# Storage of Epinephrine **URL:** \ **Category:** Factual Questions\ **Created:** [August 2, 2013, 1:04pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148 "2013-08-02T13:04:13Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![dauerbach](https://avatars.discourse-cdn.com/v4/letter/d/c2a13f/32.png) [@dauerbach](https://boards.straightdope.com/u/dauerbach)\ **Post date:** [August 2, 2013, 1:04pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/1 "2013-08-02T13:04:13Z")
I see that the instructions for the epipen say not to store it in a refrigerator. I cannot for the life of me think of any way that this could be bad for the drug. It also states that it should not exposed to heat greater than 88 degrees. I know for an undeniable fact that the optimal temperature for epinephrine is 98 degrees. So what is this warning for? I have the distinct impression that the makers of epi-pen are trying to make already nervous parents so paranoid that they keep shelling out hundreds of dollars for pennies worth of drug. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 1:27pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/2 "2013-08-02T13:27:24Z")
> [@dauerbach](#): > > It also states that it should not exposed to heat greater than 88 degrees. I know for an undeniable fact that the optimal temperature for epinephrine is 98 degrees. So what is this warning for? I know for an undeniable fact that human meat is best kept at 98 degrees, but every time I leave it out in my garage on a hot day it goes rancid and attracts maggots. Perhaps epinephrine is only good at 98 degrees between the time it’s produced and the time it’s used or the body has some mechanism for storing it besides just letting it sit there. You say you “know for an undeniable fact”, do you have a cite for this undeniable fact and since I assume your talking about inside the human body, what makes you so sure this would translate to clear glass bottle, diluted in saline, exposed to light, sitting on shelf, in 98 degree room? > [@](#): > > I have the distinct impression that the makers of epi-pen are trying to make already nervous parents so paranoid that they keep shelling out hundreds of dollars for pennies worth of drug. Sigh, you should do some research and see if you can come up with how much it cost to develop the drug. There may very well be millions or even a billion in research behind it, they have to recoop ALL of that money (plus the money in any failed drugs that never made it to market) before it goes generic or there won’t be any point in them making another drug. Everyone wants a cure for cancer, no one wants to pay for it. ---
**Author:** ![dauerbach](https://avatars.discourse-cdn.com/v4/letter/d/c2a13f/32.png) [@dauerbach](https://boards.straightdope.com/u/dauerbach)\ **Post date:** [August 2, 2013, 1:50pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/3 "2013-08-02T13:50:05Z")
Yes, my statement was based on normal body temperature. Your point is well taken, although common sense says I am much more likely right than you are. The meat degrades because of bacterial action. There is no bacteria in the epinephrine, or if there is potency is the least of the problem. The body only stores epinephrine within cells. And just to nitpik, the epi in the vial is not diluted, but ultra concentrated. And while your second point is true concerning many drugs, it is not true for epinephrine. The drug itself is very simple and easily synthesized. The actual drug in the epipen is worth pennies. You are paying solely for the delivery system. And that is just a convenience. A huge premium for convenience. ---
**Author:** ![Smeghead](https://avatars.discourse-cdn.com/v4/letter/s/f1d935/32.png) [@Smeghead](https://boards.straightdope.com/u/Smeghead)\ **Post date:** [August 2, 2013, 2:10pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/4 "2013-08-02T14:10:46Z")
Epinephrine is not stored, long term, in the body. It’s made as needed, and quickly degraded, with a half life of around 2 minutes, according to Wikipedia. The behavior of a hormone in the body is very very different from the desired behavior for long-term shelf storage. If you buy epinephrine, I’m assuming you’d like to have it around for more than, say, a half hour or so. ---
**Author:** ![WarmNPrickly](https://avatars.discourse-cdn.com/v4/letter/w/d78d45/32.png) [@WarmNPrickly](https://boards.straightdope.com/u/WarmNPrickly)\ **Post date:** [August 2, 2013, 2:11pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/5 "2013-08-02T14:11:01Z")
Chemicals decompose faster at higher temperatures. In the body, its produced then used almost immediately. It doesn’t sit there for weeks. If you could keep it in the freezer without freezing it, that would be great for shelf life. So why can’t you keep it cooler in the refrigerator? It’s probably because the packaging is not rated for that storage. When things are cool, they contract and get brittle. This can cause leaks which will cause contamination problems. ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [August 2, 2013, 2:16pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/6 "2013-08-02T14:16:03Z")
Primatene inhalers contained epinephrine, obviously they were intended to be carried on your person so no way could the storage requirements be that picky. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 2:16pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/7 "2013-08-02T14:16:21Z")
> [@WarmNPrickly](#): > > So why can’t you keep it cooler in the refrigerator? It’s probably because the packaging is not rated for that storage. When things are cool, they contract and get brittle. This can cause leaks which will cause contamination problems. There’s also going to be springs and buttons and plungers in there that aren’t going to work as smoothly if they’re covered in condensation from taking them out of the fridge on a warm summer day to take with you when you go to work or school. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 2:17pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/8 "2013-08-02T14:17:36Z")
> [@grude](#): > > Primatene inhalers contained epinephrine, obviously they were intended to be carried on your person so no way could the storage requirements be that picky. Does it make a difference that those were airtight and under pressure? ---
**Author:** ![yellowjacketcoder](https://avatars.discourse-cdn.com/v4/letter/y/4bbf92/32.png) [@yellowjacketcoder](https://boards.straightdope.com/u/yellowjacketcoder)\ **Post date:** [August 2, 2013, 2:20pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/9 "2013-08-02T14:20:53Z")
> [@dauerbach](#): > > Your point is well taken, although common sense says I am much more likely right than you are. Why is it that whenever someone actually invokes common sense, they are often arguing from ignorance with people that know better? Le sigh. The cost of producing epinephrine has very little to do with the sales cost. That’s basic economics, and until you grasp that, arguing about the price is useless. I believe the storage requirements are the way they are because, in the massive amounts of testing that drugs have to go through, that was found to be the most effective. ---
**Author:** ![dauerbach](https://avatars.discourse-cdn.com/v4/letter/d/c2a13f/32.png) [@dauerbach](https://boards.straightdope.com/u/dauerbach)\ **Post date:** [August 2, 2013, 3:09pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/10 "2013-08-02T15:09:01Z")
Why is it that whenever someone actually invokes common sense, they are often arguing from ignorance with people that know better? Le sigh. I don’t understand how you came to that conclusion. I finally hit upon the correct combination of words to google and found lots of information. A good summary article is: [http://www.emsworld.com/article/10324134/medication-storage-in-the-ems-environment-understanding-the-science-and-meeting-the-standards](http://www.emsworld.com/article/10324134/medication-storage-in-the-ems-environment-understanding-the-science-and-meeting-the-standards) Experiments there included essentially cooking the stuff. In general, keeping it above or below the recommended temperature has no effects on potency. So there is no reason to worry about short term environmental effects, although common sense says the recommendations should be followed as closely as is reasonable. ---
**Author:** ![yellowjacketcoder](https://avatars.discourse-cdn.com/v4/letter/y/4bbf92/32.png) [@yellowjacketcoder](https://boards.straightdope.com/u/yellowjacketcoder)\ **Post date:** [August 2, 2013, 3:17pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/11 "2013-08-02T15:17:52Z")
> [@dauerbach](#): > > I don’t understand how you came to that conclusion. Because **Joey P** gave you a concise and clear reason why simply being at 98 degrees Fahrenheit is not good for epinephrine, and you dismissed it with “well, common sense says otherwise”. You’re arrogantly ignoring someone else because you don’t like the explanation, however correct it may be. That is extremely frustrating for a number of posters here. Also, just because creating epinephrine involved high heat (I didn’t read your link so I won’t comment on the accuracy of that statement), doesn’t mean it lasts at that temperature. Cooking a steak requires high heat too, but leaving it on the grill for 5 hours is not going to maintain the steak’s taste. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 3:39pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/12 "2013-08-02T15:39:18Z")
> [@dauerbach](#): > > Why is it that whenever someone actually invokes common sense, they are often arguing from ignorance with people that know better? Le sigh. > > I don’t understand how you came to that conclusion. > > I finally hit upon the correct combination of words to google and found lots of information. A good summary article is: > > [http://www.emsworld.com/article/10324134/medication-storage-in-the-ems-environment-understanding-the-science-and-meeting-the-standards](http://www.emsworld.com/article/10324134/medication-storage-in-the-ems-environment-understanding-the-science-and-meeting-the-standards) > > Experiments there included essentially cooking the stuff. In general, keeping it above or below the recommended temperature has no effects on potency. So there is no reason to worry about short term environmental effects, although common sense says the recommendations should be followed as closely as is reasonable. From YOUR link: > [@](#): > > In 1999, researchers from the Denver, CO, area published a research abstract—but not a complete paper—about epinephrine stored on EMS vehicles there.7 The recorded temperatures ranged from -7.6°–38.6°C (18.3°–101.5°F) in urban settings and from 0.4°–40.2°C (32.7°–104.4°F) in rural settings, with mean kinetic temperatures of 23.6°C (74.5°F) and 20.8°C (69.4°F), respectively. By comparison, medications stored at the EMS office experienced temperatures that met the USP definition of “controlled room temperature.” After six months on the ambulances, chemical degradation was evaluated using high-pressure liquid chromatography (HPLC). Physiologic activity was determined in a laboratory by injecting the epinephrine into heart tissues and observing the response. **When compared with the epinephrine stored in the office, there was significant degradation in both chemical structure and physiologic activity of the epinephrine stored on the EMS vehicles** Bolding mine. IOW, if it wasn’t kept at room temperature, it degraded. It then goes on to test what you were talking about. > [@](#): > > The following year, researchers from North Carolina—who had previously shown that cycles of heating cause different degradation patterns15—exposed both 1:1,000 and 1:10,000 concentrations of epinephrine to cycles of either heat or cold.16 Heated samples were warmed to 70°C (158°F) and then allowed to return to room temperature; cooled samples were placed in a freezer until they reached 5°C (41°F) and then removed and allowed to return to room temperature. The cycles were repeated for 12 weeks. Chemical degradation was determined using HPLC, and the biological activity of degraded samples was assessed by administering the medication to rats. While the potency of 1:1,000 epinephrine did not diminish, the 1:10,000 epinephrine that was exposed to cyclical heating underwent significant degradation, losing 64% of its potency after the 12-week experiment. Epi Pens are 1:1000, so if you bring them up to 158 (hardly ‘cooking’) or cool them to 41 (not freezing) you seem to be okay. From what I can gather, it’s not the controlled heating and cooling that’s a problem. It’s sticking them in a corner somewhere and forgetting about them for months. Also, as I mentioned earlier, I’d be worried about condensation on the plunger, buttons, springs etc if they were in and out of the fridge every day. Furthermore, from your link it says: > [@](#): > > The practices recommended by USP can form the backbone of any EMS medication storage plan, but they’ll have to be tailored to each system. Parking in climate-controlled garages or taking the drug bag into the station house when not on a call is simple enough, but only if the EMS system operates out of station houses and has garages. Developing stock rotation strategies might be tricky in busy systems with dynamic scheduling and vehicle posting—and it’s not yet clear exactly how frequently medications should be rotated. Commercially available time-temperature indicators are reasonably inexpensive and could be applied to either individual medication packages or to the outside of a sealed drug bag or medication cabinet, but someone would have to be responsible for applying and monitoring the indicators > > SNIP > > In most systems, current EMS medication storage practices are not consistent with USP standards. Exposure to excessive heat and excessive cold are both common. **Although the clinical implications of noncompliant storage remain unclear,** it’s in the best interest of patients to do everything possible to meet the standards. IOW, we (the people that wrote the article) don’t know for sure how letting your meds get out of the temp range specified by the manufacturer will affect them, so lets just do our best to keep it in that range and replace the meds from time to time. Basically, just follow the directions on the box. As far as what the box says. The manufacturer did their best to give you the most leeway to handle the meds and give you the best shelf life they could. It takes lots of testing and the numbers aren’t arbitrary. But you read the whole report, right? I know I just did. ---
**Author:** ![dauerbach](https://avatars.discourse-cdn.com/v4/letter/d/c2a13f/32.png) [@dauerbach](https://boards.straightdope.com/u/dauerbach)\ **Post date:** [August 2, 2013, 4:29pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/13 "2013-08-02T16:29:01Z")
I skimmed the whole report, and like you, found the sentences I liked the best. Re: Cooking: [http://www.billnye.com/so-hot-you-could-fry-an-egg/](http://www.billnye.com/so-hot-you-could-fry-an-egg/) The whole thing started for me when someone I know was getting very worried about a trip to the beach and how he couldn’t take the epipens to the shore since they couldn’t be refrigerated and/or would get too hot. I said he was being ridiculous, since common sense told me he was. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 4:42pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/14 "2013-08-02T16:42:00Z")
> [@dauerbach](#): > > I skimmed the whole report, and like you, found the sentences I liked the best. No, I not only read the whole report, I even posted some of the things that YOU should have posted that you commented on. > [@](#): > > Re: Cooking: [http://www.billnye.com/so-hot-you-could-fry-an-egg/](http://www.billnye.com/so-hot-you-could-fry-an-egg/) You don’t actually read the things you post do you. Why don’t you quote the part you think is relevant from that page. > [@](#): > > The whole thing started for me when someone I know was getting very worried about a trip to the beach and how he couldn’t take the epipens to the shore since they couldn’t be refrigerated and/or would get too hot. I said he was being ridiculous, since common sense told me he was. Common sense not required, just read the directions that came with it. “Store at 20° to 25°C (68° to 77°F); excursions permitted to 15°C-30°C (59°F-86°F)” If you want to follow the actual directions, you he could take it to the beach as long as it stayed under 86F. I have some injectable meds as well and knew to look for this because I’ve read the prescribing info on them in the past. I could be wrong, but IIRC an ‘excursion’ is 24 hours. If they’re going to be out longer then that or in a temp hotter then that, maybe keep it in a cooler (with or without an ice pack depending on what it’ll take to keep it in the proper range) or just go without the epi pen for a little while. Unfortunately, having such severe allergies means some lifestyle changes. Though, if it were me, I’d probably just take the pen to the beach with me and hope for the best…or leave it at home and hope for the best. ---
**Author:** ![dauerbach](https://avatars.discourse-cdn.com/v4/letter/d/c2a13f/32.png) [@dauerbach](https://boards.straightdope.com/u/dauerbach)\ **Post date:** [August 2, 2013, 5:38pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/15 "2013-08-02T17:38:38Z")
Sheesh. Here: I found that an egg will cook on a surface that’s only 55 Celsius (130 Fahrenheit). It just takes time – almost 20 minutes. So indeed, it can be hot enough to fry an egg on the sidewalk. Excursion is not a good word. They are going to be at the shore for a week. And is is reading the insert and worrying that if the epinephrine gets to 95 degrees it will be useless, but he won’t know it until he tries to use it and then will die. I said not to worry about it, keep it in the shade and it will be fine. We are only talking a week here. And the research agrees. With me. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 5:44pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/16 "2013-08-02T17:44:28Z")
> [@dauerbach](#): > > I know for an undeniable fact that the optimal temperature for epinephrine is 98 degrees. > [@dauerbach](#): > > In general, keeping it above or below the recommended temperature has no effects on potency. > [@dauerbach](#): > > And the research agrees. > > With me. Then I guess we’re done. ---
**Author:** ![Joey\_P](https://avatars.discourse-cdn.com/v4/letter/j/919ad9/32.png) [@Joey\_P](https://boards.straightdope.com/u/Joey_P)\ **Post date:** [August 2, 2013, 6:04pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/17 "2013-08-02T18:04:00Z")
One last thing, if it was mine and I couldn’t be without it, I would probably just take it with me if it was going to be 95 degrees. I’d imagine it isn’t going to be 95 degrees for the entire week, 24 hours a day, right? I might even call a pharmacist and ask them. The epipen website says not to expose it to ‘extreme temperatures’. It’s not until you read the prescribing info that you get the exact range. I may just keep it in a cooler with an icepack in such a way that it won’t get too cold. However, I wouldn’t use my ‘common sense’ to decide that their claim that you shouldn’t refrigerate it is baseless or that 98 degrees is a better storage point. That’s…odd. ---
**Author:** ![purplehorseshoe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/purplehorseshoe/32/2996_2.png) [@purplehorseshoe](https://boards.straightdope.com/u/purplehorseshoe)\ **Post date:** [August 2, 2013, 6:28pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/18 "2013-08-02T18:28:24Z")
> [@Joey\_P](#): > > … I might even call a pharmacist and ask them. . . My goodness, what a common-sense approach! ---
**Author:** ![Smeghead](https://avatars.discourse-cdn.com/v4/letter/s/f1d935/32.png) [@Smeghead](https://boards.straightdope.com/u/Smeghead)\ **Post date:** [August 2, 2013, 7:18pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/19 "2013-08-02T19:18:56Z")
It’s so rewarding to carry on a productive debate with an open mind. The give-and-take of ideas, back and forth, is so very enlightening. ---
**Author:** ![Medi-Mouth1565p](https://avatars.discourse-cdn.com/v4/letter/m/a183cd/32.png) [@Medi-Mouth1565p](https://boards.straightdope.com/u/Medi-Mouth1565p)\ **Post date:** [August 27, 2016, 3:03pm UTC](https://boards.straightdope.com/t/storage-of-epinephrine/665148/20 "2016-08-27T15:03:39Z")
I am sorry to interrupt but may I point out that 95 degrees isn’t good and refrigeration probably isn’t optimal either, room temp is best. Consistency is what it needs as do all the EMS drugs. That’s why we bring our drugs in when it’s hot, heat the inside of the squad when it’s cold, because not only do the drugs get hot and cold but the truck does too and a cold truck means ice on the windshield which delays response time. A hot truck just isn’t comfortable for us and isn’t conducive to treating a hyperthermic patient. Epinephrine aside for the moment, consider that in that same drug bag is IV fluids that also get very hot or very cold. Any Fire department or ambulance service that doesn’t make accommodations for keeping the temperatures of their drugs and fluids neutral is negligent. Quite honestly this magazine, I don’t know where they got their “facts”. I’m not saying the information is fabricated but it goes against what I know to be true as a 20 year Paramedic. That and you might be hard pressed to find something other than JEMS laying around quarters so I am really not too familiar with this magazine’s reputation. What I see on line looks good but I remain skeptical. Lastly, most ambulances don’t carry EPI-PENS due to the cost. We make a kit of an amp of Epi 1-1,000 and a syringe which drops the cost to about $6 because when you have multiple units that you have to supply with “EPI-PENS” that don’t get used because if there is a call for an allergic reaction or anaphylaxis, a Paramedic is dispatched and will draw from the drug bag before resorting to the EPI-PEN they just aren’t practical.