Hospital Pharmacy - April 2018 - 125

738391
research-article2017

HPXXXX10.1177/0018578717738391Hospital PharmacyJoiner et al

Article

Physical Compatibility of Micafungin
With Sodium Bicarbonate Hydration
Fluids Commonly Used With High-Dose
Methotrexate Chemotherapy

Hospital Pharmacy
2018, Vol. 53(2) 125-127
© The Author(s) 2017
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https://doi.org/10.1177/0018578717738391
DOI: 10.1177/0018578717738391
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Logan C. Joiner1, Clay Tynes2, John Arnold1, Rachel R. Miller1,
and Greg Gorman1

Abstract
Purpose: The purpose of this study was to determine the physical compatibility of micafungin with commonly used
concentrations of sodium bicarbonate hydration fluids administered via a Y-site connected to a central venous catheter
(Y-site/CVC). Methods: Micafungin sodium (evaluated concentration of 1.5 mg/mL) was combined in a 3:1 (vehicle:drug)
ratio with the following commonly used hydration vehicles: 40 mEq/L sodium bicarbonate in 5% dextrose in water with ¼
normal saline (40SB-D5W-1/4NS), 75 mEq/L sodium bicarbonate in D5W (75SB-D5W), and 154 mEq/L sodium bicarbonate
in D5W (154SB-D5W). A 3:1 ratio was used based on the flow rates (typically 125 mL/m2/h for bicarbonate-containing
vehicles and 50 mL/h for micafungin) of the corresponding solutions in a clinical setting. Visual observations recorded to
determine physical compatibility included visual inspection against different backgrounds (unaided, black, and white). Other
physical observations were as follows: odor, evolution of gas, pH, and turbidity immediately recorded after mixing and at
specified time points up to 2 hours. Evaluations at each time point were compared against baseline observation values at
Time 0. Results: All combinations tested were found to be compatible up to 2 hours. Time points beyond 2 hours cannot
be safely verified as compatible. Conclusion: Micafungin may be administered safely using a Y-site/CVC delivery system with
all the vehicles tested in this study.
Keywords
intravenous therapy, oncology, drug/medical use evaluation, Y-site programs/incompatibilities

Introduction
The intravenous (IV) administration of a wide range of medications often utilizes acidic vehicles (eg, 0.9% sodium chloride, 5% dextrose in water). In contrast, there are also
instances where the same medications may need to be administered with alkaline vehicles (eg, sodium bicarbonate) for a
variety of reasons including treatment of metabolic acidosis,
diabetic ketoacidosis, and chemotherapy regimens requiring
alkalinization of the urine to avoid nephrotoxicity of the
agent. A specific example of the latter is high-dose methotrexate (HDMTX; ≥1000 mg/m2) used for acute lymphoblastic leukemia, non-Hodgkin's lymphoma, osteosarcoma, and
breast cancer.1,2 The poor solubility in acidic urine of methotrexate and its metabolites results in increased toxicities and
renal failure. To combat this or when alkalinization of urine
is required for other indications, intravenous hydration with
sodium bicarbonate fluids is often used.
Prior to initiation of drug therapy, these patients often
have a central venous catheter (CVC) inserted to administer

essential therapies, minimizing the need for repeated placement of a peripherally inserted central catheter (PICC).
Specific therapies (including HDMTX) which often result in
prolonged periods of neutropenia generally increase the risk
of invasive fungal infections.3 Echinocandins such as micafungin are often utilized for the prevention and treatment of
fungal infections. Simultaneous administration of sodium
bicarbonate hydration fluids and micafungin through a
Y-site/CVC would improve patient care by eliminating the
need for PICC lines while maintaining alkalinized urine.
Micafungin is typically administered in 0.9% sodium
1

Samford University, Birmingham, AL, USA
Children's of Alabama, Birmingham, AL, USA

2

Corresponding Author:
Greg Gorman, Professor and Vice Chair, Department of Pharmaceutical,
Social and Administrative Sciences, Director, Pharmaceutical Sciences
Research Institute, McWhorter School of Pharmacy, Samford University,
800 Lakeshore Drive, Birmingham, AL 35229, USA.
Email: ggorman@samford.edu
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