E-DRUG: Can expired drug still can be used?
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Dear e-drug colleagues,
I came across a case of prepacked drug dated 9/2004 at the pharmacy. Then my students asked whether the drug can still be used for the patient. The students thought it could be used until the end of September but the pharmacist said it can be used up 1-2 months from the stated expired date and for IV medications could be used longer then that. She said she obtained the information from the manufacturer. But my comment to my students (not in front of the pharmacist) that this medication should be used the latest at mid-of Sept. I advise my students not to used expired medication because we are not sure about the efficacy and it also possible it may change to other compound which may pose a danger to the patient.
Please to share and get comments from our colleague on this issue.
Thank you,
Noorizan Abd.Aziz M.Sc(radiopharmacy) ,Pharm.D.
Discipline of Clinical Pharmacy,
School of Pharmacy,
Universiti Sains Malaysia.
11800,Pulau Pinang Malaysia
[Moderator’s comment: The expiry date is the last day at which the manufacturer can be sure that the drug is OK. In principle the drugs should not be used after that date (end September, rather than mid September). If a pharmacist gets permission from the manufacturer that the drugs can be used after the expiry date, the manufacturer should have evidence (eg longer stability studies) to back up the new expiry date.
Obviously the drugs won’t become suddenly toxic on 1 October, but one should maintain this principle of expiry dates unless in emergencies. The use of expired drugs is then at the risk of the health worker using it, and the patient should know this. In some countries using expired drugs is illegal.
It may be better to improve drug supply management and get fresh drugs rather than spending time trying to prolong their lifespan?
Wilbert Bannenberg]
E-DRUG: Can expired drug still can be used? (2)
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Dear Dr Noorizan,
Much has been written and discussed over the years about this subject, for
which there is in my view never a satisfactory solution both from a
commercial and ethical point of view. Please refer to the result of
research some colleagues and I did in Sierra Leone, sponsored by the FIP
Pharmacist of the Year Award in 1994. The report is published the
International Pharmacy Journal, Vol 8 No. 5, pp 202-206. If you have
difficulty accessing the article, please let me know so I can send you a
scanned copy.
E-DRUG: Can expired drug still can be used? (8)
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Dear E-druggers,
The reason why we are discussing this topic is because of inadequate PHARMACUETICAL LOGISTICS management that lead to drugs expiring somewhere, and also leads to some people lacking the drugs that they need. If a manufacturer gives you 5 years on the label, what would make you want to keep the drug till after expiry to use it?
Secondly, essential drugs that meet the need of the majority of the population are for the most part affordable.
With good logistics, should be easy to procure.
These specific situations that require the use of expired drugs(??) seem to be matters of life and death, so, if one knows what happens to a particular chemical entity and its excipients, like reduction in potency and by how much, then one can postulate that the dose can be adjusted according to the percent reduction in potency.
Then there is the social side of medicine where its all about what people believe in their minds. This beliefs are influenced by everyday life-the street beggar who eats off the trash cans does not care whether the food there has gone bad (unless it smells really awful), yet I do not think this is the type of situation people find themselves in with regard to medicines.
Rather than spend too much time and money discussing and investigating whether expired drugs are useful, lets just make sure that they do not expire in the first place, because they do not have to!
Ask me how!
Atieno Ojoo, pharmacist
Boston University School of Public Health
atisojoo@yahoo.co.uk
E-DRUG: Can expired drug still can be used? (9)
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dear E-druggers,
There are two aspects: legal and scientific.
In India, it is illegal to dispense expired drugs.
Every drug store is obliged to have a part of the
premises clearly marked "Expired Medicines" which
should always remain locked till medicines are
returned to manufacturers or destroyed.
If a doctor uses expired medicines he is liable under
the Consumer Protection Act as well as under other
civil and criminal laws, depending on the case.
Scientifically I know of no drug that becomes "toxic"
or harmful just after the expiry date, if stored as
recommended. Expiry date is related to the potency
part. For example, the activity of the active
ingredients must not be below 95% and not over 105%
during the shelf life. Due to stability problems
coupled with less than ideal storage conditions, the
potency may fall below 95%. In many cases, it may not
be harmful but in some instances, such as insulin, the
patients may suffer.
Dr. Chandra M. Gulhati
Editor, MIMS INDIA
(Monthly Index of Medical Specialities)
503 Mansarovar,
90 Nehru Place,
New Delhi 110019.
seeemgee@yahoo.co.uk
Tel: 26433115
Fax: 26424016/26463720
E-DRUG: Can expired drug still can be used? (10)
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Dear E-druggers
I fully agree with Dr Ojoo that pharmaceutical logistics management
contributes to a great extent whether a drug expires or not. It is evident
that accurate selection and quantification of drugs during the procurement
process is a crucial determinant in this respect.
SIGMED, our pharmaceutical logistics management system, contains some
functions which are related to this issue. Firstly, the remaining shelf -
life of the drug is calculated at the receipt. If it is too low, the user is
warned and the drug could eventually be refused. Secondly, when distributing
the drugs, the automatically created picking lists and/or delivery notes are
based on the First Expired First Out principle (FEFO). Moreover, reports are
generated with products to expire within a user - defined period so that
management could take adequate (pro-active) actions.
If a drug has expired SIGMED removes it from the stock, so that it can't
appear on the picking list / delivery note.
kind regards
Gert Kaasschieter
MedICT BV
The Netherlands
g.kaasschieter@medict.nl
www.medict.nl
E-DRUG: Can expired drug still can be used? (11)
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Dear E-Druggers,
The very idea of considering the use of an expired
drug suggest a structural defects in both the care and
drug managements processes with in the health system.
And this underscores the important role of a committed
pharmacist to ensure that the limited funds available
are judiciously used. The importance of rational and
evidence-based selection and quantifications,
scrupulous procurement, devoid of underhand deals and
proper storage of all drugs is so central to the
successful delivery of effective and efficient health
care services to the millions of underserved people in
resource-limited setting; Where health care provisions
are often bogged down with less-than optimal drug
regulatory and distribution capacities and dubious and
practices based on dogmas (This is how we are told and
we have being doing it) rather than facts .
Thanks for bringing this to the front burner.
Kazeem Babatunde Yusuff
Dept. of Clinical Pharmacy
University of Ibadan
Nigeria
yusuffkby@yahoo.co.uk