IV Zofran and LR

[Christy1019, ASN, RN]

The other day I came across one of my old clinical pocket guide books and while flipping through it I came across iv compatible meds and was surprised to see that iv zofran wasn't compatible with lactated ringers soluton but it didn't explain why and noone I've asked at work, including pharmacy, has heard of this or know what the reasoning could be. I'm just wondering if anyone else has heard of this or knows the rationale b/c I'm sure I've given zofran ivp through a line with LR infusing, especially in trauma resus pts who usually get LR instead of NS, that are puking while we're trying to protect c-spine lol.

I've never been aware of any immediate complications after giving zofran through LR, hopefully someone can give me some insight on this, thanks!

[Esme12, ASN, BSN, RN]

Zofran is compatible IVP with all IV solutions but can lose potency/precipitate when hung as IVPB or infusion over 24 hours if not mixed with NS or D5W. I hope this helps.

COMPATIBILITY ondansetron

• compatible with most commonly used IV solutions: NS, D5W, dextrose-saline combinations, LR
  
• compatible with mannitol
  
• compatible via Y-site with amikacin, cefazolin, cefotaxime, ceftazidime, cefuroxime, clindamycin, dexamethasone, diphenhydramine, dopamine, fluconazole, gentamicin, hydrocortisone, hydromorphone, imipenem, magnesium sulphate, meperidine, metoclopramide, morphine, piperacillin-tazobactam, potassium chloride, ranitidine, ticarcillin-clavulanate, vancomycin
  
• incompatible with acyclovir, aminophylline, amphotericin B, ampicillin, furosemide, ganciclovir, lorazepam, methylprednisolone, sodium bicarbonate
  ROUTES OF ADMINISTRATION
  
  
  • IM
    
    • 4 mg or less for post-operative nausea and vomiting
      

    [*]IV direct

    • doses of 4 mg or less for post-operative nausea and vomiting given undiluted over at least 30 seconds, preferably 2-5 minutes
      

    [*]IV intermittent

    • diluted in 50-100 mL NS or D5W infused over 15 minutes
      
    • with central line, may dilute in 25 mL IV fluid
      

    [*]IV infusion

    • diluted in 250-500 mL IV fluid; infuse at a rate of 1 mg/hour for up to 24 hours
      
      

[Medic7714]

I have never read that incompatibility in any of the drug references I use or heard it mentioned from anyone before. I give lots of Zofran but we only use Normal Saline even with trauma.