Heat and GLP-1 Pens in The Bahamas: Cold Chain and Storage Rules

What the labels allow

GLP-1 drugs are peptides, and their manufacturers set narrow storage windows. The US label for Ozempic (semaglutide) states: "Prior to first use, the OZEMPIC pen should be stored in a refrigerator between 2°C to 8°C (36°F to 46°F)." After first use, the pen "can be stored for 56 days at controlled room temperature" of 15°C to 30°C (59°F to 86°F) or in a refrigerator, and "should be protected from excessive heat and sunlight"¹. It must not be frozen, and a frozen pen must not be used¹.

The Mounjaro (tirzepatide) label requires refrigeration at 2°C to 8°C and allows single-dose pens and vials to be "stored unrefrigerated at temperatures not to exceed 30°C (86°F) for up to a total of 21 days"; multi-dose KwikPens and vials may spend up to 30 days at room temperature, after which they must be discarded². "Protect MOUNJARO from heat and light," the label says, and "Do not freeze MOUNJARO"².

The Bahamian climate problem

The 30°C ceiling matters in a country where summer daytime highs exceed it. Climate normals attributed to The Bahamas Department of Meteorology and the World Meteorological Organization show average daily highs of 90°F (32°C) in Nassau in July and August³. A pen carried in a bag on Bay Street, left in a parked car or delivered to a doorstep in August can easily exceed its labelled limit. The labels do not say what happens to potency above 30°C; they simply do not permit it¹².

The research on peptides in heat is most developed for insulin. A Geneva-led study recorded temperatures oscillating between 25°C and 37°C in a Kenyan refugee camp, reproduced them in the laboratory and found that several insulin formulations remained within pharmacopoeia limits and kept their biological activity over a four-week in-use period⁹. A 2026 scoping review of medicines stored after dispensing concluded that exposure outside a labelled range "should not be interpreted automatically as loss of pharmaceutical quality", but also that evidence is fragmented and that homes, vehicles, delivery packages and power cuts can expose medicines to extreme temperatures¹¹. Neither study tested semaglutide or tirzepatide, so the GLP-1 labels remain the standard.

The refrigerator at home is not always safe either

Patients told to "keep it in the fridge" often store it badly. In a study of 338 people with diabetes who placed Bluetooth temperature sensors next to their insulin, 315 of 400 logs (78.8%) showed deviations outside the recommended range, including all 230 refrigerated logs. Refrigerated insulin was out of range 11.3% of the time, an average of 2 hours 43 minutes a day, and 17% of sensors recorded temperatures below 0°C¹⁰. Freezing is exactly what both GLP-1 labels forbid¹².

The supply chain before the pharmacy

Storage problems can begin long before a patient opens the box. The Pharmacy Act, 2009 requires drugs that are sold, imported or exported to meet a recognised pharmacopoeia standard (section 27) and bans importing medicines for storage and wholesale distribution unless the warehouse is registered under the Act (section 33)⁴. But The Bahamas has no national drug registration system, according to the Chief Pharmacist at the Ministry of Health and Wellness⁵, and a pharmacist writing to The Tribune described a "non-registration market" where drugs are sold "without local product registration or batch testing" and where branded medicines typically arrive through "supply chains based in Central America"⁶. Every additional leg is another chance for a temperature excursion that no one measures.

The informal routes are worse. The Tribune reported in February 2026 that many medicines enter in small amounts carried by travellers, some hidden in ordinary packaging⁵. With GLP-1 prices of $250 to more than $1,500 a month, The Tribune reported in September 2026 a growing market for their "unregulated acquisition"⁷. When researchers bought semaglutide vials online, they found purity of 7.7% to 14.37% and endotoxin in every sample, problems that have nothing to do with heat but show how little is known about such products' handling¹². WHO's 2024 alert on falsified Ozempic reminded patients that injectable semaglutides should be "stored in the refrigerator"⁸.

What good practice looks like

The World Health Organization's model guidance on the storage and transport of time- and temperature-sensitive pharmaceutical products sets out the principal requirements for the safe storage and distribution of these products along the supply chain, while "local legislation and regulations will continue to take precedence"¹³. For physicians, the practical steps follow from the labels: ask where a patient's pen was bought and how it travelled, advise refrigerated storage away from the cooling element, keep in-use pens below 30°C and out of cars and direct sun, and count room-temperature days against the label limit¹².