Can reconstituted Hyaluronidase be stored in a syringe for later use?

Reconstituted Hyaluronidase Should Not Be Stored in a Syringe for Later Use

Reconstituted hyaluronidase should not be stored in a syringe for later use due to significant risks of contamination and potential loss of sterility. According to the FDA label, hyaluronidase should be stored unopened in a refrigerator at 2° to 8°C (36° to 46°F) and should not be frozen 1.

Storage Requirements for Hyaluronidase

The FDA label for hyaluronidase clearly indicates that it is supplied as a nonpreserved formulation in a single-use glass vial 1. Key points regarding proper storage include:

• Unopened vials should be refrigerated at 2° to 8°C (36° to 46°F)
• The product should not be frozen
• The single-use designation indicates it should be used immediately after reconstitution

Risks of Storing Reconstituted Medications in Syringes

Storing reconstituted medications in syringes presents several significant risks:

1. Contamination risk: The British Journal of Anaesthesia guidelines explicitly state that medications should be drawn up just before being used and discarded if beyond use-by dates or with visible contamination 2. The practice of storing medications in syringes for later use increases contamination risk.

2. Syringe sterility concerns: Any contact of syringe tips with fingers or surfaces dramatically increases the rate of contamination 2. Even with careful handling, maintaining sterility over time is challenging.

3. Single-use designation: The guidelines clearly state that "single patient use only for all medications and fluids" is required, and "the practice of combining or multidosing a syringe, a vial of medication or using a drawing-up bag between patients is unacceptable" 2.

Emergency Medication Considerations

While some guidelines address preparation of emergency medications, they emphasize specific precautions:

• Emergency drugs should be labeled with medication name, concentration, date and time of preparation, and preparer's name/initials 2
• Emergency drugs should be drawn up by the person who will be responsible for administering them 2
• Emergency drugs should be changed at every shift to reduce contamination risk and potential drug errors 2

Hyaluronidase vs. Other Injectable Products

It's important to note that while some studies have examined the storage of partially used hyaluronic acid fillers 3, 4, 5, 6, these findings cannot be extrapolated to hyaluronidase for several reasons:

1. Hyaluronidase is an enzyme that may degrade over time after reconstitution
2. Hyaluronidase is specifically labeled as a single-use product 1
3. The FDA label does not provide guidance for storage after reconstitution, suggesting it should be used immediately

Best Practices for Medication Administration

To ensure patient safety when using hyaluronidase:

• Prepare medication using aseptic technique immediately before administration 7
• Verify medication labels, expiration dates, and dosages before administration 7
• Never reuse syringes or needles to prevent transmission of bloodborne pathogens 7
• Discard used syringes appropriately after use 2

Conclusion

Based on the FDA labeling and current guidelines, reconstituted hyaluronidase should not be stored in a syringe for later use. The product is designated as single-use, nonpreserved, and should be prepared immediately before administration to minimize risks of contamination, infection, and reduced efficacy.