Possible effects of excipients used in the parenteral drugs administered in critically ill adults, children and neonates.

BACKGROUND: Critically ill patients (adults, children and neonates) receiving parenteral drugs are at an increased risk of exposure to various excipients administered simultaneously, continuous infusions and at an increased dose. Hence, the present study was conducted to evaluate the excipients administered through parenteral preparations in the intensive care units of a tertiary care hospital.

RESEARCH DESIGN AND METHODS: Patients admitted in the adult, pediatric and neonatal intensive care units were recruited following their consent. Details on their demographics, diagnoses and drugs administered during their admissions in the intensive care units were collected. Details regarding the drugs and the concerned excipients were retrieved.

RESULTS: Almost all the critically ill patients receive drugs containing at least one excipient. Significant numbers of critically ill neonates received at least one of either known to be harmful or potentially harmful excipients. Critically ill neonates had significantly greater daily exposure of macrogol than children and adults; and benzyl alcohol (v/v) and propyl paraben compared to adults. Critically ill neonates and children had greater exposure to benzyl alcohol (w/v), methyl paraben, sodium metabisulphite than adults did. Benzyl alcohol exposure was likely to be several-fold high in critically ill patients. Exposures to benzyl alcohol and propylene glycol were possibly linked to increased risk of mortality particularly in neonates.

CONCLUSION: Critically ill neonates and children are likely to receive a significantly greater quantity of harmful excipients than critically ill adults. Benzyl alcohol and propylene glycol exposure are likely to be associated with increased risk of mortality in critically ill.