Safety of medicine cocktails

Barring suspensions and all other odd medications, is it ok to mix clear liquid medications?

My son is now on a regime of 3 separate medications (cough, allergies, congestion) and it would save us all some heartache if I could just measure them all, put them together in the same spoon (the ones with the tube in the handle) and give him only one shot, instead of begging him to take the 3 separate shots.

Is this generally safe to do?

I am not a doctor, pharmacist or any other sort of medical practitioner but I have made inquiries of said practitioners about this very subject for forensic purposes. It is, I am given to understand, best practice NOT to mix medications even if they are clear.

At least one reason for this is that medications are all at potentially different pH levels (for technical reasons to do with the detail of the drug chemistry), and when mixed, the alteration of the total pH that results can cause drugs to precipitate out of solution, making them effectively worthless. I have seen a demonstration of exactly that effect happening with clear liquid drugs.

Even if the precipitation is not visible, there can be chemical changes that alter the chemistry of the drugs.

I can’t comment on the magnitude of the risk in any given case, but unless you know a great deal about pharmaceutical chemistry, it is inadvisable to mix drugs into one bolus dose.

What Noel Prosequi said. I nearly killed a patient (goat) by inadvertently creating a drug mixture in it’s IV line, causing part of the medication to precipitate.

I can understand this if the drugs are going to be standing for long periods or administered intravenously, but Sapo seems to be proposing mixing the medication and drinking it immediately. Given that it’s going to be dumped into a vat of pH ~2 within a few seconds anyway, is this change in pH really going to have any effect?

This is, in summary, my thought process. They are all seconds away from being all swimming together. How can these extra 5 seconds mess it all up so bad?

It still feels unpredictable enough to make me worry. Yes, all the drugs are going to comingle in the stomach, but maybe comingling at about pH2 is okay while comingling at pH6.5 (or whatever) is not.

I know just enough chemistry to be afraid of what I don’t know.

Might be safest to avoid doing so, but depending on what the medications are, there are numerous over the counter remedies that combine the usual cold/allergy meds in one product. Can you use some of those instead of some of the individual meds?

(note: in general I dislike the combination medications as it makes it impossible to titrate individual ingredients but this is one situation would it would be useful).

The doctor already gave up on OTC meds for our boy. Which is why we are on prescribed meds, but I agree with both seemingly contradicting points of your post.

As things stand, we are giving him the meds one at a time. Normally he rejects meds the first two days of treatment and then realizes there is no point in fighting it and becomes a lot more compliant. It is just that those first days are a drag.

The question is more academic than anything else. I would have liked to hear it from someone who knows the field about what could go wrong or why it is ok.

I am not a medical professional, but my wife is a hospital phamacist. I asked her and she said, predictably enough, ask your dispensing pharmacist to see if the combination of those three particular medications is known to be safe in the manner you wish to administer them.

The safety of mixing drugs, I am told, is dependent on a vast number iof factors, including the drugs themselves, the suspending agents, sweeteners or flavouring agents, etc. Some things might never react, others might do so instantly upon contact.

The wife says that there may have been some study of these particular medications for safety and effectiveness if mixed before use, but she kind of doubts it. Those kinds of studies are much more common with IV drugs. The advice she usually gives to doctors and nurses when asked about mixing IV’s (and advice she thinks is good for this situation as well) is “If there isn’t a study that says it’s OK, assume it isn’t and don’t do it.”