Published: 5 September 2014
Publications
Medicine Storage - An Uncontained Issue?
Prescriber Update 35(3): 36-37
September 2014
Many medicines are repackaged into monitored dosage systems ("blister packs")
or plastic compartmentalised containers ("pill boxes") to aid medication
adherence and safe administration, particularly in residential care facilities.
However, healthcare professionals are reminded that removing some medicines
from original packaging to repack them into another dosage system may adversely
affect the characteristics of the medicine. Repacking medicines can impact
the medicine's effectiveness and safety.
The Centre for Adverse Reactions Monitoring (CARM) recently received a report from a patient who experienced haematuria after he began repacking dabigatran (Pradaxa) into a weekly pill box. These symptoms resolved once he stopped repacking dabigatran and kept the capsules in the original container. Dabigatran capsules absorb moisture from surroundings if removed from the original packaging. Moisture absorption may increase the bioavailability of the dabigatran dose, which can in turn increase the risk of adverse effects.
This case highlights that not all medicines are suitable for repacking. In general, the original container protects the medicine from heat, air, light and/or moisture. Exposure to these elements may affect the stability of the formulation and/or the active ingredient, which can alter the effectiveness and safety of the medicine.
The table below gives examples of medicines that should be kept in original packaging (this is not an exhaustive list):
| MEDICINE | REASON FOR ORIGINAL PACKAGING |
|---|---|
| Effervescent, dispersible, buccal, sublingual tablets (eg, Ondansetron orodispersible tablets, Rizatriptan orodispersible tablets, Prochlorperazine buccal tablets) | The foil packaging or tightly closed glass/plastic container
protects the product from moisture absorption and thereby prevents
product degradation. Use dry hands to prevent the medicine from dissolving prior to administration. |
| Dabigatran capsules | The original container protects these capsules from moisture absorption. Once the original container is opened, the contents must be used within four months. |
| Glyceryl trinitrate tablets | The glass amber bottle protects these tablets from both moisture absorption and light. Once opened, the contents need to be discarded within three months. |
| Nifedipine tablets | The foil packaging protects these tablets from both light and humidity. |
| Cabergoline tablets | The desiccant in the cap of the bottle should not be removed because it protects the tablets from excess moisture absorption (hygroscopic product). |
| Sodium valproate tablets | These tablets must be kept in protective foil until taken. This protects the tablet from excess moisture absorption (hygroscopic product). |
| Levodopa + benserazide dispersible tablets (Madopar) |
The packaging protects the tablets from moisture absorption. These tablets should be taken within half an hour of dissolving the tablet due to sedimentation issues. |
| Ciclosporin capsules | The ethanol (required for solubility of ciclosporin) vaporises out of the soft capsule when removed from the foil packaging. |
Some medicines also have special handling requirements. Healthcare professionals
who consider repacking or administering medicines need to be aware of these
for their own safety. Some examples of medicines that have special handling
requirements include:
- solid dose cytotoxic preparations such as methotrexate should not be handled, particularly by women if they are or may potentially be pregnant
- women should not handle crushed or broken finasteride tablets (5α-reductase inhibitor), as this may cause birth defects
- women must avoid contact with broken dutasteride capsules (5α-reductase inhibitor) due to absorption through the skin
- chlorpromazine can cause dermatitis when handled.
It is important that medicines are stored in a cool, dry place, out of the reach and sight of children. If in doubt about the storage conditions of a medicine, refer to the appropriate data sheet (www.medsafe.govt.nz/Medicines/infoSearch.asp) or contact the manufacturer.
*Please note that this information is advisory only and it is at the discretion of the healthcare professional to determine if repacking medication is required for patient adherence and safety.
