Stability of Hydrocortisone Sodium Succinate in Intensive Care Units: Focus on Practical Points
Jiraporn Leanpolchareanchai¹, Pitchaya Dilokpattanamongkol¹, Tospon Lertwattanachai², Auranee Trisataya PharmD³, Amaraporn Wongrakpanich¹, Thanist Pravitharangul⁴
Affiliation : ¹ Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand ² Department of Pharmacy, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand ³ Department of Pulmonary Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ⁴ Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background: Although single daily 24 hours preparation of hydrocortisone solution infusion is widely used in intensive care clinical practice, most manufacturers limit its infusion time to only four hours. The data on efficacy of this practice are scarce.
Objective: To determine the physical and chemical stability of hydrocortisone solution used in intensive care units (ICU).
Materials and Methods: Powder form of 100 mg hydrocortisone was reconstituted first with sterile water for injection (SWI) and then added to normal saline solution (NSS) to obtain 1 and 2 mg/mL solutions, or first reconstituted with NSS then added to bag of NSS to obtain 1 mg/mL solution. The solutions were then stored in three different conditions, refrigerator (4±2℃), ICU (25±3℃), and hospital room (30±2℃) temperatures for 48 hours. The physical and chemical stabilities were assessed at an initial time, 4, 8, 12, 24, and 48 hours.
Results: Hydrocortisone reconstituted in SWI showed an acceptable labeled amount range (100.28±3.83%), similar to reconstitution in NSS (96.05±1.00%). Hydrocortisone solutions of 1 and 2 mg/mL stored at 4±2℃, 25±3℃, and 30±2℃ showed similar percent label amount, and the statistical tests were not significantly different among the three ranges of temperatures (p>0.05).
Conclusion: Hydrocortisone reconstituted using SWI followed by NSS to obtain final concentrations of 1 to 2 mg/mL or using only NSS to obtain a final concentration of 1 mg/mL, provided an acceptable range of % hydrocortisone remaining up to 48 hours when stored at 4±2℃, 25±3℃, and 30±2℃.
Received 15 September 2021 | Revised 1 March 2022 | Accepted 9 March 2022
DOI: 10.35755/jmedassocthai.2022.04.13293
Keywords : Hydrocortisone; Intensive care units; Normal saline solution; Stability; Sterile water for injection
All Articles
Download