Meds and you

19 July 2006

Old pills can make you sick

Parting with costly prescription drugs may be painful, but tossing outdated medicines that are crowding your cabinet, can be good for your health.

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Parting with costly prescription drugs may be painful, but tossing outdated medicines that are crowding your cabinet can be good for your health.

Whether it's a prescription or over-the-counter remedy, drugs that have managed to stay on hand after their expiration date has passed, may be much less effective.

While reduced potency may not be a substantial problem for minor health woes, an expired drug's compromised therapeutic power could result in complications if it's used to treat a serious condition, pharmaceutical experts say.

People tend to forget
"What usually happens is people forget about medicine," said William McCloskey, associate professor of pharmacy practice at the Massachusetts College of Pharmacy and Health Sciences in Boston. "It gets buried in back behind something they bought more recently and then it's a year or two out of date."

The problem tends to turn up with drugs that are used sporadically as opposed to those used to treat chronic conditions, which often have to be consumed in a timely manner.

Summer is a critical time to preserve drugs' shelf life by protecting them from sunlight, heat and humidity, all of which accelerate degradation, said Marv Shepherd, director of the Centre for Pharmacoeconomic Study at the University of Texas-Austin School of Pharmacy.

"To be safe, the pharmaceutical companies will put maybe a 12-months or 24-months expiration date on it when they know it's probably good for 36 months, but they don't want to take any chances because they don't know where the person's going to store it," Shepherd said.

"If you put it in a glove compartment in an area that gets very hot, it won't last very long at all."

No hard-and-fast rules
Stability varies from drug to drug, and there's no way to be sure whether a medicine's potency truly has run its course once it reaches the expiration date, McCloskey said.

"If it's just a few weeks out of date that's one thing," he said. "But if it's several months out of date.... just get a new supply and toss the old one."

Erring on the side of caution is advisable, said Shepherd. "Anything over 12 months I wouldn't take, personally, even if the expiration date said it's still good over 18 months."

"You're not going to find a universal rule on this because each drug will expire at different times," he said. "Aspirin, for example - about three months is all it can handle."

It's is one of the few drugs that communicates its age and potency status in a noticeable way, McCloskey said. "Aspirin is easy to tell if it goes bad because it smells like vinegar."

Other drugs make it more difficult to know, though signs such as a tablet that breaks easily, crumbles or becomes discoloured often signal deterioration, he said.

Preserving new drugs
Since 1979, the US Food and Drug Administration has required orally ingested drug products to carry expiration dates based on manufacturers' stability data. Some topicals such as sunscreens are not required to have them.

Because the FDA can't assure that drugs held past their expiration dates are safe and effective, it recommends consumers throw out any products that have expired.

Many pharmacists also take a conservative approach. But with the costs of health care rising every year, some consumers want to keep and reuse drugs that may have passed their prime.

Some are reluctant to let go of ageing drugs, hoping that any medicine they conserve from one illness will offset the cost of treating similar bouts in the future. But such a strategy often falls short, either because regimens such as antibiotics are supposed to be taken in full or because the future illness arrives long after the drug has expired.

Some supplies can be reused
Still, some patients may be able to reuse their supplies if their health episodes aren't spaced too far apart, especially where prescription pain remedies are concerned, said Dr Joel Zive, a pharmacist in the Bronx, New York.

"Say somebody hurts [himself] and is taking Vicodin and they don't use it up because they're feeling better and then they get hurt again a few months later," he said. "They don't want to come in to the doctor and pay the copay, and then they remember they have some in the house."

Whether it's Vicodin or any other drug, Zive said he checks to make sure the pills haven't visually deteriorated and are in the original bottle. Then he asks how they were stored.

"Provided they're not keeping them in a glove compartment or in the medicine chest in the bathroom, it's fine," he said. "As a general rule, if they have filled it within a year, then it's usually OK to take it."

Boot the bathroom medicine cabinet
Zive said consumers should store medication in a cool, dry place away from children, such as in a kitchen cabinet, and direct questions about a drug's expiration date to a pharmacist. "The absolute worst place to put medicine is in the medicine chest in the bathroom."

The best way to extend the value of newly obtained drugs is to shield them from the triple threat of heat, humidity and sunlight, all of which damage the chemistry, Shepherd said. "They can destroy absorption; they can destroy the active ingredient. They can hurt a product pretty quickly."

A time-released drug, for example, that's supposed to provide 12-hour relief may be absorbed quickly and not last for the promised time if the coating is destroyed by one of the elements, said Shepherd, who's studied drug longevity.

Liquids and insulin also may be more fragile than other drugs, McCloskey said.

Another advantage to purging expired medications is it reduces the opportunity for contamination. Eye drops, for example, shouldn't stick around for more than a few months, Shepherd said.

"If you haven't used it in 30 to 60 days, get rid of it," he said. If a person touches the dropper with an eye or finger, bacteria may grow inside the bottle, which could cause an infection. – (Dow Jones)

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Meds and You Centre

July 2006

 

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