What is the best circumstances for increased shelf life?

I have a vacuum sealer and freezer space.

I keep all my antibiotics in the original, sealed packaging and placed them in my fridge.  I have seen of people freezing them too.  I keep them in all in a bag that can be grabbed immediately if needed as part of a get out of Dodge set up.

How much longer does that increase their usefulness?

Damn, I wish I'd known this earlier. All those giant ass bottles that they'd give me when I went to Afghanistan could be happily stored for later.

My little brother is a gastroenterologist in Los Angeles and he was telling me a few years back, that most modern medications generally fall under the 5/5 rule of thumb: 5% loss in efficacy for every 5 year past the expiry date, but take it for what it’s worth.

Chris

Doxy is a tetracycline.  Not safe to take after expiration.  
https://www.askaprepper.com/what-really-happens-when-you-take-antibiotics-past-their-expiration-date/

I’ve heard that that one specifically is an exception to the rule.

So one must know the base anti. and all of its derivatives, which I obviously do not!

Thanks.

Chris

Looks like a recent change!!  The SNS DID APPROVE it for extension. Edited for clarity. Their max extension is 4 years.  
NICE!
Attached File
https://www.fda.gov/media/141039/download

Not sure that's entirely true anymore. I ran across this article a couple years ago, and recently re-read it. Thought it might be enlightening. I highlighted the parts I thought were the takeaways. They even address the "expired tetracycline will kill you" issue.


The Medical Letter® on Drugs and Therapeutics
Volume 57 (Issue 1483) December 7, 2015
Published by The Medical Letter, Inc. • A Nonpro? t Organization

Healthcare providers are often asked if drugs can be used past their expiration date. Because of legal restrictions and liability concerns, manufacturers do not sanction such use and usually do not even comment on the safety or effectiveness of their products beyond the date on the label. Since our last publication on this subject, (1) more data have become available.

SAFETY — There are no published reports of human toxicity due to ingestion, injection, or topical application of a current drug formulation after its expiration date. Renal tubular damage has been reported with use of degraded tetracycline in a formulation that is no longer available. (2)

THE EXPIRATION DATE — The manufacturer's expiration date is based on the stability of the drug in the original sealed container. The date does not necessarily mean that the drug was found to be unstable after a longer period; it only means that real-time data or extrapo-lations from accelerated degradation studies indicate that the drug in the closed container will still be stable at that date. Most drug products have a labeled shelf life of 1-5 years, but once the original container is opened, the expiration date on that container no longer applies.

STABILITY — Data from the US Department of Defense/ FDA Shelf Life Extension Program, which tests the stability of drug products past their expiration date, have shown that 2650 of 3005 lots (~88%) of 122 different products stored in their unopened original containers remained stable for an average of 66 months after their expiration date. (3) Of these, 312 lots (~12%) remained stable for >4 years after the expiration date. Failure on the basis of potency, pH, water content, dissolution, physical appearance, or presence of impurities occurred in 479 lots (~18%), but none failed within 1 year. Potassium iodide, which has been extensively stockpiled for use in a radiation emergency, has shown no signi?cant degradation over many years. (4)

HEAT, HUMIDITY, AND LONG-TERM STORAGE — Storage in high heat and/or humidity can accelerate the degradation of some drug formulations, but in one study, captopril tablets, theophylline tablets (Theo-Dur, and others), and cefoxitin sodium powder for injection (Mefoxin, and others), stored at 40°C and 75% relative humidity, remained stable for 1.5-9 years beyond their expiration dates. (5) In another study, theophylline retained 90% of its potency 30 years past its expiration date. (6) A study of eight products that had been stored in their unopened original containers for 28-40 years past expiration found that 12 of 14 active ingredients had retained =90% of their original potency; aspirin retained <5% of its potency and amphetamine <60%. (7)

LIQUID DRUGS — Solutions and suspensions are generally less stable than solid dosage forms, but in one report, four outdated samples of atropine solution (three up to 12 years past expiration and one >50 years past expiration) were all found to contain significant amounts of the drug. (8) Drugs in solution that have become cloudy or discolored or show signs of precipitation, particularly injectables, should not be used. Suspensions are especially susceptible to freezing. Limiting factors with ophthalmic drugs include evaporation of the solvent and the continued ability of the preservative to inhibit microbial growth. (9) Epinephrine solutions in EpiPen auto-injectors may lose potency after the expiration date. In a study of 34 pens that had expired 1-90 months previously, the decrease in epinephrine content was proportional to the number of months past the expiration date. (10) One study found that pens 3-36 months past their expiration dates contained 84.2-101.5% of the labeled dose,(11) but a study of pens stored in EMS vehicles that had expired 1-11 years previously found that only 12.6-31.3% of the labeled dose remained. (12) No data are available on other epinephrine auto-injectors such as Auvi-Q.

CONCLUSION — When no suitable alternative is available, outdated drugs may be effective. How much potency they retain varies with the drug, the lot, the preservatives (if any), and the storage conditions, especially heat and humidity; many solid dosage formulations stored under reasonable conditions in their original unopened containers retain =90% of their potency for at least 5 years after the expiration date on the label, and sometimes much longer. Solutions and suspensions are generally less stable. There are no reports of toxicity from degradation products of currently available drugs.

1. Drugs past their expiration date. Med Lett Drugs Ther 2009; 51:100.

2. GW Frimpter et al. Reversible "Fanconi syndrome" caused by degraded tetracycline. JAMA 1963; 184:111.

3. RC Lyon et al. Stability profiles of drug products extended beyond labeled expiration dates. J Pharm Sci 2006; 95:1549.

4. US Department of Health and Human Services. Guidance for federal agencies and state and local governments: potassium iodide tablets shelf life extension. Available at: www.fda.gov. Accessed November 24, 2015.

5. G Stark et al. A study of the stability of some commercial solid dosage forms beyond their expiration dates. Pharm J 1997; 258:637.

6. R Regenthal et al. The pharmacologic stability of 35-year old theophylline. Hum Exp Toxicol 2002; 21:343.

7. L Cantrell et al. Stability of active ingredients in long-expired prescription medications. Arch Intern Med 2012; 172:1685.

8. JG Schier et al. Preparing for chemical terrorism: stability of injectable atropine sulfate. Acad Emerg Med 2004; 11:329.

9. GD Novack. Can I use those eyedrops after the expiration date? Ocul Surf 2015; 13:169.

10. FE Simons et al. Outdated EpiPen and EpiPen Jr autoinjectors: past their prime? J Allergy Clin Immunol 2000; 105:1025.

11. O Rachid et al. Epinephrine doses contained in outdated epinephrine auto-injectors collected in a Florida allergy practice. Ann Allergy Asthma Immunol 2015; 114:354.

12. A Stonemen et al. Stability of epinephrine in expired EpiPen products from EMS ambulances. Available at: http://abstracts. aaps.orgf. Accessed November 24, 2015.

13. In brief: Auvi-Q – a new epinephrine auto-injector. Med Lett Drugs Ther 2013; 55:13.

Very interesting.  I wasn't aware that they changed the formulation!

Thanks!

That presumes that the drug is kept at its "normal" storage temperature - i.e., room temperature for most drugs that don't specifically require refrigeration.

So - How much is that rule-of-thumb altered if the drug is stored at a much lower temperature instead?

At +40 degrees F, does it become the 1/5 rule?

At -20 degrees F, does it become the 1/25 rule?

Who knows? The US Army doesn’t even specify environmental conditions.

If your dick is rotting off in an emergency situation, I don’t think it’s going to matter all that much?

Chris

If you assume that drug spoilage is a series of chemical reactions...

and assume that every 10° C. reduction in temperature halves the speed of a "typical" chemical reaction (which seems to be a common figure bandied about on the internet)...

Then storing a drug at 0° C. (32° F.) rather than room temperature (25° C.) would seem to increase its shelf life fivefold.

If that was the case, we'd be told that the best place to store meds would be in the freezer?

The US Army/DOD would be storing things in freezers and they weren't, but as the like to the 'prepper guy' stated, they finally got tired of chucking things in the incinerator after 10 years, so they did their massive study, which found a couple, few years, or more for most (88%) of the stuff they tested, we 12% being the exceptions.

Freezing cold isn't the answer to everything, I guess is one point?

Chris

Arrhenius equation. Aging is ~2^[(real temp in C- ref temp in C)/10]. So store at 40C vs normal RT of 20C is 4X aging. Store at refrigerator temp of 5C vs normal RT of 20 is about 1/3 aging.

What does that mean to us stupid people?

Thanks!

Chris

Nobody really believes that the Army/DOD is interested in minimizing waste.

The drug exceeds its expiration date; they throw it out and order more.

I have no quarrel and you've been very nice to me in the past.  I have no knowledge on all of the variations, so I'll respectively bow out.

Chris

Basically its a rate thing. The rate of chemical reactions comes down to the statistical chance that either two molecules/atoms get close enough to interact, or that a complex molecule will spontaneously break apart on its own (degradation). Temperature increases the speed of molecules vibrating in solids (and actual movement in liquids/gases).

Its been a long time since organic chemistry, but I suspect when we're discussing medications degrading, it is the complex molecules themselves that denature or breakdown into a state that is lower energy (complex molecules take energy/specific conditions to form and because of entropy all matter ultimately wants to be in a simpler lower energy state...). If the pills were left open to the air, perhaps ozone or other agents could also attack them too.

Some of the byproducts of medical agents degrading can apparently be toxic (as with Tetracycline), which is what that Army study was looking at for Doxy. If you look at the treatment for Anthrax, it uses a shitload of Doxy, Penecillin and something else over 60 days. If memory is correct, the military maintains a huge stockpile of AB to treat weaponized Anthrax and some bean counter figured out this was a huge expense, so they've proven that you can use the out of date Doxy and others at something like 80% effectiveness.

I store all my emergency/SHTF AB in a beer fridge still sealed in the blister packs. I don't intend to need the stuff, but if things break down enough we lose supply chain from the pharma factories in India, I'll be damned if mine and my own die from blood poisoning or an infected tooth. YMMV.

Does anyone have a list of drugs that fit in this category?  How do you know Doxycycline is a "tetracycline" and unsafe past its' date.

Thanks for the information.

I guess the fridge (37*) is the way to go?

Thanks.

Chris

As stated previously, I was corrected in that this has been "changed" since I first got into the SNS stuff.  As now, Doxy is considered safe to store (in the proper environment) probably for 4 years now.
To answer your question, it was taught in pharmacology classes.  
Most drugs fall into classifications.
List stolen from Wiki because it was easy:  Tetracyclines are widely used in the treatment of moderately severe acne and rosacea (tetracycline, oxytetracycline, doxycycline or minocycline). Anaerobic bacteria are not as susceptible to tetracyclines as are aerobic bacteria.[9] Doxycycline is also used as a prophylactic treatment for infection by Bacillus anthracis (anthrax) and is effective against Yersinia pestis, the infectious agent of bubonic plague. It is also used for malaria treatment and prophylaxis, as well as treating elephantitis filariasis.[10] Tetracyclines remain the treatment of choice for infections caused by chlamydia (trachoma, psittacosis, salpingitis, urethritis and L. venereum infection), Rickettsia (typhus, Rocky Mountain spotted fever), brucellosis and spirochetal infections (borreliosis, syphilis and Lyme disease).[2] They are also used in veterinary medicine.[2] They may have a role in reducing the duration and severity of cholera, although drug-resistance is mounting[11] and their effect on overall mortality is questioned.[12]
 

This is a well rounded mix of AB to have on hand:

Attached File

"Best practices" show
Receipt, Store and Stage (RSS) sites must have temperature controlled storage space.  Most drugs in the push package
can be stored at room temperature (i.e., between 58°F and 86°F).

Eh, I store mine in a beer freezer at about 40F. I think freezing could break down binders or other wise compromise the packaging, so prefer an intermediate temperature.

By all accounts cycling temperatures are worse than high Temps.

Being in Miami, I'm practically always in temp controlled AC, so humidity and temps are not too problematic.

My dad and brother are both Gastros and they never, but for Pop's insulin, have rarely stored stuff in the fridge.

Hell, my li-ion cells are stored in the fridge, so why not ABs?

Anyhow...

Chris

If only we had a 17 page thread tacked at the top of the forum that we could reference...

Altons Antibiotics and Infectious Disease: The Layman's Guide To Available Antibacterials in Austere Settings