Stability of Levothyroxine in Sodium Chloride for IV Administration.

Background: Levothyroxine by IV administration is often prescribed in the intensive care unit for the management of potential solid organ donors, following declaration of brain death and provision of consent for organ donation. Published data on the stability of levothyroxine in IV solutions are limited.

Objective: To evaluate the physical compatibility and chemical stability, over a 24-h period, of 2 concentrations of levothyroxine in 0.9% sodium chloride with storage at room temperature and with exposure to or protection from light.

Methods: Levothyroxine solutions (0.4 μg/mL and 2.0 μg/mL) were prepared in 50-mL minibags of 0.9% NaCl and stored at room temperature (25°C) with exposure to or protection from light. Samples were collected from each minibag at time 0 and after 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 8.0, 12.0, and 24.0 h. The samples were analyzed in triplicate with a validated stability-indicating high-performance liquid chromatography method using ultraviolet detection. A solution was considered stable if it maintained 90% of its initial concentration of levothyroxine. Changes in colour, clarity, and pH were assessed to determine the physical compatibility of the solutions.

Results: All samples remained clear, colourless, and free of precipitate throughout the study, and there were no significant changes in pH. Based on the 95% confidence interval of the slope of the curve relating concentration to time determined by linear regression, solutions of levothyroxine with concentration 0.4 μg/mL would maintain at least 90% of the initial concentration for 16.9 h with exposure to light and for 18.0 h if kept in the dark. Solutions of levothyroxine with concentration 2.0 μg/mL would maintain at least 90% of the initial concentration for 6.5 h with exposure to light and for 12.0 h if kept in the dark, with 95% confidence.

Conclusions: Extemporaneously prepared solutions of levothyroxine in 0.9% NaCl can be expected to remain stable for at least 6.5 h if stored without protection from light and at least 12 h if stored in the dark. Stability is related to concentration, with more dilute solutions having greater stability.