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EDSEL A. RUDDMAN.

INCOMPATIBILITIES IN PRESCRIPTIONS FOR STUDENTS IN PHARMACY AND MEDICINE AND ... online

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WORKS OF Prof. E. A. RUDDIMAN

PUBLISHED BY

JOHN WILEY & SONS.



loooapatibllltles in PrMcriptlont.

For Students in Pharmacy and Medicine, and
Practising Pharmacists and Physicians. Third
Edition. Partly Rewritten. 8vo, vi + 31
Cloth, $a.oo.



Whys In PharoMcy.

A Compilation of Reasons Underlying the Princi-
ples of Pharmacy, Supplemented by a Table of
Equations, zsmo, yi + 196 pages. Cloth, $1.00



. 1 1..-



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INCOMPATIBILITIES



IN



PRESCRIPTIONS.



FOK



STUDENTS IN PHARMACY AND MEDICINE

AND PRACTICING PHARMACISTS

AND PHYSICIANS



BY

EDSEL A. RUDDIMAN, Ph.M., M.D.,

FftiStuwr of Pharmacy and Materia Mtdka, Department of Pharmacy, Vanderbiit Univertiiy;
A%tthor c/ **Why9 in Pharmacy,' " Manual of Materia Medico."



THIRD EDITION, PARTLY REWRITTEN.
SECOND THOUSAND



NEW YORK:

JOHN WILEY & SONS.

London : CHAPMAN & HALL, Limitu.
1910



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Copyright. 1897. 1900. 1908,



A. RUDDIMAN.



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PREFACE TO THE TfflRD EDITION.



On account of the revision of the PharmacojxKia and the
introduction of many new compounds into medicine, a revised
edition of this work seems desirable. The general arrange-
ment remains imchanged. About fifty new prescriptions are
introduced, replacing some that are less important or are dupli-
cated to some extent.

Acknowledgment is made of the assistance of Dr. R. H.
Smith in getting up the table of solubilities. Thanks are returned
to the many friends who have sent in prescriptions for comment

Vanderbilt University, 1908.



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PREFACE TO THE SECOND EDITION.



In this edition Part I has been entirely rewritten. Many
of the statements made in the first edition have been gone
over in the Author's laboratory ; a few were found to be in-
correct, while a modification of others was necessary. In
performing the laboratory work the fact was again empha-
sized that many conditions, such as temperature, dilution,
order of mixing, impurities in commercial drugs, etc., materi-
ally affect the results obtained. The text of this part of the
book has been made rather full so that as a reference book it
may have some value. At the same time the insertion of
numbers at the beginning of the statements makes it easy for
the teacher using the book to designate what incompatibili-
ties he wishes the student to learn.

Some changes and additional statements have been made
in Part II. Twenty-five prescriptions with comments have
also been added as well as fifty prescriptions without com-
ments. The comments on the last were omitted so that the
student can the better test his knowledge.

Since so many incompatibilities are the result of the
formation of insoluble compounds it was deemed advisable
to introduce a table of solubilities for reference. A table of
average prices charged for prescriptions not requiring par-
ticular skill or calling for expensive ingredients is also ap-
pended, so that those who have not had the drug-store experi-
ence may have some idea as to the general prices charged.
Attention is called to the complete index of prescriptions



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vi PREFACE.

which enables one to find at a glance any prescription con-
taining a certain ingredient or combination of ingredients
that is g^ven in the book.

The Author has found this book to be of as much value
to medical students as to those in Pharmacy. Since the in-
compatibility in a prescription originates with the physician,
if the subject were better understood by the^riter of the
prescription there would be less trouble both for physicians
and pharmacists.

The Author wishes to thank his many friends for the gen-
erous words of encouragement that they have given him.

Vandbrbilt University, June, 1900.



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PREFACE TO THE FIRST EDITION.



The busy prescriptionist is frequendy at a loss to know
what takes place in the prescription he is filling, and does not
have the time nor books necessary to look up the change which
he has noticed. The object of the first part of this book is to
present to him in a convenient and condensed form the more
common incompatibilities. The substances treated of are ar-
ranged in alphabetical order of their Latin names, except in
case of some of the newer remedies. In order to avoid repetition
all the incompatibilities of each substance are not always given
under that heading. For instance, the reaction between two
substances may be foimd imder the heading of one of the sub-
stances and not imder the other.

The second object of the writer is to furnish the student of
pharmacy with a list of incompatible prescriptions in such form
that he may find out for himself what the trouble is, and the
best means of avoiding or overcoming it. It is suggested that
he study the prescription thoroughly before referring to the notes.

Acknowledgment is hereby made of assistance received from
all of the books and journals mentioned in the list of abbrevia-
tions of references.

Edsel a. Ruddiman.

NASHvnxE, June, 1897.



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ABBREVIATIONS OF REFERENCES

Allen: Allen's Commercial Organic Analysis, 3d ed.

A. D. : American Dispensatory.

Am. D. : American Druggist

A. J. P.: American Journal of Pharmacy.

A. P. A.: Proceedings of the American Pharmaceutical AasodatioiL

Blyth: Blyth's Poisons, jd ed.

Br. P.: British Phannacopceia, 189S.

BuL Phar. : Bulletin of Pharmacy.

Ca^Miri: Caspari's Treatise on Pharmacy, ^d ed.

D. C: Druggist's Circular.

M. & M. : Muir and Morley's edition of Watts' Dictionary.

M. R. : Merck's Report

Nat Drug. : National Druggist.

N. S. D. : National Standard Dispensatory.

N. E. D. : New England Druggist

Ph. E. : Pharmaceutical Era.

Ph. }. : Pharmaceutical Journal.

Ph. R. : Pharmaceutical Review.

P. & J. : Prescott and Johnson's Qualitative Chemical Analysis, 5th ed.

Potter: Potter's Materia Medica, loth ed.

Prescott: Prescott's Organic Analysis.

R. & S. : Roscoe and Schorlemmer's Organic Chemistry.

Richter: Richter's Organic Chemistry, 3d Amer. ed.

Scoville: Scoville's Art of Compounding, 3d ed.

Sohn: Sohn's Dictionary of Active Principles of Plants.

Storer: Storer's Dictionary of Solubilities.

U. S. D. : United States Dispensatory, 19th ed.

U. S. P. : United States Pharmacopoeia, 8th revision.

W. D. : Western Druggist

WatU: Watts' Dictionaxy of Chemistry.

viii



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PART I.

INCOMPA TIBILITIES.

Acacia. — i. Mucilage of acacia is about neutral to litmus
on account of the lime water in it. An aqueous solution of
acacia is acid to litmus, but is not sufficiently acid to cause trouble
unless decomposition has commenced. 2. The official mucilage
of acacia is gdatinized by a solution of ferric chloride, tincture
of ferric chloride, solution of ferric sulphate, or solution of
ferric subsulphate. Alkali citrates in small proportions, alkali
acetates in larger proportions, excess of hydrochloric or other acids,
or dilution with water, will tend to prevent coagulation. One
volume of tincture of iron with an equal volume of water will give
a solution with one volume of mucilage diluted with an equal
volimie of water. Different samples of tincture chloride of iron
vary in the amoimt of free acid and this causes a variation in
the amoimt of citrate, acetate, acid, or dilution necessary to pre-
vent gelatinization. Glycerin or syrup seems to have but little
more effect in preventing coagulation than so much water. The
color of the mixture of the iron salt and the mucilage is deeper
red than that of the tincture alone. Gelatinized acacia will
afterwards slowly dissolve if an excess of water is added. 3. So-
lution of dialyzed iron when mixed with mucilage of acacia
forms gelatinous masses, having the color of ferric hydroxide,
but does not give a translucent mass as does the tincture of
iron; dilution with water or the addition of a citrate has but
little effect in preventing precipitation. 4. The solution of
ferrous chloride (N. F.), iron citrate, iron and ammonium
citrate, or a saturated solution of ferrous sulphate does not
gelatinize mucilage of acacia. 5. A saturated solution of borax
forms a more or less translucent mass with mucilage of acacia.
By diluting the borax solution with an equal volume of water,



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2 INCOMPATIBILITIES IN PRESCRIPTIONS.

and the mucilage with an equal volume of water, no coagulation
takes place. The coagulation may also be prevented by adding
three or four drops of glycerin or honey to one dram of the borax
solution, or by acidifying the borax solution. Either glycerin
or honey decomposes borax to some extent, liberating boric acid,
but not enough need be added to make the solution acid. The
ofl&cial syrup or a solution of glucose tends to prevent the coagu-
lation, but is not as efifective as glycerin. 6. A solution of lead
subacetate (not the neutral lead acetate), even if quite highly
diluted, will give white, opaque, gelatinous masses when mixed
with mucilage of acacia. Diluting the mucilage with several
volumes of water does not prevent coagulation although glycerin
and syrup do to some extent. 7. Mucilage containing lime
water will have many of the incompatibilities of lime water.
8. Acacia is nearly insoluble in alcohol. The mucilage can be
mixed with a little over one half its volume of alcohol without
permanent precipitation. If the mucilage is first diluted with
water a stronger alcoholic mixture can be obtained before pre-
cipitation is permanent. The precipitate redissolves on subse-
quent dilution with water. 9. Sulphuric acid converts acacia
into arabic and then metarabic acid and precipitates calcium
sulphate (U. S. D., 5). Dilute sulphuric acid converts it into a
sugar on prolonged boiling (M. & M., i. 296). A strong solution
of a sulphate gives a precipitate of calcium sulphate. 10. Dilute
nitric acid converts acacia into mucic, sacdharic, oxalic, and
tartaric acids (U. S. D., 5). 11. In the presence of acacia, dilute
solution of salts of mercury, lead, copper, antimony, silver,
iron, or arsenic do not give precipitates with hydrogen sulphide
or alkaline sulphides, although a coloration may be produced.
12. Acacia prevents the precipitation of dilute solutions of salts
of mercury, antimony, aluminum, iron, calcium, and some
other metals by alkali hydroxides or borax and in some cases
by carbonates. 13. Dilute solutions of alkaloidal salts in
the presence of acacia are not precipitated by potassium mer-
curic iodide, sodium phosphomolybdate, or tannic acid
(Allen, I. 426). These properties are common to many gums
(M. & M., I. 296). The solution of the alkaloid must be very



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INCOMPATIBILITIES IN PRESCRIPTIONS. 3

dilute or some precipitation will occur. 14. Mucilage of acacia
is colored blue, either at once or after standing a short time,
by a tincture of guaiac if the guaiac is fresh, but not with a
guaiac that has been exposed to air and light for some time.
A mucilage made from acacia tears may give the blue when one
made from powdered acacia will not. This is probably due to
a ferment in the tears which is destroyed by the heat necessary
before powdering. Heating a mucilage of acacia to 100° C. for
one hour destroys the ferment, without impairing the emulsifying
powers (Ph. J., 1905, 620). 15. Bourquelot (Pharm. Zeitralh.,
Aug. 10, 1905, Am. D., XLvn, 239) states that acacia contains
an oxydase which gives colors when a ten per cent, solution of
acacia is mixed with a one per cent, solution of carbolic acid,
naphthol, pyrogallol, cresol, thymol, guaiacol, vanillin, pyra-
midon, morphine, apomorphine, physostigmine, adrenalin, bar-
baloin, tannin, preparations of tar, and other compounds.

Acetanilidum. — i. With spirit of nitrous ether, amyl
nitrite, or a solution containing nitrous acid, acetanilide gives
a yellow solution, becoming red on standing for some time.
With a fresh or nearly neutral spirit of nitrous ether the yellow
coloration may not be noticed for several days and the red
for two weeks or more. The presence of an alkali or a little
sodium bicarbonate will prevent the appiearance of more than
a pale yellow within a month. Probably diazo-compoimds
are formed. 2. A cold solution of ferric chloride with
acetanilide gives no increase of color, but, if heated, it assumes
a deep red color which fades as the solution cools. If heat is
applied to a concentrated solution for several minutes a dark
green color is produced. With the tincture of iron acetanilide
gives a red color without heating, because acetanilide is soluble
in alcohol. Excess of acid lessens the color. 3. Bromine,
iodine, bromides, or iodides do not precipitate aqueous solu-
tions of acetanilide imless they are added in very large excess.
4. Adds generally hydrolize it (Ph. R., XXI., 73). 5. Ace-
tanilide is slowly decomposed by a strong solution of potassium
or sodium hydroxide, forming anilin (N. S. D., 8). 6. A
mixture of acetanilide and calomel, either dry or with water,



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4 INCOMPATIBILITIES IN PRESCRIPTIONS,

shows no perceptible change withm a month and gives no test
for a mercuric salt. 7. Rubbing acetanilide with chloral alco-
holate,piperazine, phenol, pyrocatechin^resorcin, or thymol
produces a soft mass or liquid which is soluble in alcohol and
msoluble or only partly soluble in water. 8. Heavy trituration
of acetanilide with antipyrine or chloral hydrate gives a damp
powder. 9. Chloral hydrate increases the solubility of ace-
tanilide in water; a mixture of ten grains of chloral hydrate with
one grain of acetanilide will dissolve in about five minims of water
and further addition of water does not cause precipitation. 10.
When sodium salicylate is mixed with acetanilide a pink powder
is said to be produced, but the writer did not get much increase
of color, although the paper containing the mixture became
colored after a time. 11. Acetanilide is said to be readily soluble
in a hot solution of tartaric acid from which it does not crys-
tallize. However, the writer did not find this to be the case.

Acetozone, Benzoyl-acetyl Peroxide. — i. Acetozone is
hydrolized by water and decomposed in contact with solutions of
alkalies or heated with water (N. S. D., 222). 2. Heating,
grinding, compressing or poimding will often bring about a
decomposition (U. S. D., 141 1). 3. Gradually decomposed by
all solvents except neutral petroleum oils (U. S. D., 141 1).
Acetphenetidinum. [See Phenacetinum.]
Acida. — I. Acids combine with metalic oxides and
hydroxides, with some metals, and with some alkaloids to
form salts. 2. Mineral acids and some organic acids, such as
tartaric or acetic, precipitate bismuth citrate from solutions
of bismuth and ammonium citrate by combining with the
ammonium. 3. Mineral and common organic acids precipi-
tate potassium bitartrate from concentrated solutions of Ro-
chelle salt, normal potassium tartrate, or double tartrates
containing potassium. 4. Nitric, hydrochloric, or sulphuric
acid with an aqueous solution of tartar emetic gives a precipi-
tate consisting of a basic nitrate, chloride, or sulphate of anti-
mony. The presence of tartaric acid prevents precipitation,
the amoimt of acid necessary seeming to depend upon the amoimt
of mineral acid used. 5. Mineral acids give a precipitate of



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INCOMPATIBILITIES IN PRESCRIPTIONS, «;

the phosphate or the pyrophosphate of iron when added to a
solution of the official soluble phosphate or pyrophosphate
of iron. 6. Strong mineral acids precipitate, from concen-
trated solutions of borates, salicylates, or benzoates, the
boric, salicylic, or benzoic acid. 7. Strong mineral acids
form esters and ethers with alcohol. Many organic acids in
the presence of mineral acids, as sulphuric or hydrochloric,
form esters with alcohol. 8. Nearly all acids, except hydro-
cyanic and hydrosulphuric, decompose carbonates, liberating
carbon dioxide. 9. Acids diminish or prevent the action of
pancreatin. 10. Many acids precipitate albuminous sub-
stances from aqueous solution. 11. Organic acids, except
acetic, combined with an alkali, generally form compounds
with the heavy metals, that ar^ insoluble in water. 12.
Frequently mineral acids displace organic acids and the
stronger mineral acids the weaker ones.

The following official preparations contain a free acid:
13. the vinegars of opium and squills; 14. hydrogen dioxide
water; 15. citrated caffeine; 16. fluidextracts of conium, ergot,
lobelia, nux vomica, and sanguinaria, squills; 17. fluidextracts in
general are acid to litmus, some sufficiently acid to liberate carbon
dioxide from carbonates; 18. glycerites of tannic acid, boro-
glycerih, and iron quinine and strychnine phosphates; 19. solu-
tions of arsenous acid, ammonium acetate, chlorine compound,
chloride of iron, iron and ammonium acetate, subsulphate of
iron, tersulphate of iron, nitrate of mercury, sodium phosphate
compound, and zinc chloride; 20. all of the oleates; 21. spirit
of nitrous ether, usually; 22. syrups of citric acid, hydriodic
acid, calcium lactophosphate, hypophosphites, hypophosphites
compoimd, ipecac, iron quinine and strychnine phosphates, and
squills; 23. tinctures of chloride of iron and sanguinaria; 24.
ointments of boric acid, tannic acid, and usually mercuric ni-
trate. 25. Besides these there are some substances which be-
come acid on exposure, as acetic ether, spirit of nitrous ether,
amyl nitrite, and oil of bitter almonds.

26. There are quite a number of salts that are acid in re-



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6 INCOMPATIBILITIES IN PRESCRIPTIONS.

action and sufficiently so to give an effervescence with a car-
bonate. Some of the more common are : alum, aluminum
sulphate, bismuth subnitrate, ferric chloride, ferric citrate,
iron and quinine citrate, iron and strychnine citrate, ferrous
sulphate, lead nitrate, quinine bisulphate, zinc acetate, zinc
chloride, and zinc sulphate.

Acidum Aceticum. — i . Acetic acid decomposes nearly
all carbonates, liberating carbon dioxide and forming ace-
tates. 2. It forms chloracetic acid with chlorine, slowly in
diffused light, more quickly in sunlight. 3. Soluble neutral
acetates, or the free acid if it is concentrated and the solution
of iron salt is weak, with solutions of ferric salts, give a deep
red coloration. The color varies from a yellow red to a dark
red, according to the dilution, due to the formation of ferric
acetate, which on heating precipitates as the basic ferric acetate.
The strong mineral acids in excess prevent the formation of
the color. 4. Acetic acid aids the solution of quinine sulphate
in water, increasing the fluorescence. This solution does not
precipitate on standing, but on adding potassium acetate the
fluorescence is destroyed and, if it is a fairly strong solution of
quinine, needle-shaped crystals will be formed in a few minutes.
Experiments made indicate that double decomposition takes
place, forming quinine acetate and potassium sulphate. The
precipitation may be due partly to the quinine acetate being
only sparingly soluble and partly to the quinine salt being less
soluble in a solution of potassium acetate. The precipitate
formed may be dissolved by the further addition of acetic acid
and again thrown down by adding potassium acetate, the
amount of potassium acetate necessary seeming to, depend on
the excess of acetic acid used. It may be that the potassium
acetate combines with the acetic acid (as explained in R. & S. ,
III. part I. 497)» forming potassium diacetate, thus taking up
the free acid. Potassium acetate in sufficient amount will
destroy the fluorescence and give a precipitate with a solution
of quinine bisulphate or quinine sulphate dissolved in water
by the aid of sulphuric acid. It has been suggested that



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INCOMPATIBILITIES IN PRESCRIPTIONS. 7

quinine hydrate is formed, the acetic acid being too weak to
hold the hydrate m solution (M. R., dc. 158). 5. A mixture
of alcohol, sulphuric acid and acetic acid or an acetate gives
ethyl acetate, which has a fruity odor. 6. An aqueous solution
of potassium acetate with spirit of nitrous ether produces an
effervescence. Nitrous acid in strong solution converts acetates
into carbon monoxide and other gases (Scoville, 301). The
effervescence may be due to the potassiiun acetate throwing the
volatile ethyl nitrite out of solution; salts upon which ethyl
nitrite has no action cause a similar effervescence. 7. The
stronger mineral acids transpose acetates, liberating acetic acid.
8. Acetic acid is not sensibly affected by nitric acid or readily
changed by oxidizing agents. 9. Strong acetic acid is a good
solvent for resins, gum-resins, camphor, and volatile oils.
10. Some acetates, as lead, on being exposed to the air lose
acetic acid and absorb carbon dioxide, becoming partly insol-
uble. II. Nearly all normal acetates are readily soluble in
water, except quinine, silver, and mercurous. The acetates,
except silver and mercurous, are generally soluble in alcohol.
[See AcmA.]

Acidum Benzoicum. — i. Benzoic acid combines with
the hydroxides of the alkalies and calcium to form benzoates.
2. It liberates carbon dioxide from carbonates. 3. Soluble
benzoates precipitate nearly neutral solutions of ferric salts



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