Fansidar, does anyone have a protocal? Also expred meds, how long?

[DwayneEMTP]

A case recently came to the attention of, someone, not sure who, but it landed on my desk, where a heavy equipment operator was prescribed Fansidar for his malaria and then sent back to work. They want to know if this was a safe decision.

Though it's prescribed here, it's prescribed by the local national staff. I've never prescribed it nor cared for a patient post delivery. Does anyone have any information that I can use to answer this questions? I've Googled, and gone to my fav Drugs.com, but though they explain that it can make you drowsy and/or dizzy, not how severe or common those issues are. I get the feeling that the person asking the question is looking to stomp his feet about it, so I want better information than I've found so far. (Note, he won't be stomping on me. Not my patient, nor my prescription.)

Also, I'm currently in a knock down drag out over the use of expired drugs. I was told by my family doctor, who has a related news article hanging in her office, that the vast majority of prescription drugs are good up to 5 years after their expiration date. (expiry, for those on this side of the planet.) I've also been told by a drug rep that in most cases it's the packaging that expires, and not the drugs.

Does anyone have sources for this, or arguments supporting this? They want me to remove my expired morphine and valium from my jump bag despite it's being terribly hard to replace here (as it sound is the case nearly everywhere.) I've refused so the Safety manager, who's in charge of the clinic, has told me to validate my position or destroy my drugs...

So, as often happens, here I am...

Thanks all...

[chbare]

It's a combination of two medications and it probably wouldn't be my first choice for treatment or prophylaxis. It has been black boxed due to a high risk of blood dyscrasia development and SJS.

[island emt]

unfortunately this is going to be based wholly on hearsay and inuendo: Current practice in most places is to turn in our "expired" medications to the hospital pharmacy so they can package them up and send them to medical missions in places such as Haiti or South America run by local Dr's & nurses.

There is nothing wrong with the majority of medications for many years after the published expiry.

There are exceptions in those drugs that need to be kept refrigerated or such as nitro that exposure to moisture / air after opening will decrease potency.

On the subject of expiration dating of products. Why are they dated? Does the product no longer meet safe use criteria at a stroke of the calendar?

Does the product fall apart or disintegrate at the stroke of the clock?

OR is the reason for expiration dates to make sure that we keep having to buy new products and throw away perfectly good products.

Some examples: powdered activated charcoal grannuals in hermetically sealed single use containers or nasal hoses made from silicone not natural latex. How about chemical hot or cold packs. {i got hit on annual inspection this year for hot packs that were 3 months past exp.] They still work fine and i buy them by the case. plastic bottles of saline for irrigation

[jonas salk]

There was a was Wall Street Journal article I read a few years ago about how the US armed forces has, in an effort to cut costs, established a program to determine how long drugs last post expiry date. What they found was that the vast majority were fine. Though the article also mentioned something i found interesting, that there were some drugs which the military made a conscious decisions not to use post expiry date due to possible PR ramifications. the main one being saline and ringers, that it would look absolutely terrible for an injured solider/sailor to look up in their bed to see that the NS drip running into their arm expired three years prior.

http://online.wsj.com/article/SB954201508530067326.html

[DwayneEMTP]

Thanks guys.

Jonas, I found that article, thanks. I pasted it as well as some others into my argument.

Chris, yeah, it doesn't sound like an exceptionally safe drug. I've not used it as I only get involved with the most severe malaria cases, to try an verify it's not something else more dangerous that's being confused by local staff as malaria.

Thanks Island. According to the above article, and others, the expiration dates are secondary to 'some' drugs losing their potency over time mandating expiration dates to ensure that consumers get 100% of what they purchased.

But the length wasn't mandated, so the second reason, and the reason that they are allowed such a short shelf life, is marketing. To get you to destroy them so that you'll buy more.

[DFIB]

Sorry buddy I know absolutely squat about Fansidar and it's side effects but have considerable experience with expired drugs.

What yo heard about expired drugs is true for the most part. In ophthalmic drops I was told by ophthalmologist that so long as they are not cloudy they are still good.

The only limitation I find in my personal twisted logic and life experience are drugs that are temperature and light sensitive.

I once had a pharmacologist tell me that the problem is not the drug itself but the excipient they are mixed with particularly pills. He claimed that over time the excipients can produce a low toxicity, I have only heard this once and from one person. Many other professionals have vouched for the effectiveness of drugs far past their expiration date. I have also witnessed expired drugs used with expected results.

In a place where there are no legal implications you would probably be OK.

This of course is a personal opinion without the luxury of scholarly confirmation.

[Richard B the EMT]

Speaking as someone who is only authorized to assist the patient in taking their own Nitro, administering chewable "baby" aspirin, 2 doses nebulized albuterol, and oxygen, the issue of potency decline due to age has been mentioned by the Paramedics I work with, and the instructors at refresher. Per training, even O2 in the cylinder's is supposed to have an expiration date.

If someone in authority tells me to restock with stuff that expires later than what I have already on the vehicle, or in my kit, I'll do it. Last time through, during training, we used the auto-injectors from the WMD kits that had expired. New stock, possibly other drugs, had already been put into the kits from where we'd gotten, and re-stockpiled, the 2PAM originally.

[BEorP]

Hey Dwayne,

In terms of the drugs, I think that your best source will likely be a good pharmacist. I agree that most drugs are probably good long after their expiration date, but some are not. There are also probably many factors that will affect how long they last, including how they have been stored. Also, of course, whether we are talking about weeks, months, or years expired is going to matter.

If the choices you have there are between using expired morphine or none at all (i.e. if you took the expired morphine out, it simply wouldn't be replaced as I think you're saying), then the most important question seems to be that even if the morphine were waaaaay expired and didn't work, would it actually do anything bad to the patient or would it just do nothing good for them? Again, it will probably be a pharmacist who will be in the best position to provide advice on this.

I know that this probably isn't the most practical suggestion for you, especially since you wouldn't want to ask a pharmacist who just wants to sell you more drugs and no pharmacist is likely to put on paper that a drug will be good long after its expiration date.

If you can give some more specifics on dates and storage, I can run it by some pharmacists here, though that won't get you anything on paper to bring to your people.

[DwayneEMTP]

Actually, there is a well documented, huge study done by the United States military who, as you can imagine, was destroying millions of dollars of expired drugs each year.

The study was done on 100 drugs that were neither light or temperature sensitive. After 15 years it was found that only a few of them had lost a tiny percentage of potency, and that none had been altered to become dangerous. Now, I'm going from memory and don't remember the source as I looked at skads of stuff, but I believe that the FDA concluded that the drugs from the study, I didn't find a list, should be considered acceptable for use 10 years after date of expiration. That just seems like a really powerful statement to me, coming from the FDA.

(For non Americans the Food and Drug Administration is the God of all things that go into your body in the U.S.)

Not sure if I've made my point to them or not. But for now a rule has been made for everyone to stay the hell out of my bags...

^{Thanks everyone, for your help!}

[BEorP]

Interesting stuff, thanks for that. I managed to dig up the study, which is available here. The most important line from the abstract seems to be: "Based on testing and stability assessment, 88% of the lots were extended at least 1 year beyond their original expiration date for an average extension of 66 months, but the additional stability period was highly variable."

I haven't had a had a chance to actually read the paper, but I didn't see any mention of 10 years in the abstract. Still, an average extension of 66 months is all you might need! Let me know if you need the full text to prove your point to anyone at work.