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yr ig Mixing different inhalation solutions and suspensions for simultaneous inhalation is one possibility to shorten this time timeconsuming procedure. However, mixing the inhalation solutions in the nebulizer is only recommended if compatibility of the admixtures is proven. C op Wolfgang Kamin, M.D. Ph.D. [email protected] utherian Hospital, Pediatric Department, Lu Werler Straße 130, D-59063 Hamm, Germany University Medical Cente er Mainz Langenbeckstraße 1, D--55131 Mainz, Germany Incompatibility of mixtures is proven All rights reserved by the e authors, especially the right to reproduction and d distribution as well as translation in any langua age. This leaflet is intended for p private p purp poses by p y patients p – anyy other use needs written consent of the authors. Version Sep 2014 Information Compatibility of inhalation solution admixtures© 14 © ai U Compatibility of mixtures has not been studied yet For further references please contact the authors. M ni Compatibility of mixtures is proven nz Kamin W et al. Inhalation solutions: which one are allowed to be mixed? Phyyysico-chemical compatibility of drug soluttions in nebulizers. J Cyst Fibros 2006; 5(4): 205-13 3. Which ones may be mixed? 20 rs Unused mixtures must be discarded. Do not mix Kamin W et al. Inhalation solution: Which ones ma be mi may mixed? ed? Physico-c Ph sico chemical c compatibility compatibilit of drug solutions in nebulize ers - Update 2013. J Cyst Fibros. 2014; 13(3): 243-5 50. ve Please follow the recommendations: itä References Attention: These admixtures are not licensed drugs. drugs The advices are based on in vitro studies concerning only stability and physico-chemical compatibility of the mixtures. Do not mix harm.D. Hannah Walz-Jung, Ph hannah.walz-jung@unim medizin-mainz.de University Medical Cente er Johannes Gutenberg-Un niversity Mainz Langenbeckstraße 1, D--55131 Mainz, Germany This leaflet provides information about the compatibility of selected drug solution mixtures. Please find the information in table format, visualized by the traffic light principle. Mixable Irene Krämer, Ph.D. [email protected] ts m ed iz ht Your inhalation therapy requires a lot of time and discipline. in If you have any quesstions or problems don`t hesitate to con ntact the authors Dear Patient, Compatibility of inhalation solutions/suspen nsions © in ht Choose your drug in the top line and the second one in the column on the t left. In the field where the line and the column intersect, yyou will find information about the compatibility p y of the eligible g combinattion according g to the traffic light g p principle p ((legend g see reverse side). ) Mixable # C op Gernebcin® 160 mg Colistimethate Colistin CF® Ipratropium Atrovent®** Albuterol Sultanol®** Budesonide Pulmicort® Fluticasone Flutide® Cromolyn Intal® Hypertonic saline 5.85% NaCl-solution Do not mix Pulmicort® Flutide® Intal® 5.85% NaClsolution Do not mix Do not mix Do not mix Mixable Do not mix Do not mix Do not mix Mixable M Mixable Mixable Mixable Mixable Do not mix Do not mix Mixable M Mixable Mixable Mixable Mixable Do not mix Do not mix Mixxable ** Mixable ** Mixable Mixable Do not mix Mixable Mixable # Mixable Mixable # Mixable ** Do not mix Mixable Mixable # Mixable ** Do not mix * Mi bl Mixable Mi bl Mixable Do not mix Do not mix Do not mix Mixable Mixable Do not mix Mixable Mixable Do not mix Mixable Mixable Mixable ** Mixxable # Mi bl Mixable Mi bl Mixable Mi bl Mixable Mi bl Mixable M bl Mi Mixable Mi bl Mixable Do not mix Mixable Mixable Mixable Mixxable # Mixable # * Do not mix Do not mix Do not mix Do not mix Mixxable ** Mixable ** Mixable Do not mix Do not mix Do not mix Mixable Do not mix Do not mix Mixable Do not mix Mixable ** Do not mix ni * Mixtures not recommended from a clinical point of view ** Compatibility is only proven for preservative free dosage forms # unchanged aerosol characteristics and unchanged drug output is proven Compatibility of the following triple and quadripartite admix xtures is proven: Do not mix Do not mix 14 Tobramycin Do not mix Colistin CF® nz Tobramycin Bramitob® TOBI® Bramitob®,TOBI® Mixable # 160 mg Sultanol®, Sultanol® unit dose dose** 2.5 mL itä Pulmozyme® Gernebcin® Hypertonic saline ovent®, Atro Atrrovent® uniit dose dose** 2 mL rs Dornase alfa Pulmozyme® ve Tested brands Bramitob®, TOBI® TOBI®, Gernebcin® Fluticasone-17propionate Cromolyn ts m ed iz yr ig Dornase alfa Tobramycin Tobramycin Colistimethate Iprattropium Albuterol Budesonide 20 ai M U Ipratropium (Atrovent®) + Albuterol (Sultanol®) + Tobramycin (TOBI® orr GERNEBCIN®) Ipratropium + Fenoterol (Berodual®) + Budesonide (Pulmicort®) nate (Flutide®) Ipratropium (Atrovent®) + Albuterol (Sultanol®) + Fluticasone-17-propion Ipratropium (Atrovent® unit dose 2 ml) + Albuterol (Sultanol® unit dose 2 2.5 5 ml) + Cromolyn (e (e.g. g Intal®) Ipratropium (Atrovent® unit dose 2 ml) + Albuterol (Sultanol® unit dose 2.5 2 ml) + Fluticasone-17-propionate (Flutide®)+Colistimethate (Colistin CF®) Prepare your inhalation solution mixture only immediately before the nebulization. Remaining unused admixtures are to be discarded.