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Inicio Farmacia Hospitalaria (English Edition) Review of the Stability of Photosensitive Medications
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Vol. 35. Núm. 4.
Páginas 204-215 (Julio - Agosto 2011)
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Vol. 35. Núm. 4.
Páginas 204-215 (Julio - Agosto 2011)
Review
DOI: 10.1016/j.farmae.2010.05.004
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Review of the Stability of Photosensitive Medications
Revisión de la estabilidad de los medicamentos fotosensibles
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I. Sánchez-Quiles??
Autor para correspondencia
elisabetham@hotmail.com

Corresponding author.
, M.D. Nájera-Pérez, A. Espuny-Miró, J.C. Titos-Arcos
Servicio de Farmacia, Hospital Morales Meseguer, Murcia, Spain
Información del artículo
Resumen
Texto completo
Bibliografía
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Estadísticas
Tablas (1)
Table 1. Review of Photosensitive Drugs.
Abstract
Objectives

Identify the photosensitive drugs included in the hospital pharmacotherapeutic guide and search for stability data on the storage, reconstitution, and dilution of these compounds.

Methods

The 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.

Results

The listing comprised of 139 of the 1954 photosensitive medicines included in the pharmacotherapeutical guide (Table 1).

Conclusions

The 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.

Keywords:
Stability
Photosensitive medications
Review
Resumen
Objetivo

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.

Método

La 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.

Resultados

El listado recoge 139 especialidades farmacéuticas fotosensibles, de las 1954 especialidades incluidas en la GFT (tabla 1).

Conclusiones

La 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.

Palabras clave:
Estabilidad
Medicamentos fotosensibles
Revisión
Texto completo
Introduction

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 Methods

By 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.

Results

In this review, we listed 139 of the 1954 photosensitive drugs (Table 1) included in the PTG.

Table 1.

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 besylateInibsaPFLNot applicableStable 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 24 
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)OmeprazoleAstra-ZenecaPFL (stable under light for 24h)Not applicablePFL  – Should not be kept under normal light conditions for more than 247, 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)NitroprussideRotta 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.

a

There are no studies.

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 Discussion

It 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 Interest

The authors affirm that they have no conflicts of interest.

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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.

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