• Mixing of nebuliser solutions should only be undertaken in the best interests of the patient and only by a person competent and willing to do so. Instructions for mixing should be in writing.
  • Two-way mixes of nebuliser solutions have been used for a variety of respiratory medicines. Table 1 indicates those that are deemed to be compatible.
  • Unless specified in the Summary of Product Characteristics, the manufacturers of nebuliser solutions generally do not recommend that they are mixed and as such these mixtures are unlicensed.
  • Prescribers should be aware if a medicine is to be used outside its licence and take responsibility for its use in this manner.
  • Where available, it is preferable to use licensed combination products.
  • Two-way mixes should be used immediately, and should be discarded if precipitation, turbidity or colour changes occur.
  • The mixture may be diluted with 0.9% sodium chloride to a volume of between 3 and 4mL. Any unused solution should be discarded.
  • Patients should be monitored to ensure continued clinical response to treatment.
  • Data on other three-way mixes are lacking and therefore cannot be recommended.