Innovative approach to preparing radial artery cocktails in response to manufacturer shortages of nitroglycerin and verapamil

Rupal K. Parbhoo, Karen Wetz, Marva Tschampel, Vincent Pompili, Elena Schenko, Lou Mavko, Danielle Blais

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Transradial access has gained popularity over transfemoral access for cardiac catheterization, because of the decreased risk of bleeding, time to ambulation, and length of stay leading to improved patient satisfaction. One disadvantage of the radial artery approach is vasospasm, which can be prevented with the administration of verapamil and nitroglycerin in a pre- and postradial cocktail. Unfortunately, there have been manufacturer shortages for both of these medications. Methods: The utilization of radial artery cocktails and other nitroglycerin compounding practices were evaluated in response to cost containment and waste reduction initiatives and to medication shortages. Results: A modified process for supplying verapamil and nitroglycerin for the transradial approach via separate syringes enabled physicians to have quick access to the medications and to customize the cocktail based on the patient's needs. This process also decreased costs and minimized wastage. The change in practice decreased waste from 44% for preradial cocktail syringes and 66% for postradial cocktail syringes to 8.7%. Discussion: This process for supplying the medications necessary to perform a radial artery catheterization and intracoronary nitroglycerin has allowed for conservation of commercial product supply.

Original languageEnglish (US)
Pages (from-to)628-633
Number of pages6
JournalHospital Pharmacy
Issue number7
StatePublished - 2014
Externally publishedYes


  • cardiac catheterization
  • drug shortage
  • nitroglycerin
  • radial artery spasm
  • stability
  • transradial
  • verapamil

ASJC Scopus subject areas

  • Pharmacy
  • Pharmacology
  • Pharmacology (medical)


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