COMPARATIVE LC-MS STABILITY INDICATIND ASSAYS OF ONDANSETRON HYDROCHLORIDE/NALOXONE HYDROCHLORIDE AND METOCLOPRAMIDE HYDROCHLORIDE/NALOXONE HYDROCHLORIDE USED IN PALLIATIVE CARE
Keywords:Palliative care-liquid chromatography-mass spectrometry-high performance liquid chromatography-ondansetron hydrochloride-metoclopramide hydrochloride-naloxone hydrochloride
Objectives: To compare the compatibility and chemical stability of ondansetron hydrochloride/naloxone hydrochloride and metoclopramide hydrochloride/naloxone hydrochloride admixtures used in palliative care units at three different storage conditions (4ËšC, 22 ËšC and 37ËšC) for 192 hours.
Methods: A high performance liquid chromatography-mass spectrometry (LC-MS) analytical method was established to investigate the chemical stability of the combinations.
Results: Metoclopramide hydrochloride and naloxone hydrochloride concentrations remain above 90% of their initial concentration under all storage conditions for 192 hours, while ondansetron hydrochloride remain stable at 4ËšC and 22ËšC but it losses up to 15.03% of its initial concentration when stored for 192 hours at 37 ËšC.
Conclusion: metoclopramide hydrochloride and naloxone hydrochloride admixture is more stable and preferred to ondansetron hydrochloride and naloxone hydrochloride admixture under all storage conditions.
Riechelmann RP, Krzyzanowska MK, Oâ€™Carroll A, Zimmermann C. Symptom and medication profiles among cancer patients attending a palliative care clinic. Support Care Cancer 2007;15(12):1407-12.
Medicines and healthcare products regulatory agency. Drug Saf 2009;3(4):10.
Hanks G, Conno F, Cherny N, Hanna M, Kalso E, Mc Quay, et al. Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 2001;84(5):587â€“93.
Carrol V, Miederhoff P, Cox F, Hirsch J. postoperative nausea and vomiting after discharge from outpatient surgery centers. Anesth Analg (Hagerstown MD US) 1995;80(5):903-9.
Coluzzi F, Pappagalio M. Opioid analgesics therapy for chronic noncancer pain: practice guidelines for initiation and maintenance of therapy. Minerva Anestesiol 2005;71(7-8):425-33.
Wu C, Barenholtz S, Pronovost P, Fleisher L. Systematic review and analysis of postdischarge symptoms after outpatient surgery. Anesthesiology 2002;96(4):994-1003.
Scuderi P, Wetchler B, Sung Y, Mingus M, Dupen Ssch, Claybon L, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron. Anesthesiology 1993;78(1):15-20.
McPherson M. Strategies for the management of opioid-induced adverse effects. Adv Studies Pharm 2008;5(2):52-7.
Farhat K, Pasha A, Kazi W. Comparison of ondansetron and metoclopramide for PONA prophylaxis in laparoscopic cholecystectomy. J Anesth Clin Res 2013;4(3):297-301.
Diemunsch P, Conseiller C, Clyti N, Mamet J. French ondansetron study group. Ondansetron compared with metoclopramide in the treatment of established postoperative nausea and vomiting. Br J Anaesth 1997;79(3):322-6.
Pan A, Rudra A. prophylactic single dose intravenous administration of ondansetron in the prevention of postoperative emetic symptoms during spinal anaesthesia for caesarean delivery. Indian J Anaesth 2003;47(3):178-80.
Jamil M, Gilani S, Khan S. Comparison of metoclopramide, prochlorperazine and plscebo in prevention of postoperative nausea and vomiting (ponv) following tonsillectomy in young adults. J Ayub Medical College Abbottabad 2005;17(4):40-5.
Stenseth K, Sellevold O, Breivlk H. Epidural morphine for postoperative pain: experience with 1085 patients. Acta Anaesthesiol Scand 2008;29(1):148-56.
Jarzyna D. American society for pain management nursing guidelines on monitoring opioid-induced sedation and respiratory depression. Pain Management Nursing 2011;12(3):118-45.
Stewart J, Warren F, King D, Venkateshwaran T, Fox J. Stability of ondansetron hydrochloride and 12 medications in plastic syringes. Am J Health-Syst Pharm 1998;55(24):2630-34.
Zhang Y, Trissel L, Martinez JF. Stability of metoclopramide in plastic syringes. Am J Health-Syst Pharm 1996;53(11):1300-2.
Gupta VC. Chemical stability of metoclopramide hydrochloride injection diluted with 0.9% sodium chloride injection in polypropylene syringes at room temperature. Int J Pharm Compd 2005;9(1):72-4.
European pharmacopeia. Ondansetron hydrochloride anhydride. 5thedition. Strasbourg: European Pharmacopeia Commission; 2013. p. 2151-5.