Evaluation of the physicochemical compatibility of cyclosporin infusion and parenteral nutrition when intravenously administered via the same central line lumen

Background: Patients undergoing allogeneic haematopoietic stem cell transplantation require cyclosporin (CsA) infusion to be administered concurrently with parenteral nutrition (PN).
Aims: To evaluate the physicochemical compatibility of parenteral CsA and PN administered via the same lumen of a central venous access device and to quantify and identify any particulate matter.
Methods: Three PN formulations were tested. Standard PN solution and PN solution with glutamine manufactured by Baxter Healthcare and standard PN solution manufactured by Fresenius Kabi. CsA concentrate for intravenous infusion 250 mg/5 mL (Sandimmun, Novartis Pharmaceuticals) was used. PN solutions were mixed with CsA at different volume ratios to simulate different rates of co-infusion in clinical practice. A real-life simulation was also performed with CsA in glucose 5% co-infused with the PN solution via the same lumen of a central venous access device. The size of colloidal species in the resulting samples was measured using dynamic light scattering.
Results: The static experiments for all dilution ratios and types of PN with CsA indicated average particle diameters of less than 500 nm. Only one sample indicated a particle larger than 5 μm. The ‘real-life’ simulation did not detect any particle with diameter greater than 5 μm. This was across all types of PN solutions and for all samples taken at a number of time points up to 24 h.
Conclusion: Commercially available PN formulations can be administered concurrently with CsA via the same lumen of a central venous access device. For infusions running up to 24 h, there is minimal risk of particle formation with a diameter greater than 5 μm.