Storage of Epinephrine (Adrenaline) Injections
Store epinephrine injections at controlled room temperature (20°C to 25°C or 68°F to 77°F), protected from light and freezing, and inspect the solution before each use—discard if discolored, cloudy, or contains particles. 1
Temperature Requirements
Controlled room temperature of 20°C to 25°C (68°F to 77°F) is the FDA-mandated storage range, with permitted excursions between 15°C to 30°C. 1
Epinephrine is light-sensitive and must be protected from both light exposure and freezing temperatures. 1
Refrigeration (2°C to 8°C) may actually reduce degradation compared to room temperature storage, though this is not required by FDA labeling. 2
Critical Storage Pitfalls to Avoid
Never store epinephrine at excessively high temperatures (above 30°C), as constant heat exposure causes significant degradation—storage at 70°C for 10 days reduces epinephrine content to only 77.7% of labeled dose. 3
Avoid storing in vehicles or locations with extreme temperature fluctuations, particularly ambulances or cars in hot climates, as temperatures can reach 34°C or higher. 4
Do not use epinephrine that has been stored at excessively high temperatures while still hot, and even after cooling, such devices cannot be relied upon to deliver the labeled dose. 3
Visual Inspection Before Use
Epinephrine should be clear and colorless—any discoloration (yellow, brown, or pink) indicates oxidation and degradation. 5
Discard the solution immediately if it is colored, cloudy, or contains particulate matter. 1
The presence of crystals in the solution also indicates contamination and requires discarding the medication. 5
Inspect all ampules and vials visually before each use, regardless of the expiration date, as degradation can occur without visible discoloration or precipitation. 6
Expiration and Replacement
Check autoinjector expiration dates regularly and renew prescriptions promptly before expiration. 6
For multi-dose vials, discard the vial and contents 30 days after initial use. 1
In situations of medication scarcity, expired epinephrine can be maintained as an emergency reserve if stored properly, though this should not be routine practice. 5
Real-World Temperature Considerations
Research shows that brief temperature excursions in real-world conditions may be less detrimental than previously suggested—freezing and limited heat excursions did not result in significant epinephrine degradation in most studies. 2
Epinephrine stored at average temperatures of 27°C to 34°C in drug storage rooms and ambulances in tropical climates remained stable with 90% to 115% of drug content remaining after 4 weeks. 4
However, constant exposure to extreme heat (70°C) is far more damaging than cyclic temperature fluctuations, with constant heat causing more rapid degradation. 2, 3
Storage in Prefilled Syringes
Epinephrine at 1 mg/mL concentration stored in prefilled syringes remains stable and sterile for at least 90 days when properly stored. 7
No bacterial or fungal growth was detected in prefilled syringes after 90 days of storage. 7
This option may be considered when autoinjectors are not available or affordable, though autoinjectors remain the preferred method of administration. 7