ArticlePrehospital emergency care
The 60-day temperature-dependent degradation of midazolam and Lorazepam in the prehospital environment.
Article in Prehospital emergency care. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 36 citations in OpenAlex.
- Lessons from the RAMPART study--and which is the best route of administration of benzodiazepines in status epilepticus.Epilepsia · 2013Trial
- Medications, epilepsy and climate change: Added layers of complexity.British journal of clinical pharmacology · 2025Review
- Time-based tracking of temperature and humidity of emergency medical service rapid response vehicles in Qatar: a prospective observational study.BMC emergency medicine · 2025Observational
- Emergency care drugs' chemical stability after eight weeks' deployment in the prehospital setting.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Percutaneous absorption and Skin accumulation of Lorazepam-Diphenhydramine- Haloperidol Carbopol gel in Porcine Ear Skin.AAPS PharmSciTech · 2023Article
- Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations.Journal of the American College of Emergency Physicians open · 2020Article
- Practical Management of Epileptic Seizures and Status Epilepticus in Adult Palliative Care Patients.Frontiers in neurology · 2018Review
- Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations.The western journal of emergency medicine · 2017Article
- Temperatures of storage areas in large animal veterinary practice vehicles in the summer and comparison with drug manufacturers' storage recommendations.BMC veterinary research · 2015Article
- Degradation of benzodiazepines after 120 days of EMS deployment.Prehospital emergency careArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe choice of the optimal benzodiazepine to treat prehospital status epilepticus is unclear. Lorazepam is preferred in the emergency department, but concerns about nonrefrigerated storage limits emergency medical services (EMS) use. Midazolam is increasingly popular, but its heat stability is undocumented.
objectiveThis study evaluated temperature-dependent degradation of lorazepam and midazolam after 60 days in the EMS environment.
methodsLorazepam or midazolam samples were collected prior to (n = 139) or after (n = 229) 60 days of EMS deployment during spring-summer months in 14 metropolitan areas across the United States. Medications were stored in study boxes that logged temperature every minute and were stored in EMS units per local agency policy. Mean kinetic temperature (MKT) exposure was derived for each sample. Drug concentrations were determined in a central laboratory by high-performance liquid chromatography. Concentration as a function of MKT was analyzed by linear regression.
resultsPrior to deployment, measured concentrations of both benzodiazepines were 1.0 relative to labeled concentration. After 60 days, midazolam showed no degradation (mean relative concentration 1.00, 95% confidence interval [CI] 1.00-1.00) and was stable across temperature exposures (adjusted R(2) -0.008). Lorazepam experienced little degradation (mean relative concentration 0.99, 95% CI 0.98-0.99), but degradation was correlated to increasing MKT (adjusted R(2) 0.278). The difference between the temperature dependence of degradation of midazolam and lorazepam was statistically significant (T = -5.172, p < 0.001).
conclusionsLorazepam experiences small but statistically significant temperature-dependent degradation after 60 days in the EMS environment. Additional study is needed to evaluate whether clinically significant deterioration occurs after 60 days. Midazolam shows no degradation over this duration, even in high-heat conditions.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.