drug incompatibility


Summary: The quality of not being miscible with another given substance without a chemical change. One drug is not of suitable composition to be combined or mixed with another agent or substance. The incompatibility usually results in an undesirable reaction, including chemical alteration or destruction. (Dorland, 27th ed; Stedman, 25th ed)

Top Publications

  1. Nirmal J, Saisivam S, Peddanna C, Muralidharan S, Godwinkumar S, Nagarajan M. Bilayer tablets of atorvastatin calcium and nicotinic acid: formulation and evaluation. Chem Pharm Bull (Tokyo). 2008;56:1455-8 pubmed
    ..The results indicated that the bilayer tablets could be a potential dosage form for delivering AT and NA. ..
  2. Bayol A, Breul T, Dupin P, Menegotto J, Aleman C, Duplaa H, et al. Stabilization of rasburicase and physico-chemical characterization of the resulting injectable formulation. Drug Dev Ind Pharm. 2004;30:877-89 pubmed
    ..Crystallised excipients participate in forming the structure of the powder and therefore help to prevent any collapse. Amorphous mannitol creates a surrounding medium favourable to the stability of the protein. ..
  3. Nemec K, Kopelent Frank H, Greif R. Standardization of infusion solutions to reduce the risk of incompatibility. Am J Health Syst Pharm. 2008;65:1648-54 pubmed publisher
    ..A project intended to avoid incompatibility among i.v. drugs infused in the intensive care setting included steps to standardize solutions and determine which could be given together. ..
  4. Yiu C, King N, Suh B, Sharp L, Carvalho R, Pashley D, et al. Incompatibility of oxalate desensitizers with acidic, fluoride-containing total-etch adhesives. J Dent Res. 2005;84:730-5 pubmed
    ..These surface globules may have interfered with hybridization of demineralized dentin with OB and PB resins and caused compromised bond strengths. ..
  5. Wohlt P, Zheng L, Gunderson S, Balzar S, Johnson B, Fish J. Recommendations for the use of medications with continuous enteral nutrition. Am J Health Syst Pharm. 2009;66:1458-67 pubmed publisher
    ..Clinicians should recognize potential drug-nutrient interactions and use available evidence to optimize patients' drug therapy. ..
  6. Newton D. Drug incompatibility chemistry. Am J Health Syst Pharm. 2009;66:348-57 pubmed publisher
    The chemical interactions that cause drug incompatibility in solutions, with emphasis on the acid-base and ionized-nonionized forms of organic, weak, electrolyte drugs, are examined...
  7. McKenzie J, Cruz Rivera M. Compatibility of budesonide inhalation suspension with four nebulizing solutions. Ann Pharmacother. 2004;38:967-72 pubmed
    ..These data support the chemical compatibility of budesonide inhalation suspension for up to 30 minutes with other commonly used nebulized medications for controlling pediatric asthma symptoms. ..
  8. Kharitonov V. A review of the compatibility of liposome bupivacaine with other drug products and commonly used implant materials. Postgrad Med. 2014;126:129-38 pubmed publisher
    ..No adverse synergistic effects on liposome bupivacaine were observed in evaluations involving multiple medications compared with each drug's individual effects. ..
  9. Latere Dwan isa J, Rouxhet L, Preat V, Brewster M, Arien A. Prediction of drug solubility in amphiphilic di-block copolymer micelles: the role of polymer-drug compatibility. Pharmazie. 2007;62:499-504 pubmed
    ..The data suggests that prediction of drug solubilization of block copolymer-based micelles may be facilitated by assessing the compatibility of the drug for the component polymeric domains. ..

More Information


  1. Wu J, Wei R, Wang H, Li T, Ren W. Underlying the mechanism of vancomycin and human serum albumin interaction: a biophysical study. J Biochem Mol Toxicol. 2013;27:463-70 pubmed publisher
    ..An average binding distance of 4.71 nm has been determined on the basis of the Förster resonance energy theory. It was demonstrated that vancomycin binding to HSA causes protein structural changes. ..
  2. Rose M, Currow D. The need for chemical compatibility studies of subcutaneous medication combinations used in palliative care. J Pain Palliat Care Pharmacother. 2009;23:223-30 pubmed publisher
    ..At best, it is likely that optimal symptom control is at times compromised in palliative care without chemical compatibility data for combinations of injectable medications and, at worst, toxicity is generated unknowingly. ..
  3. Athanasopoulos A, Hecq J, Vanbeckbergen D, Jamart J, Galanti L. Long-term stability of tramadol chlorhydrate and metoclopramide hydrochloride in dextrose 5% polyolefin bag at 4 degrees C. J Oncol Pharm Pract. 2009;15:195-200 pubmed publisher
    ..Based on a shelf-life of 90% residual potency, tramadol and metoclopramide were compatible and stable for at least 32 days at 4 degrees C and can be prepared in advance in a centralized intravenous additive service facility. ..
  4. Moriyama B, Henning S, Jin H, Kolf M, Rehak N, Danner R, et al. Physical compatibility of magnesium sulfate and sodium bicarbonate in a pharmacy-compounded hemofiltration solution. Am J Health Syst Pharm. 2010;67:562-5 pubmed publisher
    ..Magnesium sulfate 1.5 meq/L and sodium bicarbonate 50 meq/L were physically compatible in a pharmacy-compounded hemofiltration solution for 48 hours when stored at 22-25 degrees C without protection from light. ..
  5. Sinicropi M, Leone F, Rovito N, Genchi G. Behavior of acetyl-L-carnitine injections (Nicetile fiale) with different drugs used for combined therapy. Adv Ther. 2010;27:547-54 pubmed publisher
    ..The measurements demonstrate the physicochemical compatibility between Nicetile fiale and the other tested products, meaning that there is no evidence of interactions and degradation. ..
  6. Wakasawa T, Sano K, Hirakura Y, Toyo oka T, Kitamura S. Solid-state compatibility studies using a high-throughput and automated forced degradation system. Int J Pharm. 2008;355:164-73 pubmed publisher
    ..An extensive impact is anticipated on development workflows because this system is applicable not only to compatibility testing but also to analytical method development for drug products. ..
  7. Wang J, Guo L, Wang Y. [Study on combination components and effectiveness of Chinese traditional herbal formulas]. Zhongguo Zhong Yao Za Zhi. 2006;31:5-9 pubmed
    ..This new mode will promote the academic research and the industry development of traditional Chinese medicine. ..
  8. Leclercq L, Boustta M, Vert M. A physico-chemical approach of polyanion-polycation interactions aimed at better understanding the in vivo behaviour of polyelectrolyte-based drug delivery and gene transfection. J Drug Target. 2003;11:129-38 pubmed
    ..In the case of mixtures of two or three polyanions with the polycation, the complex formation appeared polyanion-selective at physiological ionic strength. Data are discussed with regard to phenomena that can occur in vivo. ..
  9. Wang X, Yi L, Zhang L, Li J, Luo L. [Study on the law of compatibility in three categorized formulas for tonifying Shen Yang: Shenqi pill, Yougui pill, and Yougui drink based on rough set]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2013;33:114-8 pubmed
    ..Appropriate edge herbs should be chosen for compatibility according to different core herbs. The decision rules model based on rough set has a good prospect in exploring the law of compatibility of the categorized formulas. ..
  10. Singh B, Dedhiya M, DiNunzio J, Chan P, Kupiec T, Trissel L, et al. Compatibility of ceftaroline fosamil for injection with selected drugs during simulated Y-site administration. Am J Health Syst Pharm. 2011;68:2163-9 pubmed publisher
    ..Nine drugs in 23 admixtures were observed to exhibit signs of incompatibility with ceftaroline fosamil within four hours of mixing; those drugs should not be simultaneously administered via a Y-site with ceftaroline preparations. ..
  11. Levac B, Parlow J, van Vlymen J, James P, Tuttle A, Shepherd L. Ringer's lactate is compatible with saline-adenine-glucose-mannitol preserved packed red blood cells for rapid transfusion. Can J Anaesth. 2010;57:1071-7 pubmed publisher
    ..The results indicate RL can be safely co-administered with PRBC during rapid transfusion (< 60 min). ..
  12. Bernard L, Sautou V, Bourdeaux D, Chopineau J. [Stability and compatibility of acetaminophen, ketoprofen and amoxicillin in a fail-safe intravenous administration set]. Ann Fr Anesth Reanim. 2012;31:47-52 pubmed publisher
    ..Despite the technical innovation of a fail-safe intravenous administration set, we have to stay aware of mixture consequences in intravenous infusion field. ..
  13. De Giorgi I, Guignard B, Fonzo Christe C, Bonnabry P. Evaluation of tools to prevent drug incompatibilities in paediatric and neonatal intensive care units. Pharm World Sci. 2010;32:520-9 pubmed publisher
    ..Standard operating procedures for drug-incompatibility assessment should be implemented in drug-information centres. Tools with low NCA percentage, such as the pH or CHUV tables, may be useful for nurses in ICUs. ..
  14. Chadha R, Kashid N, Jain D. Microcalorimetric evaluation of the in vitro compatibility of amoxicillin/clavulanic acid and ampicillin/sulbactam with ciprofloxacin. J Pharm Biomed Anal. 2004;36:295-307 pubmed
    ..The coefficients hi's calculated from Redlich-Kister equation for binary systems (DeltaHbi.E) and ternary interaction parameter (A) were used to predict the compatibility of the marketed formulations in pH range studied. ..
  15. Cohen B, Volovich Y, Musikant B, Deutsch A. The effects of eugenol and epoxy-resin on the strength of a hybrid composite resin. J Endod. 2002;28:79-82 pubmed
    ..17) or diametral tensile strength (p = 0.39). Group 1 (mixed directly with eugenol) was found to be statistically different from groups 2 through 7. ..
  16. Servais H, Tulkens P. Stability and compatibility of ceftazidime administered by continuous infusion to intensive care patients. Antimicrob Agents Chemother. 2001;45:2643-7 pubmed
  17. Fang Y, Zhou X, Liu B, Wang Y. A study on the basic drugs and points for point application in summer to treat the diseases with attacks in winter. J Tradit Chin Med. 2010;30:180-4 pubmed
  18. LaPlante K, Woodmansee S, Mermel L. Compatibility and stability of telavancin and vancomycin in heparin or sodium citrate lock solutions. Am J Health Syst Pharm. 2012;69:1405-9 pubmed publisher
    ..2% formulation, but no precipitation was noted after 10 minutes of incubation at 37 °C. Telavancin and vancomycin 2 and 5 mg/mL retained over 90% of the initial concentration after incubation at 37 °C over 72 hours. ..
  19. Burchett D, Darko W, Zahra J, Noviasky J, Probst L, Smith A. Mixing and compatibility guide for commonly used aerosolized medications. Am J Health Syst Pharm. 2010;67:227-30 pubmed publisher
    ..A compatibility guide for aerosolized medications was developed for use by staff who administer these agents. ..
  20. Smith W, Karpinski J, Timpe E, Hatton R. Evaluation of seven i.v. drug compatibility references by using requests from a drug information center. Am J Health Syst Pharm. 2009;66:1369-75 pubmed publisher
    ..Other popular references identified fewer pairs, and the manufacturers' labeling rarely contained compatibility information. ..
  21. Bonasia P, McVicar W, Bill W, Ong S. Chemical and physical compatibility of levalbuterol inhalation solution concentrate mixed with budesonide, ipratropium bromide, cromolyn sodium, or acetylcysteine sodium. Respir Care. 2008;53:1716-22 pubmed
    ..Admixture pH had not changed significantly at T(30). Drug recovery was 93.2-102.6% of the initial or control values. The 2-drug admixtures we studied were compatible for at least 30 min at room temperature. ..
  22. Gómez M, Arenas V, Sanjuán M, Hernández M, Almenar C, Torres V. Stability studies of binary mixtures of haloperidol and/or midazolam with other drugs for parenteral administration. J Palliat Med. 2007;10:1306-11 pubmed
    ..Common combinations of medications to control symptoms are compatible when mixed in 5% glucose or 0.9% sodium chloride. However, stability over 15 days is not uniform. ..
  23. Abanmy N, Zaghloul I, Radwan M. Compatibility of tramadol hydrochloride injection with selected drugs and solutions. Am J Health Syst Pharm. 2005;62:1299-302 pubmed
  24. Macher A, Thomas D, Paul S. Contraindicated antiretroviral drug combinations. N J Med. 2002;99:19-21; quiz 22-4 pubmed
  25. Grenier F, Ali S, Syed H, Workman R, Martens F, Liao M, et al. Evaluation of the ARCHITECT urine NGAL assay: assay performance, specimen handling requirements and biological variability. Clin Biochem. 2010;43:615-20 pubmed publisher
    ..The largest variance component in a biological variance study was within-day. The ARCHITECT NGAL assay proved to be a precise and reproducible assay for the determination of urine NGAL. ..
  26. McDonnell P. Controlling adverse drug reactions through improved monitoring. Am J Manag Care. 2006;12:256-7 pubmed
  27. West D, Golden W. Medicare part D and medication management in the elderly. J Ark Med Soc. 2006;102:320-1 pubmed
  28. Wang J, Wang Y, Yang G. [Methods and modes about the theory of traditional Chinese prescription composition]. Zhongguo Zhong Yao Za Zhi. 2005;30:6-8, 11 pubmed
    ..The researches and foundation about the new modes of compound prescription of Chinese medicine would do active influence either in making modern Chinese medicine or in increasing clinical curative effect. ..
  29. Fox L, Foushee J, Jackson D, Watson H. Visual compatibility of common nebulizer medications with 7% sodium chloride solution. Am J Health Syst Pharm. 2011;68:1032-5 pubmed publisher
    ..Eleven medications used in nebulizers for the treatment of CF were visually compatible with 7% sodium chloride solution. ..
  30. Mann H, Demmon S, Boelk D, Payne C, Effron M, Rajagopalan N, et al. Physical and chemical compatibility of drotrecogin alfa (activated) with 34 drugs during simulated Y-site administration. Am J Health Syst Pharm. 2004;61:2664-71 pubmed
  31. dos Santos C, Mazzola P, Silva P, Cholewa O, Penna T. Preliminary study on the potential utility of GFP as a biosensor for drug stability in parenteral solutions. Biotechnol Prog. 2007;23:979-84 pubmed
    ..Results show that GFP fluorescence intensity was proportional to the loss in drug stability over time and thus may potentially be added to a lot sample of a drug/parenteral solution as an immediate on-site test for defective product. ..
  32. Trissel L, Saenz C, Ogundele A, Ingram D. Physical compatibility of pemetrexed disodium with other drugs during simulated Y-site administration. Am J Health Syst Pharm. 2004;61:2289-93 pubmed
    ..However,mixture with 24 drugs resulted in precipitation (including microprecipitation) and color change. Pemetrexed disodium was incompatible with 24 drugs during simulated Y-site administration and should not be administered with them. ..
  33. Patel N, Patel N, Patel R. Design and evaluation of transdermal drug delivery system for curcumin as an anti-inflammatory drug. Drug Dev Ind Pharm. 2009;35:234-42 pubmed
    ..This formulation demonstrated good anti-inflammatory activity against carrageenan-induced oedema in Wistar albino rats similar to standard formulation. ..
  34. Wang Y, Wang Y, Liang Q, Ma Z, Xiao C, Tan H, et al. [Study on toxicity of uniform design-based compatible use of Veratrum nigrum and asarum]. Zhongguo Zhong Yao Za Zhi. 2012;37:2139-42 pubmed
    ..nigrum and asarum, and V. nigrum after the compatible use, and V. nigrum made a greater contribution to the toxicity caused by the compatible use. But the toxicity did not absolutely enhance with the increase in use of V. nigrum...
  35. Johnson C, Truong N. Stability and compatibility of tacrolimus and fluconazole in 0.9% sodium chloride. J Am Pharm Assoc (Wash). 1999;39:505-8 pubmed
    ..Tacrolimus and fluconazole are stable and compatible in a range of clinically used concentrations for 3 hours and can be intravenously co-administered through a Y-site. ..
  36. Franco O, Karnik K, Bonneux L. The future of metabolic syndrome and cardiovascular disease prevention: polyhype or polyhope? Tales from the polyera. Horm Metab Res. 2007;39:627-31 pubmed
    ..Polyproducts from the polyera in true populations might hide unexpected polyinteractions. In the polyera, polytrials will need to establish benefits, harms, and costs. ..
  37. Hoppe Tichy T, Simon K, Hentze B. [Drug interactions in practice]. Ther Umsch. 2000;57:563-7 pubmed
    ..During the administration of unavoidable mixtures visible changes of the solutions should be carefully sought. ..
  38. Xi S, Zhao J, Zhao H, Zhu H, Qian X, Li W, et al. [Theoretical study on thirteen or fourteen incompatible medicaments and opposite drug properties of Tujia ethnic medical science]. Zhongguo Zhong Yao Za Zhi. 2012;37:1500-5 pubmed
  39. Bouchoud L, Fonzo Christe C, Klingmüller M, Bonnabry P. Compatibility of intravenous medications with parenteral nutrition: in vitro evaluation. JPEN J Parenter Enteral Nutr. 2013;37:416-24 pubmed publisher
    ..These results offer new solutions to support the implementation of complex therapeutic schemes in practice, when coadministration via Y-site cannot be avoided. ..
  40. Hartman C, Baroletti S, Churchill W, Patel P. Visual compatibility of argatroban with selected drugs. Am J Health Syst Pharm. 2002;59:1784-5 pubmed
  41. Fan X, Duan J, Ding A. [Four issues of basic research on categorized formulae of Chinese medicine]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2010;30:246-51 pubmed
  42. Swart E, van Reij E, Lee W, Sinjewel A. Visual compatibility of atosiban acetate with four drugs. Am J Health Syst Pharm. 2005;62:2459, 2463 pubmed
  43. Flemming A, Picker Freyer K. Compaction of lactose drug mixtures: quantification of the extent of incompatibility by FT-Raman spectroscopy. Eur J Pharm Biopharm. 2008;68:802-10 pubmed
    ..In conclusion, FT-Raman spectroscopy is a fast and valuable tool for a quantitative determination of the extents of incompatibility in solid dosage forms. ..
  44. Dong Z, Choi D. Hydroxypropyl methylcellulose acetate succinate: potential drug-excipient incompatibility. AAPS PharmSciTech. 2008;9:991-7 pubmed publisher
    ..In addition, dyphylline was also tested with HPMC-AS and the potential incompatibility was further confirmed. ..
  45. Condie C, Tyler L, Barker B, Canann D. Visual compatibility of caspofungin acetate with commonly used drugs during simulated Y-site delivery. Am J Health Syst Pharm. 2008;65:454-7 pubmed publisher
    ..Caspofungin acetate was physically compatible during Y-site injection with 23 of 31 medications tested. ..
  46. Kamin W, Schwabe A, Krämer I. Physicochemical compatibility of fluticasone-17- propionate nebulizer suspension with ipratropium and albuterol nebulizer solutions. Int J Chron Obstruct Pulmon Dis. 2007;2:599-607 pubmed
    ..Further investigations are needed to determine whether or not drug delivery is affected by mixing the nebulizer suspensions and to ensure that simultaneous nebulization is recommendable. ..
  47. Newton D, Driscoll D. Calcium and phosphate compatibility: revisited again. Am J Health Syst Pharm. 2008;65:73-80 pubmed
  48. Ozdemir F, Anilanmert B, Pekin M. Spectrophotometric investigation of the chemical compatibility of the anticancer drugs irinotecan-HCl and epirubicin-HCl in the same infusion solution. Cancer Chemother Pharmacol. 2005;56:529-34 pubmed
    ..The positive or negative contribution of this interaction to the pharmacological effect of the combination might be of importance, and therefore should be investigated in further clinical trials. ..
  49. Zeng J, Yang L, Liang Q, Zhang X, Guan H, Xu X, et al. Influence of the drug compatibility with polymer solution on the release kinetics of electrospun fiber formulation. J Control Release. 2005;105:43-51 pubmed
    ..The burst release of the drugs can be avoided by using compatible drugs with polymers, and the drug release can follow nearly zero-order kinetics due to the degradation of the PLLA fibers in the presence of proteinase K. ..
  50. Holm R, Jensen I, Sonnergaard J. Optimization of self-microemulsifying drug delivery systems (SMEDDS) using a D-optimal design and the desirability function. Drug Dev Ind Pharm. 2006;32:1025-32 pubmed
  51. Albert K, van Vlymen J, James P, Parlow J. Ringer's lactate is compatible with the rapid infusion of AS-3 preserved packed red blood cells. Can J Anaesth. 2009;56:352-6 pubmed publisher
    ..The current study challenges recommendations that AS-3 PRBC should not be mixed with RL for rapid transfusion. ..
  52. Dansereau R, Crail D. Compatibility of risedronate sodium tablets with food thickeners. Am J Health Syst Pharm. 2008;65:2133-6 pubmed publisher
    ..193 to 0.195 mg/mL. All samples ranged from 98.8% to 99.9% of the initial concentration after 1 hour and from 96.7% to 99.2% after 24 hours. Risedronate sodium tablets were compatible for 24 hours with five food thickeners. ..
  53. Kupie T, Trusley C, Ben M, Trissel L. Physical and chemical stability of palonosetron hydrochloride with five common parenteral drugs during simulated Y-site administration. Am J Health Syst Pharm. 2008;65:1735-59 pubmed publisher
    ..Palonosetron hydrochloride is physically and chemically stable with atropine sulfate, famotidine, heparin sodium, lidocaine hydrochloride, and potassium chloride during simulated Y-site administration. ..