Stability of Advanced Life Support Drugs in the Field

Mark A. Gill; Alice Z. Kislik; Lana Gore; Angela Chandna


Am J Health Syst Pharm. 2004;61(6) 

In This Article


The data that we collected clearly indicate that the conditions inside the drug compartments of ALS units in Los Angeles County are subject to wide temperature fluctuations, which can become rather extreme during the summer months, especially in some locations. After subjecting atropine, epinephrine, and lidocaine to 45-day storage in ALS vehicles under field conditions, we were not able to show any degradation of the three drugs.

The analysis of calculated MKTs suggests that atropine, epinephrine, and lidocaine can be stored at temperatures of up to 84.1 °F (28.9 °C) for up to 45 days without undergoing degradation. Alternatively, the data suggest that spikes of up to 125 °F (51.7 °C) for a cumulative time of 795 minutes (13.25 hours) do not cause these drugs to degrade.

We were not able to investigate the stability of atropine, epinephrine, and lidocaine under conditions where the exposure to temperatures over 104 °F (40 °C) would exceed 24 hours in duration. We were also unable to investigate the stability of these agents beyond 45 days under field conditions. It is possible that a period of time longer than 45 days under the field conditions is required before degradation occurs in these three agents. Our results need confirmation in hotter environments and possibly over a longer duration of exposure.

We investigated the stability of only three emergency care drugs. There is the possibility that other drugs commonly used in emergency settings could have degraded under this study's conditions. Until the stability of all agents used under the field conditions is known, it is prudent to require that the temperature of the drug storage compartment is maintained in accordance with the drug manufacturer's or USP and FDA's established standards.


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