A List of Medicines that Require Refrigeration

Whether you're a pharmacist or a patient, knowing how to store each medicine is essential to keep them effective. While most drugs are stable at room temperature and must be stored in a cool, dry place, some pharmaceutical products are more sensitive and require refrigeration.

Each formulation has specific storage instructions, and you should always consult them before storing drugs at your pharmacy or home if you're a patient. Not only does storing medicines at the right temperature help keep them effective longer, but it also prevents them from losing potency and degrading.

But there's a lot of confusion regarding this important topic. So, let's investigate and find out precisely what drugs require refrigeration and what do not.

What drugs are refrigerated?

Drugs that must be refrigerated include insulin, vaccines, ear and eye drops, various injections, growth hormones, chemotherapy tablets, topical creams and gels, and others. The following list is not meant to be exhaustive. Always check the storage instruction for a specific medicine. 

Related article: At what temperatures should you store refrigerated drugs?

Insulin  

Insulin is an injectable medication used for the treatment of diabetes. It’s a synthetic human-like hormone that’s very sensitive to temperature and light. 

All insulin, whether contained in vials, pens, cartridges, or other containers, must be refrigerated. Most common fast-acting and long-acting insulins used in the USA include:

• Lantus
• Novolog
• Humalog
• Humulin
• Apidra
• Novolin N
• Levemir
• Tresiba
• Toujeo
• Basaglar
• Others 

Their stability at room temperature (outside of the fridge, but below 77°F / 25°C) is limited to 28 days to 56 days maximum. Insulin can quickly go bad when not stored in the right conditions.  

Diabetes and weight-loss injections

People with diabetes may be prescribed injectable medicines other than insulin to help lower their blood sugar levels. However, most of these medications are biological drugs too, and must be stored in a fridge to stay effective.

Diabetes and weight-loss injections that require refrigeration when not in use include (but are not limited to): 

• Ozempic (semaglutide)
• Mounjaro (tirzepatide)
• Trulicity (dulaglutide)
• Victoza (liraglutide)
• Byetta (exenatide)
• Saxenda (liraglutide)
• Adlyxin (lixisenatide)
• Trulicity (dulaglutide)
• Symlinpen (pramlintide)
• Wegovy (semaglutide)
• Symlin (pramlintide)
• Others

Ear and eye drops

Most ear and eye drops must be stored in the fridge to stabilize their chemical structure but can stay at room temperature for a few days/weeks after opening (usually about a month maximum). Always check the specific storage instructions for each ear and eye medication before use. 

Common ear and eye drops that require refrigeration include:

• Glaucoma eye drops like Latanoprost, Xalatan
• Timolol (dorzolamide)
• Vyzulta (latanoprostene bunod)
• Chloramphenicol, an antibiotic eye ointment to treat bacterial infections like conjunctivitis.
• Cyclopentolate, mainly used to dilate the eye before an examination.
• Azasite (azithromycin)
• Lumigan (bimatoprost)
• Propatacaine ophthalmic solution
• Others

TNF inhibitors for inflammatory conditions

Some (but not all) injectable medications used for the treatment of inflammatory diseases like rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, ankylosing spondylitis, ulcerative colitis, polyarticular juvenile idiopathic arthritis, as well as certain inflammatory bowel conditions such as Crohn's disease must be refrigerated too.

 Here are a few examples: 

• Humira (adalimumab)
• Enbrel (etanercept) 
• Cimzia (certolizumab pegol)
• Actemra (tocilizumab)
• Orencia (abatacept)
• Simponi (golimumab)
• Others

Most of these medications are biologics based on an active ingredient that belongs to the tumor necrosis (TNF) inhibitor class. They're made from living sources and do not tolerate high temperatures, freezing temperatures, temperature variation, or exposure to too much light.

They must be kept refrigerated between 36°F and 46°F (2°C - 8°C) and can only stay at room temperature for a limited time without risking spoiling and losing efficiency.

Related article: How to travel with refrigerated medications?

Vaccines

Vaccines are probably the most temperature-sensitive cold-chain drugs. This is because they're inherently biological substances and contain living organisms from viruses and bacteria called antigens. Unfortunately, like any living thing you can think of, vaccines quickly spoil and go bad when exposed to high temperatures. 

Most vaccines must be refrigerated and can only be left out of the fridge for very short periods of time (usually a few hours only!).

Related article: How long can vaccines be out of the fridge? 

Migraine injectable medicines

Adults with severe chronic migraines may be prescribed injection drugs classed as calcitonin gene-related peptide (CGRP) monoclonal antibodies, including:

• Aimoivig (erenumab-aooe)
• Emgality (galcanezumab-gnlm)
• Ajovy (fremanezumab)

All three migraine injectable drugs must be kept refrigerated between 36°F and 46°F (2°C -8°C) and can only stay at room temperature for a maximum of 7 days after first use.

Asthma inhalers and injections 

Diverse asthma medications also require refrigeration in order to stay effective for the longest possible, including biological subcutaneous injections like:

• Dupixent (dupilumab) must be refrigerated at 36°F - 46°F (2°C - 8°C). Once out of the fridge, it must be used within 14 days.
• Xolair (omalizumab) is a subcutaneous injection used to treat moderate to severe asthma, nasal polyps, and chronic spontaneous urticaria (CSU). It must be stored in the refrigerator and can only stay at room temperature for two days maximum (48 hours).
• Fasenra (benralizumab) is mainly prescribed to people with eosinophilic asthma and must be refrigerated or kept at room temperature for up to 14 days.
• Nucala (mepolizumab) is only stable at room temperature (max 86°F/30°C) for seven days. When not in use, it must be refrigerated.

Most asthma inhalers and aerosol sprays, like Albuterol or Ventolin, do not require refrigeration but must be protected from high heat and kept in dry, cool places. Some more sensitive ones might need to be stored and transported at fridge temperature. Always read the instructions before use and transportation.

Related article: Safety tips for traveling with mild and severe asthma

Growth hormones

Growth hormones are biologics. They’re extremely fragile and unstable products. All growth hormones must be stored and shipped refrigerated after reconstitution, and even a short rupture in the cold chain process can impact their potency. Common growth hormones in the USA are:

• Humatrope
• Genotropin
• Norditropine
• Nutropin
• Serostim
• Saizen
• Zorptive
• Tev-Tropin
• Omnitrope
• Nuspin
• Others

Growth hormones are available in different forms, including lyophilized powder in vials and two-chamber cartridges for reconstitution, prefilled cartridges, and prefilled pens. Once reconstituted, they must be refrigerated and can only stay out of the fridge for very short periods of time (read storage instructions for each specific medicine).

Antibiotics 

Some but not all antibiotics need to be refrigerated to prevent alteration of their chemical structures. Most liquid or reconstituted antibiotics have a short shelf life, but it does not necessarily mean they require refrigeration. When refrigeration is needed, the bottle or container usually clearly says "refrigerate" on it.

Here are a few examples of common antibiotics storage recommendations:

• Amoxicillin does not require refrigeration, even in its liquid form. However, it tastes better if refrigerated!
• Penicillin oral solution must be stored in the fridge.
• Erythromycin suspensions may sometimes need to be refrigerated, depending on the brand.
• Biaxin, Cleocin, and Bactrim liquid antibiotics are fine at room temperature.
• Augmentin must be kept refrigerated.
• Azithromycin should not be refrigerated.

Whether refrigerated or not, most liquid or reconstituted antibiotics must be discarded within a few days or weeks after opening. Tablet antibiotics generally do not require refrigeration, but always check the specific instructions before use.

Tablets and Capsules

While most medication tablets and capsules can be stored at room temperature in cool, dry places, some are more unstable and require refrigeration, especially chemotherapy and antiretroviral drugs:  

• Leukeran (chlorambucil) tablets, used for chemotherapy treatments of cancers, must be refrigerated between 36°F - 46°F (2°C - 8°C) and are only stable for up to a week at room temperature (max. 86°F/30°C). Liquid Leukeran must never leave the fridge, even for a few hours.
• Etoposide (Vepesid) capsules used to treat some forms of cancer must be stored under refrigeration.
• Emcyt (estramustine) liquid capsules to treat some prostate cancers.
• Melphalan (alkeran) tablets, another chemotherapy drug used to treat certain forms of cancers such as myeloma and ovarian cancers, must be refrigerated too.
• Liotrix (thyrolar) tablets, used for treating hypothyroidism and thyroid disorders, must be refrigerated.
• Norvir (ritonavir) capsules, an antiretroviral medication used to treat HIV, must be stored in the fridge until dispensed. They may be kept at room temperature ( 77°F/25°C) for up to 30 days.
• Kaletra (Lopinavir/ritonavir) tablets, another antiretroviral medicine used to treat HIV-1 virus in adults must be kept refrigerated. However, it's stable for two months at room temperature.
• Marinol (dronabinol) capsules, made with Cannabis delta-9-tetrahydrocannabinol and used to treat nausea and vomiting in patients undergoing chemotherapy, must be refrigerated or stored at a maximum of 59°F/15°
• Pancrelipase, enzymes to improve the digestion process in patients with conditions like pancreatitis and others.
• Others (this list is not meant to be exhaustive).

Creams and gels

Some pharmaceutical creams, gels, or ointments require refrigeration, including: 

• Dinoprostone cervical gel, used to help induce labor in pregnant women near term.
• Sinecatechins ointment, a new FDA-approved drug treatment for warts around the genitals and anus, must also be refrigerated.
• Egranex (becaplermin) gel, a cicatrizant used for wound care in diabetic neuropathy ulcers.
• DUAC topical gel (benzoyl peroxide/clindamycin), a topical treatment for acne
• CombiPatch (estradiol and norethindrone), used for transdermal hormone therapy in postmenopausal women

More Temperature-sensitive Drugs - List

Additionally, the following medicines require refrigeration too:

• Caverject (alprostadil) injections for the treatment of erectile dysfunction
• Trimix penile injections
• Alprostadil urethral suppository
• Amphotericin B, an antifungal injection
• Fortical (calcitonin-salmon rDNA-origin) nasal spray and injections, used to treat osteoporosis in women
• Aranesp (darbepoetin alfa), used for anemia and other low red blood cell disorders
• Epogen and Procrit (epoetin alfa), also used for patients with anemia.
• DDAVP rhinal tube delivering desmopressin acetate
• Dornase alfa (pulmozyme) inhaler
• NuvaRing (etonogestrel/ethinyl estradiol), a birth control vaginal ring.
• Neupogen G-CSF (filgrastim) used in oncology to stimulate the production and function of blood cells.
• Neurontin (gabapentin) oral suspension, indicated for the management of postherpetic neuralgia and partial seizure in patients with epilepsy.
• Copaxone and Brabio (glatiramer acetate) injections used for the treatment of relapsing forms of multiple sclerosis.
• Infergen (interferon alfacon-1) used for adult patients with chronic Hepatitis C.
• Avonex and Rebif (interferon beta-1a) injections used for patients with multiple sclerosis.
• Actimmune (interferon gamma-1b) used to treat chronic granulomatous disease (CGD).
• Lorazepam intensol oral concentrate, a benzodiazepine drug used to treat anxiety.
• Octreotide (sandostatin)
• Pegasys (peginterferon alfa-2a) used to treat patients with hepatitis B and hepatitis C.
• Stelara (ustekinumab), a biologic used for Crohn’s disease, ulcerative colitis, and psoriatic arthritis.
• Xgeva (denosumab) tablets
• Forteo (teriparatide) osteoporosis injection treatment
• Saxenda (liraglutide) prefilled pens for weight-loss
• Repatha (evolocumab) and Praluent injectable prescription medicines for people with high cholesterol.
• Others

This list of temperature-sensitive drugs is not meant to be exhaustive. Always read the storage instructions for each medicine before use, storage, or transportation.

At What Temperature Should You Store Refrigerated Medicines? 

Generally, drugs that require refrigeration must be kept between 36°F and 46°F (2°C and 8°C).

Pharmacists, healthcare providers, and patients should all be careful the temperature of their storage fridge is correct and does not fluctuate too much. The drugs’ quality and effectiveness highly depend on it.

Read more about how to store refrigerated drugs in our related article.

Are you a pharmacist, a healthcare provider, or a drug manufacturer? Can you help us keep that list of refrigerated drugs updated and complete? Please comment below!