- 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.
Senior Information Pharmacist, Welsh Medicines Information Centre