Neut (4% sodium bicarbonate additive solution) is indicated for use as an additive to raise the pH of acid solutions administered intravenously to reduce the incidence of chemical phlebitis and patient discomfort due to vein irritation at or near the site of infusion.
Dosage and administration
One vial (5 mL) of Neut added to a liter (1000 mL) of any of the following Hospira parenteral solutions will increase the pH to a more physiologic range. Specific pH may vary slightly from lot to lot. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS . Product List 5% Alcohol in 5% Dextrose...
To adjust acidic parenteral solutions to a more nearly neutral pH.
Fliptop Vial
Rx Only
(0.2 g in 5 mL)
DESCRIPTION
DESCRIPTION SECTION
Neut (4% sodium bicarbonate additive solution) is a sterile, nonpyrogenic solution of sodium bicarbonate in water for injection. It is administered by the intravenous route only after addition as a neutralizing agent to an acidic large volume parenteral solution. Each 5 mL contains sodium bicarbonate 0.2 g (2.4 mEq each of Na+ and HCO3– ); edetate disodium, anhydrous 10 mg added as a stabilizer. Total sodium (Na+) content of each 5 mL is 56.1 mg (11.2 mg/mL).
The solutions contain no bacteriostat, antimicrobial agent or added buffer; pH 8.0 (7.0 to 8.5).
Sodium Bicarbonate, USP is chemically designated as NaHCO3, a white crystalline powder soluble in water.
CLINICAL PHARMACOLOGY
CLINICAL PHARMACOLOGY SECTION
The acid pH of most intravenous solutions has been implicated as a factor in the production of postinfusion (chemical) phlebitis not caused by obvious infection. Vein irritation, with local redness and tenderness near the site of venipuncture or along the course of a vein, appears to be related to the nature of the substances in the infusion and the speed (insufficient dilution by the bloodstream) as well as the duration (prolonged exposure of the intima) of infusion. Other contributing factors include the size of the vein used for venipuncture, shape or method of insertion of the venipuncture needle, the use or type of indwelling catheter, infection at the infusion site and the age of the patient (children and females seem to be more susceptible).
The pH of commonly used dextrose infusion solutions ranges from 3.5 to 6.5. Other commonly used solutions also may have an acid pH. Since non-neutral parenteral solutions with a low (acid) pH are known to cause chemical irritation of tissues, it is not surprising that chemical phlebitis may occur as a complication with their infusion. Vein irritation is most likely when the duration of infusion is long or when hemodilution is minimized by a large needle in a small vein.
The amount of sodium bicarbonate recommended as an additive to neutralize acid parenteral solutions is too small to exert a clinically significant increase in electrolyte content.
INDICATIONS AND USAGE
INDICATIONS & USAGE SECTION
Neut (4% sodium bicarbonate additive solution) is indicated for use as an additive to raise the pH of acid solutions administered intravenously to reduce the incidence of chemical phlebitis and patient discomfort due to vein irritation at or near the site of infusion.
CONTRAINDICATIONS
CONTRAINDICATIONS SECTION
Not for use as a systemic alkalizer.
WARNINGS
WARNINGS SECTION
None known.
PRECAUTIONS
PRECAUTIONS SECTION
Do not administer unless solution is clear and seal is intact. Discard unused portion.
Solutions prepared with Neut (4% sodium bicarbonate additive solution) should be administered promptly. When introducing additives, use aseptic technique, mix thoroughly and do not store.
When Neut is added to Hospira solutions, the compatibility of these solutions with other drugs may be altered. (See section on COMPATIBILITY, etc., for listing of additives tested with Neut added D5-W.)
Raising the pH of I.V. fluids with Neut will only reduce the incidence of chemical irritation caused by the infusate; it will not diminish any foreign body effects caused by the needle or catheter.
Pregnancy
PREGNANCY SECTION
Animal reproduction studies have not been conducted with sodium bicarbonate. It is also not known whether sodium bicarbonate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Sodium bicarbonate should be given to a pregnant woman only if clearly needed.
ADVERSE REACTIONS
ADVERSE REACTIONS SECTION
None known.
DRUG ABUSE AND DEPENDENCE
DRUG ABUSE AND DEPENDENCE SECTION
None known.
OVERDOSAGE
OVERDOSAGE SECTION
None known.
DOSAGE AND ADMINISTRATION
DOSAGE & ADMINISTRATION SECTION
One vial (5 mL) of Neut added to a liter (1000 mL) of any of the following Hospira parenteral solutions will increase the pH to a more physiologic range. Specific pH may vary slightly from lot to lot.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.
Product
List
5% Alcohol in 5% Dextrose Injection, USP
1500
2.5% Dextrose Inj., USP
1508
5% Dextrose Inj., USP
1522
10% Dextrose Inj., USP
1530
20% Dextrose Inj., USP
1535
Ringer's Injection, USP
1582
0.9% Sodium Chloride Inj., USP
1583
Sodium Lactate Inj., USP (1/6 Molar)
1587
Addition of one vial of Neut to one-half liter (500 mL) is recommended to achieve a more physiologic pH of the following Hospira parenteral solutions:
Product
List
6% Dextran 70 and 0.9% Sodium Chloride Injection
1505
6% Dextran 70 and 5% Dextrose Injection
1507
Note: Some products, e.g., Aminosyn® solutions and those Ionosol® and Normosol® formulas containing dextrose will NOT be brought to near physiologic pH by the addition of Neut. This is due to the relatively high buffer capacity of these fluids.
COMPATIBILITY & EFFECTIVENESS OF NEUT WITH ADDITIVES TO 5% DEXTROSE INJECTION (D5-W)
SPL UNCLASSIFIED SECTION
When medications are added to intravenous solutions, the resultant admixtures may or may not be compatible in solutions containing Neut (4% sodium bicarbonate additive solution).
Following is a list of medications each added to one liter of 5% Dextrose Injection, USP (D5-W) classified according to their effect with Neut (4% sodium bicarbonate additive solution).
* Requires 2 vials of Neut to bring admixture to approximate neutrality.
2. Neut Incompatible – Additive Inactivated at Neutral pH
Conc./liter
Epinephrine
4 mg
Isuprel® (isoproterenol) HCl
1 mg
Levophed® (levarterenol) Bitartrate
8 mg
Quelicin® (succinylcholine chloride)
1 g
3. Neut Ineffective - Additive High in Titratable Acidity
Conc./liter
Achromycin® (tetracycline) HCl
500 mg
Aureomycin® (chlortetracycline) HCl
500 mg
Bejectal w/C (B complex and C)
10 mL
Kantrex® (kanamycin) Sulfate
1 g
4. Neut Not Indicated – Admixture Already At or Near Neutrality
Conc./liter
Gantrisin® (sulfisoxazole) Diethanolamine
4 g
Hydrocortone® (hydrocortisone) Phosphate
100 mg
Prostaphlin® (oxacillin) Sodium
500 mg
Sodium Bicarbonate
3.75 g
Solu-Cortef ® (hydrocortisone sodium succinate)
250 mg
5. Neut Not Indicated – Admixture Already Alkaline
Conc./liter
Aminophylline
500 mg
Amytal® (amobarbital) Sodium
500 mg
Dilantin® (diphenylhydantoin) Sodium
250 mg
Diuril® (chlorothiazide)
0.5 g
Emivan® (ethimivan)
2 g
Furadantin® (nitrofurantoin) Sodium
180 mg
Nembutal® (pentobarbital) Sodium
500 mg
Pentothal® (thiopental sodium)
1 g
Phenobarbital Sodium
320 mg
Polycillin® N (ampicillin sodium)
500 mg
Sulfadiazine Sodium
1 g
It should be noted that the admixtures were evaluated for physical compatibility, not for pharmacological compatibility. It, therefore, would be erroneous to circumvent medical judgment which must be involved in administering any solution that appears to be compatible on the basis of having no visible haze or precipitate. The inclusion of drugs in this study of their compatibility in solution does not imply their therapeutic usefulness or safety. This matter remains the judgment of the prescribing physician.
NOTE: The compatibility information contained herein is based on the studies involving Hospira dextrose only. Variations in compatibility could occur due to lot-to-lot variations or formula changes in the additives or dextrose solutions of other manufacturers.
HOW SUPPLIED
HOW SUPPLIED SECTION
Neut (4% sodium bicarbonate additive solution) is supplied in partial-fill single-dose containers 5 mL fliptop vial. Unit of Sale is a Tray containing 25 vials (NDC: 0409-6609-02).
STORAGE AND HANDLING SECTION
Store at 20 to 25°C (68 to 77°F). [See USP Controlled Room Temperature.]
SPL UNCLASSIFIED SECTION
Distributed by Hospira, Inc., Lake Forest, IL 60045 USA
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