What is the correct storage for Orofer (ferric carboxymaltose) and what should be done after it was kept in a refrigerator for three days?

Storage Requirements for Orofer (Ferric Carboxymaltose) and Management After Refrigeration

The medication should be discarded after being refrigerated for 3 days, as ferric carboxymaltose must never be frozen or stored below its specified temperature range of 8-25°C, and refrigeration at 2-8°C falls below the minimum storage temperature, potentially compromising drug stability and safety.

Correct Storage Parameters

Orofer (ferric carboxymaltose) must be stored at 8-25°C (46-77°F) and should never be refrigerated or frozen. 1, 2, 3 This temperature range is critical for maintaining the molecular structure and therapeutic efficacy of the iron formulation.

• The label explicitly states "do not refrigerate" because temperatures below 8°C can alter the drug's stability and potentially cause precipitation or molecular changes 1, 2
• Storage should occur in a cool, dry place protected from direct sunlight, heat sources, and excessive agitation 4, 1
• The medication should be kept at ambient room temperature (15-30°C is acceptable, though 8-25°C is the labeled range) away from temperature extremes 1, 3

Why the Pharmacy Error Occurred

The pharmacy incorrectly provided an ice pack, likely confusing ferric carboxymaltose storage requirements with other injectable medications that require refrigeration at 2-8°C (such as certain biologics or insulin) 2, 3. This represents a significant dispensing error.

What Happens When Stored Below 8°C

• Temperatures below the minimum threshold of 8°C can cause loss of potency, clumping, frosting, or precipitation in iron formulations 1, 3
• Exposure to refrigeration temperatures (2-8°C) for 3 days represents a significant temperature excursion outside the acceptable range 1, 2
• Visual inspection may not reliably detect all forms of degradation, as molecular changes can occur without obvious physical signs 1, 3

Recommended Action

Discard the medication and obtain a replacement vial stored correctly at 8-25°C. 1, 2

• Do not administer the refrigerated medication, even if it appears visually normal, because temperature-induced degradation may not be visible 1, 3
• Contact the pharmacy immediately to report the storage error and request proper replacement at no cost to the patient, as this was a pharmacy dispensing error 2
• Document the incident, including the lot number and dates of refrigeration, for quality assurance purposes 4

Visual Inspection Criteria (For Future Reference)

Before any administration of ferric carboxymaltose, always inspect for: 1, 2, 3

• Clumping or aggregation of particles
• Frosting or crystallization
• Precipitation or sediment
• Changes in clarity or color from the expected appearance
• Any of these findings mandate immediate disposal

Preventing Future Errors

• Verify storage requirements directly from the product label before accepting medication from the pharmacy 4, 2
• Educate the patient that ferric carboxymaltose should be stored at room temperature (8-25°C), not refrigerated 1, 3
• If transporting the medication, use insulated bags only in extreme heat (>25°C) to prevent overheating, never to keep it cold 1, 2
• Confirm with the pharmacy that they understand the "do not refrigerate" requirement for future dispensing 4, 2

Common Pitfall to Avoid

Never attempt to "salvage" improperly stored ferric carboxymaltose by warming it to room temperature. 1, 2 Once exposed to temperatures outside the 8-25°C range for an extended period (3 days in this case), the medication's integrity cannot be guaranteed and it must be replaced, not rewarmed and used.