Bot Detector
IJPC Seal
Download FREE Sample Issue or Article
LEARN MORE
Subscribe Today
A subscription to IJPC provides on-line access to full-text, full-color, printable PDF copies of all issues and individual articles published by the Journal since 1997.

Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia

Author(s):  Robert Julien, Sorrieul Jérémy, Rossignol Elsa, Beaussart Hélène, Kieffer Hélène, Folliard Caroline, Dupoiron Denis, Devys Catherine

Issue:  Jul/Aug 2017 - Volume 21, Number 4
View All Articles in Issue

Page(s):  347-351

Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia Page 1
Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia Page 2
Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia Page 3
Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia Page 4
Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia Page 5

Download in electronic PDF format for $75

Abstract:  Pain is the most feared symptom amongst individuals living with cancer. In 15% to 20% of patients, conventional analgesic therapy either fails to relieve pain or induces adverse effects. Intrathecal drug delivery systems may present an effective alternative for pain management. The Cancerology Center Paul Papin protocol includes an admixture of morphine, ropivacaine, and ziconotide in intrathecal preparations. These drugs are administered by a fully implantable or an external pump. Syringes or polyolefin infusion bags are prepared for refill just before use. Few centers in France use the method of intrathecal analgesia. Therefore, for those patients receiving intrathecal preparations, each filling requires that the patients be transported from their local hospital (or their home) to a referral center where the patients are monitored. They sometimes must travel up to a hundred kilometers to have a pump filled. The preparation and the analytical control of the mixture are carried out only by those centers meeting the proper criteria, which includes the proper equipment. To spare the patient this travel, a peripheral center may be subcontracted to manage the patient’s pump refill. No data are available concerning the chemical stability of admixtures in syringes or polyolefin infusion bags. The aim of this study was to evaluate, with a new analytical method using ultra high-performance liquid chromatography, the chemical stability of these admixtures in syringes or in polyolefin infusion bags. Ziconotide 1 µg/mL was combined with ropivacaine (7.5 mg/mL) and morphine (3.5 mg/mL) in syringes at 5°C, 21°C, and 31°C, and in polyolefin infusion bags at 21°C. Assays were performed using ultra high-pressure liquid chromatography. In syringes stored at 21°C and 31°C, concentrations after 6 hours were not in the acceptable criterion of 10% variability. When syringes were stored at 5°C, the residual concentration of ziconotide after 3 days was 100.5% +/- 2.6% [92.7% to 108.4%]. In polyolefin infusion bags, the residual concentration of ziconotide after 14 days was 96.9% +/- 2.2% [90.1% to 103.6%]. This study demonstrates the chemical stability of this admixture in syringes stored at 5°C for 3 days and in polyolefin plastibags stored at 21°C for 14 days.

Related Keywords: Elsa Rossignol, Engineer, Biochemistry, morphine, ropivacaine, ziconotide, drug admixtures, intrathecal analgesia, pain relief, pain control, compounded sterile preparations, chemical stability, storage

Related Categories: CANCER AND AIDS, PAIN MANAGEMENT, PEER-REVIEWED, STABILITIES, COMPATIBILITIES, DOSAGE FORMS/DRUG CARRIERS, STORAGE

Printer-Friendly Version



Related Articles from IJPC
Title/Author
(Click for Abstract / Details / Purchase)
Issue/​Page
View/Buy
Chemical Stability of Morphine, Ropivacaine, and Ziconotide in Combination for Intrathecal Analgesia
Robert Julien
, Sorrieul Jérémy, Rossignol Elsa, Beaussart Hélène, Kieffer Hélène, Folliard Caroline, Dupoiron Denis, Devys Catherine
Jul/Aug 2017
Pg. 347-351

Physicochemical Stability of Ternary Mixtures of Sufentanil, Baclofen, and Ropivacaine in Polypropylene Syringes for Intrathecal Analgesia
Sorrieul Jérémy
, Robert Julien, Chapel Fanny, Gossye Thomas, Devys Catherine
Mar/Apr 2020
Pg. 156-162

Chemical Stability of Admixtures Combining Ziconotide with Fentanyl or Sufentanil During Simulated Intrathecal Administration
Shields David E
, Aclan Jennifer, Szatkowski Aaron
Sep/Oct 2008
Pg. 463-466

Chemical Stability of Admixtures Containing Ziconotide 25 mcg/mL and Morphine Sulfate 10 mg/mL or 20 mg/mL During Simulated Intrathecal Administration
Shields David E
, Aclan Jennifer, Szatkowski Aaron
Nov/Dec 2008
Pg. 553-557

Dilution and Compounding of Ziconotide for Intrathecal Administration
Buchta Tony
, Fakata Keri, Stuart William
May/Jun 2008
Pg. 200-207

Stability of Morphine Sulfate in Polypropylene Infusion Bags for Use in Patient-Controlled Analgesia Pumps for Postoperative Pain Management
Nguyen-Xuan Tho
, Griffiths William, Kern Christian, Van Gessel Elisabeth, Bonnabry Pascal
Jan/Feb 2006
Pg. 69-73

Compounded Analgesic Therapy for Disorders of Movement: Arthritis, Neuropathic Pain, and Postpolio Syndrome
Brown Scott
, Erickson Brian, Muller George, Bryant-Snure Susan J, Mestayer Richard F III
May/Jun 2010
Pg. 182-192

Topical Medications for Orofacial Neuropathic Pain
Bramwell Bethany L
May/Jun 2010
Pg. 200-203

Physical and Chemical Stability of Low and High Concentrations of Morphine Sulfate with Clonidine Hydrochloride Packaged in Plastic Syringes
Xu Quanyun A
, Trissel Lawrence A, Pham Lien
Jan/Feb 2002
Pg. 66-69

Physical and Chemical Stability of Low and High Concentrations of Morphine Sulfate with Bupivacaine Hydrochloride Packaged in Plastic Syringes
Trissel Lawrence A
, Xu Quanyun A, Pham Lien
Jan/Feb 2002
Pg. 70-73

Chemical Stability of Hydromorphone Hydrochloride in Patient-Controlled Analgesia Injector
Khondkar Dristi
, Chopra Poonam, McArter John P, Rosen Joseph A, Li S Kevin
Mar/Apr 2010
Pg. 160-164

Efficacy and Clinical Value of Commonly Used Ingredients in Pain Management Compounds: A Literature Review
Beshay Sarah M
, Rivera Gerard, Balthasar Jan, Florea Naomi
Jul/Aug 2015
Pg. 295-300

Efficacy and Clinical Value of Commonly Used Ingredients in Pain Management Compounds: A Literature Review
Beshay Sarah M
, Rivera Gerard, Balthasar Jan, Florea Naomi
Mar/Apr 2024
Pg. 111-116

Compounded Pain Formulations: What is the Evidence?
Asbill Scott
, Sweitzer Sarah M, Spigener Shuler, Romero-Sandoval Alfonso
Jul/Aug 2014
Pg. 278-286

Compounded Pain Formulations: What is the Evidence?
Asbill Scott
, Sweitzer Sarah M, Spigener Shuler, Romero-Sandoval Alfonso
Mar/Apr 2024
Pg. 100-109

Compounded Drugs of Value in Outpatient Hospice and Palliative Care Practice
McNulty John P
, Muller George
May/Jun 2014
Pg. 190-200

Topical Ketamine: A Review of the History, Mechanisms, Uses, Safety, and Future
Rabi Joseph
Mar/Apr 2016
Pg. 107-113

NASEM Report on Compounded Topical Pain Creams
Allen Loyd V Jr
Nov/Dec 2020
Pg. 446-448

Topical Pain Relief: Assessment of Patient Satisfaction with a Novel Compound Containing at Least Ketoprofen
Zugerman Jessie Jean M
, Reed Thomas C
Nov/Dec 2007
Pg. 514-519

Morphine Sulfate 2-mg/mL and Droperidol 0.08-mg/mL Injection for Patient-Controlled Analgesia
Allen Loyd V Jr
Nov/Dec 2002
Pg. 456

Return to Top