Identify the photosensitive drugs included in the hospital pharmacotherapeutic guide and search for stability data on the storage, reconstitution, and dilution of these compounds.
MethodsThe data were obtained by referencing technical specifications, information provided by drug laboratories, and in some cases, we performed a more extensive bibliographic search (tertiary sources and conference lectures) for each particular medication. We also performed a data search on the PubMed information database (from 2004 to 2009).
The drugs were placed in alphabetical order by brand since the stability of each drug when exposed to light does not depend exclusively on the primary active ingredient. Eight columns describe the principal characteristics of the drugs: brand name, active ingredient, laboratory, storage, reconstitution and dilution conditions, observations, and references.
ResultsThe listing comprised of 139 of the 1954 photosensitive medicines included in the pharmacotherapeutical guide (Table 1).
ConclusionsThe lack of studies published on the stability of photosensitive medications provided the need for an internal review at our hospital.
It is important for drug-producing laboratories to perform photosensitivity tests on their products, with the results presented in the technical specifications in order to provide more accessible and reliable information. We believe that this should be required by law.
Identificar los medicamentos fotosensibles incluidos en la guía farmacoterapéutica del hospital y realizar una búsqueda de datos de estabilidad durante el almacenamiento, reconstitución y dilución de los mismos.
MétodoLa búsqueda de datos fue a través de las fichas técnicas, información aportada por los laboratorios fabricantes y en algunos casos se recurrió a una búsqueda bibliográfica más extensa (fuentes terciarias y comunicaciones a congresos) que se especifica junto a cada medicamento. También se realizó una búsqueda en la base informática Pubmed (del 2004 al 2009).
Los medicamentos han sido ordenados alfabéticamente por marca comercial ya que la estabilidad frente a la luz no depende exclusivamente del principio activo. Ocho columnas describen las características principales: nombre comercial, principio activo, laboratorio, condiciones de almacenamiento, reconstituido y diluido, observaciones y bibliografía.
ResultadosEl listado recoge 139 especialidades farmacéuticas fotosensibles, de las 1954 especialidades incluidas en la GFT (tabla 1).
ConclusionesLa carencia de estudios publicados sobre estabilidad de medicamentos fotosensibles, planteó la necesidad de realizar una revisión interna en nuestro hospital.
Es importante que los laboratorios realicen estudios de fotosensibilidad de sus productos y los resultados consten en la fichas técnicas, para así disponer de información más accesible y fiable y para ello resaltamos la necesidad de que la ley lo exija.
It is essential that drugs are stored adequately so that they maintain their physical, chemical and pharmacological properties, especially if they need to be kept under special conditions. The main objective is to ensure that medication efficacy is maintained and safety improved, since if conditions are not adequate, the medication's potency could be reduced (e.g. cefotaxime, nitroprusside), as well as changes in safety due to the degradation product toxicity (e.g. tetracyclines).1,2 Photosensitive medications are a group of drugs that need to be protected from light. There are very few studies on this matter but they report that information regarding the drugs’ light sensitivity often appears on the product's leaflet or summary of characteristics, although it does not appear on the box. All photosensitive medications should be packaged appropriately (protected from light) in the pharmacy department or in any other hospital unit so that they are not affected by light. In many cases, the pharmaceutical industry packages them in amber glass vials to protect them from the light. If not, they must always be kept inside the original packaging or wrapped in aluminium foil or any type of opaque paper.3 These medications must not come into contact with light from the moment they are manufactured until they are used.
We should therefore take the following points into account4:
They must only be taken out of the protective packaging when they are administered.
They should be reconstituted and administered immediately before they are used.
When they have been exposed to light for some time, their stability should be checked before use.
When they present any type of alteration concerning external appearance (colour change, cloudiness, precipitate formation in liquid forms) they should not be used until stability has been assessed. If necessary, they should be disposed of even if the expiry date has not been reached.
It is important to understand the stability of these type of drugs in order to dispose them, because poor storage would incur significant financial losses.
Given that there is very little data on photosensitive drugs, the aim of this study is to find out which medications need to be protected from light during storage and/or administration, and for how long they remain stable when exposed to light.
Materials and MethodsBy reviewing each medication's summary of characteristics, we identified the photosensitive medications listed in the hospital's pharmacotherapeutic guide (PTG). We then performed a search on their stability characteristics for each of the pharmaceutical products, given that the photosensitive stability may not exclusively depend on the active ingredient (it may affect the pharmaceutical form, excipients, etc.)
We designed a table placing the drugs in alphabetical order by brand, consisting of eight columns which describe their main characteristics:
Brand name;
Active ingredient;
Laboratory;
Storage: the storage conditions of the drug before being used, i.e. since it is received until it is prepared for administration;
Reconstitution: the stability conditions that should be maintained while the drug is being reconstituted;
Dilution/administration: the stability conditions that should be maintained while the drug is diluted (and administered);
Observations: aspects that should especially be taken into consideration for this drug (change in colour, cloudiness, etc.);
References.
For cases where data were not available, we (Pharmacy Department) decided whether the drug should be protected from the light or not, based on the drug-use characteristics in the hospital (administration times, route, etc.). These cases have been identified using two asterisks (**).
“Not applicable” is used for drugs that do not require dilution and/or reconstitution.
The first source of information was the drug's summary of characteristics. When it lacked information, we contacted the laboratory by telephone, e-mail or fax. The information provided was limited since light-sensitivity testing is not mandatory in the Spanish law on guarantees and rational use of drugs and health products, 2006. We performed a bibliographical search using tertiary resources and conference lectures. We also performed a search on the PubMed database (2004–2009). To complete the study, we examined whether the drug's original packaging adequately protected them from the light.
ResultsIn this review, we listed 139 of the 1954 photosensitive drugs (Table 1) included in the PTG.
Review of Photosensitive Drugs.
Brand Name | Active Ingredient | Laboratory | Storage | Reconstitution | Dilution | Observ. | Ref. |
ÁC. ASCÓRBICO® (amp) | Vitamin C | Bayer | PFL (it loses 50–60% of its activity in 24h) | Not applicable | No need to PFLa (administer immediately) | Slight colouration does not imply activity alteration | 5, 6 |
ACICLOVIR COMBINO PHARM® (caps/tab) | Acyclovir | Combino Pharm, S.L. | PFL (should be stored in light-resistant packages, 15–25%) | Not applicable | Not applicable | – | 7, 8 |
ACTOCORTINA® (vial) | Hydrocortisone sodium phosphate | Nycomed Pharma | PFL | No need to PFLa (administer immediately) | No need to PFL | – | 8 |
ACTRAPID® (vial) | Insulin | Novo Nordisk A/S | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
ADRENALINA® (img/ml amp) | Epinephrine | Braun | PFL (cover amp despite it being opaque) | Not applicable | No need to PFL | Dispose of if yellowish in colour (it darkens with oxidation) | 8 |
ADRIAMICINA® (vial) | Doxorubicin or adriamycin | TEDEC MEIJI FARMA | PFL | No need to PFLa (stable 24h) | No need to PFLa | Not applicable | 7 |
AGASTRAT® (sol/perf) | Tirofiban | Merck Sharp & Dohme de España, S.A. | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
AKINETON® (amp) | Biperiden lactate | DESMA LABORATORIO FARMACÉUTICO, S.L. | PFL | Not applicable | Not applicable | – | 9 |
AMERIDE® (tab) | Amiloride hydrochlorothiazide | Bristol-Myers Squibb | PFL | Not applicable | Not applicable | – | 7 |
ANAFRANIL® (amp) | Clomipramine | Novartis Farmacéutica | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
ARANESP® (syr) | Darbepoetin alpha | Amgen Europe B.V. | PFL (stable for 72h under artificial light – not stable under sunlight) | Not applicable | Not applicable | Do not use if cloudy or has particles | 7, 9 |
AVASTÍN® (vial) | Bevacizumab | Roche Farma S.A | PFL | Not applicable | No need to PFL | – | 7 |
BCNU® (amp) | Carmustine | Bristol-Myers Squibb S.A. | PFL | PFL (stable 7 days) | No need to PFLa | – | 12, 13, 14, 15 |
BESILATO DE ATRACURIO® (amp) | Atracurium besylate | Inibsa | PFL | Not applicable | Stable in daylight at concentration of 0.5mg/ml (no more than 30°C) | – | 8 |
Stability data: | |||||||
–4h in sodium lactate compound IV perfusion | |||||||
–8h in Ringer's injection; 5% (w/v) IV glucose perfusion; 0.18% (w/v) IV sodium chloride solution and 4% (w/v) IV glucose perfusion | |||||||
Up to 24h in sodium chloride IV perfusion | |||||||
BLEOMICINA® (vial) | Bleomycin | Almirall Merck | PFLa | PFLa | PFLa | – | 7 |
BUSCAPINA® (tab) | Butylscopolamine | Boehring Ingelheim | PFL | Not applicable | Not applicable | – | 8 |
BUSCAPINA® (amp) | Butylscopolamine bromide | Boehring Ingelheim | PFL | Not applicable | Not applicable | – | 8 |
CAELYX ® (20mg/(vial)) | Liposomal doxorubicin | Schering | PFLa | Not applicable | No need to PFLa | – | 7 |
Plough | |||||||
CEFOTAXIMA® (vial) | Cefotaxime | GES | PFL | No need to PFLa (administer immediately) | No need to PFLa (administer immediately) | Decolouration reduces drug's potency | 7, 8, 10 |
CEFUROXIMA® (vial) | Cefuroxime | Normon | PFL | No need to PFLa (administer immediately) | No need to PFLa (administer immediately) | Increased colour intensity does not affect potency | 8 |
CEFTAZIDIMA® (vial) | Ceftazidime | Normon | PFL | No need to PFL | No need to PFLa (administer immediately) | Colour becomes more intense with exposure to sunlight, but it can be used | 8 |
CEMIDON® (amp) | Isoniazid | Chiesi-España | PFL | Not applicable | PFL | – | 7 |
CIS-PLATINO® (vial) | Cisplatin | Ferrer Farma | PFL | Not applicable | PFL | – | 12 |
COSMEGEN® | Dactinomycin | WAAS-ANITA S.A. | PFL | No need to PFLa | No need to PFLa | – | 7 |
DACARBAZINA® (amp) | Dacarbazine | Medac | PFL | PFL | PFL | – | 1, 7, 13, 14 |
DAUNOBLASTINA® (vial) | Daunorubicin | Pfizer | PFL | PFL | No need to PFLa | – | 12, 14, 15 |
DAUNOXOME® (vial) | Liposomal doxorubicin | Gilead Sciences S.L | PFL | Not applicable | PFL | – | 5, 14 |
DIABINESE® (tab) | Chlorpropamide | Famasierra Laboratories | PFL | Not applicable | Not applicable | – | 11 |
DIGOXINA® (amp) | Digoxin | Teofarma | PFL | Not applicable | No need to PFLa (administer immediately) | – | 5 |
DISTRANEURINE® (caps) | Clomethiazole | Astra-Zeneca | PFL | Not applicable | Not applicable | – | 9 |
DOBUTAMINA HOSPIRA ® (vial) | Dobutamine | Hospira | PFL | Not applicable | Not applicable | – | 7 |
DOBUTAMINA INIBSA ® (vial) | Dobutamine | Inibsa | PFL | Not applicable | No need to PFLa (administer immediately) | – Pink colouration does not imply activity alteration | 7, 8, 9 |
– Use within 24h | |||||||
DOLANTINA® (amp) | Meperidine | Kernpharma | PFL | Not applicable | No need to PFL (stable for 12 weeks) | – | 5 |
DOPAMINA® (amp) | Dopamine | GRIFOLS | PFL | Not applicable | No need to PFL | – Dispose if colouration | 8 |
– Stable 36h under light | |||||||
– Stable for a min. 24h following dilution | |||||||
ELOXATIN® (vial) | Oxaliplatin | Sanofi-Aventis | PFL | Not applicable | No need to PFL | – | 7 |
ENISON® (vial) | Vindesine | STADA | PFL | PFL | No need to PFLa | – | 7 |
ESMERON® (vial) | Rocuronium bromide | Organon | PFL | Not applicable | PFL | – | 8 |
ESTRACYT® (vial) | Streptomycin | Pfizer | PFL | PFLa | No need to PFLa | – | 7 |
EUFILINA® (amp) | Aminophylline | Nycomed Pharma | PFL | Not applicable | No need to PFL | – | 7, 8 |
FARMORUBICINA® (amp) | Epirubicin | Pfizer | PFL | Not applicable | No need to PFL | – | 12, 14, 15 |
FENITOÍNA® (caps/susp) | Phenytoin | Combino-Pharm | PFL | Not applicable | Not applicable | – | 7, 8 |
FENTANEST® (amp) | Fentanyl | Kernpharma | PFL | Not applicable | No need to PFL | – | 5 |
FLUOROURACILO® (vial) | 5-Fluorouracil | Ferrer Farma | PFL | Not applicable | PFL | – | 12,13, 14, 15 |
FOLINATO CÁLCICO GES® (amp) | Calcium folinate | GES | PFL | No need to PFLa (administer immediately) | No need to PFLa (administer immediately) | – | 7 |
FUNGIZONA® (vial) | Amphotericin B | Bristol Myers Squibb | PFL | No need to PFLa (administer immediately) | No need to PFL | – | 7 |
FUROSEMIDA INIBSA® (amp) | Furosemide | Inibsa | PFL | Not applicable | PFL | Yellowish colour indicates instability | 5, 8 |
GENOXAL® (amp) | Cyclophosphamide | Baxter Oncology | PFL | PFLa | No need to PFLa | – | 7 |
HALOPERIDOL ESTEVE ® (amp) | Haloperidol | Esteve | PFL (stable for 8h under light) | Not applicable | PFL | – | 8 |
HALOPERIDOL PRODES® (tab) | Haloperidol | Prodes | PFL | Not applicable | Not applicable | – | 7 |
HYDRAPRES® (tab/amp) | Hydralazine | Rubio | PFL | No need to PFLa (administer immediately) | PFL | – | 5, 7 |
HYCAMTIN® (vial) | Topotecan | GlaxoSmithKline S.A. | PFL | PFLa | No need to PFL | – | 7 |
IMIGRAN® (amp/tab) | Sumatriptan | GlaxoSmithKline S.A. | PFL | Not applicable | Not applicable | – | 7 |
IMUREL® (tab) | Azathioprine | Ucb Pharma S.A. | PFL | Not applicable | Not applicable | – | 7 |
ESTRACYT® (vial) | Streptomycin | Pfizer | PFL | PFLa | No need to PFLa | – | 7 |
EUFILINA® (amp) | Aminophylline | Nycomed Pharma | PFL | Not applicable | No need to PFL | – | 7, 8 |
FARMORUBICINA® (amp) | Epirubicin | Pfizer | PFL | Not applicable | No need to PFL | – | 12, 14, 15 |
FENITOÍNA® (caps/susp) | Phenytoin | Combino-Pharm | PFL | Not applicable | Not applicable | – | 7, 8 |
FENTANEST® (amp) | Fentanyl | Kernpharma | PFL | Not applicable | No need to PFL | – | 5 |
FLUOROURACILO® (vial) | 5-Fluorouracil | Ferrer Farma | PFL | Not applicable | PFL | – | 12,13, 14, 15 |
FOLINATO CÁLCICO GES® (amp) | Calcium folinate | GES | PFL | No need to PFLa (administer immediately) | No need to PFLa (administer immediately) | – | 7 |
FUNGIZONA® (vial) | Amphotericin B | Bristol Myers Squibb | PFL | No need to PFLa (administer immediately) | No need to PFL | – | 7 |
FUROSEMIDA INIBSA® (amp) | Furosemide | Inibsa | PFL | Not applicable | PFL | Yellowish colour indicates instability | 5, 8 |
GENOXAL® (amp) | Cyclophosphamide | Baxter Oncology | PFL | PFLa | No need to PFLa | – | 7 |
HALOPERIDOL ESTEVE ® (amp) | Haloperidol | Esteve | PFL (stable for 8h under light) | Not applicable | PFL | – | 8 |
HALOPERIDOL PRODES® (tab) | Haloperidol | Prodes | PFL | Not applicable | Not applicable | – | 7 |
HYDRAPRES® (tab/amp) | Hydralazine | Rubio | PFL | No need to PFLa (administer immediately) | PFL | – | 5, 7 |
HYCAMTIN® (vial) | Topotecan | GlaxoSmithKline S.A. | PFL | PFLa | No need to PFL | – | 7 |
IMIGRAN® (amp/tab) | Sumatriptan | GlaxoSmithKline S.A. | PFL | Not applicable | Not applicable | – | 7 |
IMUREL® (tab) | Azathioprine | Ucb Pharma S.A. | PFL | Not applicable | Not applicable | – | 7 |
INIBSACAIN EPINEFRINA® (amp) | Bupivacaine+epinephrine | Inibsa | PFL | Not applicable | Not applicable | – Turns brownish colour when it becomes unstable | 7, 8 |
– Epinephrine is sensitive to light | |||||||
INMUCYST BCG® (inj) | Mycobacterium bovis | Aventis | PFL | PFL | No need to PFLa | – | 7 |
INSULATARD® (vial) | Isophane insulin | Novo Nordisk A/S | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
IRINOTECAN® (vial) | Irinotecan | Hospira | PFL | Not applicable | No need to PFL | – | 12, 14, 16 |
HUMALOG® (pen/vial) | Insulin lispro | Eli Lilly Netherland B.V. | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
KETOLAR® (amp) | Ketamine | Parke Davis | PFL | Not applicable | No need to PFLa (administer immediately) | It may go darker but this does not affect its potency | 7, 9 |
KONAKION® (amp) | Phytonadione | Roche Pharma | PFL | Not applicable | Not applicable | – | 6, 7 |
LANTUS (vial/pen) | Insulin glargine | Sanofi Aventis Deutschland GMBH | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
LEDERFOLÍN® (tab) | Calcium folinate | Wyeth Farma | PFL | PFL | PFL | – | 7, 9 |
LOSEC® (vial) | Omeprazole | Astra-Zeneca | PFL (stable under light for 24h) | Not applicable | PFL | – Should not be kept under normal light conditions for more than 24h | 7, 8 |
– Solution can be handled under normal light conditions without special precaution | |||||||
MAB-CAMPATH® (vial) | Alemtuzumab | Quimica Farmabayer | PFL | Not applicable | No need to PFL | – | 7 |
MELFALAN® (vial) | Melphalan | GlaxoSmithKline | PFL | PFL | No need to PFL | Immediate use | 7 |
METOTREXATO® (vial) | Methotrexate | Merck Genéricos | PFL | Not applicable | PFL | 0.1mg/ml sol. loses 5–8% stability in 10 days and 11–17% in 20 days, if exposed to light | 8 |
MIDAZOLAM COMBINOPHARM® (amp) | Midazolam | Combino-Pharm | PFL | Not applicable | Not applicable | – | 7, 8 |
MIDAZOLAM NORMON ® (amp) | Midazolam | NORMON | PFL | Not applicable | Not applicable | – | 8, 10 |
MIDAZOLAM GES ® (amp) | Midazolam | GES | PFL | Not applicable | Not applicable | Precipitate dissolves when shaken | 7, 8, 9, 10 |
MITOMYCINA – C® (vial) | Mitomycin | Inibsa | PFL | PFL (dispose of after 12h if not used) | PFL | Solutions should be used immediately (especially if contain dextrose) | 5, 8, 15 |
MIXTARD® (pen) | Insulin+isophane insulin | Novo Nordisk Pharma, S.A. | PFL | Not applicable | PFLa (administer immediately) | – | 7 |
MOLSIDAIN® (tab) | Molsidomine | Sanofi-Aventis | PFL | Not applicable | Not applicable | – | 8 |
MORFINA® 1% (amp) | Morphine | Braun | PFL | Not applicable | No need to PFL | – | 7, 8 |
MUSTOFORÁN® (vial) | FOTEMUSTINE | Italfarmaco S.A | PFL | PFL | PFL | – | 7 |
MYLOTARG® (vial) | Gemtuzumab ozogamicin | Wyeth Farma S.A | PFL | PFL | No need to PFLa | – | 7 |
MYOCET® 50mg/(vial) | Doxorubicin liposomes | Cephalon Pharma SLV | PFL | Not applicable | No need to PFLa | – | 8 |
NALOXONE® (amp) | Naloxone | Abello | PFL | Not applicable | PFL | – | 5, 7 |
NAVELBINE® (amp) | Vinorelbine | Pierre Fabre Iberica | PFL | Not applicable | No need to PFLa | – | 7 |
NAVELBINE® (tab) | Vinorelbine | Pierre Fabre Iberica | PFL | Not applicable | Not applicable | – | 7 |
NEXIUM MUPS® (vial) | Esomeprazole | ASTRA ZENECA | PFL (stability under artificial light for 24h) | No need to PFL | No need to PFL | – | 7, 8 |
NIMBEX® (amp) | Cisatracurium besylate | GlaxoSmithKline | PFL | Not applicable | No need to PFL (we do not recommend administration for more than 1 week) | – There are no studies under sunlight | 7, 8 |
– No external indication | |||||||
to show loss of stability | |||||||
NIPENT® (vial) | Pentostatin | Hospira | PFLa | PFL | PFLa | – | 7 |
NITROPRUSIATO® (inj) | Nitroprusside | Rotta Pharm | PFL | PFL (stability 24h) | PFL. Stability at 4h of light (degrades ≥20%). 24h stability protected from light | – Dispose of if strong dark orange, dark brown or blue | 6 |
– Do not administer if cloudy or precipitate | |||||||
NORCURON® (amp) | Vecuronium | Organon NU | PFL | No need to PFL (stability exposed to light for 24h) | No need to PFL (stability exposed to light for 24h) | Although unused should be disposed of due to risk of contamination | 7 |
NOVANTRONE® (vial) | Mitoxantrone | Ferrer Farma | PFLa | PFLa | PFLa | – | 7 |
NUVACTHEN DEPOT® (amp) | Tetracosactide | Padro SA | PFL | Not applicable | Not applicable | – | 6 |
OMEPRAZOL® (caps) | Omeprazole | Normon | PFL | Not applicable | No need to PFL | For NGP, open caps and disperse in acid medium | 8 |
OMNIPAQUE® (sol inj) | Iohexol | GES | PFL | Not applicable | No need to PFLa (administer immediately) | – | 7, 8 |
PARLODEL® (tab) | Bromocriptine mesylate | Meda Pharma | PFL | Not applicable | Not applicable | – | 7 |
PREDNISONA® (tab) | Prednisone | Sanofi-Aventis | PFL | Not applicable | Not applicable | – | 8 |
PRIMPERAN® (amp) | Metoclopramide | Sanofi-Aventis | PFL | Not applicable | No need to PFL | – | 6, 7 |
PROLEUKIN® (vial) | Aldesleukin | Chiron Iberia S.A | PFL | PFL | No need to PFLa (administer immediately) | – | 5, 7 |
PROPOFOL® (amp) | Propofol | Mayne | PFL | Not applicable | No need to PFLa (administer immediately) | – | 7 |
RANITIDINA® (tab) | Ranitidine | Normon | PFL | Not applicable | No need to PFL | Administer via NGP, crushed and diluted in water | 8, 10 |
RANITIDINA® (amp) | Ranitidine | Normon | PFL (remains stable for max. 15 days under light) | Not applicable | No need to PFL | Colouration does not modify activity | 7, 8 |
RIVOTRIL® (amp/tab/drp) | Clonazepam | Davis medica | PFL | Not applicable | No need to PFL (remains stable for 48h exposed to light) | – | 6, 7 |
SANDOSTATIN® (amp) | Octreotide | Novartis Farmaceutica | PFL | Not applicable | No need to PFLa (administer immediately) | – | 7, 9 |
SEGURIL® (tab) | Furosemide | Sanofi-Aventis | PFL | Not applicable | Not applicable | – | 7 |
SINOGAN® (drp) | Levomepromazine | Sanofi-Aventis | PFL | Not applicable | Not applicable | – | 7, 8 |
SINOGAN® (amp) | Levomepromazine | Sanofi-Aventis | PFL | Not applicable | Not applicable | – | 6, 7, 8 |
SOLINITRINA® FORTE (amp) | Nitroglycerin | Almirall-Prodesfarma | No need to PFL | Not applicable | PFL if exceeds 2h in infusion | More diluted, more unstable | 7, 9 |
SOLTRIM® (amp) | Trimethoprim-sulfamethoxazole | Almirall-Prodesfarma | PFL | PFLa | PFL if exceeds 2h in infusion | More diluted, more unstable | 9 |
SOMATOSTATINA NORMON® (vial) | Somatostatin | Normon | PFLa (administer immediately) | PFL | PFL | – | 7 |
SOMATOSTATINA COMBINO – PHARM® (vial) | Somatostatin | Combino-Pharm | No need to PFL | PFL | PFL | – | 7, 8 |
SUMIAL® (amp/tab) | Propranolol | Astra-Zeneca | PFL | Not applicable | No need to PFL | – Do not administer amp if colouration or cloudiness present | 6, 7, 8 |
– Tablets can be administered by NGP, but used as soon as possible | |||||||
SYNACTHEN® (amp) | Tetracosactide | Novartis Farmaceutica | PFL | Not applicable | Not applicable | – | 7 |
SYNTOCINON® (amp) | Oxytocin | Defiante Farmaceutica LDA | PFL | Not applicable | No need to PFLa (administer immediately) | – | 7 |
TAXOL® (vial) | Paclitaxel | Brystol Myers Squibb | PFL | Not applicable | No need to PFLa | – | |
TAXOTERE® (vial) | Docetaxel | Sanofi-Aventis | PFL | PFLa | No need to PFL | – | |
TIOTEPA® (vial) | Thiotepa | Irinol Farma S.A | PFL | Not applicable | No need to PFLa | – | |
TOMUDEX® (vial) | Raltitrexed | Hospira | PFL | PFL | No need to PL | – | 7 |
TORISEL® (vial) | Temsirolimus | Wyeth Farma S.A | PFL | PFLa | PFL | – | 7 |
TRANDATE® (amp) | Labetalol | Kern Pharma S.L | PFL | Not applicable | No need to PFLa (administer immediately) | – | 7 |
TRANGOREX® (amp) | Amiodarone | SANOFI-AVENTIS S.A | PFL | Not applicable | PFL | When it degrades iodine is released, changing its colour | 7, 8 |
TRIGÓN DEPOT® (amp) | Triamcinolone | Bristol Myers Squibb | PFL | Not applicable | Not applicable | – | 7 |
TRONOXAL® (amp) | Ifosfamide | BAXTER | PFL | PFL | PFL | – | 5, 6 |
TUBERCULINA PRD RT 23® (vial) | Tuberculin (tuberculosis test) | UCB Pharma | PFL | Not applicable | Not applicable | – | 6, 7 |
URBASÓN® (amp) | Methylprednisolone | Sanofi-Aventis | PFL | No need to PFLa (administer immediately) | No need to PFLa (administer immediately) | – | 6, 7 |
VELCADE® (vial) | Bortezomib | Janssen Cilag S.A. | PFL | PFL | No need to PFLa | – | 7 |
VENTOLIN® (amp) | Salbutamol | GlaxoSmithKline | PFL | Not applicable | No need to PFLa (administer immediately) | – | 6, 7 |
VEPESID® (vial) | Etoposide | Bristol Myers Squibb | PFL | Not applicable | PFL | – | 14, 15 |
VIBRAVENOSA® (amp/caps) | Doxycycline | Pfizer | PFL | Not applicable | PFL | Solution darkens when it has degraded | 6, 7 |
VINBLASTINA® (vial) | Vinblastine | Stada | PFL | PFL | PFL | – | 12, 14, 15 |
VINCRISTINA® (vial) | Vincristine | Pfizer | PFL | Not applicable | PFL | – | 12, 15 |
VISUDYNE® (amp) | Verteporfin | Novartis Europharm | PFL | PFL | PFL | – | 6, 7 |
VOLTAREN® (amp) | Diclofenac | Novartis Farmaceutica | PFL | Not applicable | Not applicable | – | 7 |
VUMON® (vial) | Teniposide | Bristol-Myers Squibb | PFL | Not applicable | No need to PFLa | – | 5 |
ZAVEDOS® (vial) | Idarubicin | Pfizer | PFL | PFL | PFL | – | 12, 14 |
ZOFRÁN® 4mg and 8mg (amp) | Ondansetron | GlaxoSmithKline, S.A | PFL | Not applicable | PFL (stable 7 days) under fluorescent light | PFL is recommended although there are studies in which it has maintained stable in light | 6, 7, 8 |
amp: ampoules; Ref.: bibliographical references; caps: capsules; tab: tablets; drp: drops; inj: injectable; syr: syringe; Observ.: observations; per: perfusion; PFL: protect from light; sol: solution; susp: suspension; NGP: nasogastric probe.
Data distribution obtained according to the information source was: 3.5% primary sources, 5.4% secondary sources, 19% tertiary sources, 19% information provided by laboratories and only 30.6% of data were obtained from the summary of product characteristics. Information about 22.5% was not found.
Most of the photosensitive medications reviewed in this study (73.4%) are received from industry in a package that does not adequately protect it from the light.
Conclusions and DiscussionIt is important that laboratories perform light-sensitivity tests on their products and that the results are included on the summary of characteristics. This would make information more accessible and reliable, since drug stability is extremely important, which is why we believe that it should be required by law. The lack of studies published on stability of photosensitive drugs meant that we had to perform an internal review of the photosensitive medications included in our hospital's PTG.
This list has been included in the “Manual de correcto almacenamiento y conservación de medicamentos en el Servicio de Farmacia” (Manual of correct drug storage in the Pharmacy Department), and to ensure that photosensitive drugs are correctly stored in our storeroom, we have stuck stickers on the photosensitive ones. In addition, the other hospital units have been provided with the list, with the aim of promoting patient safety.
Conflict of InterestThe authors affirm that they have no conflicts of interest.
Please cite this article as: Sánchez-Quiles I, et al. Revisión de la estabilidad de los medicamentos fotosensibles. Farm Hosp. 2011;35(4):204–215.