How do you handle meds expiring soon for patient?

[Jabberwocky12]

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So I am sitting with a migraine last night, and like a dork a thought popped in my head as I took my free treximet sample (imitrex is AWESOME, btw).

When you work at CVS (and prolly wags and other places) the bottles you give to the patient say not to take the meds 1 year from the fill date (so don't take anything March 2nd, 2012 if you got it today.)

Well, if you look on the bottles of a bunch of meds in the pharmacy, I'll bet you'll see an expiration date before a year (maybe within 6 months.) At least that was the case in my old CVS.

So how effective are drugs that go past the expiration? I hear that they are like, 95% effective but legally you can't tell a patient to take them anyway. So is CVS breaking the law by saying you can take it up to a year from the fill date but the meds expire within 6 months?

I know most meds are taken within a few months, but for some meds like imitrex, that are only taken PRN (and for example, I only get a migraine once a year,) how would this be handled?

As a pharmacist advising a patient, what would you say to them if they somehow found out and/or the medicine was something that you KNEW had an early expiration like a compounded antibiotic? As a pharmacist taking the medicine yourself and knowing this fact about efficacy of expired drugs, what would you do? Throw them out or take them anyway?

NOT medical advice, just the thoughts of someone who doesn't have much better to do right now. This normally wouldn't be an issue but for people who have PRN meds like nitroglycerin or imitrex it seems like it could be an issue.

 

[rxlea]

Expiration date denotes when the drug is at 90% "effectiveness" of the original product. When I worked retail back in the day, we had the blister pack for Imitrex that had the exp date on it. When my gf got her Imitrex filled this last time, they gave her a manufacturer bottle. I thought that's how they dispensed all Imitrex and the like...

For stuff like levothyroxine, I imagine it would be a problem but the true problem then would be patient compliance 😉

 

[Jabberwocky12]

Expiration date denotes when the drug is at 90% "effectiveness" of the original product. When I worked retail back in the day, we had the blister pack for Imitrex that had the exp date on it. When my gf got her Imitrex filled this last time, they gave her a manufacturer bottle. I thought that's how they dispensed all Imitrex and the like...

For stuff like levothyroxine, I imagine it would be a problem but the true problem then would be patient compliance 😉

Yeah we had some patients though who got an odd amount for insurance coverage reasons so they got a bottle. Don't ask me how that goes.

In general, if a medicine expires within 3-6 months but the bottle says a year, is the patient going to have an issue/will the pharmacy be doing something illegal?

 

[Carboxide]

Yeah we had some patients though who got an odd amount for insurance coverage reasons so they got a bottle. Don't ask me how that goes.

In general, if a medicine expires within 3-6 months but the bottle says a year, is the patient going to have an issue/will the pharmacy be doing something illegal?

Expiration date should be one year from fill OR until the manufacturer denotes expiration has occurred, whichever comes first.

 

[Jabberwocky12]

Expiration date should be one year from fill OR until the manufacturer denotes expiration has occurred, whichever comes first.

How does the patient know this though? There is no section to mark on the script the expiration date of the bottle so the patient thinks they have a year and are good to go.

 

[rxlea]

How does the patient know this though? There is no section to mark on the script the expiration date of the bottle so the patient thinks they have a year and are good to go.

That's the responsibility of the pharmacist....

 

[Jabberwocky12]

So knowing this, if you had your own medicine that had expired a few months ago, would you still use it?

I'm not talking about narrow therapeutic index drugs like warfarin or anything, but if you had a BP drug like HCTZ that you were discontinued on then started up again and you had 30 days left, would you do it? Or a medicine used infrequently like viagra or imitrex?

 

[owlegrad]

So knowing this, if you had your own medicine that had expired a few months ago, would you still use it?

I'm not talking about narrow therapeutic index drugs like warfarin or anything, but if you had a BP drug like HCTZ that you were discontinued on then started up again and you had 30 days left, would you do it? Or a medicine used infrequently like viagra or imitrex?

Whenever my mom's medications expire (aspirin, APAP, w/e) she moves them to another bottle whose expiration date is longer. Her justification? "Oh they only put those expiration dates on there to get you to buy new bottles. It's a pill, how can it expire? I'm sure it's fine." Why move it at all you may be thinking? Because she doesn't want people to think she is taking expired medication.

We once had a guy ask if he could return some expired viagra. We told him no. He then asked if it would still be good. The pharmacist told him that in all likelyhood it would still be perfectly fine to take it but that it may not be as effective as it normally would be. I thought that was kinda odd - surely telling someone that their viagra may not work as well as normal is setting them up for failure?

 

[DYSF777]

Expiration date denotes when the drug is at 90% "effectiveness" of the original product.

So would you tell this to a patient asking about their expired doxycycline prescription?

 

[rxlea]

So would you tell this to a patient asking about their expired doxycycline prescription?

No, because my first question would be, "Why are you taking expired doxycycline?"

 

[rxlea]

So knowing this, if you had your own medicine that had expired a few months ago, would you still use it?

I'm not talking about narrow therapeutic index drugs like warfarin or anything, but if you had a BP drug like HCTZ that you were discontinued on then started up again and you had 30 days left, would you do it? Or a medicine used infrequently like viagra or imitrex?

If I was "started up again" (presumably by a doc), then surely I would have a new prescription, no?

 

[DYSF777]

No, because my first question would be, "Why are you taking expired doxycycline?"

I'm sure you've worked retail. If so then you know it's a common occurrence for people to call and ask if they can take antibiotics that they had left sitting around.

 

[rxlea]

I'm sure you've worked retail. If so then you know it's a common occurrence for people to call and ask if they can take antibiotics that they had left sitting around.

Yes I have. And then I would ask why they are taking abx that are laying around... I would try to obtain more info about their situation.

So, if you want a yes/no response, I guess the answer to your question is No, I would not advise them to take expired abx.

 

[Jabberwocky12]

If I was "started up again" (presumably by a doc), then surely I would have a new prescription, no?

Yes but people don't like to waste pills/pay another copay. If I have 20-30 pills left over, would I throw them away? What if it was a brand name drug instead and they had a brand copay around 35/50 bucks?

I'm just saying that if people want to take them and they don't want to "waste" money on another set of meds when they have one already, are they harming themselves?

 

[Naidim]

If I was "started up again" (presumably by a doc), then surely I would have a new prescription, no?

But what if they can't afford a new bottle? Would you advise them to at least take the old stuff until they can afford it?

 

[rxlea]

Yes but people don't like to waste pills/pay another copay. If I have 20-30 pills left over, would I throw them away? What if it was a brand name drug instead and they had a brand copay around 35/50 bucks?

I'm just saying that if people want to take them and they don't want to "waste" money on another set of meds when they have one already, are they harming themselves?

As you pointed out, it depends on the med. It probably wouldn't HARM a patient but for meds like warfarin or levothyroxine, it would matter. For stuff like HCTZ, it probably doesn't matter as much.

EDIT: also, it depends on just how expired the meds are. 2 months? No biggie. 2-3 years? Yeah, probably matters.

 

[Old Timer]

I'm sure you've worked retail. If so then you know it's a common occurrence for people to call and ask if they can take antibiotics that they had left sitting around.

I always ask them is they would drink expired milk or eat expired meat. The answer is always NO, and then they have their answer.

 

[DYSF777]

Yes I have. And then I would ask why they are taking abx that are laying around... I would try to obtain more info about their situation.

So, if you want a yes/no response, I guess the answer to your question is No, I would not advise them to take expired abx.

It should have been an emphatic no. When doxycyline breaks down it produces nephrotoxic byproducts that can cause Fanconi syndrome. That was the point I was trying to make.

It's not as simple as stating that a drug loses 10% effectiveness after it expires.

 

[All4MyDaughter]

It should have been an emphatic no. When doxycyline breaks down it produces nephrotoxic byproducts that can cause Fanconi syndrome. That was the point I was trying to make.

It's not as simple as stating that a drug loses 10% effectiveness after it expires.

It's safer to just say no about all expired meds. There are some others that have break down issues or toxic byproducts but I can't remember them all at the moment.

 

[rxlea]

It should have been an emphatic no. When doxycyline breaks down it produces nephrotoxic byproducts that can cause Fanconi syndrome. That was the point I was trying to make.

It's not as simple as stating that a drug loses 10% effectiveness after it expires.

Nice set up. Dick move, though. You're right. And like I said before, I would not say "they lose 90 percent effectiveness" to a patient. I was saying that to an above poster. As for expired meds, as others said, the answer is No.

 

[DYSF777]

Nice set up. Dick move, though. You're right. And like I said before, I would not say "they lose 90 percent effectiveness" to a patient. I was saying that to an above poster. As for expired meds, as others said, the answer is No.

Just giving you a hard time.

 

[rxlea]

Just giving you a hard time.

Well, it's not that fun.

 

[Ackj]

It should have been an emphatic no. When doxycyline breaks down it produces nephrotoxic byproducts that can cause Fanconi syndrome. That was the point I was trying to make.

It's not as simple as stating that a drug loses 10% effectiveness after it expires.

Not only doxy either, it's all of the tetracyclines afaik. Another big one to watch is your EpiPen. Doesn't get toxic, but efficacy drop is a much bigger deal when you're gasping for air and you're just not quite getting enough drug. It's a hard drug to remember too, since you're (hopefully) not taking it very often, so getting your yearly refill might slip your mind for a few months.

 

[bwsalvas]

People ask me all the time about it- and it is my opinion not to mess around. Since I have no analytical devices at my disposal, I'd be lying if I said otherwise.

Not to say I intend to use my 1000 count ibuprofen 200mg bottle at home up before next May, but in recommending things to the public I don't have the tools to be completely sure.

As for CVS, you can edit the expiration date if it's less than a year from the dispensing date.

 

[mipharmd]

almost every software for pharmacies allow you to change when the drug expires.. so when you have a drug that is short dated- you put in that new expiration date...

if im not mistaken... its called misbranded if you dont..