Actual versus recommended storage temperatures of oral anticancer medicines at patients’ homes

Abstract

Background Substantial quantities of unused medicines are returned by patients to the pharmacy each year. Redispensing these medicines would reduce medicinal waste and health care costs. However, it is not known if medicines are stored by patients as recommended in the product label. Inadequate storage may negatively affect the medicine and reduce clinical efficacy whilst increasing the risk for side effects. Objective To investigate the proportion of patients storing oral anticancer medicines according to the temperature instructions in the product label. Methods Consenting adult patients from six Dutch outpatient hospital pharmacies were included in this study if they used an oral anticancer medicine during February 2014 - January 2015. Home storage temperatures were assessed by inclusion of a temperature logger in the original cancer medicines packaging. The primary outcome was the proportion of patients storing oral anticancer medicines as specified in the Summary of Product Characteristics, either by recalculating the observed temperature fluctuations to a single mean kinetic temperature or by following the temperature instructions taking into account a consecutive 24-h tolerance period. Results Ninety (81.1%) of the 111 included patients (47.8% female, mean age 65.2 (SD: 11.1)) returned their temperature loggers to the pharmacy. None of the patients stored oral anticancer medicines at a mean kinetic temperature above 25℃, one patient stored a medicine requiring storage below 25℃ longer than 24 h above 25℃. None of the patients using medicines requiring storage below 30℃ kept their medicine above 30℃ for a consecutive period of 24 h or longer. Conclusion The majority of patients using oral anticancer medicines store their medicines according to the temperature requirements on the product label claim. Based on our results, most oral anticancer medicines will not be negatively affected by temperature conditions at patients' homes for a maximum of three months and are likely to be suitable for redispensing.

Household Pharmaceutical Waste Management Practices in the Johannesburg Area, South Africa

“…Therefore, violating these storage conditions poses a serious health risk to both patients and children within households. Similarly, improper storage practices may affect the clinical efficiency of medicines in a negative manner, apart from their potential contribution towards the generation of medicinal wastes [ 42 , 43 , 44 ]. Nonetheless, close to 191 (51%) respondents agreed that they stored their medications inside medicine boxes, which is good practice as long as they are not accessible to children and the vulnerable.…”

Public Attitudes towards Medicinal Waste and Medicines Reuse in a ‘Free Prescription’ Healthcare System

“…However, mean temperatures for the areas were much lower (18.4–23.6 °C) [ 36 ] and the potential for isolated or regular but transient high temperatures to negatively affect medicines, particularly when considering storage periods of 3–6 months, is disputed [ 15 ]. Indeed, when researchers have assessed all temperatures that medicines have been exposed to over a pre-determined period in the home environment, they have found that the majority of patients store their medicines in acceptable temperature conditions (both studies looking at medicines which needed to be stored either below 25 or 30 °C) [ 37 , 38 ]. As medicines which are sensitive to humidity are stored in protective packaging, it is temperature that remains the primary storage concern when considering medicines reuse.…”

Guidance on Implementing an Oral Chemotherapy Drug Repository Program in a Medically Integrated Pharmacy Setting

“…For example, previous studies have identified that the majority of patients properly store their medications at room temperature. 22,23 However, those with refrigerated medications often required additional education on correct storage requirements. 24,25 To ensure that the medications are safe during patient donation, delegates from the drug repository programs or facilities should consider asking additional questions to ensure compliance with the drug's label.…”