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The ward pharmacist received a report from ward nursing staff that an aggregation formed when lansoprazole OD tablets and ground levofloxacin tablets were suspended simultaneously in water. In this study, we elucidated the factors of aggregation focusing on additives, the main drug, and pH in suspension, and also considered ways of preventing the aggregation. To elucidate the contribution of additives in levofloxacin tablets, drugs containing similar additives to those of levofloxacin tablets were suspended with lansoprazole OD tablets in water, but no aggregation was observed. Levofloxacin hydrate intravenous drip infusion (pH 4.8) did not form an aggregation with lansoprazole OD tablets, meanwhile levofloxacin hydrate intravenous drip infusion adjusted to pH 7.3 and levofloxacin hydrate solution adjusted to pH 7.3 formed an aggregation with lansoprazole OD tablets. When lansoprazole OD tablets and ground levofloxacin tablets were suspended in a buffer solution of pH 5.0, pH 6.0, and pH 7.0, no aggregation was observed in a buffer solution of pH 5.0. When generic lansoprazole OD tablets and generic lansoprazole capsules were suspended with levofloxacin tablets in water, aggregation was also observed. On the other hand, the aggregation of lansoprazole OD tablets was not observed when lansoprazole OD tablets and levofloxacin tablets were suspended in apple juice. According to the above results, factors related to the formation of the aggregation were involved in the preparation of lansoprazole, levofloxacin hydrate, and around pH 6.0, and the suspending of lansoprazole OD tablets and levofloxacin tablets simultaneously in acidic drinks such as apple juice is means of avoiding the aggregation.

Aggregation in a Suspension of Lansoprazole OD Tablets and Levofloxacin Hydrate Tablets in Water