PREPARATION
When preparing biotech products, aseptic technique must be employed as
it is with traditional parenteral products. The product should be prepared in a
clean room designed for this purpose with laminar air flow hoods, etc. Most of
the products require reconstitu-tion with sterile water or bacteriostatic water
for injection depending on stability data. The compat-ibility of individual
products varies and limited data are available. As mentioned previously, when
adding diluent to these products, care should be taken not to shake them, but
to swirl the container or roll it between the palms of the hands. In the case
of lyophilized products, introduction of the diluent should be directed down
the side of the vial and not directly on the powder to avoid denaturing the
protein. It is important to mention that stability does not mean sterility.
Biotech products require the same precautions as any other parenteral product.
Sterility is particularly important when pre-filling and pre-mixing various
doses for administration at home. Once the manufacturer’s sterile packaging is
entered, sterility can no longer be assured nor will the manufacturer be
responsible for any subsequent related problems. Many biotech drugs are not
compatible with preservative agents and single use vials do not contain a
preservative. Individual manufacturers have not addressed the issue of
sterility and each institution or organization must determine its own policy on
this issue. Many of the currently available biotechnology-produced products are
provided as single-dose vials and should not be reused. This does not, however,
prevent preparing batches (“batching”) of unit-of-use doses in order to be
efficient. Many of the patients receiving these agents are likely to have
suppressed immune systems and are vulnerable to infection. Therefore, a policy
involving the maintenance of sterility of biotech products should be developed
by each healthcare organization, especially hospitals, and specialty
phar-macies. When products are made in a sterile environment under aseptic
procedures they should remain sterile until used and thus could be stored for
as long as physical compatibility data dictate. However, most institutions have
shorter expiration dates, which are generally 72 hours or less, on
reconstituted products. These expiration dates have been arbitrarily set due to
lack of good sterility data to the contrary. Sterility studies should be
performed in order to determine if reconstituted products could be stored for a
longer period of time and still maintain sterility. For products reconstituted
for home use in the pharmacy sterile products area, a seven day expiration date
is used provided the product is stable and can be stored in the refrigerator.
The American Society of Health-System Pharmacists has published a technical
assistance bulletin on sterile products, which should be consulted for
developing policies on storage of reconstituted parenteral pro-ducts (American
Society of Hospital Pharmacy, 2000). Patients need to be informed about
specific storage requirements and expiration dates to assure sterility and
stability.
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