To maintain the effectiveness of medications, it is very important to know how they must be stored properly, whether at home or in a pharmacy.
For most medicines, it is sufficient to store them at room temperature in a cool, dry, and shaded place.
However, there are also other pharmaceutical products that require more specific storage temperatures, including refrigeration. Each medication has specific storage instructions, and it is very important to adhere to these, no matter where you are.
Proper storage not only extends shelf life but also maintains effectiveness of the active ingredients.
In this post, we will clarify exactly what medications need to be refrigerated.
What medications need to be refrigerated?
Insulin, vaccines, ear and eye drops, various injections, growth hormones, chemotherapy tablets, topical creams and gels, and many more are among the medications that need to be refrigerated. This list is not exhaustive, so it is always essential to check the storage instructions of your medication to be on the safe side.
Insulin
Insulin is prescribed for the treatment of diabetic patients. It is a synthetic hormone very similar to human insulin and is administered by injection. It is extremely sensitive to light and temperature.
Whether it's vials, pens, cartridges, or other containers, all types of insulin must be stored in the refrigerator before use. The most commonly distributed fast-acting and long-acting insulins in Germany are:
Insulin becomes unstable very quickly, so it is particularly important to ensure proper storage. Outside of the refrigerator, but under 25°C, it remains stable for a maximum of 28 to 56 days.
Diabetes and Weight Loss Injections
In addition to insulin, people with diabetes may also be prescribed other injectable medications that lower blood sugar levels.
Most of these are biopharmaceuticals, just like insulin, and must be refrigerated to maintain their effectiveness.
Diabetes and weight loss injections that require refrigeration include (but are not limited to):
- Ozempic (Semaglutide): Used for improving blood sugar control and also prescribed for weight loss.
- Mounjaro (Tirzepatide): A newer medication that affects insulin secretion and also helps with weight loss.
- Wegovy (Semaglutide): Primarily used for weight management in obese or overweight adults.
- Trulicity (Dulaglutide): Helps control blood sugar levels by mimicking the effects of GLP-1, a natural hormone.
- Victoza (Liraglutide): Also used for diabetes management and similar to GLP-1, it enhances insulin secretion.
- Byetta (Exenatide): Enhances insulin release and helps lower blood sugar after meals.
- Saxenda (Liraglutide): Mainly prescribed for weight loss, it is the same drug as in Victoza but at different dosages.
- Adlyxin (Lixisenatide): Helps control blood sugar levels by enhancing glucose-dependent insulin release.
- SymlinPen (Pramlintide): An injectable synthetic hormone that helps control blood sugar during meals.
- Symlin (Pramlintide): Similar to SymlinPen, used to improve blood sugar control.
Each of these medications has specific storage requirements to ensure their stability and efficacy. It is crucial to follow the storage instructions provided by the manufacturer and consult healthcare providers for proper handling and usage.
Migraine Injections
Migraine injections belong to the class of monoclonal antibodies and target the calcitonin gene-related peptide (CGRP). Adults with severe chronic migraines may receive these. These include:
- Aimovig (Erenumab-aooe)
- Emgality (Galcanezumab-gnlm)
- Ajovy (Fremanezumab)
All three of these injections must be stored in the refrigerator at temperatures between 2°C and 8°C. After opening, they can be stored at room temperature for up to a maximum of 7 days.
Injections and Inhalers for Asthma
Some asthma medications also need to be kept refrigerated, particularly subcutaneous injections such as:
- Dupixent (Dupilumab): Must be stored at 2°C to 8°C in the refrigerator. Once removed, it must be used within 14 days.
- Xolair (Omalizumab): A subcutaneous injection for the treatment of moderate to severe asthma, nasal polyps, and chronic spontaneous urticaria (CSU). It needs to be refrigerated and can only stay at room temperature for a maximum of 48 hours.
- Fasenra (Benralizumab): Mainly prescribed for eosinophilic asthma and can be stored refrigerated or up to 14 days at room temperature.
- Nucala (Mepolizumab): Is stable at room temperature (up to 30°C) for only 7 days and must otherwise be refrigerated.
As with all medications, protection from high temperatures and storage in a dry and cool place is always recommended. However, most asthma inhalers and aerosol sprays, such as Albuterol or Ventolin, do not require refrigeration. Nevertheless, it is always important to read the package insert for precise information, as some more sensitive products may need to be refrigerated.
Growth Hormones
Growth hormones are biopharmaceuticals, making them very sensitive and unstable. They need to be refrigerated immediately after reconstitution, and the cold chain must not be broken until they are used. Even a brief exposure to high temperatures can render them ineffective. The most common growth hormones available in Germany include:
- Humatrope (Somatropin)
- Genotropin
- Norditropin
- Nutropin
- Serostim
- Saizen
- Zorptive
- Tev-Tropin
- Omnitrope
- Nuspin
- and others
Growth hormones are available in various forms, including lyophilized powder in vials, dual-chamber cartridges for reconstitution, pre-filled cartridges, and pre-filled pens. After reconstitution, they must be stored in the refrigerator and can only be kept out of the refrigerator for very short periods. As always, it is advisable to read the specific package insert for each medication.
Antibiotics
Most antibiotics need to be refrigerated to prevent changes in their chemical structure. Although most liquid or reconstituted antibiotics have a short shelf life, refrigeration isn't always necessary. This is usually clearly marked on the bottle or packaging. Here are some storage recommendations for common antibiotics:
- Amoxicillin: Does not need to be refrigerated, even in liquid form. However, it tastes better when chilled!
- Penicillin Oral Solution: Must be stored in the refrigerator.
- Erythromycin Suspensions: Depending on the brand, some may need to be refrigerated.
- Biaxin, Cleocin, and Bactrim: These liquid antibiotics are stable at room temperature.
- Augmentin: Must be stored in the refrigerator.
- Azithromycin: Should not be refrigerated.
Antibiotics in tablet form generally do not require special refrigeration. Most liquid or reconstituted antibiotics must be used within a few days or otherwise discarded, regardless of whether they are refrigerated. Again, it is crucial to always read the instructions carefully to avoid any mistakes in storing and using the medication.
Tablets
Most tablets and capsules can be stored without issue at room temperature in cool, dry places. However, there are some less stable variants that require refrigeration, such as chemotherapy and antiretroviral medications.
- Leukeran (Chlorambucil): Tablets used for chemotherapy of cancer need to be stored refrigerated at 2°C to 8°C and are only stable at room temperature (up to 30°C) for up to one week. The liquid form of Leukeran should never leave the refrigerator, even for a few hours.
- Etoposide (Vepesid): Capsules used for treating certain types of cancer must be kept refrigerated.
- Emcyt (Estramustine): Liquid capsules for treating certain types of prostate cancer.
- Melphalan (Alkeran): Tablets, another chemotherapy drug for treating cancers such as myeloma and ovarian cancer, also need to be refrigerated.
- Liotrix (Thyrolar): Tablets for treating hypothyroidism and thyroid disorders need to be kept cool.
- Norvir (Ritonavir): Capsules, an antiretroviral medication for treating HIV, must be stored in the refrigerator until dispensing. However, they can be stored at room temperature (25°C) for up to 30 days.
- Kaletra (Lopinavir/Ritonavir): Tablets, another antiretroviral medication for treating HIV-1 in adults, must be refrigerated but are stable up to two months at room temperature.
- Marinol (Dronabinol): Capsules made from cannabis Delta-9-Tetrahydrocannabinol, used to treat nausea and vomiting in chemotherapy patients, must be kept refrigerated or stored at a maximum of 15°C.
- Pancrelipase: Enzymes that aid the digestive process in patients with conditions such as pancreatitis.
- Other medications (this list is not exhaustive).
As always, it is crucial to follow the specific storage instructions for each medication to ensure their effectiveness and safety.
Medicated Creams and Gels
Some pharmaceutical creams, gels, or ointments need to be refrigerated to maintain their stability and effectiveness. These include:
- Dinoprostone Cervical Gel: Used to induce labor in pregnant women near their due date.
- Sinecatechins Ointment: A medication for treating genital and anal warts, which also requires refrigeration.
- Egranex (Becaplermin) Gel: A scar healing agent used in wound care for diabetic neuropathy ulcers.
- DUAC Topical Gel (Benzoyl Peroxide/Clindamycin): A topical medication for treating acne that must be kept cool.
- CombiPatch (Estradiol and Norethindrone): Used for transdermal hormone therapy in postmenopausal women.
Following specific storage instructions is essential to ensure the potency and effectiveness of these treatments. Always check the packaging or consult with a pharmacist to confirm proper storage requirements.
More Medications That Must Be Refrigerated
In addition to the commonly refrigerated medications, the following also require cooling:
- Caverject (Alprostadil): Injections for the treatment of erectile dysfunction.
- Alprostadil: Urethral suppositories.
- Amphotericin B: An antifungal injection.
- Fortical (Calcitonin-Salmon, rDNA origin): Nasal spray and injections for treating osteoporosis in women.
- Aranesp (Darbepoetin alfa): Used for the treatment of anemia and conditions with low red blood cell counts.
- Epogen and Procrit (Epoetin alfa): Also used for treating anemia.
- DDAVP Rhinal Tube: Delivers desmopressin acetate.
- Dornase Alfa (Pulmozyme): Inhaler medication.
- NuvaRing (Etonogestrel/Ethinylestradiol): A contraceptive ring.
- Neupogen G-CSF (Filgrastim): Used in oncology to stimulate blood cell production and function.
- Neurontin (Gabapentin): Oral suspension for the treatment of postherpetic neuralgia and focal seizures in epilepsy patients.
- Copaxone and Brabio (Glatiramer Acetate): Injections for treating relapsing multiple sclerosis.
- Avonex and Rebif (Interferon beta-1a): Injections for multiple sclerosis treatment.
- Actimmune (Interferon gamma-1b): Used for treating chronic granulomatous disease (CGD).
- Lorazepam Intensol: Oral solution, a benzodiazepine for treating anxiety.
- Octreotide (Sandostatin)
- Pegasys (Peginterferon alfa-2a): For treating hepatitis B and C.
- Stelara (Ustekinumab): A biologic for treating Crohn's disease, ulcerative colitis, and psoriatic arthritis.
- Xgeva (Denosumab): Tablets.
- Forteo (Teriparatide): Injections for osteoporosis treatment.
- Saxenda (Liraglutide): Pre-filled pens for weight reduction.
- Repatha (Evolocumab) and Praluent: Injectable medications for managing high cholesterol levels.
This list of temperature-sensitive medications is not exhaustive. Always check the storage instructions for each medication before use, storage, or transport to ensure proper handling.