Practice rePorts storage of medications
Room-temperature storage of medications
labeled for refrigeration
Victor cohen, Samantha P. Jellinek, leftherioS tePerikidiS, elliot BerkoVitS,
and William m. Goldman
Purpose. Data regarding the recom-
in tabular format. The U.S. Pharmacopeia’s The U.S. Pharmacopeia’s Med-
m a r x m e d i c a t i o n - e r r o r- definition of room temperature (20–25 °C [68–77 °F]) was used for this review.
Results. Of the 189 medications listed in
AHFS Drug Information 2006 for storage in a refrigerator, 89 were present in the Methods. During May and June of 2006,
pharmacy department’s refrigerator. Since six manufacturers were unable to provide tions labeled for refrigeration as obtained from the supplier were reviewed for data medications were included in the review. This table may help to avoid unnecessary Telephone surveys of the products’ manu- facturers were conducted when this infor- mation was not available in the prescribing Conclusion. Information regarding the
information. Medications were included in the review if they were labeled to be stored tions labeled for refrigerated storage was at 2–8 °C and purchased by the pharmacy department for uses indicated on the hos- pital formulary. Frozen antibiotics thawed Index terms: Errors, medication; Labeling;
in the refrigerator and extemporaneously Pharmacy, institutional, hospital; Stability; Am J Health-Syst Pharm. 2007; 64:1711-5
of vaccine-related adverse events.2 For example, two days after receiving a pneumococcal polysaccharide vacci- on the midposterior lateral forearm was insufficient regarding room- nation that had not been refrigerated, after receiving varicella vaccine that temperature stability and pharma-a patient developed dizziness, racing was not properly refrigerated.2 cists were not routinely able to predict heart, jerking of the limbs, and “pins nized that pharmacists were often cal properties of the medications, sulting in a persistent and significant asked about the stability of refriger- disability. In another case, a patient ated medications that are acciden- developed a cluster of 20 painful and tally stored at room-temperature. of selected medications labeled for itchy vesicles on an erythematous base However, because product labeling refrigeration. This information was Victor Cohen, Pharm.D., BCPS, is Clinical Pharmacy Manager, is Associate Director, Pharmacy for Clinical and Educational Services, Departments of Emergency Medicine and Pharmaceutical Sciences, MMC, and Clinical Assistant Professor of Pharmacy, Arnold & Marie Maimonides Medical Center (MMC), Brooklyn, NY, and Assistant Schwartz College of Pharmacy and Health Sciences, LIU.
Professor of Pharmacy Practice, Arnold & Marie Schwartz College Address correspondence to Dr. Cohen at the Department of of Pharmacy and Health Sciences, Long Island University (LIU), Pharmaceutical Sciences, Maimonides Medical Center, 4802 Tenth Brooklyn. Samantha P. Jellinek, Pharm.D., BCPS, is Clinical Phar- Avenue, Brooklyn, NY 11219 ([email protected]).
macy Manager, Medication Reconciliation and Safety, and Clinical Coordinator, Pharmacy Practice Residency Program; Leftherios Copyright 2007, American Society of Health-System Pharma- Teperikidis, Pharm.D., is Pharmacy Resident; and Elliot Berkovits, cists, Inc. All right reserved. 1079-2082/07/0802-1711$06.00.
Pharm.D., is Pharmacy Resident, MMC. William Goldman, Pharm.D., Am J Health-Syst Pharm—Vol 64 Aug 15, 2007 Practice rePorts storage of medications
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Am J Health-Syst Pharm—Vol 64 Aug 15, 2007 Practice rePorts storage of medications
then compiled into a table for use as a ducted when information about room- guide to control drug storage within temperature storage was not available methods of stability information is the authors’ institution. Medications were included in methods to evaluate temperature- compiled a similar table describing the review if they were labeled to be related storage recommendations the acceptable duration of storage stored at 2–8 °C and purchased by for medications are required to be of medications labeled for refrig- our pharmacy department for uses reported to the Food and Drug Ad- eration when refrigerated (2–8 °C) indicated on the hospital formulary. ministration as part of current good after 24 hours of storage at room- Frozen antibiotics thawed in the manufacturing practices.
temperature, when stored in a cool refrigerator and extemporaneously place (8–15 °C), and when stored at compounded medications were ex- cluded. Information was compiled trievable from the medications’ pre- In 1987, Sterchele5 described and arranged in tabular format. Of the 189 medications listed in Retrieving this information from AHFS Drug Information 2006 for each manufacturer was complicated thor reported that this information storage in a refrigerator,9 89 were by prolonged response times, lack was not easily retrievable and often present in our pharmacy depart- incomplete and compiled an updated ment’s refrigerator and were includ- table to supplement the previously ed in this review. The information information for legal reasons.
available information on the topic. for 34 of these medications (38%) was
Only 22 of 36 manufacturers replied obtained from the official prescribing Conclusion
with information about 39 products, information. A total of 44 manufac-
turers were contacted and asked to temperature storage of 79 medica- vide data for storage in “a cool place,” provide the relevant information for tions labeled for refrigerated storage as it was unrecognized as a method the remaining 55 medications (62%). was compiled.
for storage. In 1990, Dalton-Bunnow Since 6 manufacturers were unable to and Halvachs6 updated the available provide information for 10 medica- References
data. In 2006, Cobos Campos et al.7 tions, information was compiled and 1. Santell JP, Cousins D. Refrigerated compiled written information from tabulated for 79 medications (Table 1).
article&page=8_1144.htm (accessed 2006 Discussion
2. Centers for Disease Control and Preven- tion. VAERS public data. http://vaers.hhs.
information was limited by the fact tal pharmacy’s formulary; however, United States and published in the rent literature. stability of drug products labeled for re- frigerated storage. Am J Hosp Pharm. 1975; guide when medications labeled for 4. Vogenberg FR, Souney PF. Stability to provide an updated table of the refrigerated storage are inadvertently maximum acceptable duration that exposed to room-temperature. This drug products. Am J Hosp Pharm. 1983; may occur during routine excursions, 5. Sterchele JA. Update on stability guidelines for routinely refrigerated drug products. Am J Hosp Pharm. 1987; 44:2698, 2701.
6. Dalton-Bunnow MF, Halvachs FJ. Update During May and June of 2006, we need for refrigeration is unknown. products labeled for refrigerated storage. reviewed the prescribing information According to the manufacturers Am J Hosp Pharm. 1990; 47:2522-4.
Gomez Gener A et al. [Maximum stability of eration as obtained from the supplier in the table may be returned to the thermolabile drugs outside the refrigerator.] for data addressing room-temperature refrigerator within the time period Farm Hosp. 2006; 30:33-43. In Spanish.
storage. The U.S. Pharmacopeia’s defi- rev., and The national formulary, 20th ed., nition of room-temperature (20–25 expiration date. This table may help °C [68–77 °F]) was used.8 Telephone to avoid unnecessary drug loss and surveys and follow-up inquiries of the expenditures due to improper stor- Am J Health-Syst Pharm—Vol 64 Aug 15, 2007

Source: http://fdohcentralpharmacy.com/resources/downloads/storagerequirements.pdf

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