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Once you start using a pen, it can typically be stored at room temperature for several weeks, but unopened pens need to stay refrigerated until first use

Mannucci E, Monami M, Di Bari M, Lamanna C, Gori F, Gensini GF, et al

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In the researchers sub-analyses of NAC doses, only patients with high cumulative daily dose levels demonstrated a significant reduction in the risk of developing dry AMD, whereas no significant effects were observed in the lower dosage groups

The trade-off is shorter shelf life from the moment you receive the product, since the stability clock started ticking when the pharmacy mixed it, not when you open it