Userguide

How to Use ASHP’s Handbook on Injectable Drugs®

What Is ASHP’s Handbook™?

The American Society of Health-System Pharmacists’ (ASHP’s) Handbook on Injectable Drugs® is a collection of summaries of information from the published literature on the pharmaceutics of parenteral medications as applied to the clinical setting. ASHP’s Handbook™ is constructed from information derived from 3422 references with the information presented in the standardized structure described below. The purpose of the Handbook™ is to facilitate the use of this clinical pharmaceutics research by knowledgeable health care professionals for the benefit of patients. The summary information from published research is supplemented with information from the labeling of each product and from other references.

The information base summarized in ASHP’s Handbook on Injectable Drugs® is large and highly complex, requiring thoughtful consideration for proper use. The Handbook™ is not, nor should it be considered, elementary in nature or a primer. A single quick glance in a table is not adequate for proper interpretation of this highly complex information base. Proper interpretation includes the obvious need to consider and evaluate all relevant research information and results. Additionally, information on the formulation components (e.g., excipients), product attributes (especially pH), and the known stability behaviors of each parenteral drug, as well as the clinical situation of the patient, must be included in a thoughtful, reasoned evaluation of clinical pharmaceutics questions.

Who Should Use ASHP’s Handbook™?

ASHP’s Handbook on Injectable Drugs® is designed for use as a professional reference and guide to the literature on the clinical pharmaceutics of parenteral medications. The intended audience consists of knowledgeable healthcare professionals, particularly pharmacists, who are well versed in the formulation and clinical use of parenteral medications and who have the highly specialized knowledge base, training, and skill set necessary to interpret and apply the information. Practitioners who are not well versed in the formulation, essential properties, and clinical application of parenteral drugs should seek the assistance of more knowledgeable and experienced healthcare professionals to ensure patient safety.

Users of ASHP’s Handbook™ must recognize that no reference work, including this one, can substitute for adequate decision-making by healthcare professionals. Proper clinical decisions must be made after considering all aspects of the patient’s condition and needs, with particular attention to the special demands imposed by parenteral medications. ASHP’s Handbook™ cannot make decisions for its users. However, in knowledgeable hands, it is a valuable tool for the proper use of parenteral medications.

Organization of ASHP’s Handbook™

ASHP’s Handbook on Injectable Drugs® has been organized as a collection of monographs on each of the drugs. The monographs are arranged alphabetically by nonproprietary (generic) name. The nonproprietary names of the drugs are the United States Adopted Names (USAN) and other official names for drugs as described in the USP Dictionary of USAN and International Drug Names. Also included are some of the trade (proprietary, brand) names and manufacturers of the drug products; this listing is not necessarily comprehensive and should not be considered an endorsement of any product or manufacturer.

All of the information included in ASHP’s Handbook™ is referenced so that those who wish to study the original sources may find them. Efforts are ongoing to provide increased specificity of references to product labeling as individually cited references to the labeling for a drug product, including the proprietary name (if available), manufacturer, and revision date of the prescribing information; this will facilitate location of specific labeling that has been used as a reference. In addition, the full list of the AHFS® Pharmacologic-Therapeutic Classification© system and specific classification numbers within each individual monograph have been included to facilitate the location of therapeutic information on the drugs.

The monographs have been divided into the subheadings described below:

Products—lists many of the sizes, strengths, volumes, and forms in which the drug is supplied, along with other components of the formulation. Instructions for reconstitution (when applicable) are included in this section.

The products cited do not necessarily comprise a comprehensive list of all available products. Rather, some common representative products are described. Furthermore, dosage forms, sizes, and container configurations of parenteral products may undergo important changes during the lifespan of this edition of ASHP’s Handbook™.

Following the product descriptions, the pH of the drug products, the osmotic value(s) of the drug and/or dilutions (when available), and other product information such as the sodium content and definition of units are presented.

Practitioners have not always recognized the value and importance of incorporating product formulation information into the thought process that leads to their decision on handling drug compatibility and stability questions. Excipients used in the formulation of commercially available products may vary among manufacturers and can influence drug compatibility and stability; specific product labeling should be consulted for additional formulation details. Consideration of the product information and formulation components, as well as the properties and attributes of the products (especially pH), is essential to proper interpretation of the information presented in ASHP’s Handbook™.

Administration—includes route(s) by which the drug can be given, rates of administration (when applicable), and other related administration details.

The administration information is a condensation derived principally from product labeling. For complete information, including dosage information sufficient for prescribing, the reader should refer to product labeling and therapeutically comprehensive references, such as the AHFS® Drug Information®.

Stability—describes the drug’s stability and storage requirements. The storage condition terminology of The United States Pharmacopeia, 41st ed., is used in ASHP’s Handbook on Injectable Drugs®.

The United States Pharmacopeia defines controlled room temperature as a temperature that encompasses the usual and customary working environment of 20–25°C and that results in a mean kinetic temperature no greater than 25°C.3206 Temperature excursions between 15–30°C that are experienced in pharmacies, hospitals, warehouses, and during shipping are permitted.3206 Transient temperature elevations up to 40°C also are permitted provided that they do not persist beyond 24 hours and that the mean kinetic temperature does not exceed 25°C.3206 In contrast, room (ambient) temperature is defined simply as a temperature prevailing in a work environment.3206

Protection from excessive heat is often required; excessive heat is defined as any temperature above 40°C.3206 Similarly, protection from freezing may be required for products that are subject to loss of strength or potency or to destructive alteration of their characteristics, in addition to the risk of container breakage, upon exposure to freezing temperatures.3206

Some products may require storage at a cool temperature, which is defined as any temperature between 8–15°C, or a cold temperature, which is defined as any temperature not exceeding 8°C.3206 A refrigerator is defined as a cold place in which the temperature is controlled between 2–8°C.3206 A freezer refers to a place in which the temperature is controlled between -25 and -10°C.3206 Some products may have a recommended storage condition below -20°C, and in such cases, the temperature should be controlled to within 10°C of -20°C.3206

In addition to storage requirements, aspects of drug stability related to pH, freezing, and exposure to light are presented in this section. Also presented is information on repackaging of the drugs or their dilutions in container/closure systems other than the original package (e.g., prefilling into syringes or in ambulatory pump reservoirs). Sorption and filtration characteristics of the drugs are provided as well when this information is available. The information is derived principally from the primary published research literature and is supplemented by the product labeling and the AHFS® Drug Information®.

Compatibility Information—tabulates the compatibility results of the subject drug with infusion solutions and other drugs based on published reports from the primary research as well as the product labeling. The various entries are listed alphabetically by solution or drug name; the information is completely cross-referenced among the monographs.

Four types of tables are utilized to present the available information, depending on the kind of test being reported. The first type is for information on the compatibility of a drug in various infusion solutions and is depicted in Table 1. The second type of table presents information on two or more drugs in intravenous solutions and is shown in Table 2. The third type of table is used for tests of two or more drugs in syringes and is shown in Table 3. The fourth table format is used for reports of simulated or actual injection into Y-sites and manifolds of administration sets and is shown in Table 4.

Many published articles, especially older ones, do not include all of the information necessary to complete the tables. However, the tables have been completed as fully as possible from the original articles; in some cases, editorial staff have supplemented the published information based on direct communication with the authors of the published research.

Table 1. Solution Compatibility

Monograph drug name

Solution

Mfr

Mfr

Conc/L or %

Remarks

Ref

C/I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

  1. Solution in which the test was conducted.

  2. Manufacturer of the solution.

  3. Manufacturer of the drug about which the monograph is written.

  4. Concentration of the drug about which the monograph is written. (See The Listing of Concentration.)

  5. Description of the results of the test.

  6. Reference to the original source of the information.

  7. Designation of the compatibility (C) or incompatibility (I) of the test result according to conventional guidelines.

Table 2. Additive Compatibility

Monograph drug name

Drug

Mfr

Conc/L or %

Mfr

Conc/L or %

Test Soln

Remarks

Refs

C/I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

  1. Monograph title for the test drug.

  2. Manufacturer of the test drug.

  3. Concentration of the test drug.

  4. Manufacturer of the drug about which the monograph is written.

  5. Concentration of the drug about which the monograph is written. (See The Listing of Concentration.)

  6. Infusion solution in which the test was conducted.

  7. Description of the results of the test.

  8. Reference to the original source of the information.

  9. Designation of the compatibility (C) or incompatibility (I) of the test result according to conventional guidelines.

Table 3. Drugs in Syringe Compatibility

Monograph drug name

Drug (in syringe)

Mfr

Amt

Mfr

Amt

Remarks

Ref

C/I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

  1. Monograph title for the test drug.

  2. Manufacturer of the test drug.

  3. Actual amount of the test drug.

  4. Manufacturer of the drug about which the monograph is written.

  5. Actual amount of the drug about which the monograph is written.

  6. Description of the results of the test.

  7. Reference to the original source of the information.

  8. Designation of the compatibility (C) or incompatibility (I) of the test result according to conventional guidelines.

Table 4. Y-Site Injection Compatibility (1:1 Mixture)

Monograph drug name

Drug

Mfr

Conc

Mfr

Conc

Remarks

Ref

C/I

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

  1. Monograph title for the test drug

  2. Manufacturer of the test drug.

  3. Concentration of the test drug prior to mixing at the Y-site.

  4. Manufacturer of the drug about which the monograph is written.

  5. Concentration of the drug about which the monograph is written prior to mixing at the Y-site.

  6. Description of the results of the test.

  7. Reference to the original source of the information.

  8. Designation of the compatibility (C) or incompatibility (I) of the test result according to conventional guidelines.

Additional Compatibility Information—provides additional information and discussions of compatibility presented largely in narrative form.

Other Information—contains any relevant auxiliary information concerning the drug that does not fall into the previous categories.

The Listing of Concentration

The concentrations of all admixtures in intravenous solutions in the tables (Table 1 and Table 2) have been indicated in terms of concentration per liter (L) to facilitate comparison of the various studies. In some cases, this may result in amounts of the drug that are greater or lesser than those normally administered (as when the recommended dose is tested in 100 mL of vehicle), but the listings do accurately reflect the actual concentrations tested, expressed in standardized terms.

For studies involving syringes, the amounts actually used are indicated. The volumes are also listed if indicated in the original article.

For studies of actual or simulated Y-site injection of drugs, the concentrations are cited in terms of concentration per mL of each drug solution prior to mixing at the Y-site. Most published research reports have presented the drug concentrations in this manner, and ASHP’s Handbook on Injectable Drugs® follows this convention. For those few published reports that presented the drug concentrations after mixing at the Y-site, the concentrations have been recalculated to be consistent with the more common presentation style to maintain the consistency of presentation in ASHP’s Handbook. Note that the Y-Site Injection Compatibility table is designed with the assumption of a 1:1 mixture of the subject drug and infusion solution or admixture. For citations reporting other than a 1:1 mixture, the actual amounts tested are specifically noted.

Concentration may be expressed as a percentage for certain drugs or solutions (e.g., dextran, hetastarch, mannitol, fat emulsion) to reflect the style commonly used to express concentration for these products.

Designating Compatibility or Incompatibility

Each summary of a published research report appearing in the Compatibility Information tables bears a compatibility indicator (C, I, or ?). A report receives a designation of C when the study results indicate that compatibility of the test samples existed under the test conditions. If the study determined an incompatibility existed under the test conditions, then an I designation is assigned for ASHP’s Handbook on Injectable Drugs® entry for that study result. A designation of ? indicates that the test result does not clearly fit either the compatibility or incompatibility definition. Specific standardized guidelines are used to assign these compatibility designations and are described below. The citation is designated as a report of compatibility when results of the original article indicated one or more of the following criteria were met:

  1. Physical or visual compatibility of the combination was reported (no visible or electronically detected indication of particulate formation, haze, precipitation, color change, or gas evolution).

  2. Stability of the components for at least 24 hours in an admixture under the specified conditions was reported (decomposition of 10% or less).

  3. Stability of the components for the entire test period, although in some cases it was less than 24 hours, was reported (time periods less than 24 hours have been noted).

The citation is designated as a report of incompatibility when the results of the original article indicated either or both of the following criteria were met:

  1. A physical or visual incompatibility was reported (visible or electronically detected particulate formation, haze, precipitation, color change, or gas evolution).

  2. Greater than 10% decomposition of one or more components in 24 hours or less under the specified conditions was reported (time periods of less than 24 hours have been noted in the table).

Reports of test results that do not clearly fit into the compatibility or incompatibility definitions cannot be designated as either. These are indicated with a question mark.

Although these criteria have become the conventional definitions of compatibility and incompatibility, the reader should recognize that the criteria may need to be tempered with professional judgment. Inflexible adherence to the compatibility designations should be avoided. Instead, they should be used as aids in the exercising of professional judgment.

Therapeutic incompatibilities or other drug interactions are not within the scope of ASHP’s Handbook and are therefore not addressed. Therapeutically comprehensive references and the product labeling should be consulted for such information.

Interpreting Compatibility Information in ASHP's Handbook™

As mentioned above, the body of information summarized in ASHP’s Handbook on Injectable Drugs® is large and complicated. With the possible exception of a report of immediate gross precipitation, it usually takes some degree of thoughtful consideration and judgment to properly evaluate and appropriately act on the research results that are summarized in this book.

Nowhere is the need for judgment more obvious than when apparently contradictory information appears in two or more published reports. The body of literature in drug-drug and drug-vehicle compatibility is replete with apparently contradictory results. Except for study results that have been documented later to be incorrect, the conflicting information has been included in ASHP’s Handbook to provide practitioners with all of the information for their consideration. The conflicting information will be readily apparent to the reader because of the content of the Remarks section as well as the C, I, and ? designations following each citation.

Many or most of the apparently conflicting citations may be the result of differing conditions or materials used in the studies. A variety of factors that can influence the compatibility and stability of drugs must be considered in evaluating such conflicting results, and absolute statements are often difficult or impossible to make. Differences in concentrations, buffering systems, preservatives, vehicles, temperatures, and order of mixing all may play a role. By reviewing a variety of reports, the user of ASHP’s Handbook is better able to exercise professional judgment with regard to compatibility and stability.

The reader must guard against misinterpretation of research results, which may lead to inappropriate assumptions of compatibility and stability. As an example, a finding of precipitate formation two hours after two drugs are mixed does not imply nor should it be interpreted to mean that the combination is compatible until that time point, when a sudden precipitation occurs. Rather, it should be interpreted to mean that precipitation occurred at some point between mixing and the first observation point at two hours. Such a result would lead to a designation of incompatibility in ASHP’s Handbook.

Precipitation reports can be particularly troublesome for practitioners to deal with because of the variability of the time frames in which they may occur. Apart from combinations that repeatedly result in immediate precipitation, the formation of a precipitate can be unpredictable to some degree. Numerous examples of variable precipitation time frames can be found in the literature, including paclitaxel, etoposide, and sulfamethoxazole-trimethoprim (co-trimoxazole) in infusion solutions and calcium and phosphates precipitation in parenteral nutrition mixtures (e.g., TNAs, TPNs). Differing drug concentrations also can play a role in creating variability in results. A good example of this occurs with co-administered vancomycin hydrochloride and beta-lactam antibiotics. Users of the information in ASHP’s Handbook must always be aware that a marginally incompatible combination might exhibit precipitation earlier or later than that reported in the literature. In many such cases, the precipitation is ultimately going to occur, it is just the timing that is in question. This is of particular importance for precipitate formation because of the potential for serious adverse clinical consequences, including death, that have occurred. Certainly, users of ASHP’s Handbook information should always keep in mind and anticipate the possibility of precipitation and its clinical ramifications. Furthermore, all injections and infusions should be inspected for particulate matter and discoloration. If found, such injections and solutions should be discarded.

In addition, many research reports cite test solutions or concentrations that may not be appropriate for clinical use. An example would be a report of a drug’s stability in unsterile water. Although ASHP’s Handbook summary will accurately reflect the test solutions and conditions that existed in a study, it is certainly inappropriate to misinterpret a stability report like this as being an authorization to use the product clinically. In such cases, the researchers may have used the clinically inappropriate diluent to evaluate the drug’s stability for extrapolation to a more suitable vehicle that is similar, or they may not have recognized that the diluent is clinically unsuitable. In either event, it is incumbent on the practitioner in the clinical setting to use professional judgment to apply the information in an appropriate manner and recognize what is not acceptable clinically.

Further, it should be noted that many of the citations designated incompatible are not absolute. While a particular admixture may incur more than 10% decomposition within 24 hours, the combination may be useful for a shorter time period. The concept of “utility time” or the time to 10% decomposition may be useful in these cases. Unfortunately, such information is often not available. Included in the Remarks columns of the tables are the amount of decomposition, the time period involved, and the temperature at which the study was conducted when this information is available.

Users of ASHP’s Handbook information should always keep in mind that the information in the Handbook must be used as a tool and a guide to the research that has been conducted and published. It is not a replacement for thoughtfully considered professional judgment. It falls to the practitioner to interpret the information in light of the clinical situation, including the patient’s needs and status. What is certain is that relying solely on the C or I designation without the application of professional judgment is inappropriate.

Limitations of the Literature

In addition to conflicting information, many of the published articles have provided only partial evaluations, not looking at all aspects of a drug’s stability and compatibility. This is not surprising considering the complexity, difficulty, and costs of conducting such research. There are, in fact, articles that do provide evaluations of both physical stability/compatibility and chemical stability. But some are devoted only to physical issues, while others examine only chemical stability. Although a finding of precipitation, haze, or other physical effects may constitute an incompatibility (unless transient), the lack of such changes does not rule out chemical deterioration. In some cases, drugs initially designated as compatible because of a lack of visual change were later shown to undergo chemical decomposition. Similarly, the determination of chemical stability does not rule out the presence of unacceptable levels of particulates and/or turbidity in the combination. In a classic case, the drugs leucovorin calcium and fluorouracil were determined to be chemically stable for extended periods by stability-indicating HPLC assays in several studies, but years later, repeated episodes of filter clogging led to the discovery of unacceptable quantities of particulates in combinations of these drugs. The reader must always bear in mind these possibilities when only partial information is available.

And, finally, contemporary practitioners have come to expect that the analytical methods used in reports on the chemical stability of drugs will be validated, stability-indicating methods. However, many early studies used methods that were not demonstrated to be stability indicating.

Biological drugs (therapeutic proteins [e.g., enzymes, monoclonal antibodies, immune globulins]) are particularly sensitive to environmental factors and undergo more complex and numerous degradation pathways than classical drugs.3207 3208 3212 In addition to physicochemical instability issues similar to those observed with classical drugs (e.g., precipitation, decomposition), such proteins are subject to other stability issues (e.g., protein conformation, biologic activity) that must be considered.3207 3208 3209 3212 Therefore, a single analytic method that only assesses protein concentration is insufficient to determine stability of biological products.3209 3210 Interpretation of the results of compatibility and stability studies of such proteins poses a challenge because both analytic methods and meaningful acceptance criteria should be specific to the biologic; official compendial standards (e.g., The United States Pharmacopeia monographs and analytic methods) should be consulted when available.3206 3209 3212 Although many experts agree that multiple complementary methods should be used to assess the physical and chemical stability as well as assessment of biologic activity, no clear guideline or recommendation for in-use stability studies for therapeutic proteins is available.3208 3210 3211 3212

Literature Search for Updating ASHP’s Handbook™

To gather the bulk of the published compatibility and stability information for updating ASHP’s Handbook, a literature search is performed using the International Pharmaceutical Abstracts (IPA) database and PubMed. By using key terms (e.g., stability), a listing of candidate articles for inclusion in ASHP’s Handbook™ is generated. From this list, relevant articles are critically evaluated and prioritized for inclusion. As a supplement to this automated literature searching, a manual search of the references of the articles is also conducted, and any articles not included previously are similarly evaluated for inclusion. In addition, pharmaceutical manufacturers may be contacted for additional in-house (unpublished) data.

Abbreviations

AA

Amino acids (percentage specified)

D

Dextrose solution (percentage unspecified)

D5LR

Dextrose 5% in Ringer’s injection, lactated

D5R

Dextrose 5% in Ringer’s injection

D-S

Dextrose-saline combinations

D2.5½S

Dextrose 2.5% in sodium chloride 0.45%

D2.5S

Dextrose 2.5% in sodium chloride 0.9%

D5¼S

Dextrose 5% in sodium chloride 0.225%

D5½S

Dextrose 5% in sodium chloride 0.45%

D5S

Dextrose 5% in sodium chloride 0.9%

D10S

Dextrose 10% in sodium chloride 0.9%

D5W

Dextrose 5%

D10W

Dextrose 10%

IM

Isolyte M

IP

Isolyte P

IS10

Invert sugar 10%

LR

Ringer’s injection, lactated

NM

Normosol M

NR

Normosol R

NRD5W

Normosol R in dextrose 5%

NS

Sodium chloride 0.9%

R

Ringer’s injections

REF

Refrigeration

RT

Room temperature

S

Saline solution (percentage unspecified)

½S

Sodium chloride 0.45%

SL

Sodium lactate (1/6) M

TNA

Total nutrient admixture (3-in-1)

TPN

Total parenteral nutrition (2-in-1)

W

Sterile water for injection

Manufacturer and Compendium Abbreviations

AB

Abbott

ABV

AbbVie

ABX

Abraxis

ACC

American Critical Care

ACD

Accord Healthcare

ACT

Actavis

AD

Adria

AGT

Aguettant

AH

Allen & Hanburys

AHP

Ascot Hospital Pharmaceuticals

AKN

Akorn

ALP

Alpharma

ALT

Altana Pharma

ALV

Alveda Pharma

ALZ

Alza

AM

ASTA Medica

AMB

Amneal Biosciences

AMD

Amdipharm

AMG

Amgen

AMP

Amphastar

AMR

American Regent

AMS

Amerisource

AND

Andromaco

ANT

Antigen

AP

Asta-Pharma

APC

Apothecon

APO

Apotex

APP

American Pharmaceutical Partners

APT

Aspen Triton

AQ

American Quinine

AR

Armour

ARC

American Red Cross

ARD

Ardeapharm

ARR

Arrow

AS

Arnar-Stone

ASC

Ascot

ASP

Astellas Pharma

AST

Astra

ASZ

AstraZeneca

AT

Alpha Therapeutic

AUB

Aurobindo

AUR

Auromedics

AVD

Avadel Legacy Pharmaceuticals

AVE

Aventis

AVG

Alvogen

AW

Asta Werke

AY

Ayerst

AZV

Laboratórios Azevedos

BA

Baxter

BB

B & B Pharmaceuticals

BAN

Banyu Pharmaceuticals

BAY

Bayer

BC

Bencard

BCT

BioCryst Pharmaceuticals

BD

Becton Dickinson

BE

Beecham

BED

Bedford

BEH

Behring

BEL

R. Bellon

BFM

Bieffe Medital

BI

Boehringer Ingelheim

BIO

Bioniche Pharma

BK

Berk

BKN

Baker Norton

BM

Boehringer Mannheim

BMS

Bristol-Myers Squibb

BN

Breon

BP

British Pharmacopoeiaa

BPC

British Pharmaceutical Codexa

BR

Bristol

BRD

Bracco Diagnostics

BRN

B. Braun

BRT

Britianna

BT

Boots

BTK

Biotika

BV

Ben Venue

BW

Burroughs Wellcome

BX

Berlex

BXT

Baxalta

CA

Calmic

CAD

Cadence Pharmaceuticals

CAR

Cardinal Health

CBH

CSL Behring

CE

Carlo Erba

CEN

Centocor

CER

Cerenex

CET

Cetus

CH

Lab. Choay Societe Anonyme

CHI

Chiron

CHS

Chiesi

CI

Ciba

CIS

CIS US

CL

Clintec

CLA

Claris Lifesciences

CMB

Cumberland

CN

Connaught

CNF

Centrafarm

CO

Cole

COM

CommScope

COR

COR Therapeutics

COV

Covis

CP

Continental Pharma

CPP

CP Pharmaceuticals

CPR

Cooper

CR

Critikon

CRC

Caraco

CSL

CSL Ltd.

CTI

Cell Therapeutics Inc.

CU

Cutter

CUB

Cubist

CUP

Cura Pharmaceuticals

CUR

Curomed

CY

Cyanamid

DAK

Dakota

DB

David Bull Laboratories

DCC

Dupont Critical Care

DI

Dista

DIA

Diamant

DM

Dome

DME

Dupont Merck Pharma

DMX

Dumex

DRA

Dr. Rentschler Arzneimittel

DRT

Durata Therapeutics

DRX

Draxis

DU

DuPont

DUR

Dura

DW

Delta West

EA

Eaton

EBE

Ebewe

ECL

Éclat

EI

Eisai

ELN

Elan

EN

Endo

ENZ

Enzon

ERF

Erfa

ERM

Erempharma

ES

Elkins-Sinn

ESL

ESI Lederle

ESP

ESP Pharma

EST

Esteve

EV

Evans

EX

Essex

EXL

Exela

FA

Farmitalia

FAN

Fandre Laboratories

FAU

Faulding

FC

Frosst & Cie

FED

Federa

FER

Ferring

FI

Fisons

FOR

Forest Laboratories

FP

Faro Pharma

FRE

Fresenius

FRK

Fresenius Kabi

FUJ

Fujisawa

GEI

Geistich Pharma

GEM

Geneva-Marsam

GEN

Genentech

GG

Geigy

GIL

Gilead

GIU

Giulini

GL

Glaxo

GLT

Generics Limited

GNS

Gensia-Sicor

GO

Goedecke

GRI

Grifols

GRP

Gruppo

GRU

Grunenthal

GSK

GlaxoSmithKline

GVA

Geneva

GW

Glaxo Wellcome

GZ

Genzyme

HAE

Haemonetics

HB

Hoechst-Biotika

HC

Hillcross

HE

Hengrui Medicine Co.

HER

Heritage

HIK

Hikma

HMR

Hoechst Marion Roussel

HO

Hoechst-Roussel

HOS

Hospira

HQS

HQ Specialty Pharma

HR

Horner

HY

Hyland

ICI

ICI Pharmaceuticals

ICN

ICN Pharmaceuticals

IMM

Immunex

IMS

IMS Ltd.

IN

Intra

INT

Intermune

IV

Ives

IVX

Ivex

IX

Invenex

JAZ

Jazz

JC

Janssen-Cilag

JHP

JHP Pharmaceuticals

JJ

Johnson & Johnson

JN

Janssen

JP

Jones Pharma

KA

Kabi

KED

Kedrion

KEY

Key Pharmaceuticals

KN

Knoll

KP

Kabi Pharmacia

KV

Kabi-Vitrum

KY

Kyowa

LA

Lagap

LE

Lederle

LEM

Lemmon

LEO

Leo Laboratories

LFB

Laboratoire Français du Fractionnement et des Biotechnologies

LI

Lilly

LJ

La Jolla

LME

Laboratoire Meram

LUN

Lundbeck

LY

Lyphomed

LZ

Labaz Laboratories

MA

Mallinckrodt

MAC

Maco Pharma

MAR

Marsam

MAY

Mayne Pharma

MB

May & Baker

MCD

Merck Chibret Dohme

MDI

Medimmune

MDX

Medex

ME

Merck

MEL

Melinta Therapeutics

MG

McGaw

MGI

MGI Pharma

MI

Miles

MIL

Millimed

MJ

Mead Johnson

MM

Merrimack

MMD

Marion Merrell Dow

MMT

Meridian Medical Technologies

MN

McNeil

MON

Monarch

MRD

Merrell-Dow

MRN

Merrell-National

MSD

Merck Sharp & Dohme

MTN

Marathon

MUN

Mundi Pharma

MY

Maney

MYL

Mylan

MYR

Mayrhofer Pharmazeutika

NA

National

NAB

Nabi

NAP

NAPP Pharmaceuticals

NCI

National Cancer Institute

NE

Norwich-Eaton

NIN

Ningbo Team

NF

National Formularya

NO

Nordic

NOP

Novopharm

NOV

Novo Pharm

NVA

Novartis

NVN

Novo Nordisk

NVP

Nova Plus

NVX

Novex Pharma

NYC

Nycomed

OHM

Ohmeda

OM

Omega

OMJ

OMJ Pharmaceuticals

OMN

Ortho-McNeil

ON

Orion

OR

Organon

ORC

Orchid

ORP

Orphan Medical

ORT

Ortho

OTS

Otsuka

PAD

Paddock

PAL

Paladin

PAN

Panpharma Laboratory

PAR

Par

PB

Pohl-Boskamp

PD

Parke-Davis

PE

Pentagone

PF

Pfizer

PFM

Pfrimmer

PH

Pharmacia

PHC

Pharmachemie

PHS

Pharmascience

PHT

Pharma-Tek

PHU

Pharmacia & Upjohn

PHX

Phoenix

PNN

Pantheon

PNT

Parenta

PO

Poulenc

PP

Pharmaceutical Partners

PPC

Pharmaceutical Partners of Canada

PPR

Premier Pro Rx

PR

Pasadena Research

PRF

Pierre Fabre

PRK

Parkfields

PRM

Premier

PRP

Premier Pro

PX

Pharmax

QI

Qilu

QLM

Qualimed Labs

QU

Quad

RB

Robins

RBP

Ribosepharm

RC

Roche

REN

Renaudin

RI

Riker

RKB

Reckitt & Benckhiser

RKC

Reckitt & Colman

ROR

Rorer

ROX

Roxane

RP

Rhone-Poulenc

RPR

Rhone-Poulenc Rorer

RR

Roerig

RS

Roussel

RU

Rugby

SA

Sankyo

SAA

Sanofi Aventis

SAG

Sageant

SAN

Sanofi

SB

Sintetica Bioren

SC

Schering

SCI

Scios

SCN

Schein

SCS

SCS Pharmaceuticals

SE

Searle

SEQ

Sequus

SER

Servier

SGS

SangStat

SGT

Sagent

SHI

Shionogi

SIA

Siam Pharmaceutical

SIC

Sicor

SIG

Sigma Tau

SKB

SmithKline Beecham

SKF

Smith Kline & French

SM

Smith

SMX

SteriMax

SN

Smith + Nephew

SO

SoloPak

SP

Spectrum Pharmaceuticals

SQ

Squibb

SRB

Serb

SS

Sanofi-Synthelabo

ST

Sterilab

STP

Sterop

STR

Sterling

STS

Steris

STU

Stuart

SUN

Sun

SV

Savage

SW

Sanofi Winthrop

SX

Sabex

SY

Syntex

SYN

Synergen

SYO

Synthelabo

SZ

Sandoz

TAK

Takeda

TAL

Talon Therapeutics

TAP

TAP Holdings

TAR

Targanta Therapeutics

TAY

Taylor

TE

Teva

TEC

Teclapharm

TES

Tesaro

TL

Tillotts

TMC

The Medicines Company

TO

Torigian

TR

Travenol

UCB

UCB

UP

Upjohn

USB

US Bioscience

USP

United States Pharmacopeiaa

USV

USV Pharmaceuticals

UT

United Therapeutics

VHA

VHA Plus

VI

Vitarine

VIC

Vicuron Pharmaceuticals

VT

Vitrum

WAS

Wasserman

WAT

Watson

WAY

Wyeth-Ayerst

WB

Winthrop-Breon

WC

Warner-Chilcott

WED

Weddel

WEL

Wellcome

WI

Winthrop

WG

WG Critical Care

WL

Warner Lambert

WOC

Wockhardt

WW

Westward

WY

Wyeth

XGN

X-Gen

XU

Xudong Pharmaceutical Co.

YAM

Yamanouchi

ZEN

Zeneca

ZLB

ZLB Biopharma

ZNS

Zeneus Pharma

ZY

ZyGenerics

a While reference to a compendium does not indicate the specific manufacturer of a product, it does help to indicate the formulation that was used in the test.