Ask the Doctors August 2003 Issue

Ask Dr. Marks: 08/03

In cleaning out my medicine cabinet recently, I noticed a number of drugs that have expiration dates that have passed. Is there any danger in my taking these drugs now? When do good drugs go bad?

All over-the-counter medications will have an expiration date printed on their label. Expiration dates will vary from medication to medication and from lot to lot. They are based on the pharmaceutical company’s test for stability of the drug.

Medications lose potency after time. It is important not to take medications after the expiration date since they will have lost some of their potency. They not only may not help your condition, but at the same time they can expose you to side effects. For prescription medications, expiration dates are not printed on the label. Your doctor will expect you to take the medications as directed and dispose of the medication after its use has been completed. All unused prescription medications should be disposed of after one year. This may be considerably shorter for antibiotics, especially antibiotics in liquid form. The potency of a liquid antibiotic will last between 15 and 60 days depending on the antibiotic.

----------

I’m taking ibuprofen daily to treat my arthritis, but its effect seems to have worn off. Is there any danger in my doubling the dose? If one tablet helps a little, shouldn't two help a lot?

Osteoarthritis is a progressive disease. Medications that help initially may not help as the osteoarthritis becomes more advanced, and it is frequently necessary to increase the dosage of ibuprofen as the arthritis progresses. The smallest effective dose should be used. Ibuprofen can be taken every four to six hours. Over-the-counter ibuprofen has as its limit 1200mg in 24 hours. This medication comes in 200mg tablets, so the dosage will be two tablets three times a day. Under the direction of a doctor, the dosage can be increased to 2400mg a day in three to four divided doses. It is important to remember that side effects may increase with the increase in dosage. Any sign of gastrointestinal bleeding or excessive heartburn should be reported to your doctor and the drug discontinued.

----------

I have a tough time swallowing pills for my arthritis. It there some other form in which I can take my medication?

The easiest thing to do when you’re unable to swallow pills is to crush them and to take them either with a large glass of water or with food. Some pills, however, cannot be crushed since they are extended release pills and crushing alters their behavior. Check with your pharmacist to see if your medication can be crushed. Ibuprofen and naproxen come in liquid form. Other newer NSAIDs also come in liquid form, but this varies from medication to medication. Again, check with your pharmacist. When taking NSAIDs orally is impossible, interarticular injections can offer prolonged relief. The injections contain a glucocorticoid, which is commonly referred to as a “cortisone injection.” An injection will last 8-10 weeks and can be repeated every three months. Some patients find it very effective in controlling the inflammation and pain of arthritis. There are no effective nasal sprays or topical creams for the delivery of anti-inflammatories to arthritic joints.