Children below the age of five years can have five to eight viral respiratory infections in a year. Fever is often the presenting symptom. Despite telling parents that ‘fever is a friend’, they get anxious and overzealous in treating it. Viral fever usually lasts three to five days. In the meantime, parents visit multiple doctors and each doctor prescribes his/her favourite brand despite the National Medical Council recommendation on generic drugs and not brand names. Habits die hard!
I would like to take the example of a four-year-old girl, Meena. Her affluent parents consulted four doctors in five days for her fever. Each doctor prescribed the same paracetamol (drug for fever), but in different brand names. Meena’s parents believed that once the cap of a medicine was opened, the product cannot be used again at a later date. Thus, they had four bottles of paracetamol, that is, 240ml (4x60).
My concern is disposal of these medicine bottles. In fact, one bottle of paracetamol can be used for two years as per the expiry date mentioned. We, medical professionals, recommend use of the product till the expiry date and not disposal once the cap has been opened.
Why should one be concerned? Because of the cost of the drug at one end and disposal of the unwanted pharmaceuticals. How many of us know how to dispose unused or expired medicines and its threat to environment and mankind? Pharmaceutical waste is any waste that contains medicinal drugs that are unused, no longer needed, contaminated, damaged or expired. A rough estimate of pharmaceuticals waste in Bengaluru is 120 tonnes/year and 480 tonnes/year in Karnataka.
Wholesalers and retailers have explicit guidelines for their disposal. But what about the end user in individual homes? We should be concerned about disposal of the medicine and its use beyond expiry date. How are Meena’s parents going to discard the package, bottle, syrup, cap and the measuring cup? Each of these components has a different method of disposal. Is it not the responsibility of the treating doctor to advise parents not only on the drug usage but also its method of disposal and that it should not be used beyond the expiry date?
In addition, should not the label on the bottle have one more line — ‘How to discard’? Present drug bottles are provided with a QR code that can be scanned with a smart phone and every information of the product is available except its disposal. Of course, many of our patients/parents do not have smart phones to use the scanner.
Expired medicines
In the late 1970s, the FDA first began requiring expiration dates on both prescribed and over-the-counter medications — to assure that a drug product meets applicable standards of identity, strength, quality and purity at the time of use and it will bear an expiration date determined by appropriate stability testing. Expired medicines can be less effective or harmful due to decrease in strength or a change in chemical composition. All medicines will have the date of manufacture and expiry mentioned. Do not use medicines beyond their expiry date.
What happens if one takes expired medicines? Expired medicines are particularly harmful to children as the drug dynamics are different from that in adults and their bodies are growing. For example, Thalidomide-induced phocomelia (seal-like limbs). Expired antibiotics can lead to increased antibiotic resistance, which is becoming a global pandemic and treatment failure. Sometimes, the expired drug molecule can cause adverse drug reaction. Liquid (syrup) antibiotics degrade more quickly and also diabetic medication like insulin.
The effectiveness of the medication is very critical in cardiac drugs, diabetic medication like insulin and antibiotics. Their use beyond expiry date will either make the disease worse or kill the patient. Some of the drugs like Tetracycline can cause serious toxic effects. One should be very careful with eye drops, which may blind a person. Similarly, injectables can cause serious tissue damage. Luckily, cream preparations ‘crack’ once their expiry date is passed. Special precautions must be taken in disposal of non-biodegradable products like antibiotics, anticancer drugs and disinfectants. Inefficient and improper sorting and disposal may allow drugs beyond their expiry date to be diverted for resale to the general public.
Pharmaceutical disposal should be undertaken at minimal financial cost and with minimal risk to public health and environment. Disposal should be carried out under the supervision of regional and national authorities. WHO’s guidelines for safe disposal of unwanted pharmaceuticals in and after emergency is excellent.
Tips for individual users of medicines: Check the expiry date on all your medicines once a month; Never keep medicines exposed to direct sunlight, heat or extreme cold; Keep all medicines in a locked cabinet; Ensure proper disposal of expired medicines. In Meena’s case, the drug could have been used for two years.
We have only one planet, which is threatened with enormous environmental degradation. Waste is overfilling the landfills that are becoming extinct. It is every individual’s responsibility to protect our planet.
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