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[e-drug] Stability and administration of drugs at very low temperature (2)

E-DRUG: Stability and administration of drugs at very low temperature (2)

Dear colleagues

Medicines should be stored as recommended on the label. There are a number that 
are unstable when stored at a cooler temperature than is recommended. 

Some injectable solutions precipitate at low temperatures, such as fluorouracil 
50mg/mL which is labelled 'Store between 8degC and 25degC' or similar. It 
should not even be stored in a refrigerator. For some injectables, 
reconstitution may be possible, but only if permitted by the prescribing 
information because high temperature may lead to chemical instability. 

Many insulins crystallize below 2degC and cannot be reconstituted into the slow 
release form they were intended to be. Their instructions include 'Protect from 
freezing' or similar. 

While many (most) biological medicines are recommended for storage in a 
refrigerator, some are unstable when frozen, such as heparin, trastuzumab and 
erythropoietin. Read the label! 

But this does not help pharmacists who have limited storage facilities. And 
Seyfu has a point when he notes that IV fluids at low temperature may be 
unhelpful for sick people. In the latter case, the pharmacist should notify the 
physician of the problem.

Susan Walters

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