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The Myth of Drug Expiration Dates

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Re: The Myth of Drug Expiration Dates

#91

Post by pitaa »

lobster_johnson wrote: post #29
jws wrote: post #12

Earlier quoted context omitted.

Hospital systems and HMOs turn their inventory fast enough that inventory control can probably handle their problem. Small hospitals and pharmacies probably suffer more from expirations.

Aren't there many drugs that hospitals need to have at hand, but are rarely used? Things like antivenins, anti-rabies serums, or other agents that are only reached for in extreme cases. It may not be a high proportion compared to what hospitals are using on a daily basis, of course (but they might be proportionally more expensive, too).

As far as antivenins, it is my understanding that most hospitals don't keep them on hand for the most part, and instead rely on an "antivenin bank" to fly it in when needed. Interestingly, the main bank in the US is run by the Miami-Dade Fire Rescue [1]. They have a 24 hour hotline and will arrange to have antivenin immediately flown to anywhere in the world.

[1] http://www.miamidade.gov/fire/about-special-venom.asp

Re: The Myth of Drug Expiration Dates

#92

Post by JohnJamesRambo »

criley2 wrote: post #56
JohnJamesRambo wrote: post #46

Earlier quoted context omitted.

And to add into that, dosage studies are rarely adequately done for most drugs. The dose we take is often a best guess and may be twice or more than we need, so 10% is even more inconsequential.

This is completely wrong. Dosage studies happens between Phase 2 and Phase 3 trials (and Phase 4 "post marketing" too) and are the most expensive, longest and most scientific process that arguably any business engages in in the entire world. Phase 1 is a safety test in healthy ~men. These seek to find the maximum dose before adverse effects appear in the healthiest humans. Phase 2 is a safety/dosage test in a much la…

Please see papers like-

https://www.ncbi.nlm.nih.gov/pubmed/14714120 No difference in response between people taking 20 mg prozac daily vs. every third day.

Re: The Myth of Drug Expiration Dates

#93

Post by valuearb »

jessriedel wrote: post #45

This article has some shoddy logic. For the vast majority of drugs, the actual marginal manufacturing price per pill is essentially zero. That means that when the expired pills are thrown away and new pills are manufactured, there is no true economic loss. Rather, all that potentially happens is a transfer between the consumer and the manufacturer. If pill prices were set by some external force, this could at least b…

Your logic would be fine if manufacturers were required to replace expired pills with new ones. But they aren't, so early expiry dates impose enormous economic costs on consumers of drugs, while manufacturers get the massive benefits of selling drugs twice to same consumer.

Re: The Myth of Drug Expiration Dates

#94

Post by ballenf »

slr555 wrote: post #66

This issue is a conundrum. Most drugs don't fall off a cliff of efficacy when they reach their expiration date. There are drugs such as tetracyclines that should never be used past their expiration dates because they degrade into toxic compounds. Certain classes of drugs such as anti-arrhythmics or drugs like warfarin are dosing critical to the point where I would not want them if they were out of date. I worked in p…

The article states with absolute certainty that no patient has ever been harmed by an expired drug. Not doubting your point about tetracycline, but how much would a patient need to ingest to be harmed? Then there's the argument that the reason no one's been harmed is because the policy is working.

Harm due to unavailability of drugs or higher costs are much harder to track, of course.

Yet another case of a balance being hard to reach due to the visibility of costs on one side versus the difficulty of measuring on the other. So easy for the general public to see the cost of strictly enforcing overly conservative expiration dates as close to zero.

/offtopic: these issues are the achilles heals of democracies. Not that there's a better system.

Re: The Myth of Drug Expiration Dates

#95

Post by lobster_johnson »

pitaa wrote: post #91
lobster_johnson wrote: post #29

Earlier quoted context omitted.

Aren't there many drugs that hospitals need to have at hand, but are rarely used? Things like antivenins, anti-rabies serums, or other agents that are only reached for in extreme cases. It may not be a high proportion compared to what hospitals are using on a daily basis, of course (but they might be proportionally more expensive, too).

As far as antivenins, it is my understanding that most hospitals don't keep them on hand for the most part, and instead rely on an "antivenin bank" to fly it in when needed. Interestingly, the main bank in the US is run by the Miami-Dade Fire Rescue [1]. They have a 24 hour hotline and will arrange to have antivenin immediately flown to anywhere in the world. [1] http://www.miamidade.gov/fire/about-special-venom.asp

That's very interesting, thanks!

Re: The Myth of Drug Expiration Dates

#97

Post by valuearb »

Allowing drug makers to set expiry dates is a huge conflict of interest, they have massive incentives to expire their drugs as soon as possible. I'm surprised the FDA doesn't do the testing and set the dates itself.

The best solution is to require drug makers to replace expired drugs with new, for free. Given that manufacturing costs are typically a tiny fraction of sales price, this is not an expensive warranty. This will also give them incentive to make expiry dates as reasonable as possible.

Re: The Myth of Drug Expiration Dates

#98

Post by compuguy »

civilitty wrote: post #25
harshreality wrote: post #4

> The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations. What kind of reporting is this? Anything less than 100% is not "as potent as when manufactured", and the sentence implies some of those dozen weren't close to 100%. > The idea that drugs expire on specified dates goes back at…

When working with biological systems, most of the time your acceptable error margin is between 10-25%. There are a few compounds (like fentanyl or LSD) where the dosages are so small and the compound so potent that 10-25% makes a difference but for the majority, precision isn't that critical. The ones where it does matter are tightly controlled and clinically applied by a professional with active monitoring. The only…

For the former (Amphetamines, or drugs derived from them), wouldn't the potency reduction of 25% be a big deal?

Re: The Myth of Drug Expiration Dates

#99

Post by pitaa »

I was once sedated for a procedure, and heard the Doctor ask for a certain type of needle. The Nurse replied that they were out; she had just thrown them all away since they were expired. The Dr asked "how expired", and she said "2 weeks". He replied that that was fine, he wanted them anyway. And then I heard the lid on the trash can opening...

I found it quite humorous; I couldn't care less that their supplies were a bit 'expired,' nor that the sealed packages had sat in the trash can for a bit!

Re: The Myth of Drug Expiration Dates

#100

Post by collyw »

Greed wrote: post #34
harshreality wrote: post #4

> The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations. What kind of reporting is this? Anything less than 100% is not "as potent as when manufactured", and the sentence implies some of those dozen weren't close to 100%. > The idea that drugs expire on specified dates goes back at…

I work for a company that has some periphery exposure to FDA-regulation, and as a result we have to do a lot of very similar scientific calculations to satisfy their archival records. A big part of why most medicines still expire (at least for medicines available over the counter) much earlier than they should is that a majority of the testing is done to determine the expiration date at a controlled temperature, pres…

Most medicines are sold in blister packs these days. Won't that prevent a fair bit of the environmental stress from affecting them?
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