Drugs stored in ambulances can degrade faster than those kept refrigerated

NEW YORK (Reuters Health) - Drugs that are often used in emergencies and typically kept in ambulances may deteriorate beyond a safe level in a few weeks or months, according to a new study from Belgium.

That's because - unlike drugs stored in the controlled settings of hospitals - drugs stored in ambulances are exposed to temperature variations, sunlight and motion, said Dr. Mark Merlin, who studied drug deterioration but wasn't involved in the new research.

"It's a very different concept and we're learning that expiration dates are very different (in ambulances)," said Merlin, an emergency physician at Newark Beth Israel Medical Center in New Jersey.

He added that because few studies have looked at the subject, emergency physicians and technicians tend to throw out drugs before their printed expiration date.

"We don't know when to throw them out and as a result we're usually very conservative," he said.

For the new study, Sabrina De Winter and her colleagues at the University Hospitals Leuven compared commonly used injectable drugs stored for one year at room temperature, in the back of an emergency response vehicle and in a refrigerator - as they're supposed to be.

The drugs included muscle relaxers cisatracurium and succinylcholine, the seizure drug lorazepam, methylergonovine to stop women from bleeding after birth, and the heart, allergy and asthma drug epinephrine.

The researchers checked how much the drugs deteriorated weekly during the first month of storage and every other month after that.

As expected, none of the refrigerated drugs degraded to below 90 percent potency - a commonly used benchmark for usability.

Methylergonovine and epinephrine also remained stable for more than one year in the back of an emergency vehicle and at room temperature.

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Drugs stored in ambulances can degrade faster than those kept refrigerated