Tag: drugs

“Nothing is impossible; the word itself says, ‘I’m possible!'” -Audrey Hepburn

Naloxone is a life saving medication when used after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription.

There are three kinds of opioid drugs. These are synthetic opioids (example fentanyl), semi-synthetic opioids (oxycodone, heroin), and natural opioids (opium, morphine, codeine). Natural opioids are from a natural source – opium poppy.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anaesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illness like cancer.

Fentanyl is a powerful drug. It is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been responsible in the number of overdose deaths in recent years. It plays a role in the deaths of more than four people on average every day in B.C. and Alberta alone.

Fentanyl poisoning results in respiratory depression, miosis (excessive constriction of the pupils) and altered level of consciousness. These three features should alert physicians to the possibility of fentanyl poisoning.

An article in the Canadian Medical Association Journal (CMAJ September 18, 2017) titled “Five things you should know about take-home naloxone” emphasis the following points:

1. Naloxone is available without prescription in Canada

In 2016, naloxone was removed from the federal Prescription Drug List. Now pharmacists can dispense it without prescription. It is available in commercial formulations, including intranasal preparations, as well as in locally prepared take-home naloxone kits, available from some pharmacies, clinics, emergency departments and community health centres.

2. Most take-home naloxone kits contain similar equipment

Most take-home naloxone kits will contain two ampules of naloxone (0.4 mg per vial), two safety-engineered syringes, two ampule-opening devices, alcohol swabs, nonlatex gloves and a rescue-breathing barrier. The average cost for a take-home naloxone kit is $35. However, many sites offer them free of charge.

3. Multiple doses of naloxone may be required for overdoses related to high-potency opioids

In overdoses related to fentanyl and other synthetic opioids, multiple doses may be required to restore breathing. Most take-home naloxone kits include two doses, and additional doses can safely be administered every two to five minutes if there is no response. Naloxone should be used in conjunction with basic life support principles, such as rescue breathing, cardiopulmonary resuscitation and calling 911.

4. Take-home naloxone kits may reduce overdose-related mortality

Observational studies in North America, Europe and Australia, has found that take-home naloxone programs led to improved survival rates among program participants.

5. Take-home naloxone kits are not only for patients with current opioid abuse

The kit can be used for other at-risk populations include individuals who are on methadone or on high doses of prescription opioids, or who frequently use recreational drugs.

Naloxone can be delivered to the patients in different forms: intravenously, intramuscularly, subcutaneously, through the trachea and nose. The drug is effective in one to eight minutes after administration.

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In the Medical Post (November 25, 2003) Dr. Maria Hugi wrote a column titled, “Drugs still effective long past their expiry dates.” Dr. Hugi is an emergency physician in Vancouver. She was using the information obtained from an article in the Medical Letter (October 28, 2002).

The Medical Letter article says drugs stored without exposure to humidity (stored at a dry room temperature) probably retain 90 per cent efficacy five years after the expiration date if not much longer.

What does U.S. Food and Drug Administration (FDA) web site say?

It says expiration date matters. If your medicine has expired, it may not provide the treatment you need. Expiration dates help determine if medicine is safe to use and will work as intended.

According to Wikipedia, shelf life is defined as the length of time that a commodity may be stored without becoming unfit for use, consumption, or sale. Most expiration dates are used as guidelines based on normal and expected handling and exposure to temperature.

The Canadian Food Inspection Agency produces a Guide to Food Labelling and Advertising that sets out a “Durable Life Date”. The authority for producing the guide comes from the Food and Drugs Act. The guide sets out what items must be labelled and the format of the date.

Harvard Health Publications (HHP) asks, “Drug Expiration Dates – Do They Mean Anything?”

Since a law was passed in the U.S. in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

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.

What they found from the study is 90 per cent of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.

So the expiration date does not really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state expired drugs are safe to take, even those that expired years ago, says the article in the Harvard Health Publications (HHP).

What are the exceptions to the rule?

Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long lasting as the ones tested by the military. Place medication in a cool place, such as a refrigerator, will help a drug remain potent for many years, says HHP.

So the expiration date doesn’t really indicate a point at which the medication is no longer effective or has become unsafe to use. There is relatively little scientific data about out-dated medications. What you see on the drug and food packages is a guideline. Use the guideline smartly. If in doubt talk to your pharmacist or food store.

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Let us start with the use of acetaminophen (Tylenol) in pregnancy. Acetaminophen is generally considered safe in all stages of pregnancy because it doesn’t have the same risks as other over the counter painkillers.

But new animal research says otherwise. Studies following birth outcomes in Denmark and New Zealand have suggested that the use of acetaminophen in pregnancy may be associated with behavioural problems in the new born. Studies carried out in animal models suggest the drug seems to disrupt hormonal function and brain development.

A British study on humans (published in JAMA Pediatrics August 15, 2016) suggests children born to women who used acetaminophen during pregnancy could be at increased risk for several behavioural problems.

The British researchers followed about 14,000 pregnant women who were expected to deliver in 1991 or 1992. They collected detailed information, through clinical visits and questionnaires, about the health and development of the children until the age of seven and looked at the genetic risk factors.

Children born to women who took acetaminophen during the second trimester (18 weeks) and the third trimester (32 weeks) showed emotional problems and behavioural difficulties.

Children born to mothers who took the drug during the third trimester, about six out of 100, had behavioural difficulties – compared with four out of 100 whose mothers did not take the drug.

There was no association with the mother’s use of acetaminophen after giving birth or a partner’s use of acetaminophen. The researchers did not have any information on the dose taken or for how long.

What now?

Some experts believe more research is needed to understand the mechanism of action of acetaminophen during pregnancy. Until we understand this fully, pregnant mothers should follow their physicians’ advice because there is a risk to the fetus of not using acetaminophen when it is required. For example, fever during pregnancy can be dangerous and can lead to pre-term labour.

The bottom line is more research is required. We need to know the dose and duration of acetaminophen use which can be risky. As far as we know, there is no risk when acetaminophen is used during the first trimester.

Under normal circumstances if acetaminophen is taken too often it can cause liver damage. Acetaminophen is a medicinal ingredient in more than 470 products. That is lot of drugs.

There are stricter guidelines and warnings in the U.S. on the safe use of acetaminophen. This move comes as Johnson & Johnson, the makers of Tylenol, face more than 85 personal injury lawsuits in U.S. federal court that blame Tylenol for liver injuries and deaths. The U.S. Food and Drug Administration is planning to curtail the use of some acetaminophen products. The maximum daily dose is 4 grams, in people with healthy liver and kidneys.

Acetaminophen was discovered in 1877. It is used to treat mild to moderate pain and fever. There is poor evidence for fever relief in children. It is typically taken by mouth or rectally, but is also available intravenously. Effects last between two and four hours.

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