The FDA recently announced that it has received numerous reports of patients who had been on metoclopramide (Reglan, Octamide, Maxolon) for more than twelve weeks who then developed Tardive Dyskinesia.

Tardive Dyskinesia (”TD”) is a serious neurological disorder, characterized by uncontrollable, involuntary body movements such as lip smacking, tongue thrusting, eye blinking and bulging, head jerking, facial grimacing, puckering and pursing of the lips, and involuntary movements of the fingers, as though the patient were playing an invisible piano. The movements are not controllable, and they are continuous, stopping only when the person sleeps. Tardive Dyskinesia may persist for months, even years after the medication has been discontinued, and is usually not reversible. There is no known treatment for TD. The majority of people who develop TD continue to have symptoms for the rest of their lives.

Metoclopramide, marketed as Reglan, Octamide, and Maxolon, is a drug which increases the stomach’s ability to empty digested food and move it on to the small intestine. Slowed stomach-emptying sometimes becomes a problem in diabetes, and many users of metoclopramide (Reglan, Octamide, Maxolon) are diabetics. Other uses include treatment of heartburn in gastroesophageal reflux when first-line drugs have not worked, and management of nausea and vomiting in migraines and in cancer treatment.

Prescribing literature for metoclopramide (Reglan, Octamide, Maxolon) has always recommended that metoclopramide should be used for no more than twelve weeks, because increased use and higher dosages exposes the patient to greater risk of developing TD. In its announcement, the FDA cited a study in which 20% of patients were maintained on metoclopramide for longer than three months.

Patients who are on short term metoclopramide therapy should be aware that there are other anti-nausea drugs and other drugs which can assist with slow stomach emptying. Patients should consult their doctor about alternatives.

If you or a loved one has taken metoclopramide and have developed TD symptoms, you should immediately notify your prescribing physician, and be guided by your physician’s advice.

If you or a loved one has taken metoclopramide (Reglan, Octamide, Maxolon) and has developed symptoms of Tardive Dyskinesia, you should consult the prescribing physician as soon as possible. If you or a loved one has been diagnosed with TD, you should immediately consult an experienced pharmaceutical attorney who handles dangerous drug cases for review of a potential claim against the manufacturer.

Most states have laws called statutes of limitation which specify how long after an event you may file a claim or a lawsuit related to the event. Because of these statutes, it is urgent that if you or a loved one believes you have a claim, you will want to contact an experienced plaintiff’s attorney so that your claim can be evaluated before the time limit is reached.

An intestinal yeast infection develops when yeast, which is naturally present in our intestines, multiplies to a level that is beyond normal. The yeast in our intestinal tract will not become an infection as long as the immune system keeps this yeast in balance and the bacteria that control it remain at a stable level. To understand more about this condition and how it can be cured, read on.

Causes of intestinal yeast infections

The balance that we need to keep the Candida albicans housed within our bodies in check can be upset by several factors. These can include using antibiotics, which can weaken the immune system and rid our stomachs of the ‘good’ bacteria that keep Candida in balance. The weakening of the immune system can also be caused by other diseases and also by stress. Once this happens, we become more prone to developing a yeast infection in the intestinal tract.

Intestinal yeast infection symptoms

Symptoms of this condition include diarrhea, constipation, inflammatory bowel disease and flatulence. A person suffering from this infection might also experience food allergies or food sensitivities, oral yeast infection or thrush and itching in the rectum area. Pain in the lower abdomen, especially after eating, can also be a symptom of infection, in addition to joint pain.

Diagnostic methods

A stool test is often the first test administered by a doctor to determine whether a person has an intestinal tract yeast infection. The Indican test, which measures the ratio of ‘good’ and ‘bad’ bacteria in the stomach, is another method of diagnosing the condition. Testing the blood alcohol is also another way of determining whether the yeast balance within our stomachs has been upset.

Intestinal yeast infection treatment options

Most of the time, a stomach yeast infection is treated using natural methods. Although oral drugs may be prescribed, most doctors are reluctant to advise using these medications because they could create other stomach-related problems and may even aggravate the condition.

Often times, a yeast infection diet program is suggested to the patient, which is mostly comprised of fresh vegetables and complex carbohydrates. Dietary supplements that contain digestive enzymes and probiotic supplements are also recommended by some doctors to help strengthen the stomach and protect it against bad bacteria.

An intestinal yeast infection can remain undiagnosed for years because its symptoms can be misconstrued as causes of entirely different conditions. If you ever experience some of the symptoms mentioned, consult a doctor and ask for some tests specifically designed for yeast infections.

When it comes to medical terms, you’ve probably heard of clinical trials. However, that doesn’t mean that you really know what they are, how they work, or why they are so important. Clinical research has to be done, though, so that doctors and researchers can find what works, what does not work, and what kinds of side effects will be seen. If you want to participate in a clinical trial - often because you will be paid for your time - think carefully about what you’re doing. The drugs or procedures that you are given could be dangerous. Of course these have been tested on animals, usually, or tested in the laboratory in other ways, but the reason that they are in clinical trials is to see if they are safe for humans to take or use. There are only certain people who can participate in a clinical trial. It depends on the specific trial and what the drug or procedure is for. There may be age restrictions, and overall health may be considered as well, as there could be conditions that would render a person ineligible for any type of clinical trial.

If you find that you’re eligible, one of the benefits can be the idea that you’ll get a medication or treatment that wouldn’t otherwise be available to you. These things can sometimes save lives. What exactly happens, though, depends on what the trial is for. There are some differences based on whether the trial is for a medication or a procedure, who the participants are, and what types of side effects might be involved (i.e. how closely the trial participants must be monitored). By participating you’ll be helping others, too, because trials that go well make for drugs and procedures that can be used on others. The risks have to be considered, however, because they can be life-altering and even life-threatening in some cases. The benefits that a person might receive from clinical research have to be carefully weighed against the dangers that are present, so that your consent to the trial is well-informed and you know the potential risks.?????

As time goes by and millions of more people turn to antidepressant drugs to ‘escape’ the anxiety, stress and depression that modern life can sometimes cause, alarming horror stories about antidepressant use are piling up. The SSRI or selective serotonin reuptake inhibitor was introduced as a ‘miracle’ drug that would greatly reduce the side effects of the previous class of tricyclic antidepressants with little or no downside. Unfortunately, the pharmaceutical companies are not telling the whole story. These drugs can be dangerous for some people in ways that most people have no idea about. Not surprising really when you realize they work the same way that cocaine does.

One of the little known things about antidepressants is that the process in which SSRI drugs function in order to increase the levels of serotonin is remarkably similar to the way that cocaine works. In selective serotonin reuptake inhibitors, the drugs function by preventing existing serotonin from exiting the brain by crossing the brain/blood barrier. This creates a ‘backlog’ of serotonin in the brain and as new serotonin is produced it is simply added to the ‘old’ serotonin that is being prevented from leaving the brain. The theory is that since serotonin is one of the primary neurotransmitters responsible for the ‘feel good’ emotion of happiness and satiety that this is a good thing.

The same holds true for the other feel good neurotransmitters of dopamine and norepinephrine. There’s only one problem. The substance that causes dopamine to be kept in the brain and to not cross the blood/brain barrier so to increase levels of dopamine in the brain is…you guessed it…cocaine. Our experience with cocaine however shows that there is a distinct downside of having all this ‘old’ dopamine circulating in the brain along with the new. At a certain point, the brain simply stops making fresh dopamine causing the famous cocaine ‘crash’. Could the same be true of Serotonin? Is it really ‘good’ to have old serotonin and new serotonin circulating in the brain together, especially for long periods like months and years? Perhaps this is why some people have an opposite reaction to antidepressants and end up more depressed than they began after a short while.

The truth is that scientists willingly admit that they don’t truly understand many of the implications of ssri and similar drugs on the human brain. The studies initially submitted to the FDA only followed patients for very short periods. No long term studies that delved into the safety or efficacy of patients were ever done on people taking these drugs for months and years. Now, after almost 2 decades and millions of users later it is coming out that there are many adverse side effects and even life changing and personality altering reactions that were never known or disclosed when these medications first became legal.

You won’t find many of these adverse or dangerous outcomes listed on the back of your medicine bottle. But is it any wonder why? Would you expect to see negative reviews in a brochure printed up by a car manufacturer about their newest car? Would you purchase a home without doing any research on if the homebuilder or town was any good? Of course not. But this is exactly what doctors and patients do every day by simply accepting the limited warnings, usually physical and not mental, that are on the inserts in antidepressant medications. To find out unbiased and very revealing stories and experiences from people that have actually been on the drugs and know first hand one should search the internet for the numerous sites that people use to tell their real life stories on these drugs. One such site is www.sedatednation.com where we are building a community that tells the real story and not just the ‘corporate line’ about antidepressant and other mood altering drugs.

The ability for a patient to be counseled on treatment choices when seeking conventional treatment is called Complementary Medicine (CM). A patient’s decision in therapies and services are important as an ethical, political, and moral necessity in the medical world. While providing these people with choice in treatment, it is also necessary to counsel them in the right methods to choose because they may choose treatments that are too costly, unnecessary or not available for the ailment they have.

Sometimes limits occur in the health care choices available to patients, and conflicts are created. Health care resources are often limited to patient decision because of the inability to continuously fund certain kind of diagnostic functions, and conflict arises.

Another issue that arises is that complementary medicine is a service that is paid for outside of medical care, and individuals with lower incomes are not able to afford this service. Most of these sick person are satisfied with CM services which make the inequalities quite unfair. The inequalities of care in the health system should be eliminated if the best interest of the patient is truly the focus. The goal is to make complementary medicine a service in routine care, allowing it to become funded by public funds.

Providing these sick persons with a choice in their treatment options can potentially pose a lot of problems for the medical community, as bad as that sounds. CM is still new in its development, and that does not provide a lot of options for them in terms of the modalities of treatment. There is no hard data that suggests the risks of complementary medicine are numerous, and physicians do not see many risks either, but without additional research and testing, many therapies have not passed that standard.

A patient who uses complementary medicine runs the risk of choosing unproven healing therapies for chronic illness, choosing therapies that are impractically expensive when there are better, less expensive options, or choosing an option purely because they liked it for another ailment although that treatment does not work well for their new illness. With the choice to dismiss conventional therapies altogether in complementary medicine, should the medications that are included on the list for patients to choose from also be unapproved therapies? The answer in conventional medicine would certainly be “no”, as unapproved treatments can be dangerous, and allowing those therapies in the network as a patient?s choice opens the doors for liability.

Depending on the causes, halitosis or foul-smelling breath could either be persistent or occasional. This is not an uncommon condition; in fact we may have all suffered from it at some points in our lives. Halitosis is quite common because we all play host to millions of bacteria in our mouths. Bacteria flourish in exactly that type of environment - dark, warm, and wet. Normally, halitosis can be treated as soon as the mouth is cleansed properly and regularly. If your bad breath goes away as soon as you brush your teeth, then you have acute halitosis - something that can easily be prevented and treated via proper oral hygiene.

Acute halitosis can also be caused by infections in the mouth; these can be in the gums on the inside of cheeks, tonsils, and on the tongue. You should see a dentist about this to make sure that you get to the real cause of your bad breath. Additionally, halitosis can also be a sign of tooth decay which should be treated promptly by your dentist. To prevent most of these cases, you need to learn how to brush your teeth properly and to always honor dental appointments.

Getting the right tools in maintaining oral hygiene is essential if you want to prevent acute halitosis from ever occurring again. Buy a good toothbrush, one that is recommended by your dentist; or you could purchase an electric toothbrush that is really effective in cleaning your mouth. You should also find the right floss, and of course the right mouthwash. Mouthwash with coloring, flavors, and alcohol should definitely be avoided.

The Escalating Cost of Prescription Medications

The cost of medications is an increasing concern to many American families. As a nation we spent over $200 billion on prescriptions 2006. The cost of medications has increased faster than the cost of hospitals or physician care. Medicare implemented its Part D prescription drug benefit in 2006. The nasty surprise of Part D is the coverage gap, also called the doughnut hole. This is the portion where you pay 100% of your costs for medications.

In a nutshell here’s how Part D works…including the doughnut hole…for 2009:

* If you join a Medicare prescription drug plan (Part D), you pay the first $295 of your drug costs. This is known as the deductible.

* During the initial coverage phase, your drug plan pays 75% of the covered prescription drug costs after your deductible is met, and you pay 25% until the total drug costs (including your deductible) reach $2,700.

* Once you reach $2,700 in total drug costs, you will be in the donut hole and you must pay the full cost of prescription drugs until your total out-of-pocket cost reaches $4,350. This annual out-of-pocket spending amount includes your yearly deductible and copay amounts.

* When you spend more than $4,350 out-of-pocket, the coverage gap ends and your drug plan pays most of the costs of your covered drugs for the remainder of the year. You will be responsible for a copay of $2.40 for each generic drug and $6.00 for other drugs. This is known as catastrophic coverage. Remember, to qualify for Medicare you must be either 65 years old or disabled. When you’re on Medicare you pay a monthly fee for Part B, doctors’ services, which is normally deducted from your monthly Social Security payment. For 2009 that fee is $96…and it does increase each year.

Typically Congress votes a raise in Social Security - just enough to cover the Part B increase…plus a few bucks. For those of us not on Medicare we rely mostly on major medical insurance plans offered through our employers. Now that the unemployment rate has exceeded 8% nationally, this has become more of a problem since a good many Americans are losing their health insurance. Yes, coverage can be extended for typically 18 months through COBRA…but this is often prohibitively expensive…since you pay 100% of the cost of the insurance. An increase of 400% or more over what you paid while employed is not uncommon.

Lack of insurance coverage for prescription drugs can have adverse effects. CNN reports that 18% of Americans under 65 are now without health insurance. So what are we to do when prescription costs get out of hand? When they become unmanageable? Discount programs can help save hundreds, even thousands, on medications. There is also a program many Americans use to cap their prescription costs at under $100 a month. There are some income limits on this so it’s not intended for the wealthy.

To see if you may qualify, visit the link in our Resource box.

Evidence-based medicine (EBM) is the practice of integrating clinical experience and patient values with the best available research information to optimize patient outcomes. A healthcare provider concluding on a clinical decision through EBM can be akin to a financial analyst concluding on a business model. A balance sheet of benefits and harms is drawn up based on a combination of research findings and the patient’s unique circumstances and the clinician then makes an informed decision in the best interest of the patient’s outcome.

Incorporating the best available research information is key to EBM decision-making and involves four essential steps:

1. Asking answerable questions

2. Accessing the best information

3. Appraising the information obtained for validity and relevance

4. Applying the information to specific patient care

In asking answerable questions, it is paramount to frame the clinical question appropriately. Information needs analysis has revealed an average of 1-2 questions arise for each outpatient consultation while the figure can go up to 5 for each inpatient consultation. About a third of questions will relate to treatment of a specific condition while a quarter will relate to diagnosis. Background questions that address basic physiological processes are best left to textbooks to answer while foreground questions that relate to clinical decision-making are best facilitated by EBM. Framing a good question to be answered is accomplished by defining a population with a clinical problem, the intervention or exposure to the population, a suitable comparator for the intervention, and the outcome variables to be assessed. An example of a patient’s clinical question that relates to EBM may be rephrased as “In asymptomatic adult women at average risk of breast cancer (population), does screening at a cancer clinic (intervention) reduce the likelihood of breast cancer fatality (outcome) compared with routine self-examination (comparator)?”

In accessing the best available information, summarized primary (new studies and findings) research sources like evidence-based guidelines and systematic reviews are of the highest value. The ideal information source should have high quality data, be clinically applicable, be comprehensive and be user-friendly. Should the important summarized information be unavailable, the next best option is to access the primary research itself. The most common filter of primary research called MEDLINE, PubMed is available online.

EBM is modeled on levels of evidence that relate to the way primary research is carried out. The “prospective, double-blind, randomized, controlled” study is often hailed as the gold standard upon which clinical evidence is generated. A prospective study involves following the study group over a period of time. Double blinding in a study involves the subject and the researcher not being aware of the identity of the intervention. Randomization involves reducing bias in the choice of subjects for the study. The control is often a placebo but can also be the currently available standard of treatment thereby adding further weight to the intervention outcomes. At the lower rungs of evidence, studies would only consist of case reports and other anecdotal comments.

Once research information is gathered, this needs to be appraised for quality and relevance. Poor quality studies have been known to overestimate the benefits of interventions by 30% or more and this can make actually ineffective interventions seem effective. The clinician practicing EBM at this stage has to query how strong the evidence is, how big the effect is and whether the effect matters to patients. The statistical precision of results is often important as it points to whether the study’s findings can be explained by chance.

The last stage to EBM decision-making is for the clinician to decide on whether the best available research can relate to the individual patient’s situation and if so, how the research can best determine the course of action to take in diagnosing or treating the patient. A balance sheet of benefits and harms of the intervention is first drawn up after which the likelihood of the benefits and harms are quantified in relative terms. These relative terms are then converted into absolute terms based on the patient’s individual characteristics. The final stage of the clinical decision in diagnosis or treatment then rests with whether the individualized benefits outweigh the individualized harms.

In adopting the EBM approach, clinicians sometimes cite insufficient time, limited search skills and limited access to evidence as impeding their use of the best research information. In most practical clinical situations, EBM is a core foundation upon which sound decisions can be made. Nevertheless the final decision also hinges on the clinical experience of the healthcare provider, the individual patient’s values as well as the costs of the diagnosis or therapy. The clinical experience of the healthcare provider remains crucial to patient outcomes especially should there be a highly urgent clinical situation, a distinct lack of useful research information available or the patient circumstances are unique beyond the direct applicability of research information.

New tools and support structures however, are rapidly becoming available to assist clinicians in adopting EBM. These include newer and more sophisticated computer software and clinical decision support tools along with mobile hardware that clinicians can carry along to better practice EBM at points of patient care. Several initiatives are also ongoing in encouraging the greater adoption of EBM in practice. At the forefront is the Cochrane Collaboration, which develops systematic reviews. Other proponents of EBM include Bandolier, McMaster University, the Centre for Evidence-based Medicine, the Evidence-based Medicine Resource Centre as well as other prominent government and non-profit organizations.

EBM works in the best interest of patients to complement the experience of clinicians in delivering the best outcomes. When adopted appropriately, EBM serves to make the healthcare experience safer and more cost-effective.

Expired medications are commonplace and inertia notwithstanding, many of us tend to rely on an intuitive sense of their value in continuing to store and use them. Such drugs can be harmful to health in several ways; they can be unpredictable in effectiveness, simply ineffective, or even toxic.

The formal way of classifying a medication as having expired is through it’s labeled expiry date. This date is often set based on a combination of the common properties of the dosage form as well as the stability and expiration studies of the product that have been conducted by the manufacturer. Importantly, this expiry date is contingent on specific storage conditions of the product. Although a medication may pass it’s labeled expiry date, it may not necessarily be any less effective or dangerous to consume depending on the product itself, the storage conditions and the circumstances leading up to expiry.

When most medications pass their expiry date under appropriate storage conditions, they are generally taken to have become so variable in effectiveness as to have become unsuitable for use. This often comes about as a result of the degradation of the active ingredients of the medication with exposure to physical, chemical or microbiological variables like temperature, pressure, humidity, light, bacteria as well as other components of the product known as excipients.

Creams may “crack” once their expiry date is passed, leading to a separation of the components and hence provide a non-uniform delivery of active ingredients. This can lead to the poor control of conditions like eczema or acne. Tablet medications can mechanically “powder” off, change in consistency with exposure to water vapor or even experience the contained drug itself becoming ineffective on prolonged exposure to air as occurs with glyceryl trinitrate, an emergency medicine that can easily become ineffective in relieving acute symptoms of chest pain. With common injections, should the acidity change to fall outside a fairly narrow range, significant pain and tissue damage can result from use. With most eye drops, an expiry date of one month after opening is accepted to minimize the potential for dangerous bacterial contamination.

With any medication, once a specific threshold of remaining active ingredient is passed, the medication can no longer be relied upon to deliver accurate doses. This loss of reliability is often exacerbated by the fact that the active ingredients can degrade into various combinations of active, inactive or toxic breakdown products. The common aspirin is for instance, known to react with moisture to breakdown into salicylic acid, which is active, and acetic acid, which is inactive and can lead to toxicity in excess.

While the expiry date provides a useful gauge of when to stop using a medication, there are also many other factors that can informally accelerate the expiry of a medication and make it dangerous to use, chief among which is how the medication is stored. It is oftentimes not just the medication that is affected by storage conditions but also the storage container. Under inappropriate storage conditions, certain containers can leech material into liquid medication preparations, or medication particles can stick to the container rather than remain separated. On average, a 10 degree rise in temperature doubles the rate of chemical reactions that occur to a medication product and can accelerate the rate of bacterial contamination several fold. Just like an ice cream can simply melt or a loaf of bread becomes mouldy much quicker if not refrigerated, many medication products can easily expire much faster when not stored appropriately.

With oral liquid and topical medications, potentially dangerous changes associated with expiry can at times be detected by color or consistency changes, component separations, altered smell or taste (oral preparations). Should a suspicion of expiry arise, a medication expert should be consulted regardless of whether or not the labeled expiry date has been passed.

“Expiry” should also be understood to occur once a supply of medications is no longer used appropriately for it’s intended purpose. Consultation with a medication expert is always advised to prevent the inappropriate use of existing medication supplies. Inappropriate use can often occur with self-medication and is harmful. An unfinished supply of a previously used antibiotic may be tried to treat a new infection that is actually untreatable by or resistant to that antibiotic. This practice may not only delay recovery but can also encourage the proliferation of “super bugs” that have resistance to many antibiotics. Another incorrect purpose involves sharing medications and this can be especially harmful if another is allergic to the shared medication or a child or pet is medicated with an adult’s medication. Children often require dose adjustments to accommodate their size while many human drugs are often unsuitable for pets. Even a simple food like chocolate that we may enjoy can easily be toxic to a pet dog.

Another mechanism whereby medication expiry is dangerous occurs when an unfinished supply is used despite new information that points to increased precautions associated with the medication or that has led to it’s recall. An example is obtaining pain relief from a previous supply of a painkiller like Vioxx (rofecoxib) or Celebrex (celecoxib) in spite of an existing heart condition that is now known to relate to an increased risk of fatality under those circumstances of consumption.

Expired medications that are kept instead of discarded not only take up space but can actually discourage the appropriate use of new supplies in the treatment of illness. A medication cabinet, if not tended to regularly, could eventually contain more expired medications than viable ones and this can lead to the accidental consumption of an expired medication in place of a viable one. It is definitely advisable to clear the medication cabinet of expired medicaitons at least annually if not more often.

A further danger however, lies in how expired medications are disposed of. Expired medications and pharmaceutical byproducts can be harmful to the environment especially when they end up in our rivers and drinking water supply. Hormonal compounds like estrogen from birth control pills and patches as well as antibiotics have been linked to being flushed by individuals and institutions into sewage, draining largely unchanged and collecting in rivers and streams, then returning in tiny amounts into drinking water. Traces of antibiotics could worsen bacterial resistance while estrogens and other steroids are known to change the reproductive characteristics of fish. Even trace amounts of chemotherapy medications have emerged in tap water and this could be severely detrimental to the unborn babies of pregnant women who drink such water. The long-term impact on human health of medications in our rivers and drinking water is as yet unknown but no one would want to wait to find out. We can all play our part by inquiring on and using pharmacy or state-run programs for the disposal of expired medications instead of sending them down the sink or the toilet bowl.

A pharmacist is the expert of choice to approach in handling medication expiry and should be consulted if in doubt. As a general rule, it is always best to safeguard your own health and that of those around you by expeditiously and appropriately discarding all expired medications.

Expired medications are commonplace and inertia notwithstanding, many of us tend to rely on an intuitive sense of their value in continuing to store and use them. Such drugs can be harmful to health in several ways; they can be unpredictable in effectiveness, simply ineffective, or even toxic.

The formal way of classifying a medication as having expired is through it’s labeled expiry date. This date is often set based on a combination of the common properties of the dosage form as well as the stability and expiration studies of the product that have been conducted by the manufacturer. Importantly, this expiry date is contingent on specific storage conditions of the product. Although a medication may pass it’s labeled expiry date, it may not necessarily be any less effective or dangerous to consume depending on the product itself, the storage conditions and the circumstances leading up to expiry.

When most medications pass their expiry date under appropriate storage conditions, they are generally taken to have become so variable in effectiveness as to have become unsuitable for use. This often comes about as a result of the degradation of the active ingredients of the medication with exposure to physical, chemical or microbiological variables like temperature, pressure, humidity, light, bacteria as well as other components of the product known as excipients.

Creams may “crack” once their expiry date is passed, leading to a separation of the components and hence provide a non-uniform delivery of active ingredients. This can lead to the poor control of conditions like eczema or acne. Tablet medications can mechanically “powder” off, change in consistency with exposure to water vapor or even experience the contained drug itself becoming ineffective on prolonged exposure to air as occurs with glyceryl trinitrate, an emergency medicine that can easily become ineffective in relieving acute symptoms of chest pain. With common injections, should the acidity change to fall outside a fairly narrow range, significant pain and tissue damage can result from use. With most eye drops, an expiry date of one month after opening is accepted to minimize the potential for dangerous bacterial contamination.

With any medication, once a specific threshold of remaining active ingredient is passed, the medication can no longer be relied upon to deliver accurate doses. This loss of reliability is often exacerbated by the fact that the active ingredients can degrade into various combinations of active, inactive or toxic breakdown products. The common aspirin is for instance, known to react with moisture to breakdown into salicylic acid, which is active, and acetic acid, which is inactive and can lead to toxicity in excess.

While the expiry date provides a useful gauge of when to stop using a medication, there are also many other factors that can informally accelerate the expiry of a medication and make it dangerous to use, chief among which is how the medication is stored. It is oftentimes not just the medication that is affected by storage conditions but also the storage container. Under inappropriate storage conditions, certain containers can leech material into liquid medication preparations, or medication particles can stick to the container rather than remain separated. On average, a 10 degree rise in temperature doubles the rate of chemical reactions that occur to a medication product and can accelerate the rate of bacterial contamination several fold. Just like an ice cream can simply melt or a loaf of bread becomes mouldy much quicker if not refrigerated, many medication products can easily expire much faster when not stored appropriately.

With oral liquid and topical medications, potentially dangerous changes associated with expiry can at times be detected by color or consistency changes, component separations, altered smell or taste (oral preparations). Should a suspicion of expiry arise, a medication expert should be consulted regardless of whether or not the labeled expiry date has been passed.

“Expiry” should also be understood to occur once a supply of medications is no longer used appropriately for it’s intended purpose. Consultation with a medication expert is always advised to prevent the inappropriate use of existing medication supplies. Inappropriate use can often occur with self-medication and is harmful. An unfinished supply of a previously used antibiotic may be tried to treat a new infection that is actually untreatable by or resistant to that antibiotic. This practice may not only delay recovery but can also encourage the proliferation of “super bugs” that have resistance to many antibiotics. Another incorrect purpose involves sharing medications and this can be especially harmful if another is allergic to the shared medication or a child or pet is medicated with an adult’s medication. Children often require dose adjustments to accommodate their size while many human drugs are often unsuitable for pets. Even a simple food like chocolate that we may enjoy can easily be toxic to a pet dog.

Another mechanism whereby medication expiry is dangerous occurs when an unfinished supply is used despite new information that points to increased precautions associated with the medication or that has led to it’s recall. An example is obtaining pain relief from a previous supply of a painkiller like Vioxx (rofecoxib) or Celebrex (celecoxib) in spite of an existing heart condition that is now known to relate to an increased risk of fatality under those circumstances of consumption.

Expired medications that are kept instead of discarded not only take up space but can actually discourage the appropriate use of new supplies in the treatment of illness. A medication cabinet, if not tended to regularly, could eventually contain more expired medications than viable ones and this can lead to the accidental consumption of an expired medication in place of a viable one. It is definitely advisable to clear the medication cabinet of expired medicaitons at least annually if not more often.

A further danger however, lies in how expired medications are disposed of. Expired medications and pharmaceutical byproducts can be harmful to the environment especially when they end up in our rivers and drinking water supply. Hormonal compounds like estrogen from birth control pills and patches as well as antibiotics have been linked to being flushed by individuals and institutions into sewage, draining largely unchanged and collecting in rivers and streams, then returning in tiny amounts into drinking water. Traces of antibiotics could worsen bacterial resistance while estrogens and other steroids are known to change the reproductive characteristics of fish. Even trace amounts of chemotherapy medications have emerged in tap water and this could be severely detrimental to the unborn babies of pregnant women who drink such water. The long-term impact on human health of medications in our rivers and drinking water is as yet unknown but no one would want to wait to find out. We can all play our part by inquiring on and using pharmacy or state-run programs for the disposal of expired medications instead of sending them down the sink or the toilet bowl.

A pharmacist is the expert of choice to approach in handling medication expiry and should be consulted if in doubt. As a general rule, it is always best to safeguard your own health and that of those around you by expeditiously and appropriately discarding all expired medications.