Hot and Cold Drugs: National Park Service Medication Stability at the Extremes of Temperature

Armenian, Patil; Campagne, Danielle; Stroh, Geoff; Tallman, Crystal Ives; Zeng, William Z. D.; Lin, Thomas S.; Gerona, Roy

doi:10.1080/10903127.2016.1258098

Cited by 19 publications

(18 citation statements)

References 16 publications

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“…In addition, medication required to be stored at “room temperature” may still be affected given the high environmental temperatures during the pilgrimage. Extreme temperatures cause the degradation of medications, which may change their pharmacological characteristics, reduce their potency and efficacy or result in compromised or toxic products, leading to adverse health outcomes [ 1 , 2 , 3 , 4 , 20 ]. Consequently, the appropriate handling and storage of medication among pilgrims during Hajj are of public health importance.…”

Section: Discussionmentioning

confidence: 99%

“…Humidity and light are additional environmental factors that can affect medications. If medications are significantly degraded, this may affect their clinical effectiveness, which may result in changes in dosage, storage conditions, or how often they need to be replaced [ 3 , 4 ]. For most drugs, manufacturers assure a potency of 90–110% for a specified period, but only if stored as recommended [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

et al. 2021

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We aimed to investigate the knowledge and practices of Hajj pilgrims regarding medication storage and handling during the Hajj mass gathering. In this cross-sectional study, adult pilgrims from 30 countries were interviewed using a structured questionnaire during the 2019 Hajj. The study enrolled 1221 participants with a mean age of 50.8 years (SD = 12.5, range = 18–98) and male:female ratio of 1.7:1. Most pilgrims were literate, 50.4% had a university or higher education, and 38% reported at least one underlying health condition. Most pilgrims reported receiving education regarding the proper way to store their medication during Hajj, mainly from physicians (73.7%) and pharmacists (39.4%). Although 68.2% of pilgrims had good knowledge regarding medication storage and the potential effect of inappropriate storage conditions on medications and health, inadequate knowledge and poor practice were identified among some. Level of education, having an underlying health condition and receiving health education on mediation storage were independently associated with good knowledge. Most pilgrims took their medications with them during Hajj, although storage and handling of their medication also varied depending on the stages of their Hajj pilgrimage journey. Improving Hajj pilgrims’ awareness and knowledge about appropriate storage and handling of their medications are beneficial in reducing the risk of associated adverse health outcomes, both during Hajj and beyond the mass gathering.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

et al. 2021

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“…Armenian et al also observed naloxone hydrochloride exhibits temperature-dependent degradation [15]. Naloxone hydrochloride ampoules were subject to several conditions ( sustained temperatures of − 20 °C, + 45 °C, or alternating weekly between the two) for 1 month.…”

Section: Discussionmentioning

confidence: 99%

“…For example, although temperatures as high as 70 °C have been evaluated, internal vehicle temperatures can reach up to 80 °C [12, 13]. Several studies also assessed the effect of temperature fluctuations from extreme cold to heat (− 20 °C to 70 °C; − 6 °C to 54 °C; − 20 °C to 45 °C); however, it is unlikely that these conditions would be experienced within the span of a single day, should a THN kit be left within a vehicle [12, 14, 15]. These studies also did not investigate the association of stability with the duration of exposure.…”

Section: Introductionmentioning

confidence: 99%

The effects of heat and freeze-thaw cycling on naloxone stability

et al. 2019

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Purpose The availability of take home naloxone (THN) was increased for Canadians in 2016, including access to kits via pharmacies. Unlike typical over-the-counter (OTC) and prescription drugs, THN kits may be stored in non-standard conditions, including in vehicles, backpacks, and out of doors. To evaluate whether these non-standard storage conditions affect stability, we investigated the impact of heat and freeze-thaw cycling on naloxone hydrochloride stability. Methods To assess the effect of heat, naloxone hydrochloride ampoules were exposed to 80 °C in a temperature-controlled oven for 8 h followed by 16 h at room temperature. To assess the effect of freeze-thaw cycles, naloxone hydrochloride ampoules were exposed to − 20 °C for 16 h followed by 8 h at 4 °C. The impact of these conditions on naloxone hydrochloride stability was evaluated each day for 1 week and after 2 and 4 weeks. The concentration of remaining naloxone hydrochloride was quantified using high-performance liquid chromatography (HPLC). Naloxone hydrochloride ampoules stored at room temperature served as the experimental control. Results Naloxone hydrochloride ampoules exhibit no changes in drug concentration following exposure to heat or freeze-thaw cycles for up to 28 days compared to ampoules maintained at room temperature (as indicated in the product monograph). Conclusions Naloxone hydrochloride remains chemically stable following exposure to heat or freeze-thaw cycles after 28 days. If THN kits are stored in non-standard conditions (for up to 28 days) the active naloxone is likely to remain stable. Despite this, pharmacists should continue to emphasize the importance of appropriate storage of THN kits to ensure optimal efficacy should naloxone administration be required in an emergency situation. Electronic supplementary material The online version of this article (10.1186/s12954-019-0288-4) contains supplementary material, which is available to authorized users.

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“…Temperatures can range from -20ºC in mountainous regions to 40ºC in deserts. 10,11 The time constraints of TXA administration necessitate that it be readily available within these conditions. Multiple studies have already shown large fluctuations in storage temperatures of prehospital medications.…”

Section: Introductionmentioning

confidence: 99%

Effect of Fluctuating Extreme Temperatures on Tranexamic Acid

Loner

Estephan

Davis

et al. 2019

Prehosp. Disaster med.

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Introduction:Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce morbidity and mortality in hemorrhagic shock. It has potential use in prehospital and wilderness medicine; however, in these environments, TXA is likely to be exposed to fluctuating and extreme temperatures. If TXA degrades under these conditions, this may reduce antifibrinolytic effects.Problem:This study sought to determine if repetitive temperature derangement causes degradation of TXA.Methods:Experimental samples underwent either seven days of freeze/thaw or heating cycles and then were analyzed via mass spectrometry for degradation of TXA. An internal standard was used for comparison between experimental samples and controls. These samples were compared to room temperature controls to determine if fluctuating extreme temperatures cause degradation of TXA.Results:The coefficient of variability of ratios of TXA to internal standard within each group (room temperature, freeze, and heated) was less than five percent. An independent t-test was performed on freeze/thaw versus control samples (t = 2.77; P = .17) and heated versus control samples (t = 2.77; P = .722) demonstrating no difference between the groups.Conclusion:These results suggest that TXA remains stable despite repeated exposure to extreme temperatures and does not significantly degrade. These findings support the stability of TXA and its use in extreme environments.

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Hot and Cold Drugs: National Park Service Medication Stability at the Extremes of Temperature

Cited by 19 publications

References 16 publications

Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

The effects of heat and freeze-thaw cycling on naloxone stability

Effect of Fluctuating Extreme Temperatures on Tranexamic Acid

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