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NEPHROLOGY

Stability of Vancomycin in Icodextrin Peritoneal Dialysis Solution

Assistant Professor, Department of Pharmaceutical Sciences, Albany College of Pharmacy, Albany, NY

Rowland J Elwell, PharmD

Assistant Professor, Albany Nephrology Pharmacy Group, Department of Pharmacy Practice, Albany College of Pharmacy

Reprints: Dr. Nornoo, Department of Pharmaceutical Sciences, Albany College of Pharmacy, 106 New Scotland Ave., Albany, NY 12208-3492, fax 518/694-7017, nornooa{at}acp.edu

BACKGROUND: Icodextrin is a glucose polymer used as an alternative osmotic agent in peritoneal dialysis (PD) solutions. There are few data regarding the long-term stability of vancomycin in icodextrin PD solution.

OBJECTIVE: To determine the chemical stability of vancomycin in icodextrin PD solution in polyvinyl chloride containers over a 7 day period at 4, 24, and 37°C.

METHODS: Study samples were prepared by adding 2000 mg vancomycin HCl to commercially available 2.0 L bags of icodextrin 7.5% PD solution. Nine bags were prepared and stored in the following conditions: 3 under refrigeration (5°C), 3 at room temperature (24°C), and 3 at body temperature (37°C). Samples were withdrawn from each bag immediately after preparation and at predetermined intervals over the subsequent 7 days. Solutions were visually inspected for precipitation, cloudiness, or discoloration at each sampling interval. Total concentration of vancomycin in dialysate fluid was determined by high performance liquid chromatography.

RESULTS: Under refrigeration, a mean ± SD of 99.7% ± 0.5% of the initial vancomycin concentration remained at 168 hours (7 days). At room temperature, 97.5% ± 3.4% remained at 168 hours. At body temperature, 94.3% ± 3.9% remained at 24 hours. Stability was not assessed beyond these time points.

CONCLUSIONS: Premixed vancomycin-icodextrin PD solutions, whether stored refrigerated or at room temperature, were found to be stable for up to 7 days. However, we recommend that these solutions be kept refrigerated whenever possible. Solutions stored at body temperature were stable for up to 24 hours, permitting the practice of prewarming solutions prior to administration.

Key Words: icodextrin, peritoneal dialysis, stability, vancomycin

Published Online, October 24, 2006. www.theannals.com, DOI 10.1345/aph.1G321