Can you take expired medicine?

Check out my video to know the answer!

You go to your local Costco, and see that they sell GIANT BOTTLES of medicine for a much cheaper than if you were to get it at your local pharmacy….naturally, you grab it since it makes sense financially.

You take it home and store it in your medicine cabinet, feeling good that you have all the medicine you need for any pain/redness ect..

Fast forward a year + later, these bottles of medicine are untouched (yay! You’re been doing very well and haven’t need to take the meds)…..well the next morning, you wake with a huge migraine, time to go to your medicine cabinet and reach for your Tylenol!

Uh oh…it says that the medicine has been expired! Should you take it? is it safe? Do you need to throw it away?

But it’s such a waste!

Ahh…all these emotions over a bottle of expired medicine.

Did you know that in 1979, the U.S Food and Drug Administration began requiring an expiration date on both prescribed and OTC medicines. The expiration date is a critical part of deciding if the product is safe to use and will work efficiently. Once the expiration date has passed there is no guarantee that the medicine will be safe and effective. If your medicine has expired, do not use it.

It is extremely risky to take expired medicine due to it being less effective and also due to a change in chemical composition and decreases in strength. Expired medications are also at risk of bacterial growth and sub-potent antibiotics can fail to treat infections, leading to more serious illnesses and antibiotic resistance.

My advice? Skip out on medicine bottles that contain large quantity of pills. Purchase smaller amount. Make sure you read the expiration date label and properly dispose expired medicines.

Could automatic pharmacy be the future?

This was what I asked my fellow pharmacy managers and most said no, there are too many “shades of gray” in retail pharmacy that require a pharmacist to figure out. I do agree that pharmacists are required for a lot of tasks that a robot can not do like: counseling, unclear directions, catching uncommon errors, etc. On the other hand, I am a big fan of science fiction, and imagining a world where there are robot pharmacists really piques my interest. 

Thinking rationally though, there could be a pharmacy where only robot dispensing units are present. Simply, you just need to meet a few specific parameters.

1) The pharmacy likely has to be in an outpatient hospital setting, not retail. This allows it to have a set formulary, creating a very controlled environment.

2) Providers (from the hospital) can only order medication on the formulary and only with very specific directions.

3) If there are any major drug interactions, doctors can not order those medications. They will have to pick something else. 

4) You have a robot filling all medications. You can have another robot check to make sure the right pills are in the bottles. Pharmacy technicians will dispense the medications to patients. 

Of course, this hospital outpatient pharmacy can not exist at this point due to pharmacy laws but at least, it should be relatively safe for patients. 

There are quite a few issues with this pharmacy of course, feel free to point them out 🙂

High burnout for Clinical Pain Pharmacist

Though rare at one point. Clinical pain pharmacists (CPP) are becoming more common place; some pharmacist can even take extra schooling specifically to go into pain pharmacy. With this specialization becoming more popular, the increase risk of burnout also comes hand-in-hand. Why would this specialty cause so much burnout?

Opiates might not be appropriate for some chronic pain patients and will need to be stopped (tapered off). This process is very difficult and time consuming. A CPP main goal is to help patient through this very difficult time. When patients have an increase in pain during a taper, they might take out of their frustration towards the CPP.

Chronic pain is very difficult condition for most providers to talk about, and more so to try and treat. It should be treated by many different methods, not just medications. Some patients put too much focus on medications versus the other methods. This also puts a lot of focus and pressure for a CPP to come up with a solution by using only medications alone, which is not possible.

Hydroxychloroquine hoarding versus toilet paper hoarding.

This post is not to argue for or against the off-label use of hydroxychloroquine for COVID-19 since there are already some good thoughts from the CDC on it. The main thing people should take away is that the CDC mentions “hydroxychloroquine is currently under investigation in clinical trials for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection, and treatment of patients with mild, moderate, and severe COVID-19. ”

What is more concerning to me is how there are rumblings from the pharmacy community of doctors prescribing large amounts of tablets for themselves and/or for their family members. This large amount is assumed to be an attempt to stockpile the medication for use as prevention/treatment of COVID-19. I guess toiler paper isn’t the only thing we are stockpiling. This is frequent enough that Washington’s Medical Commission sent out a statement asking “pharmacists to act with their best discretion to ensure patients continue to receive appropriate treatment in time of shortages.” The appropriate treatment of hydroxychloroquine would be lupus, rheumatoid arthritis, and malaria and NOT for prophylaxis of COVID-19. We are potentially creating a drug shortage for people who actually need it, ie people with approved indications for it.

Again, I want to emphasize that I am not against the use of hydroxychloroquine for clinical studies. I also feel at this point (3/25/2020), there are probably good reasons for physicians to prescribe off-label use of hydroxychloroquine for COVID-19 patients who are critically ill. So the hoarding hydroxychloroqine would, to me, be purposely slowing down clinical studies and hurting critically ill COVID-19 patients.

In short, hoarding of toilet paper might leave someone in “deep shit,” pun intended, but hoarding of hydroxychloroquine will leave someone in deep shit health wise.

Stay safe everybody!

Diabetes and “the virus”

Hello everyone,

I hope everyone is keeping their hopes up and their pillboxes full. As always, it’s prudent to keep a good supply of your medications in case you cannot leave your house, but you might want to be more vigilant with stocking up on other things if you have diabetes. In 2018, potentially 10.5% of the US population had diabetes so we know how important it is to keep diabetics safe during these difficult times. We all know high blood glucose (sugar) is not a good thing but don’t forget low blood sugar (hypoglycemia) is not safe either especially when you are a diabetic.

It scares me to hear when a patient say, “my blood sugar was so low that it woke me up and I had to go downstairs to get juice.” Please consider keeping a good supply of juice (or your glucagon kit) in easily accessible areas throughout the house so you do not have to walk up or down the stairs while you are dizzy and shaking from hypoglycemia.

Also, don’t forget to refill all your test strips and lancets to keep monitoring your blood sugar if that is what your doctor recommends. You might not be as active if you are stuck in the house so good monitoring of your blood sugars is especially important during these times.

Hope everyone is doing well and is staying safe. Please note my *disclaimer* at the bottom of this blog. Thank you.

Out of Hand Sanitizer? Ask your compounding pharmacist.

Hello friends,

Are you frantically searching for hand sanitizers but they are nowhere to be found? Well, you technically can find them but it’s going to cost you an arm and leg for just a bottle of hand sanitizer.

Worry no more! The FDA released some good news that allows temporary compounding of certain alcohol-based Hand Sanitizer products by pharmacists in State-licensed pharmacies or Federal facilities and registered outsourcing facilities.

These “State-licensed pharmacies” refers to compounding pharmacies so if you are already using a compounding pharmacy to make your other medications, you can ask the compounding pharmacist if they are able to make a nice batch of Hand Sanitizer. This is not a perfect solution but would be a lot better than trying to make your own Hand Sanitizer (which I know some people have been doing).

Word of warning though, when I called my local compounding pharmacy, they said the cost was $6 for a small 2 ounce bottle!

Stay safe and well-informed, friends!

Coronovirus preventing medication fills? Talk to your local pharmacist!

For those living in the state of Washington, there are some recent news that might help cure some of your coronavirus woes. If you are having problems filling your prescriptions because of the following, try asking your friendly local pharmacist to help:

  1. The Insurance Commissioner issued an emergency order to Washington state health insurers to allow a one-time early refill for prescription drugs. But before you call your local pharmacy, make sure to check with your health plan whether or not your prescriptions (and drug plan) is included in this emergency order.
  2. It was recently announced by the Pharmacy Quality Assurance Commission that rule WAC 246-869-105 is in effect which allows a pharmacist to provide an emergency refill of an expired prescription for a 3 day supply for non-maintenance medications and a thirty-day supply for a maintenance medication if the pharmacist is unable to obtain refill authorization from the prescriber.

In general, there might be some lag time between these announcements and and the participation of your local pharmacy, so it is always good to work collaboratively with your pharmacy and insurance to figure things out. Hope this helps someone and don’t forget to wash your hands!

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