Cernevit Caution For Usage

Pharmaceutical precautions: The product after reconstitution with Water for Injections should be used immediately, or failing this, be stored under refrigeration for no more than 24 hours.
Incompatibilities: Additives may be incompatible with parenteral nutrition containing Cernevit.
Do not add other medicinal products or substances without first confirming their compatibility and the stability of the resulting preparation.
If co-administration of drugs that are incompatible at the Y-site is necessary, administer via separate IV lines. Vitamin A and thiamine in Cernevit may react with bisulfites in parenteral nutrition solutions (e.g., as a result of admixtures) leading to degradation of vitamin A and thiamine.
An increase in pH of a solution may increase the degradation of some vitamins. This should be considered when adding alkaline solutions to the admixture containing Cernevit.
Folic acid stability can be impaired with increased calcium concentrations in an admixture.
Numerous other incompatibilities between vitamins and other medicinal products, including certain antibiotics, and trace elements have been described.
Refer to appropriate compatibility references and guidelines as needed.
Instructions for Use and Handling, and Disposal: Aseptic conditions must be followed during reconstitution and when used as part of an admixture in parenteral nutrition.
Mix gently to dissolve the lyophilized powder.
Before transfer from the vial, Cernevit must be completely dissolved.
Do not use product unless the reconstituted solution is clear and the original seal is intact.
After addition of Cernevit to a parenteral nutrition solution, check for any abnormal color change and/or the appearance of precipitates, insoluble complexes, or crystals.
Mix the final solution thoroughly when Cernevit is used as an admixture in parenteral nutrition.
Any unused portion of reconstituted Cernevit should be discarded and should not be stored for subsequent admixing.
Parenteral drug products should be inspected visually for particulate matter and abnormal discoloration prior to administration, whenever solution and container permit.
Use of a final filter is recommended during administration of all parenteral nutrition solutions.