What medications should remain in their manufacturer's stock bottle?

Medications That Should Remain in Manufacturer Stock Bottles

Certain medications must remain in their original manufacturer stock bottles for safety, stability, and regulatory compliance reasons. These include antidotes, certain antibiotics, and medications with special storage requirements 1, 2.

Medications That Must Remain in Manufacturer Stock Bottles

Antidotes and Emergency Medications

• Fomepizole: Should remain in original container to avoid compounding in pharmacy, reduce medication errors, and maintain safety profile 1
• Cyanide antidote kit: Components (amyl nitrite, sodium nitrite, sodium thiosulfate) must remain in manufacturer packaging to ensure integrity 1
• Hydroxocobalamin: Must remain in original container due to potential for red color interference with laboratory tests 1
• Lipid emulsion (IV): Should remain in manufacturer packaging to maintain sterility and stability 1

Antibiotics

• Amoxicillin for oral suspension: Must be kept in original bottle with specific storage instructions; unreconstituted powder should be stored at 20°C to 25°C (68°F to 77°F) in a tight, light-resistant container 2
• Reconstituted antibiotic suspensions: Should remain in original bottles with manufacturer labeling that includes concentration information and expiration dates 2

Medications with Special Formulations

• Propofol: Particularly problematic as it can support bacterial and fungal growth; must remain in original container to maintain sterility 1
• Insulin preparations: Should remain in manufacturer vials to prevent contamination and maintain potency; extreme temperatures and excess agitation should be avoided 1

Rationale for Keeping Medications in Original Containers

Safety Considerations

1. Contamination prevention: Original containers minimize risk of bacterial contamination 1
2. Medication errors reduction: Manufacturer labeling provides clear identification of drug name, strength, and expiration date 1
3. Special storage requirements: Some medications require specific storage conditions that are indicated on original packaging 1, 2

Regulatory and Stability Factors

1. Expiration dating: Manufacturer bottles contain validated expiration dates that are only applicable when stored in original containers 2
2. Light protection: Some medications require protection from light, provided by manufacturer bottles 2
3. Moisture protection: Original containers often contain desiccants or special seals to protect against humidity 2

Best Practices for Medication Storage

General Guidelines

• Medications should be stored according to product-specific recommendations 1
• Medications should be drawn up just before being used 1
• Discard medications beyond use-by dates or with visible contamination 1
• Single patient use only for all medications and fluids 1

Special Considerations

• Insulin vials: Not in use should be refrigerated; in use may be kept at room temperature to limit local irritation at injection site 1
• Antifungal powders: Should be stored in sealed containers at -20°C or below with a desiccant unless otherwise recommended by manufacturers 1
• Reconstituted antibiotics: It is preferable to refrigerate amoxicillin suspensions (though not required); shake well before each use and keep bottle tightly closed 2

Common Pitfalls to Avoid

• Transferring medications between containers: Increases risk of contamination, medication errors, and loss of important information about storage and expiration 1
• Combining medications: The practice of combining or multidosing a syringe, a vial of medication, or using a drawing-up bag between patients is unacceptable 1
• Ignoring manufacturer storage instructions: Can lead to decreased potency or increased toxicity 1, 2
• Failing to check expiration dates: Medications may lose potency after the bottle has been opened, even before the printed expiration date 1

By maintaining medications in their original manufacturer stock bottles, healthcare facilities can ensure drug stability, prevent contamination, reduce medication errors, and comply with regulatory requirements.