Scribd
Upload
786 views

INCOMPATIBILITIES

This document discusses different types of incompatibilities that can occur with medications, including physical, chemical, and therapeutic incompatibilities. Physical incompatibilities involve conflicting properties like insolubility, while chemical incompatibilities refer to reactions like oxidation or hydrolysis that change a drug's composition. Therapeutic incompatibilities occur when drugs have antagonistic medical effects if taken together. The document provides many examples of specific incompatibility issues and their remedies.

Uploaded by

Ark Olfato Parojinog
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
786 views

INCOMPATIBILITIES

This document discusses different types of incompatibilities that can occur with medications, including physical, chemical, and therapeutic incompatibilities. Physical incompatibilities involve conflicting properties like insolubility, while chemical incompatibilities refer to reactions like oxidation or hydrolysis that change a drug's composition. Therapeutic incompatibilities occur when drugs have antagonistic medical effects if taken together. The document provides many examples of specific incompatibility issues and their remedies.

Uploaded by

Ark Olfato Parojinog
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 27

*******************, RPh

INCOMPATIBILITY means..
• Conflict, disagreement, differences in prescription.
• Problem which could arise during the compounding or
dispensing of a prescription.
• Interaction of two or more substances.

• ADVERSE DRUG REACTIONS (ADR) – results when a


problem arise using only a single drug.
1. INTENTIONAL
- an obvious change once compounds are combined
but their therapeutic effect is maintained.
▪ Example : Effervescence
2. NON-INTENTIONAL
- changes which affect the therapeutic value of the
medication.
▪ Example: Na Phenobarbital gr. 6
Lactated Pepsin Elixir qs ad fz.1
1. PHYSICAL INCOMPATIBILTY
- A condition arising in the process due to conflicting physical
properties of the ingredient in a solvent.
2. CHEMICAL INCOMPATIBILTY
- A condition arising from chemical reaction that changes the
original composition of a substance.
3. THERAPEUTIC INCOMPATIBILTY
- A condition arising from conflicting property in the action of
the drug.
• Physical or chemical interaction between two or more
ingredients that leads to a visibly recognizable change.
• Causes non-uniform or non-palatable mixture which may
possess a potential danger.
1. INCOMPLETE SOLUTION
▪ Forms of Incomplete Solution
o INSOLUBILITY – Inability of the solid material to dissolve in a particular
solvent system.

EXAMPLE: * Camphor + Water (Remedy: Change H2O and use alcohol)


* Gum + Alcohol (Remedy: Change alcohol and use H2O)
* Iodine + Water (Remedy: Use solubilizing agent =
KI, Low amount of water needed)
o IMMISCIBILITY- Two or more liquids fail to mix with one another
homogenously.

EXAMPLE: * Cod liver oil + Water


(Remedy: Convert to emulsion, add emulsifying agent)
* 1mL phenol + 10mL water
(Remedy: Add glycerin drop by drop (co-solvent))
2. PRECIPITATION – the solute which is originally dissolved in the solvent
is thrown out of solution; separation of the solute
- A substance is generally precipitated from its solution in one solvent
in which it is insoluble when added to a solution.
o SALTING OUT – concentrated solutions of electrolytes are mixed in
prescription with solutions of non-electrolytes.
- “Salting-out” also occurs w/ liquids aside from solids where
the less soluble component is pushed out of the solution.

EXAMPLE: KBr + Camphor water (Remedy: Dispense separately)

o CHANGE IN SOLVENT SYSTEM


EXAMPLE: NH4Cl + Camphor + Alcohol + Water
(Remedy: Dispense separately)
o CHANGE IN TEMPERATURE (Endothermic/Exothermic Reactions)

• ENDOTHERMIC REACTION – absorbs heat from the surrounding;


increased temperature of the solution increases solubility.
EXAMPLE: NH4Cl+Water (Imp.Reminder: Store in temperature)
• EXOTHERMIC REACTION – gives off heat to the surrounding; the lower
the temperature of the solution; the lower its solubility, except lime water.
EXAMPLE: Lime water is more soluble in cold than in hot water.

o CHANGE IN pH
EXAMPLE: Phenobarbital Na + Syrup of Orange
(Remedy: Change syrup of Ipecac to simple syrup)
3. LIQUEFACTION OF SOLID INGREDIENT – due to deliquescence,
efflorescence, and eutexia.
▪ Deliquescence – absorbs moisture and liquefies (NaCl)
▪ Efflorescence – release of water of crystallization (Citric acid)
▪ Eutexia – liquefaction of solids at room temperature, due to the
lowering of their melting points. Exhibited by ASA, menthol, phenol,
thymol, camphor, salol and other aldehydes and ketones.
EXAMPLE: Lidocaine + Prilocaine → EMLA
* ASA + Thymol (Remedy: Dispense separately)

** NOTE: Eutexia is NOT always to be expected in mixing ECs.


EXAMPLE: Salol: Acetanilide (2:1 liquefies; 1:2 will not)
Salol: MgCO3 (2:1 liquefies; 1:2 will not)
4.VAPORIZATION – AKA ‘volatilization’; liberation of the API.
EXAMPLE:Volatile oils, ketone, esters, NTG, aldehyde, alcohol
5. POLYMORPHISM – existence of one or more crystalline and/or amorphous
form.
EXAMPLE: Cubic: NaCl Tetragonal: Urea
Monoclinic: Sugar Rhombic: Iodine
Triclinic: Boric acid Hexagonal: Iodoform
6.WATER LOSS – manifested by liquid dosage forms; reverse of liquefaction.
EXAMPLE: Emulsion (phase inversion in O/W emulsion)
Crumbling of ointments and creams
(Remedy: add humectant to prevent dryness e.g. Glycerin & sorbitol)
This occurs due to interactions between or among the
ingredients/drugs.
Reactions in which visible change is NOT necessarily
observed.
1. DELAYED CHEMICAL INCOMPATIBILITY
- changes which occur to as light extent or at a very slow rate with no
distinguishable change that occurs. This may result in a loss of therapeutic
activity.
EXAMPLE: NaCl, ZnSO4 = precipitation
(Remedy: change tonicity agent (NaCl) into boric acid)
A. INTENTIONAL – product of reaction is the one that is used.
EX: ZnSO4 + K2S = white lotion (No correction!)
A. UNINTENTIONAL – product of reaction presents a problem.
EX: Ascorbic Acid + NaHCO3 = Neutralization
(Remedy: Change NaHCO3, use an inert diluent)
** Rx with delayed incompatibility may be dispensed if the prescription
will be used up before about 10% of the therapeutic activity is lost.

2. IMMEDIATE CHEMICAL INCOMPATIBILITY


- This occurs immediately upon compounding and usually it is
apparent.
EXAMPLE: Effervescence, precipitation
1. OXIDATION-REDUCTION (REDOX)
o OXIDATION – remember VILEORA → Valence Increase; Loss of Electrons;
Oxidation; Reducing Agent
• Dehydrogenation
• Triggered by oxygen, light metals
• Manifests as change in color
EXAMPLE: Ascorbic Acid = white to yellow ; Epinephrine = yellow to pink
o REDUCTION – remember VDGEROA → Valence Decrease; Gain of
Electrons; Reduction; Oxidizing Agent
• Hydrogenation
EXAMPLE: Tollen’s test – ‘silver mirror image/test’
2. ACID-BASE REACTIONS (General Reaction: A + B → Salt + Water)
o PRECIPITATION – new product is formed
EXAMPLE: Ca(OH)2 + CO2 → CaCO3 + H2O
o EVOLUTION OF GAS – facilitates effervescence
• Effervescence is desired to mask salty and bitter-tasting drugs
• Chemical reaction involved : NaHCO3 + Citric Acid + Tartaric Acid

3. HYDROLYSIS
- the most common type of incompatibility
- it involves water as the solvent
- the most common mechanism of drug degradation
EXAMPLE: Susceptible groups of the following groups:
* Lactams (penicillins, cephalosporins)
* Esters (local anesthetics)
* Amides (local anesthetics)
* Imines (Benzodiazepines, barbiturates)
4. SOLVOLYSIS – interaction of drug with solvent other than water.
5. PHOTOCHEMICAL DEGRADATION (Photooxidation; Photolysis)
• Degradation by light
• Manifests as change in color
EXAMPLE: Nifedipine, Nitroprusside, Riboflavin, Phenothiazines,
Adriamycin, Cisplatin, and Amphotericin B
(Remedy: Store in light-resistant containers)
6. RACEMIZATION – the optically active form of drug is converted into its
enantiomorph, continues until 50% of original drug is converted to its
optically inactive mixture.
• Product: Racemic mixture – contains equal amounts of dextro (+R) and
levo (- L) isomers.
EXAMPLE: Thalidomide (R- for morning sickness; S - teratogenic)
Naproxen (Active form – NSAID; Inactive - Hepatotoxic)
7. GELATINIZATION – gel or gelatin formation
EXAMPLE: Acacia + Ferrous salts
8. CEMENTATION – cake formation
EXAMPLE: Acacia + Bismuth salts
9. EXPLOSIVE MIXTURE – reducing agent (RA) + oxidizing agent (OA)
EXAMPLE: Sugar + KMnO4 ; Glycerin + KMnO4
10. POLYMERIZATION – Formation of 5-OH-methylfurfural from Dextrose
- Also known as Pharmacologic Incompatibility, is a
form of incompatibility whereby the ingredients of the drugs
of antagonistic medicinal activity are prescribed together.
- It usually involves drug to drug interactions, drug to
food interactions, drug and herbal medicines interaction
and drug to laboratory tests interaction.
1. PROPERTIES OF THE DRUG
A. Physical Properties – these are drugs that can cause absorption or
adsorption of drugs
EXAMPLE: Kaopectate suspension + Tetracycline
* TCN can be absorbed by kaolin, hence no TCN is absorbed
B. Chemical Properties – the tendency of the drugs to produce a rxn
EXAMPLE: TCN + Milk = Chelation
C. Toxic Properties – Toxic + Toxic = VERY TOXIC
EXAMPLE: Aminoglycoside + Loop Diuretic = Both ototoxic → more toxic
D. Therapeutic Properties
EXAMPLE: Penicillin + Chloramphenicol = no effect
(bactericidal) + (bacteriostatic)
2. COMBINATION WITH OTHER DRUGS AND EXCIPIENTS
EXAMPLE: Veegum – excipient in antacid suspension that causes drug
interaction with antibiotics.
3. ROUTE AND FREQUENCY OF ADMINISTRATION
EXAMPLE: IV using the same tube for Carbenicillin and Gentamycin
Correction: Change the ROA of one of the drugs.
4. KINETICS OF THE DRUG – ADME
5. DRUG INTERACTIONS - If the drug has the ability to interact with other
drugs, drug interaction or therapeutic inability occurs.
1. IMPROPER DOSES
o Overdosage
• Excessive amounts taken at one time
• Doses repeated at too frequent intervals
• Milligram instead of microgram
• Dose-dumping from modified release formulation
o Underdosage
• Administration of very small doses
• Dosage given at less frequent intervals
• Milligram instead of gram
• Tinctures instead of fluidextracts
2. SYNERGISTIC AND ANTAGONISTIC COMBINATION
* Synergistic – drugs with same pharmacologic action; intentional or
unintentional.
* Antagonistic – drugs with opposing pharmacologic action; may be
acceptable or not.
3. WRONG DRUG
o Trademark error or ineffective generic name – SALADs
o Improperly formulated dosage – physical or chemical incompatibilities
o Dosage form error – ophthalmic ointment instead of topical gel
o Improper dose – Buccal or SL tablets being swallowed.

4. CONTRAINDICATD DRUG
EXAMPLE: Hypertensives – NO to vasoconstrictors
Asthmatics – NO to penicillins
Patients with ulcer – NO to steroids
5. FORMATION OF TOXIC COMPOUNDS – May result from chemical
incompatibility
6. REDUCTION OR DELAY IN THERAPEUTC EFFECTIVENESS
o May be due to chemical reaction or physical change
o Failure to comply instructions for proper storage and administration of
the product.

You might also like