It obvious that use of expired medicines where there are alternatives is unacceptable. There are, however, situations where the only available alternative medical product (medicine) used for life-threatening disease condition is expired and left with bare hands. What do healthcare professionals do on this situation, especially in this covid-19 pandemic where procurement is a challenge? Based on the risks-benefits assessment - the risk of leaving a patient without alternative and using expired medicine to save the patient and its associated risks - if they clinicians are going to use the product, what strategies they should follow to avoid medico-legal issues and transparency with consumers.
Looking forward to hear back from you?
Kind regards,
Mulugeta
Many products have an extended shelf life. Most people would use an expired EPI pen in an emergency situation if that was all that was available. On 05 Feb 2020, Medscape published an interesting article by Douglas Paauw, MD, "Are Drug Expiration Dates a Myth?" https://www.medscape.com/viewarticle/924683_1
Thank you so much Bruno for this important information. Such people are making the world very sensitive and insecure.
Kind regards,
Mulugeta
Many products have an extended shelf life. Most people would use an expired EPI pen in an emergency situation if that was all that was available. On 05 Feb 2020, Medscape published an interesting article by Douglas Paauw, MD, "Are Drug Expiration Dates a Myth?" https://www.medscape.com/viewarticle/924683_1
Dear All,
Thank you so much for your thoughts/comments. The suggested reading provided by Anne Macek was interesting and connected me with several studies conducted aimed at evaluating potency of expired medicines years after expiration date. The studies (see links below) revealed that many pharmaceutical products were found to retain greater than 90% of their potency several years after expiration. Accordingly, the authors recommend or suggest reconsideration of the current practice of drug expiration dating and some recommend to used when no suitable alternative is available.
The main challenge here is the safety issue. There are fear of poisoning, fear of serious adverse effects and other related risks. Besides, use of expired medicines, even under seriously critical condition is not legal and thus, might raise medico-legal issues. For example, in a situation where the only available antivenom is expired, what do you do, as clinician, if you have a severely ill patient with snake envenomation? Would you administer the expired antivenom to possibly save the patient or you leave him/her without alternative? In case, legal issues raised, how do get ride of it?
Links:
1. https://www.wemjournal.org/article/S1080-6032(18)30209-6/fulltext
2. Article Stability of Active Ingredients in Long-Expired Prescription...
3. svmi.web.ve/wh/documentos/Drugs-Past-Their-Expiration-Date.pdf
Thank you and kind regards,
It depends. USA has an official SLEP program of appropriately stored drugs, mostly at emergency stockpiles. Many of such drugs could not be returned to the manufacturers due to very limited use in peace time. Needless to say that such programs save to taxpayers billions of $. All batches are tested accordingly to USP or manufacturer's test methods and effective shelf-life of many batches is prolonged for many months/years. Individual user - different story and nobody really knows the right way - money saving vs potential health harm. Recent story about n95/surgical face masks, their potential shortage and talks about strategies of reuse/expiry extension is another point proving the complexity of the question
Thank you Pavel for the important information. It is much appreciated.
Ideally, expired drugs should never be used. The manufacturers however have procedures in place to re-analyse expired products and if they meet the necessary quality parameters, re-label them extending the expiry date.
Many drugs may retain their potency beyond the expiry date, but the main concern is with regard to degradation products and their safety!
In my view, sometimes there is need of medicine for life threatening condition and your stock is out of balance. well, I think the decision to give the medicine should be not only be made by one doctor, rather a discussion between doctors, Hospital pharmacist, clinicians have to be made prior to giving the medicine.
In my opinion, it depends on the dosage form. But for business reasons, pharmaceutical companies make the expiry date based on their benefits.
https://www.health.harvard.edu/staying-healthy/is-it-ok-to-use-medications-past-their-expiration-dates
https://www.medscape.com/viewarticle/924683_2
Regards
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