Table 2 Stability of epinephrine in prefilled syringes
From: A systematic review of epinephrine stability and sterility with storage in a syringe
Study | Concentration of epinephrine (mg/mL) | Variable conditions | # of samples in study arm | Time period of storage (24 h days) | Mean percent of initial (or labeleda) dose remaining (%) | Significance test used | Significant degradation of epinephrine concentration? (yes/no) | Notes |
|---|---|---|---|---|---|---|---|---|
Donnelly [22] | 0.1 | Stored in plastic syringe | 4b | 7 | 96.0 ± 1.01 | Clinical significance: < 90% of mean initial dose remaining | No | No other signs of degradation noted; all solutions remained clear and colorless; needles capped |
4b | 14 | 88.5 ± 1.29 | Yes | |||||
4b | 28 | 86.2 ± 1.40 | Yes | |||||
4b | 56 | 79.5 ± 2.06 | Yes | |||||
Stored in glass vial | 4 b | 7 | 94.2 ± 2.60 | No | ||||
4 b | 14 | 87.4 ± 1.36 | Yes | |||||
4 b | 28 | 83.6 ± 1.22 | Yes | |||||
4 b | 56 | 76.7 ± 1.95 | Yes | |||||
0.7 | Stored in plastic syringe | 4b | 7 | 98.5 ± 1.98 | No | |||
4b | 14 | 96.8 ± 1.38 | No | |||||
4b | 28 | 94.0 ± 3.69 | No | |||||
4b | 56 | 94.6 ± 6.47 | No | |||||
Stored in glass vial | 4 b | 7 | 99.2 ± 0.27 | No | ||||
4 b | 14 | 98.3 ± 0.55 | No | |||||
4 b | 28 | 98.3 ± 1.06 | No | |||||
4 b | 56 | 97.8 ± 1.42 | No | |||||
Kerddonfak [24] | 1 | Prepared under laminar flow hood | 20 | 30 | 101.40a | Clinical significance: < 90% or > 110% of labelled dose remaining | No | No other signs of degradation noted in samples; norepinephrine not detected in any sample; brown particles found at needle cap in some syringes; solutions were pink-brown at 4 months |
20 | 60 | 102.68a | No | |||||
20 | 90 | 101.19a | No | |||||
Prepared in open air | 20 | 30 | 101.36a | No | ||||
20 | 60 | 99.31a | No | |||||
20 | 90 | 101.09a | No | |||||
Zenoni [11] | 0.1 | Storage at room temperature (20–24 °C) | 2c | 7 | 90 ± 1.2 | Statistical significance: one-way ANOVA; Clinical significance: < 90% of labelled dose remaining | Statistically yes (compared to refrigerated storage, p < 0.002); clinically no | No other signs of degradation noted: no degradation products detected, no changes in color or clarity visualized |
2c | 14 | 91 ± 0.3 | ||||||
2c | 28 | 91 ± 0.5 | ||||||
2c | 56 | 98 ± 0.5 | ||||||
2c | 168 | 96 ± 0.7 | ||||||
Storage at 2–8 °C | 2 c | 7 | 104 ± 0.1 | No | ||||
2 c | 14 | 105 ± 0.1 | ||||||
2 c | 28 | 102 ± 1.0 | ||||||
2 c | 56 | 110 ± 1.0 | ||||||
2 c | 168 | 104 ± 3.8 |