Do you think the medicines you are taking are perfectly alright? Then revisit your position!

The doctors prescribe you medicines based on costly diagnostic tests. Then you purchase them at prices placed higher than the best rocket system ever invented by man could reach! And think they work wonderfully in your body to magically remove all the agony you are undergoing. Right?

No! You are naive to think in this way! Why?

Because many drugs are susceptible to some form of chemical decomposition, be it through the interaction with enzymes or through improper storage and use, and such degradation often leads to a loss of potency.

Several factors can damage your medication, including heat, air, light, ph factor, and moisture (2). Exposure of medication to inappropriate conditions at the manufacturing, transportation, storage, selling, and consumption levels may render them ineffective, or even harmful if ingested. It’s important to keep in mind that where you store your medication can affect its potency and safety. 

When scientists find new medicines for pains and diseases after following several exaustive  procedures and innumerable tests, they send them into the public domain with several recommendations. So each and every medication has its own recommended storage condition- from room temperature, to refrigeration, to freezing.

In India and in several other developing countries too, most of the people handling medicines at various levels never follow these instructions given by scientists. They keep them in cars, transport trucks and trains where temperatures can go very high.  As you increase the temperature the rate of chemical reaction increases. And medicines are made up of chemicals! 

Majority of medications can be stored at room temperature, in a cool dry place. Examples include a storage box, a shelf, a drawer, and a closet in your bed room. However, some medicines need special handling for the potency to remain intact and work wonderfully. For instance insulin has to be stored at lower temperatures. Bottles, cartridges, and pens of insulin have to be kept in the refrigerator (between 36°F and 46°F or 2.2 to 7.7 C). If stored properly,  it will be good until the expiration date listed on the insulin. But very often people transport them in very hot conditions like at 40-50 degree C in summer without proper cool covering! The result? It will lose its potency and will not work to its optimum level and will not control sugar levels in your body like you think it does!

Liquid antibiotics used for children may vary in their recommended storage conditions. Some liquids must be refrigerated (e.g. cephalexin), some should be stored at room temperature (e.g. azithromycin), while others may have different expiry dates depending on which option is chosen (e.g. amoxicillin).

Thyroid and other medicines that contain hormones are especially susceptible to temperature changes. These are often protein-based, and when protein gets hot it changes properties.

Pharmaceutical manufacturers recommend most of their products be stored at a controlled room temperature of 58 to 77 degrees F. 68 to 86 degrees F are the maximum limits these things can tolerate. During heat waves and cold spells, storage locations can go above or below those ranges, causing medicines to physically change, lose potency or even threaten your health. Because badly damaged medicines can impact your kidneys and liver which try to eliminate toxins from the body. They also cause severe stomach upsets.

Climate changes can also affect the storage conditions of your medication. A medication that should be stored at room temperature means between 15 to 25 degrees Celsius; cool temperature means between 8 to 15 degrees Celsius; refrigeration means between 2 to 8 degrees Celsius; and freezing temperature means -10 to -25 degrees Celsius. Does your pharmacist or you follow these temperature ranges suggested by the scientists for your medication? In case you and they don't,  forget about disease control and cure!

Think about this... during transportation from one place to another or during your travel in the hot summer months, do you and your pharmacist take all the precautions recommended by the researchers? Do you consider placing silica packs in medication vials if extended travel is planned in hot/humid environments? If the answer is negative, again it is a disastrous situation! The improperly stored drugs and medications will not have any effect on the health conditions you face. This is a fact!

“Hygroscopicity” is a measure of the ability of a powder to take up water vapor from the atmosphere. It occurs both by absorption (absorption is a physical or chemical phenomenon or a process in which atoms, molecules or ions enter some bulk phase – gas, liquid or solid material) and adsorption (adsorption is the adhesion of atoms, ions, or molecules from a gas, liquid, or dissolved solid to a surface). 

And how high moisture in the rainy season effects medicines? Like this: A large number of functional groups ( like esters and amides) in medicines can react with water, resulting in broken bonds(3).

Any type of diagnostic test strip, like those used to test for blood sugar levels or pregnancy  is extremely sensitive to humidity. If moisture sticks to the strips, it will dilute the test liquid and can give a false reading!

Some of the chemicals in tablets gets sticky by absorbing the moisture outside and some even get completely liquefied. Water associated with drugs in the solid state can have significant effects on a variety of physical and chemical properties, such as chemical degradation, dissolution rate, flow and compactibility (1). Water may also have significant effects on product stability, tablet compaction, wet granulation, powder flow properties, and microbial growth.

Photosensitivity is defined as responsiveness to light exposure. For many common dermatologic drugs, proper storage conditions are essential for maintaining drug activity. Degradation and loss of activity can occur with exposure to light, temperature, and/ or moisture. For example, ketoconazole degrades after 24 hours of light exposure. 

So what should you do to arrest the degradation of your life saving magic potions?

It is important to follow these precautions and  check for the changes before taking the medicines:

• Do not place medications in an area of sunlight (especially not in a windowsill), near the lit stove or heater that is on, or in a car, truck, bus or train without insulating them when recommended to do so.
• Read and follow all the instructions made available by the manufacturers. Don't throw away the paper slips that come with the drugs without reading things written on them. 
• When you are buying medicines, check whether they are stored properly or not. Insist that your insulin be brought with cold pads by your pharmacist to your home or ask them to provide them when you yourself are taking them home .
• Always store the medicines in a cool, dry and dark place. 
• Do not store medications in an area of high humidity (for example, avoid storing in a bathroom with a shower or bathtub, or in a kitchen cabinet near the dishwasher).
• If possible, store medications in the coolest area of the house (potentially a basement or in the middle of the house)
• Take a minute to look at your medications before you take them. If they are stuck together in the bottle, if they have any changes in form or shape, hard or soft to touch, discoloured or transforms into a totally different colour or coating appears different- cracked or chipped, or "runny", if they smell funny, creams that show indications of separation — the integrity of the medication may have been compromised. (However, please note that you often cannot tell there is a problem just by looking. If you can visually see a change, the integrity is likely to be compromised, but the opposite isn’t true. There can still be a decrease in potency/effectiveness even if you can’t see a notable difference in the outside of the product.). What should you do then? Simply throw the medicines away. No matter how much they cost you. Your health and safety are much more important than money. If the power goes out for more than a few hours, you should discard any medications that need to be refrigerated. And before throwing them away, buy new ones if they are very essential in order to live! 
• Always check the expiration date on your medicine. Throw out medicines that are out of date.
• Do not keep old or unused medicine around. It goes bad due to unfavourable atmospheric conditions and you should not use it. You can donate left over medicines in good condition to charity so that poor people can make use of them.
• Do not buy liquid medicines if they come in plastic bottles. The harmful chemicals in plastic can react with the contents of your medicines and might make them harmful or less potent.
• Always keep medicine in its original container only.
• Remove the cotton ball out of the medicine bottle. The cotton ball pulls moisture into the bottle which in turn can spoil the medicine.

So now you know what you thought all these days has a faulty tinge to it. You also know how to store your medicines like a scientist does in his/her lab. Follow these procedures to the ultimate tee to get the maximum benefits. 

References:

1. http://cat.inist.fr/?aModele=afficheN&cpsidt=19349699

2. https://www.scribd.com/doc/25293385/Stability-of-Drugs-and-Dosage-F...

3. http://www.pharmaceutical-journal.com/opinion/comment/understanding...