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The Myth of Drug Expiration Dates

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Re: The Myth of Drug Expiration Dates

#151

Post by mjevans »

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as anti-arrhythmics or drugs like warfarin are dosing critical to the point where I would not want them if they were out of date.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…

A 'mishandling indicator' for field dispensary seems like a good idea.

I think that a better approach to 'expiration dates' should be that highly controlled dispensaries (pharmacies) track lot and production dates. A given medication should have a standard expiration date based on /observed/ potency and reserving a safety factor (which should be known and recorded).

Drugs before the typical expiration date would have very infrequent random samples tested for effectiveness. If there is economic or technical incentive, medications nearing the expiration date would be tested and based on the results a new expiration date and testing schedule for the remaining units set.

Re: The Myth of Drug Expiration Dates

#152

Post by t0mbstone »

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as anti-arrhythmics or drugs like warfarin are dosing critical to the point where I would not want them if they were out of date.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…

Wouldn't the real solution here be to put real expiration dates on things that can harm you, and real expiration dates on things that haven't actually expired?

Like a "dangerous to use after 01/01/2019" label on things that actually are dangerous.

Other items could have labels like, "Safe for use until 01/01/2025 - Effectiveness may be degraded after 09/05/2019"

Re: The Myth of Drug Expiration Dates

#153

Post by cwsx »

BrandoElFollito wrote: post #147
dragonwriter wrote: post #116

Earlier quoted context omitted.

> Most medicines are sold in blister packs these days. Won't that prevent a fair bit of the environmental stress from affecting them? Well, it keeps out humidity, and might prevent air-exposure effects. It won't prevent heat effects and some other environmental effects. Also, quite a lot are sold in bottles of pills or other non-blister-pack forms.

I live in France and cannot remember the last time I saw pills not in a blister pack. I remember vaguely having seen pills in bottles maybe 20 or 30 years ago. Again this is for France, I know that e.g. in the US one gets refills. Which by the way I find great because the waste of pills is tremendous. It would have been much better to get the specific number prescribed.

This varies quite a bit throughout the world (I think). I've had both blisters and bottles in New Zealand/Australia.

Re: The Myth of Drug Expiration Dates

#154

Post by ars »

vkou wrote: post #143
gumby wrote: post #77

(former pharmaceutical developer here). This article makes it sound like there's a big conspiracy, which there isn't. A very few drugs (like erythromycin) become toxic so should be discarded. Some drugs become less efficacious over time, but nobody really knows the shape of the curve as they are simply tested to see if they have the same efficacy on day E as they did on day 0. Well of course all drugs will become wor…

> And of course US egg producers take steps that reduce the storage time of eggs, which can be months old when you get them -- and then "expire" a week after getting home. I've yet to have a US carton of eggs go bad, and they often spend a few weeks in my fridge.

I've stored eggs for 2 months out of the fridge and they did not go bad.

As far as I know eggs will not go bad at all - they will just slowly dry out.

Re: The Myth of Drug Expiration Dates

#155

Post by techthroway443 »

t0mbstone wrote: post #152
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…

Wouldn't the real solution here be to put real expiration dates on things that can harm you, and real expiration dates on things that haven't actually expired? Like a "dangerous to use after 01/01/2019" label on things that actually are dangerous. Other items could have labels like, "Safe for use until 01/01/2025 - Effectiveness may be degraded after 09/05/2019"

Seems simple enough, just extend the expiration dates on the meds that don't turn toxic and that still work.

The issue here though is that it's not in the drug manufacturers interest to have super long dates. Putting labels that expire sooner means they can push higher volume.

Re: The Myth of Drug Expiration Dates

#156

Post by civilitty »

sevenfive wrote: post #148
civilitty wrote: post #64

Earlier quoted context omitted.

Wrong. LSD and fentanyl have polar opposite therapeutic indexes - the therapeutic index is specific to toxicity whereas I'm talking about clinical outcomes in general. There are drugs that have threshold doses below which there is essentially no effect on the patient but aren't toxic until 10-1000x that threshold dose. Fentanyl just happens to have an effective threshold dosage that is dangerously close to its LD50.

Excuse me, index. A dimensionless quantity. Nothing to do with potency. And you could hardly pick worse drugs to spread misinformation about.

I do not believe that you have the requisite knowledge of pharmacology to talk intelligently on these topics so you should stop correcting people who do, especially when your other comments suggest that your knowledge is based entirely on recreational drug databases. Anyone who has spent time working in the pharmaceutical industry knows that "therapeutic index" and "therapeutic ratio" are used interchangeably and that I never said anything even remotely related to either of those until you brought it up out of nowhere.

The therapeutic index is the ratio of the therapeutic dose to the dose at which the drug starts becoming toxic in 50% of the sample. I repeat, for the third time, I was not talking about toxicity. We are discussing drug expiration dates and you will not experience toxicity from a drug that has been degraded over time to a dosage lower than the one you were prescribed, except in extremely rare circumstances. A drug's therapeutic index is entirely irrelevant to what I am talking about - I don't know how I can make that any more clear.

Re: The Myth of Drug Expiration Dates

#157

Post by gumby »

vkou wrote: post #143
gumby wrote: post #77

(former pharmaceutical developer here). This article makes it sound like there's a big conspiracy, which there isn't. A very few drugs (like erythromycin) become toxic so should be discarded. Some drugs become less efficacious over time, but nobody really knows the shape of the curve as they are simply tested to see if they have the same efficacy on day E as they did on day 0. Well of course all drugs will become wor…

> And of course US egg producers take steps that reduce the storage time of eggs, which can be months old when you get them -- and then "expire" a week after getting home. I've yet to have a US carton of eggs go bad, and they often spend a few weeks in my fridge.

This is why I put "expire" in quotation marks -- it is bogus.

Eggs can indeed go bad, but not immediately, and last a lot longer if the cuticle is not washed off.

Re: The Myth of Drug Expiration Dates

#158

Post by hrktb »

agumonkey wrote: post #89
dekhn wrote: post #73

Earlier quoted context omitted.

yes, that's a big part of it. It's a simple rule that's easy to follow, which can often be better in terms of health overall.

Yeah unless we put something better in place, maybe a dedicated QR code website to quickly verify if that box is 1, 2, 10, toxic

In principle this would be a god send. In practice I think this will be so drawn in legalese it will take incredible amount of effort to get valuable information.

There is already a super long information sheet in each of the drugs I take, and each time I read them to get a better grasp of how I should take them I'm flooded by useless warnings (could be all summed up by 'you might get worse taking this. If it happens, stop and call a doctor') and disclaimers.

Every time I needed specific practical info I had to go to a pharmacy and ask someone or search non official online resources. Even super basic stuff like 'should it be taken before, during or after a meal ?', no word what so ever in the notice.

Re: The Myth of Drug Expiration Dates

#159

Post by gumby »

derefr wrote: post #84
gumby wrote: post #77

(former pharmaceutical developer here). This article makes it sound like there's a big conspiracy, which there isn't. A very few drugs (like erythromycin) become toxic so should be discarded. Some drugs become less efficacious over time, but nobody really knows the shape of the curve as they are simply tested to see if they have the same efficacy on day E as they did on day 0. Well of course all drugs will become wor…

> Last week purchased some vacuum-packed lamb that had a manufacturer label with an expiration date a month away, but was prominently labeled to expire this week. Are you sure this was an expiration dates, and not a "sell by" or "best before" date? A sell-by date is the date at which the grocery store will voluntarily throw out the product—not because it has gone bad, but rather because its unprepared appearance/text…

> Are you sure this was an expiration dates, and not a "sell by" or "best before" date?

In the case of this lamb (sold by Trader Joe's FWIW) both were labeled "use before". Hmm.

Re: The Myth of Drug Expiration Dates

#160

Post by Lordarminius »

BurningFrog wrote: post #144
Greed wrote: post #34

Earlier quoted context omitted.

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…

Here's a startup idea: Develop an "indicator pill" that changes color at the same rate as an individual medication. It would be in (or part of) the bottle with the other pills, and be customizable to react to humidity, temperature and time in the same way as the particular medication.

> Here's a startup idea:...

How feasible would that be for thousands of different drugs with hundreds of thousands of different formulations and chemical compositions and various storage factors ?

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