How to Store Drugs in the Veterinary Clinic

Properly storing drug products is crucial for drug handling and maintaining quality and efficacy, as well as increasing patient safety.

This article references chapters in the United States Pharmacopeia (USP), which is a compilation of quality standards for medications.

How Should Drug Products Be Stored? 

Safe and effective therapy relies on the use of quality drugs, which can be affected by storage protocols. Each individual therefore has a legal and ethical responsibility to store drugs properly.¹ Improperly stored drugs can become adulterated and/or misbranded, dispensation of which is a violation of the Federal Food, Drug, and Cosmetic Act.  

Drugs should be stored as described by the package insert available in the product container or online (eg, National Library of Medicine DailyMed database). Storage requirements may include specifications for temperature control, maximum humidity, and/or light protection. The USP defines common phrases used in the storage section of package inserts (Table 1).²

Table 1: Common Environmental Storage Phrases Used In Package Insert²

*Drugs directed to be stored in a cool place may be stored in a refrigerator unless specified otherwise by the package insert.

^†Drugs directed to be stored at temperatures below −4°F (−20°C) should be stored at ±18°F (±10°C) of the required temperature.

Storage areas should be kept clean and organized and designed with consideration for security, temperature requirements, ease of maintenance, and staff workflow.¹ Access to storage areas should be limited to authorized personnel.

How Can Storage Prevent Administration Errors?

Proper storage methods can help prevent incorrect medication administration. Drugs with names that look or sound alike (eg, hydroxyzine and hydralazine) are of significant concern, and differentiation can help prevent incorrect drugs from being administered or dispensed.³ Methods of differentiation may include labeling shelves or other storage locations using tall man lettering (eg, hydrOXYzine and hydrALAzine), circling or highlighting parts of names that are different on drug containers, and/or storing drugs on separate shelves.  

Maintaining an organized storage area can help avoid use of incorrect drugs stored in the wrong place. 

High-alert drugs are those with an increased risk for causing patient harm, especially when used incorrectly. Extra attention should be given to these drugs, for example, storing paralytics in brightly colored bins.

How Can Proper Storage Help Ensure Drugs Are In-Date?

Drugs with the earliest expiration dates should be placed near the front of storage locations. Checking for drugs that expire within the following few months can be helpful. Short-dated drugs can be marked with small, colorful stickers that display the expiration date to draw attention to when the drug should be discarded.  

An expiration date sticker should also be added to opened injectable drugs. Expiration dates not noted on multidose vial bottles are typically defined at 28 days. Vials labeled as single-dose should be discarded after use. Creating a chart of expiration dates for all injectable drugs can help prevent administration of drugs no longer safe to use (eg, due to microbial contamination, loss of potency).

How Should Controlled Substances Be Stored?

Controlled substances should be stored in spaces designed for diversion prevention and that meet legal requirements. In the United States, these requirements are set by the Controlled Substances Act; individual states may have additional requirements. State boards of veterinary medicine and pharmacy can be consulted to ensure compliance with local regulations.  

All controlled substances should be stored in a securely locked, substantially constructed cabinet (eg, locked cabinet, safe, automated dispensing cabinet).⁴ Additional security may be provided by installing cameras where controlled substances are stored, prepared, and counted, as well as requiring electronic badge scanning to access controlled substances. Blank prescription pads, security paper, and order request forms (ie, Drug Enforcement Agency Form 222) should also be securely stored.

What Special Precautions Are Needed When Storing Hazardous Drugs? 

Hazardous drugs, as listed in the National Institute for Occupational Safety and Health List of Antineoplastic Drugs and Other Hazardous Drugs in Healthcare Settings (ie, the NIOSH List),⁵ as well as veterinary drugs with similar characteristics, require special precautions to protect staff, pet owners, and patients from unnecessary exposure (Table 2). USP chapter <800> provides detailed guidance for handling these drugs.⁶

Table 2: Examples of Hazardous Drugs*

*The NIOSH List is a compilation of human-approved drugs known to have hazardous characteristics and divides hazardous drugs into 3 groups: antineoplastics, nonantineoplastics, and nonantineoplastics with predominantly reproductive effects. Veterinary-only drugs and drugs no longer sold for human use (eg, cisapride) are not included.

Hazardous drugs should be stored off the ground and in a manner that prevents breaks and spills. Injectable antineoplastic drugs should be stored separately from nonhazardous drugs, ideally in a negative-pressure room. Negative-pressure rooms maintain lower air pressure inside relative to outside the room, resulting in net airflow into the room, which helps prevent the spread of hazardous particles to other areas of the building in the event of breaks, spills, or contamination on the outside of containers.  

Hazardous drugs that are nonantineoplastic, nonantineoplastic hazardous drugs that have predominantly reproductive adverse effects, and noninjectable antineoplastic drugs can be stored with nonhazardous drugs but should include a hazard indicator (eg, use of auxiliary labels on bottles, storage in special-colored bins). All hazardous drug handling areas should be marked with signage.

What Should Pet Owners Be Told Regarding Drug Storage?

Pet owners should be educated on proper storage requirements, especially for hazardous drugs and controlled substances. Pet owners should be counseled not to store drugs in a bathroom, as most dispensed drugs are affected by humidity. Drugs, especially flavored ones, should be kept away from children and pets. Drugs dispensed in the United States are generally required to be placed in child-resistant containers, but this is not a guaranteed protection.

Conclusions

Proper drug storage can help prevent drug-related errors and promote safety for veterinary staff, pet owners, and patients. Storage requirements should be communicated with pet owners to preserve drug integrity and prevent accidental ingestion and potential toxicosis.