Which of the following scenarios represents appropriate storage of insulin product assuming the stored products prior to opening were before the expiration date? Select all that apply. 

A. A 56 year old male with hemoglobin A1c of 7.5% kept his Lantus Solostar product refrigerated unopened until 60 days ago when he began using the product and storing at room temperature. He continues to use today.

B. A 43 year old female with hemoglobin A1c of 6.9% kept her Toujeo Solostar refrigerated unopened until 45 days ago when she began using the product and storing at room temperature. She is continuing to use it today.

C. A 24 year old female with hemoglobin A1c of 7.2% picked up her Afrezza product 3 days ago at the pharmacy and has kept at room temperature since beginning to use the day she picked up the prescription. 

D. A 65 year old male has stored his Basaglar Kwikpen refrigerated unopened until 40 days ago when he opened and kept at room temperature. He is still using the product today. 

E. A 72 year old female has stored his Tresiba Flextouch in the freezer unopened until 15 days ago when he opened and began using. He is still using the product today.

Answers with rationale:

The correct answers are B and C. Area 5.6 of the NAPLEX competency statements covers packaging, storage, handling, or disposal. While not necessarily a common question on many rotations, these are incredibly important areas of pharmacy practice as patients often have these concerns. Insulin is a hormone that requires very specific storage for optimal and therapeutic use. Often there are significant differences between various products with regards to storage as evidenced by this question. Three questions to ask when determining these as correct or incorrect are 1) Is the product open or unopened? 2) If kept refrigerated the whole time, has the expiration date passed? 3) If at room temperature, when did the product begin being stored at this temperature?

All of these options are purposefully listed as brand names. Area 2 of the exam specifically states you must be able to identify both brand and generic names of medications. Often in pharmacy school or in formal educational presentations, generic names are used universally but in practice, prescribers often use trade names. Insulin products notoriously get mixed up with errors so it is important to know both brand and generic names when preparing for the examination.

Answer B is correct as Toujeo Solostar pen is unique in that per the manufacturer you have up to 56 days to use the pen after opening and storing at room temperature. Answer C is correct as this is an inhaled insulin product that can be stored unopened for up to the expiration date (foil package), up to one month (blister cards and strips), or up to 10 days once opened and stored at room temperature. 

Answer A is incorrect as once opened, you can store at room temperature for up to 28 days before discarding. Answer D is incorrect for the same reason, as Basaglar is another formulation of insulin glargine that is good for up to 28 days opened at room temperature. Answer E is incorrect as insulin should never be frozen and cannot be used per manufacturer if stored in this manner.