Inopressor stability in commercial plastic syringes
Extract:
“Hypotensive states commonly require intravenous infusions of inopressors such as epinephrine, norepinephrine, and phenylephrine. Traditionally, these high-alert medications were prepared in plastic bags at “standard” concentrations and administered using high-volume infusion pumps. Several studies have documented the stability of these medications in plastic bags for infusions, supporting compounded pharmacy and industry preparations. The introduction of smart syringe infusion pumps has allowed for accurate lower infusion rates and decreased volume load but with a requirement of higher medication concentrations.
The U.S. Food and Drug Administration recommends against storing compounded medications in syringes after multiple reports of decreasing concentration (up to 70%) of multiple medications stored in Becton Dickinson syringes. Other factors affecting the stability of compounded sympathomimetics include interactions with air, light, elevated temperature, heavy metals, and alkaline pH, which favor oxidative degradation. Previous sympathomimetics stability studies report a variety of experimental conditions, thus limiting comparisons.”
Reference:
Neira VM, AlFaraj A, Wiseman L, John R, Andreou P, Cohen A. Stability of Epinephrine, Norepinephrine, and Phenylephrine for Intravenous Infusions Stored in Three Commercial Plastic Syringe Brands. Anesthesiology. 2024 Mar 8. doi: 10.1097/ALN.0000000000004944. Epub ahead of print. PMID: 38457213.