Stability of epinephrine at standard concentrations

Area of Science:

• Pharmacology
• Pharmaceutical Science
• Pediatric Critical Care

Background:

• Standardized medication concentrations are crucial for minimizing errors in pediatric continuous infusions.
• Premixing epinephrine, a key treatment for pediatric septic shock, can enhance safety, timeliness, and cost-effectiveness.
• Limited data exists on the stability of epinephrine at standard concentrations used in pediatric care.

Purpose of the Study:

• To assess the stability of epinephrine in 5% dextrose in water at standard concentrations.
• To determine the extended expiration date for epinephrine infusion bags stored at 4°C and 25°C for up to 30 days.

Main Methods:

• Epinephrine solutions at three standard concentrations (25, 50, 100 μg/mL) were prepared in 5% dextrose in water.
• Infusion bags were stored at 4°C and 25°C, with physical characteristics monitored daily and then every 1-5 days up to 30 days.
• High-performance liquid chromatography was used to analyze epinephrine concentration, with stability defined as ≥90% of initial concentration.

Main Results:

• No significant changes in pH, color, or precipitate were observed in any epinephrine solutions over 30 days at either temperature.
• All epinephrine formulations retained over 95% of their initial concentration at day 30.
• The 95% confidence interval indicated that at least 93% of the initial epinephrine concentration remained on day 30.

Conclusions:

• Epinephrine preparations in 5% dextrose in water are stable for up to 30 days, irrespective of refrigeration.
• The demonstrated stability supports the potential for premixed epinephrine in standard concentrations for pediatric use.
• Future clinical research is recommended to evaluate the pharmacokinetics and pharmacodynamics of these stable epinephrine formulations.