Journal article
DEGRADATION OF BENZODIAZEPINES AFTER 120 DAYS OF EMS DEPLOYMENT
Prehospital emergency care, Vol.18(3), pp.368-374
07/01/2014
DOI: 10.3109/10903127.2013.869642
PMCID: PMC4272820
PMID: 24548058
Abstract
Introduction. EMS treatment of status epilepticus improves outcomes, but the benzodiazepine best suited for EMS use is unclear, given potential high environmental temperature exposures. Objective. To describe the degradation of diazepam, lorazepam, and midazolam as a function of temperature exposure and time over 120 days of storage on active EMS units. Methods. Study boxes containing vials of diazepam, lorazepam, and midazolam were distributed to 4 active EMS units in each of 2 EMS systems in the southwestern United States during May-August 2011. The boxes logged temperature every minute and were stored in EMS units per local agency policy. Two vials of each drug were removed from each box at 30-day intervals and underwent high-performance liquid chromatography to determine drug concentration. Concentration was analyzed as mean (and 95% CI) percent of initial labeled concentration as a function of time and mean kinetic temperature (MKT). Results. 192 samples were collected (2 samples of each drug from each of 4 units per city at 4 time-points). After 120 days, the mean relative concentration (95% CI) of diazepam was 97.0% (95.7-98.2%) and of midazolam was 99.0% (97.7-100.2%). Lorazepam experienced modest degradation by 60 days (95.6% [91.6-99.5%]) and substantial degradation at 90 days (90.3% [85.2-95.4%]) and 120 days (86.5% [80.7-92.3%]). Mean MKT was 31.6 degrees C (95% CI 27.1-36.1). Increasing MKT was associated with greater degradation of lorazepam, but not midazolam or diazepam. Conclusions. Midazolam and diazepam experienced minimal degradation throughout 120 days of EMS deployment in high-heat environments. Lorazepam experienced significant degradation over 120 days and appeared especially sensitive to higher MKT exposure.
Details
- Title: Subtitle
- DEGRADATION OF BENZODIAZEPINES AFTER 120 DAYS OF EMS DEPLOYMENT
- Creators
- Jason T. McMullan - Univ Cincinnati, Dept Emergency Med, Cincinnati, OH USAElizabeth Jones - Univ Texas Hlth Sci Ctr Houston, Dept Emergency Med, Houston, TX 77030 USABruce Barnhart - Univ Arizona, Arizona Emergency Med Res Ctr, Tucson, AZ USAKurt Denninghoff - Univ Arizona, Arizona Emergency Med Res Ctr, Tucson, AZ USADaniel Spaite - Univ Arizona, Arizona Emergency Med Res Ctr, Tucson, AZ USAErin Zaleski - Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USARobert Silbergleit - Univ Michigan, Dept Emergency Med, Ann Arbor, MI 48109 USANeurological Emergencies Treatment Trials investigators
- Contributors
- Santiago Ortega-Gutiérrez (Contributor) - University of Iowa, Radiology
- Resource Type
- Journal article
- Publication Details
- Prehospital emergency care, Vol.18(3), pp.368-374
- DOI
- 10.3109/10903127.2013.869642
- PMID
- 24548058
- PMCID
- PMC4272820
- NLM abbreviation
- Prehosp Emerg Care
- ISSN
- 1090-3127
- eISSN
- 1545-0066
- Publisher
- Taylor & Francis
- Number of pages
- 7
- Grant note
- U10NS058960 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) U01NS056975; U01NS059041 / National Institute of Neurological Disorders and Stroke (NINDS); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) National Institutes of Health Office of the Director CounterACT Program Biomedical Advanced Research and Development Authority of the Assistant Secretary for Preparedness and Response UL1TR001425 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Language
- English
- Date published
- 07/01/2014
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984302206702771
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