Can you mix 3 medications in a syringe?

[GQRN]

Benadryl, Dilaudid, and Promethazine are all compatible with each other.

For an IM shot, can you mix all three in one syringe and administer?

I've been giving a lot of Dilaudid/Promethazine or Morphine/Promethazine or Morphine/benadryl or dilaudid/benadryl IM Shots.

Today I had an order for benadryl, Dilaudid, and promethazine IM. I didn't mix all three but just curious if I could had done it tho they are all compatible with each other.

Anyone?

[RazorbackRN, BSN, RN]

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[RazorbackRN, BSN, RN]

So far this is the most logic post in this enitre thread I've started. I did not mention the patient is allergic to any of the meds and most of you are jumping to allergies and reactions.

All I simply wanted to know was whether it is safe to mix 3 compatible drugs in one syringe, not allergic reactions.

Just in case you haven't figured it out yet, when you post on a public internet website asking a question, you are going to get multiple responses. People also tend to provide their reasoning behind the answers. Also, some people are kind enough to also remind one to take x,y,z into consideration, as many people's level of skill, knowledge and experience differ.

Perhaps if you do not want multiple, varied answers, you should perform the research for yourself or ask a colleague.

[nightmare, RN]

I have also seen,but not recently,one needle used and then the separate syringes used with the one needle in situ.This may not be allowed anymore however.

[GQRN]

Just in case you haven't figured it out yet, when you post on a public internet website asking a question, you are going to get multiple responses. People also tend to provide their reasoning behind the answers. Also, some people are kind enough to also remind one to take x,y,z into consideration, as many people's level of skill, knowledge and experience differ.

Perhaps if you do not want multiple, varied answers, you should perform the research for yourself or ask a colleague.

Thanks for taking the time to post

[Dolce, RN]

I hope that patient has a bed because he is going to be snowed. I would never give Phenergan and Benadryl at the same time to a patient I wanted to see awake that day!

[BinkieRN, BSN, RN]

I have also seen,but not recently,one needle used and then the separate syringes used with the one needle in situ.This may not be allowed anymore however.

That is definately not smart. I would report anyone I saw doing that!

[BinkieRN, BSN, RN]

I hope that patient has a bed because he is going to be snowed. I would never give Phenergan and Benadryl at the same time to a patient I wanted to see awake that day!

Phenergan, Benadryl and Dilaudid. Many patients can tolerate this combination of drugs w/o issue. I've had patients with Fentanyl patches who took Hydrocodone 10mg 2 tabs q 6 hrs, plus Ativan 2mg Q 6 hours, plus Ambien at HS. I was afraid I was going to kill the patient but this patient has been taking this same regiment of pills for years. Also smokes and drinks.

[Dixielee, BSN, RN]

I hope that patient has a bed because he is going to be snowed. I would never give Phenergan and Benadryl at the same time to a patient I wanted to see awake that day!

We use that in the ER as part of a "migraine cocktail" and it really does work. People who have chronic pain have an amazing tolerance to meds. I recently gave a man a total of 7 mg Dilaudid, along with 15 mg Valium IV over a period of 2 hours. He never even stopped talking. He had been on percocet for 2 years for back problems.

We had a young woman with sickle cell a few years ago with a constantly accessed port, who came in routinely and got 4 mg dilaudid, 100 mg benadryl IV, and went home. Sometimes she got a second dose prior to leaving. Again, never even topped talking, much less breathing.

On the other hand, some people can't walk after a percocet, so you just never know.

[Dalzac, LPN, LVN, RN]

When in doubt call pharmacy Thats what I always did but I don't think I ever mixed 3 I would think it would be too much volume.

[michigooseBSN]

I have a different concern about this. It dates back to many years ago when I was a student nurse in peds. We were taught that we should not mix oral liquid meds to give to a child because if they spit it out or didn't take all of it, we wouldn't know which med was lost or incompletely given. Makes sense to me. As far as mixing injectable, it is very rare but I have seen a needle pop off the syringe during injection leaving the needle in the patient and the med (or part of it) on the linen. I guess the lesson is to be very sure the needle is tightly screwed on to the syringe.

[DuanePharmD]

It is generally true: if drug A is compatible with drug B and drug B is compatible with drug C and drug C is compatible with drug A, all 3 will be compatible together. It is no guarantee, though. There is the possibility that mixing the 3 together will create an environment (i.e. pH) different from that of mixing 2 drugs together. I would personally not mix the 3 together unless I found a reference that said all 3 have been mixed and found to be compatible. Better safe than sorry.

[Emergency RN]

this reply may be a bit late, but none of the other respondents mentioned anything like it so i thought to chime in. compatability isn't just limited to whether or not an item can be combined, but can often be determined by how it is combined and for what duration. for example, an admixture (having two substances being put into an iv bag, eg. like hydrocortisone and potassium) is quite different from y-port (where one substance is injected through a port of a line infusing the other), and is again different from syringe (having multiple substances together in single syringe).

this matters because as substances increase in concentration, what may have been compatible at one dilution (eg. admixture) may not be at higher concentrations (eg. y-port or syringe). further, substances that may be compatible for only short duration may actually combine and or precipitate after being together for long duration.

hence, most drug compatibility studies would only state no preciptate noted or compatible for x number of hours. in other cases, even though several substances may be compatible in admixture or y-port; if there has not been any studies regarding those substances being combined in a syringe, compatibility should not be assumed. i would hesitate putting them together at all.