As technicians, we may need to compound medications for specific patient needs and care
As we compound it’s important to know the signs of incompatibility to prevent an adverse event for the patient
What is Nonsterile Compounding?
Nonsterile compounding refers to compounding medications in a nonsterile environment (in the pharmacy)
A sterile environment is a clean room free of contaminants and has pressure and airflow controls
Related: Nonsterile Compounding Techniques
Incompatibilities While Compounding
As you compound, pay close attention to the behaviors of the medication; abnormal reactions signify a potential incompatibility that could pose a threat to the safety of the patient
Physical Change
A color change indicates a chemical reaction is occurring; darkening, yellowing, or clouding in the mixture
Clouding in the mixture could indicate microbial contamination, which can cause an adverse reaction in the patient
Small undissolved particles or precipitate formation indicate the components are either insoluble or reacting with each other
During mixing if the compounds separate into different layers (image oil mixed with water), this indicates improper mixing
Texture, Smell, and Flavor Change
Keep an eye on the consistency and texture of your compound as you work
If you notice clumping, grittiness, or thickening this could indicate a reaction occurring within the compounding mixture
Odors also indicate an unintentional change within the compound, so take note of any strong smells as you compound
Though you should NOT be tasting the mixture, it is important to note taste may also change if an unwanted reaction occurs, so take note if the patient mentions a strange flavor in their medication
Pay attention to the packaging, if it begins to warp or change in shape with the medication do not dispense
What to do if you see incompatibility
Don’t panic, it happens! The most important thing is you catch it before it leaves the pharmacy
Do not let an incompatible compound reach the patient
Alert the responsible party, whether that be the pharmacist, head technician, or manager on duty
Be sure to properly document any ingredients going to waste, this maintains stock in the pharmacy and maintains a proper record if it happens to come up later
Do not try to salvage the incompatible compounds, dispose of the mixture in the proper waste bin depending on the ingredients used
Extra Resources
Beyond Use Dates For USP 795 and 797