With Meds, How Expired is Expired?

If you take a big swig off the milk container that’s been sitting in your fridge too long, you’re likely to get an immediate — and nasty — surprise.  When dairy and meat products exceed their expiration dates, the change is anything but subtle. However, the same aesthetic and sensory clarity typically doesn’t exist for prescription and over-the-counter (OTC) medications. They may look, feel and smell the same…but are they effective and safe after the expiration date has come and gone, and if so, for how long?

The answer to that question can vary according to the kind of drug, how it’s been stored, if it’s been opened and its intended purpose. Medications are expensive, and we hate throwing them away if it isn’t necessary. On the other hand, we don’t want to take medications that are no longer potent or effective, especially if we rely on them for life-saving purposes such as epi-pens for allergic reactions, insulin for diabetes or antibiotics for fighting infections.

Where do you draw that line, though, on all those prescription bottles cluttering up your medicine cabinet, and common drugs such as pain relievers, topical ointments for itchy skin, and cough syrup?

What does an expiration date mean?

The expiration date is the final day that the manufacturer guarantees the full potency and safety of a medication. Drug expiration dates exist on most medication labels, including prescription, over-the-counter and dietary (herbal) supplements. U.S. pharmaceutical manufacturers are required by law to place expiration dates on prescription products prior to marketing. For legal and liability reasons, manufacturers will not make recommendations about the stability of drugs past the original expiration date.

The expiration date of a drug is estimated using stability testing determined by the Food and Drug Administration (FDA). Drug products marketed in the United States typically have an expiration that extends from 12 to 60 months from the time of manufacture. Once the original container is opened, either by the patient or the health care provider who will dispense the drug, that original expiration date on the container can no longer be relied upon.  However, the actual shelf life of the drug may be much longer.

At the pharmacy, “beyond-use” dates are often put on the prescription bottle label given to the patient. These dates often say “do not use after…” or “discard after…” and are required by the Board of Pharmacy in many states. These dates are typically one year from the date on the stock bottle. According to the manufacturer, the stability of a drug cannot be guaranteed once the original bottle is opened. Therefore, the United States Pharmacopeia (USP), the body that sets the standards for pharmaceutical quality in the U.S., recommends using “beyond use” dates. The “beyond use” date would never be later than the expiration date on the manufacturer’s bottle.

The American Medical Association (AMA) concluded more than a decade ago that the actual shelf life of some products is longer than the labeled expiration date. Over 3,000 lots, representing 122 different drug products, were assessed in a government test program. Based on stability data, expiration dates on almost 90 percent of the lots were extended beyond their original expiration date for an average of 66 months. Of these 2,652 lots, only 18 percent were terminated due to failure. Examples of common drug products that were tested with no failures included amoxicillin, ciprofloxacin, diphenhydramine, and morphine sulfate injection. Drug expiration extension dates on these products ranged from 12 to 184 months.

However, it is difficult for consumers or health care providers to know which specific products could have an extended shelf life. The ability for a drug to have an extended shelf life would be dependent upon the actual drug ingredients, presence of preservatives, temperature fluctuations, light, humidity, and other storage conditions. Additionally, the drug lots tested in the program were kept in their original packaging. Once a drug is repackaged into another container, as often happens in the pharmacy, the shelf-life might decline.

Is it safe to take expired medications?

There are no specific reports linking expired medication use to human toxicity. Solid dosage forms, such as tablets and capsules, appear to be most stable past their expiration date. Drugs that exist in solution or as a reconstituted suspension, and that require refrigeration (such as amoxicillin suspension), may not have the required potency if used when outdated. Loss of potency can be a major health concern, especially when treating an infection with an antibiotic. Additionally, antibiotic resistance may occur with sub-potent medications. Drugs that exist in solution, especially injectable drugs, should be discarded if the product forms a precipitant or looks cloudy or discolored.

EpiPen autoinjectors should not be used after the expiration date as the epinephrine has been shown to lose its potency. EpiPen’s are used in life-threatening situations like anaphylaxis, so there is a major health threat with an expired EpiPen. Expired medications that contain preservatives, such as ophthalmic (eye) drops, may be unsafe past their expiration date. Outdated preservatives may allow bacterial growth in the solution.

Insulin is used to control blood sugar in diabetes and may be susceptible to degradation after its expiration date. Oral nitroglycerin (NTG), a medication used for angina (chest pain), may lose its potency quickly once the medication bottle is opened. Vaccines, biologicals or blood products could also be subject to quick degradation once the expiration date is reached. If a patient finds a medication is powdery or crumbling, has a strong smell, or has dried up (as in the case of ointments or creams), these drugs should be discarded.

Proper storage of medications may help to extend their potency. The bathroom and medicine cabinet are not ideal places to store medications due to heat and humidity. Similarly, medications should not be left in a hot car. Medications remain most stable in dry, cool spaces away from light. Keep the prescription bottle caps tightly closed and always keep medications out of reach of children and pets.

If questions still remain about whether or not to use an old or expired medication, it is wise to speak with your pharmacist or physician, who can offer additional information and advice.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

The Eyes Have It

Our eyes, it’s said, are our windows to the world. Romantic and aesthetic benefits aside, taking care of our peepers is an important and often overlooked task, especially since we don’t think about eye health until we have a problem. But as January is National Glaucoma Awareness Month, it’s a good time to consider how best to care for our eyes, and to become aware of warning signs that may require medical care or interventions.

Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and blindness. The optic nerve is a bundle of more than 1 million nerve fibers, and it is necessary for good vision as it connects the retina to the brain. The retina is the light-sensitive tissue at the back of the eye.

Studies have shown that eye pressure is a major risk factor for optic nerve damage. In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid flows through a spongy meshwork, like a drain, and leaves the eye.

With glaucoma, the fluid passes too slowly through the meshwork drain. Since the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, glaucoma — and vision loss — may result. That’s why controlling pressure inside the eye is important.

Another risk factor for optic nerve damage relates to blood pressure. It is important to make sure that your blood pressure is at a proper level. This can be determined by visiting your primary care physician.

Glaucoma has no early warning signs. However, symptoms can include blurriness or clouded vision, sensitivity to light, headaches, reduced peripheral or “side” vision, or “tunnel vision.” It’s more common in adults over 60, in African American adults over 40, or in adults with diabetes or a family history of glaucoma. It’s most often treated through medications and surgery.

Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher levels of eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.

Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That’s why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.

Take care of your eyes, and they’ll take care of you

Adults should visit with an optometrist or an ophthalmologist at least once every other year, and annually if you have bad eyesight or a family history of glaucoma, cataracts, or other congenital or age-related eye ailments. Many eye maladies develop as we get older, part of the natural aging process. Through a comprehensive eye exam that typically involves dilating your pupils and conducting a number of standard (and painless) tests, eye care professionals not only determine sight deficiencies and illnesses, but also find warning signs pointing to other dangers such as heart disease, diabetes, high blood pressure, and cancer.

Being aware of the potential damage from ultraviolet light also is important. Sunglasses and clear eyeglasses with protective coatings filter out the sun’s damaging rays, so if you work or spend a lot of time outdoors, you need that extra protection.

Dry eye syndrome also affects us as we age. If the glands in our eyes stop making enough natural lubricants, we can buy over-the-counter remedies, but should have our eyes checked for inflammation or infection. Sometimes dry eyes occur from living or working in windy, dry, or low-humidity environments, or in buildings with air-blown hot air. Doctors recommend “fake tears,” which don’t have as many chemicals as the “get the red out” eye drops. Anti-inflammation medications and vitamins or foods like fish oil, which are high in Omega-3, are often recommended.

Through comprehensive, regular eye exams, doctors can check for early warning signs of glaucoma, potential retinal detachment (which causes floaters or flashes in the eye but can be sight threatening) and other common eye diseases, and help keep those beautiful eyes of ours sparkling and healthy.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Keep Your Skin in the Game

The cold weather often means an increase in chapped lips, dry, itchy skin, rashes and a worsening of skin conditions like eczema or psoriasis. The main culprit is lack of moisture. During winter, the humidity in the outside air plunges, and thanks to indoor heating, we’re assailed by dry, warm air in our house, office, school or workplace.

During flu and cold season, we’re also washing our hands more often than ever, which saps the natural oils in our skin, leaving them dehydrated until they crack, peel and bleed.

The skin barrier is a mix of proteins, lipids and oils. It protects your skin, and how good a job it does is largely genetic, but also a measure of environmental conditions. If you have a weak barrier, you’re more prone to symptoms of sensitive skin such as itching, inflammation and eczema. Your hands are also more likely to become very dry in winter if they’re constantly exposed to cold air, water, extreme heat or other environmental factors.

One solution is to keep ourselves, and our skin, properly hydrated. But drinking water alone won’t do the trick for your skin; it also requires replenishment. Using moisturizers especially formatted for your skin is an important tool in your hydration arsenal. But putting moisturizers on once a day isn’t enough – you need to apply five or more applications daily to afford day-long protection. Coverage should include hands, fingernails, face, arms and legs and even your feet.

There are many effective hand creams and body lotions available in our local drugstores and supermarkets.  Choosing the one that’s best may require some trial and error, but focus on the two main ingredients that make the greatest difference:  emollients and humectants.

Emollients act as lubricants on the surface of the skin. They fill the crevices between cells that are ready to be shed and help the loose edges of the dead skin cells that are left behind stick together. Emollients help keep the skin soft, smooth, and pliable. Look for ingredients such as lanolin, jojoba oil, isopropyl palmitate, propylene glycol linoleate, squalene, and glycerol stearate.

Humectants draw moisture from the environment to the skin’s surface, increasing the water content of the skin’s outer layer. Scan the ingredients label for common humectants such as glycerin, hyaluronic acid, sorbitol, propylene glycerol, urea, and lactic acid.

If your hands go from just being dry and rough to having little cracks, or fissures, and are tender or bleeding, it’s time to move on to more therapeutic moisturizers. Petroleum jelly is a reliable standby. Or choose a thick, rich moisturizer in a formula that contains heavier ingredients such as dimethicone, cocoa or shea butter, or beeswax. Applying a generous coating at bedtime, and wearing a pair of cotton gloves will help retain the healing salve until it can be fully absorbed while you sleep.

If you already have sensitive skin, look for a moisturizer that contains soothing ingredients such as chamomile or aloe, and doesn’t contain potential allergens such as fragrances or dyes. Also, avoid products containing acids, which can irritate sensitive skin.

As we age, our skin tends to become drier because our oil-producing glands become less active. To keep skin soft and well hydrated, choose an oil-based moisturizer that contains petrolatum as the base, along with antioxidants or alpha hydroxy acids to combat wrinkles. These ingredients help hold in moisture and prevent flaky, scaly skin.

Hand washing, though critical for your overall health and to prevent the spread of germs, also dries out skin and hands. The best bet is to choose a mild soap, use warm — not hot — water, pat your hands dry and apply a moisturizer right away. If you have severely dry hands or you wash your hands a dozen or more times a day, substitute a hand-sanitizing gel or wipes for some soap-and-water sessions.

Other tricks for limiting dry skin is to sleep with a humidifier at night, take short, warm (not hot) showers, and to wear gloves, a hat and sunscreen when you’re outdoors. A balanced diet rich in vegetables and fruits also provides the vitamins and minerals your body needs to help it remain healthy. If redness, peeling and tenderness persist, see a dermatologist. He or she can prescribe a steroid cream to help fight inflammation, and also check on whether your dry hands may be due to a skin condition such as eczema or psoriasis.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

CBIA Healthy Connections at Work

When your employees are sick or absent, it has a measurable impact on service and your bottom line. When they’re at work but not feeling well — physically or mentally — it affects their attitude, their responsiveness, their interactions with customers and other employees, and their overall performance.

Ensuring that your employees are at their personal best was part of the vision in creating CBIA Healthy Connections. When we function at 100 percent of our capacity, everyone benefits. And when you and your employees are healthier, it increases productivity and saves you money. Ultimately, these savings can help control escalating premium costs, which is good for your business, your employees, and their families.

It’s a new calendar year, and opportunities abound for improving workplace health and wellness. If you’re new to CBIA Health Connections or considering membership, the benefits of workplace wellness are waiting for you and your employees!

Helping employees take control of their health

As a small business owner, you know how important every employee’s contribution is to your bottom line. So CBIA Healthy Connections is designed to help employees take better control of their own health. Benefits of increased health and wellness at work include:

  • A decrease in paid and unpaid sick days
  • Reduced general absenteeism
  • Increased productivity
  • Improved morale and teamwork
  • Fewer work-related accidents and violations
  • Enhanced customer satisfaction

Once you and your team are enrolled, a CBIA Healthy Connections representative will contact each employee by email and encourage them to complete a free, confidential, online health assessment on his or her physical and mental health. The health assessment utilizes a simple online questionnaire that helps determine the employees’ current understanding of and commitment to wellness. It includes questions about their general health such as weight, stress, diet and exercise, and asks about habits such as smoking and alcohol consumption. The information is confidential. None of this information is shared with the employer or with the insurance carrier.

In return for completing the health assessment, each employee will receive a $50 Amazon.com electronic gift card. After the employee completes the health assessment, they’ll receive a report that outlines their general state of health and highlights areas for improvement. The employee will be encouraged to visit CBIA’s interactive, personalized wellness website for health tips and suggestions, educational information, and to participate in wellness workshops.

This easy-to-use online program will provide you and your team with:

  • Increased awareness of the benefits of wellness
  • Access to useful, pertinent health and wellness information
  • Simple interactive tools
  • Informed decision-making about health choices
  • A dedicated support mechanism
  • Personal and team incentives

Each participating employee has access to information through the website that covers a variety of wellness topics including diet and nutrition; exercise and recreation; stress reduction; weight reduction or weight-gaining guidance; smoking cessation; and much more. They’ll be able to return to the site as often as they’d like to receive confidential program feedback and support.

Learn more about CBIA Healthy Connections here. You can join up to 90 days after your company’s renewal. And remember, it’s free as part of your participation in CBIA Health Connections!

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