Systems and Methods for Compounding Injectable Therapeutic Agents
Methods for compounding a therapeutic agent for intravenous administration. The method comprise providing a syringe or vial comprising the agent dissolved or pre-dissolved in a carrier at a dose or concentration that is therapeutically effective for a particular patient but is not commercially available at the therapeutically effective dose or concentration or is on the U.S. FDA drug shortage list, and adding the therapeutic agent dissolved in the carrier to an intravenous solution (diluent). The methods exclude reconstituting multiple solid forms of the commercially available agent and combining the reconstituted preparations together, for example, according to traditional compounding procedures at point-of-care pharmacies.
1 . A method for compounding a therapeutic agent for intravenous administration, comprising:
providing a syringe containing the therapeutic agent dissolved in a carrier at a dose or concentration that is therapeutically effective for a particular patient but is not commercially available at the therapeutically effective dose or concentration or is on the U.S. FDA drug shortage list, disinfecting the syringe and disinfecting a port on a container containing a diluent, connecting the disinfected syringe to the disinfected port, injecting the therapeutic agent dissolved in the carrier into the diluent via the port, and verifying that the syringe is depleted of the therapeutic agent dissolved in the carrier;
provided that the therapeutic agent is not dissolved in the carrier by drawing the carrier into a first syringe, injecting the carrier from the first syringe into a vial containing the agent in powder form and mixing the carrier with the agent to obtain a reconstituted preparation of the agent, removing the reconstituted preparation of the agent from the vial, and combining the reconstituted preparation of the agent with another reconstituted preparation of the agent.
2 . The method according to claim 1 , wherein the therapeutic agent is a calcium channel blocker, antibiotic, contrast agent, local anesthetic, epidural agent, electrolyte supplement, opioid analgesic, non-steroidal anti-inflammatory analgesic, corticosteroid, proton pump inhibitor, h2 antagonist, anticholinergic, sympathomimetic vasopressor, catecholamine vasopressor, anticoagulant, benzodiazepine, oxytocic agent, alpha-adrenergic receptor agent, beta-adrenergic blocking agent, or anticonvulsant.
3 . The method according to claim 1 , wherein the therapeutic agent comprises one or more of hydromorphone, midazolam, morphine, norepinephrine, oxytocin, phenylephrine, ropivacaine, bupivacaine, lidocaine, vancomycin, gentamicin, atropine, betamethasone, calcium gluconate, cefazolin, dexamethasone, diltiazem, epinephrine, ephedrine, esmolol, fentanyl, flumazeril, glycopyrrolate, heparin, hydralazine, ketamine, labetalol, magnesium sulfate, metropropolol, xanthine, caffeine, rocuronium, sodium citrate, sodium thiosulfate, succinylcholine, vasopressin, verapamil, or vecuronium.
4 . The method according to claim 1 , wherein the carrier comprises water and, optionally, one or more buffers.
5 . The method according to claim 1 , wherein the diluent is an isotonic fluid, a hypotonic fluid, or a hypertonic fluid.
6 . The method according to claim 1 , wherein the method further comprises connecting the disinfected syringe to the disinfected port via a needle.
7 . A method for compounding a therapeutic agent for intravenous administration, comprising:
providing a vial comprising a puncturable closure and containing the therapeutic agent dissolved in a carrier at a dose or concentration that is therapeutically effective for a particular patient but is not commercially available at the therapeutically effective dose or concentration or is on the U.S. FDA drug shortage list, disinfecting the closure and optionally disinfecting a port comprising a spike and connected to a container containing a diluent, connecting the vial to the port such that the spike punctures the closure, adding the therapeutic agent dissolved in the carrier to the diluent through the port, and verifying that the vial is depleted of the therapeutic agent dissolved in the carrier;
provided that the therapeutic agent is not dissolved in the carrier by drawing the carrier into a syringe, injecting the carrier from the syringe into the vial containing the agent in powder form and mixing the carrier with the agent to obtain a reconstituted preparation of the agent, removing the reconstituted preparation of the agent from the vial, and combining the reconstituted preparation of the agent with another reconstituted preparation of the agent, provided that no diluent is removed from the container prior to allowing the therapeutic agent dissolved in the carrier to flow into the diluent via the port, and provided that the volume of the agent dissolved in the carrier is less than 10% of the volume of the diluent in the container.
8 . The method according to claim 7 , wherein the therapeutic agent is a calcium channel blocker, antibiotic, contrast agent, local anesthetic, epidural agent, electrolyte supplement, opioid analgesic, non-steroidal anti-inflammatory analgesic, corticosteroid, proton pump inhibitor, h2 antagonist, anticholinergic, sympathomimetic vasopressor, catecholamine vasopressor, anticoagulant, benzodiazepine, oxytocic agent, alpha-adrenergic receptor agent, beta-adrenergic blocking agent, or anticonvulsant.
9 . The method according to claim 7 , wherein the therapeutic agent comprises one or more of hydromorphone, midazolam, morphine, norepinephrine, oxytocin, phenylephrine, ropivacaine, bupivacaine, lidocaine, vancomycin, gentamicin, atropine, betamethasone, calcium gluconate, cefazolin, dexamethasone, diltiazem, epinephrine, ephedrine, esmolol, fentanyl, flumazeril, glycopyrrolate, heparin, hydralazine, ketamine, labetalol, magnesium sulfate, metropropolol, xanthine, caffeine, rocuronium, sodium citrate, sodium thiosulfate, succinylcholine, vasopressin, verapamil, or vecuronium.
10 . The method according to claim 7 , wherein the carrier comprises water and, optionally, one or more buffers.
11 . The method according to claim 7 , wherein the diluent is an isotonic fluid a hypotonic fluid, or a hypertonic fluid.
12 . The method according to claim 7 , wherein the vial containing the therapeutic agent dissolved in the carrier comprises a ratio of carrier volume to empty space of about 1 to about 1 or greater.
13 . The method according to claim 7 , wherein the vial containing the therapeutic agent dissolved in the carrier comprises a ratio of carrier volume to empty space of about 1 to about 2 or greater.
14 . A method for compounding a therapeutic agent for intravenous administration, comprising:
providing a vial comprising a puncturable closure and containing the therapeutic agent dissolved in a carrier at a dose or concentration that is therapeutically effective for a particular patient but is not commercially available at the therapeutically effective dose or concentration or is on the U.S. FDA drug shortage list, disinfecting the closure and disinfecting a port comprising a spike, connecting the vial to the disinfected port such that the spike punctures the closure, and connecting the port to a container containing a diluent, adding the therapeutic agent dissolved in the carrier to the diluent through the port, and verifying that the vial is depleted of the therapeutic agent dissolved in the carrier;
provided that the therapeutic agent is not dissolved in the carrier by drawing the carrier into a syringe, injecting the carrier from the syringe into the vial containing the agent in powder form and mixing the carrier with the agent to obtain a reconstituted preparation of the agent, removing the reconstituted preparation of the agent from the vial, and combining the reconstituted preparation of the agent with another reconstituted preparation of the agent, provided that no diluent is removed from the container prior to allowing the therapeutic agent dissolved in the carrier to flow into the diluent via the port, and provided that the volume of the agent dissolved in the carrier is less than 10% of the volume of the diluent in the container.
15 . The method according to claim 14 , wherein the therapeutic agent is a calcium channel blocker, antibiotic, contrast agent, local anesthetic, epidural agent, electrolyte supplement, opioid analgesic, non-steroidal anti-inflammatory analgesic, corticosteroid, proton pump inhibitor, h2 antagonist, anticholinergic, sympathomimetic vasopressor, catecholamine vasopressor, anticoagulant, benzodiazepine, oxytocic agent, alpha-adrenergic receptor agent, beta-adrenergic blocking agent, or anticonvulsant.
16 . The method according to claim 14 , wherein the therapeutic agent comprises one or more of hydromorphone, midazolam, morphine, norepinephrine, oxytocin, phenylephrine, ropivacaine, bupivacaine, lidocaine, vancomycin, gentamicin, atropine, betamethasone, calcium gluconate, cefazolin, dexamethasone, diltiazem, epinephrine, ephedrine, esmolol, fentanyl, flumazeril, glycopyrrolate, heparin, hydralazine, ketamine, labetalol, magnesium sulfate, metropropolol, xanthine, caffeine, rocuronium, sodium citrate, sodium thiosulfate, succinylcholine, vasopressin, verapamil, or vecuronium.
17 . The method according to claim 14 , wherein the carrier comprises water and, optionally, one or more buffers.
18 . The method according to claim 14 , wherein the diluent is an isotonic fluid, a hypotonic fluid, or a hypertonic fluid.
19 . The method according to claim 14 , wherein the vial containing the therapeutic agent dissolved in the carrier comprises a ratio of carrier volume to empty space of about 1 to about 1 or greater.
20 . The method according to claim 14 , wherein the vial containing the therapeutic agent dissolved in the carrier comprises a ratio of carrier volume to empty space of about 1 to about 2 or greater.