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Expired Medications – Which Ones Get Missed?

Working in long-term care, I’ve had the opportunity to audit medication carts and storage areas on a daily basis. In addition, surveyors will often cite deficiencies when they find expired medications. The most commonly cited medications that I’ve seen in my practice as a consultant pharmacist include insulins, eye drops (especially latanoprost), Tuberculin PPD, lorazepam oral solution, and Miacalcin nasal spray.

When working with patients who are taking their medications on their own, most medications will be used by the patient long before they expire, but there are a few that have unique expiration dates that need to be noted. Here are the most common medications to watch out for.

Eye Drops

  • Xalatan (latanoprost): 6 weeks once opened
  • Xalacom (latanoprost/timolol): 4 weeks once opened
  • Cosopt PF (dorzolamide/timolol): 15 days after opening the foil pouch

Insulins

  • Humalog (lispro): 28 days after removing from the fridge
  • Novolog (aspart): 28 days after removing from the fridge
  • Lantus (glargine): 28 days after opening or removing from the fridge
  • Toujeo (glargine): 56 days after opening
  • Levemir (detemir): 42 days after opening or removing from the fridge
  • Tresiba (degludec): 56 days after opening or removing from the fridge

GLP-1 agonists

  • Ozempic (semaglutide): 56 days after first use
  • Victoza (liraglutide): 30 days after first use
  • Trulicity (dulaglutide): 14 days after removing from the fridge
  • Byetta (exenatide): 30 days after first use
  • Bydureon BCise (exenatide extended-release): 4 weeks after removing from the fridge

Inhalers

  • Advair Diskus (fluticasone/salmeterol): 30 days after removing from foil pouch
  • Breo Ellipta (fluticasone/vilanterol): 6 weeks after opening the foil tray
  • Flovent Diskus (fluticasone): 6 weeks (50mcg strength) or 2 months (100 and 250mcg strengths) after opening the foil pouch
  • Pulmicort Respules (budesonide): 2 weeks after opening foil pack
  • Spiriva Respimat (tiotropium): 3 months after first use or when the locking mechanism is engaged, whichever comes first
  • Symbicort (budesonide/formoterol): 3 month after removing from foil pouch

Miscellaneous

  • Calcitonin (miacalcin) nasal spray: 35 days after opening
  • Tuberculin PPD: 30 days after opening
  • Ativan (lorazepam) oral concentrate: 90 days after opening

It is important to write the expiration dates on the medication packaging after opening or removing them from the fridge. Pharmacy and nursing staff should be made aware to check for the expiration date before giving. If the medication is being dispensed to a patient, make sure to counsel on the expiration date.

Are there any other expired medications that you frequently find in your practice?

This article was written by madison Bonn, PharmD candidate in collaboration with Eric Christianson, PharmD, BCPS, BCGP.

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