolinate in 5% dextrose infusion polyolefin bags J Clin Pharm Ther 2009;34:423428 Galanti L, Lebitasy MP, Hecq JD, Vanbeckbergen D, Jamart J Long-term stability of 5-Fluorouracil in 0.9 % sodium chloride after freezing, microwave thawing and refrigeration Can J Hosp Pharm 2009 ; 62 (1) : 34-38 Cadrobbi J, Hecq JD, Vanbeckbergen D, Jamart J,Galanti L Effect of freezing, long-term storage and microwave thawing on the stability of sodium folinate in dextrose 5 % polyolefin bags. EJHP-S 2009 ; 15 (1) : 15- 19
Rodenbach MP, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L. Stability of cefuroxime infusion : the brand-name versus a generic product. EJHP-S 2006 ; 12 : 16-18 Hecq JD, Evrard JM, Vanbeckbergen D, Jamart J, Galanti LEffect of freezing, long term storage and microwave thawing on the stability of ceftriaxone sodium in 5 % dextrose infusion polyolefin bags at 2-8C. EJHP-S 2006 ; 12 : 52-56 Rodenbach MP, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L. Effect of Freezing, Long-Term Storage, and Microwave Thawing on the Stability of Vancomycine Hydrochloride in 5 % dextrose infusions. EJHP-S 2005; 11 : 111-113 Hecq JD, Schlesser V, Vanbeckbergen D, Jamart J, Galanti L. Effect of freezing, long-term storage, and microwave thawing on the stability of cefuroxime sodium in 5 % dextrose infusion polyvinyl chloride bags. EJHP-S 2005; 1 : 23-25

Hecq JD, Boitquin LP, Vanbeckbergen DF, Jamart J, Galanti LM. Effect of Freezing, Long-Term Storage, and Microwave Thawing on the Stability of Ketorolac Tromethamine Ann Pharmacother 2005; 39 : 1654-1658. DOI 10.1345/aph. IG 194 Hecq JD, Boitquin LP, Vanbeckbergen DF, Jamart J, Galanti LM. Effect of the Freezing Conditions and Microwave Thawing Power on the Stability of Cefuroxime in Dextrose 5 % Infusion Polyolefin Bags at 4C. Ann Pharmacother 2005; 39 (7-8) : 1244-1248 Boitquin LP, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L. Stability of sufentanil citrate with levobupivacaine HCl in 0,9 % sodium chloride infusion after microwave freeze-thaw treatment. Ann Pharmacother 2004; 38 : 1836-1839 Boiquin LP, Hecq JD, Evrard JM, Vanbeckbergen D, Jamart J, Galanti L. Long term stability of sufentanil citrate with levobupivacaine HCl in 0,9 % sodium chloride infusion pvc bags at 4C. J Pain Symptom Manage 2004; 28 : 4-6
Hecq JD, Berlage V, Vanbeckbergen D, Jamart J, Galanti L. Effects of freezing, long-term storage, and microwave thawing on the stability of piperacillin plus tazobactam in 5 % dextrose for infusion. Can J Hosp Pharm 2004; 57 (5) : 276-282 Lebrun J, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L. Effect of freezing, long-term storage and microwave thawing on the stability of tramadol in 5 % dextrose infusion PVC bags. Int J Pharm Compound 2004; 8 (2) : 156-159 Schlesser V, Hecq JD, Vanbeckbergen D, Jamart J, Galanti L. Effect of freezing, long-term storage and microwave thawing on the stability of cefepime in 5 % dextrose infusion PVC bags. Int J Pharm Compound 2002; 6 : 391-394 Galanti LM, Hecq JD, Jeuniau P, Vanbeckbergen D, Jamart J. Assessment of the stability of teicoplanin in intravenous infusions. Int J Pharm Compound 2001; 5 : 397-400

Quelques mdications largement utilises dans les Institutions Hospitalires - cefepime, - ceftriaxone - cefuroxime, - ketorolac, - piperacilline + tazobactam, - sufentanil + levobupivacaine - tramadol - vancomycine
Standardisation des Reconstitutions & Administration
Molcule Cefepime Ceftriaxone Cefuroxime Ketorolac Piperacilline + tazobactam Tramadol Vancomycine Dose 2g 2g 1,5 g 20 mg Diluant glucose 5 % glucose 5 % glucose 5 % glucose 5 % Volume 100 ml 100 ml 100 ml 100 ml Conteneur pvc polyolefine pvc polyolefine

4g 100 mg 500 mg

glucose 5 % glucose 5 % glucose 5 %

100 ml 100 ml 100 ml

pvc pvc polyolefine
Stabilits : ouvrages de rfrences
Allwood M - Wright P. The Cytotoxic Handbook - 4e dition Bing C.M. Extended stability for parenteral drugs ASHP, 4th ed. 2009 Catania P.N. King Guide to parenteral admixtures King Guide Publications 2009 Hecq J.-D. Stabilit des mdicaments injectables en perfusion. ABPH-BVZA - Baxter 2009
Stabilits : ouvrage de rfrences
Morris N. Australian Handbook injectable drugs - 2e dition Society of Hospital Pharmacist of Australia 1997 Needle R. - Sizer T. The Civas Handbook. Pharmaceutical Press, 1998 Trissel L.A. Handbook on injectable drugs, 15th Edition ASHP 2009 Turco S.J. Parenteral admixtures and incompatibilities Sterile dosage forms. Their preparation and clinical application, 4th Edition, 1994 Vigneron J. Stabilis
Molcules : 400 Renseignements : 45.100 Rfrences : 2.562
Essai et vrification de la mthode HPLC Dosages Recueil des donnes, analyse, conclusion et dcision
Molcule Cefepime Ceftriaxone Ceftriaxone Cefuroxime Cefuroxime Cefuroxime Cefuroxime Cefuroxime Fluorouracile Folinate Sodique 2g 2g 2g 1,5 g 1,5 g 1,5 g 1,5 g 1,5 g

Dosage/ 100 ml

Poche pvc polyolefine polyolefine pvc polyolefine polyolefine polyolefine polyolefine pvc polyolefine
Stockage - 20C 30 jrs 98 jrs 98 jrs 90 jrs 98 jrs 98 jrs 98 jrs 98 jrs 79 jrs 90 jrs
Conditions Optimales Optimales Optimales Optimales Optimales Optimales Minimales Minimales Optimales Optimales
Cycle 270 W 270 W 800 W 270 W 800 W 270 W 270 W 800 W 270 W 270 W
Stockage 4C 11 jrs 44 jrs 56 jrs 15 jrs 21 jrs 23 jrs 21 jrs 18 jrs 28 jrs 30 jrs
800 mg/100 ml NaCl 0,9 % 800 mg/250 ml
Molcule Ketorolac Ketorolac Ketorolac Ketorolac Ketorolac 10 mg 10 mg 20 mg 30 mg 30 mg
Poche polyolefine polyolefine polyolefine polyolefine polyolefine
Stockage - 20C 15 jrs 15 jrs 90 jrs 15 jrs 15 jrs
Conditions Optimales Optimales Optimales Optimales Optimales
Cycle 270 W 800 W 270 W 270 W 800 W
Stockage 4C 35 jrs au moins 35 jrs au moins 60 jrs 35 jrs au moins 35 jrs au moins 30 jrs
Levofolinate Calcique Piperacilline + Tazobactam Sufentanil + levobupivacaine Tramadol Vancomycine