Temperature considerations for naloxone kits
For the naloxone distributed by Hamilton Public Health Services the product monograph recommends that naloxone be kept at room temperature (between 15°C and 25°C).1 Naloxone should also be stored in its case to protect from light. A product monograph is a scientific document on a drug product that describes the conditions of use of the drug and any other information required for safe and effective use of the drug.
Naloxone and heat (above 25°C) or cold (below 15°C) - What does the evidence say?
Naloxone can become less potent if exposed to heat (above 25°C). The potency of naloxone is not likely reduced with exposure to cold temperatures. Potency is a measure of the strength of naloxone. Evidence from a lab study found that naloxone became less potent when exposed to heat, but not to cold.2 Another study, where naloxone was exposed to daily temperatures between -6°C to 54°C found that the potency was unchanged after 7 days of cold/heat exposure and potency was decreased by only 11% after 28 days.3 No studies have directly tested the effectiveness of naloxone in humans after exposure to heat or cold.
Naloxone Expansion sites, please share the following recommendations with clients
Recommendations for clients
- Always carry your naloxone in its protective case to keep it safe.
- If you are out in the cold for a long period, keep your naloxone kit close to your body to keep it warm.
- Try not to leave your naloxone exposed directly in the sun, in your car, a backpack, or in another hot location.
- If your naloxone is exposed to extreme heat or freezing temperatures (over 40°C or under 5°C) for longer than 24 hours, you should try to replace it when you can at a community naloxone site.
- Exposure to heat or cold should not stop you from using naloxone if it is needed. Always carry two doses of naloxone and if the response with one dose is inadequate consider using the second dose as instructed.
- Always call 9-1-1 for an overdose.
These recommendations are consistent with advice from other jurisdictions including Alberta Health Services, and British Columbia Centre for Disease Control.
References
1 NarcanTM Nasal Spray, Adapt Pharma Canada Ltd. Available at: https://www.narcannasalspray.ca/pdf/en/product_monograph.pdf
2 Armenian, P., Campagne D., Stroh, G., Ives Tallman, C., Zeng, WZD. and Gerona, RR. (2017). Hot and Cold Drugs: National Park Service Medication Stability at the Extremes of Temperature. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28059581
3 Gammon, D., Su, S., Huckfeldt, R., Jordan, J., Patterson, R., Finley, P. and Lowe, C. (2008). Alteration in prehospital drug concentration after thermal exposure. Available at https://doi.org/10.1016/j.ajem.2007.09.004
