Good afternoon all, on a daily basis I take the above powdered inhaled antibiotic (Promixin) through my nebuliser with a saline solution to help with my pseudomonas bugs.
The other day I noticed I had ran out of saline so I had to used one of my salbutamol solutions to mix it.
Will this have been ok?
Has anyone else had to do this before? I just want to make sure.
Kind regards as always
Joe x
Short answer: it’s unlikely to have done you any harm at all, but it’s not advised. The only thing you can officially, definitely substitute normal saline for without any issues to mix promixin (and colomycin generally) is water for injections.
Longer answer: if the liquid remained clear it’s probably fine as a one off, but the advice from both medics and manufacturers remains that you should only ever mix antibiotics as per the instructions. The main reason is because there have been very few studies into nebulised ‘admixtures’ to date, but we know that mixing with anything other than the intended diluent can potentially reduce the effectiveness of one or both drugs in the mixture. In some cases, we also know that mixing nebbed drugs can lead to solid particles (precipitation) forming in the liquid as they interact, so if you ever mixed two nebs together and the mixture turned cloudy, it definitely shouldn’t be used. One of the other issues is that meds have different particle sizes when aerosolised in a nebuliser, so by combining them you’re potentially altering the distribution of the drug within the lungs, again reducing effectiveness. The particle distribution and size is particularly relevant if you use an iNeb - I only mention this as you specifically mention promixin, which is usually only prescribed by the NHS for use with an iNeb. The colour-coded chambers on the iNeb are engineered based on drug particle size, which is only established for the drug when diluted as instructed, although both salbutamol and promixin go through the grey (we use an iNeb with the child), so would have the same particle size when prepared and used as separate drugs.
Thank you.
I think I would have thought twice about nebulising with own cocktail. Though we do get desperate to breathe sometimes. I hope you are on the mend.
Thank you
An excellent and detailed answer, as usual, from Charlie_G. I have done this in error before (brain fade) only noticing when I had an odd number of saline left. I didn’t have any adverse effects probably the shakes from too much salbutamol.
Thank you
I’m interested to know if you’re taking Promixin haven’t you been given an iNeb? It only takes a couple of minutes to inhale Promixin from a iNeb. Joy.
Hi there, I have been on Promixin for around 6 years. My Respiratory Team at my hospital gave me a Philips Respironics InnoSpire Deluxe Nebuliser to inhale it through. It generally takes about 10 minutes. Thank you for your comments.
You can also use chilled, boiled water if you don’t have saline. Joy.
Unless you were specifically advised this is ok by a doctor, I don’t know this is a very good idea. Even if you were advised it’s ok by a doctor, I’ve got to be honest and say I would still consider it to not be a good idea based on my understanding. For the purposes of inhalation, boiled tap water is not even close to being similar to water for injection (or saline, which is made with WfI as its base), which is completely distilled and filtered to remove all impurities, particles, minerals, and bacteria. Water is sterile once held at a rolling boil for a minute (usually requiring a pan), but will still have minerals, particles and impurities, which whilst fine for drinking, are not something you necessarily want to deliberately aerosolise and inhale. There is also the risk of bacteria or contaminants being introduced by the pan it’s boiled in, and during the cooling process. If done in a kettle, there’s the additional risk of microscopic limescale sediment, which isn’t great for your equipment, never mind your lungs. Pari (the nebuliser manufacturer) stipulate that if you don’t use steam, their nebs should only ever be sterilised by boiling in distilled water to prevent damage and contamination from these kinds of impurities and minerals. To the best of my knowledge, there are a very few exceptions where missing a dose or two of a neb whilst trying to sort out some saline or WFI from somewhere would cause serious harm.
Thank you
Double boiling water can help sterilise it: bringing to the boil and boiling for 10 minutes, leaving to cool until hand temperature, and then boiling for 10 minutes again. But as others have said, this would not remove the minerals and impurities.
Thanks
travel 
A GP advises she or the surgery cannot give me a prescription for hypertonic saline as it is not on the surgery list.
nebuliser recommendations? 
Nebulizers
Recent diagnosis of Bronchiectasis 
