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Re: Expired drugs question. [spudone] [ In reply to ]
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But windy is so much fun
Wink

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Re: Expired drugs question. [slink] [ In reply to ]
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slink wrote:
sphere wrote:
For our edification, from UpToDate, the go-to providers' resource for current practice guidance and rationale:


Quote:

Indications — Routine treatment of fever in otherwise normal children is not warranted [1,6]. Decisions regarding the treatment of fever in children should be made on a case-by-case basis depending upon the clinical circumstances (eg, underlying disease, level of discomfort, desire to monitor fever curve).

There is no evidence that reducing fever reduces the morbidity or mortality from a febrile illness (with the possible exception of children with underlying conditions that limit the ability to tolerate increased metabolic demands). The role of antipyretic therapy in recurrence of febrile seizures is discussed separately. (See "Treatment and prognosis of febrile seizures", section on 'Antipyretics'.)

Potential benefits of treating fever with antipyretics include improvement of discomfort and decrease in insensible water loss, which may decrease the risk of dehydration [39]. Antipyretic agents also have analgesic effects, which may enhance their overall effect. Potential downsides of treating fever include delayed identification of an underlying illness and drug toxicity; it is uncertain whether treating fever increases the risk for or complications of certain types of infections. (See 'Benefits and harms' above.)

Indications for the short-term treatment of fever may include [1,36]:

●Shock
●Underlying neurologic or cardiopulmonary disease, or other condition with increased metabolic rate (eg, burn, postoperative state)
●Alteration in fluid and electrolyte balance
●High fever (ie, ≥40°C [104°F])
●Discomfort
●Major head trauma
●Postcardiac arrest


In pediatrics we often cater to the parents more so than the patients. Have you ever heard a pediatrician advise against tylenol or motrin in low grade fevers? I have arguments with my ICU nurses, who ought to know better by now, about giving patients with 100F temperatures tylenol. It's one of those paradoxes in medicine in which we all know better, but so few actually follow guidelines. I'd gladly suffer a day's midgrade fever if it killed off a virus days ahead of the normal course with antipyretics.


Yes our pediatrician advises not to give fever reducing medication until the temperature hits 40. He doesn't say it's bad, just not necessary.

So has Windy admitted that you don't need to treat a mild fever, and since giving people drugs when not needed is not a great idea..

Well Windy admitted you were wrong, and came out guns a blazin and need to put on big boy pants and admit you were wrong.

Just Triing
Triathlete since 9:56:39 AM EST Aug 20, 2006.
Be kind English is my 2nd language. My primary language is Dave it's a unique evolution of English.
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Re: Expired drugs question. [rich_m] [ In reply to ]
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rich_m wrote:
30+ years doing technical development of pharmaceutical products including preparing and and submitting data packages to request shelf-life labelling. Your colleague described things reasonably well. The active content of products generally has to stay within a specification of 90-110% of label through shelf-life, but allowable amounts of degradation products before a whole expensive work stream is created may be in the order of 0.10%. A situation where shelf-life is dictated by loss of drug content (and not formation of degradation products) would typically be an indication that the analytical method for degs is inadequate and is missing lots of things as there is unlikely to be mass balance. i guess sublimation is an option but not very likely in most cases.

Only adding, most drug studies show about a 30% placebo effect which does not go away with expired meds. Unless you tell the person they are expired.

Use uhm if you got them.. and really need them

Just Triing
Triathlete since 9:56:39 AM EST Aug 20, 2006.
Be kind English is my 2nd language. My primary language is Dave it's a unique evolution of English.
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Re: Expired drugs question. [rich_m] [ In reply to ]
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rich_m wrote:
30+ years doing technical development of pharmaceutical products including preparing and and submitting data packages to request shelf-life labelling. Your colleague described things reasonably well. The active content of products generally has to stay within a specification of 90-110% of label through shelf-life, but allowable amounts of degradation products before a whole expensive work stream is created may be in the order of 0.10%. A situation where shelf-life is dictated by loss of drug content (and not formation of degradation products) would typically be an indication that the analytical method for degs is inadequate and is missing lots of things as there is unlikely to be mass balance. i guess sublimation is an option but not very likely in most cases.

It doesn't matter what the subject is, somebody here is going to know way more about it than do. Thanks for adding the specifics.
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Re: Expired drugs question. [DavHamm] [ In reply to ]
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DavHamm wrote:
slink wrote:
sphere wrote:
For our edification, from UpToDate, the go-to providers' resource for current practice guidance and rationale:


Quote:

Indications — Routine treatment of fever in otherwise normal children is not warranted [1,6]. Decisions regarding the treatment of fever in children should be made on a case-by-case basis depending upon the clinical circumstances (eg, underlying disease, level of discomfort, desire to monitor fever curve).

There is no evidence that reducing fever reduces the morbidity or mortality from a febrile illness (with the possible exception of children with underlying conditions that limit the ability to tolerate increased metabolic demands). The role of antipyretic therapy in recurrence of febrile seizures is discussed separately. (See "Treatment and prognosis of febrile seizures", section on 'Antipyretics'.)

Potential benefits of treating fever with antipyretics include improvement of discomfort and decrease in insensible water loss, which may decrease the risk of dehydration [39]. Antipyretic agents also have analgesic effects, which may enhance their overall effect. Potential downsides of treating fever include delayed identification of an underlying illness and drug toxicity; it is uncertain whether treating fever increases the risk for or complications of certain types of infections. (See 'Benefits and harms' above.)

Indications for the short-term treatment of fever may include [1,36]:

●Shock
●Underlying neurologic or cardiopulmonary disease, or other condition with increased metabolic rate (eg, burn, postoperative state)
●Alteration in fluid and electrolyte balance
●High fever (ie, ≥40°C [104°F])
●Discomfort
●Major head trauma
●Postcardiac arrest


In pediatrics we often cater to the parents more so than the patients. Have you ever heard a pediatrician advise against tylenol or motrin in low grade fevers? I have arguments with my ICU nurses, who ought to know better by now, about giving patients with 100F temperatures tylenol. It's one of those paradoxes in medicine in which we all know better, but so few actually follow guidelines. I'd gladly suffer a day's midgrade fever if it killed off a virus days ahead of the normal course with antipyretics.


Yes our pediatrician advises not to give fever reducing medication until the temperature hits 40. He doesn't say it's bad, just not necessary.

So has Windy admitted that you don't need to treat a mild fever, and since giving people drugs when not needed is not a great idea..

/quote]

No because windy took exception to saying treating a fever with medication is not a good idea. It is in fact safe.
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Re: Expired drugs question. [windywave] [ In reply to ]
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windywave wrote:
DavHamm wrote:
slink wrote:
sphere wrote:
For our edification, from UpToDate, the go-to providers' resource for current practice guidance and rationale:


Quote:

Indications — Routine treatment of fever in otherwise normal children is not warranted [1,6]. Decisions regarding the treatment of fever in children should be made on a case-by-case basis depending upon the clinical circumstances (eg, underlying disease, level of discomfort, desire to monitor fever curve).

There is no evidence that reducing fever reduces the morbidity or mortality from a febrile illness (with the possible exception of children with underlying conditions that limit the ability to tolerate increased metabolic demands). The role of antipyretic therapy in recurrence of febrile seizures is discussed separately. (See "Treatment and prognosis of febrile seizures", section on 'Antipyretics'.)

Potential benefits of treating fever with antipyretics include improvement of discomfort and decrease in insensible water loss, which may decrease the risk of dehydration [39]. Antipyretic agents also have analgesic effects, which may enhance their overall effect. Potential downsides of treating fever include delayed identification of an underlying illness and drug toxicity; it is uncertain whether treating fever increases the risk for or complications of certain types of infections. (See 'Benefits and harms' above.)

Indications for the short-term treatment of fever may include [1,36]:

●Shock
●Underlying neurologic or cardiopulmonary disease, or other condition with increased metabolic rate (eg, burn, postoperative state)
●Alteration in fluid and electrolyte balance
●High fever (ie, ≥40°C [104°F])
●Discomfort
●Major head trauma
●Postcardiac arrest


In pediatrics we often cater to the parents more so than the patients. Have you ever heard a pediatrician advise against tylenol or motrin in low grade fevers? I have arguments with my ICU nurses, who ought to know better by now, about giving patients with 100F temperatures tylenol. It's one of those paradoxes in medicine in which we all know better, but so few actually follow guidelines. I'd gladly suffer a day's midgrade fever if it killed off a virus days ahead of the normal course with antipyretics.


Yes our pediatrician advises not to give fever reducing medication until the temperature hits 40. He doesn't say it's bad, just not necessary.


So has Windy admitted that you don't need to treat a mild fever, and since giving people drugs when not needed is not a great idea..

/quote]

No because windy took exception to saying treating a fever with medication is not a good idea. It is in fact safe.

Well first, no you just left it open and ambigous like you always do. Maybe thats so when pointed out your wrong you left yourself an out. In the future try longer replies.

2nd. did you not read the bold.. Potential downsides of treating fever include delayed identification of an underlying illness and drug toxicity; it is uncertain whether treating fever increases the risk for or complications of certain types of infections. (See 'Benefits and harms' above.)



So yes it is not a good idea. I mean maybe you like pumping your body full of drugs, but most people recommend only using them when needed, a mild fever is not when it is needed.


Just Triing
Triathlete since 9:56:39 AM EST Aug 20, 2006.
Be kind English is my 2nd language. My primary language is Dave it's a unique evolution of English.
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Re: Expired drugs question. [Moonrocket] [ In reply to ]
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Moonrocket wrote:
There is a huge children’s Tylenol shortage.

If you had a sealed box in your medicine cabinet that expired 7/2021

Would you offer it to a friend looking for some?

What about sealed kids cold and flu liquid?



Yes I would offer all of them.

Drug Expiration Dates — Do They Mean Anything? - Harvard Health

" Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date."
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Re: Expired drugs question. [Moonrocket] [ In reply to ]
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I would inform my friend that i have some and then it would be his call to make.
In my opinion expired drugs can't harm, maybe they don't help as much as they used to, but nothing bad can happen.
Normally i would buy viagra online and never use it before the expire date.
Last edited by: MitchMcCrown: Dec 26, 22 11:29
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Re: Expired drugs question. [DavHamm] [ In reply to ]
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Quote:
Well first, no you just left it open and ambigous like you always do. Maybe thats so when pointed out your wrong you left yourself an out. In the future try longer replies.

2nd. did you not read the bold.. Potential downsides of treating fever include delayed identification of an underlying illness and drug toxicity; it is uncertain whether treating fever increases the risk for or complications of certain types of infections. (See 'Benefits and harms' above.)

The reason we don't--or shouldn't--treat low grade fever in the ICU is exactly this, it can delay identification and treatment of an underlying infection. My practice is to hold all antipyretics until the temp hits 101*F, then panculture blood, urine, sputum, and make a clinical decision as to whether antibiotics are indicated (some neurologic injuries produce fever of noninfectious origin and we typically prevent any elevation in body temperature for these patients).

As for kids, some don't tolerate even low grade fevers well and may stop taking in fluids. If that persists long enough, likely the risk of dehydration and general misery exceeds the low risk of tylenol and whatever effect it may have on the duration and severity of illness. My guess is the body of evidence suggests the difference falls in the margin and so there's no strong recommendation for or against treating low grade fever, that child and parent tolerance for discomfort typically determine the course and whichever course is chosen, it'll be fine.

But again, my work is in ICU where shit can go south quickly and the bugs are vastly different from what little Jane and Johnny are bringing home from elementary school. So I let fever do its job until it becomes disregulatory. I follow the guidelines.


The devil made me do it the first time, second time I done it on my own - W
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