Expired Drugs. Die or Ditch? New Report

[brownoarsman]

Originally Posted by Alan Mighty

You need a new nurse.

As long as you don't suggest he needs a new wife! 🙊

I checked this specifically with regards to asthma medication (I can't get the kind I like in the US so load up overseas), and was told that rescue inhalers are fine from a safety standpoint, but lose a marginal amount of potency. No big deal, as in an asthma emergency, I'm puffing like a fiend anyways


Sent from my iPhone using Cruisers Sailing Forum

[GordMay]

Originally Posted by Alan Mighty

.... Tetracycline, a common antibiotic, is one medication that can "turn toxic" by decomposing into epi-tetracycline and anhydro-tetracycline. One possible result is a form of kidney damage called Fanconi Syndrome.

Not since the 1960s.
From the article:
“... There are no published reports of human toxicity due to ingestion, injection, or topical application of a current drug formulation after its expiration date.
Renal tubular damage has been reported with use of degraded tetracycline in a formulation that is no longer available ...
... There are no reports of toxicity from degradation products of currently available drugs."

[Alan Mighty]

Originally Posted by GordMay

Renal tubular damage has been reported with use of degraded tetracycline in a formulation that is no longer available ...
... There are no reports of toxicity from degradation products of currently available drugs."[/I]

Very brave to make that assertion in these days of generic drugs. The Big Pharmas are no longer the only manufacturers, no? You're prepared to guarantee that you know how all the world's tetracycline is formulated? I'd guess that at least some of the world's production 'tetracycline' is fake.

[Moonos]

Well if they are quaaludes (wolf of wall street...) then they might take longer to take effect..

[Captain Bill]

Originally Posted by Alan Mighty

You need a new nurse.

Tetracycline, a common antibiotic, is one medication that can "turn toxic" by decomposing into epi-tetracycline and anhydro-tetracycline. One possible result is a form of kidney damage called Fanconi Syndrome.

I have also been warned about the closely related antibiotic doxycycline.

[MarkJ]

Originally Posted by Alan Mighty

Very brave to make that assertion in these days of generic drugs. The Big Pharmas are no longer the only manufacturers, no? You're prepared to guarantee that you know how all the world's tetracycline is formulated? I'd guess that at least some of the world's production 'tetracycline' is fake.

Did you read the report I posted in the initial post in this thread?


Doesn't look like many did.



Mark

[elliott52]

Worked in big pharma for 23 years. Expiration date is pulled-in a minimum two years from actual expiration date to guard against lawsuits. Drugs stored in a cool, dry space will last even longer.

[roland stockham]

There are several issues here. First when administering drugs in a clinical setting (as compaired to giving them for you to take home) then we are often using high doses to get the required affect. This may be a dose at the top of the theraputic range. If the drug has lost potency that can have a significant effect so even a 10% loss could mean I want a fresh supply. Does not apply on the boat! Frequently dosage limits are set at the point where side effects become a problem but just because the drug has lost potency does not mean it has lost side effects. Again unlikely to be significant on the boat. Things get contaminated, how good is the pakaging at resisting microbial contamination, could I be giving the patient something extra with their drugs? Again probably not significant on the boat unless you live in a mangrove swamp. So there are good reasons for opting for a shorter shelf life in a hospital. It may be that useful life is significantly longer in other environments. Lastly shelf life is not a problem. I almost never throw out drugs simply on an expiry date, they are either used or thrown out because the patient no longer needs them. Given that hospitals are such a major consumer of drugs it is not surprising if manufacturers aim expiry dates at this market. Labeling with expiry date of 10yrs - but only five in hospital would not look so good.
The final point is that if I give a drug beyond it's expiry date, or advise someone that it is OK to take one it could be considered mal-practice

[sailon46]

Originally Posted by MarkJ

Cruising "out there" means long expired drugs in the cabinet or First Aid Kit.

Some cruisers say you will die poppin an expired drug. Some say they last forever.

A new reports show that its closer to Forever, and NO toxic worries.

Drugs degrade over the years, but we are talking up to 50 years. Many are fine to 5 years after expiry just maybe the dose has dropped off a bit

So have a look at this report and lets here your thoughts. (Please read the report before you comment. I will know )





https://m.medicalletter.org/w1483b


Would particularly appreciate any Medicos thoughts


Mark



Sent from a stupid phone that replaces words with weird stuff.

I perform stability studies of drugs used in hospitals for pharma in my business and I would say that it depends on the drug agent and if it is in solid or liquid suspension.
In the boat environment make sure all your meds (solids) have a silicon dehumidifier cap in them, it will help a lot in the long run. For NSAID's aspirin cannot degrade easily but your Acetaminophen and Ibuprofen will if wet. Antibiotics will do OK if not wet and even pain meds survive a boat trip or two ok, I have checked them
Ernie on the Mary Jane

[fatherchronica]

according to an FDA report from about 2 or 3 years ago there are a couple of drugs that will lose their effectiveness over time, but none that will hurt you. It is according to the FDA a scam by the pharmaceutical companies and the AMA to get you to throw them away and go see a doctor. They need money right now a lot. Likewise Consumer Reports did a study using New York taxi cabs that determined that changing your oil every 3,000 miles was an oil industry scam to sell oil and that in a healthy gas powered car engine oil was in perfect shape to 5,000 before it began to degrade. That said, I am about 1 oil change ahead on my Yanmar right now, and I change oil when it is convenient ahead of long voyages no matter the hours.

[Meacenas]

We also keep old Vicodin stashed for toothaches. Its never fun to have a toothache when your a couple days away from a dentist. The old Vicodin seems to hold its strength for a few years.

As an important side note, any old medicines and drugs should be disposed of at your local certified disposal sites, NOT dumped down the head or tossed overboard or put in the garbage. The drugs that are dumped into the head end up in the water directly and the meds that are put in the garbage ends up leaching out of the sites through the ground water to our drinking water sources.
We live on Lake Ontario and the water is constantly tested now for pharmaceuticals because they are tainting our drinking water. You can read about it here....
Ontario Has Record-Breaking Level Of Drugs In Water

We keep all expired drugs we are not using in a plastic container and about once every six months, take them to a local supermarket when they have a drop off day.

[grantmc]

Originally Posted by Island Time O25

Years ago I had a relative who worked for pharma company in Europe. She used to laugh at the expiration date worries saying that most dates are there for marketing reasons as 99% of the drugs are still good years after these mostly arbitrary dates.

Of course it is about marketing. It's exactly the same thinking in the food industry.

Would you buy a drug labeled as having a 10 year expiry that had been made 8 years ago? Some of us have been around long enough to remember when they didn't have expiry dates; and not too many people worried how long an item had been stored.

[pete33458]

I'm not a "medico" but I am a scientist and chemist and biologist, and I can tell you a couple of things for sure. 1) expiration dates are for protecting the manufacturer against claims more than protecting the recipient from loss of activity; 2) storage conditions are EVERYTHING. If you store your drugs absolutely dry (dessicated, assuming they are not liquids, which are a different story) and cold (refrigerated or frozen), they will be good for MUCH longer than ambient conditions; 3) even in the best conditions, dosage is quite inexact. Consider a 200lb man and a 100lb woman (for those of you who say "medico," 45kg or 90kg...); both would be prescribed the same dose of almost any drug, but I am sure you can appreciate that serum or tissue levels of the active ingredient would be quite different. In fact, drugs are designed or selected to have as large a therapeutic range as possible, this range being set by no effect (at the low end) and severe adverse effects (at the high end). As "therapeutic range" implies, everything in between is effective. So losing 10% or 20% or even in some cases 50% of potency is really not a problem.

These are generalizations, so please don't interpret this as being true for all drugs and all conditions, but it is generally applicable for MOST drugs and MOST conditions.

Pete

[Dody]

Originally Posted by MarkJ

... A new reports show that its closer to Forever, and NO toxic worries.

Drugs degrade over the years, but we are talking up to 50 years. Many are fine to 5 years after expiry just maybe the dose has dropped off a bit

https://m.medicalletter.org/w1483b
...

Thanks MarkJ for posting this!

I was never concerned about using medicine which was expired (don't use much of this stuff anyway) and got even less concerned to moment I found out that the "expired" stuff is sent to 3rd world countries to be used as medication there. Your article confirms my ideas about the subject!

Fair winds
Dody

[Hoodsail]

Drug stability studies are conducted in the USA per FDA guidance and as your Medical Letter piece describes is based upon the unopened original packaging. As a pharmacist we would routinely label medications with a 6 month expiration regardless if the original container's date was much longer. Our thinking was...typically a 1 month supply is dispensed (so 6 month is sufficient) and we had no knowledge of how the drug was stored. Is this a profession-wide practice...I can only speak for the few pharmacies I have worked in over the years and none in about 10. Factors that negatively impact drug degradation have already been mentioned. Would point out that expiration dates have no correlation to a drug's half-life and tetracycline as noted can degrade but would have to be ingested in huge amts to be harmful. Finally would recommend that you check drug expirations every 6-12 months and replace when possible. If not possible then would take what you have and based upon your response (eg pain relieved, infection resolves, blood pressure reduced) you will have a good indication of its potency. Potency is more important with some drugs (ie Lanoxin, Dilantin) than others as some have what we refer to as a narrow therapeutic index - meaning a fine line between efficacy and toxicity. Lastly, would speak with your pharmacist for specific information for your situation. thnks, Dave